Published online October 1, 2004
PEDIATRICS Vol. 114 No. 4 October 2004, pp. 1056-1064 (doi:10.1542/peds.2004-1305)
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Counseling Parents and Children on Sun Protection: A National Survey of Pediatricians

Sophie J. Balk, MD*, Karen G. O’Connor, BS{ddagger} and Mona Saraiya, MD, MPH§

* Children’s Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, New York
{ddagger} Division of Health Policy Research, American Academy of Pediatrics, Elk Grove Village, Illinois
§ Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia

Objective. To describe pediatricians’ attitudes toward skin cancer (SC), sun protection (SP) counseling, and the quantity and content of such counseling and to identify barriers to counseling.

Methods. An American Academy of Pediatrics Periodic Survey was mailed to 1616 randomly selected US members between October 2001 and February 2002. The response rate was 54.6%.

Results. More than 90% of pediatricians agreed that SC is a significant public health problem and that preventing episodic high exposures to the sun during childhood will reduce the risk of adult melanoma. However, only 22.3% of respondents reported counseling most patients in all age groups. Female pediatricians were more likely to counsel most patients; pediatricians located in the South and West and those who practice in hospital/clinic settings were least likely to counsel compared with those in other regions. Approximately half (53%) of pediatricians reported selectively counseling on the basis of patient characteristics The most important SP recommendation named was using a sunscreen with a sun protection factor ≥15. Only 38% of pediatricians rated SP as very important to their patients’ health compared with other topics such as use of car seats (86%), nutrition (79%), immunization issues (76%), and smoking/avoidance of environmental tobacco smoke (74%). The most frequently named barrier to SP counseling was lack of time (58% reporting).

Conclusions. Although the majority of pediatricians believe that SC prevention is a worthy issue, only a minority reported providing routine SP counseling to most patients in every age group, and most ranked SP lower in importance than other issues. Interventions might include programs and materials to educate patients and pediatricians alike. To have an effect on increasing rates of SC and SC mortality, a broader public health approach is needed as a complement to pediatricians’ counseling efforts.

Key Words: sun protection • skin cancer • melanoma • pediatricians • counseling • prevention • vitamin D

Abbreviations: SC, skin cancer • BCC, basal cell carcinoma • SCC, squamous cell carcinoma • NMSC, nonmelanoma skin cancer • UVR, ultraviolet radiation • SP, sun protection • AAP, American Academy of Pediatrics • SPF, sun protection factor

Accepted Jul 1, 2004.




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