Number Of Sunburns Research Articles

Consistency of reported tanning behaviors and sunburn history among sorority and fraternity students

Reliable measurements of behavior are crucial to evaluating health promotion efforts. The goal of this reliability study was to examine the consistency of recalled tanning behaviors in a population with a potentially high use. We used the test-retest reliability of a self-administered survey to examine the consistency of reporting behavior patterns regarding artificial ultraviolet (UV) tanning, sunburns and sun sensitivity among sorority- and fraternity-affiliated university students. High reliability on test-retest for questions evaluating the number of artificial UV tanning sessions and the number of sunburns during specific time periods was found. Overall, this study suggests that this sub-population of 18-23-year-olds, with a wider range of exposures than other 18-23-year-olds and older subjects, report lifetime artificial UV tanning consistently when required to recall time period-specific exposures before estimating their lifetime exposure.

Common Melanocytic Nevi in 7-Year-Old Schoolchildren Residing at Different Latitudes in Sweden

Current epidemiologic research shows consistently that increased number of acquired common melanocytic nevi (CMN) is an important risk factor for cutaneous malignant melanoma. The purpose of this study was to investigate the number of CMN in relation to tanning habits and complexion among 7-year-old children residing at different latitudes in Sweden. Two municipalities were chosen at latitude 65 degrees N to 68 degrees N in the north of Sweden and two at latitude 57 degrees N in the south. Children born in 1994 and registered in the municipalities were to be included (N = 1,676). A questionnaire was sent to their parents asking about the child's tanning habits. A body examination of CMN of size >or=2 mm was done by the same trained nurse in 1,380 (82.3%) of the children. CMN was significantly less prevalent among children living in the north with a prevalence of 5.6 [95% confidence interval (95% CI), 4.8-6.5] inland and 6.2 (95% CI, 5.3-7.2) coastal compared with the south with a prevalence of 9.5 (95% CI, 8.2-11.0) inland and 10.4 (95% CI, 8.9-12.0) coastal. In addition, blond hair, blue/gray/green eyes, holidays at seaside resorts abroad, more frequent sunburns, and parents fancying tanning were significant predictors of higher prevalence of CMN. These findings support previous evidence that the development of CMN is related to the level of sun exposure in childhood expressed as latitude of residence, holidays at seaside resort abroad, and number of sunburns. To reduce the incidence of cutaneous malignant melanoma, a change in attitude and behavior must start with young children and their parents.

Alcohol consumption and self-reported sunburn: A cross-sectional, population-based survey

Heavy drinking has been associated with several cancers, including melanoma and basal cell carcinoma. The purpose of this study was to determine whether excessive drinking is associated with sunburn, a risk factor for skin cancer. As part of the 2004 Behavioral Risk Factor Surveillance System, a population-based telephone survey, 299,658 adults reported their use of alcohol in the preceding month and a history of sunburn in the preceding year. Approximately 33.5% of respondents reported a sunburn within the past year. Heavier average alcohol use and binge drinking were both positively associated with prevalence and number of sunburns within the past year. The adjusted odds ratios for prevalence and number of sunburns among binge drinkers were 1.39 (95% confidence interval 1.31-1.48) and 1.29 (95% confidence interval, 1.20-1.38), respectively. Associations tended to be of similar magnitude for average alcohol use and in all subgroups evaluated. This study was cross-sectional and relied upon participant self-report. Excessive drinking is associated with higher rates of sunburn among American adults. The observed relationship typifies the high-risk behavior associated with excessive drinking and suggests one pathway linking alcohol use with skin cancer.

