Sun-protective Clothing Research Articles

Walking and Sun Protective Behaviors: Cross-Sectional Associations of Beneficial Health Factors.

Sun protective behaviors and physical activity have the potential to reduce cancer risk. Walking is the most common type of physical activity in the United States, but it is unclear whether sun protective behaviors differ by categories of walking, such as leisure versus transportation walking. We examined whether sun protective behaviors varied by category or duration of walking in the 2015 National Health Interview Survey (N = 26,632), age ≥ 18 years. We used logistic regression to estimate sunscreen use, sun avoidance, and sun protective clothing use by four categories of walking (no reported walking, transportation only, leisure only, or walking for both) and separately for walking duration for the general population and sun-sensitive individuals. Prevalence of sunscreen use varied across walking categories and the odds of use were higher with longer walking duration for transportation and leisure compared to those who reported no walking. Sun avoidance varied across walking categories and the odds of avoidance were lower with longer duration leisure but not transportation walking. Sun protective clothing varied across walking categories and the odds of use were higher for longer duration transportation, but not leisure walking. Data on the concurrence of walking and sun protection is needed to further understand the relationship between these health behaviors. By examining leisure and transportation walking, we found variations in sun protective behaviors that may provide important insight into strategies to increase sun protection while promoting physical activity.

Associations between linguistic acculturation and skin cancer knowledge and beliefs among U.S. Hispanic adults.

The incidence of melanoma among U.S. Hispanics is rising and Hispanics have poorer melanoma survival compared to non-Hispanic whites. Acculturation has been linked with skin cancer-related behaviors among Hispanic individuals, such that Hispanic individuals who are more acculturated to U.S. norms and attitudes have been found to use sunscreen more frequently, to seek shade and use sun protective clothing less often, to sunbathe and indoor tan more frequently, and to have more sunburns than less acculturated individuals. However, little is known about factors that may account for the effect of acculturation on such behaviors and outcomes. The goal of this study was to examine the association between linguistic acculturation and skin cancer-related knowledge and beliefs among Hispanic adults. 788 Hispanic adults completed an online survey measuring linguistic acculturation, sun protection knowledge, perceived skin cancer risk, perceived severity, perceived worry, skin color preference, perceived suntan benefits, photo-aging concerns, sun protection norms, tanning norms and skin cancer fatalism. Compared with Spanish-acculturated Hispanics, English-acculturated Hispanics had greater knowledge, lower levels of perceived risk of skin cancer, lower perceived severity of skin cancer, less worry about skin cancer, greater perceived suntan benefits, and lower photo-aging concerns. This study highlights the importance of considering an individual's level of acculturation when designing skin cancer prevention interventions. Additional research is warranted to develop and test culturally relevant, tailored interventions to reduce the risks of skin cancer among U.S. Hispanics.

Sun protective behaviours during maximum exposure to ultraviolet radiation when undertaking outdoor activities: an integrated literature review

The aim of this review is to describe current patterns of adolescent and adult sun-protective behaviours in Australia and overseas. A systematic search of electronic databases was conducted in CINAHL, ProQuest, Medline, PubMed and Informit (Australian) for studies that included participants aged ≥12 years and reported proportions of participants’ sun-protective behaviours. The search period covered 14 years from January 2004 to April 2018. Selected studies were critically appraised by two independent reviewers using the Effective Public Health Practice Project Quality Assessment tool. A total of 29 relevant articles were identified. The review found that self-reported sun-protective behaviours differ markedly from observed behaviours, with observed behaviours indicating lower levels of sun protection. Sun-protective behaviours are highest among outdoor workers with mandatory personal protective equipment, boaters and snow skiers. A majority of the studies reviewed revealed that sun-protective behaviour continues to be poor during outdoor activities, indicating people are at risk of developing sun-related skin conditions such as skin cancer. These findings offer important insights for future sun safety campaigns. Despite numerous sun safe campaigns over time, it appears that low perceptions of risk are undermining the messages. Future health promotion campaigns should focus on appearance-based interventions, avoidance of harmful ultraviolet radiation exposure in all climates, and the importance of sun-protective clothing and eye protection necessary during necessary periods of high ultraviolet radiation exposure.

