{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,12]],"date-time":"2025-10-12T04:02:12Z","timestamp":1760241732170,"version":"build-2065373602"},"reference-count":44,"publisher":"MDPI AG","issue":"9","license":[{"start":{"date-parts":[[2018,8,21]],"date-time":"2018-08-21T00:00:00Z","timestamp":1534809600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>Minimizing exposure to ultraviolet radiation (UVR) is strongly recommended as the most important primary prevention measure regarding skin cancer. The responsibility for adequate sun protection of young children lies with their parents and external caregivers. Since a high proportion of 3- to 6-year-old children in Germany attend nurseries, the practice of sun protection in this setting was assessed. A survey was conducted in 246 nurseries in southern Germany during spring and summer of 2014 and 2015. Shade coverage in the outdoor area of the nursery was assessed by study team members and UVR protective behavior of staff was assessed by an interview with the directors. On average, 52% of the entire outdoor area and 65% of the children\u2019s outdoor play area were covered by shade, with a significant difference between nurseries of different sizes, pointing to a better shade coverage in larger nurseries. The daily outdoor stay was not regularly scheduled before or after peak sun intensity hours around noon to avoid intense UVR exposure. General sun protection rules were present in the majority of the nurseries and addressed predominantly wearing sunhats and applying sunscreen. Our findings show that current sun protection recommendations for children are only partially met in nurseries and indicate a lower level of sun protection in small institutions. Especially, avoidance of excessive exposure to UVR around noon and the importance of shade provision over play structures needs to be emphasized in future information campaigns.<\/jats:p>","DOI":"10.3390\/ijerph15091793","type":"journal-article","created":{"date-parts":[[2018,8,21]],"date-time":"2018-08-21T11:12:42Z","timestamp":1534849962000},"page":"1793","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["Shedding Light on the Shade: How Nurseries Protect Their Children from Ultraviolet Radiation"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7523-2813","authenticated-orcid":false,"given":"Cornelia","family":"Fiessler","sequence":"first","affiliation":[{"name":"Department of Medical Informatics, Biometry and Epidemiology, Friedrich-Alexander University of Erlangen-Nuremberg, 91054 Erlangen, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2234-1215","authenticated-orcid":false,"given":"Annette B.","family":"Pfahlberg","sequence":"additional","affiliation":[{"name":"Department of Medical Informatics, Biometry and Epidemiology, Friedrich-Alexander University of Erlangen-Nuremberg, 91054 Erlangen, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4498-3710","authenticated-orcid":false,"given":"Wolfgang","family":"Uter","sequence":"additional","affiliation":[{"name":"Department of Medical Informatics, Biometry and Epidemiology, Friedrich-Alexander University of Erlangen-Nuremberg, 91054 Erlangen, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8985-7582","authenticated-orcid":false,"given":"Olaf","family":"Gefeller","sequence":"additional","affiliation":[{"name":"Department of Medical Informatics, Biometry and Epidemiology, Friedrich-Alexander University of Erlangen-Nuremberg, 91054 Erlangen, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2018,8,21]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"385","DOI":"10.1002\/ijc.27616","article-title":"International trends in the incidence of malignant melanoma 1953\u20132008\u2014Are recent generations at higher or lower risk?","volume":"132","author":"Erdmann","year":"2013","journal-title":"Int. J. Cancer"},{"key":"ref_2","unstructured":"Robert Koch-Institut (2017). Krebs in Deutschland f\u00fcr 2013\/2014, Zentrum f\u00fcr Krebsregisterdaten. [11th ed.]."},{"key":"ref_3","unstructured":"Statistisches Bundesamt (2017). 17% Mehr Station\u00e4re Hautkrebsbehandlungen Innerhalb Von 5 Jahren, Press Release."},{"key":"ref_4","first-page":"168","article-title":"Disease costs of malignant melanoma in Europe\u2014A systematic review","volume":"15","author":"Krensel","year":"2017","journal-title":"J. Dtsch. Dermatol. Ges."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"28","DOI":"10.1016\/j.ejca.2004.10.015","article-title":"Meta-analysis of risk factors for cutaneous melanoma: I. Common and atypical naevi","volume":"41","author":"Gandini","year":"2005","journal-title":"Eur. J. Cancer"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"45","DOI":"10.1016\/j.ejca.2004.10.016","article-title":"Meta-analysis of risk factors for cutaneous melanoma: II. Sun exposure","volume":"41","author":"Gandini","year":"2005","journal-title":"Eur. J. Cancer"},{"key":"ref_7","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"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"13","DOI":"10.1111\/phpp.12329","article-title":"Mechanisms and prevention of UV-induced melanoma","volume":"34","author":"Sample","year":"2018","journal-title":"Photodermatol. Photoimmunol. Photomed."