26th October 2018, Volume 131 Number 1484

Ryan Gage, Michelle Barr, James Stanley, Anthony Reeder, Christina Mackay, Moira Smith, Tim Chambers, William Leung, Louise Signal

Skin cancer accounts for up to 80% of total cancer cases in New Zealand.1 Each year, there are over 2,000 incident cases and 350 deaths from melanoma,2 and over 90,000…

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Our study used wearable cameras to explore sun protection and shade availability in New Zealand’s outdoor recreation spaces at times when sun protection was warranted. Children wore the devices, which captured images of 2,635 people in 16 outdoor recreation spaces (beaches, playgrounds and pools). We assessed the clothing worn and shade used by each person, as well as the amount of shade available in each setting. Only 4.3% of the people observed wore sun-protective hats and only 10.7% were under shade. New Zealand has the highest rate of skin cancer in the world. Our findings highlight the need to encourage sun safety behaviours and increase opportunities for shade in outdoor recreation settings.



We aimed to investigate sun protection behaviours and shade availability in outdoor recreation spaces using images captured by children who, in 2014/15, wore wearable cameras for four consecutive days.


The 168 participants visited 16 outdoor recreation spaces between 10am and 4pm, capturing 378 images, on average, in each setting. People observed in the images (n=2,635) were coded for age, sex, clothing worn (38 clothing types) and shade used. Mean temperature and ultraviolet index (UVI) values were linked with the time-stamped and geo-referenced images.


The UVI in most settings was high enough to warrant sun protection, but only 4.3% of people wore sun-protective hats (broad-brim, bucket and legionnaire styles) and 10.7% used shade. Areas most popular with children, including playground equipment, beach sand and pool areas, had little or no shade available.


Despite New Zealand having the highest incidence of melanoma skin cancer in the world, the results indicate that few New Zealanders wear hats and seek shade in outdoor recreation settings. The findings highlight the need to improve policy and environmental support for skin cancer prevention activities.

Author Information

Ryan Gage, Assistant Research Fellow, University of Otago, Wellington; 
Michelle Barr, Assistant Research Fellow, University of Otago, Wellington; 
James Stanley, Research Fellow/Biostatistician, University of Otago, Wellington; 
Anthony Reeder, Research Associate Professor, University of Otago, Dunedin; 
Christina Mackay, Lecturer, Victoria University of Wellington, Wellington; 
Moira Smith, Research Fellow, University of Otago, Wellington; 
Tim Chambers, Assistant Research Fellow, University of Otago, Wellington; 
William Leung, Lecturer, University of Otago, Wellington; 
Louise Signal, Professor, University of Otago, Wellington.


We thank the children, parents and caregivers who let us into their lives. We also thank the wider Kids’Cam team for their work in producing the image data including, Jiang Zhou, Aaron Duane, Cathal Gurrin and Alan Smeaton at Dublin City University, and Professor Cliona Ni Mhurchu at the National Institute for Health Innovation, University of Auckland. This research was funded by a University of Otago, Wellington Dean's Grant. The Kids’Cam project was funded by a Health Research Council of New Zealand Programme Grant (13/724), by Science Foundation Ireland (Grant 12/RC/2289), and a European Commission FP7 International Research Staff Exchange Scheme (IRSES) funding award (2011-IRSES-295157-PANAMA). Associate Professor Reeder and the Cancer Society Social & Behavioural Research Unit receive support from the Cancer Society of New Zealand Inc. and the University of Otago. The cameras and GPS recorders were funded by a University of Otago Wellington Research Equipment Grant.


Ryan Gage, Health Promotion & Policy Research Unit, Department of Public Health, University of Otago, PO Box 7343, Wellington 6242.

Correspondence Email


Competing Interests

Dr Stanley and Dr Leung report grants from New Zealand Health Research Council during the conduct of the study. Dr Reeder reports grants from Cancer Society of NZ Inc and Cancer Society of NZ Inc, non-financial support from University of Otago, outside the submitted work.


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