Original article
Knowledge, attitudes, and behaviors toward skin cancer in Maryland youths

https://doi.org/10.1016/S1054-139X(02)00377-4Get rights and content

Abstract

Purpose: To describe the knowledge, attitudes, and practices of 7th-graders in Maryland with respect to sun protection and skin cancer.

Methods: Maryland middle school students ages 10 to 16 years (55% girls, estimated 67% white) from 6 counties completed an in-school questionnaire (n = 2775) developed by the Coalition for Skin Cancer Prevention in Maryland in 1999 to assess knowledge, attitudes, and behaviors concerning sun exposure and skin cancer. To evaluate for gender and age differences, mean knowledge and attitude scores were compared using Student’s t-tests and the prevalence of behaviors were compared using Chi-square tests. Multiple regression was used to model how age, gender, knowledge, and attitudes predicted the likelihood of being sunburned the previous summer.

Results: On average, these youths correctly answered 65% of 13 true/false items and 43% of 7 multiple choice items. Approximately one-third (32%) felt a tan looked healthy and 51% felt a tan looked attractive; on the other hand, 36% agreed/strongly agreed that sun protection was “cool.” Attitudes toward skin protection became less favorable with age (p-for-trend < .001). When out in the sun the previous summer, 37% rarely or never used sunscreen and 43% never wore a hat. The prevalence of two or more painful sunburns during the past summer was 30%. Less favorable attitudes toward skin protection were associated with a higher likelihood of sunburn (p < .001). The likelihood of sunburn did not differ by gender, even though when compared with boys, girls had significantly higher knowledge scores (p < .01), more favorable attitudes (p < .001), and were significantly more likely to report using sunscreen (p < .001).

Conclusions: A substantial proportion of youths were not protecting themselves adequately from sunlight. The overall low levels of knowledge accentuate the need to incorporate basic knowledge of skin cancer and sun protective behaviors in preventive interventions designed for this population. The results particularly emphasize the need to positively impact attitudes toward sun protective behavior early in life to help curb the epidemic of skin cancer.

Section snippets

Methods

This study evaluates baseline data collected as part of the “SunGuard Your Skin” project of the Coalition for Skin Cancer Prevention in Maryland, a Centers for Disease Control (CDC) sponsored skin cancer prevention project. Children enrolled in 7th grade in public schools in 6 Maryland counties were surveyed in the Spring semester of 1999. CDC judged the survey to be exempt from Institutional Review Board review owing to the anonymous voluntary nature of the data collection. Of the 3256 youths

Results

The study population was an average of 12.1 years old. We were unable to collect data on race/ethnicity, but based on county-level data 67% of the study population would be expected to be Caucasian. In both boys and girls, the average number of correct responses to the multiple choice knowledge items was less than 50% and to the true/false knowledge items was less than 70% (Table 1). The majority reported using sunscreen always/sometimes when out in the sun (Table 1). Not counting “don’t

Discussion

The results of this cross-sectional survey emphasize the need for skin cancer prevention programs targeted toward youths, as the knowledge and behaviors of the 7th-graders concerning skin cancer and skin protection were suboptimal. A major finding was the overall low level of knowledge in Maryland youths, emphasizing the need to incorporate basic knowledge of skin cancer and sun protective behaviors in preventive interventions designed for this population. Not surprisingly under these

Acknowledgements

This study was conducted with funding from the Centers for Disease Control and Prevention. Dr. Alberg is a recipient of a Preventive Oncology Academic Award (CA73790) from the National Cancer Institute. We thank the anonymous reviewers for their helpful suggestions on an earlier version of this manuscript.

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