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Sunscreen use in grade schoolers: Wide racial, ethnic disparities seen.

In a study of more than 5,000 fifth graders, fewer than a quarter of participants almost always used sunscreen, and the figures were much lower for non-Hispanic black children.

The odds of sunscreen adherence across the group were higher if a child also performed other preventive health behaviors; those who flossed regularly, for example, had an odds ratio of 2.41 for regular sunscreen use (95% confidence interval, 1.86-3.13, P less than .001).

Just 23% of fifth graders almost always used sunscreen, according to data drawn from the Healthy Passages study, which surveyed the parents or caregivers of 5,119 fifth graders. That figure was similar in the 1,802 Hispanic respondents, but fell to just 6% of the 1,748 non-Hispanic black respondents.

Some other factors that were associated with less chance of adherence to sunscreen use included being male and having lower socioeconomic status, wrote Christina M. Correnti, MD, and her study coauthors. The report was published in in Pediatric Dermatology. Perhaps surprisingly, they said, "School-based sun-safety education and involvement in team sports were not significant factors."

Healthy Passages is a prospective multisite cohort study of child and adolescent health. Dr. Correnti, a dermatology resident at the University of Maryland, Baltimore, and her colleagues used baseline Healthy Passages data collected from the period of 2004-2006. Children enrolled in fifth grade at public schools in Birmingham, Ala., Houston, and Los Angeles, together with their caregivers, participated in the survey. Deidentified demographic data were collected, and participants were asked about four preventive health behaviors in addition to sunscreen use and flossing teeth; brushing teeth, helmet use, seatbelt use, and well-child examinations.

Dr. Correnti and her colleagues used multivariable analysis to calculate odds ratios for the association between the various demographic factors and other preventive behaviors and sunscreen use. They found that sunscreen adherence was correlated with all other preventive behaviors (P less than .001), but that the interrelationship with helmet use was confounded by racial and ethnic variables. Seatbelt use was not significantly correlated with sunscreen use for non-Hispanic black or Hispanic respondents.

"Children from more-educated and affluent households were more likely to use sun protection. Perhaps they had greater parental awareness and practice of sun safe habits," wrote Dr. Correnti and her colleagues, noting that other work has shown that even low-income parents generally don't see the cost of sunscreen as a barrier to use.

Although overall use of sunscreen among non-Hispanic black children was low, both non-Hispanic black and Hispanic children were more likely to use sunscreen if they had three or more sunburns within the prior 12 months. "Although darker skin tones may afford some sun protection, melanoma incidence is growing in Hispanic populations," the researchers wrote.

To address these overall low rates of sunscreen use, the investigators discussed the utility of a variety of education options. The well-child visit affords an opportunity to reinforce the importance of preventive behaviors, but physicians may run into a time crunch and forgo thorough sun safety education, they said. Written materials can be a useful adjunct for clinicians in this setting.

"Health care practitioners may use absence of other preventive behaviors as potential markers for inadequate sunscreen use, prompting a point-of-care sun-safety intervention," they suggested.

A school-based public health approach offers another route for education. "School sun-safety programs may alleviate the primary care burden," wrote Dr. Correnti and her coinvestigators. The opportunity to deliver repeated, age-tailored messages as children progress through school may be effective in promoting healthy sun behaviors. Messaging that focuses on the negative effects of sun exposure on appearance such as age spots and wrinkles have been more effective than those warning of the risk of skin cancer for teens; investigating appearance-based content for this age group might be a good idea, the authors said.

The fact that the survey sites were in southern cities may mean that national rates of consistent sunscreen use for elementary schoolers may be even lower, said Dr. Correnti and her coauthors. Many other real-world factors, such as frequency and amount of sunscreen applied and the use of sun-protective clothing, couldn't be captured by the survey, they acknowledged.

"Even in the most adherent group, non-Hispanic whites, only 44.8% always used sunscreen," the researchers wrote. The study's findings leave plenty of room for implementation of broad-based programs, especially in low-resource communities.

The National Institutes of Health funded the research. Dr. Correnti was supported by NIH awards.

SOURCE: Correnti CM et al. Pediatr Dermatol. 2018. doi: 10.1111/pde. 13550.



Preventative health behaviors are most durable when ingrained early in life. A survey of parents or caregivers of more than 5,000 fifth graders in three U.S. cities suggests there is considerable room for improvement when it comes to sunscreen use, particularly among certain groups.

Only 23% of respondents reported "almost always" using sunscreen; that figure dropped to 6% for non-Hispanic black individuals. Other factors negatively correlating with sunscreen use included male sex, and lower socioeconomic status. Kids who engaged in other preventative health behaviors, such as flossing, were more likely to use sunscreen.

Correnti et al. acknowledge barriers to use including cost and limited primary care time available for proper education, but their work and others' have not clearly linked these factors. They advocate for school-based education to decompress busy well-child care visits, with attention to age-appropriate messaging. For better or worse, teens are likely moved more by a risk of wrinkles and age spots than skin cancer.



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Author:Oakes, Kari
Publication:Pediatric News
Date:Jun 1, 2019
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