A comprehensive approach to evaluating and classifying sun-protective clothing

Summary Excessive exposure to sunlight causes skin cancer, the most common cancer in humans. An estimated 80% of melanoma (the most deadly form of skin cancer) cases in Australia could be prevented by reducing sun exposure. Clothing provides a protective barrier that reduces the amount of solar ultraviolet radiation (UVR) reaching the skin. In 1996, Australia pioneered a relative ranking of the sun-protective capabilities of clothing based on the transmission of UVR through fabric, known as the Ultraviolet Protection Factor (UPF). UPF garment swing tags were introduced as part of this original standard (AS/NZS 4399:1996) which was widely adopted by industry. However, it did not consider the body surface area (BSA) covered by garments. Minimum body coverage requirements for the torso and limbs were added to some standards (e.g. European Union, 2003; Australian/New Zealand, 2017) but not others (e.g. USA). In light of recent evidence showing that clothing coverage is important in preventing some of the pigmented moles that develop in childhood (important risk-factor for melanoma), it is imperative that sun-protective clothing rating schemes consider BSA coverage of the garment, in addition to fabric UPF. We developed a new index for rating sun-protective clothing, “the Garment Protection Factor (GPF)” that incorporates both of these important factors. BSA coverage is determined based on the number of lines visible on a clothed versus an unclothed mannequin. GPF increases with BSA coverage of the garment and fabric UPF over 3 categories: GPF 0 to < 3 indicates the garments ‘meets’ minimum standards; 3 to < 6 indicates ‘good’ sun-protection; and GPF ≥ 6 indicates ‘excellent’ protection. Adoption of this rating scheme should provide an incentive for manufacturers to design sun-protective garments that exceed the minimum standard for BSA coverage and fabric UPF, and provide consumers with adequate information on which to base their choice, with positive implications for skin cancer prevention.

The Garment Protection Factor: further advances in labelling sun-protective clothing.

Abstract Linked Article: Downs and Harrison. Br J Dermatol 2018; 178:958–964.

Skin Cancer Risk Awareness and Sun-Protective Behavior Among Solid-Organ Transplant Recipients.

Solid-organ transplant recipients are at an increased risk of developing skin cancer; this risk is due to long-term graft-preserving immunosuppressive therapy, and excessive sun exposure is a major contributing factor to this process. The aim of this study was to evaluate the skin cancer awareness and sun-protective behavior of solid-organ transplant recipients. In all, 70 consecutive solid-organ transplant recipients were evaluated regarding knowledge of their increased skin cancer risk and regarding the influence of this knowledge on their sun-protective practices, by applying a questionnaire during their routine check-up visits. Of 70 solid-organ transplant recipients, 38 (54.3%) stated knowledge of hazardous consequences of sun exposure; however, only 28 (40%) had the knowledge of causal relationship between sun and skin cancer development. There were 31 patients (44.3%) who were unable to recall anybody giving any information to them about sun protection, and 40 patients (57.1%) had never visited a dermatology clinic. The 10 solid-organ transplant recipients (14.3%) who used sunscreen creams daily had been undergoing regular dermatologic examination. Regarding sun-protective clothing, only 8 patients (11.4%) had been wearing a suitable hat, long sleeves, and sunglasses when outdoors. There was a statistically significant difference between the groups who had visited a dermatology clinic versus those who had not regarding knowledge of sun protection, the causal relationship between sun exposure and skin cancer, the use of sunscreens, and use of sun-protective clothing (P < .05). Our data showed that dermatologic examination and education of patients about skin cancer development and sunscreen measures improved the sun-protective habits of solid-organ transplant recipients. Therefore, orderly visits once or twice a year should be strongly advised for this patient population by their medical care providers.

Sun protective behaviors at an outdoor entertainment event in Australia.

An observational study was conducted to examine the use of sun protective hats, clothing, and sunglasses of people attending an outdoor entertainment event in an area of high-to-extreme ultraviolet radiation in New South Wales, Australia. Armidale is unique, as it is a highly-elevated area, almost 1000 m above sea level, and temperatures are often mild with very high-to-extreme levels of ultraviolet radiation. Four trained data collectors observed attendees as they entered the event, and recorded their use of sun protective hats, clothing, and sunglasses. While more than half of the attendees wore sun protective hats, only 14% wore sun protective clothing. Broad-brimmed hats were considered sun protective, while sun protective clothing was defined by shirts with at least three-quarter-length sleeves. Females were more likely to wear both a sun protective hat and clothing than males, and children were less protected than adults. Legislative changes are required to ensure that organizers of outdoor events have a legal responsibility to provide a safe environment for attendees, including strategies to help reduce ultraviolet radiation exposure.

