By Eighth Grade, Sunscreen Use Halves, Tanning Rises

Jenni Laidman

January 23, 2012

January 23, 2012 — Between the fifth and eighth grades, children learn to love a tan, and sunscreen use plummets, despite growing evidence of a link between childhood sunburn and adult melanoma, according to results from a survey of 1 group of children, published in the February issue of Pediatrics.

Stephen W. Dusza, DrPH, from the Department of Medicine, Dermatology Service, Memorial Sloan-Kettering Cancer Center, New York City, and colleagues surveyed 360 Framingham, Massachusetts, fifth graders about tanning attitudes and behaviors in 2004, and surveyed them again in 2007 as eighth graders.

In surveys issued 1 month after returning from summer break, children did not report significantly more sunburns the summer before eighth grade than they did 3 years earlier (55% among eighth graders compared with 53% among fifth graders; P = .79), but both boys and girls reported a growing preference for tans in eighth grade (67% to 34%; P < .001) and for dedicating time to tanning (40% of eighth graders compared with 22% of fifth graders; P < .001). Strikingly, sunscreen use fell by half. As fifth graders, 50% of students reported they "often or always" used sunscreen when outdoors 6 hours or more compared with 25% of eighth graders.

"We have identified a crucial period in periadolescence in which students increase time spent in the sun to get a tan and strengthen tan-promoting attitudes," the authors write.

"With at least 50% of children experiencing sunburns before age 11 and again 3 years later, targeting children in pediatric offices and community settings regarding unprotected [ultraviolet] exposure may be a practical approach," they write.

The American Academy of Dermatology says melanoma is the most common form of cancer in young adults (aged 25 - 29 years), and the second most common cancer in those aged 15 to 29 years.

Childhood appears to be a critical time in melanoma development. A 2008 meta-analyses of 51 studies concluded that a single sunburn in childhood almost doubled melanoma risk ( Ann Epidemiol. 2008;18:614-627). In addition, a 2008 study showed an increased melanoma incidence in young people from 1992 to 2004 ( Cancer. 2008;112:416-432).

The sharpest increase in sunburn rates were among children with the highest risk for melanoma: those with fair or very fair skin. Some 34% of those children reported more sunburns, whereas only 15% of children with light brown to light olive skin did (P < .001). Children with very fair skin also were more likely to spend time getting tan (odds ratio [OR], 2.8; 95% confidence interval [CI], 1.9 - 4.1; P < .001) than children with light olive to black skin (OR, 1.7; 95% CI, 0.9 - 3.0; P = .08).

Girls were more likely to report spending time tanning in 2007 compared with in 2004 (OR, 4.2; 95% CI, 2.5 - 7.0; P < .001), although more boys also reported time spent tanning (OR, 1.6; 95% CI, 1.0 - 2.5; P = .03). A study published in the December 2008 issue of the Journal of Investigative Dermatology showed that melanoma rates among young women have been on the increase, rising 50% from 1980 to 2004.

Ultraviolet light radiation is the leading risk factor for melanoma that individuals can change, and sunburn frequency, which is a marker for intense, intermittent ultraviolet light radiation exposure, puts someone at a higher risk for melanoma than chronic exposure, the authors write.

The authors have disclosed no relevant financial relationships.

Pediatrics. 2012;129:309-317.

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