Seeking Shade Research Articles

Welfare and performance benefits of shade provision during summer for feedlot cattle in a temperate climatic zone.

There is increasing interest from cattle lot-feeders in the use of shade to mitigate the effects of a potential heat stress event, though it is unclear whether the reported benefits of shade in previous studies conducted in more high-risk heat stress zones are pertinent in cooler temperate zones. The objectives of this study were to measure the welfare and performance benefits of shade provision for lot-fed cattle at a commercial feedlot located in a mild heat-stress risk zone in Western Australia. Six blocks of black Angus (Bos taurus) steers were inducted into the feedlot over six time-windows across a southern hemisphere summer, with 80 cattle per block housed in a partially shaded pen (providing 3.125 m2 of shade per animal) and 80 in an unshaded pen. Parameters assessed in 960 cattle over the first 70 days in the feedlot included weight gain, feed intake, and physiological and behavioral indices of overall health and welfare. Over the months of October through to May in which the experiment was conducted, shaded cattle demonstrated a modest 0.13kg overall increase in average daily gain across the 70-day feedlot period (P = 0.13). There was no difference in dry matter intake between any block or treatment. The physiological and behavioral markers of health and welfare revealed that, even during to hottest times of the experiment, the cattle were quite able to thermoregulate, via increased panting and seeking shade (if available), to maintain physiological homeostasis. In addition, we measured the effect of heat stress and shade provision on the affective state of the cattle. Qualitative behavioral assessment was used to indicate that the cattle in the 'no stress' temperature humidity index (THI) category and the shaded cattle in the 'moderate stress' THI category displayed the most positive demeanor (P < 0.05), being described as more 'settled and sociable', while the unshaded cattle in the 'moderate stress' THI category and all cattle in the 'severe stress' THI category were described as more 'agitated/anxious' (P < 0.05). Overall, the findings from the present study suggest that there are definite welfare and modest performance benefits associated with providing cattle with shade in summer in a feedlot situated in a temperate climatic zone.

Drug-Induced Pigmentation: A Review.

Drug-induced pigmentation (DIP) is estimated to account for 20% of all cases of acquired hyperpigmentation. Over 50 agents have been implicated, including antibiotics, antimalarials, antiretrovirals, antipsychotics, prostaglandin analogs, heavy metals, and chemotherapeutic agents. The skin, mucosal surfaces, nails, and hair can all be affected, with the color, distribution, onset, and duration of pigmentation varying between offending agents. Both a thorough physical examination and medication history are necessary to determine the offending agent. In terms of mechanism, DIP occurs most frequently through the accumulation of melanin within the dermis but also by drug accumulation, pigment synthesis, and iron deposition. Photoprotection, including applying a broad-spectrum sunscreen, wearing photoprotective clothing, and seeking shade, plays an important role in the prevention of exacerbation of DIP. Multiple lasers, including the picosecond alexandrite, Q-switched Nd:YAG, Q-switched alexandrite, and Q-switched ruby lasers, have been successful in obtaining clearance of DIP. In this review, we examine the unique characteristics of each of the inciting agents in terms of incidence, clinical presentation, time to onset and resolution, and pathogenesis.

Patient demographic characteristics and risk factors associated with sun protection behaviours in specialist melanoma clinics.

We investigated the association between sun protection behaviours and demographic and melanoma risk characteristics of patients attending Australian melanoma specialist clinics. This may assist in targeting and tailoring melanoma prevention patient education for people at high-risk and specific population subgroups. A cross-sectional analysis of questionnaire data collected from participants attending the dermatology clinics at two major melanoma centres in Sydney, Australia between February 2021 and September 2023. The primary outcome was Sun Protection Habits (SPH) index (a summary score measured as habitual past month use of sunscreen, hats, sunglasses, a shirt with sleeves that covers the shoulders, limiting midday sun exposure and seeking shade, using a Likert scale). The primary analysis considered the SPH index and its component items scored as continuous. Data from 883 people were analysed. Factors associated with less frequent sun protection behaviours overall included male gender, no personal history of melanoma, lower perceived risk, lower calculated 10-year risk of developing melanoma, and no private health insurance. People aged >61 years reported lower use of sunscreen but higher use of hats and sleeved-shirts compared with people in the younger age group. There was no difference in overall sun protection behaviours according to family history of melanoma, country of birth or by lifetime melanoma risk among people without a personal history of melanoma. These findings highlight the potential for targeting high-risk individuals with less frequent use of sun protection for patient education, public health messaging and ultimately improving sun protection behaviours.

