It looks like advice to protect children and young adults against the dangers of too much sun is falling on deaf ears, according to articles in the June and July issues of Pediatrics (Vol. 109, No. 6: 1009-1014, 1124-1130; Vol. 110, No. 1).

Many children are following their parents' poor examples when it comes to indoor tanning bed use, said researchers. And to make matters worse, summer sunburn has become the norm for youth ages 11 to 18, they said.

The first study, done in 1999 by Alan Geller, RN, MPH, and associates from Boston University and Harvard Medical School, both in Boston, and the Memorial-Sloan Kettering Cancer Center in New York City, surveyed the association between sunscreen use, tanning bed use, and sunburning among more than 10,000 boys and girls ages 12 to 18 from all 50 states.

They also looked at the relationship between sun exposure when young and the risk of skin cancer in later life.

The study was limited to white youth, since non-white children have a far lower risk of developing skin cancer.

The authors were not surprised by their findings. Only 40% of the girls surveyed used sunscreens, while even fewer boys used the protective lotions.

One out of 10 children had used a tanning bed, with older girls leading the pack — one out of six girls had used a tanning booth the previous year.

About one-third of the girls and almost 25% of the boys thought it was a good idea to burn in trying to get a good tan. In fact, many of the young people had a sunburn the previous year, and a good number of them had three or more sunburns during that period of time.

The authors noted that the risk of melanoma, the deadliest type of skin cancer, could be reduced by up to 78% if children and young adults limited sun exposure and used sunscreens regularly.

“As we look to the lessons learned from Australia, preventing skin cancer will require a long-term, sustained effort,” the authors wrote. Australia's melanoma education is a top priority because the disease is so common there.

In a second article in the June issue of Pediatrics, Vilma Cokkinides, PhD, and colleagues from the American Cancer Society and Brown University in Providence, R.I., looked at the use of tanning sunlamps by young people ages 11 to 18 in the US. They also looked at the tanning behavior of their parents or adult caregivers.

Researchers found that if a parent or caregiver used a sunlamp in the previous year, then 30% of their children did the same. More disturbing, they said, was the finding that four out of 10 young women ages 17 to18 had used a tanning sunlamp over the previous year.

Other factors associated with the use of tanning lamps, aside from age and parental influence, included a desire to have a tanned look, and not using a sunscreen of 15 or greater when at the beach or pool.

Overall, looking at the entire group, more than 10% of youth had used indoor tanning sunlamps in the previous year, according to the study.

“A single 15- to 30-minute salon session exposes the body to the same amount of harmful UV sunlight as a day at the beach,” the authors wrote. The result is that children are putting themselves “at greater [and unnecessary] risk of experiencing the short- and long-term health impact of UV exposure.”

The problem needs to be attacked from several angles, according to Geller’s report. Change in attitudes and behaviors are key, along with long-term public health approaches, such as putting age limits on who can use a tanning bed.

Teach the dangers in school and make people aware how much UV exposure they are likely to get by using “UV index” reports on weather, news, and other broadcasts, wrote Geller.

Cokkinides suggested parental consent where possible. While “teenagers may be the most vulnerable because of their lack of full awareness of the health risks involved and their [desire] to intentionally tan,” the authors wrote, “parents are able to directly advocate prevention and incorporate preventive behaviors into their family routines.”

In the third article, reported by Kourtney J. Davis, PhD, and colleagues from Worldwide Epidemiology in Research Triangle Park, N.C., and other centers, three-quarters of children ages 11 to 18 had at least one sunburn during the summer when surveyed in 1998. And, many of those children had several sunburns that summer.

Even using sunscreen didn’t make much difference. Four out of 10 children said they had used sunscreen when they developed their most serious sunburn of the summer.

Only one in 20 children had used “sun sensible” ways of protecting themselves before they had their most serious sunburn, for example, by wearing protective clothing or a wide-brimmed hat.

“The high frequency of sunscreen use during the sunburning episodes suggests the need to educate youth and parents better about proper use of these agents, as well as the importance of practicing other sun protection behaviors, such as wearing hats and protective clothing and avoiding the sun during peak exposure times,” the authors said.

“We need to find new ways to talk with teens about protecting their skin,” Davis said. “Teens are different, and nagging them is not effective.”