Sun Protection Behaviors Research Articles

Sun-protective clothing and shade use in public outdoor leisure settings from 1992 to 2019: Results from cross-sectional observational surveys in Melbourne, Australia

Skin cancer presents a significant public health burden in Australia. The present study aimed to supplement population-based estimates of sun protection behaviour by examining setting-specific trends in directly observed sun protection in public outdoor leisure settings. Repeated cross-sectional observational surveys of adolescents and adults were conducted on summer weekends between 11 am and 3 pm from 1992 to 2002, 2006 to 2012, and 2018 to 2019 (N = 44,979) at pools/beaches and parks/gardens within 25 km of the centre of Melbourne, Victoria. The primary outcome was a binary index representing individuals having above or below the median level of body surface covered by hat, shirt, and leg garments in each setting type. The prevalence of above-median body coverage increased between 1992 and 2002 in both settings. At pools/beaches, a slight decline in above-median body coverage between 2006 and 2019 in males and females (adjusted odds ratio, AOR = 0.96 [0.94, 0.97]; 0.94 [0.93, 0.95]) appeared to be driven by a decline in leg coverage, while arm coverage, hat, sunglasses, and shade use remained stable. At parks/gardens, a decline in above-median body coverage between 2006 and 2019 (AOR = 0.90 [0.89, 0.91]; 0.94 [0.93, 0.95]) was accompanied by small declines across other protective behaviours that varied between males and females. Patterns in protective behaviours observed in outdoor leisure settings may reflect the changing composition of individuals choosing to remain outdoors during peak UV times and highlight the importance of continued promotion and monitoring of the use of multiple measures to protect against UV damage in Australia.

A study looking at UV exposure and genetic risks in relation to melanoma

British Journal of DermatologyVolume 183, Issue 2 p. e39-e39 Plain Language Summary Free Access A study looking at UV exposure and genetic risks in relation to melanoma First published: 02 August 2020 https://doi.org/10.1111/bjd.19273 AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onEmailFacebookTwitterLinked InRedditWechat Abstract Melanomas are common cancers among people of European ancestry, accounting for 1·6% of all new cancer cases and 0·6% of all cancer deaths worldwide in 2018. The only environmental factor consistently implicated as a cause of melanoma is ultraviolet (UV) radiation, but the relationship is complex, and little is known about how genetic factors influence the association between UV and melanoma. The effects of UV exposure are affected by ‘host factors’ (meaning factors that are specific to the individual, such as their genes), and by ‘host behaviours’ (such as their patterns of sun exposure and history of sunburns). The aim of this study was to examine whether melanoma risk varies according to reported levels of sun exposure, even within populations exposed to year-round high levels of sunlight (i.e. Queensland, Australia). More particularly, the authors sought to determine whether the associations with sunlight differ according to a person's inherent genetic risk. In a large Australian study, country of birth, age at migration and sunburns during all periods of life were all strongly associated with melanoma risk. People who had a past history of other types of skin cancer (specifically, BCC or SCC) and of other skin lesions caused by sun exposure had a higher risk of developing melanoma than people without sun-related skin lesions. The authors found evidence for gene-environment interactions that are consistent with the ‘divergent pathway’ hypothesis for melanoma development, which almost 20 years ago proposed that people with a high genetic susceptibility (i.e. at higher risk of melanoma, genetically) may only need modest levels of sun exposure to trigger melanoma development, whereas those with low genetic susceptibility require continued high levels of sun exposure to trigger melanoma development. In line with this hypothesis, the authors found that people who were at low genetic risk for melanoma, but who did eventually develop melanoma, were more likely to have been treated for sun-related skin lesions than people at high genetic risk. In other words, the people at low genetic risk who developed melanoma appeared to need a much larger dose of sun exposure than those at high genetic risk. In contrast, among people at high genetic risk, markers of high-level early life ambient exposure were relatively more important. These findings may help to identify and inform people at high risk of melanoma who stand to benefit most from adopting sun protective behaviours. Linked Article: Olsen et al. Br J Dermatol 2020; 183:303–310. Volume183, Issue2August 2020Pages e39-e39 RelatedInformation

Skin Photosensitivity is Associated with 25-Hydroxyvitamin D and BMD but not Fractures Independent of Melanin Density in Older Caucasian Adults.

