Public sunscreen dispensers and sun-protective behaviours: an observational study in Toronto, Canada.

Background: Skin cancer is the most common type of cancer in the United States. Rates of melanoma, a malignant form of skin cancer, are on the rise and are high among people under 30 years of age. Objective: This study aims to explore factors related to sun protection and tanning behavior and examine the influence of social media use and health information-seeking behaviors (HISB) on sun protection actions among a group of college students. Methods: In this cross-sectional study, students (N=258) at a large public university completed a survey that included questions on sun safety and tanning attitudes and behaviors, as well as HISB. A sun protection behavior score was created on the basis of behaviors related to seeking shade, using sunscreen, tanning booth and bed use, and the number of lifetime blistering sunburns. Multivariate logistic regression analyses were performed to assess associations between high and low sun protection behavior and sun safety and tanning attitudes and HISB. Results: The majority of participants were females (164/258, 63.8%), 31.0% (80/258) were white, and the mean age was 20.3 (SD 4.1) years. Females (odds ratio [OR] 0.42, 95% CI 0.22-0.81) and believers that suntan improves appearance (OR 0.25, 95% CI 0.10-0.66) were less likely to have “high” sun protection behaviors. Conclusions: The cultural belief that having a suntan improves appearance, especially among female college students, results in low sun protection behaviors. Interventions can be developed to improve skin cancer-related HISB among college students with the aim of developing better cognizance of skin cancer and sun protection behaviors.

The association between skin cancer and ultraviolet radiation (UVR) is well established, and sun protection behavior represents an important preventative measure. In children, caregivers play a key role in this regard. The subject of this study was threefold: whether caregivers of 1 to 11 year-old children are more likely to use sun protection measures compared to non-caregivers, whether considering oneself a role model is associated with sun protection behaviors, and whether their sun protection and risk behaviors are related to children’s behaviors. We used data from the 2020 wave of the National Cancer Aid Monitoring (NCAM) comprised of 4000 individuals (including 554 caregivers of at least one child aged 1–10 years) aged 16 to 65 years and living in Germany. Data were collected through telephone interviews between October and December 2020. No significant differences between caregivers and non-caregivers regarding sun protection and risk behaviors were identified (except tanning on vacation). In both groups, sun protection behaviors were deficient. Caregivers who considered themselves role models concerning sun safety were more likely to use sun protection measures (e.g., using sunscreen on the face: OR = 5.08, p < 0.001). In addition, caregivers’ sun protection behaviors were positively associated with children’s behaviors. Caregivers being highly protected against UVR were more likely to report the use of different measures by/in the child (mean = 4.03), compared to caregivers with medium (3.41) and low (2.97, p < 0.001) protection levels. However, we also found that caregivers’ risk behavior was associated with children’s reported risk behavior. For future prevention, it might be worth focusing on the aspect of caregivers serving as role models. A comprehensive public-health strategy is needed, including key figures such as pediatricians to prevent today’s children from developing skin cancer in later life.

Farmers and farmworkers face increased risks of skin cancer from exposure to solar ultraviolet radiation (UVR) when working outdoors. The objective of this study was to evaluate the evidence from behavioral and intervention studies from the peer-reviewed studies related to sun safety among farmers and farmworkers and identify any gaps in the literature. A comprehensive review was conducted between 1990 and 2013; 22 studies were identified related to behavior and health interventions of sun safety among these targeted groups. The inconsistency of data collection methods makes it difficult to estimate with accuracy any overall meaningful results of behavior. However, from the studies reviewed, farmers and farmworkers most frequently reported wearing some type of hat (23.6%–100%) as a primary method of protection from the sun when working outdoors. Female farmers were more likely than male farmers to use sunscreen and engage in indoor tanning behavior. All sun safety educational interventions studies reviewed reported positive increases in behavioral change. To a large degree, adequate sun protection is lacking and varies geographically among farmers. Although targeted education is key to making improvements on sun protection behavior, aggressive attempts have to be made. Studies related to farmworkers, sun safety behavior, and skin cancer are scarce and more research is needed in this area.