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"63","DOI":"10.1111\/j.1365-2133.2012.11088.x","article-title":"Getting in early: Primary skin cancer prevention at 55 German kindergartens","volume":"167","author":"Stover","year":"2012","journal-title":"Br. J. Dermatol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"215","DOI":"10.1177\/1059840508319627","article-title":"The SunWise Policy intervention for school-based sun protection: A pilot study","volume":"24","author":"Emmons","year":"2008","journal-title":"J. Sch. Nurs."},{"key":"ref_11","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_12","doi-asserted-by":"crossref","first-page":"349","DOI":"10.1016\/j.pbiomolbio.2011.08.010","article-title":"Childhood exposure to ultraviolet radiation and harmful skin effects: Epidemiological evidence","volume":"107","author":"Green","year":"2011","journal-title":"Prog. Biophys. Mol. Biol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"397","DOI":"10.1097\/00004703-199812000-00002","article-title":"Elementary school-age children\u2019s developmental understanding of the causes of cancer","volume":"19","author":"Chin","year":"1998","journal-title":"J. Dev. Behav. Pediatr."},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"Gefeller, O., Uter, W., and Pfahlberg, A.B. (2016). Protection from ultraviolet radiation during childhood: The parental perspective in Bavaria. Int. J. Environ. Res. Public Health, 13.","DOI":"10.3390\/ijerph13101011"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"31","DOI":"10.1016\/j.ypmed.2016.05.016","article-title":"Long-term development of parental knowledge about skin cancer risks in Germany: Has it changed for the better?","volume":"89","author":"Gefeller","year":"2016","journal-title":"Prev. Med."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"4768","DOI":"10.3390\/ijerph110504768","article-title":"The impact of parental knowledge and tanning attitudes on sun protection practice for young children in Germany","volume":"11","author":"Gefeller","year":"2014","journal-title":"Int. J. Environ. Res. Public Health"},{"key":"ref_17","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_18","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_19","first-page":"391","article-title":"Prevention of malignant melanoma by sun protective measures in childhood\u2014Changing awareness parents over time","volume":"48","author":"Kolmel","year":"1997","journal-title":"Hautarzt"},{"key":"ref_20","doi-asserted-by":"crossref","unstructured":"Altmayer, P., Hoffmann, K., and St\u00fccker, M. (1997). The improvement of sun protection among children: Empirical evidence from successive studies in G\u00f6ttingen. Skin Cancer and UV-Radiation, Springer.","DOI":"10.1007\/978-3-642-60771-4"},{"key":"ref_21","unstructured":"Steinmetz, M. (2014). Current solar UV status in Germany. UMID: Umwelt und Mensch\u2014Informationsdienst, Umweltbundesamt."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"543","DOI":"10.1097\/CMR.0000000000000205","article-title":"Replacing surrogate measures by direct quantification of ultraviolet radiation exposure in registry-based analyses of seasonality of melanoma diagnoses","volume":"25","author":"Keller","year":"2015","journal-title":"Melanoma Res."},{"key":"ref_23","unstructured":"R Core Team (2017). R: A Language and Environment for Statistical Computing, R Foundation for Statistical Computing. Available online: http:\/\/www.R-project.org\/."},{"key":"ref_24","unstructured":"Deutsche Krebshilfe (2016). Clever in Sonne und Schatten\u2014Kinderhaut sch\u00fctzen, Deutsche Krebshilfe. Press Release."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"31","DOI":"10.1016\/S0749-3797(99)00031-8","article-title":"\u201cBlock the Sun, not the Fun\u201d: Evaluation of a skin cancer prevention program for child care centers","volume":"17","author":"Crane","year":"1999","journal-title":"Am. J. Prev. Med."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"491","DOI":"10.1007\/s10900-005-7283-2","article-title":"Sun protection policies and practices at child care centers in Massachusetts","volume":"30","author":"Kenfield","year":"2005","journal-title":"J. Commun. Health"},{"key":"ref_27","unstructured":"World Health Organization (2003). Sun Protection in Schools: An Educational Package to Protect Children from Ultraviolet Radiation, WHO."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"261","DOI":"10.1093\/her\/cyl068","article-title":"Baseline survey of sun-protection knowledge, practices and policy in early childhood settings in Queensland, Australia","volume":"22","author":"Harrison","year":"2007","journal-title":"Health Educ. Res."