LOS ANGELES – It takes a multi-pronged approach to prevent a child from getting sunburned, the results of a randomized trial of sun protection strategies suggest.
An intervention group of children in the sixth to eighth grades–a time when youths usually increase their sun exposure–in 10 New Hampshire towns were matched with grade-equivalent controls and monitored for 2 years, during which time they received sun safety information (Pediatrics 2007;119:e247-56). Study patients randomized to the control group showed a 23% decrease in sun protection during that time, but the level of sun protection decreased by only 8% in towns randomized to a multifaceted intervention.
The children in the intervention group “avoided a majority of the drop-off of sun protection that happens in those middle-school years.” Dr. Martin A. Weinstock noted at the annual meeting of the Society for Investigative Dermatology.
The investigators targeted communities with populations of 6,000-34,000. They observed children at lakes and other recreational areas, noting whether the kids played in the shade and wore protective clothing, and how much of their skin was covered. They asked the children whether they were using sunscreen–if the answer was yes, then they asked to see the container.
Using these elements, the researchers created a measure of the percentage of body surface protected. “It was a fairly objective measure of what sun protection these kids were using,” said Dr. Weinstock, professor of dermatology and community health at Brown University, Providence, R.I. He was not an investigator in the study, but disclosed that he has been a consultant to sunscreen manufacturers. The intervention in the study group reflects a growing understanding that changing behavior requires more than printing a booklet on sun protection or developing a curriculum for teachers, he said.
The investigators went to schools, recreational facilities, primary care practices, and other venues to encourage sun-safe behavior messages from teachers, coaches, lifeguards, clinicians, and others. They trained teen peer counselors to promote the delivery of sun protection messages.
The middle-school students in the intervention group “heard it from their parents, from their teachers, from their doctors–they heard it from everybody,” Dr. Weinstock said. “For long-term benefit, we need to take the type of approach that's informed by these recent results.” The primary change in the children's behavior was in sunscreen use.
Sun protection in childhood is a complex goal that needs to be balanced with the need for physical activity and healthy vitamin D levels. Even if an intervention improves sun exposure, it will take many years to show it reduces melanoma incidence, he said.