Sun protective behaviour and sunburn prevalence in primary and secondary schoolchildren in western Switzerland
AIMS OF THE STUDY: Although solar overexposure during childhood and adolescence increases the risk of melanoma, determinants of sunburn and sun protective behaviours of Swiss children have scarcely been explored.We investigated sunburn occurrence and sun protective behaviours of schoolchildren in western Switzerland, the region with the highest incidence of melanoma in Europe.
MATERIAL AND METHODS: Self-reported questionnaires were administered during regular classes to pupils in 5th (primary school, n = 431), 8th and 11th grades (secondary school, n = 837) in the 18 public schools of La Chaux-de-Fonds. Descriptive statistics and multivariate logistic regression analyses were performed to assess predictors of sunburns and of three sun protective behaviours (sunscreen, shade, wear of covering clothes).
RESULTS: Response rate was 91%. Sunburn prevalence over the preceding year was high (60% at least one sunburn, 30% at least two, 43% at least one severe sunburn). Younger age, fair skin, regular sunscreen use, higher sun-related knowledge and preference for a tanned skin were predictors of sunburn. Sunscreen was the most used protective measure (69%), followed by seeking shade (33%) and wearing long-sleeved shirts (32%). Decline in all protective measures was observed in older pupils and those with pro-tan attitudes. The wear of covering clothes was significantly associated with sunscreen use and seeking shade. Parental encouragement favoured sunscreen use and wearing of protective clothes.
CONCLUSIONS: Sunscreen use as a last protective barrier against ultraviolet radiation should be better emphasised in prevention campaigns targeting children and adolescents. Multi-faceted interventions, including role models, parents and peers should help to improve children’s sun protective behaviours.
- Gordon LG, Rowell D. Health system costs of skin cancer and cost-effectiveness of skin cancer prevention and screening: a systematic review. Eur J Cancer Prev. 2015;24(2):141–9. doi:http://dx.doi.org/10.1097/CEJ.0000000000000056.
- Erdmann F, Lortet-Tieulent J, Schüz J, Zeeb H, Greinert R, Breitbart EW, et al. International trends in the incidence of malignant melanoma 1953-2008 – are recent generations at higher or lower risk? Int J Cancer. 2013;132(2):385–400. doi:http://dx.doi.org/10.1002/ijc.27616.
- Ferlay J, Steliarova-Foucher E, Lortet-Tieulent J, Rosso S, Coebergh JW, Comber H, et al. Cancer incidence and mortality patterns in Europe: estimates for 40 countries in 2012. Eur J Cancer. 2013;49(6):1374–403. doi:http://dx.doi.org/10.1016/j.ejca.2012.12.027.
- Garbe C, Leiter U. Melanoma epidemiology and trends. Clin Dermatol. 2009;27(1):3–9. doi:http://dx.doi.org/10.1016/j.clindermatol.2008.09.001.
- Gandini S, Sera F, Cattaruzza MS, Pasquini P, Picconi O, Boyle P, et al. Meta-analysis of risk factors for cutaneous melanoma: II. Sun exposure. Eur J Cancer. 2005;41(1):45–60. doi:http://dx.doi.org/10.1016/j.ejca.2004.10.016.
- Gandini S, Sera F, Cattaruzza MS, Pasquini P, Abeni D, Boyle P, et al. Meta-analysis of risk factors for cutaneous melanoma: I. Common and atypical naevi. Eur J Cancer. 2005;41(1):28–44. doi:http://dx.doi.org/10.1016/j.ejca.2004.10.015.
- Gandini S, Sera F, Cattaruzza MS, Pasquini P, Zanetti R, Masini C, et al. Meta-analysis of risk factors for cutaneous melanoma: III. Family history, actinic damage and phenotypic factors. Eur J Cancer. 2005;41(14):2040–59. doi:http://dx.doi.org/10.1016/j.ejca.2005.03.034.
- Dennis LK, Vanbeek MJ, Beane Freeman LE, Smith BJ, Dawson DV, Coughlin JA. Sunburns and risk of cutaneous melanoma: does age matter? A comprehensive meta-analysis. Ann Epidemiol. 2008;18(8):614–27. doi:http://dx.doi.org/10.1016/j.annepidem.2008.04.006.
- Dixon H, Borland R, Hill D. Sun protection and sunburn in primary school children: the influence of age, gender, and coloring. Prev Med. 1999;28(2):119–30. doi:http://dx.doi.org/10.1006/pmed.1998.0392.
- Livingston PM, White V, Hayman J, Dobbinson S. Australian adolescents’ sun protection behavior: who are we kidding? Prev Med. 2007;44(6):508–12. doi:http://dx.doi.org/10.1016/j.ypmed.2007.02.015.
- Iannacone MR, Youlden DR, Baade PD, Aitken JF, Green AC. Melanoma incidence trends and survival in adolescents and young adults in Queensland, Australia. Int J Cancer. 2015;136(3):603–9.
- Campbell LB, Kreicher KL, Gittleman HR, Strodtbeck K, Barnholtz-Sloan J, Bordeaux JS. Melanoma Incidence in Children and Adolescents: Decreasing Trends in the United States. J Pediatr. 2015;166(6):1505–13. doi:http://dx.doi.org/10.1016/j.jpeds.2015.02.050.
- Wright C, Reeder AI, Gray A, Cox B. Child sun protection: sun-related attitudes mediate the association between children’s knowledge and behaviours. J Paediatr Child Health. 2008;44(12):692–8. doi:http://dx.doi.org/10.1111/j.1440-1754.2008.01408.x.