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"520","DOI":"10.1111\/j.1467-842X.2003.tb00826.x","article-title":"Health promotion in childcare centres: A survey of sun protection policy and practice","volume":"27","author":"Parkinson","year":"2003","journal-title":"Aust. N. Z. J. Public Health"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"53","DOI":"10.1093\/her\/cyq070","article-title":"The relationship between sun protection policy and associated practices in a national sample of early childhood services in Australia","volume":"26","author":"Ettridge","year":"2011","journal-title":"Health Educ. Res."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1093\/her\/cyt105","article-title":"The relationship between sun protection policies and practices in schools with primary-age students: The role of school demographics, policy comprehensiveness and SunSmart membership","volume":"29","author":"Dono","year":"2014","journal-title":"Health Educ. Res."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"562","DOI":"10.1177\/1090198105277850","article-title":"Effects of a preschool staff intervention on children\u2019s sun protection: Outcomes of Sun Protection is Fun!","volume":"34","author":"Gritz","year":"2007","journal-title":"Health Educ. Behav."},{"key":"ref_33","first-page":"40","article-title":"\u201cGood intentions, but inadequate practices\u201d\u2014Sun protection in early childhood centres, a qualitative study from New Zealand","volume":"127","author":"Duignan","year":"2014","journal-title":"N. Z. Med. J."},{"key":"ref_34","unstructured":"Skin Cancer Foundation (2018, March 06). Sun Safety Tips for Infants, Babies and Toddlers. Available online: https:\/\/www.skincancer.org\/prevention\/sun-protection\/children\/sun-safety-tips-for-infants-babies-and-toddlers."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"1067","DOI":"10.1007\/s10552-011-9780-1","article-title":"Hat, shade, long sleeves, or sunscreen? Rethinking US sun protection messages based on their relative effectiveness","volume":"22","author":"Linos","year":"2011","journal-title":"Cancer Causes Control"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"264","DOI":"10.1111\/j.1600-0781.2007.00309.x","article-title":"Photoprotection by clothing","volume":"23","author":"Gies","year":"2007","journal-title":"Photodermatol. Photoimmunol. Photomed."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"958","DOI":"10.1111\/bjd.15938","article-title":"A comprehensive approach to evaluating and classifying sun-protective clothing","volume":"178","author":"Downs","year":"2018","journal-title":"Br. J. Dermatol."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"835","DOI":"10.1111\/bjd.16344","article-title":"The Garment Protection Factor: Further advances in labelling sun-protective clothing","volume":"178","author":"Gefeller","year":"2018","journal-title":"Br. J. Dermatol."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"357","DOI":"10.1016\/j.ypmed.2005.01.007","article-title":"An intervention for parents to promote preschool children\u2019s sun protection: Effects of Sun Protection is Fun!","volume":"41","author":"Gritz","year":"2005","journal-title":"Prev. Med."},{"key":"ref_40","first-page":"36","article-title":"Smartphones as tools for delivering sun-smart education to students","volume":"59","author":"Igoe","year":"2013","journal-title":"Teach. Sci."},{"key":"ref_41","unstructured":"Dobbinson, S., Buller, D., Kane, I., Shane, J., and English, D. (2014, January 15\u201317). Successful use of a tablet computer mobile app to observe sun protection practices in Australia and the United States. Presented at the NIWA UV Workshop, Auckland, New Zealand."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"293","DOI":"10.1016\/S1470-2045(17)30114-6","article-title":"Bringing the \u201cSunSmart\u201d message to smart phones","volume":"18","author":"Jenkins","year":"2017","journal-title":"Lancet Oncol."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"856","DOI":"10.1007\/s00103-017-2570-5","article-title":"Knowledge and information sources of parents of 3- to 6-year-old children concerning skin cancer risk factors","volume":"60","author":"Uter","year":"2017","journal-title":"Bundesgesundheitsblatt-Gesundheitsforschung-Gesundheitsschutz"},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"479","DOI":"10.1111\/php.12237","article-title":"Shade provision for UV minimization: A review","volume":"90","author":"Parisi","year":"2014","journal-title":"Photochem. Photobiol."}],"container-title":["International Journal of Environmental Research and Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1660-4601\/15\/9\/1793\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T15:19:53Z","timestamp":1760195993000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1660-4601\/15\/9\/1793"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2018,8,21]]},"references-count":44,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2018,9]]}},"alternative-id":["ijerph15091793"],"URL":"https:\/\/doi.org\/10.3390\/ijerph15091793","relation":{},"ISSN":["1660-4601"],"issn-type":[{"type":"electronic","value":"1660-4601"}],"subject":[],"published":{"date-parts":[[2018,8,21]]}}}