Student–parent agreement in self-reported sun behaviors

We sought to describe agreement between parent proxy and student self-reported sun behaviors and sun protective practices in adolescents aged 10 to 14 years. We conducted a cross-sectional pilot study of students (n = 52) from two classrooms, grades 6 and 7, at a school system in Framingham, Mass. Data were collected using self-administered questionnaires. Students were asked to report their sun behaviors and sun protective practices. Proxy measures were obtained by asking parents to report sun behaviors and practices of their children. Agreement was measured using weighted kappa analysis for ordinal data. Mean differences (95% confidence intervals) were calculated. The response rate for student/proxy pairs was 96% (n = 50). Agreement between student and proxy was good for skin color, sunscreen use, number of sunburns in the past summer, and application of sunscreen while in other outdoor places (range kappa = 0.52-0.73). Lowest agreement was found for questions relating to wearing a shirt, wearing a hat, sitting in the shade, and frequency of parental sunscreen application to the students' backs (range kappa = 0.08-0.28). Mean differences in responses between student and proxy respondents were relatively small ranging from -0.39 to +0.25. The lack of a gold standard in the assessment of sun exposure and related sun protective practices limits the ability to validate these exposure measures in skin cancer studies. The assessment of sun exposure behaviors is especially problematic when relying on a child's ability to accurately recall these exposures. Parent proxy measures are often used as surrogate measures and for validation purposes. We found low to moderate student/proxy agreement in this pilot study suggesting that adolescents can effectively recall their recent sun behaviors and protective practices when compared with parent proxy measures.

Examination of the Short-Term Efficacy of a Parent-Based Intervention to Prevent Skin Cancer

The research evaluated an intervention strategy designed to prevent skin cancer in young adolescents. The intervention used parents as change agents to effectively communicate the risks of skin cancer and encourage their children to avoid high-risk sun-related behaviors while increasing positive sun-safe behaviors. Three hundred and forty parents in two regions of the United States were educated about the dangers of risky sun behaviors and how to convey information about skin cancer prevention to their children. Parents were then encouraged to talk with their children about these issues over a 1-month period prior to the onset of summer. Following this time period, children whose parents received and implemented the intervention materials were compared with a control sample of 129 children. These two groups were matched on age, gender, and school on number of sunburns and sunburn severity, attitudes and beliefs, and sunbathing behavior. Children in the treatment condition differed significantly from controls in the predicted directions on all outcome variables. The findings are discussed in terms of reducing skin cancer risk behaviors of children via parent-based intervention approaches.

Solar lentigines are strongly related to sun exposure in contrast to ephelides.

Solar lentigines and ephelides are different types of pigmented skin lesions predominantly present on sun-exposed skin. Both lesions are risk indicators for melanoma and non-melanoma skin cancer. Solar lentigines are considered as a sign of photodamage although well-conducted epidemiological studies are lacking on this subject. Ephelides are associated with fair skin type and red hair. The aim of the present study was to investigate the relation of sun-exposure estimates with solar lentigines and ephelides. In the Leiden Skin cancer Study 577 patients with malignant melanoma and/or non-melanoma skin cancer and 385 individuals without a history of skin cancer were studied. The presence of solar lentigines and ephelides in the face and on the back was assessed. Data on skin type, hair color, sun-exposure variables and cutaneous signs of photodamage were collected, by questionnaire and physical examination. Data were analyzed by chi-square or Student t-tests and with multivariable regression. Exposure odds ratios with 95% confidence intervals (95% CI) were calculated to estimate the relative risk for the presence of solar lentigines and ephelides dependent on signs of photodamage. The association with age was strongly positive for solar lentigines whereas it was strongly negative for ephelides (P-values for trend <0.0001). After adjustment for age, sex and skin type, solar lentigines on the back were positively associated with cumulative (P = 0.01) and intermittent (P = 0.0002) sun exposure. After adjustment, solar lentigines on the back were also associated with a history of sunburns before the age of 20 yr (P = 0.0003) and the number of sunburns in childhood (P = 0.002). Solar lentigines in the face were significantly associated with cutaneous signs of photodamage, i.e. elastosis (odds ratio 2.4, 95% CI 1.7-3.3) and actinic keratosis (odds ratio 1.8, 95% CI 1.3-2.4) whereas ephelides were not. Ephelides in the face and on the back showed an inverse association with chronic sun exposure but after adjustment theses associations disappeared. Sunburns before the age of 20 appeared to be positively associated with ephelides on the back (P = 0.04). In contrast to lentigines, ephelides were much more associated with constitutional host factors such as fair skin and/or red hair (both P < 0.0001). This study indicates that both chronic and acute sun exposure are important in the pathogenesis of solar lentigines.