Investigating the relationship between heat load and shade seeking behaviour in dairy buffaloes.

The study presented in this Research Communication aimed to investigate the relationship between physiological responses, body surface temperature and shade-seeking behaviour in Nili Ravi dairy buffaloes during summer months. We enrolled 60 buffaloes, and each animal was observed for three consecutive days starting before sunrise until they moved towards the shade structures. A repeated measures ANOVA was employed to assess the changes in physiological parameters and body surface temperature between the early morning and the occurrence of shade-seeking behaviour. The average temperature humidity index and heat load index during the behavioural monitoring period (0400 to 1200 h) were 81.3 ± 6.5 and 92.9 ± 17, respectively (mean ± sd). There was no significant difference in core body temperature between sunrise and the time of shade-seeking event. However, the buffaloes had a slightly higher respiration rate at the time of shade-seeking (19.2 vs. 22.4 breaths/min). In addition, body surface temperature, measured at the flank region, shoulder, base of the ear and forehead was significantly higher at the occurrence of shade-seeking behaviour compared to the early morning. On average, the buffaloes sought shade when the surface temperature was 2°C higher than the temperature recorded before sunrise. Overall, the current findings suggest that body surface temperature, rather than core body temperature was strongly associated with shade-seeking behaviour in dairy buffaloes. These findings could be useful in developing strategies to mitigate the effects of heat stress in dairy buffalo herds and thereby improve animal welfare.

Skin cancers are the most frequent cancers in fair-skinned populations, but we can prevent them.

Cancers of the skin are the most commonly occurring cancers in humans. In fair-skinned populations, up to 95% of keratinocyte skin cancers and 70–95% of cutaneous melanomas are caused by ultraviolet radiation and are thus theoretically preventable. Currently, however, there is no comprehensive global advice on practical steps to be taken to reduce the toll of skin cancer. To address this gap, an expert working group comprising clinicians and researchers from Africa, America, Asia, Australia, and Europe, together with learned societies (European Association of Dermato-Oncology, Euromelanoma, Euroskin, European Union of Medical Specialists, and the Melanoma World Society) reviewed the extant evidence and issued the following evidence-based recommendations for photoprotection as a strategy to prevent skin cancer. Fair skinned people, especially children, should minimise their exposure to ultraviolet radiation, and are advised to use protective measures when the UV index is forecast to reach 3 or higher. Protective measures include a combination of seeking shade, physical protection (e.g. clothing, hat, sunglasses), and applying broad-spectrum, SPF 30 + sunscreens to uncovered skin. Intentional exposure to solar ultraviolet radiation for the purpose of sunbathing and tanning is considered an unhealthy behaviour and should be avoided. Similarly, use of solaria and other artificial sources of ultraviolet radiation to encourage tanning should be strongly discouraged, through regulation if necessary. Primary prevention of skin cancer has a positive return on investment. We encourage policymakers to communicate these messages to the general public and promote their wider implementation.

Basal Cell Carcinoma: Diagnosis, Management and Prevention

Basal cell carcinoma (BCC) is a slow-growing, locally aggressive, rarely metastasizing, low-grade cutaneous neoplasm that arises from the epidermal basal layer and invades the adjoining tissues. It is the most common skin cancer. It is fairly common in fair Caucasians and quite uncommon in dark-skinned populations. It contributes to 65–75% of cutaneous malignancies in whites and 20–30% in Asian Indians. The most important causal factors appear to be radiation exposure and genetic predisposition. It may present as a nonhealing lesion that occasionally bleeds or as a pruritic lesion with no symptoms. Tumours rarely spread to regional lymph nodes. The clinical appearances and morphology of BCC are diverse. Clinical types include nodular, cystic, superficial, pigmented, morphoeaform, (sclerosing), keratotic and fibroepithelioma of Pinkus. Most of the lesions appear on the head and neck, usually above the line joining the tragus and the angle of the mouth. A biopsy should be performed on all lesions suspected of BCC. The primary aim of treatment is the complete excision of the tumour tissue. Other treatment modalities include cryotherapy, immunomodulatory drugs, laser treatment or locally applicable chemotherapeutic agents. Prevention consists of lifestyle changes such as avoiding sunburn, tanning beds and prolonged direct sun exposure, shade seeking, sunscreen application on the skin, and physical barrier methods such as protective clothing, hats and sunglasses. Regular sunscreen use in childhood and adolescence seems more beneficial than in adulthood.