Whether skin photosensitivity modulates sun exposure behaviours, consequent vitamin D status and skeletal health outcomes independently of constitutive pigmentation have not been systematically investigated. 1072 community-dwelling adults aged 50-80years had skin photosensitivity quantified by questionnaire and melanin density by spectrophotometry. Bone mineral density (BMD), falls risk and 25-hydroxyvitamin D (25OHD) were measured using DXA, short form physiological profile assessment and radioimmunoassay, respectively. Sun exposure and symptomatic fractures were assessed by questionnaire. Participants were followed up at 2.5 (n = 879), 5 (n = 767) and 10 (n = 571) years. Higher resistance to sunburn and greater ability to tan were associated with reduced sun protection behaviours (RR 0.87, p < 0.001 & RR 0.88, p < 0.001), higher lifetime discretionary sun exposure in summer (RR 1.05, p = 0.001 & RR 1.07, p = 0.001) and winter (RR 1.07, p = 0.001 & RR 1.08, p = 0.02) and fewer lifetime sunburns (RR 0.86, p < 0.001 & RR 0.91, p = 0.001). Higher resistance to sunburn was associated with lower total body (β = - 0.006, p = 0.047) and femoral neck (β = - 0.006, p = 0.038) BMD, but paradoxically, fewer prevalent fractures (RR 0.94, p = 0.042). Greater ability to tan was associated with higher 25OHD (β = 1.43, p = 0.04), lumbar spine (β = 0.014, p = 0.046) and total body (β = 0.013, p = 0.006) BMD, but not fracture or falls risk. These associations were independent of constitutive melanin density. Cutaneous photosensitivity was associated with sun exposure behaviours, cutaneous sequelae and, consequently, 25OHD and BMD in older Caucasian adults independent of constitutive melanin density. There was no consistent association with fracture outcomes, suggesting environmental factors are at least as important.

Solar ultraviolet radiation exposure among outdoor workers in Alberta, Canada

BackgroundOutdoor workers are at risk of prolonged and high solar ultraviolet radiation (UVR) exposure, which is known to cause skin cancer. The objectives of this study were to characterize the UVR exposure levels of outdoor workers in Alberta, Canada, and to investigate what factors may contribute to their exposure. MethodsThis study collected objective solar UVR measurements from outdoor workers primarily in Alberta during the summer of 2019. Workers were recruited via the management or health and safety teams from building trade unions and employers. Calibrated, electronic UVR dosimeters were worn by workers on their hardhats, wrists, or lapels for five working days. Data on workers’ demographics, jobs, sun protection behaviors, and personal risk factors were collected using questionnaires, and meteorological data for each sampling day were noted. Mean daily exposure measured as the standard erythemal dose (SED) was calculated and compared to the international occupational exposure limit guideline (1.3 SED). Marginal models were developed to evaluate potential determinants of occupational solar UVR exposure. ResultsIn total, 883 measurements were collected from 179 workers. On average, workerswere exposed to 1.93 SED (range: 0.03–16.63 SED) per day. Just under half of workers (45%) were exposed to levels exceeding the international exposure limit guideline. In the bivariate analyses, landscape and maintenance workers, as well as trade and recreation workers, had the highest levels of exposure (average: 2.64 and 1.84 SED, respectively). Regional variations were observed, with the “other” cities/regions (outside of Edmonton and Calgary) experiencing the highest average levels (2.60 SED). Workers who placed the dosimeters on their hardhats experienced higher levels compared to the other groups. Exposure was highest on sunny and mixed days. Education, trade, city, dosimeter placement, forecast, hair colour, and number of hours outside were included in the final exposure model, of which trade, dosimeter placement, forecast, and number of hours outside at work were statistically significant. ConclusionsExposure to elevated solar UVR levels is common among outdoor workers in Alberta. The study findings can help inform future monitoring studies and exposure reduction initiatives aimed at protecting workers.

Acceptability of online sun exposure awareness-raising interventions among youngAustralian women: an exploratory mixed-methods study.

