Sophie J. Balk

Ultraviolet light: A hazard to children

BACKGROUND Sunlight is subdivided into visible light, ranging from 400 nm (violet) to 700 nm (red); longer infrared, “above red” or .700 nm, also called heat; and shorter ultraviolet radiation (UVR), “below violet” or ,400 nm. UVR is further subdivided into UV-A (320–400 nm), also called black (invisible) light; UV-B (290–320 nm), which is more skin-penetrating; and UV-C (,290 nm). UV-B constitutes ,0.5% of sunlight reaching the earth’s surface, but is responsible for most of the acute and chronic sunrelated damage to normal skin.1 Most UVR is absorbed by stratospheric ozone. UV-B has greater intensity in summer than in winter, at midday than in morning or late afternoon, in places closer to the equator, and at high altitudes. Sand, snow, concrete, and water can reflect up to 85% of sunlight, thus intensifying exposure.1

The relationship of partner support to outcomes for teenage mothers and their children: A review

This article reviews the literature on the relationship of partner support to outcomes for teenage mothers and their children. It discusses the changing alliance over time between men who father their babies and the young mothers and their children. This report considers both adults and adolescents who father children with adolescent women. The discussion focuses on the relationship between partner support and three outcomes for the mothers: educational outcomes, economic outcomes, and psychological well-being. The general association between partner support and the childrens development is also examined. In addition, partner support is viewed within the context of the teenagers family system, providing a framework for assessing key features of support for teenage mothers. The article outlines suggestions for future research.

Counseling Parents and Children on Sun Protection: A National Survey of Pediatricians

Objective. To describe pediatricians’ attitudes toward skin cancer (SC), sun protection (SP) counseling, and the quantity and content of such counseling and to identify barriers to counseling. Methods. An American Academy of Pediatrics Periodic Survey was mailed to 1616 randomly selected US members between October 2001 and February 2002. The response rate was 54.6%. Results. More than 90% of pediatricians agreed that SC is a significant public health problem and that preventing episodic high exposures to the sun during childhood will reduce the risk of adult melanoma. However, only 22.3% of respondents reported counseling most patients in all age groups. Female pediatricians were more likely to counsel most patients; pediatricians located in the South and West and those who practice in hospital/clinic settings were least likely to counsel compared with those in other regions. Approximately half (53%) of pediatricians reported selectively counseling on the basis of patient characteristics The most important SP recommendation named was using a sunscreen with a sun protection factor ≥15. Only 38% of pediatricians rated SP as very important to their patients’ health compared with other topics such as use of car seats (86%), nutrition (79%), immunization issues (76%), and smoking/avoidance of environmental tobacco smoke (74%). The most frequently named barrier to SP counseling was lack of time (58% reporting). Conclusions. Although the majority of pediatricians believe that SC prevention is a worthy issue, only a minority reported providing routine SP counseling to most patients in every age group, and most ranked SP lower in importance than other issues. Interventions might include programs and materials to educate patients and pediatricians alike. To have an effect on increasing rates of SC and SC mortality, a broader public health approach is needed as a complement to pediatricians’ counseling efforts.

Risk of ionizing radiation exposure to children: A subject review

Exposure of children to ionizing radiation most commonly is from the environment, chiefly through cosmic rays and radon, or from medical technology. Medical radiation exposure occurs during diagnosis, therapy, and dental radiography. More is known about the biological effects of exposure to ionizing radiation than to nonionizing radiation from microwaves, radiowaves, and the electrical fields of other electrical appliances. This review applies only to sources of ionizing radiation and does not include the potential risks of indoor radon. The effects on children of ionizing radiation have been studied from war activities and environmental accidents. Projections are made from that data to help pediatricians evaluate risk from radiation when ordering radiographs.

Policy statement - Ultraviolet radiation: A hazard to children and adolescents

Ultraviolet radiation (UVR) causes the 3 major forms of skin cancer: basal cell carcinoma; squamous cell carcinoma; and cutaneous malignant melanoma. Public awareness of the risk is not optimal, overall compliance with sun protection is inconsistent, and melanoma rates continue to rise. The risk of skin cancer increases when people overexpose themselves to sun and intentionally expose themselves to artificial sources of UVR. Yet, people continue to sunburn, and teenagers and adults alike remain frequent visitors to tanning parlors. Pediatricians should provide advice about UVR exposure during health-supervision visits and at other relevant times. Advice includes avoiding sunburning, wearing clothing and hats, timing activities (when possible) before or after periods of peak sun exposure, wearing protective sunglasses, and applying and reapplying sunscreen. Advice should be framed in the context of promoting outdoor physical activity. Adolescents should be strongly discouraged from visiting tanning parlors. Sun exposure and vitamin D status are intertwined. Cutaneous vitamin D production requires sunlight exposure, and many factors, such as skin pigmentation, season, and time of day, complicate efficiency of cutaneous vitamin D production that results from sun exposure. Adequate vitamin D is needed for bone health. Accumulating information suggests a beneficial influence of vitamin D on many health conditions. Although vitamin D is available through the diet, supplements, and incidental sun exposure, many children have low vitamin D concentrations. Ensuring vitamin D adequacy while promoting sun-protection strategies will require renewed attention to childrens use of dietary and supplemental vitamin D.