- Wright CY, Albers PN, Oosthuizen MA, Phala N. Self-reported sun-related knowledge, attitudes and behaviours among schoolchildren attending South African primary schools. Photodermatol Photoimmunol Photomed. 2014;30(5):266–76. doi:http://dx.doi.org/10.1111/phpp.12107.
- Vuadens A, Ackermann S, Levi F, Bulliard J-L. Sun-related knowledge and attitude of primary and secondary schoolchildren in western Switzerland. 2016 Oct 5. [Epub ahead of print]. DOI: 10.1097/CEJ.0000000000000279
- Suppa M, Cazzaniga S, Fargnoli MC, Naldi L, Peris K. Knowledge, perceptions and behaviours about skin cancer and sun protection among secondary school students from Central Italy. J Eur Acad Dermatol Venereol. 2013;27(5):571–9. doi:http://dx.doi.org/10.1111/j.1468-3083.2012.04484.x.
- Reinau D, Meier C, Gerber N, Hofbauer GF, Surber C. Sun protective behaviour of primary and secondary school students in North-Western Switzerland. Swiss Med Wkly. 2012;142:w13520.
- Reinau D, Meier CR, Gerber N, Surber C. Evaluation of a sun safety education programme for primary school students in Switzerland. Eur J Cancer Prev. 2014;23(4):303–9. doi:http://dx.doi.org/10.1097/CEJ.0000000000000040.
- Saridi M, Toska A, Rekleiti M, Wozniak G, Liachopoulou A, Kalokairinou A, et al. Sun-protection habits of primary students in a coastal area of Greece. J Skin Cancer. 2012;2012:1–9. doi: 10.1155/2012/629652
- Filiz TM, Cinar N, Topsever P, Ucar F. Tanning youth: knowledge, behaviors and attitudes toward sun protection of high school students in Sakarya, Turkey. J Adolesc Health. 2006;38(4):469–71. doi:http://dx.doi.org/10.1016/j.jadohealth.2005.01.016.
- Bulliard J-L, Panizzon R, Levi F. Epidémiologie et prévention du mélanome cutané en Suisse. Forum Med Suisse. 2009;9(17):314–8.
- Swiss Federal Statistical Office, National Institute for Cancer Epidemiology and Registration, Swiss Childhood Cancer Registry. Le cancer en Suisse. Etat et évolution de 1983 à 2007. Statistique de la Suisse. Neuchâtel: Swiss Federal Statistical Office; 2011.
- Bulliard J-L, Raymond L, Levi F, Schüler G, Enderlin F, Pellaux S, et al. Prevention of cutaneous melanoma: an epidemiological evaluation of the Swiss campaign. Rev Epidemiol Sante Publique. 1992;40(6):431–8.
- Levi F, Negri E, La Vecchia C, Te VC. Socioeconomic groups and cancer risk at death in the Swiss Canton of Vaud. Int J Epidemiol. 1988;17(4):711–7. doi:http://dx.doi.org/10.1093/ije/17.4.711.
- Townsend P, Davidson N. Inequalities in Health: the Black Report. Harmondsworth: Penguin; 1982.
- Hosmer DW, Jr, Lemeshow S. Applied logistic regression. 2nd ed. New York: Wiley & Sons; 2000.
- Autier P, Boniol M, Doré JF. Sunscreen use and increased duration of intentional sun exposure: still a burning issue. Int J Cancer. 2007;121(1):1–5. doi:http://dx.doi.org/10.1002/ijc.22745.
- Autier P, Boniol M, Severi G, Doré J-F; European Organizatin for Research and Treatment of Cancer Melanoma Co-operative Group. Quantity of sunscreen used by European students. Br J Dermatol. 2001;144(2):288–91. doi:http://dx.doi.org/10.1046/j.1365-2133.2001.04016.x.
- Faurschou A, Wulf HC. The relation between sun protection factor and amount of suncreen applied in vivo. Br J Dermatol. 2007;156(4):716–9. doi:http://dx.doi.org/10.1111/j.1365-2133.2006.07684.x.
- Dadlani C, Orlow SJ. Planning for a brighter future: a review of sun protection and barriers to behavioral change in children and adolescents. Dermatol Online J. 2008;14(9):1.
- Greinert R, de Vries E, Erdmann F, Espina C, Auvinen A, Kesminiene A, et al. European Code against Cancer 4th Edition: Ultraviolet radiation and cancer. Cancer Epidemiol. 2015;39(Suppl 1):S75–83.
- Lower T, Girgis A, Sanson-Fisher R. How valid is adolescents’ self-report as a way of assessing sun protection practices? Prev Med. 1998;27(3):385–90. doi:http://dx.doi.org/10.1006/pmed.1998.0252.
- Riley AW. Evidence that school-age children can self-report on their health. Ambul Pediatr. 2004;4(4 Suppl):371–6.
- Stanton WR, Janda M, Baade PD, Anderson P. Primary prevention of skin cancer: a review of sun protection in Australia and internationally. Health Promot Int. 2004;19(3):369–78. doi:http://dx.doi.org/10.1093/heapro/dah310.
- Buller DB, Borland R. Skin cancer prevention for children: a critical review. Health Educ Behav. 1999;26(3):317–43. doi:http://dx.doi.org/10.1177/109019819902600304.
- Bennetts K, Borlands R, Swerissen H. Sun protection behaviour of children and their parents at the beach. Psychol Health. 1991;5(4):279–87. doi:http://dx.doi.org/10.1080/08870449108400428.