{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,12]],"date-time":"2026-06-12T07:33:32Z","timestamp":1781249612975,"version":"3.54.1"},"reference-count":45,"publisher":"MDPI AG","issue":"5","license":[{"start":{"date-parts":[[2014,5,5]],"date-time":"2014-05-05T00:00:00Z","timestamp":1399248000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/3.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>Public health campaigns have improved knowledge on UVR-associated skin cancer risk and increased sun protection awareness. However, tanned skin is still a common beauty ideal. The relationship between knowledge, attitudes and protective behavior is not fully understood yet. A population-based survey was thus performed in the district of Erlangen involving 2,619 parents of 3- to 6-year old children. By means of a  self-administered standardized questionnaire parental knowledge about risk factors for skin cancer, their attitudes towards tanning and details of protective measures taken for their children were assessed. The study analyzed specifically the impact of parental tanning attitudes on sun-protective measures for their children while controlling for parental knowledge about skin cancer risk factors. While parental knowledge was significantly (inversely) associated with agreement to the statement \u201cTanned skin is healthy skin\u201d, this was not the case for \u201cTanning makes me look better\u201d. Overall, tanning affirmative attitudes were inversely associated with protective measures taken for the children, whereas parental knowledge had a positive impact on sun protection at the beach only. Multivariable analyses provided evidence for an effect of parental attitude on protective behavior independent of parental knowledge. Tanning attitudes and tanned skin as the misguided ideal of beauty need to be addressed in future public health campaigns to enhance the effectiveness of preventive activities in changing sun protective behavior.<\/jats:p>","DOI":"10.3390\/ijerph110504768","type":"journal-article","created":{"date-parts":[[2014,5,5]],"date-time":"2014-05-05T11:53:53Z","timestamp":1399290833000},"page":"4768-4781","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":29,"title":["The Impact of Parental Knowledge and Tanning Attitudes on Sun Protection Practice for Young Children in Germany"],"prefix":"10.3390","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8985-7582","authenticated-orcid":false,"given":"Olaf","family":"Gefeller","sequence":"first","affiliation":[{"name":"Department of Medical Informatics, Biometry and Epidemiology, Friedrich Alexander University of Erlangen-Nuremberg, Erlangen D-91054, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jiang","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Medical Informatics, Biometry and Epidemiology, Friedrich Alexander University of Erlangen-Nuremberg, Erlangen D-91054, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wolfgang","family":"Uter","sequence":"additional","affiliation":[{"name":"Department of Medical Informatics, Biometry and Epidemiology, Friedrich Alexander University of Erlangen-Nuremberg, Erlangen D-91054, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2234-1215","authenticated-orcid":false,"given":"Annette","family":"Pfahlberg","sequence":"additional","affiliation":[{"name":"Department of Medical Informatics, Biometry and Epidemiology, Friedrich Alexander University of Erlangen-Nuremberg, Erlangen D-91054, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2014,5,5]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"222","DOI":"10.1016\/j.sder.2011.08.003","article-title":"Ultraviolet radiation and melanoma","volume":"30","author":"Kanavy","year":"2011","journal-title":"Semin. Cutan. Med. Surg."},{"key":"ref_2","unstructured":"IARC (2009). Monographs on the Evaluation of Carcinogenic Risks to Humans, International Agency for Research on Cancer."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1016\/j.clindermatol.2008.09.001","article-title":"Melanoma epidemiology and trends","volume":"27","author":"Garbe","year":"2009","journal-title":"Clin. Dermatol."},{"key":"ref_4","unstructured":"Batzler, W., Giersiepen, K., and Hentschel, S. (2008). Contributions to Federal Health Reporting, Mercedes Druck."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"392","DOI":"10.1097\/CMR.0b013e32835861d6","article-title":"Incidence of cutaneous melanoma in Western Sweden, 1970\u20132007","volume":"22","author":"Claeson","year":"2012","journal-title":"Melanoma Res."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1205","DOI":"10.1038\/sj.bjc.6601294","article-title":"Nonmelanoma skin cancer in the Federal State of Saarland, Germany, 1995\u20131999","volume":"89","author":"Stang","year":"2003","journal-title":"Br. J. Cancer"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"734","DOI":"10.3390\/ijerph110100734","article-title":"Temporal and spatial melanoma trends in Austria: An ecological study","volume":"11","author":"Haluza","year":"2014","journal-title":"Int. J. Environ. Res. Public Health"},{"key":"ref_8","unstructured":"Husmann, G., Kaatsch, P., Katalinic, A., Bertz, J., Haberland, J., Kraywinkel, K., and Wolf, U. (2010). Cancer in Germany 2005\/2006. Incidence and Trends, Robert Koch Institute."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"149","DOI":"10.1016\/j.det.2008.11.008","article-title":"The benefits and risks of ultraviolet tanning and its alternatives: The role of prudent sun exposure","volume":"27","author":"Sivamani","year":"2009","journal-title":"Dermatol. Clin."