Objective Agricultural workers face significantly higher ultraviolet radiation (UVR) exposure than indoor workers, increasing their skin cancer risk. This systematic review evaluates peer-reviewed literature from 2013 to 2024 on sun safety behaviors and interventions among agricultural workers. Methods Following PRISMA guidelines, a search was conducted across PubMed, SCOPUS, Cochrane Library, Web of Science, Agricola, and EBSCO using MeSH terms and keywords including “farmworker,” “sun safety,” “skin cancer,” and “interventions.” Eligible studies were full-text manuscripts published in English between February 1, 2013, and May 15, 2024. A total of 166 manuscripts were identified, with 84 remaining after duplicate removal. Two independent reviewers screened the abstracts and full texts, resulting in 38 manuscripts. Eight additional manuscripts were added after reference review. Results Of the 46 included studies, 39 (84.8%) were primary and seven (15.2%) were secondary studies. While five of the primary studies were intervention-focused, 34 were primarily descriptive. Geographically, 71.7% of studies investigated populations outside the U.S. while 17.4% focused on U.S. farmers. Knowledge levels and attitudes about sun protection varied significantly. Sun protection behaviors also varied widely, with hats and long pants being more commonly used methods, although regional and cultural differences were evident. In terms of intervention-based studies, multicomponent strategies, like workplace-specific action plans, highlighted the effectiveness of tailoring interventions to workplace culture and environmental needs. Conclusions Research on sun safety interventions for agricultural workers remains limited. As a one-size-fits-all approach is ineffective, future research should prioritize designing and evaluating tailored, workplace-driven interventions in collaboration with employees.

e22505 Background: Decreasing unprotected exposure to ultraviolet (UV) radiation during childhood can significantly decrease the risk of developing skin cancer as an adult. School-based sun safety curricula have demonstrated efficacy in teaching young adults about the harms of prolonged, unprotected UV exposure and have been effective in increasing safety practices. This project provided a 50-min sun safety curriculum to high school students at a public high school in San Diego, CA just prior to the summer break in 2022. The curriculum addressed skin cancer risk factors, skin protection methods, the benefits of limiting lifetime UV exposure, and methods for performing a skin self exam. The study objective was to assess sun safety knowledge before and after the class, and measure behavior changes three months thereafter when students returned from summer break. Methods: The sun safety classes were taught in groups of 40-60 students across six class periods in June 2022. Students were asked to complete an anonymous pre-participation online survey assessing their knowledge of common skin cancer types and skin cancer risk factors. Students were taught the curriculum over 45 minutes with 5 minutes reserved for questions. Two follow-ups surveys were conducted with the students, one at the end of the class period and a second follow-up three months later. Follow-up surveys assessed retention of knowledge and changes in sun safety behavior. Students had the option of providing a cell phone number so they could be contacted to participate in the second follow-up survey. Results: The curriculum was taught to nine classes of approximately 300 students in a single day across six class periods. A total of 206 students completed the pre-participation survey. At the first follow-up, 95.1% of students completed the post-participation survey and students showed significant improvement in knowledge of common skin cancer types (12.6% pre-participation to 68.9% post-participation), skin cancer risk factors (11.2% pre-participation to 16.8% post-participation), and skin cancer prevention methods (22.8% pre-participation to 45.9% post-participation). For the second follow-up, 128 students provided contact information and the survey had a response rate of 71.5%. After 3 months, students demonstrated retention of knowledge of skin cancer types and risk factors. A majority (87.2%) of students indicated that their use of sunscreen had increased and 57.4% indicated that their use of sun protective barriers had increased over the summer because of this course. Conclusions: This pilot course demonstrates that targeted sun safety education for teenagers before summer break can significantly increase sun safety awareness, adoption of protective behaviors, and knowledge about skin cancer. Such an intervention can promote skin cancer awareness at a young age where behavior changes can decrease lifetime risk of skin cancer.

