Validity of covering-up sun-protection habits: Association of observations and self-report

J Am Acad Dermatol. 2009 May;60(5):739-44. doi: 10.1016/j.jaad.2008.12.015. Epub 2009 Mar 17.


Background: Few studies have reported the accuracy of measures used to assess sun-protection practices. Valid measures are critical to the internal validity and use of skin cancer control research.

Objectives: We sought to validate self-reported covering-up practices of pool-goers.

Methods: A total of 162 lifeguards and 201 parent/child pairs from 16 pools in 4 metropolitan regions in the United States completed a survey and a 4-day sun-habits diary. Observations of sun-protective behaviors were conducted on two occasions.

Results: Agreement between observations and diaries ranged from slight to substantial, with most values in the fair to moderate range. Highest agreement was observed for parent hat use (kappa = 0.58-0.70). There was no systematic pattern of over- or under-reporting among the 3 study groups.

Limitations: Potential reactivity and a relatively affluent sample are limitations.

Conclusion: There was little over-reporting and no systematic bias, which increases confidence in reliance on verbal reports of these behaviors in surveys and intervention research.

Publication types

  • Research Support, N.I.H., Extramural
  • Validation Study

MeSH terms

  • Child
  • Child, Preschool
  • Data Collection
  • Environmental Exposure / prevention & control
  • Health Behavior*
  • Humans
  • Parents
  • Skin Neoplasms / prevention & control*
  • Sunburn / prevention & control*
  • Sunlight / adverse effects
  • Swimming Pools
  • United States