Excess exposure to solar ultraviolet radiation (UVR) is the only readily modifiable skin cancer risk factor, and childhood exposure is implicated in melanoma aetiology. To assist the design and evaluation of child sun protection interventions in the school and community context, this first comprehensive study used electronic monitors to record time-stamped, second-by-second UVR exposure of 325 children (from 28 randomly selected New Zealand primary schools) who kept a diary record of concurrent activities and sun-protective practices and completed a sun-related knowledge, attitudes and usual behaviours questionnaire. School principals and Health promoters (HPs) were interviewed about school and community sun protection efforts.
Using the Haddon matrix and Ottawa Charter of Health Promotion to guide research, four potential domains of influence were identified: the physical and social environments, protective products, and host (child). Two key outcomes identified were child UVR exposure and sun-protective practices. A path model was developed where potential influences on these outcomes included school, community, host factors (demographics, skin type, sun-related attitudes, and sun-related knowledge), and pattern of concurrent outdoor activity. Seven specific hypotheses were defined to investigate the effects of host, school and community factors on UVR exposure, sun-protective practices, and sun-related knowledge, attitudes and behaviours.
To test for the effects of host factors, day of the week and activity on UVR exposure and sun-protective practices, linear mixed models containing these factors and interactions between Year level-sex, activity-Year level and activity-sex, accounting for clustering within schools and allowing for repeated measures, were applied. Logistic regression with a random school effect was used to assess differences in scored student questionnaire items. Structural equation modelling was implemented to consider associations between sun-related knowledge, attitudes and behaviours, and other explanatory factors for variations in UVR exposure and sun-protective practices.
Three of the seven specific hypotheses were supported. There were statistically significant differences in UVR exposure by sex, skin type, day of the week and activity, and sex-activity and Year level-activity interactions. Passive pursuits were associated with the highest UVR exposure rates compared to outdoor active, travel and unclassified pursuits.
There were statistically significant differences in sun-protective practices by sex, ethnicity and skin type, and sex-activity and Year level-activity interactions. Girls tended to have higher sun protection scores than boys, but were more likely to sunbathe and use sunscreen. Children identifying with Pacific Island ethnicities had higher scores than children with other ethnicities, and children with Fitzpatrick skin types I and II had higher scores than children with skin types III, IV and V.
School and community factors were not associated with UVR exposure, sun-protective practices, sun-related knowledge, attitudes and behaviours, but school and HPs� scores were relatively high, reflecting the significant time and effort spent promoting youth sun protection.
Trends for Year level indicated that whereas child sun-related knowledge increased with Year level, attitudes and behaviours supportive of sun protection declined. When considering sun-related knowledge, attitudes and behaviours simultaneously, knowledge was only significantly associated with behaviours when mediated by attitudes. The study findings have implications for child sun protection interventions.
| Identifer | oai:union.ndltd.org:ADTP/217744 |
| Date | January 2007 |
| Creators | Wright, Caradee Yael, n/a |
| Publisher | University of Otago. Dunedin School of Medicine |
| Source Sets | Australiasian Digital Theses Program |
| Language | English |
| Detected Language | English |
| Rights | http://policy01.otago.ac.nz/policies/FMPro?-db=policies.fm&-format=viewpolicy.html&-lay=viewpolicy&-sortfield=Title&Type=Academic&-recid=33025&-find), Copyright Caradee Yael Wright |
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