Health Education Research, Vol. 15, No. 3, 271-281,
June 2000
© 2000 Oxford University Press
Sun-safe behaviour among secondary school students in Australia
Centre for Health Promotion and Cancer Prevention Research, University of Queensland, Medical School, Herston, Queensland 4006 and
1 Centre for Behavioural Research in Cancer, Anti-Cancer Council of Victoria, Carlton South, Victoria 3053, Australia
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Abstract |
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This paper reports data on the first national survey of sun-protection measures of Australian secondary school students. A cross-sectional survey of a representative sample of 23,915 Australian school children in Years 7–12 was conducted in 1993. Students were questioned about usual sun-protection practices, beliefs about skin cancer and suntans, and sunburn history. The results showed differences in sun-protection behaviours as a function of `year level', `gender', `skin type' and `concern about getting cancer' among others. Adolescents who believe there is a lot they can do to avoid skin cancer are more likely to engage in sun-protective behaviours. Males were more likely to wear a cap, yet females tended to use sunscreen. The use of clothing to protect themselves from the sun was higher in males, yet females were more likely to stay mainly in the shade. All behaviours decreased with age. Poorer protective practices were also associated with increased sunburn, except for sunscreen use where the converse was the case. Suntan was still a desire for adolescents. While there is considerable room for improvement in the sun-protection behaviour of adolescents (particularly those in higher grades), most students usually take some precautions. However, by Year 12 (17 and 18 year olds) less than half report usually wearing a hat and just two-thirds reported usual sunscreen usage.
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Introduction |
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Skin cancer is a major public health problem in Australia (Giles et al., 1998). Non-melanoma skin cancers, particularly squamous cell carcinoma, have been associated with cumulative levels of ultraviolet radiation (UVR) exposure (Kricker et al., 1994
), but for melanoma, acute over- exposure (often indexed by sunburn) may play a more important role (Lew et al., 1983; Weinstock et al., 1989; Hurwitz, 1998). For all types of skin cancer, there is evidence that exposure in childhood and adolescence is important (Marks et al., 1990; Hurwitz, 1998). For example, a number of studies have found that skin cancer risk is increased by living in a high UVR climate during childhood (Holman et al., 1986; Marks et al., 1990; Hurwitz, 1998). However, it is not clear whether this is because young peoples' skin is more sensitive or because they spend more time out in the sun and thus a greater proportion of life-time exposure is acquired during their early years. It has been shown that among a sample of Victorians, younger people spend more time in the sun than other people (Hill et al., 1993).
Although sun exposure during childhood and adolescence may eventually lead to skin cancer, remarkably little is known about young peoples' behaviour in the sun. There are no published national data on sun-protection behaviours for this group, although there are a number of state-based surveys. A study using a sample from part of the state of New South Wales using diaries to assess sun-protection behaviours was the first large-scale study of adolescents. Results of the study showed that only around 30% of the Year 9 and 10 students adequately protected themselves from the sun, with females reporting higher levels of sun protection than males (Cockburn et al., 1989).
Broadstock et al. (Broadstock et al., 1996) studied a representative sample of over 4000 secondary school students in Victoria in 1990. The results indicated moderately high levels of knowledge about skin cancer and sun exposure, and generally positive attitudes to sun protection. Using retrospective reports of usual sun-protection behaviour, they found that only a minority reported always protecting themselves, but most said they at least sometimes used each of the possible sun protection strategies, with sunscreen being the most popular method of protection. Girls were generally more knowledgeable and had more positive attitudes towards sun protection than boys, but they were more likely to prefer a darker tan. There was less evidence of differences in behaviour, although boys were more likely to report wearing hats and girls more likely to report using sunscreen. Although knowledge increased linearly with age, attitudes and reported sun- protective behaviours became progressively less common from ages 12 through to around 15, at which point they either stayed low or showed some evidence of recovery.
A Queensland study of primary and secondary school children indicated a high level of awareness and knowledge of sun protection (Lowe et al., 1993). This statewide survey was conducted among a random sample of Queensland students, and shows knowledge to be high (90%) for students regardless of grade level and gender. Similar to the Victorian study, boys were more likely to report the wearing of hats and girls the wearing of sunscreen. During the late 1980s and 1990s national campaigns were conducted in Australia to measure awareness of the harmfulness of the sun, and the need to slip on a shirt, slap on a hat and slop on sunscreen.
