Childhood and adolescence are critical periods during which exposure to UV radiation is more likely to contribute to skin cancer in later life, representing 33% of the lifetime melanoma risk up to 60 years of age. It has been estimated that 50% of total UV exposure up to age 60 occurs before age 20; the dermis is thinner in children, with skin thickness gradually increasing from birth to adulthood. Skin thickness of the face, limbs, and trunk of children aged two-13 years is significantly thinner compared with young adults, 25-40 years. A Queensland study found UV exposure during the first 18 years of a person's life was the most critical risk factor for skin cancer, and also caused skin damage and premature ageing. Studies of child and adult migrants from low UV environments to high UV environments also add to the evidence that childhood and adolescence are critical periods during which exposure to UV radiation is more likely to contribute to skin cancer in later life.
Like many cancers, skin cancer has a long latency period, and overexposure during childhood and adolescence increases risk of developing skin cancer at a later age. Up to the age of 20, exposure has been shown to result infrequently in melanoma, and much more rarely, in non-melanocytic skin cancer. Mild premature skin ageing, freckling and the development of melanocytic naevi are the more immediate results of overexposure to UV radiation in the first two decades of life. Although early onset melanoma is comparatively rare (with mean diagnosis age 60.8 years), melanoma is one of the most common cancers and the leading cause of cancer-related death for young adults with fair pigmentation. In young people aged 12-24 years in Australia, melanoma is the most common cancer, with more than double the number of cases of any other kind of cancer. Below the age of 20, most melanomas occur in the 15-19 year old age group (70-85%). Research from Queensland suggests a decline in the incidence of thin invasive melanoma since the mid- to late 1990s among young people who have been exposed to primary prevention and early detection programs since birth.
In the period 2004-2010, five-year relative survival was high (96%) for adolescents with melanoma. Among adolescents and young adults, melanoma of the skin was the third most common cause of cancer death (91 deaths) following brain cancer and bone cancer. Deaths due to melanoma of the skin accounted for 2.0% of all cancer deaths in those aged 15-19, 7.1% in those aged 20-24 and 14% in those aged 25-29.13 Mortality trends in adolescents and young adults between 1983 and 2007 indicate that deaths from melanoma of the skin decreased significantly by 2.5% per year for the entire period.
The National SunSmart Schools Program was launched in November 1998, followed by the Early Childhood Program, which was established in all states by 2009. The program aims to minimise UV radiation exposure and ultimately reduce lifetime risk of skin cancer in schools and early childhood settings.
Early childhood services
According to 2013 data collated from state and territory SunSmart programs, more than two-thirds of early childhood education and care (ECEC) services across Australia voluntarily participate in the National SunSmart Early Childhood Program. Participation rates vary across the country due to individual Cancer Council resourcing, capacity, support of educational organisations, and number of years involved in the program. Participation is lowest in NT (42%), WA (44%) and SA (45%). The highest membership rates are in the ACT (88%), followed by NSW (84%) and Victoria (80%).
The most recent national study (2013) to assess the sun protection policies and practices of early childhood education and care services across Australia indicated significant improvements since the previous national survey was conducted in 2008.
- Most ECEC services (96%) had a written sun protection policy in 2013, similar to the 95% figure for services surveyed in 2008.
- The percentage of services requiring children at their service to wear sunscreen increased significantly from 90% in 2008 to 97% in 2013.
- Nearly all services require hat wearing for children (>99%) and staff (98%)
- A significantly higher percentage of services required children to wear a Cancer Council approved hat (broad-brimmed, legionnaires or bucket hat) in 2013 than 2008 (87% vs. 74%)
- 83% of services required children to wear sun protective clothing - a significant increase from 2008 (67%)
- 89% of services did not require children to wear sunglasses at any time, while only 1% of services required children to wear Australian/New Zealand AS/NZS Standard 1067:2003 sunglasses.
