Sun-Safety Understanding Among Canadian Elementary Students: A Survey-Based Cohort Study Across Racial/Ethnic Groups.

Background: Early promotion of sun-protective behavior may play a pivotal role in skin cancer prevention. School-based interventions have shown effectiveness in increasing sun-safety knowledge, yet few studies assess children's baseline perceptions before formal education.

Objective: To assess elementary students' baseline sun-safety perceptions before an educational session.

Methods: Elementary students completed online surveys before sun-safety presentations (May 2023-April 2024). Race/ethnicity data were collected for subgroup analyses.

Results: Among 260 respondents (mean age 12; 51.2% female), the race/ethnicity distribution included White (53.9%), Asian (13.9%), Mixed race (7.7%), and Black (6.9%) students, with smaller proportions of Hispanic, Arab, and Indigenous students (each 1.9%). While most students had positive attitudes toward photoprotection and negative perceptions of tanning, notable differences emerged. Regular sunscreen use was more challenging for Black, Hispanic, and Indigenous respondents. Pressure to tan was highest among Indigenous and Asian respondents, and Arab respondents most associated tanning with aging. Indigenous and Hispanic respondents had the highest tanning rates, while Indigenous and White respondents had the highest sunburn rates.

Conclusions: Sun-safety perceptions and behaviors varied across racial/ethnic groups. Most students understood that sun exposure contributes to skin cancer, recognized the importance of sunscreen, and acknowledged that darker skin can benefit from sun protection. However, misconceptions remained about sun-protection factor (SPF) meaning, sunscreen use on cloudy days, and the belief that sunscreen fully prevents tanning-related damage. Future studies should explore how sun-safety education can be better tailored for diverse populations.