The aims of this study were to report the extent to which some key beliefs regarding sun protection are evident among secondary students and their usual sun-protection behaviour. Also, the extent to which the key beliefs and demographic variables are related to sun-protective behaviours is assessed.
These were not targeted at any gender or age differences.
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Methodology |
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Method
The defined target population was all students enrolled in Years 7–12 in all school education systems (government, Catholic, independent) in 1993. Students in these year levels were mainly aged between 12 and 17 years although some students aged 11, 18 and 19 were included in these year levels. Schools in all Australian States and the Northern Territory formed the target population of schools.
A stratified two-stage sample was used within each state and territory. In the first stage a random sample of secondary schools with an enrolment of more that 100 students was drawn separately from each school system. During the early 1990s, the Australian secondary education system was increasing being organized into junior colleges (Years 7–10) and senior colleges (Years 11 and 12). To reflect this, schools enrolling students in Years 7–10 were sampled separately from those schools enrolling students in Years 11 and 12. The probability of any school being selected was proportional to the number of 14 year olds either attending the school for junior campuses or attending the primary feeder school for senior campuses. Thus selecting two samples did not alter the probability of individual students from any year level being selected. This sampling frame provided an almost complete coverage of Australian secondary students as less than 2% of secondary aged students attend schools outside the three educational systems or with an enrolment less than 100.
Of the 358 secondary schools selected to participate in the survey, 55 refused, giving a response rate of 85%. From a sample of replacement schools, drawn at the same time as the original sample, 29 of the 52 replacement schools approached agreed to take part in the study. Thus a total of 332 schools participated in the study. This represents 14% of the number of secondary schools across Australia.
In the second stage of sampling, 80 students in each school were selected at random from names on the school roll by the researchers. Schools drawn for the Years 7–10 sample supplied the school roll for all four year levels and 20 students (and five replacements) were randomly selected by a number of the research team from each of these year levels. Schools from the senior secondary sample supplied the roll for Years 11 and 12, and 40 students (and 10 replacements) were sampled from each of these years. In South Australia, Western Australia, Queensland and Northern Territory, Year 7 students in the government system were included in the primary school system. In these states, the main primary feeder schools for the selected secondary school was identified and Year 7 students were sampled from this school.
Subject
A total of 23 915 students in Years 7–12 surveyed. As the total number of students in participating schools we aimed to survey was 26 560, this represents a participation rate of 90%. As a total of 1301112 students were in secondary schools across Australia in 1993, our sample represents 2% of the target population.
Procedure
In each state and the Northern Territory, members of the research team administered the pencil and paper questionnaire to groups of up to 20 students on the school premises. Students from two different year levels were surveyed together. The presence of teachers during the survey was discouraged, but 19% of students completed the questionnaire in the presence of teachers. The proportion varied with state, ranging from a low of 6% in New South Wales to a high of 47% in the Northern Territory and 38% in Queensland, reflecting different education policies. The presence of a teacher did not appear to influence the responses of students and the data were combined in the analyses. Students answered the questionnaire anonymously.
Questionnaire
Students were asked about their usual sun- protection behaviour when they are out in the sun for an hour or more between 10 a.m. and 2 p.m. on a sunny summer day in those states without daylight saving time, and between 11a.m. and 3p.m. in those that have. The questions covered usual hat use, preferred type of hat, usual sunscreen use, usual use of clothing as a means of sun protection (measured in two ways: to cover most of the body and wearing briefer clothes to get some sun on their skin) and wearing sunglasses. Students were also asked if they would usually stay in the shade when outside on a sunny summer day, and whether they would stay inside on a sunny summer day between 10a.m. and 2p.m. (or 11 a.m. to 3 p.m.). In tables showing the percentage trends, responses to each usual behaviour question were `never/rarely', `sometimes' and `usually/always'.
Students' perceptions of skin cancer were assessed by asking them their perceived risk of getting skin cancer sometime in the future, their perceived concern about getting skin cancer and their perception of how much they could do to avoid skin cancer. Recent sunburn experience (over the last summer) and a history of severe blistering sunburn were also assessed. Students were also asked whether they like to get a suntan. Demographic variables of gender and skin type were recorded.
