Sun Safety for the Next Generation
Every dermatologist knows how critical sun safety can be over a lifetime. While sunlight exposure is critical for cutaneous vitamin D production, UV radiation has a known association with increased rates of skin cancers,1 including melanoma,2-4 basal cell carcinoma,5,6 and squamous cell carcinoma.7,8 Following photoprotective practices can be almost literally lifesaving, especially when those behaviors start in school-aged children.9 Amy Brodsky, MD, a dermatologist in the greater Chicago, IL, area, has been working to show children and their families how they can be their own hero when it comes to sun safety.
“I originally started a Sun Safety 501(c)(3) charity in 2012 called Pediatric Sun Protection Foundation, and the premise behind it was two-fold. I felt like I kept hearing patients say to me, ‘I’m never in the sun, why do I have skin cancer?’ and I would constantly explain that it’s because of everything that happened before you were 18 years old,” she said. At that time, her 7- and 8-year-old children became increasingly more resistant to wearing their sun-protective shirts. “I wanted to make it ‘cool in the pool’ to wear those sun-shirts,” she added.
After some time, the Pediatric Sun Protection Foundation grew, coming to support a 2-year study with Ann & Robert H. Lurie Children’s Hospital of Chicago and Advocate Children’s Hospital, the largest hospital system in Illinois, to determine if children would wear sun-protective clothing and if this behavior reduced the risk of sunburns. The foundation and Dr Brodsky, with collaboration with the American Society of Dermatologic Surgery, later went on to lobby the Illinois state and the federal government for the bill SUNucate, which was later passed at both levels to allow school nurses to help children to apply sun- screen in schools.
“In addition, I would continually hold a sun safety day at Wrigley Field, where I would give away 40,000 samples of sunscreen and sun-protective shirts to the first 5000 children, which was a lot of fun,” said Dr Brodsky.
“I also would spend at least 4 days each year traveling to schools and teaching sun safety. I would go with the weather-man from a local news station, and after the kids had a chance to participate and learn, we would feature their pictures on television,” she continued. This endeavor found success, both for the children and schools but also for Dr Brodsky as well.
Empowering Patients as Their Own Sun Heroes
Around 2019, Dr Brodsky realized the nonprofit foundation needed some help to continue its growth. She connected with industry, and L’Oreal bought into the concept. The additional support lead to the creation of “Be a Sun Hero,”10 a program for dermatologists, advanced practice clinicians in dermatology, and even pediatricians to take a similar educational approach to sun- protective behaviors.
“When I go to the schools with my white coat on, I easily spend 45 minutes presenting evidence-based information at an appropriate level for the children,” explained Dr Brodsky. Her presentation incorporates 5 or 6 true-false questions to help dispel rumors and promote photoprotective behaviors. She also hands out “Sun Hero kits,” an orange drawstring bag with trade- size sunscreen samples, a laminated sheet of safety facts, cards with a take-home quiz, and stickers that say I’m a Sun Hero.
“When I hand out those Sun Hero kits at the beginning of the presentation, I tell the kids to not take anything out of the bag until we start talking. They get so excited that they can take home this bag!” said Dr Brodsky. “During my talk, I have them put the sticker on and say, ‘After today, you will be a Sun Hero.’”
Dr Brodsky explained how the Sun Hero program is a benefit for everyone involved. “The doctor who presented gets their business card out there while doing something good for their community. The free curriculum is a win for the schools, since they typically have to pay for this sort of curriculum. The kids also absorb all the information and get to take home a few free things, and when they come home and tell their parents, the parents are often thinking about how cool it is that their child learned all that information,” she said.
Educating children about the importance of the sun safety could make a difference in improving the habits and knowledge of their parents, guardians, and caregivers. A cross-sectional survey of 409 parents of children enrolled in kindergarten through grade 8 found that use of sun-protective strategies (sun screen, long sleeves, wide-brimmed hats) was associated with the child’s cooperation; if the child did not cooperate, the strategies were not used.11
In the same survey, parents did report using sunscreen and long sleeves, but less than 25% reported using shade, wide-brimmed hats, or sunglasses for their children. These results may be reflective of the lack of awareness of sun-protective measures. A qualitative study of 26 semi-structured interviews found that parents were often unaware of their child’s sunburn, particularly when related to water-related activities, lack of shade, and misconceptions regarding UV index.12 In addition, sunburn in children is significantly associated with sunburn in their caregivers,13 and tanning is often seen as a positive trait.12,13 However, Salvado and colleagues14 administered a questionnaire to 198 caregivers and found that caregiver education level was associated with increased self- knowledge about sun protection and exposure for their children.