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"179","DOI":"10.1111\/j.1365-2133.2004.05708.x","article-title":"Global perspectives of contemporary epidemiological trends of cutaneous malignant melanoma","volume":"150","author":"Lens","year":"2004","journal-title":"Br. J. Dermatol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"406","DOI":"10.1007\/s10865-009-9219-2","article-title":"Skin cancer-related prevention and screening behaviors: A review of the literature","volume":"32","author":"Kasparian","year":"2009","journal-title":"J. Behav. Med."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1175","DOI":"10.1016\/S0277-9536(00)00418-4","article-title":"Public health responses for skin cancer prevention: The policy framing of sun safety in Australia, Canada and England","volume":"53","author":"Garvin","year":"2001","journal-title":"Soc. Sci. Med."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"369","DOI":"10.1093\/heapro\/dah310","article-title":"Primary prevention of skin cancer: A review of sun protection in Australia and internationally","volume":"19","author":"Stanton","year":"2004","journal-title":"Health Promot. Int."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"215","DOI":"10.1615\/JLongTermEffMedImplants.v14.i3.60","article-title":"National health strategies to reduce sun exposure in Australia and the United States","volume":"14","author":"Edlich","year":"2004","journal-title":"J. Long Term Eff. Med. Implants"},{"key":"ref_15","first-page":"422","article-title":"Interventions to prevent skin cancer by reducing exposure to ultraviolet radiation: A systematic review","volume":"27","author":"Saraiya","year":"2004","journal-title":"Am. J. Prev. Med."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"290","DOI":"10.1177\/109019810102800304","article-title":"Slip! Slop! Slap! And sunsmart, 1980\u20132000: Skin cancer control and 20 years of population-based campaigning","volume":"28","author":"Montague","year":"2001","journal-title":"Health Educ. Behav."},{"key":"ref_17","unstructured":"Planning for A Brighter Future: A Review of Sun Protection and Barriers to Behavioral Change in Children and Adolescents. Available online:http:\/\/www.ncbi.nlm.nih.gov\/pubmed\/19061583."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"432","DOI":"10.1039\/b9pp00122k","article-title":"Knowledge, motivation, and behavior patterns of the general public towards sun protection","volume":"9","author":"Goulart","year":"2010","journal-title":"Photochem. Photobiol. Sci."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"474","DOI":"10.1097\/CEJ.0b013e328350b084","article-title":"Sunscreen use and skin protection behaviour on the Belgian beach: A comparison 9 years later","volume":"21","author":"Devos","year":"2012","journal-title":"Eur. J. Cancer Prev."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"3203","DOI":"10.3390\/ijerph10083203","article-title":"Sun protection preferences and behaviors among young adult males during maximum ultraviolet radiation exposure activities","volume":"10","author":"Wickenheiser","year":"2013","journal-title":"Int. J. Environ. Res. Public Health"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"67","DOI":"10.1067\/mpd.2003.mpd039","article-title":"Sunburn reduction through parental role modeling and sunscreen vigilance","volume":"142","author":"Geller","year":"2003","journal-title":"J. Pediatr."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"127","DOI":"10.1016\/j.ypmed.2008.02.025","article-title":"The formation of specific action plans can enhance sun protection behavior in motivated parents","volume":"47","author":"Reubsaet","year":"2008","journal-title":"Prev. Med."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"1133","DOI":"10.1001\/archpedi.1997.02170480063009","article-title":"Sun protection counseling by pediatricians","volume":"151","author":"Easton","year":"1997","journal-title":"Arch. Pediatr. Adolesc. Med."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"473","DOI":"10.1046\/j.1525-1470.2001.1861996.x","article-title":"Parental knowledge and practice of primary skin cancer prevention: Gaps and solutions","volume":"18","author":"Weinstein","year":"2001","journal-title":"Pediatr. Dermatol."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"317","DOI":"10.1177\/109019819902600304","article-title":"Skin cancer prevention for children: A critical review","volume":"26","author":"Buller","year":"1999","journal-title":"Health Educ. Behav."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"853","DOI":"10.1542\/peds.2005-3109","article-title":"Trends in sunburns, sun protection practices, and attitudes toward sun exposure protection and tanning among us adolescents, 1998\u20132004","volume":"118","author":"Cokkinides","year":"2006","journal-title":"Pediatrics"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"372","DOI":"10.1016\/S1054-139X(02)00377-4","article-title":"Knowledge, attitudes, and behaviors toward skin cancer in Maryland youths","volume":"31","author":"Alberg","year":"2002","journal-title":"J. Adolesc. Health"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"692","DOI":"10.1111\/j.1440-1754.2008.01408.x","article-title":"Child sun protection: Sun-related attitudes mediate the association between children's knowledge and behaviours","volume":"44","author":"Wright","year":"2008","journal-title":"J. Paediatr. Child Health"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"196","DOI":"10.1111\/j.1600-0781.2011.00598.x","article-title":"Parental perspective on sun protection for young children in Bavaria","volume":"27","author":"Li","year":"2011","journal-title":"Photodermatol. Photoimmunol. Photomed."