Analysis
The analysis is presented by gender and year level. In most year levels, there were students from at least two age groups. Since students attitudes and behaviours are substantially influenced by their peers, it was decided to assess trends across year level rather than age group. This also allowed use of the entire data set.
To ensure that any disproportional sampling of state, school and year level groupings did not bias the estimates, the data were weighted to bring the sample into line with the population distribution. The prevalence estimates are based on the weighted data.
The relationship between sun-protective behaviour and students' perception of skin cancer and their personal sunburn experiences was assessed using logistic regression models. Seven models were fitted, one for each of the sun-protective behaviours, re-coded as `usually/always' versus the remainder. In each model, the covariates were the students' perception of skin cancer, their personal sunburn experiences, skin type, year level and gender (see Table I). Analyses were conducted using SUDAAN. SUDAAN is a statistical software package that utilizes both Taylor's series linearization and replication methods to take into account the changed variance associated with clustered or multistage sample survey data (Shah et al., 1996). SUDAAN specifically allows for the increase in variance associated with cluster sampling. Records with missing values were listwise deleted, resulting in a final sample size of 21 501 students. Due to the large sample size and number of analyses, significance was calculated at P < 0.001 in the regression models.
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Results |
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Usual sun-protection behaviour
The prevalence of reported usual sun-protective behaviour for males and females within each year level is shown in Table II
. Sixty-two percent of male students said they would usually or always wear a hat when outside on a sunny day, compared to 38% of females. As year level increased, the proportion of students who usually/always wore a hat when outside decreased from 65% in Year 7 to 43% in Year 12. The type of hat preferred by most students was the cap, favoured by 72% of male students and 50% of the female students.
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In contrast to usual hat-wearing behaviour, reported use of maximum sun protection factor (SPF) sunscreen when out in the sun was higher among female students (73%) than male students (54%), with this gender difference consistent across the year levels.
Compared to hat and sunscreen use, students' reported use of clothes as a means of sun protection was relatively low. Male students and students in the lower year levels were more likely to wear clothes as a means of sun protection, compared to female students and those in the upper year level. Only a quarter of all students (27% of males and 22% of females) said they would usually or always wear clothes that cover most of their body when out in the sun, while about one-fifth of students (18% of males and 27% of females) said they usually wear less clothing to get some sun on their skin.
A greater proportion of female students (55%) reported that they usually or always wore sunglasses when out in the sun, compared to 32% of male students. The proportion of students who reported usually wearing sunglasses increased as year level increased, although the gender difference remained consistent.
The reported use of shade during the middle of the day was higher among female (30%) than male students (23%), while there was no consistent pattern across the year levels. Less than 20% of students reported usually or always staying inside on sunny summer days between 10a.m. and 2p.m., while over 40% never or rarely stayed inside.
Perceptions about skin cancer
Differences in perceptions relating to skin cancer and personal sunburn experiences for males and females within each year level are shown in Table III. Nearly half of the students (45% of males and 47% of females) thought it was likely that they would get skin cancer sometime in the future. This perception of personal skin cancer risk was lowest in Year 7 (36%) and increased to 51% in Year 12.
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About half of the male students (51%) reported to be very concerned about getting skin cancer, compared to 64% of females. Levels of concern for females were similar across the year levels, while levels decreased for males as year level increased.
Only 10% of students thought there was very little or nothing they could do to avoid skin cancer, while 39% thought they could do a great deal to avoid getting skin cancer. These perceptions were relatively consistent across both gender and year levels.
The desirability of suntan was high, with over 83% of students reported to want at least a light suntan. Of the students that wanted a tan of some type, less than one-fifth wanted a dark or very dark tan. A slightly higher proportion of female students (86%) wanted a tan, but this gender difference was more pronounced in the lower year levels than the upper year levels.
Previous sunburn experience
Over two-thirds of all students (68%) reported being sunburnt during the previous summer. There was no gender or year level differences.
About one-third of students (36%) reported having a sunburn in their lifetime that was severe enough to blister, with negligible differences between males and females. The proportion of students who reported having a severe sunburn increased from 29% in Year 7 to 42% in Year 12.