Melanoma is the most common cancer among young Australians. Despite school-based programs such as 'Sun Smart' leading to increased knowledge among children of the harmful effects of sun exposure, many young adults continue to desire a darker skin tone because of a general perception among their peers that tanned skin is attractive. This 'tanned-ideal' may be challenged through exposure to material posted on social media. This study aimed to investigate the impact of two online interventions on knowledge of skin cancer and intentions to engage in sun tanning and protective behaviours, as assessed by survey. In addition, the likelihood that the intervention would be 'shared' on social media was explored by interview during an intervention session. Eighteen women aged 18-24 years participated in this pilot, mixed-methods intervention study. Participants completed surveys 2 weeks before and 2 weeks after attending an intervention session in which they viewed a video and completed a face-aging activity, with the order of completion balanced within the sample. Two weeks after the intervention, there was a significant increase in knowledge and intended sun protection behaviours and a significant decrease in intended future tanning hours. There was no effect of intervention order. Interview data indicated that younger participants would share the ageing application with peers because it was fun; older participants reported that they would share the video because it was educational. Factors that encourage sharing on social media include being realistic, instructive or personally meaningful, and short in duration.

The Melanoma Genomics Managing Your Risk Study randomised controlled trial: statistical analysis plan

BackgroundThe Melanoma Genomics Managing Your Risk Study is a randomised controlled trial that aims to evaluate the efficacy of providing information on personal genomic risk of melanoma in reducing ultraviolet radiation (UV) exposure, stratified by traditional risk group (low or high phenotypic risk) in the general population. The primary outcome is objectively measured total daily Standard Erythemal Doses at 12 months. Secondary outcomes include UV exposure at specific time periods, self-reported sun protection and skin-examination behaviours, psychosocial outcomes, and ethical considerations surrounding offering genomic testing at a population level. A within-trial and modelled economic evaluation will be undertaken from an Australian health system perspective to assess the cost-effectiveness of the intervention.ObjectiveTo publish the pre-determined statistical analysis plan (SAP) before database lock and the start of analysis.MethodsThis SAP describes the data synthesis, analysis principles and statistical procedures for analysing the outcomes from this trial. The SAP was approved after closure of recruitment and before completion of patient follow-up. It outlines the planned primary analyses and a range of subgroup and sensitivity analyses. Health economic outcomes are not included in this plan but will be analysed separately. The SAP will be adhered to for the final data analysis of this trial to avoid potential analysis bias that may arise from knowledge of the outcome data.ResultsThis SAP is consistent with best practice and should enable transparent reporting.ConclusionThis SAP has been developed for the Melanoma Genomics Managing Your Risk Study and will be followed to ensure high-quality standards of internal validity and to minimise analysis bias.Trial registrationProspectively registered with the Australian New Zealand Clinical Trials Registry, ID: ACTR N12617000691347. Registered on 15 May 2017.

Prevalence and correlates of sun protections with sunburn and vitamin D deficiency in sun-sensitive individuals.

Sun sensitivity is an inherent risk factor for skin cancer. Sun protection is important in sun-sensitive individuals to reduce sunburns for skin cancer prevention. However, concerns have arose regarding the possible impact of sun protection on vitamin D deficiency. To examine the prevalence and correlates of sun-protective behaviours (staying in the shade, using sunscreen and wearing long sleeves) with sunburn and vitamin D deficiency in sun-sensitive individuals. This was a cross-sectional study of 2390 US non-Hispanic white adults aged 20-59years in the National Health and Nutrition Examination Survey 2011-2014. Sun sensitivity was defined as self-reported tendency to severe sunburn when exposed to the sun for half an hour after months of non-sun exposure, and single serum 25(OH)D levels less than 50nmol/L was determined as vitamin D deficiency. We calculated adjusted odds ratios (aORs) and 95% confidence intervals (95% CIs) using multivariable logistic regression taking into account the complex survey design. Sun-sensitive individuals had higher odds of frequently staying in the shade (aOR=3.08; 95% CI 2.19-4.33) and using sunscreen (aOR=1.93; 1.44-2.59) but not associated with sun exposure time (aOR=0.91; 0.62-1.32). Yet, sun-sensitive individuals had significantly higher likelihood of sunburns (aOR=1.93; 1.45-2.55), and no increased likelihood of vitamin D deficiency (aOR=1.15; 0.84-1.58). Among sun-sensitive individuals, being younger, male and spending more time outdoors were associated with increased odds of sunburns and the risk of sunburn was reduced with frequently staying in the shade and engaging in multimodal sun protections. Sun-sensitive individuals more frequently used sun protection methods yet they still were significantly more likely to experience sunburns and the risk of vitamin D deficiency was not increased. Education on proper application of sunscreen combined with other sun-protective techniques is important to reduce sunburn in sun-sensitive populations.