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"698","DOI":"10.1136\/jech.51.6.698","article-title":"Public awareness of malignant melanoma risk factors in Germany","volume":"51","author":"Pfahlberg","year":"1997","journal-title":"J. Epidemiol. Community Health"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"803","DOI":"10.1111\/j.1365-2133.2012.10805.x","article-title":"A comparison of patterns of sun protection during beach holidays and everyday outdoor activities in a population sample of young German children","volume":"166","author":"Li","year":"2012","journal-title":"Br. J. Dermatol."},{"key":"ref_32","unstructured":"Can An Hour or Two of Sun Protection Education Keep the Sunburn Away? Evaluation of the Environmental Protection Agency\u2019s Sunwise School Program. Available online:http:\/\/www.ncbi.nlm.nih.gov\/pubmed\/14613488."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"1136","DOI":"10.2466\/pr0.1995.77.3f.1136","article-title":"Children and exposure to the sun: Relationships among attitudes, knowledge, intentions, and behavior","volume":"77","author":"Kubar","year":"1995","journal-title":"Psychol. Rep."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"409","DOI":"10.1177\/109019819902600310","article-title":"Promoting sun protection in children: Rationale and challenges","volume":"26","author":"Hill","year":"1999","journal-title":"Health Educ. Behav."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"265","DOI":"10.1016\/j.amepre.2012.10.027","article-title":"Children\u2019s skin cancer prevention: A systematic review of parents\u2019 psychosocial measures","volume":"44","author":"Tripp","year":"2013","journal-title":"Am. J. Prev. Med."},{"key":"ref_36","first-page":"391","article-title":"Prevention of melanoma by sun protective measures in childhood. Temporal changes in awareness of parents","volume":"48","author":"Pfahlberg","year":"1997","journal-title":"Hautarzt"},{"key":"ref_37","doi-asserted-by":"crossref","unstructured":"Klar, R., and Opitz, O. (1997). Classification and Knowledge Organization, Springer.","DOI":"10.1007\/978-3-642-59051-1"},{"key":"ref_38","doi-asserted-by":"crossref","unstructured":"Altmeyer, P., Hoffmann, K., and St\u00fccker, M. (1997). Skin Cancer and UV-Radiation, Springer.","DOI":"10.1007\/978-3-642-60771-4"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"199","DOI":"10.1016\/j.bodyim.2006.05.002","article-title":"An investigation of appearance motives for tanning: The development and evaluation of the physical appearance reasons for tanning scale (parts) and its relation to sunbathing and indoor tanning intentions","volume":"3","author":"Cafri","year":"2006","journal-title":"Body Image"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"209","DOI":"10.1007\/s12160-008-9022-2","article-title":"Appearance motives to tan and not tan: Evidence for validity and reliability of a new scale","volume":"35","author":"Cafri","year":"2008","journal-title":"Ann. Behav. Med."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"1311","DOI":"10.1001\/archderm.138.10.1311","article-title":"Awareness of the risks of tanning lamps does not influence behavior among college students","volume":"138","author":"Knight","year":"2002","journal-title":"Arch. Dermatol."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"182","DOI":"10.1111\/j.2044-8287.2012.02089.x","article-title":"Appearance-based interventions to reduce ultraviolet exposure and\/or increase sun protection intentions and behaviours: A systematic review and meta-analyses","volume":"18","author":"Williams","year":"2013","journal-title":"Br. J. Health Psychol."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"S40","DOI":"10.1111\/j.1365-2133.2009.09448.x","article-title":"Sunscreen abuse for intentional sun exposure","volume":"161","author":"Autier","year":"2009","journal-title":"Br. J. Dermatol."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"1666","DOI":"10.1038\/jid.2008.423","article-title":"Increasing burden of melanoma in the United States","volume":"129","author":"Linos","year":"2009","journal-title":"J. Investig. Dermatol."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"2040","DOI":"10.1016\/j.ejca.2005.03.034","article-title":"Meta-analysis of risk factors for cutaneous melanoma: III. Family history, actinic damage and phenotypic factors","volume":"41","author":"Gandini","year":"2005","journal-title":"Eur. J. Cancer"}],"container-title":["International Journal of Environmental Research and Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1660-4601\/11\/5\/4768\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T21:11:01Z","timestamp":1760217061000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1660-4601\/11\/5\/4768"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2014,5,5]]},"references-count":45,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2014,5]]}},"alternative-id":["ijerph110504768"],"URL":"https:\/\/doi.org\/10.3390\/ijerph110504768","relation":{},"ISSN":["1660-4601"],"issn-type":[{"value":"1660-4601","type":"electronic"}],"subject":[],"published":{"date-parts":[[2014,5,5]]}}}