Baseline survey of sun protection policies and practices in primary school settings in New Zealand.

The SunSmart Schools Accreditation Programme (SSAP) was launched as a national programme in October 2005 to help reduce the risk of excessive child exposure to ultraviolet radiation. As part of the need for evaluation, this paper reports the findings of a national survey of a randomly selected sample of approximately 12% of New Zealand primary schools prior to the national launch of the SSAP. Principals at 242 schools completed a mail survey (81% response rate) relating to school sun protection policies, practices, curriculum and environment. Survey responses were evaluated according to the 12 criteria of the SSAP, with schools assigned a score from 0 to 12. No school fully met all 12 accreditation criteria, although 2% of schools attained 11 criteria and another 2% attained 10. Nine per cent of schools attained three or fewer criteria. Overall, 7 was the most common score, achieved by 23%. School socio-economic decile rating and roll size were positively associated with higher scores (both P < 0.02). Continued support and resources are needed to encourage schools to address sun protection across the spectrum of curriculum, practices and environment and through commitment to written policy.

Melanoma and sun exposure: an overview of published studies.

To assess the association between the incidence of cutaneous melanoma; intermittent, occupational and total sun exposure; and history of sunburn at different ages, we conducted a systematic review using results of all published case-control studies which have assessed incident melanoma, sun exposure and sunburn. Twenty-nine studies contributed data on sun exposure and 21 on sunburn. Overall, there was a significant positive association (odds ratio [OR] = 1.71) for intermittent exposure, a significantly reduced risk for heavy occupational exposure (OR = 0.86) and a small, marginally significant excess risk for total exposure (OR = 1.18). There was a significantly increased risk with sunburn at all ages or in adult life (OR = 1.91) and similarly elevated relative risks for sunburn in adolescence (OR = 1.73) and in childhood (OR = 1.95). There was significant heterogeneity with all of these estimates except that of all ages or adult sunburn. These results show the specificity of the positive association between melanoma risk and intermittent sun exposure, in contrast to a reduced risk with high levels of occupational exposure. The association with sunburn also is likely to reflect intermittent exposure; the results do not suggest any strong relationship to age at sunburn. These associations are similar to those reported for basal cell skin cancer but different from those reported for squamous cell cancer. The mechanisms by which intermittent exposure increases risk, while other patterns of exposure do not, remain to be elucidated.