Sun exposure and sun protection behaviours among Australian adolescents: trends over time

Background
This study compared the sun exposure and sun protection behaviours of adolescent students between 1993 and 1999.

Methods
Schools from all Australian states and the two territories participated in each of the 1993, 1996, and 1999 surveys and a sample of students from years 7 to 12 were surveyed. In each of the states and territories a random sample of schools was selected within each education sector (government, Catholic, independent). The questionnaire was a self-completed booklet with questions about sunburn history during the previous summer, tan preferences, skin-type, and usual reported behaviour. Data from a total of 78,032 students were available for analysis.

Results
From 1993 to 1999 there was a significant increase in the number of students reporting sunburn during the previous summer (χ2 = 225.77, df = 2, P < 0.01). However, the percentage of students who preferred no tan at all increased over the same period (χ2 = 184.47, df = 2, P < 0.01). The percentage of students who usually or always wore clothing that covered most of their body decreased between 1993 and 1999 (χ2 = 20.46, df = 2, P < 0.01); the percentage of students usually or always wearing maximum protection sunscreen decreased over time (χ2 = 27.71, df = 2, P < 0.01). Staying in the shade increased from 1993 (26%) to 1996 (32%) but decreased slightly in 1999 (30%). Across all survey years, only 11% of students routinely followed all three protective behaviours of wearing a hat, sunscreen, and clothes that cover the body.

Conclusions
Sun protection practices among adolescents are still below optimal levels. Future educational programs require innovative approaches that aims to change attitudes toward tanning as being healthy and attractive and modify adolescent behaviours in relation to sun exposure.

Knowledge, attitudes and self-care practices related to sun protection among secondary students in Australia

The aim of this research was to ascertain changes in sun-related knowledge, attitudes and self-care practices among Australian secondary school students between 1993 and 1996. Two cross-sectional surveys of sun-related attitudes, beliefs and behavior of young people aged 12–17 years of age, were conducted in 1993 and 1996. Over 80% of adolescents at both time periods knew about the issues related to skin cancer prevention, frequency of burning and burning on cloudy days. Adolescent attitudes had shifted positively in the areas of staying inside in 1996 [relative risk (RR): 1.13; 95% confidence interval (CI): 1.09–1.17] and staying under shade in 1996 (RR: 1.16; 95% CI: 1.13–1.18). Desire for a moderate or dark tan was lower in 1996 (45%) than in 1993 (50%). Respondents reported that they were less likely to wear brief clothing to get a suntan in 1996 (RR: 0.81; 95% CI: 0.78–0.84) and were significantly more likely to stay in the shade in 1996 (RR: 1.19; 95% CI: 1.16–1.23). We conclude that there has been a shift in attitudes towards use of shade and avoidance of unnecessary exposure, and away from use of sunscreens and sunglasses. The results suggest that adolescents may be more ready to accept structural changes that move desired activities out of the sun.

Australian adolescents' sun protection behavior : who are we kidding?

Purpose
To examine the influence of tan preference and skin type on sun protection behaviors of Australian adolescents.

Methods
The Australian Secondary School Alcohol and Drug Questionnaires were conducted in 1993, 1996, 1999 and 2002 among randomly selected students aged 12–-17. Schools were randomly selected from each education sector in each state. The self-administered questionnaire contained questions about tan preferences, skin type and usual SunSmart behavior (use of sunscreen, hats and covering clothing).

Results
The routine use of SunSmart behavior was low in all survey years. There was a significant decrease over time in the proportion of students who practiced SunSmart behavior, with prevalence rates lower in 2002 than in any other survey year (males: p < 0.01 and females: p < 0.01). As desire for a tan increased, routine practice of SunSmart behaviors decreased. Across the four survey periods, male (p < 0.01) and female (p < 0.01) students who preferred no tan were significantly more likely to practice SunSmart behavior than students who preferred any sort of tan. Across the four survey years, male (p < 0.01) and female (p < 0.01) students with skin that ‘just burns’ were most likely to routinely practice SunSmart behavior.

Conclusions
Sun protection practices among adolescents have continued to decline significantly over time. Future educational programs require an innovative approach to modify adolescent behaviors in relation to sun exposure and sun protection.

Sun exposure and sun protection behaviours among young adult sport competitors

Objective: To explore the relationship between sun protection and physical activity in young adults (18-30 years) involved in four organised sports.

Methods: Participants (n=237) in field hockey, soccer, tennis and surf sports completed a self-administered survey on demographic and sun-protective behaviours while playing sport. Differences in sun-protective behaviour were explored by sport and by gender.

Results: Sunburn during the previous sporting season was high (69%). There were differences between sports for sunburn, sunscreen use and reapplication of sunscreen. Lifesaving had the highest rates compared with the other three sports. Hats and sunglasses worn by participants varied significantly by sports. A greater proportion of soccer and hockey players indicated they were not allowed to wear a hat or sunglasses during competition. For all sports, competition was played mainly in the open with no shade provision for competitors while they were playing. There were some gender differences within each of the sports. Female soccer and tennis players were more likely to wear sunscreen compared with males. Female hockey players were more likely to wear a hat compared with males.

