Certification of sun protection practices in a German child day-care centre improves children's sun protection--the 'SunPass' pilot study.
BACKGROUND
Nonmelanoma skin cancer (NMSC) and malignant melanoma (CMM) are among the most common malignancies in the white population. The major risk factor for those malignancies is ultraviolet radiation (UV) causing directly DNA damage and promoting the development of skin cancer. It is suggested that the exposure to UV during childhood elevates an individual's lifetime risk of developing skin cancer more than exposure in adulthood. Since an increasing number of children spend the time of the most intense UV in a day-care centre, it seems an excellent place for establishing primary skin cancer prevention. Important targets are staff members and parents of the day-care centre, since sun protection of children depends directly on their knowledge and their attitude towards sun protection practices.


OBJECTIVE
To establish a feasible certification program for sun protection in a German child day-care centre, for a better sun protection of the children and the reduction of skin cancer incidence in the long term.


METHODS
Initially sun protection practices of the centre at baseline were assessed. A written sun protection policy was developed in consultation with all members of the day-care centre as basis for certification. It was followed by training sessions for staff members (n=12) and parents (n=46). After a fixed period of time the final assessment of the child day-care centre was conducted and the centre then was certified for improved sun protection practices and better protection of the children. The primary assessed outcomes were the gain in knowledge of staff members and parents after the training sessions, the number of children wearing a hat when playing outside, the use of sunscreen and the percentage of shaded areas on the playground.


RESULTS
Sun protection was an issue more discussed during the time of intervention than before. Staff members (n=12) and parents (n=27) had a significant gain in knowledge (staff members: P=0.002; parents: P=0.001) concerning sun related issues. The number of children wearing a hat increased from 13.2% to 73%. The sunscreen use increased, 58.8% of staff members reported a more regular application of sunscreen to the children. There was a higher percentage of shaded area on the playground (70-80% before intervention, 90% after intervention). The intervention failed in keeping the children inside during the most intense UV and in educating the staff members to be a convincing example of sun protection by wearing appropriate clothes.


CONCLUSIONS
The intervention showed that the introduction of a simple certification program including a written sun protection policy and training sessions for staff members and parents helps to improve children's sun protection. We suggest that a certificate for adequate sun protection acts as a motivating factor. It seems important to refresh sun protection practices each year by repeating training sessions and reviewing the sun protection policy.
Department of Dermatology, Charité, Skin Cancer Centre Charité, University Hospital of Berlin, Berlin, Germany.
W
W
Aulbert
C
C
Parpart
R
R
Schulz-Hornbostel
B
B
Hinrichs
D
D
Krüger-Corcoran
E
E
Stockfleth
D002568:Certification; D002648:Child; D002656:Child Day Care Centers; D002675:Child, Preschool; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D009381:Neoplasms, Radiation-Induced / Q000517:prevention & control*; D016487:Parenting; D010865:Pilot Projects; D011314:Preventive Health Services; D011481:Protective Clothing / Q000706:statistics & numerical data; D012878:Skin Neoplasms / Q000517:prevention & control*; D013471:Sunburn / Q000517:prevention & control*; D013473:Sunscreening Agents / Q000008:administration & dosage; D011795:Surveys and Questionnaires
D013473:Sunscreening Agents