Association between usual behaviour and perceptions/experience
Generally, students' concerns and perceptions about skin cancer, personal sunburn experience and skin type were all significantly associated (P < 0.001) with their usual reported skin- protective behaviour (Table I
). This association was consistent across most types of sun-protective behaviours. In general, students were likely to employ sun-protective behaviours if they were concerned about skin cancer, thought they could avoid getting skin cancer or have skin that burns easily. Students who reported lower levels of skin protection methods were more likely to like a suntan and reported higher future skin cancer risk, were more likely to have been sunburnt over the previous summer and ever to have had a sunburn that had blistered. Students' attitudes had less effect on wearing sunglasses compared to the other skin-protective behaviours.
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Discussion |
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Limitations
A number of issues need to be considered when analysing this data. First, this is a school-based survey. School leavers and those not attending classes the day the survey was administered did not participate. These individuals may not have the same knowledge, attitudes or behaviours of the student population surveyed. While the small percentage absent for the day probably had little effect, school leavers could have had quite a marked influence in later years (post school leaving age) if their behaviour/attitudes differed.
Second, this study relied on the self-report of usual behaviour which can overestimate actual behaviour (Bennetts et al., 1991) and, therefore, as an estimate of the actual evidence of behaviour it needs to be treated with caution (Hill and Borland, 1996).
Last, this paper looks at data at a national level. There may be state differences as they vary in latitude (which influences UVR levels), climate, and the amount of effort and money devoted to skin cancer prevention. We are working on developing a better understanding of these factors.
There appears to be gender and age differences with regard to how students protect themselves from the sun. The use of sunscreen by females was significantly higher than that of males. Females also reported staying in the shade more than males and were also more likely to report the wearing of sunglasses `usually/always'. In contrast, males were more likely than females to report wearing a hat. However, this head protection was almost entirely provided by a cap and not `sun-safe' head gear. There were no gender differences in the use of protective clothing or staying indoors. The use of these types of sun-protection strategies was low in both groups.
Although the survey did not determine the reason for the behaviours, one interpretation of these results is that females appear to be selecting sun-protection behaviours that fit into their lifestyle/or socialization, such as using a sunscreen which is similar to the use of make-up, or moisturizers, or other skin care products. Currently, there are a number of make-up/ moisturizing products on the market that include a SPF 15+ sunscreen. Similarly, males probably wear caps more as a fashion statement than for protection from the sun.
There was a decrease in the appropriate use of sun protection as students progress from Year 7 to 12, and this was most striking between Year 7 and 8. For some states, this also represents a transition for the student from primary school to secondary school. This decrease was observed for most sun-protection measures except the wearing of caps by males and the wearing of sunglasses by both genders, suggesting these two behaviours are different from other types of sun-protection behaviours. The decreasing trend is consistent with other state-based studies indicating a marked decrease in sun-protection measures as the child gets older (Broadstock et al., 1996; Lowe et al., 1993). This suggests that much more could be done in secondary schools to promote sun-protective behaviours.
The majority of students still want to get a suntan and this desire increases with age. However, the social desirability of a tan appears to be moving away from a dark tan to a light to moderate tan evidenced by the appearance of models in magazines (Chapman et al., 1991). The desire for a suntan alone, however, should not be the primary concern for public health professionals, but rather the damage done to the skin through sunburn while in the process of getting a tan. It appears that only about 20–25% of the students reported being able to get a tan without burning. The social unacceptability of having red skin may be a useful focus of future campaigns. Student support of non-burning may help to reinforce the messages to protect oneself from the sun.
One of the most important findings was the consistent association between students' belief that they were likely to develop skin cancer in the future and low levels of protective activities. This could be interpreted as either those not protecting themselves being aware that they are putting themselves at risk and/or that those who are protecting themselves see it as having reduced their risk. By contrast, increased concern about getting cancer appears to motivate sun protection. It seems reasonable to conclude that at least some of the failure to engage in protective activities is among those who know of the increased risk of sun exposure, but who are relatively unconcerned about it.
