Sun-Protective Clothing Worn Regularly during Early Childhood Reduces the Number of New Melanocytic Nevi: The North Queensland Sun-Safe Clothing Cluster Randomized Controlled Trial.

Numerous pigmented moles are associated with sun exposure and melanomarisk. This cluster randomized controlled trial aimed to determine if sun-protective clothing could prevent a significant proportion of the moles developing in young children (ACTRN12617000621314; Australian New Zealand Clinical Trials Registry. Twenty-five childcare centers in Townsville (19.25° S), Australia, were matched on shade provision and socioeconomic status. One center from each pair was randomized to the intervention arm and the other to the control arm. Children at 13 intervention centers wore study garments and legionnaire hats at childcare and received sun-protective swimwear and hats for home use, while children at the 12 control centers did not. The 1-35-month-old children (334 intervention; 210 control) were examined for moles at baseline (1999-2002) and were re-examined annually for up to 4 years. Both groups were similar at baseline. Children at intervention centers acquired fewer new moles overall (median 12.5 versus 16, p = 0.02; 0.46 versus 0.68 moles/month, p = 0.001) and fewer new moles on clothing-protected skin (6 vs. 8; p = 0.021 adjusted for confounding and cluster sampling) than controls. Intervention children had 24.3% fewer new moles overall (26.5 versus 35) and 31.6% (13 versus 19) fewer moles on clothing-protected skin than controls after 3.5 years. Sunlight's influence on nevogenesis is mitigated when children regularly wear UPF 30-50+ clothing covering half their body, implying that increased clothing cover reduces melanoma risk. Sun-protective clothing standards should mandate reporting of the percentage of garment coverage for childrenswear.

Slip, Slop, Slap, Slide, Seek and Sport: A Systematic Scoping Review of Sun Protection in Sport in Australasia.

Australia and New Zealand have the highest incidence of skin cancer. Sport is a fundamental part of Australasian culture, beginning in childhood, often with life-long participation. Participating in outdoor sports can contribute significantly to the lifetime ultraviolet radiation (UVR) dose individuals receive and their risk of developing skin cancer. This systematic scoping review explores the use of sun-protection by outdoor sporting participants in Australasia and considers how sun-protection practices may be improved and better evaluated in the community. A search of electronic databases using the search strategy "sun protection" AND "sport" AND "Australia" yielded 17 studies published in English from January 1992 to August 2021. Study methods included using UV-dosimeters to measure individual UVR-exposure; remote estimates of clothing-adjusted UVR-exposure; direct observation of sun-protection practices; and self-reported sun-exposure and sun-protection. Despite 40 years of 'Slip, Slop, Slap' campaigns in Australia, the use of sun-protection in most outdoor sports is inadequate. The paucity of comparable data limited our analyses, demonstrating a need for standardized, objective evaluation tools. Such tools, if used across a range of sports, should inform the development of workable recommendations that sporting clubs could implement and adopt into policy, thus empowering them to better protect the health of their participants.

Electronic Sun Journal Versus Self-report Sun Diary: A Comparison of Recording Personal Sunlight Exposure Methods.

This research compared personal sunlight exposure times monitored electronically within suburban Australian environments against self-report paper journals for determining the timing and total duration of individual exposure to daily solar radiation. A total of 90 Electronic Sun Journal (ESJ) daily readings and self-report timing and duration estimates of exposure for weekend and weekdays were compared. A Wilcoxon ranked sign test showed a significant difference (V = 157, P < 0.001) between the duration of exposure recorded electronically and the duration of exposure that was self-reported in a diary. There was also found to be a statistically significant difference between total exposure time measured using both methods for weekends (V = 10, P < 0.001) and weekdays (V = 87, P < 0.001). General trends in outdoor exposure timing confirmed that the most frequent daily exposures received over the weekend occurred between 1 and 2 h earlier than the most frequent exposures received on weekdays. This preliminary research found that exposure durations as recorded by the ESJ were longer on the weekends compared to weekdays (W = 402, P < 0.001) and confirmed that the ESJ is a viable alternative to self-reporting diaries.

Clinical Characteristics in Early Childhood Associated with a Nevus-Prone Phenotype in Adults from Tropical Australia: Two Decades of Follow-Up of the Townsville Preschool Cohort Study.