Conclusions: Our findings highlight that there is still room for improvement in sun-protective behaviours among young adult sport competitors. There is a need for a systematic approach to sun protection in the sporting environments of young adults.

Implications: Health promotion efforts to increase physical activity need to be paired with sun protection messages.

Promoting comprehensive sun protection policies and practices in outdoor sports: a qualitative study of perceived priorities and practicalities

Sun protection policies, environments, practices, and attitudes in sporting club contexts might be significant determinants of sun exposure among adult sporting participants. Face-to-face interviews, using standardised, open-ended questions were conducted with 20 club officials from four sports: soccer, hockey, tennis and surf lifesaving. Thematic content analysis identified a number of salient themes. Formal sun protection policies were well-implemented in surf lifesaving, but less so in soccer, hockey and tennis clubs, which often had informal sun protection practices in place. Officials perceived sun protection to be important, which was related to perceived exposure levels, the type of sport, length of time played and the season. Consistent logistical and practical considerations emerged, including limited resources, availability of shade, and lack of control over sporting facilities, uniform regulations and games scheduling. Sun protection efforts often focused on children more than adult players. Reciprocal responsibility was an important theme, where it was perceived that responsibility for sun protection should be equally shared between the club and the member. In this study it was found that reciprocal responsibility, duty of care and sport-specific practical requirements might significantly influence the success of policy, environmental and education initiatives for sun protection in sporting settings.

The influence of yarn parameters on the ultraviolet protection of yarns

 Improving ultraviolet (UV) protection of textiles is essential to protect wearers against UV radiation induced risks. In addition to fabric parameters, yarn parameters are important factors affecting UV protection of textiles. This work is to examine the influence of yarn parameters on UV protection in order to set up a statistical model for predicting the UV protection of yarns. Wool yarns with different variables were used to test the ultraviolet protection factor (UPF) values for data analysis and the model verification. The model provides the optimized parameters for the UV protective fabric design. This work is helpful as a pre-cursor to the development of a more advanced optical model, which will look at understanding the penetration of UV light through fibres, yarns and fabrics.

Photostability of wool fabrics coated with pure and modified TiO2 colloids

The surface of wool fabrics was coated with TiO2 and TiO2-based nanocomposite colloids and the impact of this coating on the photostability of wool was investigated. TiO2 along with TiO2/Metal and TiO2/Metal/SiO2 sols were synthesized through a low-temperature sol-gel method and applied to fabrics. Composite colloids were synthesized through integrating the silica and three noble metals of silver (Ag), gold (Au) and platinum (Pt) into the synthesis process of sols. Four different molar ratios of Metal to TiO2 (0.01%, 0.1%, 0.5% and 1%) were used to elucidate the role of metal type and amount on the obtained features. Photostability and UV protection features of fabrics were evaluated through measuring the photo-induced chemiluminescence (PICL), photoyellowing rate and ultraviolet protection factor (UPF) of fabrics. PICL and photoyellowing tests were carried out under UVA and UVC light sources, respectively. PICL profiles demonstrated that the presence of pure and modified TiO2 nanoparticles on fabrics reduced the intensity of PICL peak indicating a lower amount of polymer free radicals in coated wool, compared to that of pristine fabric. Moreover, a higher PICL peak intensity as well as photoyellowing rate was observed on fabrics coated with modified colloids in comparison with pure TiO2. The surface morphology of fabrics was further characterized using FESEM images.

Reprint of: photostability of wool fabrics coated with pure and modified TiO2 colloids

The surface of wool fabrics was coated with TiO2 and TiO2-based nanocomposite colloids and the impact of this coating on the photostability of wool was investigated. TiO2 along with TiO2/Metal and TiO2/Metal/SiO2 sols were synthesized through a low-temperature sol-gel method and applied to fabrics. Composite colloids were synthesized through integrating the silica and three noble metals of silver (Ag), gold (Au) and platinum (Pt) into the synthesis process of sols. Four different molar ratios of Metal to TiO2 (0.01%, 0.1%, 0.5% and 1%) were used to elucidate the role of metal type and amount on the obtained features. Photostability and UV protection features of fabrics were evaluated through measuring the photo-induced chemiluminescence (PICL), photoyellowing rate and ultraviolet protection factor (UPF) of fabrics. PICL and photoyellowing tests were carried out under UVA and UVC light sources, respectively. PICL profiles demonstrated that the presence of pure and modified TiO2 nanoparticles on fabrics reduced the intensity of PICL peak indicating a lower amount of polymer free radicals in coated wool, compared to that of pristine fabric. Moreover, a higher PICL peak intensity as well as photoyellowing rate was observed on fabrics coated with modified colloids in comparison with pure TiO2. The surface morphology of fabrics was further characterized using FESEM images.