Parent and Child Characteristics Associated with Child Sunburn and Sun Protection Among U.S. Hispanics.

Skin cancer incidence has been increasing in U.S. Hispanics over several decades and the postdiagnosis outcomes are worse for Hispanics than for non-Hispanic whites. Parents are influential in children's health preventive behaviors, but little is known about parental factors associated with children's skin cancer-related behaviors in the U.S. Hispanic population. The present study examined parental and child correlates of skin cancer-related behaviors (sunburns, sunbathing, sun-protective clothing use, and sunscreen use) of children of Hispanic parents. This survey study included a population-based sample of 360 U.S. Hispanic parents (44.8% male) who had a child 14years of age or younger. Measures included parental reports of parent and child demographic characteristics, parent skin cancer knowledge and linguistic acculturation, and parent and child skin cancer-related behaviors. Approximately 28% of children and 31.9% of parents experienced at least one sunburn in the past year and approximately 29% of children and 36.7% of parents were reported to sunbathe. Moderate use of sun-protective clothing and sunscreen was reported for parents and their children. Child sun-protective clothing use and sunscreen use, sunburns, and sunbathing were associated with the corresponding behaviors of their parents. Future research should consider the role of acculturation and perceived risk in the sun protection behaviors of U.S. Hispanic children, particularly in those who report a fair skin type. Hispanic parents should be included in interventions targeting their children's skin cancer-related behaviors, and it is suggested that such interventions could also encourage parents to improve their own behaviors.

Assessment of Patient Knowledge of Longitudinal Melanonychia: A Survey Study of Patients in Outpatient Clinics

Importance: Subungual melanoma (SM) is a rare subtype of cutaneous melanoma but carries a worse prognosis than similarly staged cutaneous melanomas. Assessing patient knowledge of melanonychia is integral to early diagnosis of SM. Objectives: The aim of this paper is to determine patient knowledge of longitudinal melanonychia (LM) and warning signs for SM, frequency of nail self-examinations, and satisfaction of patients with their physician's nail examinations. Design, Setting, and Participants: We conducted a survey-based study of 363 random patients at Weill Cornell Medicine in New York, USA, performed at 3 different clinics: a general dermatology clinic (n = 167), a nail specialty clinic (n = 44), and a primary care clinic (n = 152). Main Outcomes and Measures: Knowledge of the ABCDEF mnemonic for SM was compared to the ABCD mnemonic for cutaneous melanoma. Analyses were performed for patient behavior regarding suspicious nail changes as well as satisfaction with nail counseling and examination. Results: Only 5% (18/363) of the patients in our study had heard of the ABCDEF mnemonic. In contrast, 9.9% (36/363) of the patients had heard of the ABCD mnemonic for cutaneous melanoma. In total, 37/363 (10.2%) patients reported having LM, 32.4% (12/37) of the patients noted changes in color or width of the band, and 10.8% (4/37) presented with pain or bleeding of the nail, with only 45.9% (17/37) seeking medical attention. Only 11.8% (43/363) of the patients stated that their physician asked them about nail changes, and 1.4% (5/363) of the patients stated that they were counseled about the ABCDEF mnemonic. In comparison, 13.8% (50/363) of the patients were advised on the ABCD mnemonic for the cutaneous melanoma mnemonic. While 70.2% (255/363) of the patients stated that they used sunscreen or wore sun-protective clothing, only 31.4% (114/363) assessed their nails for color changes, with 54.9% (128/233) of the patients categorizing themselves as “very unsatisfied” with the evaluation of their nails by their dermatologist. Conclusions and Relevance: Our data shows that there is a lack of patient knowledge of LM and warning signs for SM. Further testing is needed to determine whether educating patients about LM, warning signs for SM, and nail self-examinations would improve patient outcomes.

Protection from Ultraviolet Radiation during Childhood: The Parental Perspective in Bavaria.