Solar ultraviolet radiation has been acknowledged as the main culprit for the three major types of skin cancer which are among the most numerous (basal cell carcinoma [BCC], squamous cell carcinoma [SCC]) and most dangerous (cutaneous malignant melanoma) malignancies in Caucasian populations. The present thesis comprises six individual projects providing a multifaceted perspective on the prevention of these tumours. Project I evaluated a school-based sun safety education programme developed by the Swiss Cancer Leagues. Primary school students in the Canton of Zurich (North-Eastern Switzerland) were asked to answer a questionnaire regarding their sun-related knowledge, behaviour, and sunburn experience shortly before and one year after the intervention (repeated cross- sectional assessment). Based on the data from more than 3000 students, the sun safety education programme was effective in sustainably improving children’s sun-related knowledge and possibly to some extent in decreasing sunburn rates, but had no obvious impact on the examined sun protective behaviours (use of sunscreen, seeking shade). Project II represents a systematic review of cross-sectional and interventional studies on sun-related knowledge, attitudes, and protective behaviours of outdoor workers. The 52 relevant publications identified through an electronic search of medical literature databases (PubMed, Embase, PsycINFO) and an extensive hand search suggested that outdoor workers’ sun protective behaviours are largely inadequate and sunburn rates are high (50-80% per season). However, there is evidence that sun safety education in outdoor occupational settings is effective in increasing workers’ protective behaviours and presumably also in reducing sunburn incidence. Project III investigated sun protective behaviour and sunburn experience of vacationers spending holidays in the tropics or subtropics. The 1165 standardised face-to-face interviews conducted among air passengers waiting in the departure or baggage claim area at the Airport Basel-Mulhouse (Switzerland/France) and among vacationers waiting for pre-travel health advice at the Travel Clinic of the Swiss Tropical and Public Health Institute Basel (Switzerland) revealed that almost all respondents used sunscreen at the holiday destination. Nevertheless, wearing a sunhat and protective clothing as well as seeking shade were clearly less common sun protection methods. The assessed sunburn rate among the 324 interviewed returning air passengers was alarmingly high, with 44% having suffered from sunburn during their holiday stay. Project IV comprehensively analysed the content and quality of 2103 print media articles pertaining to skin cancer prevention and related topics (solaria, vitamin D) published in Germany and Switzerland over a one-year period (2012-2013). Whereas skin cancer secondary prevention received little press attention, primary prevention was a frequently covered media topic. However, the delivered information was generally rather superficial. By far the most common and often sole sun protection recommendation made was the use of sunscreen. In total, 27% of all analysed articles contained misleading or erroneous statements which were mostly related to the use of sunscreen and vitamin D issues. Projects V and VI are based on data derived from the Clinical Practice Research Datalink, a large, well-validated primary care database established in the United Kingdom (UK). Project V estimated BCC incidence in the UK and characterised affected patients regarding lifestyle factors and comorbidities. The calculated age-standardised BCC incidence in adults rose from 119 to 165 per 100 000 person-years between the years 2000 and 2011. According to the matched case-control analysis including 57 121 BCC cases and 57 121 BCC-free controls, BCC risk was slightly increased in alcohol drinkers, but reduced in smokers and in individuals with a body mass index outside the normal range. BCC was associated with various comorbidities related to iatrogenic or non-iatrogenic immunosuppression. Project VI explored whether patients regularly exposed to systemic nonsteroidal anti- inflammatory drugs (NSAIDs) are at a reduced risk of nonmelanoma skin cancer (NMSC). The matched case-control analysis comprised 65 398 BCC cases, 65 398 BCC-free controls, 7864 SCC cases, and 31 456 SCC-free controls. Overall, NSAID use was not negatively associated with BCC, but when looking exclusively at users of single NSAID substances there was a suggestion of a reduced BCC risk in regular users of aspirin and ibuprofen. SCC risk was slightly decreased in regular users of any NSAIDs, with the strongest risk reduction observed in current users of coxibs. These findings provide evidence that patients predisposed to NMSC may benefit from chemoprevention with NSAIDs.