Behavioural changes to moderate heat load in grazing dairy cows under on-farm conditions

Heat stress poses an increasing risk to welfare, health and productivity of dairy cows, especially for cows on pasture. To apply timely mitigation strategies for grazing cows, simple indicators are needed that signal heat stress. We conducted an exploratory study on the behaviour of grazing dairy cows in relation to the environmental heat load on four commercial dairy farms in Switzerland with herd sizes ranging from 20 to 57 cows. In a scan-sampling procedure standing/lying, feeding/ruminating, low inter-individual distances, proximity to drinker, use of natural shade and insect infestation were observed during 30 days (5–9 days/per farm). Additionally, 10 focal cows per farm were equipped with accelerometers to analyse lying duration and locomotor activity during on average 46 days per farm. On one farm all cows (N = 57) were equipped with GPS devices which were used to calculate inter-individual distances among cows continuously during 69 days. Air temperature and relative humidity were recorded to calculate the temperature-humidity index (THI). For behaviours recorded in direct observations, a principal component analysis was performed for variable reduction. The first three principal components (PC) as well as the variables from automatic measurements were used as outcome variables in mixed effects models with daily maximum THI (THImax), time of day (continuous, in 10 min intervals) and their interaction as explanatory variables. The three PCs could be described as: “feeding and standing”, “proximity to drinker” and “standing in close proximity and seeking shade”. The daily pattern of these PC's differed by THImax (interaction time of day * THImax; all p < 0.01). On days with high THImax compared to days with lower THImax cows were seen more often close to the drinker in the morning, but not in the afternoon when they were observed standing close to each other and in the shade. On days with high THImax, cows also were lying less and increased their locomotor activity towards noon (interaction time of day * THImax; p < 0.001). Data from GPS devices confirmed the findings: On days with high THImax, cows reduced their inter-individual distances over the course of the day, while this was not observed on days with lower THImax (interaction time of day * THImax; p < 0.001). Insect infestation increased with higher THImax. We conclude that a distinct change in daily behavioural patterns, especially a reduction of lying behaviour, an increase in locomotor activity and a decrease in inter-individual distances could be used to monitor heat stress of dairy cows on pasture.

A review of thermal stress in cattle.

Cattle control body temperature in a narrow range over varying climatic conditions. Endogenous body heat is generated by metabolism, digestion and activity. Radiation is the primary external source of heat transfer into the body of cattle. Cattle homeothermy uses behavioural and physiological controls to manage radiation, convection, conduction, and evaporative exchange of heat between the body and the environment, noting that evaporative mechanisms almost exclusively transfer body heat to the environment. Cattle control radiation by shade seeking (hot) and shelter (cold) and by huddling or standing further apart, noting there are intrinsic breed and age differences in radiative transfer potential. The temperature gradient between the skin and the external environment and wind speed (convection) determines heat transfer by these means. Cattle control these mechanisms by managing blood flow to the periphery (physiology), by shelter-seeking and standing/lying activity in the short term (behaviourally) and by modifying their coats and adjusting their metabolic rates in the longer term (acclimatisation). Evaporative heat loss in cattle is primarily from sweating, with some respiratory contribution, and is the primary mechanism for dissipating excess heat when environmental temperatures exceed skin temperature (~36°C). Cattle tend to be better adapted to cooler rather than hotter external conditions, with Bos indicus breeds more adapted to hotter conditions than Bos taurus. Management can minimise the risk of thermal stress by ensuring appropriate breeds of suitably acclimatised cattle, at appropriate stocking densities, fed appropriate diets (and water), and with access to suitable shelter and ventilation are better suited to their expected farm environment.

Sun exposure behaviours as a compromise to paradoxical injunctions: Insight from a worldwide survey.