Adolescents who believe there is a lot they can do to avoid skin cancer were more likely to engage in sun-protection behaviours. Given almost universal knowledge of sun-protection behaviour (Borland et al., 1990; Lowe et al., 1993), personally acceptable strategies, i.e. strategies individuals see as appropriate for them, appear to be more important in this regard. Unfortunately, their choice of behaviour may not provide optimal sun protection, e.g. use of baseball caps rather than broad brimmed hats or legionnaire-style caps. If this is so, it suggests that changing fashions and structures to make sun-safe options more attractive to young people might be an effective strategy. Fashion is influenced by a number of factors, many such as style are not determined for health reasons alone. In some cases, structural change may be easier. For example, providing shade over basketball hoops or other desirable locations of outdoors activity should lead to it being used, as it seems likely the activity will take priority over concerns for or against sun exposure.
Other factors clearly related to sun protection were age (younger students being more protective) and skin type (those with more sensitive skin, i.e. just burn, are most likely to protect themselves). There was a complex relationship between protection and recent sunburn. Generally, those with a history of burning were less likely to protect themselves. The exception being usual use of maximum protection sunscreen, where those who reported burning `last summer' were more likely to use sunscreen. It is not clear whether this latter effect is due to sunscreen users generally putting themselves more at risk or to a failure to apply sunscreens to all exposed areas.
Programs which address individual sun- protection behaviour also need to have an emphasis on adherence to sun protection. Increasing and sustaining sun protection will need to be supported by environmental and structural changes both in the school and the community. Timetables at school may need to be restructured to provide an opportunity for students to stay in the shade during peak UVR periods and not out at the outdoor playing area on a sunny day with no shade. Student sports carnivals may need to be moved from the middle of the day to times with lower UVR levels. Yet, changing school schedules is only part of a sun protection package. Shade structures to help facilitate shade use by students may need to be considered as a priority. Partial covering of playgrounds to provide players and spectators with shade can also provide opportunities to stay out of the sun. Local government authorities need to take responsibility for providing shade to play areas and local swimming pools. Students want to participate in outdoors activities from organized physical activities to socializing with friends and environmental structures need to be constructed to enable students to be protected from the sun without having to compromise their lifestyles. This is particularly so, given that much outdoor activity is likely to be of real value to those concerned.
The school is only one setting in a multitude of settings that children are in to expose themselves to the sun. In concert, schools, communities and agencies need to work to provide a sun-safe environment, that supports sun protection.
The overall picture is of a secondary school population who are moderately protected, but whose levels of protection decline with age. Unfortunately, we lack historical data to compare earlier periods, but those working in the field believe that sun protection has increased. Again, while data are limited, as yet unpublished work of ours and others suggest that protection is better in primary school than their counterparts in secondary school. The findings of this study that protection was best in Year 7 (when some students are still in primary school) supports this conclusion. Students appear to adhere to school policies of `no hat no play'. This suggests that there is a major challenge facing us to encourage children as they move into their teen years (adolescence) to maintain the sun-protection practices they appear to take with them from childhood.
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Acknowledgments |
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This survey was carried out under the auspices of the Australian Cancer Society and its member organizations to whom we are grateful for endorsement, funding and staff members' time. Ms Cathy Segan coordinated the running of the study at a national level. The coordination and initial analysis of the survey data were carried out in the Centre for Behavioural Research in Cancer, Anti-Cancer Council of Victoria. Particular thanks to Ms Barbara McKenzie for management of the national data set, Dr Malcolm Rosier for advice on all aspects of sampling and David Walker for further analyses of the data presented in this paper. At the state level, the following individuals and their respective organizations coordinated the fieldwork: Anti-Cancer Council of Victoria (Ms Cathy Segan and Mrs Trudi De Luise), NSW Cancer Council (Mr Noel Fitzgerald and Ms Rebecca FitzGerald), NT Anti-Cancer Foundation (Ms Sue Smellie), NT Department of Health and Community Services, Queensland Department of Education (Ms Anne Little), Anti-Cancer Foundation of South Australia (Ms Daniela Follese, Ms Pam Bekkers and Dr Lyn Roberts), Health Promotion Services, Health Department of Western Australia (Research and Evaluation Team), Menzies Centre for Population Health Research, University of Tasmania (Dr Lin Thorpe). In all states (except Queensland and Tasmania), the organizations listed above funded the project. Organizations responsible for funding the Queensland and Tasmanian components of the project were: Queensland Cancer Fund, Tasmanian Department of Health and Commonwealth Department of Health, Housing and Local Government and Community Services.
