Natural history of sun protection behaviors in a cohort of children in Colorado

Skin cancer rates in the US have risen steadily over the past decade, even in younger age groups. Sun exposure in childhood is the most important preventable risk factor for skin cancer, yet risk reduction efforts remain inadequate. Guided by the Precaution Adoption Process Model (PAPM), the present analysis used longitudinal data from 381 parents in Colorado to examine trends in sun protection practices for children aging from 6 to 8 years, and in parents' perceptions of skin cancer risk, disease severity, effectiveness of preventive behaviors, and barriers to engaging in preventive behaviors. Parents' readiness to limit their children's time in the mid-day sun increased over the three-year study period whereas their readiness to dress their children in long clothes changed little. Disease risk and severity perceptions were relatively constant over time, whereas the perceived effectiveness of protection behaviors increased and barriers to engaging in those behaviors decreased. Results of mixed-model repeated measures analyses revealed that temporal reductions in barriers were the strongest predictors of increases in the readiness to limit mid-day sun and to use clothes for sun protection. Reductions in barriers also predicted increases in the frequency with which parents limited their child's time in the mid-day sun, and used clothes, hats, shade and sunscreen for their child's protection. These findings suggest that removing barriers to sun protection plays a critical role in changing behavior and should be emphasized in skin cancer prevention efforts with parents and children.