Critical processes for creating health-promoting sporting environments in Australia

The reach of sporting organizations into the community makes them an ideal vehicle through which to promote health to the general population. There are now a number of documented examples demonstrating that sponsorship can lead to improvements in the health of the sporting environment, but relatively little is known as to why some sponsorships are more successful in achieving these structural changes than others in ostensibly similar sports. The purpose of this study was to identify the processes required for health promotion agencies and sporting organizations working in collaboration to implement structural changes in sporting settings such as smoke-free environments, provision of healthy food choices, responsible alcohol management and sun protection, along with the factors that facilitate and hinder this from being achieved. We conclude that such changes are difficult to achieve, especially in the absence of a programmatic approach to health promotion.

Policy interventions implemented through sporting organisations for promoting healthy behaviour change (review)

Background
Sporting organisations provide an important setting for health promotion strategies that involve policies, communication of healthy messages and creation of health promoting environments. The introduction of policy interventions within sporting organisations is one strategy to target high risk behaviours such as smoking, alcohol consumption, excess sun exposure, unhealthy eating and discrimination.

Objectives
To review all controlled evaluation studies of policy interventions organised through sporting settings to increase healthy behaviour (related to smoking, alcohol, healthy eating, sun protection, discrimination, safety and access).

Search strategy
We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, PsyclNFO, CINAHL, SPORTDiscus, Sociological Abstracts, Dissertation Abstracts, freely available online health promotion and sports-related databases hosted by leading agencies, and the internet using sport and policy-related key words. We identified further studies in the bibliographies of articles and by contacting authors of key articles in the area.

Selection criteria
We aimed to identify research that had used study designs that incorporated an evaluated intervention and comparison. Uncontrolled studies, meeting other inclusion criteria, were to be reported in an annex to the review.
Types of studies: Studies in which sporting organisations were allocated to a policy intervention or control/comparison group. No minimum follow-up required.
Types of participants: People of all ages.
Types of interventions: Any policy intervention implemented through sporting organisations to instigate and/or sustain healthy behaviour change, intention to change behaviour, or changes in attitudes, knowledge or awareness of healthy behaviour. Policies must address any of the following: smoking, alcohol, healthy eating, sun protection, access for disadvantaged groups, physical safety (not including injuries), and social and emotional health (e.g.. anti-vilification, anti-discrimination).
Types of outcome measures: Behaviour change, intention to change behaviour, change in attitudes, knowledge or awareness of healthy behaviour, and policy presence.

Data collection and analysis
We assessed whether identified citations were controlled evaluation studies and investigated the use of policy implemented in sporting settings. Abstracts were independently inspected by two reviewers and full papers were obtained where necessary. As no controlled evaluation studies were located, no data collection or analysis was undertaken. No uncontrolled studies meeting other inclusion criteria were identified and therefore no annex is presented.

Main results
No rigorous studies were located to test the effectiveness of policy interventions organised through sporting organisations to increase healthy behaviours, attitudes, knowledge or inclusion of health oriented policies within the organisarions.

Authors' conclusions
We were unable to find any controlled studies to guide the use of policy interventions used in sporting settings. The search process revealed a number of case studies with anecdotal reporting of outcomes. We strongly recommend that rigorous evaluation techniques are employed more commonly in this field to illuminate the impact of health promoting policy on outcomes, and the contexts and processes which are likely ro be effective in reducing harmful behaviours.

Prevalence of health promotion policies in sports clubs in Victoria, Australia

In recent years, some health agencies offered sponsorship to sporting associations to promote healthy environments by encouraging clubs to develop health-related policies. However, the extent to which these sponsorship contracts reach their stated aims is of concern. This study aimed to quantify levels of policy development and practice in sports clubs for each of five key health areas, namely smoke-free facilities, sun protection, healthy catering, responsible serving of alcohol and sports injury prevention. Representatives from 932 Victorian sports clubs were contacted by telephone with 640 clubs (69%) participating in the survey. Results suggested that the establishment of written policies on the key health areas by sports clubs varied widely by affiliated sport and health area: 70% of all clubs with bar facilities had written policies on responsible serving of alcohol, ranging from 58% of tennis clubs to 100% of diving and surfing clubs. In contrast, approximately one-third of sports clubs had a smoke-free policy, with 36% of tennis, 28% of country football and 28% of men's cricket clubs having policy. Moreover, 34% of clubs overall had established sun protection policy, whereas clubs competing outside during summer months, [diving (86%) and life-saving (81%)] were most likely to have a written sun protection policy. Injury prevention policies were established in 30% of sports clubs, and were most common among football (56%), diving (43%) and life-saving (41%). This study suggests that policy development for health promotion can be achieved in sports clubs when it is well supported by health agencies and consideration is given to the appropriateness of the specific behaviours to be encouraged for a given sport. Communication between associations and clubs needs to be monitored by health agencies to ensure support and resources for policy development to reach the club level.

Maximising students' use of purpose-built shade in secondary schools: Quantitative and qualitative results of a built-environment intervention

A trial installing shade sails at secondary schools found increased students' use of newly shaded areas, but relatively low use overall. We examined site features and weather related to use of these shaded areas. Tables with seats and temperatures ≥27 °C increased student use of shaded areas, presence of grass decreased use. Focus groups at eight schools suggest students were unaware of changes to their habitual use of favoured locations. Results infer careful selection of locations for built-shade and provision of tables with seats will assist in maximising student use and investments in shade sails.