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

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. (C) Society for Adolescent Medicine, 2002.