Changes in the pattern of sun exposure and sun protection in young children from tropical Australia

Background: Australia has one of the highest rates of skin cancer globally. Lifetime risk is associated with childhood sun exposure. Objective: We sought to investigate whether skin cancer prevention programs have resulted in improvements in sun-exposure and sun-protection behavior among young children in tropical Australia. Methods: Two cohorts of 12-to 35-month-old children from Townsville, Australia, were compared: cohort 1 was recruited from hospital birth records (1991) and cohort 2 was recruited via local child-care centers (1999-2002). Children's phenotypic characteristics were assessed. Parents completed questionnaires detailing children's demographic characteristics, and sun-exposure and sun-protective practices. Results: Although 1-year-old children from cohort 2 spent more time in the sun than those from cohort 1 (median 2.2 vs 2.8 h/d; P = .002), a higher proportion almost always wore sunscreen and a swim-shirt year round. Although more 1-year-old children in cohort 2 had experienced a sunburn (35.5% vs 51.2%; P = .007), both cohort 2 age groups experienced fewer hours of sun exposure to the back of the trunk (P < .001), were less likely to have been sunburned on the back/shoulders (age 1 year 34.8% vs 10.1% and age 2 years 52% vs 10.1%; P < . 001), and acquired fewer melanocytic nevi at these sites (P < . 001). Limitations: There was potential for socially desirable responses (information bias). Conclusion: Although duration of sun exposure in early childhood did not decrease during an 8-year period, reported use of personal sun protection did. The observed increase in popularity of swim-shirts and sunscreen between cohorts coincided with the development of significantly fewer melanocytic nevi in these children. (J Am Acad Dermatol 2013;68:774-83.)