Despite schools being encouraged to implement sun protective hat wearing policy to reduce children’s future risk of skin cancer, less than half participating in a University of Otago study had robust policy in place.

A team of Dunedin researchers, led by Associate Professor Tony Reeder (left) of the Social & Behavioural Research Unit in the Department of Preventive & Social Medicine, surveyed 1242 schools – 62 percent of New Zealand primary and intermediate schools – about their sun protection policies, including requirements about the use of sun hats.

“Our study demonstrates that despite its potential significance for the prevention of head and neck skin cancers, there remains substantial scope for improvement in New Zealand primary school sun protection hat wearing policy, with only 43 per cent meeting optimal criteria,” Associate Professor Reeder says.

“Given expectation that these policies have been in place for several years, it is disappointing to see that many schools still struggle to implement them, especially in New Zealand where seasonal solar ultraviolet radiation (UVR) levels can be high and it is known that exposure to UVR in early life is linked with subsequent increased skin cancer risk,” he says.

“The head and neck suffer a disproportionately high burden of skin cancer as a consequence of high exposure to solar UVR. The wearing of a sun protective hat can effectively shield the scalp and reduce exposure to other areas of the head and neck.

“Rigorous school hat wearing policies can potentially help reinforce sun protective behaviour patterns and reduce lifetime skin cancer risk.”

As part of their investigations, the researchers identified potential ways to improve the situation. The uptake of two relatively straightforward strategies was associated with schools having the most rigorous policies requiring children to wear the most protective types of sun hats.

If a school was a member of the SunSmart Schools programme or used the SchoolDocs professional policy drafting service, which manages all school policies and ensures they remain up to date and accurate, the study results show that sunhat wearing policy in those schools was more robust. This was after socioeconomic differences, such as school roll size and decile rating, were taken into account.

SunSmart accredited schools and schools using SchoolDocs demonstrated a significantly increased probability (6.48 and 7.47 times, respectively), of obtaining the highest protective hat score (3) rather than the lowest score (zero).

In addition, when compared with non-accredited schools, accredited schools had 228 per cent increased odds of incorporating a compulsory “no hat, play in the shade” requirement in their policy. Similarly, there was a 170 per cent increase in the odds for schools that used SchoolDocs.

Associate Professor Reeder says the positive association between schools belonging to an organised school sun protection programme and the strength of hat wearing and shade use policies suggests that such programs help improve the policy by requiring the school to meet the minimum criteria when applying for accreditation.

Anecdotally, these policies provide continuity when school staff changes occur and, in particular, when a principal is replaced and commitment to the SunSmart Schools programme may wane.

Associate Professor Reeder says schools which used professional policy management services also had better and more comprehensive sun protection policies in place, suggesting these services may help strengthen policy as well as potentially ensure a more comprehensive, unambiguous specification of all recommended criteria and encourage consistency between schools.

Currently, schools pay an annual fee for this service and Associate Professor Reeder says improvement in sun protection policy, as well as in other policy areas in New Zealand schools would likely occur if the Ministry of Education or other agencies met the cost of the service.

New Zealand and Australian melanoma skin cancer rates are consistently the highest in the world. Skin cancer treatment places a significant cost burden on New Zealand’s health services, estimated at $180 million annually and negatively affects the lives of many New Zealanders, with about 500 dying every year.

Yet, Associate Professor Reeder says most skin cancers are potentially preventable by reducing harmful levels of exposure to UVR and there is no better place to start than among school children.

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