Knowledge Levels of Kindergarten Teachers About Skin Cancer, Sun Protection Behaviors, and Affecting Factors.

The aim of this study was to determine the knowledge level of kindergarten teachers regarding skin cancer, the sun protection behaviors they exhibit for themselves/their students, and the affecting factors. This descriptive study was carried out in the Mediterranean region in a province located by the sea. The universe of the study consisted of 181 teachers working in kindergartens, and data were collected from the 81% who agreed to participate in the study. The mean Skin Cancer and Sun Knowledge Scale of the teachers was 12.50 ± 3.27 (range 0-25) and the mean Sun Protection Behavior Scale score was 24.78 ± 6.26 (range 8-40). When the Sun Protection Behavior Scale sub-dimensions were analyzed, the teachers' mean score of refraining from the sun was 13.02 ± 2.02, sunscreen use was 9.88 ± 4.46, and hat use was 5.13 ± 2.52. Significant positive correlations were found between the teachers' knowledge scores and refraining from the sun (r = 0.222; p = 0.007) and sunscreen use (r = 0.243; p = 0.003). The least used sun protection practice of the teachers regarding the students was wearing sunglasses (64.8%) and the most used practice was remaining in the shade (75.9%). The level of teachers' knowledge about skin cancer and sun protection and their behavior regarding sun protection for themselves were moderate, but the sun protection behaviors they use for their students were inadequate. Thus, educational programs about sun exposure are needed in schools and non-formal education institutions.

Effects of a brief multimodal online intervention on the intention to conduct sun protective behaviours through targeting illness representations about skin cancer: a randomized controlled trial

Objective: The incidence of skin cancer can be reduced by increasing sun protective behaviours. Based on the Common-Sense Model and the Intervention Mapping approach, a brief intervention targeting illness representations about skin cancer to increase the intention to conduct sun protective behaviours was developed and evaluated regarding its effectiveness.Design: A randomized pre-post control group design with 509 healthy participants (69% women, mean age 39 years).Main outcome measures: Changes in illness representations about skin cancer (emotional representations, illness coherence, and prevention control) and the intention to conduct sun protective behaviours, i.e. UV protection and sun avoidance.Results: ANCOVAs showed that the intervention increased illness coherence and perceived prevention control as well as the intention to conduct sun protective behaviours. Mediation analyses revealed that the increase in illness coherence and/or perceived prevention control partially mediated the effect of the intervention on the increase of the intention to use UV protection (indirect effects: .02*, .06*) and to avoid sun exposure (indirect effects: .01 ns, .04*).Conclusion: The intervention was successful in changing illness representations and thereby increasing the intention to conduct sun protective behaviours. The findings provide evidence for the usefulness of the Common-Sense Model in the context of illness prevention.

Skin cancer risk and shade: comparing the risk of foresters with other outdoor workers.

Keratinocyte carcinoma (KC) is an increasingly important public health problem with an especially high prevalence in outdoor workers. In contrast to other occupations, foresters spend most of their outdoor time under the shade of trees. We aimed to compare the unique sun exposure patterns and sun protection behaviour of foresters with those of other outdoor workers and their relation to the KC risk. In July 2018, a cross-sectional study was conducted at an international forestry fair using a questionnaire about health awareness and skin cancer screening by dermatologists to assess the prevalence of KC. A total of 591 participants (78.7% male; mean age 46.8±16.2years) including 193 foresters were enrolled. Of all foresters, 72% experienced sunburns (solar erythema) within the past year and 50% of them experienced the worst sunburn during work. Foresters were most likely to often/always wear protective clothes (29.0%) but were least likely to often/always avoid midday sun (23.8%) and stay in the shade (31.1%). Having an outdoor profession or spending hours outside for leisure was negatively associated with sun protection. Skin examination revealed an overall KC prevalence of 16.7%, with 16.5% of foresters being affected. Despite being protected by trees, the risk of KC for foresters is comparable to that of other professional groups. Shade alone may not provide sufficient protection. Additional sun protection measures are necessary.