Having numerous melanocytic nevi increases melanoma risk. Few studies have enumerated nevi in children and re-examined them as adults. We aimed to determine if childhood nevus-counts predict nevus-prone adults, and further explore the relevance of host-factors and sun-exposure. Fifty-one Caucasian residents of Townsville (19.16° S, Queensland, Australia) had full-body nevus-counts aged 1-6 and 21-31 years-old. Sun-exposure was determined from questionnaires. Children in the upper-quartile of nevus-counts acquired nevi more rapidly than those in the bottom-quartile (13.3 versus 4.7 nevi/year; p < 0.0005). Children sunburnt before 7 years-old acquired more incident nevi by adulthood (238 versus 126, p = 0.003) particularly if sunburn was severe (321 versus 157.5, p = 0.003) or erythema occurred annually (380 versus 132, p = 0.008). Fair-skinned, freckled children with some nevi ≥ 3 mm, solar lentigines, or a family history of melanoma acquired more incident nevi than children without these attributes. Nevus-prone adults exhibit distinguishing features earlier in life (<7 years-old in Queensland) than has been shown previously. In addition to intervening with sun-protection counselling early enough to reduce risk, being able to reliably triage children into high- and low melanoma-risk groups may inform more efficacious and cost-effective targeted-screening in melanoma-prone populations. Further longitudinal research is needed to confirm that these attributes can reliably separate risk-groups.

Exposure to Solar UVR Suppresses Cell-Mediated Immunization Responses in Humans: The Australian Ultraviolet Radiation and Immunity Study.

Animal and human studies show that exposure to solar-simulated UVR is immunomodulatory. Human studies that used natural sun exposure and controlled for confounding are rare. We immunized 217 healthy adults (age range = 18-40 years) with a T-cell-dependent antigen, keyhole limpet hemocyanin, and measured personal clothing-adjusted UVR exposure (for 5 days before and after immunization), lifetime cumulative UVR exposure, serum 25-hydroxyvitamin D concentration at immunization, and potential confounding factors. We tested cellular and humoral immune responses in relation to UVR exposure. The delayed-type hypersensitivity response to keyhole limpet hemocyanin recall challenge was lower in individuals with higher personal clothing-adjusted UVR exposure on the day before immunization (P = 0.015) and during intervals spanning the day before to 2-3 days after immunization. There was an incremental increase in T helper type 17 cells (as a proportion of CD4+ T cells) from preimmunization to postimmunization in the high, compared with the low, personal clothing-adjusted UVR exposure group (0.31% vs. -0.39%, P = 0.004). Keyhole limpet hemocyanin-specific antibody titers were not associated with acute or cumulative UVR exposure or serum 25-hydroxyvitamin D levels. Higher UVR exposure at antigen sensitization was associated with a reduced delayed-type hypersensitivity response and altered T helper type 17 kinetics. This has implications for the effectiveness of vaccinations and susceptibility to infections that rely on cell-mediated immune responses.

Seasonal Minimum and Maximum Solar Ultraviolet Exposure Measurements of Classroom Teachers Residing in Tropical North Queensland, Australia.

The risk of keratinocyte skin cancer, malignant melanoma and ultraviolet radiation (UVR)-induced eye disease is disproportionately higher in Australia and New Zealand compared to equivalent northern hemisphere latitudes. While many teachers are aware of the importance of reinforcing sun safety messages to students, many may not be aware of the considerable personal exposure risk while performing outdoor duties in locations experiencing high to extreme ambient UVR year-round. Personal erythemally effective exposure of classroom teachers in tropical Townsville (19.3°S) was measured to establish seasonal extremes in exposure behavior. Mean daily personal exposure was higher in winter (91.2 J m-2 , 0.91 Standard Erythema Dose [SED]) than summer (63.3 J m-2 , 0.63 SED). The range of exposures represents personal exposures that approximate current national guidelines for Australian workers at the study latitude of approximately 1.2 SED (30 J m-2 effective to the International Commission on Non-Ionizing Radiation Protection). Similar proportions of teachers spent more than 1 h outdoors per day in winter (28.6%) and summer (23.6%) as part of their teaching duties with seasonal differences having little effect on the time of exposure. Personal exposures for teachers peaked during both seasons near school meal break times at 11:00 am and 1:00 pm, respectively.

A Pilot Observational Study of Environmental Summertime Health Risk Behavior in Central Brisbane, Queensland: Opportunities to Raise Sun Protection Awareness in Australia's Sunshine State.