During childhood, parents play a vital role in sun protection of their children. Their guidance is essential for avoiding excessive exposure to ultraviolet (UV) radiation, a risk factor for developing skin cancer in later life. In a population-based cross-sectional study conducted between October 2011 and February 2012, we assessed how 3281 parents implemented sun protection for their three- to six-year-old children in practice. In particular, clothing, shade-seeking behavior, wearing of sunhats and sunglasses, use of sunscreens and the amount of time spent outdoors were ascertained in two settings (beach, garden/playground). The results showed that the overall level of parental sun protection for their children in the beach setting, and to a lesser extent also in the everyday outdoor setting, is relatively high. Using sunscreens with a high sun protection factor and instructing children to wear a sunhat were very common. Lesser attention was paid to sun-protective clothing, seeking the shade and wearing sunglasses. The amount of time spent outdoors during summer days was high. Therefore, the recommendation to completely avoid sun exposure during peak UV times around noon during summertime needs to be reinforced. In addition, the observed difference in the protective behavior between the beach and an everyday outdoor setting points to the necessity to encourage better sun protection for children also in outdoor activities of daily living.

Sun protection for preventing basal cell and squamous cell skin cancers.

'Keratinocyte cancer' is now the preferred term for the most commonly identified skin cancers basal cell carcinoma (BCC) and cutaneous squamous cell carcinoma (cSCC), which were previously commonly categorised as non-melanoma skin cancers (NMSC). Keratinocyte cancer (KC) represents about 95% of malignant skin tumours. Lifestyle changes have led to increased exposure to the sun, which has, in turn, led to a significant increase of new cases of KC, with a worldwide annual incidence of between 3% and 8%. The successful use of preventive measures could mean a significant reduction in the resources used by health systems, compared with the high cost of the treatment of these conditions. At present, there is no information about the quality of the evidence for the use of these sun protection strategies with an assessment of their benefits and risks. To assess the effects of sun protection strategies (i.e. sunscreen and barrier methods) for preventing keratinocyte cancer (that is, basal cell carcinoma (BCC) and cutaneous squamous cell carcinoma (cSCC) of the skin) in the general population. We searched the following databases up to May 2016: the Cochrane Skin Group Specialised Register, CENTRAL, MEDLINE, Embase, and LILACS. We also searched five trial registries and the bibliographies of included studies for further references to relevant trials. We included randomised controlled clinical trials (RCTs) of preventive strategies for keratinocyte cancer, such as physical barriers and sunscreens, in the general population (children and adults), which may provide information about benefits and adverse events related to the use of solar protection measures. We did not include trials focused on educational strategies to prevent KC or preventive strategies in high-risk groups. Our prespecified primary outcomes were BCC or cSCC confirmed clinically or by histopathology at any follow-up and adverse events. Two review authors independently selected studies for eligibility using Early Review Organizing Software (EROS). Similarly, two review authors independently used predesigned data collection forms to extract information from the original study reports about the participants, methods of randomisation, blinding, comparisons of interest, number of participants originally randomised by arm, follow-up losses, and outcomes, and they assessed the risk of bias. We resolved any disagreement by consulting a third author and contacted trial investigators of identified trials to obtain additional information. We used standard methodological procedures expected by Cochrane. We included one RCT (factorial design) that randomised 1621 participants.This study compared the daily application of sunscreen compared with discretionary use of sunscreen, with or without beta-carotene administration, in the general population. The study was undertaken in Australia; 55.2% of participants had fair skin, and they were monitored for 4.5 years for new cases of BCC or cSCC assessed by histopathology. We found this study to be at low risk of bias for domains such as allocation, blinding, and incomplete outcome data. However, we found multiple unclear risks related to other biases, including an unclear assessment of possible interactions between the effects of the different interventions evaluated (that is, sunscreen and beta-carotene). We found no difference in terms of the number of participants developing BCC (n = 1621; risk ratio (RR) 1.03, 95% confidence interval (CI) 0.74 to 1.43) or cSCC (n = 1621; RR 0.88, 95% CI 0.50 to 1.54) when comparing daily application of sunscreen with discretionary use, even when analyses were restricted to groups without beta-carotene supplementation. This evidence was of low quality, which means that there is some certainty that future studies may alter our confidence in this evidence.We reported adverse events in a narrative way and included skin irritation or contact allergy.We identified no studies that evaluated other sun protection measures, such as the use of sun-protective clothing, sunglasses, or hats, or seeking the shade when outdoors. In this review, we assessed the effect of solar protection in preventing the occurrence of new cases of keratinocyte cancer. We only found one study that was suitable for inclusion. This was a study of sunscreens, so we were unable to assess any other forms of sun protection. The study addressed our prespecified primary outcomes, but not most of our secondary outcomes. We were unable to demonstrate from the available evidence whether sunscreen was effective for the prevention of basal cell carcinoma (BCC) or cutaneous squamous cell carcinoma (cSCC).Our certainty in the evidence was low because there was a lack of histopathological confirmation of BCC or cSCC in a significant percentage of cases. Amongst other sources of bias, it was not clear whether the study authors had assessed any interaction effects between the sunscreen and beta-carotene interventions. We think that further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate.