“Ultimately, it would be great if this became a national program,” said Dr Brodsky. The immediate impact would mean sun safety growing in popularity across society and cultures, an important initiative as Black, Hispanic, and male gender are factors for lower odds of sunscreen adherence,15 and even families with a history of skin cancer may need a gentle reminder regarding sun-safe practices.16,17
How to Get Involved
Dr Brodsky shared that getting involved with the Sun Hero program is easy for dermatologists and other providers. For physicians who were already visiting schools and doing similar presentations, the program helps streamline sample collection from sales representatives and industry contacts, and it is easy to sign up, she added.
“After you schedule the presentation with the school, my number one tip is to not go in there and scare kids,” said Dr Brodsky. “Make it fun! Talk about how it’s great to be in the sun but why we have to stay safe in the sun. You really want to focus on making it short, light, and fun. If we can make an impact with the next generation, we just might start to see more sun safety across the board.”
1. Zanetti R, Rosso S, Martinez C, et al. Comparison of risk patterns in carcinoma and melanoma of the skin in men: a multi-centre case-case-control study. Br J Cancer. 2006;94(5):743-751. doi:10.1038/sj.bjc.6602982
2. Oliveria SA, Saraiya M, Geller AC, Heneghan MK, Jorgensen C. Sun exposure and risk of melanoma. Arch Dis Child. 2006;91(2):131-138. doi:10.1136/adc.2005.086918
3. Cust AE, Jenkins MA, Goumas C, et al. Early-life sun exposure and risk of melanoma before age 40 years. Cancer Causes Control. 2011;22(6):885-897. doi:10.1007/s10552-011-9762-3
4. Solomon CC, White E, Kristal AR, Vaughan T. Melanoma and lifetime UV radiation. Cancer Causes Control. 2004;15(9):893-902. doi:10.1007/s10552-004-1142-9
5. Little MP, Linet MS, Kimlin MG, et al. Cumulative solar ultraviolet radiation exposure and basal cell carcinoma of the skin in a nationwide US cohort using satellite and ground-based measures. Environ Health. 2019;18(1):114. doi:10.1186/s12940-019-0536-9
6. Wu S, Han J, Laden F, Qureshi AA. Long-term ultraviolet flux, other potential risk factor, and skin cancer risk: a cohort study. Cancer Epidemiol Biomarkers Prev. 2014;23(6):1080-1089. doi:10.1158/1055-9965.EPI-13-0821
7. English DR, Armstrong BK, Kricker A, Winter MG, Heenan PJ, Randell PL. Case- control study of sun exposure and squamous cell carcinoma of the skin. Int J Cancer. 1998;77(3):347-353. doi:10.1002/(sici)1097-0215(19980729)77:3<347::aid-ijc7>3.0.co;2-o
8. Chen YC, Christiani DC, Su HJJ, et al. Early-life or lifetime sun exposure, sun reaction, and the risk of squamous cell carcinoma in an Asian population. Cancer Causes Control. 2010;21(5):771-776. doi:10.1007/s10552-010-9505-x
9. Thoonen K, Scheider F, Candel M, de Vries H, van Osch L. Childhood sun safety at different ages: relations between parental sun protection behavior towards their child and children’s own sun protection behavior. BMC Public Health. 2019;19(1):1044. doi:10.1186/s12889-019-7382-0
10. The Sun Hero Program. Sun Hero. Accessed January 19, 2022. https://beasunhero.com/
11. Schlarbaum JP, Lazovich D, Dodd E, Hanson B, Polcari IC. Examination of use and barriers for five sun protection strategies in parents and their children. Pediatr Dermatol. 2020;37(5):827-832. doi:10.1111/pde.14250
12. Thoonen K, van Osch L, Drittij R, de Vries H, Schneider F. A qualitative exploration of parental perceptions regarding children’s sun exposure, sun protection, and sunburn. Front Public Health. 2021;9:596253. doi:10.3389/fpubh.2021.596253
13. Robinson JK, Rigel DS, Amonette A. Summertime sun protection used by adults for their children. J Am Acad Dermatol. 2000;42(5 Pt 1):746-753. doi:10.1067/mjd.2000.103984
14. Salavado M, Fraga A, Marques DL, Pires IM, Coelho Gonçalves C, Mendes Silva N. Sun exposure in pediatric age: perspective of caregivers. Children (Basel). 2021;8(11):1019. doi:10.3390/children8111019
15. Correnti CM, Klein DJ, Elliott MN, et al. Racial disparities in fifth-grade sun protection: evidence from the Healthy Passages study. Pediatr Dermatol. 2018;35(5):588-596. doi:10.1111/pde.13550
16. Geller AC, Brooks DR, Colditz GA, Koh HK, Frazier AL. Sun protection practices among offspring of women with personal or family history of skin cancer. Pediatrics. 2006;117(4):e688-e694. doi:10.1542/peds.2005-1734
17. Glenn BA, Bastani R, Chang LC, Khanna R, Chen K. Sun protection practices among children with a family history of melanoma: a pilot study. J Cancer Educ. 2012;27(4):731-737. doi:10.1007/s13187-012-0377-5
