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Krishna S, Ambrecht E, Maher IA. Portable Shade Structure Use at a Youth Soccer Camp. JAMA Dermatol. 2014;150(9):1011–1012. doi:10.1001/jamadermatol.2013.10502
More than 3 million nonmelanoma skin cancers (NMSCs) are diagnosed annually in the United States.1,2 The incidence of malignant melanoma (MM) has increased annually by 2.4%.3 Open field activities in youth are a major source of sun exposure, which leads to skin cancer later in life.4-6 Few studies exist on the use of shade structures in open field sports, particularly soccer. In this pilot study, we assess the rate of use of portable shade structures among soccer-playing youths.
The Virginia Commonwealth University (VCU) institutional review board approved this study, waiving participant written informed consent. A summer soccer camp for boys and girls in metropolitan Richmond, Virginia, consisted of 15 3-hour periods of play over 10 days, of which 8 periods were observed (rainfall forced cancellation of the other 7). Shade tents donated by Virginia Commonwealth University Medical Center and the Sun Safe Soccer program of the American Society for Dermatologic Surgery were erected within 10 yards of the field. Coaches neither encouraged nor discouraged use.
Research assistants followed written protocols and recorded tallies of the number of players using the shade tents during the breaks. Two minutes after a rest period began, 2 data collectors independently counted the children beneath the shade structures and recorded the mean value. Rest periods ranged from 5 to 10 minutes. The UV index and temperature, accessed from the US Weather Service at Richmond International Airport, were recorded for the times at which the counts were made.
The overall mean percentage of children using shade structures per rest session was calculated, with stratifications by age and week. Pearson correlation coefficients were calculated to assess the association between a session’s UV index and temperature and shade structure use. A generalized linear model was created to estimate overall shade structure use, controlling for the potential confounding variables of group, week, UV index, and temperature.
Seventy-eight rest sessions were observed on 7 different days (Table). The mean number of children observed during each session was 80.9. The mean (SD) percentage of children using shade structures was 71.4% (37.8%) across all rest sessions. The mean (SD) outside temperature was 84.3°F (2.7°F) (range, 79°F-93°F). Two recordings were below 80°F, at 79°F. There was no correlation between temperature and shade structure use (P = .19). However, there were differences in shade use by camper group: older campers (14-18 years) who attended the afternoon sessions (51.2%) were less likely to use shade structures than younger campers (8-18 years) in the morning sessions (76.6%) (P = .02). There were also differences in shade use between week 1 (98%) and week 2 (66%) (P = .01), which correspond with differences in cloud coverage as noted by data collectors. Controlling for camper group and week, the adjusted mean percentage of children using shade structures was 79.7% per rest session.
In this pilot study, we examine the rate of use of commercially available shade tents in soccer-playing youths. We observed a mean adjusted use rate of 79.7%, which suggests that shade structures will be used if they are provided and sufficient time is allowed for use. Our study is limited by the small sample size, single club, and location in the southern United States. However, our findings suggest that inexpensive, portable shade structures at sporting events encourage sun protection, which could be augmented by providing sunscreen there as well. Larger, multicenter studies are needed to confirm the utility of shade structures to decrease UV exposure in a meaningful way and to inform policy makers, recreation facility managers, and architects of the public health value of shade structures for open field sports activities.
Corresponding Author: Ian A. Maher, MD, Department of Dermatology, St Louis University, 1755 S Grand Blvd, St Louis, MO 63104 (firstname.lastname@example.org).
Accepted for Publication: December 17, 2013.
Published Online: July 30, 2014. doi:10.1001/jamadermatol.2013.10502.
Author Contributions: Drs Ambrecht and Maher had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.
Study concept and design: Krishna, Maher.
Acquisition, analysis, or interpretation of data: Krishna, Ambrecht, Maher.
Drafting of the manuscript: Krishna, Ambrecht, Maher.
Critical revision of the manuscript for important intellectual content: Krishna, Ambrecht, Maher.
Statistical analysis: Ambrecht, Maher.
Obtained funding: Maher.
Administrative, technical, or material support: Ambrecht, Maher.
Study supervision: Maher.
Conflict of Interest Disclosures: None reported.
Funding/Support: This study was supported in part by the Sun Safe Soccer program of the American Society of Dermatologic Surgery.
Role of the Sponsor: The sponsor had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.
Additional Contributions: We are indebted to the Virginia Commonwealth University medical students who assisted with data collection.
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