COUNSELING PARENTS AND CHILDREN ON SUN PROTECTION: RESULTS OF A NATIONAL SURVEY OF PEDIATRICIANS Sophie J. Balk, Karen G. O?Connor. Department of Pediatrics, Children?s Hospital at Montefiore, Bronx, NY; Division of Health Policy Research, American Academy of Pediatrics, Elk Grove Village, IL.

BACKGROUND: Excessive sun exposure in childhood and adolescence is linked to skin cancer, including melanoma, in adulthood. Pediatricians have a role in skin cancer prevention by providing sun protection (SP) counseling to patients and parents; however, little is known about pediatricians? attitudes and practices in this area.

OBJECTIVE: To describe pediatricians? attitudes towards SP counseling, the quantity and content of such counseling, and to identify barriers to SP counseling.

DESIGN/METHODS: American Academy of Pediatrics (AAP) Periodic Survey mailed in 2001 to 1,616 randomly selected US members. Response rate = 55%; n = 775 pediatricians providing direct patient care.

RESULTS: More than 90% of pediatricians agree that skin cancer is a significant public health problem and that preventing childhood sun exposure will reduce the risk of adult melanoma. About half of pediatricians (48% to 54%, depending on patient age) report discussing SP with the majority of parents/patients at least once during summer months. Among those (53%) who selectively counsel, 74% identify patients needing counseling based on white/ light skin, 73% by parent concern, 67% by tendency to sunburn, and 56% by family history of skin cancer. The most important SP recommendation named is using a ³ SPF15 sunscreen (64%); 23% say avoiding sun during peak hours is most important. Pediatricians agree that they, as well as schools, should educate parents/patients on SP (93%and 75%, respectively). However, only 38% of pediatricians rate SP as "very important" to their patients? health compared to use of car seats (86%), nutrition (79%), immunization issues (76%), smoking/ETS avoidance (74%), bike helmets (61%), and gun storage (47%). The most frequently named barrier to SP counseling is lack of time (58% reporting); others include parent/patient reluctance to comply with recommendations (42%), parent/child disinterest in hearing SP advice (38%), and lack of SP patient education materials (39%).

CONCLUSIONS: Although most pediatricians reported that skin cancer prevention is important, only half reported providing routine SP counseling and most rank SP counseling lower in importance than other issues. Pediatricians? ranking of sunscreen as the most important SP recommendation is concerning since using sunscreen may extend time spent in the sun. Interventions might include programs and materials to educate parents, patients and pediatricians.