Behavioural interventions can improve attitudes towards sun protection but the impact remains inconsistent worldwide. To assess awareness of and attitudes towards the multiple facets of sun exposure and suggest ways to improve prevention from overexposure to the sun in all geographical zones and multiple skin types. Online survey was conducted from 28 September to 18 October 2021. Study population was selected from the Ipsos online Panel (3,540,000 panellists), aged ≥18 years, from 17 countries around the five continents. Demographics, sun-exposure habits and practices, understanding of risks and information on phototypes were documented and analysed using descriptive statistics. Eighty-eight per cent of participants knew that sunlight can cause skin health problems (90% phototypes I-II, 82% phototypes V-VI, >90% in American and European countries, 72% in Asia and 85% in Africa). Eighty-five per cent used some form of protection against sunlight, predominantly: Seeking shade (77%), avoiding the midday sun (66%), facial application of sunscreen (60%) and wearing protective clothing (44%). The perception of sunlight itself is positive ('it gives energy' for 82%; 'tanned skin looks attractive' for 72%), although less in Asian countries and among individuals with dark skin phototypes. Eighty-three per cent reported having experienced sunburn, mainly in Australia, Canada, USA, Germany, France and Russia, and among individuals with dark skin phototypes. Only 12% systematically/often used all types of protection during exposure to the sun and 23% believed it is safe to go out in the sun with no protection when their skin is already tanned. From 13% (skin phototype I) to 26% (phototype VI) reported not using any form of protection against the sun. Knowledge and habits were significantly superior among people who are accustomed to seeing a dermatologist for a complete skin exam. Dermatologists could play a crucial role in relaying novel prevention messages, more finely tailored to specific risks, populations and areas of the world.

Assessing the Knowledge, Attitude, Practice towards the Sun Exposure and the use of Sunscreen by the General Population in Makkah, Saudi Arabia

Context: Sunlight exposure is a major cause of melanoma and non-melanoma skin cancer (NMSC). The sunscreen use can reduce the risk of developing melanoma and NMSC. Purpose: To assess the knowledge, attitude, and practice of the general population of Makkah city, Saudi Arabia related to sun exposure and the use of sun protection. Methods and Material: The present study is a descriptive cross-sectional study including 577 participants from the general population of Makkah city, Saudi Arabia using an online pretested Arabic questionnaire designed via Google Forms. Results: More than three-quarters of the respondents (78.4%) stated that sun exposure is harmful; of these, 61.9% stated that tanning, pigmentation, burns, skin cancer, and aging are potential risks that result from sun exposure. Further, 39.5% of the participants sometimes used sunscreen, while 23.9% of them regularly used sunscreen when exposed to the sun; the majority (75.1%) was unaware of the different forms of sunscreens. The factors associated with the regular use of sunscreen were female gender, aged between 18-25 years, and single. The majority of the respondents admitted that sunscreen use is necessary for protection against harmful ultraviolet radiation (88.9%); however, only 34.7% of them used other protective methods such as avoiding exposure to the sun (84.0%) and seeking shade (72.0%). Conclusions: According to the results, various attitudes toward the usage of sunscreen were found. Most of the respondents believed that exposure to the sun are harmful. However, the rate of sunscreen use by our population was average despite their reasonable awareness of the effects of sun exposure. This implies the need for health education campaigns and programs.

Patterns of Sun Protection Behaviours among Australian Adolescents and Adults over a Six-Year Period.

The major cause for skin cancer is the excessive and unprotected exposure to ultraviolet radiation (UVR), which can be prevented by engaging in sun protection behaviours. As longitudinal studies on both adolescents' and adults' performances of sun protection behaviours are limited, the current study aimed to investigate changes in sun protection in these population segments in Western Australia, a region with high annual UVR. During six summer seasons (2015/16 to 2020/21), cross-sectional surveys were conducted among 1806 adolescents (14 to 17 years old) and 1808 adults (18-45 years old), investigating the frequency of five sun protection behaviours (wearing clothing, applying sunscreen, wearing a hat, wearing sunglasses, and seeking shade) and sun avoidance (staying indoors). Over the six-year period, staying indoors increased in both groups. Among adolescents, a decrease in wearing clothing and sunglasses and an increase in seeking shade was demonstrated, and hat and sunscreen use remained relatively stable. Among adults, an increase in sunscreen use was shown, whereas all other sun-related behaviours remained consistent over the six-year period. The results from this study can provide directions for health communications focusing on improving sun protection behaviours among both adolescent and adult populations.