Melanoma skin cancer rates in Queensland exceed the national Australian incidence rate, which together with New Zealand are recognized as the world's highest. Incidence is especially high among younger members of the population. In this study, the sun-protective behaviors of urban Queenslanders (n = 752) going about their day-to-day activities during a midweek noon time hourly period were observed on a summer's day in central Brisbane (27.47°S, 153.03°E), Australia. Observed sun protection practices were poor, given the time of year and peak solar noon period of the study. More individuals (n = 249; 33.1%) were seen wearing sunglasses than a hat (n = 101; 13.4%). Ninety-three individuals were actively engaging with mobile phones (phone in hand). A further 231 individuals (30.7%) were observed with a mobile phone on them. Opportunities to modify group behavior based on mobile phone sun protection notifications and to engage with "at risk" members of the Queensland population are considered from the variable codependencies examined in this study, including the influence of social group size, observed sun protection and mobile phone use. Our preliminary findings suggest that mobile phones provide an underutilized opportunity for delivering tailored skin cancer prevention messaging.

Modifiable Risk-factors for Keratinocyte Cancers in Australia: A Case-control Study.

Keratinocyte cancer is the most common malignancy in Caucasians. The aim of this study was to investigate risk-factors responsible for development of keratinocyte cancer in Australia. A case-control study was conducted, including 112 cases of squamous cell carcinoma (SCC), 95 cases of basal cell carcinoma (BCC) and 122 controls. Freckling during adolescence (SCC: odds ratio (OR) 1.04, p < 0.01; BCC: OR 1.05, p < 0.01), propensity to sunburn (SCC: OR 2.75, p = 0.01, BCC: OR 2.68 p = 0.01) and high cumulative sun-exposure (SCC: OR 2.43, p = 0.04; BCC: OR 2.36 p = 0.04) were independent risk-factors for both SCC and BCC. This study provides further evidence that a sun-sensitive phenotype and excessive sun-exposure during adulthood contribute to the risk of developing keratinocyte cancer. Wearing a hat, long-sleeved shirts, and sunscreen did not significantly reduce the risk of keratinocyte cancer in this study.

The geospatial relationship of pterygium and senile cataract with ambient solar ultraviolet in tropical Ecuador.

Tropical Ecuador presents a unique climate in which we study the relationship between the ambient levels of solar ultraviolet radiation and eye disease in the absence of a latitudinal gradient. The national distribution of surface ultraviolet, taking into account MODIS and OMI satellite observation of aerosol, ozone, surface albedo, local elevation and cloud fractions measured during 2011, was compared with the national pterygium (WHO ICD H11) and senile cataract (WHO ICD H25) incidence projected from the 2010 National Institute of Statistics and Census (Ecuador). Public Health Ministry projections for age categories 0 to 39, 40 to 59 and 60+ years were compared to surface ultraviolet irradiance data in 1040 parishes. Correlations drawn between modelled surface ultraviolet and eye disease incidence show a significant increase in both pterygium and senile cataract in the highest ambient exposure regions of the Pacific coast and western lowlands with incidence rates of 34.39 and 16.17 per 100 000 residents respectively. The lowest rates of incidence for pterygium (6.89 per 100 000) and senile cataract (2.90 per 100 000) were determined in high altitude sites and are attributed here to increased daily cloud fraction for parishes located in the Andean mountain range. The South American Andes experience the highest solar UV exposures on Earth and report frequent high incidence of keratinocyte cancer. Our results show the high Andes to be the location of the lowest eye disease incidence suggesting that both pterygium and senile cataract are the result of cumulative exposure to solar ultraviolet. These findings have clear implications for the agricultural workers and fishermen of the lowland districts of Ecuador, contrary to conventional understanding that greater risks are faced in locations of high altitude.

Sun protective behaviors at an outdoor entertainment event in Australia.

An observational study was conducted to examine the use of sun protective hats, clothing, and sunglasses of people attending an outdoor entertainment event in an area of high-to-extreme ultraviolet radiation in New South Wales, Australia. Armidale is unique, as it is a highly-elevated area, almost 1000 m above sea level, and temperatures are often mild with very high-to-extreme levels of ultraviolet radiation. Four trained data collectors observed attendees as they entered the event, and recorded their use of sun protective hats, clothing, and sunglasses. While more than half of the attendees wore sun protective hats, only 14% wore sun protective clothing. Broad-brimmed hats were considered sun protective, while sun protective clothing was defined by shirts with at least three-quarter-length sleeves. Females were more likely to wear both a sun protective hat and clothing than males, and children were less protected than adults. Legislative changes are required to ensure that organizers of outdoor events have a legal responsibility to provide a safe environment for attendees, including strategies to help reduce ultraviolet radiation exposure.