Market availability and use of sun protective clothing/ accessories among women consumers

Present investigation is based on market availability and use of sun protective clothing/accessories among women consumers. The study was conducted using survey work on 180 sample subjects selected randomly comprised of working women and college going girls of Udaipur city. Questionnaire method was used to gather desired information. Findings revealed that majority of respondents were aware about sun protective clothing/accessories available in market and were using it readymade. Light colour cotton material was their choice, majority of respondents were not satisfied with the variety of colours, prints, materials and also with the type of clothing/accessories available in the market for sun protection.

Optimizing Sun Protection for Children

Approximately 1 in 5 Americans are destined to develop skin cancer annually.1 Of particular concern is the increase in the rates of malignant melanoma, which have doubled over the past 3 decades.2 UV light exposure has been considered theprincipal knownandpreventablecarcinogen inthedevelopmentof skin cancer,3 andnumerousprogramshavebeen developed to help educate patients about the hazards of UV lightexposureandcreatepolicies for sunprotection,manyspecifically aimed at children. Over the past decade, several studies have evaluated the effectiveness of various sun protection programs. Although studydesignsvary,commonelementsstandardly includesome degree of education about using sunscreen, wearing sunprotective clothing or eyewear, seeking shade to avoid sun at peak hours, and periodically examining the skin for suspicious lesions. Someprojects initiatededucationas early asday care4orpreschool,5 andothersduringmiddleandhighschool,6 to determineoptimal timingof educational interventions. Efforts have focused predominantly on school settings,7,8 although some have targeted programs for sun protection behavior at the beach,8 at ski and snowboard schools,9 in the outpatient medical setting,10 or as part of government-based childhood public health services.11 An underlying assumptionhasbeen thatearly interventionwithchildren instills longtermbehavior changes that can translate intomeaningful outcomes. Complicating the evaluationof theseprogramsare the heterogeneity of study designs and the reliance on selfreporting of metrics (dependence on parental reports on whether and howoften sunscreen is used, howoften hats are worn, whether sun-protective clothing is worn, as just a few examples). Studies assessdifferences inknowledgebeforeand after interventions, whichmight not always translate into actual meaningful changes in sun-protective behaviors. Fewer investigationsusemoreobjectivephysicalmeasuresof sunexposure (indirectly throughmeasures ofUV light damage such asnevuscounts12ormoredirectly throughchanges inskincolor after sun exposure using techniques such as skin reflectance spectrophotometry13). The studybyHoet al14 offers an intriguingmultimodal approachtosunprotectioneducation involvingbothearlyschoolagedchildrenandtheirparentsor relatives (hereafter simply referred to as caregivers) in the outpatientwell-care setting. Key components of the interventions include the use of a childorientedread-alongbook,theprovisionofasize-appropriatesunprotective swim shirt, and a series of 4 weekly text-message reminders tocaregiversaboutsunsafety,withnominal financial compensationat thebeginningandendof thestudy. Inaddition toassessmentsof self-reportedsunsafetybehaviors,measurements of changes in skin color were taken at baseline and followed up using reflectance spectrophotometry. The choice by the investigators to educate both the caregiverandthechild throughtheuseofanactive read-aloudbook was a pragmatic one because this process engages both caregivers and their children to recruit each other in reinforcing recommended behaviors. Supplying rather than simply recommending sun-protective clothing as part of the study encouragesadherencebyeliminating theobstacleofhaving families purchase the sun-protective clothing themselves, thus removing associated economic barriers. Several hundred publications have now documented the use of shortmessage service or textmessaging in a number of othere-healthsettings to improveadherence insituations ranging frommedication adherence to smoking cessation to vaccine reminders. Our understanding of best practices for text messaging and the science around how to ideally incorporate text messaging—in terms of timing, frequency, and such— continue to evolve. A Cochrane review of patients exposed to textmessaging as ameans of facilitating self-management of long-termillnesshighlightssubgroupsofpatientswhoaremore responsive to textmessaging, namely thosewhoare younger, have smartphones, andhavea financial incentive to followthe text-messaging advice.15 Evidence indicates that this type of text messaging should be culturally tailored, and likely economically tailored as well, given the difference in smartphone data plans.16 Theremay also be a role for using social networking sites in addition to text messaging in a multimodal e-health approach.A recent systemic reviewof theuseof socialmedia for HIVcommunication17 suggested that theadditionof socialnetworking sites helped bridge communication among a diverse range of users, in various geographic and economic contexts. Anonymity benefited participants who sought to ask additional health questions, and socialmedia sites (eg, Facebook, Twitter, and blogs) brought together a diverse audience, includingpersonswithdisease,healthprofessionals,andthegeneral public. The implementation of e-health technology such as textmessaging and the emerginguseof socialmedia are increasinglybeingacceptedbypatientsandparticularlybyyoung people.10 Given the complexity of the program evaluated by Ho and colleagues,14 future studies should focus on teasing out the relative utility of the individual components of this Related article page 334 Opinion