Illuminating the Shadows: Exploring the Causes, Overcoming Challenges, and Advancing Solutions for Skin Cancers in Pakistan

Skin cancer poses a significant and growing public health concern in Pakistan, with rising incidence rates and a burden that weighs heavily on individuals, families, and healthcare systems. Understanding the causes, addressing the challenges, and implementing effective solutions are critical steps in combating this escalating issue.1 In this editorial, we shed light on the complexities of skin cancers in Pakistan, exploring the underlying causes, the challenges faced, and the pathways to advancing solutions for prevention, early detection, and treatment. The primary cause of skin cancers, including melanoma and non-melanoma types, is excessive and prolonged exposure to ultraviolet (UV) radiation from the sun1. Pakistan's geographical location, with abundant sunshine and a predominantly sunny climate, places its population at a heightened risk of developing skin cancers. Cultural practices, such as limited sun protection measures and a preference for fair skin, further contribute to increased UV exposure and vulnerability to skin cancers.1 Public awareness campaigns and education on the importance of sun protection practices, such as wearing protective clothing, using sunscreen, and seeking shade during peak sun hours, are crucial for reducing UV-related risks. Another significant challenge in combating skin cancers in Pakistan is the lack of comprehensive and consistent data on the incidence, prevalence, and mortality rates. Limited national registries and fragmented data collection systems impede accurate assessment and hinder evidence-based decision-making.2 Strengthening surveillance mechanisms, establishing cancer registries, and promoting data sharing and collaboration among healthcare institutions and researchers are pivotal in obtaining a comprehensive understanding of the burden and trends of skin cancers. Access to healthcare services, particularly in rural areas, poses a significant obstacle to early detection and timely treatment of skin cancers. Limited healthcare infrastructure, inadequate training of healthcare professionals and financial constraints restrict access to dermatological expertise, specialized diagnostics, and appropriate treatment modalities. Investment in dermatology services, the training of healthcare professionals, and the establishment of skin cancer centers can enhance early detection, diagnosis, and treatment accessibility for all individuals across Pakistan.3 Community engagement and health education programs play a pivotal role in raising awareness about skin cancers, dispelling misconceptions, and encouraging early detection behaviors4. Collaboration with community leaders, schools, and local organizations can facilitate the dissemination of information on risk factors, warning signs, and the importance of regular self-examinations4. By empowering individuals to recognize suspicious lesions and seek timely medical attention, we can promote early diagnosis and improve treatment outcomes.4 Furthermore, innovative technological solutions, such as telemedicine and mobile health applications, have the potential to bridge the geographical gaps and improve access to dermatological expertise in remote areas. Telemedicine platforms enable dermatologists to remotely assess and diagnose skin lesions, providing guidance on further evaluation and treatment options. Integrating these digital solutions into the healthcare system can greatly enhance dermatology services and improve outcomes for individuals with skin cancers.5 Collaborative research efforts and partnerships between academia, healthcare institutions, and governmental bodies are vital in advancing the understanding of skin cancers in Pakistan.6 Research studies focused on epidemiology, genetic factors, environmental influences, and treatment outcomes can provide valuable insights into the unique characteristics of skin cancers in the Pakistani population. These insights can inform the development of tailored prevention strategies, treatment guidelines, and targeted interventions. In conclusion, addressing the rising burden of skin cancers in Pakistan requires a multifaceted approach that encompasses awareness, prevention, early detection, treatment accessibility, and research collaboration. By illuminating the shadows cast by skin cancers, we can create a comprehensive framework that combines public education, healthcare infrastructure development, technological innovations, and research advancements. Together, we can combat this growing epidemic and improve the lives of individuals affected by skin cancers in Pakistan.7-10 How to Cite This: Rani B. Illuminating the Shadows: Exploring the Causes, Overcoming Challenges, and Advancing Solutions for Skin Cancers in Pakistan. Isra Med J. 2023; 15(1):35-36. DOI: https://doi.org/10.55282/imj.ltr35

The impact of a novel digital sun protection campaign on sun‐related attitudes and behaviours of healthcare workers: A prospective observational study