Validation of Sun Exposure Reported Annually Against Interim Self-report and Daily Sun Diaries.

Data on personal sun exposure over a period exceeding the immediate past days or weeks are typically self-reported in brief questionnaire items. The validity of such self-reporting of longer term personal sun exposure, for example over a year, including detail on variation across seasons, has not previously been investigated. In a volunteer sample (n = 331) of Australian adults aged 18 years and over, we assessed the 12-month reliability of sun exposure reported separately for each season, and its accuracy compared to a daily sun diary in the same season. Seasonal time outdoors displayed fair-to-good reliability between baseline and end of study (12 months), with responses showing higher agreement at lower levels of time outdoors. There was good agreement for ranking of individuals' time outdoors with the daily sun diary data, although the actual diary time outdoors was typically considerably lower than the self-reported questionnaire data. Place of residence, education, being a smoker, day of the week (i.e. working day vs nonworking day) and working mainly outdoors were significant predictors of agreement. While participants overestimated their actual time outdoors, the self-report questionnaire provided a valid ranking of long-term sun exposure against others in the study that was reliable over time.

Investigating the patterns and determinants of seasonal variation in vitamin D status in Australian adults: the Seasonal D Cohort Study.

BACKGROUND: Vitamin D status generally varies seasonally with changing solar UVB radiation, time in the sun, amount of skin exposed, and, possibly, diet. The Seasonal D Study was designed to quantify the amplitude and phase of seasonal variation in the serum concentration of 25-hydroxyvitamin D, (25OH)D)) and identify the determinants of the amplitude and phase and those of inter-individual variability in seasonal pattern. METHODS: The Seasonal D Study collected data 2-monthly for 12 months, including demographics, personal sun exposure using a diary and polysulphone dosimeters over 7 days, and blood for serum 25(OH)D concentration. The study recruited 333 adults aged 18-79 years living in Canberra (35°S, n = 168) and Brisbane (27°South, n = 165), Australia. DISCUSSION: We report the study design and cohort description for the Seasonal D Study. The study has collected a wealth of data to examine inter- and intra-individual seasonal variation in vitamin D status and serum 25(OH)D levels in Australian adults.

Solar ultraviolet and the occupational radiant exposure of Queensland school teachers: A comparative study between teaching classifications and behavior patterns.

Classroom teachers located in Queensland, Australia are exposed to high levels of ambient solar ultraviolet as part of the occupational requirement to provide supervision of children during lunch and break times. We investigated the relationship between periods of outdoor occupational radiant exposure and available ambient solar radiation across different teaching classifications and schools relative to the daily occupational solar ultraviolet radiation (HICNIRP) protection standard of 30J/m(2). Self-reported daily sun exposure habits (n=480) and personal radiant exposures were monitored using calibrated polysulphone dosimeters (n=474) in 57 teaching staff from 6 different schools located in tropical north and southern Queensland. Daily radiant exposure patterns among teaching groups were compared to the ambient UV-Index. Personal sun exposures were stratified among teaching classifications, school location, school ownership (government vs non-government), and type (primary vs secondary). Median daily radiant exposures were 15J/m(2) and 5J/m(2)HICNIRP for schools located in northern and southern Queensland respectively. Of the 474 analyzed dosimeter-days, 23.0% were found to exceed the solar radiation protection standard, with the highest prevalence found among physical education teachers (57.4% dosimeter-days), followed by teacher aides (22.6% dosimeter-days) and classroom teachers (18.1% dosimeter-days). In Queensland, peak outdoor exposure times of teaching staff correspond with periods of extreme UV-Index. The daily occupational HICNIRP radiant exposure standard was exceeded in all schools and in all teaching classifications.

Self-Reported Changes in Sun-Protection Behaviors at Different Latitudes in Australia.

