Sun protection for adolescents at school in Aotearoa/New Zealand

Abstract

Skin cancer is a substantial public health issue in New Zealand (NZ) with exposure to solar ultraviolet radiation (UVR) being the major modifiable risk. Excessive UVR during adolescence can have a lasting effect on long-term cancer risk. Additionally, risky behaviours can continue to adulthood. The aspirational-shared aim of the series of studies included in this thesis is to identify and assess processes and actions to help to reduce excessive exposure of UVR during adolescence for young people, thereby potentially contributing to reducing the burden of skin cancer. There were four studies undertaken as part of this PhD, chosen specifically to address knowledge gaps with respect to this cohort in NZ and internationally.

The first study was a systematic review using Effective Public Health Practice Project guidelines to review the quality of interventions targeting adolescents and delivered in secondary schools. In total 13 interventions were identified and received quality ratings of ‘strong’ (n=0), ‘moderate’ (5) or weak (8). Most interventions were health-based, emphasising the association between UVR exposure and skin cancer. These have limited success in changing behaviour. Two promising interventions were identified as potentially relevant. Both moved beyond presenting didactic education in the classroom. The first was an appearance-based intervention using facial ageing technology. The second was an environmental intervention with the provision of a real time ultraviolet index (UVI) display meter in the playground. Subsequently, the second and third studies assessed the feasibility and/or piloting of two separate interventions based on those identified in the review. The first was a classroom-based appearance intervention using ultraviolet filtering photographic technology, and the second a UVI display meter in a school sports setting. The classroom-based intervention was well accepted by students, however, it was resource intensive and so in its current format would not be practical for a population-based intervention. Unfortunately, ethical issues surrounding research with adolescents impeded the second study. In combination with the potential expense of repeated calibration of the UVI display meter, there was insufficient support to pursue a full Randomised Controlled Trial (RCT) in the current format.

As National Sporting Organisations (NSO) are the governing organisations for many school sports, the fourth study was an audit, using both desk top review and semi-structured interviews, of NSO sun protection policies. Only two NSOs in NZ have a sun protection policy.

Schools are the obvious choice for addressing sun protection in adolescents. Furthermore, the school setting for this thesis is wider than the ‘in school’ environment, specifically with respect to participating in schools sports. There is no ‘one size fits all’ solution to sun protection for adolescents. It is not always feasible to provide a sun protective environment, so often there is no choice but for young people to engage in personal sun protection practices. Healthy policies and environments that either mandate or encourage young people to use appropriate sun protection are essential. Even this will not be entirely effective, and young people themselves need to be convinced that sun protection is important and necessary for them to engage in.