Abstract IA18: The unnecessary epidemic: Skin cancer in Hispanics and what we need to do about it

Abstract Melanoma is a highly complex disease with multifaceted etiology, whose incidence is on the rise, over and above the impact of screening. Hispanics represent an underserved and understudied population when it comes to melanoma occurrence and outcome. Hispanics are diagnosed with melanoma at later stages than their non-Hispanic white (NHW) counterparts, leading to increased likelihood of metastasis and worse survival. Hispanics are the largest ethnic group in the United States and have rising rates of melanoma, and in particular, increases in tumors with the worst prognosis. While histologic type of melanoma varies by ethnicity (Hispanics tend to get more acral lentiginous melanomas, which tend to present at a later stage), histology does not explain the poorer experience of Hispanics: they are diagnosed with later-stage disease regardless of histology. In our recent analysis, while the risk of presenting with a late-stage melanoma was higher for Hispanics (OR:1.65 [95% CI:1.52-1.79]) than NHW, the overall risk of death from melanoma after accounting for stage at diagnosis was similar for Hispanics and NHW (HR: 0.99 [95% CI: 0.94-1.04]), implying that the overall poorer prognosis for Hispanics is due almost entirely to their later stage of disease at diagnosis, rather than response to treatment or other factors (e.g., ability to access treatment) once they are diagnosed. However, the key question remaining to be answered is why Hispanics are diagnosed at a later stage: without answering that question, we cannot begin to design, test, and implement effective interventions to reduce the melanoma burden in Hispanics. A later stage of diagnosis among Hispanics (compared to NHWs) could be due to a multitude of factors, all of which are modifiable: a lack of access to appropriate screening, lack of adherence to screening recommendations, lack of understanding of appropriate screening approaches in the primary care setting (among both patients and physicians), or a combination of these factors. Addressing the epidemic of melanoma among Hispanics is not limited to investigation of factors resulting in delayed diagnosis: we also lack an understanding of the primary drivers of Hispanics’ lower overall incidence of melanoma (roughly 7 times lower than non-Hispanic whites). Melanoma risk factors either have similar frequency in Hispanics and NHWs (e.g., many large nevi) or are less frequent in Hispanics but do not explain a high proportion of disease variation (e.g., red hair). Considering current knowledge of risk factor prevalence, melanoma incidence rates should actually be similar in Hispanics and non-Hispanic whites. Understanding the factors leading to the lower overall rate of melanoma in Hispanics could help inform prevention strategies for non-Hispanic whites—or determine new genetic pathways as yet undiscovered. While it is possible that Hispanics’ rates of melanoma are lower because they practice better sun-exposure behaviors, we have recently shown that Hispanic children, while frequently engaging in some sun-protective behaviors, also had a high rate of sunburn (59%). U.S.-acculturated Hispanic children reported less shade-seeking at school (P = .001). The surprisingly high rate of sunburn in Hispanic children suggests that the way in which they are practicing sun protection is not preventing sunburns and is an alarming early warning sign for future increases in melanoma rates among Hispanics. Sun safety interventions should be targeted toward Hispanic youth to provide them with practical methods of effective sun protection, in addition to education on the risks of high sun exposure. The contrast in melanoma experience between Hispanics and NHW implies that we already know how to reduce the occurrence of late-stage melanoma in Hispanics, and a better understanding of the differing rates of melanoma among Hispanics and NHW might actually provide insight into enhanced melanoma primary prevention in both groups. Citation Format: Myles Cockburn, Jennifer Unger, Kimberly Miller. The unnecessary epidemic: Skin cancer in Hispanics and what we need to do about it [abstract]. In: Proceedings of the Twelfth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2019 Sep 20-23; San Francisco, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl_2):Abstract nr IA18.

Effectiveness of the SolSano Program on Sun Protection Habits, Knowledge, and Attitudes Among University Students

Background and objectiveThe SolSano (HealthySun) project is a primary school sun education program that has been running in Aragon, Spain, since 2000. In the short term, it has proven to be effective at promoting sun protection behaviors and heightening awareness in childhood. The aim of this study was to evaluate the long-term effectiveness of the SolSano program. Participants and methodsRetrospective, observational, analytical, cohort study of students at the University of Zaragoza between 2015 and 2016. The students answered a previously validated, purpose-designed, online questionnaire. We calculated descriptive statistics for all variables and performed bivariate and multivariate analyses to test for differences between students who had attended a primary school that ran the SolSano program and those who had not. ResultsData for 324 students were analyzed. Mean age was 22.9 years and 78% of the respondents were women. In total, 44% of the students had participated in the SolSano program at primary school. Half of the respondents (50.5%) had experienced 1 or 2 sunburn episodes the previous summer. Significant differences were only observed for some aspects addressed by the questionnaire between SolSano participants and nonparticipants. ConclusionsThis is the first study to evaluate the long-term effectiveness (15 years) of a primary school sun protection program. The absence of significant differences in our sample might be explained by non-continuation of the program into adolescence and the existence of sun protection campaigns outside the school.