- 80% of services reported that infants (children aged 0 to 12 months) were taken outside only under shaded areas, and 43% reported that infants were taken outside for a restricted amount of time
- There were significant increases in the proportion of services that had shade available from shade cloths/sails (89% vs. 94%) and portable umbrellas/shade tents (20% vs. 30%)
- 78% of services in 2013 reported there was enough shade for all children to play outside
- SunSmart services were more likely to have a written sun protection policy and were more likely to require sunscreen, sun protective hats and sun protective clothing compared to non-SunSmart services.
Research on children’s UV radiation exposure in New Zealand primary schools has shown that exposure is generally higher on weekdays than during the weekend. Physical education, athletics and lunch breaks are associated with high UV radiation exposure. This confirms the importance of sun protection in the primary school setting.
According to the latest 2013 data collated from the individual state and territory SunSmart programs, just under two-thirds of primary schools across Australia voluntarily participate in the National SunSmart Schools Program. The proportion of Australian primary schools participating in the SunSmart program increased from 19% in 1998 to 60% in 2013. Participation rates vary across the country due to individual Cancer Council resourcing, capacity, support of educational organisations, and number of years involved in the program. Participation is lowest in WA (24%), NT (25%) and SA (43%). The highest membership rates are in Victoria (90%), ACT (78%) and NSW (66%).
In a study evaluating sun protection policies in primary schools and the effect of the National SunSmart Schools Program, it was found that sun protection policy and practice significantly improved between 1998 (just prior to the establishment of the national program in 1999) and 2011-12, (please note: programs in NSW and NT commenced in 2008).
- The proportion of SunSmart and non-SunSmart schools with a written sun protection policy increased from 62% in 1998 to 79% in 2011-12.
- More than half (56%) of primary schools in 1998 recommended SunSmart hats (broad-brimmed, legionnaire and bucket hats). This has increased significantly to 89% in 2011-12.
- The majority of schools (72%) required teachers to wear hats in 2011-12.
- Most schools (92%) actively encouraged the use of sunscreen in 2011-12. Approximately half of these schools allowed time for students to apply (51%) and encouraged students to come to school wearing sunscreen (55%). In 1998, 55% of schools made sunscreen available in all classrooms compared to 61% in 2011.
- There has been an increase in the number of schools reporting they have enough shade for active and passive activities—from 28% in 1998 to 47% in 2011-12.
A study of the comprehensiveness of sun-protection policies in North Queensland primary schools found that although 96.6% of schools had a written sun protection policy, less than one in four schools addressed shade use or providing shade at events, while policies addressing hats (93.8%) and clothing (98.2%) were the most common. Only 5.4% of Queensland primary schools met all SunSmart criteria in their written policy (encompassing sun protection including adequate shade provision, role modelling, rescheduling, promoting sun safety and education, policy use for planning outdoor events and periodic review of policies).
A recent Queensland study has shown that although the proportion of students and adult role-models wearing hats was not significantly higher in SunSmart status schools overall, a greater proportion of students at SunSmart schools wore highly protective hats (broad-brimmed/bucket/legionnaires) in October–March compared to non-SunSmart schools.
Results of a survey of Australian secondary students in 1996 showed that they were likely to "accept structural changes that move desired activities out of the sun". Consistent with this, a study of randomly selected Melbourne secondary schools showed that adolescents used—rather than avoided—shade in the form of newly-installed shade-sails. This is evidence that built shade can help reduce exposure to UV radiation in secondary school settings.
Routine use of hats, sunscreen and covering clothing was low among adolescents taking part in the Australian Secondary School Alcohol and Drug Questionnaires in 2002. Only 54% of boys and 31% of girls routinely wore a hat. The prevalence of adolescents ‘usually’ or ‘always’ wearing covering clothing was also low (25% and 13%). Routine sunscreen use was more common: 36% among boys and 50% among girls.
Sun protection compliance among adolescents on summer weekends
See here for trends in sun protections behaviours among Australian adolescents on summer weekends.
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