BACKGROUND: High exposure to solar ultraviolet radiation in early life increases the risk of developing skin cancer later, especially cutaneous malignant melanoma (CMM), with increasing risk related to an increasing number of sunburns. Switzerland has high incidence rates of skin cancers compared to surrounding countries.
OBJECTIVES : We aimed to estimate the number of sunburns in the previous year, frequency of sun protection behaviors and determinants of sunburns among children in Switzerland.
METHODS: In February 2019, we sent questionnaires to the parents of a random sample of 8,221 Swiss resident children. The questionnaires of 2,841 children were returned (response rate 35%). In Spring and Summer of the same year, follow-up questionnaires were sent to these children (response rate ~50%). Parents were asked about their child regarding protection measures, number of sunburns in the previous year, and skin phototype. We calculated the number of sunburns, severity of worst sunburn, and frequency sun-protective behaviors (wearing a hat, seeking for shade, and use of sunscreen) by season, sociodemographic characteristics and skin phototype. Severity of worst sunburn was defined as having had at least one sunburn “Painful without blister” or “Painful and blistered” or “Painless and blistered”. Multivariate negative binomial models were fitted including suspected determinants of sunburns. Logistic regressions were performed to analyze determinants of severity of worst sunburn.
RESULTS: Among participating children, 36.8% had at least one sunburn in the previous year, and 7.7% had a severe sunburn. When outside on a sunny day in Summer, 50 % wore a hat, 21.1% sought shade and 53% used sunscreen more than half of the time. Number of sunburns and severe sunburn increased with age and skin sensitivity. Prevalence of both outcomes varied substantially between regions. Number of sunburns was associated with lower use of sun protection, but not severity of worst sunburn.
CONCLUSIONS: Compared to previous regional studies in Switzerland, we found a lower prevalence of sunburns and of protection behaviors, with important regional heterogeneity. Previous studies were conducted in regions with high prevalence of sunburns and high proportion of children with a sensitive skin phototype, these differences could explain our observations. However, further research is needed to better understand these differences. Our results should help tailor sun exposure prevention measures to specific age groups and regions.