Effectiveness of a Multicomponent Sun Protection Program for Young Children: A Randomized Clinical Trial.

Emphasizing sun protection behaviors among young children may minimize sun damage and foster lifelong sun protection behaviors that will reduce the likelihood of developing skin cancer, especially melanoma. To determine whether a multicomponent sun protection program delivered in pediatric clinics during the summer could increase summertime sun protection among young children. Randomized controlled clinical trial with 4-week follow-up that included 300 parents or relatives (hereafter simply referred to as caregivers [mean age, 36.0 years]) who brought the child (2-6 years of age) in their care to an Advocate Medical Group clinic during the period from May 15 to August 14, 2015. Of the 300 caregiver-child pairs, 153 (51.0%) were randomly assigned to receive a read-along book, swim shirt, and weekly text-message reminders related to sun protection behaviors (intervention group) and 147 (49.0%) were randomly assigned to receive the information usually provided at a well-child visit (control group). Data analysis was performed from August 20 to 30, 2015. Multicomponent sun protection program composed of a read-along book, swim shirt, and weekly text-message reminders related to sun protection behaviors. Outcomes were caregiver-reported use of sun protection by the child (seeking shade and wearing sun-protective clothing and sunscreen) using a 5-point Likert scale, duration of outdoor activities, and number of children who had sunburn or skin irritation. The biologic measurement of the skin pigment of a child's arm was performed with a spectrophotometer at baseline and 4 weeks later. Of the 300 caregiver-child pairs, the 153 children in the intervention group had significantly higher scores related to sun protection behaviors on both sunny (mean [SE], 15.748 [0.267] for the intervention group; mean [SE], 14.780 [0.282] for the control group; mean difference, 0.968) and cloudy days (mean [SE], 14.286 [0.282] for the intervention group; mean [SE], 12.850 [0.297] for the control group; mean difference, 1.436). Examination of pigmentary changes by spectrophotometry revealed that the children in the control group significantly increased their melanin levels, whereas the children in the intervention group did not have a significant change in melanin level on their protected upper arms (P < .001 for skin type 1, P = .008 for skin type 2, and P < .001 for skin types 4-6). A multicomponent intervention using text-message reminders and distribution of read-along books and swim shirts was associated with increased sun protection behaviors among young children. This was corroborated by a smaller change in skin pigment among children receiving the intervention. This implementable program can help augment anticipatory sun protection guidance in pediatric clinics and decrease children's future skin cancer risk. clinicaltrials.gov Identifier: NCT02376517.