Menores quemados por el sol y su relación con la radiación ultravioleta y la cubierta de ozono, durante seis veranos (1996 a 2001) en Santiago de Chile (33,5°S)

During the recent 10 years the ozone layer has decreased while ultraviolet radiation has increased in Santiago, Chile. To determine whether the number of sunburns in children correlate with ultraviolet radiation in Santiago. During six Austral Summers (1996-2001) children below 15 years old, consulting for sunburn, were evaluated at the "Corporation for the Aid of Burned Children" (COANIQUEM) in Santiago (33.5 degrees S). The number of children with sunburns during each Summer was compared with the corresponding UV-B radiation and the ozone thickness, to establish a probable relation between a geophysical change and its consequences in skin health. The ozone layer values were obtained from the NASA WEB-page and the ultraviolet radiation was measured with a four-channel medium resolution radiometer. In each Summer there was a predominance of sunburns among boys and among ages between 6 and 10 years. During the 96-97 Austral Summer, the highest number of children with sunburns (63) was diagnosed. That Summer also had the highest mean UV-305 nm radiation with an important amount of days with ozone < or = 260 Dobson Units. Only during that Summer an inverse correlation between ozone and UV-305 nm radiation was detected. At the same time the maximal values of Erythemal Dose Rate (33 muWatt cm2), UV Index (13) and Erythemal Daily Dose (7.500 Joule m2) were observed. In Santiago, Summers with a higher number of days with low ozone protection seem to reappear every 3 years. Understanding the interaction of physical processes that control the ozone layer, may help to design better photo-protection programs for human health.

Sun habits in kidney transplant recipients with skin cancer: a case-control study of possible causative factors.

Organ transplant recipients are frequently affected by skin cancer, which might also be a major cause of long-term mortality. Excessive sun exposure is considered to be a factor in the aetiology, but uncertainty about the importance of this and other proposed risk factors remains. The purpose of this study was to investigate sun behaviour before and/or after the transplantation in kidney transplant recipients with or without cutaneous squamous cell carcinoma. A nested, population-based, case-control study was carried out on 95 kidney transplant recipients who had contracted cutaneous squamous cell carcinoma after the transplantation and on an accurately matched control population of 154 kidney transplanted patients. Information on sun exposure before and after the transplantation, skin type, use of sunbeds, warts, etc., was obtained from a questionnaire which contained 38 detailed questions. The differences between cases and control subjects were not significant for sun exposure before or after the transplantation, sun protective measures, number of sunburns, outdoor occupation, smoking habits or use of sunbeds. Compared to patients with skin type IV, the cutaneous squamous cell carcinoma odds ratio was 3.0 (95% CI = 1.3-7.0) for skin type I + II. Patients with light blond or red hair colour also had a higher odds ratio than those with dark hair, 3.2 (95% CI = 1.2-8.2), and patients with warts after the transplantation had a higher odds ratio than those without, 2.2 (95% CI = 1.2-4.2). In conclusion, poor tanning ability rather than the amount of sun exposure is associated with the development of cutaneous squamous cell carcinoma in kidney transplant recipients and warts appearing after the transplantation indicate increased risk.

A randomized trial of skin cancer prevention in aquatics settings: The pool cool program.

Skin cancer is increasing, and prevention programs are essential. This study evaluated the impact of a skin cancer prevention program on sun-protection habits and swimming pool environments. The intervention included staff training; sun-safety lessons; interactive activities; providing sunscreen, shade, and signage; and promoting sun-safe environments. A randomized trial at 28 swimming pools in Hawaii and Massachusetts tested the efficacy of this program (Pool Cool) compared with an attention-matched injury-prevention control program. Results showed significant positive changes in children's use of sunscreen and shade, overall sun-protection habits, and number of sunburns and improvements in parents' hat use, sun-protection habits, and reported sun-protection policies and environments. Observations corroborated the positive findings. Pool Cool had significant positive effects at swimming pools in diverse audiences.

