Evaluation of habits, attitudes and awareness concerning sun exposure in adolescents

Resumen

INTRODUCTION Teenagers form a population group that is at special risk of developing skin cancer later in life, mainly due to their habits of recreational sun exposure, the greater availability of leisure time, the high rates of sunburn experienced, and the culture of body image and the importance given to a suntanned appearance. One of the goals of our study was to examine adolescents’ behaviour, attitudes and knowledge with respect to sun exposure, both in the school context and during sports activities. In addition, we evaluated the sensitivity to change of a questionnaire on sun exposure for use in future interventions in the field of skin cancer prevention. MATERIAL AND METHODS Two study designs were applied, for the different articles submitted for publication: The first design is quasi-experimental, before and after an educational intervention, and includes adolescents in secondary education. The baseline study (before the intervention) was performed on the same sample, and is reported in Articles I and II. The third study was performed after the educational intervention, to analyse the questionnaire’s sensitivity to change. Population and sample. Adolescents aged 14-17 years, enrolled in secondary schools, randomly selected, resident within the catchment area of the Costa del Sol Healthcare Agency. Questionnaire: The completed questionnaire contained demographic data, together with information about skin colour, Fitzpatrick skin type, sun exposure habits, sunburn experience, photoprotection practices, sun-related attitudes and sun-exposure-related knowledge. The second design is descriptive, and includes adolescents who are active in sports, specifically skateboarders. This study corresponds to the fourth article. Finally, we conducted a review of the literature on the photoprotection behaviour of adolescents in Andalusia. This study is presented in the fifth article.” RESULTS The first study included 270 students from 11 schools, aged 14-17 years. 50.4% were girls, 43.7% were 14 years old and 85.9% had Spanish nationality. The skin type was predominantly light (49.3%), with phototypes III (42.2%) and IV (34.8%). These adolescents spent a lot of time exposed to ultraviolet radiation and 74.4% had suffered a sunburn episode the previous summer. 47.8% used sun cream but only 1.1% wore a long-sleeved shirt or long trousers on the beach. Regarding attitudes, 60.7% reported that being tanned made them feel better, and regarding knowledge of the issues involved, most were aware of the harmful effects of the sun on the skin. Regarding the sensitivity to change detected by the Beach Questionnaire, the comparison of results before and after the intervention revealed changes in the responses made to various components of the questionnaire (sun exposure habits, sunburn, photoprotection practices, attitudes and knowledge). CONCLUSIONS As a population group, adolescents are at risk of developing skin cancer because they tend to spend long periods of time exposed to the sun, have high rates of sunburn, take few precautions regarding photoprotection and have positive attitudes toward tanning. Accordingly, this strategic priority group should be targeted in primary prevention campaigns aimed at changing teenagers’ favourable attitudes toward the sun and tanning and at promoting positive attitudes toward sun protection. As part of our study of sensitivity to change, we developed a questionnaire on behaviour, attitudes and knowledge concerning sun exposure. This Spanish-language questionnaire presents good qualities of validity, reliability and sensitivity to change, and constitutes a useful tool for epidemiological research and the prevention of skin cancer, as well as in the evaluation of educational interventions.