Direct and indirect effects of sunscreen exposure for reef biota

Coral reefs are ecologically and economically important, contributing to both fishing and ecotourism economies around the world. Tourism and recreational activities have increased in coastal areas and so has the use of sunscreen. Sunscreen reduces human exposure to harmful UV rays, but washes off during aquatic recreational activities, which may negatively affect reef biota. To evaluate how sunscreen affects coral reef ecosystems, we added sunscreen at concentrations similar to previous studies to growing environments containing flatworms (Convolutriloba macropyga) with symbiotic algae, photosynthetic diatoms (Nitzschia sp.), Aiptasia anemones, and pulse corals (Xenia sp.). Using behavioral observations and estimates of population and colony growth, we show nominal concentrations of sunscreen negatively affect all of the studied species. Furthermore, we show that mobile flatworms do not avoid water which contains sunscreen and flatworms exposed to sunscreen prefer darker conditions. Based on our results, beach goers should limit use of sunscreens when near coral reefs and consider alternative protective measures, such as the utilization of sun-protective clothing.

Sun protection practices in New Zealand secondary schools: a 2014 baseline study.

ObjectiveGuided by the established primary school SunSmart programme, a survey of secondary schools' sun protection policies, planning, behavioural expectations, curriculum content and environment was undertaken in order to establish a baseline to inform advocacy and secondary level programme development.MethodsAll 448 principals of state or state integrated public secondary schools identified from the Ministry of Education database were mailed a hard copy questionnaire. School sun protection practices were assessed and a summative, non-weighted, 11-item Total Sun Protection Score (TSPS) was created. Associations between TSPS and socio-demographic factors, as well as school sun protection policy, were investigated using unadjusted and multiple linear regressions.ResultsUsable responses received from 211 of the 448 schools (47% participation) indicated reasonable representativeness of eligible schools, but under-representation of low socioeconomic decile institutions (p = 0.003) and those with the smallest roll size (p = 0.004). Only 50% of schools reported having a sun protection policy. The least attained TSPS components were outdoor event planning (17.1%), student breaks (16.6%), sun-protective clothing (8.5%) and shade provision (6.2%). The mean (SD) TSPS was 4.58 (2.06). In multivariable analysis, TSPS was statistically significantly positively associated with having a sun protection policy (p < 0.001) and the presence of primary level classes (p < 0.001) — the latter suggesting a possible influence of programme continuity, but negatively associated with integrated school status (p = 0.036).ConclusionA standard SunSmart programme could be promoted to all schools, irrespective of socioeconomic decile, overall roll size, gender status or regional population density. Low attainment of some TSPS components indicates targeting priorities.

Malignant and Pre-Malignant Manifestations of Xeroderma Pigmentosum in Ghanaians

Introduction: Xeroderma pigmentosum is an autosomal recessive disease with sun sensitivity, photophobia, early onset of freckling, and subsequent neoplastic changes on sun-exposed surfaces. There is cellular hypersensitivity to UV radiation and to certain chemicals in association with abnormal DNA repair. Patients with defective DNA nucleotide excision repair (NER) have defects in one of seven NER genes; xeroderma pigmentosum variants have normal NER and a defect in a polymerase gene. Study design: This is a case presentation of five patients with the features of xeroderma pigmentosum, aged 48, 26, 15, 14 and 8 years. The first and last patients were males. Each of the first four patients presented with areas of hyper- and hypo-pigmentation over sun exposed body surfaces. Each of them had a minimum of two cutaneous malignancies, distributed on the upper chest, face or scalp. The fifth patient had skin atrophy, with mottled hyperpigmentation and hypopigmentation but had no malignant lesions. Result: The first, second and fourth patients had their lesions surgically excised and the defects were skin grafted. The third patient was treated with radiotherapy. All the lesions were confirmed histologically as squamous cell carcinoma. No recurrence has been observed. Conclusion: Xeroderma pigmentosum in Ghanaians presents with squamous cell carcinoma involving the head, neck and upper trunk. A minimum period of exposure to UV radiation, not precisely known, is required for the development of the lesions. Education on sun avoidance and protective clothing is necessary to prevent morbidity and mortality.

Pigmented naevi and sun protection behaviour among primary and secondary school students in an Eastern Hungarian city.

