Turner, Denise, Harrison, Simone L., Buettner, Petra, and Nowak, Madeleine (2014) 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. Preventive Medicine, 60. pp. 107-114.

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Abstract

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.

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