AbstractBackground13 000 cases of skin cancer are diagnosed annually in Ireland, with ultraviolet (UV) radiation exposure the strongest risk factor. Public health primary prevention campaigns focus on encouraging safe sun protective measures and skin cancer awareness. We designed a novel, digitally‐animated hospital‐based campaign targeting all aspects of sun‐protective behaviour.ObjectivesTo explore the sun‐protective attitudes and behaviours of healthcare workers, and the effect of a digital hospital‐based campaign on these findings.MethodsThis was a cross‐sectional prospective observational study involving hospital staff across the six hospitals that form the University of Limerick Hospital Group (ULHG). A two‐phase online survey, the first taking place before campaign launch, and the second upon campaign completion. The digital campaign was displayed across all hospital sites from June to September 2021. Surveys comprised questions on sun‐related attitudes and behaviours, including the internationally validated Sun Exposure Protection Index (SEPI) questionnaire.ResultsEight hundred fifty‐seven staff members completed survey 1 and 704 completed survey 2; 90% in each were female; 79% were aged 25–54; 71% reported skin types I–III. Best sun‐protective habits pre‐campaign included sunscreen use and avoiding sunburn, while wearing hats, protective clothing and seeking shade were least adopted. For 177 matched participants, there were small improvements in SEPI scores. SEPI Part 1 scores, reflecting improved risk behaviour, pre‐campaign had a median of 11 (IQR 7), and 11 (IQR 6) post campaign. SEPI Part 2 scores, reflecting readiness to adopt sun‐protective behaviours, improved from median 7 (IQR 8) to 6 (IQR 6). Post‐campaign, small improvements were seen across some individual sun‐protective behaviours and attitudes, particularly reducing time spent in the midday sun and on sun‐seeking holidays, and improved readiness to seek shade and reduce sunbathing; 79% of all respondents post‐campaign (n = 556) reported raised skin cancer awareness, and 65% (n = 458) said it influenced them to discuss sun protection with others.ConclusionsPositive improvements in attitudes and behaviours related to sun protection were seen following the digital campaign in this population of healthcare workers. These improvements along with increased willingness to discuss sun protection with others, including patients, has the potential to further benefit wider society, and supports future digital health promotion initiatives.

The effect of shade on sheep grazing pasture during summer conditions

Providing shade in situ in paddocks may lead to better animal welfare and/or improved sheep production outcomes. However, there are no replicated experiments detailing the effect of the provision of shade in situ under grazing during summer on behavioral, physiological, and production outcomes of sheep in the scientific literature. This study uses a replicated field experiment to examine the effect of provision of shade in situ to sheep under grazing on animal behavior, respiration rate, core body temperature (CBT), growth, and immunological function during summer in south east Australia. The experiment consisted of eight unshaded pasture plots and eight shaded pasture plots with an 18 m2 shade structure. Each plot was stocked with 20 sheep. Sheep with access to shade chose to use the shade in the hottest part of the day, reducing their 12 pm respiration rate to 64 breaths per minute (bpm) compared with sheep without shade at 98 bpm (P < 0.0001). However, the provision of shade had no effect on CBT, immunological function, or animal production. In the hottest part of the day, sheep without shade exhibited shade seeking behavior by either being located along the fence line (P < 0.0001) or at the water trough (P < 0.001). In conclusion, provision of shade in situ to sheep under grazing during summer conditions improved the affective state, and thus welfare, of the sheep by reducing the respiration rate needed to maintain thermostability.

Sun-protective behaviors and sunburn among US adults.

Individuals can reduce the risk of developing skin cancer by minimizing ultraviolet sunlight exposure, though recent trends in sun-protective behaviors remain to be investigated. To evaluatesun-protective behaviorsand sunburn among US adults. We analyzed data from the 2010, 2015, and 2020 National Health Interview Survey (NHIS), an annual, cross-sectional survey conducted by the US Census Bureau. Multivariable regression models were stratified by demographic variables and constructed to evaluate sun-protective behaviors and sunburn avoidance across time. From 2010 through 2020, US adults had significantly increased prevalence of seeking shade (pvalue, 0.003), wearing wide-brimmed hats (< 0.001), wearing long-sleeved shirts (< 0.001), using sunscreen (< 0.001), and avoiding sunburns (< 0.001) and significantly decreased prevalence of sun avoidance (< 0.001). Disparities in sun-protective behaviors also exist among different sexes, ages, education levels, and those reporting higher sun sensitivity. This cross-sectional study found that by 2020, US adults had an increased prevalence of wearing sun-protective clothing and sunscreen use, though decreased prevalence of sun avoidance. Although certain sun-protective behaviors have become more prevalent, the incidence of skin cancer continues to rise. Efforts to understand drivers of sun-protective behaviors and targeted intervention efforts are needed.

