Maximising students' use of purpose-built shade in secondary schools: Quantitative and qualitative results of a built-environment intervention
Introduction
Reducing exposure to ultraviolet radiation (UVR) in sunlight is advocated for primary prevention of skin cancer (Saraiya et al., 2004, Armstrong, 2004). Sun protection can be encouraged via provision of environments supporting and enabling people to use sun protection (World Health Organisation, 1986, Saraiya et al., 2004). Where shade is extensive in a particular outdoor setting it might be utilised for active pursuits such as walking, running and swimming, while localised shade is more suited for passive recreation. Many forms of shade, including both built and natural shade, such as trees, can provide good reductions in overall UVR exposure (Gies and Mackay, 2004, Gies et al., 2007). There is also good evidence that shade use results in sufficiently reduced UVR exposure to decrease the odds of sunburn of Australians who were outdoors on summer weekends (Dobbinson et al., 2008). The WHO recommend the use of shade, and other sun protection measures, during the seasons and times of the day when ambient UVR levels reach above a UV index of three (World Health Organization, 2002) to balance the benefits of exposure to sunlight for healthy bones, and other potential health benefits (Norval et al., 2011, Australian and New Zealand Bone and Mineral Society,).
In Australia, where rates of skin cancer are among the highest in the world (Parkin et al., 2005, Liang et al., 2010), there is a need for sun protection throughout the year in many jurisdictions and through spring and summer months in all states (Samanek et al., 2006, Roy et al., 1995). Adolescents have been typically resistant to using sun protection (Livingston et al., 2007, Livingston et al., 2003) despite widespread knowledge of skin cancer risks (Livingston et al., 2001). Peer fashions and norms tend to discourage adolescents wearing hats or covering clothing (Potente et al., 2011, Broadstock et al., 1996).
Given slow uptake of sun protection policies by secondary schools (SunSmart Schools Program, 1999), a built shade intervention at schools was tested as an alternative strategy to promote adolescents' sun protection (Dobbinson et al., 2009). This pre-post cluster randomised trial built 23 shade-sails in secondary schools. The trial found increased use of the newly created shaded areas compared with unshaded areas at control schools, and no evidence of shade avoidance by students moving into adjacent unshaded areas near the intervention areas (Dobbinson et al., 2009). Although promising, the increase in the mean number of students using the newly shaded areas at any given observation time was relatively small. For this reason we were interested in identifying factors that maximised students' use of the shade sail areas at the schools. The current study examined the effect of the physical characteristics of the study areas and ambient weather conditions on the variation in numbers of students using the newly shaded areas at intervention schools. The study also explored students' opinions about the shade sails and their reasons for use or non-use of these newly shaded areas.
Section snippets
Methods
The detailed methods of the trial, including the flow of school clusters (n=26 control and n=25 intervention schools) and main findings on efficacy are published (Dobbinson et al., 2009). In brief, the study recruited secondary schools with limited available shade located in the outer suburbs of Melbourne, Australia. The methods entailed video observation (with content analysis) of student numbers using predefined study areas at the schools during lunchtimes before and after building
Quantitative findings
The post-test analyses included 10–14 observation dates per school (n=267 school dates overall), with 85 missing observations excluded. Table 1 describes the variation in area features across the schools. Common features at intervention study areas were seats only (41%) or tables with seats (36%), ground surface of grass (50%) or paving (41%), and near-by garden beds (50%) or near-by tall trees (59%). Fifty-five per cent of areas had a shade-sail of at least 70 m2. The ambient temperatures
Discussion
Our findings assist in identifying key features of passive recreation areas at schools that could be used to maximise students' use of shade sail areas during lunch time. The qualitative research highlighted that students viewed their use of school areas during the lunch break to be largely governed by age demarcations and habitual use/perceived ownership of specific areas by their social group rather than consideration of a need for sun protection. Shade was also considered valuable to
Conclusions
Students' use of built-shade had a strong positive relationship with presence of tables and seats, a weak positive relationship with temperature, and a weak negative relationship with presence of grass. Accordingly, the built environment can exert a strong influence on students' shade seeking behaviour, particularly where tables and seats are provided. Our findings suggest this occurs without promotion of health benefits or coercions for use. Sustainability is an important advantage of this
Acknowledgements
We acknowledge the funding support of the Australian National Health and Medical Research Council (Research Project Grant id: 265902). We acknowledge the work of Professor Dallas English for his contributions to study development. We also thank the participating schools and their staff and students, the shade-sail manufacturer, and the research assistants for their contributions to this study.
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