Sun exposure is the most important source of vitamin D, but is also a risk factor for skin cancer. This study investigated attitudes toward vitamin D, and changes in sun-exposure behavior due to concern about adequate vitamin D. Participants (n = 1002) were recruited from four regions of Australia and completed self- and interviewer-administered surveys. Chi-square tests were used to assess associations between participants' latitude of residence, vitamin D-related attitudes and changes in sun-exposure behaviors during the last summer. Multivariate logistic regression analyses were used to model the association between attitudes and behaviors. Overall, people who worried about their vitamin D status were more likely to have altered sun protection and spent more time in the sun people not concerned about vitamin D. Concern about vitamin D was also more common with increasing latitude. Use of novel item response theory analysis highlighted the potential impact of self-reported behavior change on skin cancer predisposition due concern to vitamin. This cross-sectional study shows that the strongest determinants of self-reported sun-protection behavior changes due to concerns about vitamin D were attitudes and location, with people at higher latitudes worrying more.

Sun protection provided by regulation school uniforms in Australian schools: an opportunity to improve personal sun protection during childhood.

Childhood sun exposure is linked to excessive pigmented mole development and melanoma risk. Clothing provides a physical barrier, protecting skin from ultraviolet radiation (UVR). Extending sleeves to elbow length and shorts to knee length has been shown to significantly reduce mole acquisition in preschoolers from tropical Queensland. We used publicly available uniform images and guidelines from primary schools in Townsville (latitude 19.25°S, n = 43 schools), Cairns (16.87°S, n = 46) and the Atherton Tablelands (17.26°S, n = 23) in tropical Australia to objectively determine the body surface proportion covered by regulation school uniforms. Uniforms of nongovernment, large (≥800 students), urban, educationally advantaged schools with comprehensive sun protection policies covered more skin than those of government schools (63.2% vs 62.0%; P < 0.001), smaller schools (63.4% vs 62.3%; P = 0.009), rural (62.7% vs 61.9%; P = 0.002) and educationally disadvantaged schools (62.8% vs 62.3%; P < 0.001) with underdeveloped sun protection policies (62.8% vs 62.2%; P = 0.002). Overall, SunSmart and non-SunSmart school uniforms covered identical body surface proportions (62.4%, P = 0.084). Although wearing regulation school uniforms is mandatory at most Australian primary schools, this opportunity to improve children's sun protection is largely overlooked. Recent evidence suggests that even encouraging minor alterations to school uniforms (e.g. slightly longer sleeves/dresses/skirts/shorts) to increase skin coverage may reduce mole acquisition and melanoma risk, especially in high-risk populations.

School sun-protection policies-does being SunSmart make a difference?

Evaluate the comprehensiveness of primary school sun-protection policies in tropical North Queensland, Australia. Pre-determined criteria were used to assess publicly available sun-protection policies from primary schools in Townsville (latitude 19.3°S; n = 43), Cairns (16.9°S; n = 46) and the Atherton Tablelands (17.3°S; n = 23) during 2009-2012. Total scores determined policy comprehensiveness. The relationship between policy score, SunSmart status and demographic characteristics was explored. At least 96.6% of primary schools sampled had a sun-protection policy. Although policies of Cancer Council accredited 'SunSmart' schools addressed more environmental, curriculum and review-related criteria than those of 'non-SunSmart' schools, the overall median score for both groups was low at 2 from a possible 12 (48.5% of SunSmart schools [SSSs]: inter-quartile range [IQR = 2.0-9.0] versus 65.9% of non-SSSs: [IQR = 2.0-3.0], P = 0.008). Most policies addressed hat wearing, while criteria related to shade provision at outdoor events, regular policy review and using the policy to plan outdoor events were poorly addressed. Although most primary schools in skin cancer-prone North Queensland have written sun-protection policies, the comprehensiveness of these policies could be vastly improved. These schools may require further support and advice to improve the comprehensive of their policies and incentives to continually implement them to achieve and maintain exemplary sun-protection compliance.

Measuring exposure to solar ultraviolet radiation using a dosimetric technique: understanding participant compliance issues.

Personal ultraviolet dosimeters have been used in epidemiological studies to understand the risks and benefits of individuals' exposure to solar ultraviolet radiation (UVR). We investigated the types and determinants of noncompliance associated with a protocol for use of polysulphone UVR dosimeters. In the AusD Study, 1002 Australian adults (aged 18-75 years) were asked to wear a new dosimeter on their wrist each day for 10 consecutive days to quantify their daily exposure to solar UVR. Of the 10 020 dosimeters distributed, 296 (3%) were not returned or used (Type-I noncompliance) and other usage errors were reported for 763 (8%) returned dosimeters (Type-II noncompliance). Type-I errors were more common in participants with predominantly outdoor occupations. Type-II errors were reported more frequently on the first day of measurement; weekend days or rainy days; and among females; younger people; more educated participants or those with outdoor occupations. Half (50%) the participants reported a noncompliance error on at least 1 day during the 10-day period. However, 92% of participants had at least 7 days of usable data without any apparent noncompliance issues. The factors identified should be considered when designing future UVR dosimetry studies.