663 Non-sunscreen photoprotection methods are associated with lower serum 25-hydroxyvitamin D, with Asian and Black individuals showing less decrease in 25-hydroxyvitamin D with shade seeking: NHANES 2011-2016

Individuals with skin of color (SOC) have increased epidermal melanin that protects against photocarcinogenesis but increases the risk of vitamin D deficiency. Whether recommendations on photoprotection should differ for SOC is an important public health question, and few studies have examined the association between photoprotection and serum 25-hydroxyvitamin D [25(OH)D] levels in SOC populations, particularly in Asian individuals. We analyzed the data of 8269 adults aged 20-59 years (3050 Non-Hispanic White [NHW], 2001 Hispanic, 1042 Non-Hispanic Asian [NHA], 1848 Non-Hispanic Black [NHB], 328 other race/multiracial) from the National Health and Nutrition Examination Survey, 2011-2016. After adjusting for survey cycle, season, age, sex, race-ethnicity, education, income to poverty ratio, body mass index, smoking, alcohol use, physical activity, vitamin D intake, and other photoprotection methods, sunscreen use was not associated with significant change in 25(OH)D (0.317 nmol/L/unit increase in frequency, p=0.393). Lower 25(OH)D was seen with increased shade seeking (-2.304 nmol/L/unit increase in frequency, p<0.001) and long sleeve use (-0.874 nmol/L/unit increase in frequency, p=0.009). Heterogeneity of effects by race-ethnicity was present for shade seeking (likelihood ratio test [LRT], p=0.030) but not sunscreen or long sleeve use (LRT, p=0.438 and p=0.265). When stratified by race-ethnicity, the association between shade seeking and decreased 25(OH)D was stronger in NHW individuals (-2.877 nmol/L/unit increase in frequency, p<0.001) than in NHA (-0.734 nmol/L/unit increase in frequency, p=0.044 vs. NHW) and NHB participants (-0.486 nmol/L/unit increase in frequency, p<0.001 vs. NHW). In summary, we found that long sleeve use and shade seeking, but not sunscreen use, were associated with lower 25(OH)D across all participants, with NHA and NHB individuals showing less decrease in 25(OH)D with shade seeking, which may shift the risk-benefit ratio of shade seeking in these populations.

Photoprotection for Skin of Color.

Photoprotection behaviors can mitigate skin damage caused by ultraviolet radiation, and common methods include seeking shade, avoiding sun exposure during peak daylight hours, wearing sun-protective clothing, applying sunscreen, and using sunglasses. While the role of sun protection in preventing sunburns, photoaging, and skin cancer is well established in fair-skinned populations, individuals with skin of color (SOC) are presumed to suffer fewer negative effects from solar radiation. Thus, the importance of photoprotection in this population is understudied and may be underestimated. In SOC populations, sun exposure is known to cause pigmentary disorders, photoaging, and basal cell carcinoma (BCC), highlighting the potential benefits of photoprotection. Although SOC populations tend to practice photoprotection by seeking shade and wearing sun-protective clothing, survey and interview-based studies have consistently found relatively low use of sunscreen among these populations. Common motivators for photoprotection in individuals with SOC include preventing sunburn and pigmentation, with the prevention of skin cancer being a less important reason. As a skin cancer risk behavior, indoor tanning is relatively rare in SOC populations, but its use may increase with acculturation to US norms. While more studies are necessary to clarify whether photoprotection behaviors may decrease skin cancer-related mortality in SOC populations, regular dermatologic care and counseling on photoprotection remain essential in patients with SOC for overall skin health.

Sun Protection and Sunburn in Children Aged 1-10 Years in Germany: Prevalence and Determinants.

