Student-parent agreement in self-reported sun behaviors

Objective: We sought to describe agreement between parent proxy and student self-reported sun behaviors and Sun protective practices in adolescents aged 10 to 14 years. Methods: We conducted a cross-sectional pilot study of students (n = 52) from two classrooms, grades 6 and 7, at a school system in Framingham, Mass. Data were collected using self-administered questionnaires. Students were asked to report their sun behaviors and sun protective practices. Proxy measures were obtained by asking parents to report sun behaviors and practices of their children. Agreement was measured using weighted kappa analysis for ordinal data. Mean differences (95% confidence intervals) were calculated. Results: The response rate for student/proxy pairs was 96% (n = 50). Agreement between student and proxy was good for skin color, sunscreen use, number of sunburns in the past summer, and application of sunscreen while in other outdoor places (range kappa = 0.52-0.73). Lowest agreement was found for questions relating to wearing a shirt, wearing a hat, sitting in the shade, and frequency of parental sunscreen application to the students' backs (range kappa = 0.08-0.28). Mean differences in responses between student and proxy respondents were relatively small ranging from -0.39 to +0.25. Conclusions: The lack of a gold standard in the assessment of sun exposure and related sun protective practices limits the ability to validate these exposure measures in skin cancer studies. The assessment of sun exposure behaviors is especially problematic when relying on a child's ability to accurately recall these exposures. Parent proxy measures are often used as surrogate measures and for validation purposes. We found low to moderate student/proxy agreement in this pilot study suggesting that adolescents can effectively recall their recent sun behaviors and protective practices when compared with parent proxy measures.