title: Does being a "SunSmart School" influence hat-wearing compliance? An ecological study of hat-wearing rates at Australian primary schools in a region of high sun exposure.
abstract: BACKGROUND
  Childhood sun exposure is an important risk factor for skin cancer. Anecdotal evidence suggests that hats are under-utilized by Australian primary school students.
  
  
  METHODS
  The proportion of students and adult role-models wearing hats was observed at 36 primary schools (63.9% SunSmart schools [SSS]) in Townsville (latitude 19.3°S; high to extreme maximum daily UV-index year round), Queensland, Australia, from 2009 to 2011.
  
  
  RESULTS
  Overall, 52.2% of 28,775 students and 47.9% of 2954 adults were observed wearing a hat. Hat use (all styles) among SSS and non-SunSmart school (NSSS) students was similar before (24.2% vs 20.5%; p=0.701), after (25.4% vs 21.7%; p=0.775) and during school-hours (93.0% vs 89.2%; p=0.649) except SSS students wore gold-standard (broad-brim/bucket/legionnaire) hats during school play-breaks more often in the warmer months (October-March) than NSSS students (54.7% vs 37.4%; p=0.02). Although the proportion of adults who wore hats (all styles) was similar at SSS and NSSS (48.2% vs 46.8%; p=0.974), fewer adults at SSS wore them before school (3.7% vs 10.2%; p=0.035).
  
  
  CONCLUSIONS
  SunSmart status is not consistently associated with better hat-wearing behavior. The protective nature of hats and the proportion of school students and adult role-models wearing them could be improved, possibly by offering incentives to schools that promote sun-safety.
authors.affiliation: Skin Cancer Research Group, School of Public Health, Tropical Medicine and Rehabilitation Sciences, Anton Breinl Centre for Health Systems Strengthening, Australian Institute of Tropical Health and Medicine, James Cook University, Townsville, QLD 4811, Australia. Electronic address: denise.turner@my.jcu.edu.au.
authors.forename: Denise
authors.initials: D
authors.lastname: Turner
authors.affiliation: Skin Cancer Research Group, School of Public Health, Tropical Medicine and Rehabilitation Sciences, Anton Breinl Centre for Health Systems Strengthening, Australian Institute of Tropical Health and Medicine, James Cook University, Townsville, QLD 4811, Australia.
authors.forename: Simone L
authors.initials: SL
authors.lastname: Harrison
authors.affiliation: Tropical Health Solutions Pty Ltd, Idalia, Townsville, Australia.
authors.forename: Petra
authors.initials: P
authors.lastname: Buettner
authors.affiliation: Skin Cancer Research Group, School of Public Health, Tropical Medicine and Rehabilitation Sciences, Anton Breinl Centre for Health Systems Strengthening, Australian Institute of Tropical Health and Medicine, James Cook University, Townsville, QLD 4811, Australia; School of Medicine, James Cook University, Townsville, QLD 4811, Australia.
authors.forename: Madeleine
authors.initials: M
authors.lastname: Nowak
mesh_terms: D000293:Adolescent; D000328:Adult; D019985:Benchmarking / Q000379:methods; D002648:Child; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006293:Health Promotion / Q000379:methods*; D006801:Humans; D007100:Imitative Behavior; D007857:Leadership; D008297:Male; D011481:Protective Clothing / Q000592:standards / Q000706:statistics & numerical data*; D011793:Queensland; D012572:School Health Services / Q000592:standards*; D012621:Seasons; D012878:Skin Neoplasms / Q000517:prevention & control*; D013334:Students / Q000706:statistics & numerical data; D013472:Sunlight / Q000009:adverse effects*; D013997:Time Factors; D014466:Ultraviolet Rays / Q000009:adverse effects
keywords: Hat-wearing; Skin cancer; Sun-protection; SunSmart; Ultraviolet radiation