Seeking shade, the use of textile sun protection and sunscreen, and protecting one’s eyes by wearing sunglasses are recommended sun protection measures in children. We aimed to quantify the use of these measures as well as the prevalence of sunburn in children aged 1 to 10 years in Germany and to identify their determinants. Data collected via telephone interviews in a nationwide sample of 554 parents or caregivers in family were analyzed. Use of sunscreen was the most common measure applied (77.8%), while sunglasses were least frequently used (12.5%). The prevalence of sunburn during the past year was 21.8%, and it was positively associated with children’s age. The use of sun protection measures was significantly associated with the age and skin color of the child, while characteristics and tanning behaviors of the caregivers only played a minor role. The use of sun protection measures was higher when caregivers perceived themselves as a role model (Odds Ratio (OR) = 4.33, p < 0.001). Our nationwide data show that there remains a need for the improved use of sun protection measures, especially in children aged 7 to 10 years. In educational material, parents should be encouraged to become positive role models for their children regarding sun protection.

A Randomized Trial of Precision Prevention Materials to Improve Primary and Secondary Melanoma Prevention Activities among Individuals with Limited Melanoma Risk Phenotypes.

Simple SummaryInherited genetic variation at the MC1R gene is associated with increased risk of melanoma among non-Hispanic whites (NHWs), especially among those with skin and pigmentation characteristics that are associated with average to lower melanoma risk, for whom MC1R genetic testing may reveal unrecognized melanoma risk. We conducted a randomized trial to examine whether providing MC1R genetic risk information together with precision prevention materials would increase primary and secondary melanoma preventive behaviors compared to providing generic prevention materials only. We found that among participants with MC1R variants associated with higher risk of melanoma, the intervention increased shade-seeking or using an umbrella, increased wearing sleeved shirts, and decreased sunburns among their young children. We conclude that MC1R genetic testing and precision prevention materials may increase the practice of some sun-protective behaviors.Inherited variation at MC1R is associated with elevated melanoma risk among non-Hispanic whites (NHWs). MC1R genetic testing may unmask previously unrecognized disease risk, especially among individuals with few melanoma phenotypic risk factors. We recruited NHW individuals with limited phenotypic risk factors from two primary care clinics in west-central Florida. Participants (n = 1134) were randomized within MC1R genotype risk group (average/higher) to receive mailed precision prevention (i.e., intervention) or generic prevention materials. Participants reported hours of weekday and weekend sun exposure, frequency of intentional outdoor tanning and sun protection behaviors, number of sunburns, indoor tanning episodes, and skin examinations at baseline, and after 6 and 12 months. Among MC1R higher-risk participants, the intervention increased the likelihood of often or always wearing a shirt with sleeves (OR = 1.49, p = 0.03) and seeking shade or using an umbrella (OR = 1.42, p = 0.046), and it decreased the number of sunburns among their young children (β = −0.13, p = 0.03). Intervention effects were not noted among MC1R average-risk participants. Moderation analyses identified intervention effects within subgroups in average-risk and higher-risk participants. Precision prevention information conveying MC1R testing results can increase the practice of some sun protection behaviors among at-risk individuals with limited melanoma risk phenotypes and may provide a cross-generational tool to counteract increasing incidence of melanoma.

Habit Facilitates Actioning Sun Protective Behavior Intentions

Skin cancer is highly burdensome, but preventable with regular engagement in sun protective behaviors. Despite modest effectiveness of sun-protective behavior promotional efforts thus far, rates of engagement in sun-protective behaviors remain low. More is needed to understand motivation for using sunscreen, wearing sun-protective clothing, and seeking shade. This study tested whether the links of intention and habit strength with behavior differed between sun-protective behaviors. It was hypothesized that sun protective behaviors would be predicted by both habit and intention and that intention-behavior associations would be weaker for people with stronger habits. Participants residing in Queensland, Australia (N = 203; 75.96% female; M age = 37.16 years, SD = 14.67) self-reported their intentions and habit strength about sun-protective behavior for the next 7 days. Participants were followed-up 7 days later to self-report their sun-protective behavior. Multilevel modeling, accounting for nesting of multiple behaviors within-person, revealed that habit moderated the intention strength – behavior association and this moderation effect did not differ as a function of which behavior was being predicted. People with strong or moderate habit strength tended to act in line with their intentions; however, for people with very weak habits (2 SD < M), there was less alignment between their intention and behavior. These findings suggest that habit plays a facilitative role in the implementation of strong sun protective behavior intentions. Interventions should consider how to encourage intention and habit to enhance sun-protective behaviors and reduce the burden of skin cancer from sun exposure. Supplemental data for this article is available online at https://doi.org/10.1080/08964289.2021.1903380 .