Risk of cutaneous malignant melanoma in relation to use of sunbeds: further evidence for UV-A carcinogenicity.

In a population-based, matched, case–control study from southern Sweden of 571 patients with a first diagnosis of cutaneous malignant melanoma and 913 healthy controls aged 16–80 years, the association between sunbed use and malignant melanoma was evaluated. A total of 250 (44%) cases and 372 (41%) controls reported ever having used sunbeds. A significantly elevated odds ratio for developing malignant melanoma after regular exposure to sunbeds was found, adjusted for hair colour, raised naevi, skin type and number of sunburns (odds ratio (OR) 1.8, 95% confidence interval (CI) 1.2–2.7). A dose–response relationship between total number of sunbed uses and melanoma risk was only found up to the level of 250 times. The OR was higher in individuals younger than age 36 years (adjusted OR 8.1, 95% CI 1.3–49.5 for regular vs never use). The association seemed to be true only for subjects with black/dark brown or light brown hair and among females. Lesions of the extremities showed the strongest association of increased risk with sunbed use. An increased risk was related to commercial exposure and to exposure during the winter. The results substantiate the hypothesis that exposure to sunbeds might increase the risk of developing malignant melanoma. © 2000 Cancer Research Campaign

Risk of basal and squamous cell carcinomas of the skin in Sion, Switzerland: a case-control study.

Non-melanocytic skin cancers are the most common cancers in white populations. Studies on populations of Anglo-Saxon and Mediterranean origins highlighted different patterns of risk of basal-cell carcinoma and squamous-cell carcinoma in relation to sunlight exposure, skin characteristics and phenotype susceptibility. In Sion, and in Switzerland as a whole, the high incidence suggests the possible presence of additional risk factors or of a different pattern of exposure to solar radiation as well as different composition of pigmentary traits and skin sensitivity to sun. We conducted a case-control study of 146 cases (73% of eligible cases) and 144 controls (81% of eligible subjects) to further evaluate the relationship between nonmelanocytic skin cancer and risk factors in the Sion population. Interviews were conducted by trained interviewers with a standardized questionnaire. Pigmentary characteristics such as blonde and red hair as well as tendency to sunburn without tanning and number of sunburns showed a statistically significant and independent risk increase in basal-cell carcinoma. Sun exposure during recreational activities (outdoor sports) showed a risk increase in basal-cell carcinoma with borderline statistical significance. Analysis of squamous-cell carcinoma risk was limited by the small number of cases, but it was positively associated with lifetime exposure to sun during outdoor work and with skin characteristics. Results confirmed previous suggestions of a different mechanism leading to malignant transformation of target cells from the basal and squamous epidermal layers, mediated by different phenotypes, and conditioning the ability to develop an effectively protective tan.

Clinical and histopathological characteristics in relation to aetiological risk factors in cutaneous melanoma: a population-based study.

In this population-based, case-control study from Sweden using data collected from 1988 to 1990, an increased risk of melanoma was associated with the number of sunburns, propensity to freckle, the number of raised naevi and a family history of melanoma. Furthermore, a decreased risk was associated with occupational sun exposure. The purpose of this study was to investigate whether different histopathological features of the melanoma and clinical factors were related to the different aetiological risk factor patterns. All the confirmed primary cutaneous melanomas (n = 366) were included in the study. Both univariate analyses with tests for interaction and multivariate analyses were performed. Patients with melanoma on the trunk and patients with thin melanomas had an excess of close relatives with a history of melanoma (odds ratios [ORs] = 2.7 and 2.3, respectively). A relationship was also seen between melanomas in younger persons and a family history of melanoma (OR = 2.6). The presence of raised naevi on the arm had a tendency to be closer related to melanoma of the nodular type (OR = 4.3) than melanoma of the superficial spreading type (OR = 1.6). Patients with outdoor occupations during summer had a decreased risk of developing melanoma on the extremities. Melanoma diagnosed in patients born before 1939 had an association with sunburns (OR = 1.9) and freckling (OR = 2.0), while melanomas in patients born in 1939 or later were related to a family history of melanoma (OR = 2.2). These results suggest that different histopathological and clinical features of melanoma are associated with different risk factor patterns, which may imply diverging tumour genesis.