The most important risk factors for malignant melanoma are skin type I or II, large number of atypical naevi and a history of sunburn in childhood and adolescence. A cross-sectional study was performed to assess skin type, number of pigmented lesions and sun protection behaviour in 1157 12- to 19-year-old Hungarian students at 20 primary and secondary schools in Debrecen, Hungary. After receiving dermatological training, 18 school doctors examined the students' skin. A questionnaire was completed by the students with the assistance of their parents about sun protection, sunburns and the use of sunbed. Data from 612 questionnaires were evaluated. Based on the doctors' evaluation, most of the pupils were classified as having skin type II and majority of them had 5-20 naevi, particularly on the trunk. Based on the student's response, 5.2% purposely sunbathed daily, 10.1% did not use any form of sun protection, 32.2% wore sun-protective clothing and 65.7% applied sunscreen generally. 6.9% used sunbed, and 74.0% previously experienced serious sunburn at least once. Indoor tanning statistically correlated with the number of melanocytic naevi. A high prevalence of sunburn was reported by the students and some of them did not apply any sun protection methods but used sunbed at a critical age for developing melanoma at a later time. These data highlight the importance of educating children and parents about appropriate sun protection.

Development of a Reproducible Rating System for Sun Protective Clothing That Incorporates Body Surface Coverage

Sunlight is a known skin carcinogen. Skin cancer is the most common form of cancer in humans, and typically affects sun-exposed parts of the body. Sunny Australia and New Zealand have the highest incidence of skin cancer globally. Clothing provides a protective barrier that reduces the amount of ultraviolet radiation (UVR) reaching the skin. Australia pioneered the development of a relative ranking of the sun-protective capabilities of clothing based on the transmission of UVR through fabric. Standardized Ultraviolet Protection Factor (UPF) measurement procedures and associated labeling specifications are documented in the Australian and New Zealand Standard, AS/NZS 4399:1996. The standard was intended to enable consumers to make informed choices. Since its introduction, this standard has been adopted almost universally by the textile industry, and is still in use almost two decades on, with plans to revise it only commencing recently. However, AS/NZS 4399:1996 does not consider garment design, particularly in relation to body surface coverage. Although swim-shirts have grown in popularity in Australia since the late 1990s, particularly among children, clothing remains under-utilized as a form of sun-protection in contemporary society. Skin cancer prevention campaigns should emphasize the sun-protective benefits of clothing and collaboration with the fashion industry is urgently needed to improve the aesthetic appeal, comfort, durability and affordability of sun-protective clothing to increase its popularity in skin cancer prone populations. In light of recent evidence showing that high UPF clothing which covers more of the body surface reduces pigmented mole development in children (major risk factor for melanoma), the rating system for sun-protective clothing should incorporate body surface covered as well as the UPF of the fabric. We discuss progress towards developing a protocol for measuring the extent of coverage of sun-protective garments. Once fully evaluated and refined, the testing protocol developed from this research may influence future revisions of international standards for evaluating and classifying sun-protective clothing.

The most common skin cancers and the risk factors in geriatric patients: A hospital based-controlled study

Our aim was to detect the distribution of all malign skin tumors in geriatric patients,and evaluate risk factors comparing with health volunters. Two hundred patients with malignant skin tumors over 65 years old and 75 healty volunters were enrolled into the study. Sociodemographic characteristics, hair colour, eye colour, Fitzpatrick’s skin type, the degree of photoaging by using Glogau’s Photodamage Classification Scale, sunbathing habits, the use of sun protective clothings, sunscreen cream usage, working outdoor, vitamine intake habit, smoking, and alcohol consumption, family history of skin tumor, accompanying systemic diseases, exposition to chemicals and tumors localization were recorded. Tumors’ localizations were detected. A total of 109 (54.5%) of patients were male, 91 were (45.5%) female and the mean age of patients was 72.97±6.73 in the study group. A total of 209 skin tumors identified in 200 patients. Basal cell carcinoma (BCC) was the most common skin tumor (n=153, 72.85%) and followed by squamous cell carcinoma (SCC) (n=36, 17.28%) and malignant melanoma (n=10, 4.7%). The most common localization of tumors was the face (n=159, 75.71%). There were significant differences regarding sun protective clothing habits between BCC and SCC patients when compared to the control group (p<0.05). Glagou’s Photodamage Classification Scale scores in BCC and SCC groups were higher than the control group (p<0,05). UV radiation and sun exposure seemed to be the main risk factors of skin tumors in geriatric patients.