The contributions of solar ultraviolet radiation exposure and other determinants to serum 25-hydroxyvitamin D concentrations in Australian adults: the AusD Study.

The Quantitative Assessment of Solar UV [ultraviolet] Exposure for Vitamin D Synthesis in Australian Adults (AusD) Study aimed to better define the relationship between sun exposure and serum 25-hydroxyvitamin D (25(OH)D) concentration. Cross-sectional data were collected between May 2009 and December 2010 from 1,002 participants aged 18-75 years in 4 Australian sites spanning 24° of latitude. Participants completed the following: 1) questionnaires on sun exposure, dietary vitamin D intake, and vitamin D supplementation; 2) 10 days of personal ultraviolet radiation dosimetry; 3) a sun exposure and physical activity diary; and 4) clinical measurements and blood collection for 25(OH)D determination. Our multiple regression model described 40% of the variance in 25(OH)D concentration; modifiable behavioral factors contributed 52% of the explained variance, and environmental and demographic or constitutional variables contributed 38% and 10%, respectively. The amount of skin exposed was the single strongest contributor to the explained variance (27%), followed by location (20%), season (17%), personal ultraviolet radiation exposure (8%), vitamin D supplementation (7%), body mass index (weight (kg)/height (m)(2)) (4%), and physical activity (4%). Modifiable behavioral factors strongly influence serum 25(OH)D concentrations in Australian adults. In addition, latitude was a strong determinant of the relative contribution of different behavioral factors.

Does being a "SunSmart School" influence hat-wearing compliance? An ecological study of hat-wearing rates at Australian primary schools in a region of high sun exposure.

BACKGROUND: Childhood sun exposure is an important risk factor for skin cancer. Anecdotal evidence suggests that hats are under-utilized by Australian primary school students. METHODS: The proportion of students and adult role-models wearing hats was observed at 36 primary schools (63.9% SunSmart schools [SSS]) in Townsville (latitude 19.3°S; high to extreme maximum daily UV-index year round), Queensland, Australia, from 2009 to 2011. RESULTS: Overall, 52.2% of 28,775 students and 47.9% of 2954 adults were observed wearing a hat. Hat use (all styles) among SSS and non-SunSmart school (NSSS) students was similar before (24.2% vs 20.5%; p=0.701), after (25.4% vs 21.7%; p=0.775) and during school-hours (93.0% vs 89.2%; p=0.649) except SSS students wore gold-standard (broad-brim/bucket/legionnaire) hats during school play-breaks more often in the warmer months (October-March) than NSSS students (54.7% vs 37.4%; p=0.02). Although the proportion of adults who wore hats (all styles) was similar at SSS and NSSS (48.2% vs 46.8%; p=0.974), fewer adults at SSS wore them before school (3.7% vs 10.2%; p=0.035). CONCLUSIONS: SunSmart status is not consistently associated with better hat-wearing behavior. The protective nature of hats and the proportion of school students and adult role-models wearing them could be improved, possibly by offering incentives to schools that promote sun-safety.

Changing the risky beliefs of post-partum women about therapeutic sun-exposure.

BACKGROUND: Many post-partum women hold risky beliefs about perceived therapeutic benefits of sun-exposure in the post-partum period and infancy. QUESTION: Can a maternity hospital based educational intervention reduce the prevalence of such beliefs among post-partum women? METHODS: In this outcome evaluation of an interventional study, two groups of healthy post-partum women (hospital inpatients) were interviewed, 1-4 days following delivery. The first cross-section (106 women) was recruited prior to in-services for maternity staff; the second (203 women) was recruited after completion of the in-services. Data were compared between the groups. FINDINGS: More pre-intervention than post-intervention women reported they would expose their baby to sunlight to treat suspected jaundice (28.8% vs. 13.3%; p<0.001) or help his/her skin adapt to the sun (10.5% vs. 2.5%; p=0.003); or use sunlight to manage breastfeeding-associated sore/cracked nipples (7.6% vs. 2%; p=0.026). CONCLUSION: This simple, effective educational intervention could be implemented in programmes for parents, health professionals and students.