Skin cancer is one of the most preventable types of cancer, yet agricultural workers especially women remain at high risk due to prolonged sun exposure and limited access to preventive health education. This study aimed to evaluate the effect of a social media based educational program on agricultural women's knowledge of skin cancer risk, self skin examination (SSE), and sun protection behaviors. The single-group pretest-posttest design was employed among 85 agricultural women in the Fethiye district of Muğla, Turkey, between May and July 2024. Participants completed pretest and posttest assessments using a Personal Data Form, the Knowledge and Practices about Skin Cancer and SSE Form, and the Sun Protection Behavior Scale (SPBS). The intervention consisted of five weeks social media-based educational program incorporating culturally adapted visual and interactive content on skin cancer prevention, SSE, and sun safe behaviors. The analysis was performed employing IBM SPSS, with the utilisation of descriptive statistics, paired-sample t-tests, and McNemar tests. Following the social media-basededucation program, participants showed significant improvements in knowledge and protective behaviors related to skin cancer. The mean knowledge score for skin cancer risk factors increased from 5.08 ± 1.08 to 7.67 ± 0.76 (p < .001), and knowledge of symptoms rose from 8.75 ± 1.70 to 11.81 ± 1.38 (p < .001). The Sun Protection Behavior Scale score also improved from 24.98 ± 4.39 to 25.72 ± 2.40 (p < .001), with significant gains in sun avoidance, sunscreen use, and hat wearing behavior. Knowledge and performance of self skin examination (SSE) improved remarkably; after the intervention, all participants correctly identified SSE principles, including the ABCDE rule, and 88.2% reported performing SSE (p < .001). The social media-based educational program substantially improved agricultural women's knowledge of skin cancer risk factors, self skin examination, and sun protection behaviors. These findings suggest that culturally adapted digital interventions can serve as practical, scalable strategies to promote skin cancer awareness and early detection among rural populations with limited access to traditional health education.

BackgroundAdequate sun safety during childhood is crucial for decreasing skin cancer risk in later life. Although parents are an essential target group in applying sun protection measures for their children, insight into the determinants associated with their sun protection behaviors is limited.AimsThis study aims to identify the most relevant determinants in predicting multiple parental sun protection intentions and behaviors in different sun exposure situations.MethodA longitudinal survey study with two measurements was conducted among Dutch parents (N = 670) of children (4–12 years old). Twenty-seven sociocognitive determinants were examined in terms of relevance regarding four parental sun protection behaviors in different sun exposure situations. The Confidence Interval-Based Estimation of Relevance approach was used to visualize room for improvement (sample means) on all determinants and their association strengths (correlations) with sun protection intentions and behaviors.ResultsBehavior-specific rather than generic determinants were most relevant in explaining all sun protection behaviors. Of these determinants, attitude, self-efficacy and action planning, and especially parental feelings of difficulty in performing sun protection behaviors, were most relevant. Altogether, the explained variance of all sociocognitive determinants was highest for shade-seeking behavior (R2 = .41 and .43) and lowest for supportive behavior (R2 = .19 and .29) in both planned and incidental sun exposure situations, respectively.DiscussionThis study provides detailed insight into relevant sociocognitive determinants of parental sun protection behaviors in various sun exposure situations and directions for composing parental skin cancer prevention interventions.ConclusionsFuture composition of sun safety interventions should emphasize on enhancing parental feelings of self-efficacy, especially for shade-seeking and clothing behaviors.

Issue addressedSun protection practices in Australian primary schools remain inconsistent. Therefore, this study investigates primary PSTs sun protective sun behaviours, ultraviolet (UV) radiation awareness and perceived ability to teach sun safety.MethodsA convenience sample of undergraduate PSTs (N = 275; mean age = 23.13 years) enrolled at one Western Australian university completed an online survey. Descriptive analyses provided features of the data. Factors associated with sun protection behaviours and perceived knowledge and skill to teach sun safety were explored using multivariable logistic regression models.ResultsLesser than 10% of participants reported using sun protective measures daily (midday shade use: 6.5%; sunscreen: 7.6%; hat: 4.4%). Only 56.3% reported they understand the UV index, with 68.0% rarely/never using it to aid sun protection. Under half the participants reported they felt they had the knowledge (38.5%) or skills (40%) to effectively teach sun safety in primary schools. Regression analysis revealed gender, undergraduate, year and skin sensitivity were not predictors of UV index use (P > .05) or perceived knowledge of sun safety (P > .05). Skin sensitivity was the strongest predictor for shade usage (P = .02), hat usage (P = .05) and perceived skill to teach sun safety (P = .02).ConclusionsSurvey data indicate UV radiation is inconsistently understood by PSTs. Many felt that they did not have the required knowledge or skill to teach sun safety effectively.So what?Improving PSTs UV radiation knowledge while at university is a potential opportunity to improve sun safety delivery in primary schools. A targeted intervention for PSTs is warranted.