The Environment in Pediatric Practice: A Study of New York Pediatricians’ Attitudes, Beliefs, and Practices towards Children’s Environmental Health

Chronic diseases of environmental origin are a significant and increasing public health problem among the children of New York State, yet few resources exist to address this growing burden. To assess New York State pediatricians self-perceived competency in dealing with common environmental exposures and diseases of environmental origin in children, we assessed their attitudes and beliefs about the role of the environment in children’s health. A four-page survey was sent to 1,500 randomly selected members of the New York State American Academy of Pediatrics in February 2004. We obtained a 20.3% response rate after one follow-up mailing; respondents and nonrespondents did not differ in years of licensure or county of residence. Respondents agreed that the role of environment in children’s health is significant (mean 4.44 ± 0.72 on 1–5 Likert scale). They voiced high self-efficacy in dealing with lead exposure (mean 4.16–4.24 ± 0.90–1.05), but their confidence in their skills for addressing pesticides, mercury and mold was much lower (means 2.51–3.21 ± 0.90–1.23; p < 0.001). About 93.8% would send patients to a clinic “where pediatricians could refer patients for clinical evaluation and treatment of their environmental health concerns.” These findings indicate that New York pediatricians agree that children are suffering preventable illnesses of environmental origin but feel ill-equipped to educate families about common exposures. Significant demand exists for specialized centers of excellence that can evaluate environmental health concerns, and for educational opportunities.

State of the Science on Prevention and Screening to Reduce Melanoma Incidence and Mortality: The Time is Now

Answer questions and earn CME/CNE

Teens and Indoor Tanning: A Cancer Prevention Opportunity for Pediatricians

In October 2011, California became the first US state to ban indoor tanning for minors under age 18 years. Vermont followed in May 2012. Increasingly, scientific evidence shows that artificial tanning raises the risk of skin cancer, including melanoma, a common cancer in adolescents and young adults and the type most likely to result in death. The World Health Organization, the American Academy of Pediatrics, the American Academy of Dermatology, the American Medical Association, and other organizations strongly recommend legislation to ban minors under age 18 from indoor tanning. Several nations have banned teen tanning. Yet, tanning in salons is still a prevalent practice in the United States, especially among teen girls, where rates for the oldest teens approach 40%. There is no federal legislation to restrict minors from salon tanning. More than 60% of states have some kind of legislation regarding minors’ use of tanning salons, but only California and Vermont have passed complete bans of indoor tanning for minors. The Indoor Tanning Association, an industry advocacy group, has vigorously opposed legislative efforts. Pediatricians can play key roles in counseling families and with legislative efforts. In this update, we review the prevalence of salon tanning, association with skin cancer risk, tanning addiction, the roles of the federal and state governments in regulation and legislation, and responses to arguments created by industry to oppose legislation. Preventing exposure to artificial tanning may save lives, including young lives, and is a key cancer prevention opportunity for pediatricians.

Teaching About Pediatric Environmental Health

P ediatricians are often asked about pediatric environmental health (PEH) issues but feel unprepared to respond as a result of inadequate training. The Accreditation Council on Graduate Medical Education’s Residency Review Committee states that pediatric residents should acquire an understanding of environmental influences on children’s health, including instruction about the effects of environmental toxicants. Because such educational efforts depend on the presence of faculty with PEH expertise, it is necessary to understand faculty members’ knowledge of PEH subjects and their educational needs. This investigation had three aims: to determine level of confidence in PEH teaching reported by faculty expressing PEH expertise, to identify barriers to PEH educational activities, and to identify strategies to augment PEH teaching in medical education. The study was approved by the Institutional Review Board of the Medical University of South Carolina. One author (James R. Roberts) developed a questionnaire and then sent it to the American Academy of Pediatrics (AAP) Committee on Environmental Health (COEH) for input. The revised questionnaire was distributed at the 2004 Pediatric Academic Societies’ meeting to workshop participants convened by the COEH in collaboration with the Ambulatory Pediatric Association Environmental Health Special Interest Group. Participants were asked whether they considered themselves expert in PEH and whether they had formal PEH training (eg, fellowship training, advanced degree). Twelve 5-point Likert scale questions requested information from participants about confidence in ability to teach particular subjects; 6 additional questions asked about attitudes and barriers to teaching PEH. We used open-ended questions about

Stronger Laws Are Needed to Protect Teens From Indoor Tanning

* Abbreviations: FDA — : US Food and Drug Administration The article by Balaraman et al1 in this issue of Pediatrics examines practices of indoor tanning facilities in Missouri, 1 of 17 states with no regulations regarding minors’ use of these facilities. More than two-thirds of respondents working at the facilities stated that they would allow children as young as 10 to 12 years old to tan, some without parental consent. More than 40% claimed that there were no tanning-associated health risks. The study’s findings are alarming but unfortunately not surprising given that there is no law in Missouri protecting minors from indoor tanning. Indoor (“artificial”) tanning is a