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

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.