The steady increase in the incidence of melanoma, non-melanoma cutaneous neoplasia and preneoplastic disorders has contributed to the demand for more effective protection from the sun. In this study, we aimed to determine the prevalence of sunscreen use and other sun protection behaviors in a large sample of students and personnel of Celal Bayar University, Manisa, Turkey. The study group included 1018 participants of whom 607 work in the Celal Bayar University Hospital and 411 are students from the Medical Faculty and School for Health Professionals. All participants completed a questionnaire composed of 45 items about sun protection and other health behaviors, such as sports activity, use of cigarettes, alcohol and seat-belts. Sun protection factor (SPF) of sunscreen, avoiding sun exposure during peak hours, wearing clothing, a hat and sunglasses were studied. Of the 1018, 403 participants were male and 615 were female. While avoiding sun exposure during peak hours was the most popular preventive behavior for men (42.5%), wearing sunglasses was the most popular one for women (50.7%). Avoiding exposure was the second preventive behavior for women (42.1%). Use of sunscreen with SPF 15+ was the second popular protective measure for men (19.4%) and the third one for women (39.2%). There were no significant relationships between sun protection behaviors and obesity, use of cigarettes and alcohol. We also investigated behavioral changes with sunburn experience in the participants who had sunburn history. Among these behavioral changes, increased use of sunscreen and decreased sun exposure during peak hours with sunburn experience were significant. Our study demonstrated that the risk of sun exposure is largely unrecognized in Manisa, Turkey, and we have very incomplete information about protective measures. An efficient policy of education on the effective use of sun protection methods should be developed to prevent skin cancer.

BackgroundSunburns during childhood are strongly associated with development of melanoma in later life. While parents play an important role in children’s sun protection, insight in possible shifts in behavioral responsibility from parents towards their children and the possible effect of children’s sex is important for targeting sun safety interventions throughout childhood and adolescence.MethodsThis cross-sectional survey study was conducted among a representative sample of Dutch parents (N = 1053) of children aged between 4 and 13 years old. Questionnaires measured both parental and children’s own sun safety behavior during planned (e.g. going to the beach) and incidental (e.g. bycicling) sun exposure situations. Analyses of variance were used to test for age group differences and linear regression models were computed to detect behavioral shifts in executive behavior.ResultsParents applied all sun safety behaviors (i.e. sunscreen use, wearing UV-protective clothing and seeking shade) more often on younger children, except for supportive behavior (facilitating children’s own sun safety behavior), which remained relatively stable over the years. Older children and girls were more likely to execute sun safety behaviors themselves. A behavioral shift was found in wearing UV-protective clothing during planned situations among 11 year old children. For other behaviors, shifts were predicted after the age of 13.ConclusionsOlder children execute sun safety behaviors more often than younger children, although they still largely depend on their parents’ protection. Specific attention for boys in the primary school years, and for both boys and girls in the years adjacent to adolescence is warranted in skin cancer prevention interventions.

