Attitudes, knowledge, and behaviors of secondary school adolescents regarding protection from sun exposure: a survey in Bangkok, Thailand

Background: Sun protection behavior is a proven intervention for aging skin and skin cancer prevention, especially if training on prolonged sun exposure can be performed early in life. Despite the fact that there are several study reports from multicenters in the West, there are limited data on sun protection in tropical countries where the prevalence of sunburn as well as sun protection behavior and knowledge are low. In Bangkok, sun protection behavior among adolescents is different from the studies performed in the West. Schools are key institutions in encouraging students to prevent themselves from acquiring problems of long-time sun exposure. Objective: To assess the amount of time exposed to the sun, sun protection behavior, attitudes, and knowledge about sun exposure protection among secondary school adolescents in Bangkok, Thailand. Methods: This is a nonrandomized, cross-sectional survey. All students from seven secondary schools in Bangkok (public/private, male/female/coed) were recruited in to the study. Results: A total of 10 387 students were enrolled in to the study; 6176 (59.5%) and 4211 (40.5%) students were from grades 7 to 9 and 10 to 12, respectively. Male students significantly lacked proper sun-protecting behaviors when compared to the female students in the use of sunscreen (9.4% vs. 28.0%, P < 0.001), staying under the shade (55.5% vs. 65.2%, P < 0.001), and use of umbrellas (5.2% vs. 12.1%, P < 0.001). Proper attitudes and sun-protecting behaviors among junior high school students were deficient when compared to high school students in the use of sunscreen (57.1% vs. 60.6%, P < 0.001), types of clothing (10.5% vs. 15.3%, P < 0.001), and hat (3.2% vs. 3.9%, P < 0.001). Conclusion: Sun protection behavior among adolescents in Bangkok was poor compared to Western countries. The attitudes and general knowledge about sun protection were significantly different among male and female students from grades 7 to 9 and 10 to 12. Limitation: The limitation of the study is the use of self-reported questionnaires in assessing sun exposure and protection.