title: Determinants of inadequate parental sun protection behaviour in their children--results of a cross-sectional study in Germany.
abstract: OBJECTIVE
  Unprotected sun exposure especially during childhood is a risk factor for skin cancer. A combined use of sun protection measures is recommended to protect children. However, the prevalence and determinants for combined use have been scarcely studied in children. The objective of this study was to identify determinants of parental sun protection behaviour.
  
  
  METHODS
  A cross-sectional survey was performed in five regions in Bavaria (Germany) during school entrance health examination (2010/2011). Parents of 4579 children (47% female, aged 5-6 years) completed a self-administered questionnaire (response 61%).
  
  
  RESULTS
  Most children were regularly protected with single measures (shade (69%), clothes (80%), hat (83%), sunscreen (89%), sunglasses (20%)). However, regarding regular and combined use, >50% of children were inadequately protected. Larger family size, lower household equivalent income, darker skin and sunburn history were associated with inadequate use of different sun protection measures. The less frequent use of one sun protection measure was associated with less frequent use of the others. Child's sex, migration background, parental education and sun exposure showed inconsistent results regarding the different sun protection outcomes.
  
  
  CONCLUSIONS
  Based on our results a regular, combined and correct use of multiple sun protection for children should be promoted independent of sociodemographic characteristics. Priority of shade, clothes and hat before sunscreen should be clarified.
authors.affiliation: Department of Occupational and Environmental Epidemiology, Bavarian Health and Food Safety Authority, Germany.
authors.forename: Swaantje
authors.initials: S
authors.lastname: Klostermann
authors.affiliation: Department of Occupational and Environmental Epidemiology, Bavarian Health and Food Safety Authority, Germany; Department of Social Epidemiology, Institute for Public Health and Nursing Research, University of Bremen, Germany. Electronic address: gabriele.bolte@uni-bremen.de.
authors.forename: Gabriele
authors.initials: G
authors.lastname: Bolte
mesh_terms: D000328:Adult; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D054242:Emigrants and Immigrants; D005190:Family; D005191:Family Characteristics; D005260:Female; D005858:Germany; D015438:Health Behavior; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007182:Income; D008297:Male; D016487:Parenting; D010290:Parents; D011481:Protective Clothing; D012307:Risk Factors; D012867:Skin; D012878:Skin Neoplasms / Q000517:prevention & control*; D013471:Sunburn / Q000517:prevention & control; D013472:Sunlight; D013473:Sunscreening Agents; D011795:Surveys and Questionnaires
chemical_list: D013473:Sunscreening Agents
keywords: Skin cancer; Sun exposure; Sunscreen; UV index; Ultraviolet radiation