Background: Melanoma is the third most common cancer in individuals ages 15 – 29. The greatest risk for melanoma is ultraviolet (UV) radiation from the sun. Collegiate athletes are exposed to 1,000 more sun hours per year than the average adult, placing them at higher risk for melanoma. Evidence supports sunscreen education and screening to promote protective behaviors in young adults. Objective: This evidence-based pilot project implements the standardized screening of sunscreen use and sun protective behaviors in women’s soccer players ages 18 to 21 years old at the University of San Diego. Methods: The Sun Exposure and Protection Index (SEPI), reflecting both UV exposure risk and sun protective behaviors, was administered to female soccer players before and after the intervention period. Athletes were instructed to apply SPF 50 to the face, neck, and chest once daily for 7 days while practicing on the soccer field. Educational materials about sun safety were provided. Principles of the Iowa Model and Health Belief Model guided this pilot project. Outcomes: Twenty-two athletes participated in this pilot. 86.4% reported using sunscreen 5 or more days during the intervention period. 100% reported sunscreen use 3 or more days during intervention period, compared to 45.4% prior to implementation. The average score on the SEPI Part 2 prior to the pilot was 10. After intervention, there was an average reduction of 1.45 points in SEPI Part 2 scores, representing an increased propensity for sun protection and improved sun protection behaviors. Sun exposure screening should be considered as primary prevention in college athletes, who are at an elevated lifetime risk of ultraviolet radiation exposure. Furthermore, providing sunscreen and educational materials prior to sun exposure may decrease the risk of future melanoma in this high-risk population.

B16 Background Behaviors such as sunscreen use and use of skin-protective clothing can help prevent skin cancer, but little is known about how these sun protection behaviors vary by phenotypic risk factors for skin cancer. Objective We carried out a cross-sectional study (n = 6898) nested within a community-based prospective cohort in Washington County, MD. We measured the associations between skin cancer risk characteristics (skin type, complexion, freckling, and eye color) and personal sun protection behaviors (sunscreen and sun-protective clothing use). Results The prevalence of regular use of sunscreen was 23%, and the prevalence of regular use of sun-protective clothing was 21%. There were consistent trends indicating those at highest risk of skin cancer were most likely to engage in sun protection behaviors. For example, compared to those who tan without burning, those who develop blistering sunburns were more likely to use sunscreen (OR 6.55, 95% CI 3.08 -13.92 men, OR 4.87, 95% CI 3.34 - 7.09 women) and sun-protective clothing (OR 2.90, 95% CI 1.73 - 4.85 men, OR 4.29, 95% CI 2.81 - 6.55 women). Those with fair skin were more likely than those with medium or dark brown complexion to use sunscreen or sun-protective clothing. Other factors significantly associated with sun protection behaviors were lifestyle-related factors such as lower body mass index and never smoking. Conclusion The overall prevalence of sun protection behaviors was low. Our results indicate individuals with the highest skin cancer susceptibility are most likely to use sunscreen and sun-protective clothing, and may also be most receptive to skin cancer prevention educational interventions. Citation Information: Cancer Prev Res 2008;1(7 Suppl):B16.

Sun Protection Behaviors and Knowledge in Mountain Marathon Runners and Risk Factors for Sunburn

Increased exposure to ultraviolet radiation (UVR) is associated with an increased risk of nonmelanoma skin cancer. Cutaneous surgery can be negatively influenced by UVR, causing delayed wound healing, hyperpigmentation of the scar, and an increased incidence of additional skin cancers. By changing sun protection behavior, these risks can be limited. Therefore, this study evaluates changes in patients' sun protective behavior after Mohs micrographic surgery (MMS). Patients undergoing MMS between December 2017 and November 2019 were included. Patients were asked to complete the FACE-Q Skin Cancer - Sun Protection Behavior checklist before and 3 months and 1 year post-surgery. A total of 125 patients completed the pre-operative and 3-months post-operative checklists, and 89 (71.2%) completed the 1-year post-operative checklist. Reported sun protective behaviors increased post-surgery at all time points (p < 0.001). Patients with a prior history of facial skin cancer demonstrated a larger increase in sun protection behaviors after surgery than patients without a history of facial skin cancer (p = 0.04). Patients with defects located on the ear or scalp demonstrated a lesser increase in sun protection behaviors than patients with defects located in more conspicuous areas as the face (p = 0.02). Our study demonstrates a change in sun protection behavior, with an increase in sun protection behavior over time in patients after MMS. However, more improvement is possible. Targeted counseling can increase sun protection behavior in patients without a history of facial skin cancer and patients with skin cancer located on the ears or scalp.