Objective: Protecting the skin from ultraviolet (UV) radiation is critical during adolescence to reduce the risk of developing skin cancer later in life, but adolescents tend to be less likely to engage in sun‐protective behaviours than adults. The present study examined changes and trends (2001/02–2011/12) in sun‐protection behaviours among adolescents living in Western Australia – a region with high levels of UV radiation. Methods: A cross‐sectional survey was conducted during 10 summers between 2001/02 and 2011/12 to investigate how often adolescents engaged in various sun‐protection behaviours, including outdoor protective measures (wearing a hat, wearing protective clothing, using sunscreen, wearing sunglasses, seeking shade) and avoidance of UV radiation by staying inside. Results: Hat use significantly decreased between 2001/02 and 2011/12, whereas use of sunscreen and wearing covering clothes were unchanged in most survey years relative to 2001/02. Use of sunglasses peaked in 2006/07 and 2007/08, but returned to first survey year levels in 2011/12, while staying inside was more frequently reported from 2006/07 onwards. Conclusions: New approaches are needed to minimise reactance responses in adolescents while fostering favourable attitudes to sun protection. Implications and opportunities for interventions to promote better sun‐protection practices among adolescents are provided.

BackgroundExcessive sun exposure and sunburn increase individuals’ risk of skin cancer. It is especially important to prevent sunburn in childhood due to the higher relative risk of skin cancer across the life span compared to risk associated with sunburn episodes experienced later in life. This study examined demographic and attitudinal factors associated with engagement in a range of sun protection behaviours (wearing a hat, wearing protective clothing, staying in the shade, and staying indoors during the middle of the day) and the frequency of sunburn among Western Australian adolescents to provide insights of relevance for future sun protection campaigns.MethodsCross-sectional telephone surveys were conducted annually with Western Australians between 2005/06 and 2014/15. The results from 4150 adolescents aged 14–17 years were used to conduct a path analysis of factors predicting various sun protection behaviours and sunburn.ResultsSignificant primary predictors of the sun protection behaviours included in the study were skin type (sun sensitivity), gender, tanning-related attitudes and behaviours, and perceived relevance of public service advertisements that advocate sun protection. Of the four sun protection behaviours investigated, staying in the shade and staying indoors during the middle of the day were associated with a lower frequency of sunburn.ConclusionThere is a particular need to target sun protection messages at adolescent males who are less likely to engage in the most effective sun protection behaviours and demonstrate an increased propensity to experience sunburn. The results suggest that such future sun protection messages should include a focus on the importance of staying in the shade or indoors during periods of high UV radiation to increase awareness of the efficacy of these methods of avoiding skin cancer.

Further efforts are required to encourage greater enactment of sun-protection behaviour, especially on the use of protective clothing and seeking shade during periods of high UV radiation.

The present study assessed perceptions of effective sun-protection strategies among the general public and whether these perceptions have changed in recent years. During five summers from 2007/2008 to 2011/2012, 4217 adolescents and adults living in a region with very high levels of solar UV radiation participated in annual, cross-sectional telephone surveys. Respondents' perceptions of the most effective sun-protection strategy were measured with a single open-ended question. In all survey years, sunscreen was the by far most frequently nominated sun-protection strategy, with an average mention rate of 71.0 %. The tendency to nominate sunscreen increased significantly over the 5-year study period and on average, was more common among adolescents compared to adults (81.6 vs 60.0 %) and females compared to males (73.6 vs 68.3 %). Despite respondents' increasing tendency to nominate sunscreen as the most effective sun-protection strategy, health experts have voiced concerns about flawed application practices. Current sun-protection hierarchies indicate that protective clothing and shade are better options.

The results indicate significant differences between the telephone and online surveys on most measures used to assess the effectiveness of a health promotion advertising campaign. Health promotion practitioners could consider the combination of both methods to overcome the deterioration in telephone survey response rates and the likely differences in respondent outcomes.