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Brief Report
March 2018

Sun Protection Behaviors in Head Start and Other Early Childhood Education Programs in Illinois

Author Affiliations
  • 1Medical student at Northwestern University Feinberg School of Medicine, Chicago, Illinois
  • 2Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
  • 3Editor, JAMA Dermatology
JAMA Dermatol. 2018;154(3):336-340. doi:10.1001/jamadermatol.2017.5257
Key Points

Question  What are the sun protection practices and attitudes of Head Start (HS)/Early Head Start (EHS) and day care centers in Illinois for 2- to 6-year-old children?

Findings  This survey study found that staff considered sun protection a less important habit than nutrition, exercise, and brushing teeth. Avoiding outdoor activities during peak sun intensity was performed less by HS/EHS than by day care programs, and half of HS/ESHS programs used spray sunscreen to avoid unnecessarily touching children.

Meaning  Education is needed about making sun safety a high-priority health habit, the danger of spraying sunscreen into a child’s face, and using the UV index to determine when to use sun protection.

Abstract

Importance  Sun safety attitudes developed in early childhood can reduce lifetime UV radiation exposure and the risk of skin cancer.

Objective  To assess the current policies, practices, and attitudes among caregivers regarding sun protection in children aged 2 to 6 years.

Design, Setting, and Participants  A survey of 202 administrators or managers and teachers of Illinois Head Start/Early Head Start (HS/EHS) and day care centers was conducted from July 3 through 21, 2017. Organizations were randomly selected from 4 lists of urban, suburban, town, and rural locations and stratified to ensure population-based proportional representation of the Illinois population vulnerable to UV exposure. Program administrators or managers participated in a 5- to 10-minute telephone interview that assessed importance of health and sun protection behaviors, program practices, and demographic characteristics. Data analysis was conducted August 2, 2017.

Main Outcomes and Measures  Outcomes included attitudes toward the importance of health behaviors in comparison with sun protective behaviors, reported use of sun protection (seeking shade, scheduling outdoor activities, sun protective clothing, and sunscreen practices), and sunburn prevalence.

Results  Respondents (from 102 HS/EHS programs with 52% boys overall and a mean [SD] child age of 2.5 [0.5] y and 100 day care programs with 49% boys and age of 2.3 [0.4] y) stated that the 3 most important habits were good nutrition (66 [64.7%] HS/EHS, 71 [71.0%] day care), adequate exercise (41 [40.2%] HS/EHS, 55 [55.0%] day care), and brushing teeth (35 [34.3%] HS/EHS, 38 [38.0 %] day care). Scheduling outdoor activities to avoid peak sun intensity was performed less by HS/EHS programs (46 [45.1%]) in comparison with day care programs (71 [71.0%]; P < .001). Sunscreen was provided for students in 109 programs, but 84 (77.1%) did not allow children to apply sunscreen themselves. Half of the programs (100 of 202 [50.0%]) used spray sunscreen to avoid unnecessarily touching children. Most programs did not report any children having sunburns (129 [63.9%]) and followed heat index guidelines (114 [56.4%]).

Conclusions and Relevance  Administrators and teachers did not identify sun safety as one of the most important health habits. While spray sunscreen was used frequently, avoiding spraying sunscreen directly on a child’s face, which may get it into the child’s eyes, was not done. The heat index was widely used to determine outdoor playtime. Adopting UV index policies could help prevent sunburns in early spring when the heat index is low but UV index is high. Dermatologists may assume responsibility for educating the administrators about the danger of spraying sunscreen into a child’s face and the advantage of using the UV index to determine when sun protection is needed.

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