.•ttisiralasian Journal o/Dfrmntology (1996) 37, 30-36 RESEARCH ARTICLE Primary school children's perceptions ofthe effects of sun on skin Marius Rademaker,* Kim Wyllie,' Margaret Collins^ and Noreen Wetton^ ^Department of Dermatology, Health Waikato, Hamilton, New Zealand and ^Health Education Unit, School of Education, University of Southampton, Southampton, United Kingdom SUMMARY To assess whether young children understand the dangers and results of sun exposure, a novel Draw and Write technique was used to survey a group of 5-8 year old primary school children. One hundred and ninety- four children were invited to draw and write comments to six scenarios involving sun exposure. Ofthe children surveyed, 84% gave a negative sentiment to sunburn, with only 6% displaying positive sentiments towards sunbathing. Sixty-five per cent of children suggested the use of sun blocks, 69% the use of protective clothing, 45% the wearing of hats and 43% the use of shade as a mechanism for protecting the skin from sun damage. Only 2% of children made any reference to skin cancer. The primary school children surveyed had a good level of awareness of the dangers of sunburn and the need to take appropriate actions to avoid sun damage. Key words: health behaviour, New Zealand, skin cancer, sunblocks, sunburn, sun protection. INTRODUCTION The rate of melanoma is doubling every 10 years in the Western world. Age-specific exposure to sunlight seems to be important in the development of both melanoma and other non-melanoma skin cancer.'"^ A number of studies suggest that sun exposure, particularly blistering sunburns, prior to the age of 15 years has a major impact on the development of malignant melanoma during later life.*' ^ This may be explained by the observation that 50-80% of a person's cumulative lifetime sun exposure occurs prior to age 18 years.' It is unclear why sun-protection habits are so disparate within the general population. The amount of sun which young children are exposed to is largely dependent on their adult carers. Studies have shown that the sun protection activities of Correspondence: Dr M Rademaker, Director of Dermatology, Health Waikalo. Hamilton, New Zealand. Marius Rademaker, DM. Rim Wyllie, NZRNO. Margaret Collins, BEd(Hons). Noreen Wetton. MEd. Received 30 May 1995; revised manuscript accepted 29 August 1995. the parent predict the level of sun exposure ofthe children.' It has also been shown that the earlier children are taught sun protection, the greater and longer lasting the alteration in both attitudes and behaviours.*'® It is therefore disappointing to find that, whereas awareness of the adverse effects of sun exposure and the need for sun protection are high in day-care centres, the actual implementation of sunscreen use is limited.'" In New Zealand, the Cancer Society has promoted a 'Shady School Policy' for pre-schools and primary schools since 1989. A recent survey revealed that 42% of primary schools had a 'Shady School Policy' but no information is available on how well it is being implemented. Among adolescents in New Zealand, despite a high level of awareness of melanoma as a dangerous form of cancer, there arc still high levels of sun exposure without appropriate protection." Of even greater concern arc the persisting positive attitudes towards tanning and sun exposure."^^' The purpose of the present study was to determine the knowledge base ofthe youngest primary school children (aged 5-8 years) with regard to their understanding ofthe dangers of sun exposure and how this might be avoided. A specifically designed Draw and Write technique was used in a class room setting to obtain this information (N Welton, M Collins. J Newton Bishop pers. comm.). METHOD The Draw and Write strategy consists of a series of invitations to draw pictures of specific situations and to write comments by the pictures in response to a given instruction. Drawing a picture around a specific situation is a much-used classroom activity. In this research strategy, the drawing provided time for the children to focus on the situation and to organize their thinking before writing or dictating their response to specific instructions or questions.'""'^ The children were given six invitations (Table 1) to draw and write around specific scen- arios. Writing, for some of the younger children, included dictating in a whisper to an adult scribe. By using the invitations, it was hoped that the children would show something of: (i) what they knew about protecting a young child's skin from sun damage; (ii) what they knew about how people take good care of their skin; (iii) what people do to damage their skin; (iv) whether they thought having a suntan was proof of a good holiday and whether they could distinguish between suntan and sunburn; (v) how a very sun-