NEW YORK - Another problem: Kids who pursued physical exercise were twice as likely to suffer sunburns. That wasn't surprising, but it concerned the study's authors because the brochures about exercise were separate from those about sun protection and avoiding rays between 10 a.m. and 4 p.m. - meaning some kids might get one message, but not the other.
"Physicians are in the habit of writing prescriptions and advising how to use the medication. It is a huge step for physicians to take the step of engaging the parent/child in the decision to change behaviour," Dr. June Robinson, the senior author of the study, told Reuters Health by email.
It's possible that the way pediatricians offer such counseling - more as a prescription rather than as a way to engage parents and find ways to change their behaviour - led to the results, said Robinson, a dermatology professor at Northwestern University Feinberg School of Medicine.
In 2011, the American Academy of Pediatrics recommended that children's doctors should advise their patients about sunburns and tanning.
To get a sense of what advice doctors offer, Robinson and her colleagues surveyed 30 medical staff members at three pediatricians' offices in the Chicago area about their recommendations regarding sun protection.
One office provided the most extensive counseling on sun protection, offering it year-round during regular check-ups, physical exams and when the child came in with a sunburn.
This included advice on wearing and reapplying sun block and protective clothing and seeking shade.
The office that provided the least extensive counseling only advised families about sun protection when they were about to go on a family vacation or to summer camp or when the child had a sunburn.
Staff there also only offered recommendations on wearing sun block.
The other office fell somewhere between the two in how much sun protection counseling it provided.
Robinson's colleagues then surveyed 100 parents who had visited one of the offices with a child between nine and 16 years old.
They asked the parents about their children's behaviours, such as how long they spent in the sun, whether they used indoor tanning, how many sunburns they had had, and whether they used sun block.
The researchers found that the parents who visited the office with the most extensive counseling were no more likely to practice sun-safe habits than the parents who visited the office that offered the least amount of advice.
For instance, children who were seen at the office that gave the most advice scored an average of 10 on a 39-point scale of how well they were sun-protected, compared to a score of 12 among children seen at the office that offered the least advice.
A score of one is considered best protected, while 39 is totally unprotected from the sun.
When Robinson's group took into account factors such as the child's age and skin tone, the differences between the offices were so small that they were likely due to chance.
And those children who exercised outdoors between 10 a.m. and 4 p.m. "were twice as likely to use inadequate sun protection and sustain sunburns," according to the study, than those who performed exercise outside of those hours.
Robinson said that doctors can be effective at promoting behaviours among families, but that they might need to change their communication style.
"Communication by physicians with parents in a way that incorporates the principles of motivational interviewing, a patient-centred technique that attempts to engage patients in order to find reasons to change behaviour that resonate with each individual, may be more effective in promoting behavioural change than admonitions to use sunscreen," she said.
Lori Crane, a professor of community and behavioural health at the Colorado School of Public Health, has found in an earlier study that doctors who do offer more extensive counseling on sun protection end up with patients more likely to stick to that advice.
"The methodology in (the current) article is not really very strong for coming up with this conclusion that sun protection counseling doesn't have an effect," said Crane, who did not participate in the latest research.
Crane pointed out that there's no direct measure of how much counseling each family received, leaving room for the possibility that some families at each office received more or less.
Robinson and her colleagues write in their report in The Journal of Pediatrics that because they didn't directly observe the counseling, there could have been potential errors in how much the staff remembered giving.
However, "since these are stable and well established practices, the pediatricians have a continuing relationship with the families and have counseled prior to the survey," she said.
Dr. Richard Roetzheim, a professor of family medicine at the University of South Florida, who was not involved in the study, said he "wasn't really convinced by this study that counseling doesn't work."
However, he was pleased to see a study like this.
"I think physicians are increasingly being called on to change patients' behaviours," Roetzheim told Reuters Health, and it's important to see what works.