Sun protection counseling by pediatricians.

To establish a national baseline regarding pediatricians' sun protection counseling perceptions and behaviors. A survey was mailed to a random sample of 600 pediatricians selected from the 1996 American Academy of Pediatrics Directory using a 3-wave mailing technique to maximize the response rate. The 3-wave mailing resulted in 414 returned surveys of 583 surveys (17 surveys were nondeliverable) (a 71% response rate). Most (60%) of the pediatricians lacked formal training on how to counsel parents and children about sun protection. Approximately 3 (78%) of 4 indicated that not enough time was spent in their residency program on how to educate parents and children about sun protection. Greater than half (60%) of the respondents indicated that they usually (47%) or always (13%) counseled about sun protection. Seventy-seven percent of the respondents indicated that pediatricians have a professional responsibility to counsel parents and children about sun protection. The results of this investigation suggest that most pediatricians surveyed believed that they had a professional responsibility to counsel about sun protection and that such counseling would be effective in decreasing skin cancer and the number of sunburns. Although most had not had training on sun protection counseling in their residency program, 6 of 10 indicated that they usually or always counseled about sun protection. Sun protection counseling training in residency programs can potentially extend pediatricians' knowledge of skin cancer and the importance of a broad spectrum of preventive measures, as well as increase their ability to counsel about such measures.

An Exploratory Analysis of the Occupational Correlates of Large Pigmented Nevi at Lawrence Livermore National Laboratory

To examine the association between exposure to occupational factors and the presence on the body of large pigmented nevi greater than 5 mm, data were collected from 110 employees of Lawrence Livermore National Laboratory employed between 1969 and 1980. In this exploratory prevalent case-control study analysis, 38 employees reported having at least one large pigmented nevus and 72 reported none. Occupational factors associated with the presence of large pigmented nevi (adjusted for age and the number of sunburns per year under age 21) were being an engineer (prevalence odds ratio [POR] = 3.20, 95% confidence interval [CI] = 1.0,10.6) or an electrical engineer (POR = 2.56, 95% CI = 0.3,20.3), being hired at Lawrence Livermore National Laboratory before 1962 (POR = 3.07, 95% CI = 1.2,7.7), and having one's skin exposed to rare earth metals (POR = 3.78, 95% CI = 0.9,15.1).

Markers and relative risk in a German population for developing malignant melanoma.

The relationship between cutaneous malignant melanoma (MM) and possible risk factors was assessed in a case-controlled study. Two hundred patients and 200 non-melanoma controls of German origin matched for age and sex were interviewed and examined for pigmented moles and pigmentation characteristics. In patients with MM significantly more melanocytic nevi greater than or equal to 2 mm (MCN) were found (mean, 53 MCN) compared to control cases (mean, 18 MCN). For persons with greater than 60 MCN the relative risk (RR) for developing MM increased 15 times compared to less than or equal to 10 MCN. Additional independent markers for an increased risk were presence of atypical MCN (RR = 7 vs. none) found in 45% of patients and in 5% of the control group, moderate to large numbers of actinic lentigines (RR = 6.2 vs. none), and lack of tanning as well as a tendency to sunburn (skin type I; RR = 2.2 vs skin type IV) No significant correlation was found between the relative risk for MM and hair color, eye color, duration of free time sun exposure and number of sunburns. Individuals with permanent outdoor profession and sun exposure, however, showed a clearly increased relative risk for developing MM.