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References |
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Bennetts, K., Borland, R. R. and Swerissen, H. (1991) Sun protection behaviour of children and their parents at the beach. Psychology and Health, 5, 279–287.
Borland, R., Hill, D. and Noy, S. (1990) Being SunSmart: changes in community awareness and reported behaviour following a primary prevention program for skin cancer control. Behaviour Change, 7, 126–135.
Broadstock, M., Borland, R. and Hill, D. (1996) Knowledge, attitudes and reported behaviours relevant to sun protection and suntanning in adolescents. Psychology and Health, 11, 527–539.
Chapman, S., Marks, R. and King, M. (1992) Trends in tans and skin protection in Australian fashion magazines, 1982 through 1991. American Journal of Public Health, 82, 1677–1680.
Cockburn, J., Hennrikus, D., Scott, R. and Sanson-Fisher, R. (1989) Adolescent use of sun protection measures. Medical Journal of Australia, 151, 136–140.[Web of Science][Medline]
Giles, G. G., Marks, R. and Foley, P. (1988) Incidence of non-melanocytic skin cancer treated in Australia. British Medical Journal, 196, 13–17.
Hill, D. and Borland, R. (1996) Methodological issues in research on primary and secondary prevention of malignant melanoma. In Mackie, R. M. (ed.), Primary and Secondary Prevention of Malignant Melanoma. Pigment Cell. Karger, Basel, vol. 11, 1–21.
Hill, D., White, V., Marks, R. and Borland, R. (1993) Changes in sun-related attitudes and behaviour, and reduced sunburn prevalence in a population at high risk of melanoma. European Journal of Cancer Prevention, 2, 447–456.[Medline]
Holman, C. D. J., Armstrong, B. K., Heenan, P. J., Blackwell, J. B., Cumming, F. J., English, D. R., Holland, S., Kelsall, G. R. H., Matz, L. R., Rouse, I. L., Singh, A., Ten Seldam, R. E. J., Watt, J. D. and Xu, Z. (1986) The causes of malignant melanoma: results from the West Australian Lions Melanoma Research Project. Recent Results in Cancer Research, 102, 18–37.[Medline]
Hurwitz, S. (1988) The sun and sunscreen protection: recommendations for children. Journal of Dermatological, Surgery and Oncology, 14, 657–660.[Web of Science][Medline]
Kricker, A., Armstrong, B. F. and English, C. R. (1994) Sun exposure and non-melanocytic skin cancer. Cancer Causes Control, 5, 367–392.[Web of Science][Medline]
Lew, R. A., Sober, A. J., Cook, N., Marvell, R. and Fitzpatrick, T. B. (1983) Sun exposure habits in patients with cutaneous melanoma. Journal of Dermatological, Surgery and Oncology, 9, 981–986.[Web of Science][Medline]
Lowe, J. B., Balanda, K. P., Gillespie, A. M., Del Mar, C. B. and Gentle, A. F. (1993) Sun-related attitudes and beliefs among Queensland school children: the role of gender and age. Australian Journal of Public Health, 17, 202–208.[Web of Science][Medline]
Marks, R., Jolley, D., Lectsas, S. and Foley P. (1990) The role of childhood exposure to sunlight in the development of solar keratoses and non-melanocytic skin cancer. Medical Journal of Australia, 152, 62–66.[Web of Science][Medline]
Shah, B. V., Barnwell, B. G. and Bieler, G. S. (1996) SUDAAN. Software for the Statistical Analysis of Correlated Data. Research Triangle Institute, Research Triangle Park, NC.
Weinstock, M. A., Colditz, G. A., Willet, W. C., Stampfer, M. J., Bronstein, B. R., Mihm, M. C. and Speizer, F. E. (1989) Nonfamilial cutaneous melanoma incidence in women associated with sun exposure before 20 years of age. Pediatrics, 84, 199–204.
Received on April 10, 1999; accepted on October 22, 1999
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