Efectividad del programa SolSano en los hábitos, conocimientos y actitudes en materia de fotoprotección de los universitarios

Background and objectiveThe SolSano (HealthySun) project is a primary school sun education program that has been running in Aragon, Spain, since 2000. In the short term, it has proven to be effective at promoting sun protection behaviors and heightening awareness in childhood. The aim of this study was to evaluate the long-term effectiveness of the SolSano program. Participants and methodsRetrospective, observational, analytical, cohort study of students at the University of Zaragoza between 2015 and 2016. The students answered a previously validated, purpose-designed, online questionnaire. We calculated descriptive statistics for all variables and performed bivariate and multivariate analyses to test for differences between students who had attended a primary school that ran the SolSano program and those who had not. ResultsData for 324 students were analyzed. Mean age was 22.9 years and 78% of the respondents were women. In total, 44% of the students had participated in the SolSano program at primary school. Half of the respondents (50.5%) had experienced 1 or 2 sunburn episodes the previous summer. Significant differences were only observed for some aspects addressed by the questionnaire between SolSano participants and nonparticipants. ConclusionsThis is the first study to evaluate the long-term effectiveness (15 years) of a primary school sun protection program. The absence of significant differences in our sample might be explained by non-continuation of the program into adolescence and the existence of sun protection campaigns outside the school.

Priority of Risk (But Not Perceived Magnitude of Risk) Predicts Improved Sun-Protection Behavior Following Genetic Counseling for Familial Melanoma.

Understanding multiple components of risk perceptions is important because perceived risk predicts engagement in prevention behaviors. To examine how multiple components of risk perceptions (perceived magnitude of and worry about risk, prioritization of the management of one's risk) changed following genetic counseling with or without test reporting, and to examine which of these components prospectively predicted improvements in sun-protection behavior 1 year later. A prospective, nonrandomized study design was used. Participants were 114 unaffected members of melanoma-prone families who (i) underwent genetic testing for a CDKN2A/p16 mutation (n = 69) or (ii) were at comparably elevated risk based on family history and underwent genetic counseling but not testing (no-test controls, n = 45). Participants reported risk perception components and sun-protection behavior at baseline, immediately following counseling, and 1 month and 1 year after counseling. Factor analysis indicated three risk components. Carriers reported increased perceived magnitude and priority of risk, but not cancer worry. No-test controls showed no changes in any risk perception. Among noncarriers, priority of risk remained high at all assessments, whereas magnitude of risk and cancer worry decreased. Of the three risk components, greater priority of risk uniquely predicted improved self-reported sun protection 1 year post-counseling. Priority of risk (i) seems to be a component of risk perceptions distinguishable from magnitude of risk and cancer worry, (ii) may be an important predictor of daily prevention behavior, and (iii) remained elevated 1 year following genetic counseling only for participants who received a positive melanoma genetic test result.

PUTTING USER IN CONTEXT: A PARTICIPATORY DESIGN APPROACH USING A SIMULATED BEACH ENVIRONMENT

AbstractThe research outlined in this paper investigated the sun protection behaviour in young men age 18 to 24. Firstly, field observations were conducted on the beach where the sun protection behaviour occurs. The findings highlighted the importance of gender linked with low levels of sun protection behaviour in young men. This informed the next study through participatory design sessions using a simulated beach environment. The results showed design opportunities with taking an account of gender in sun protection behaviour which opens new avenues where design has a key role in health promotion.

Behavioural and pharmaceutical interventions for the prevention of skin cancers in solid organ transplant recipients: a systematic review of randomised controlled trials

ObjectivesSolid organ transplant recipients are at increased risk of skin cancer, affecting more than 50% of recipients. We aimed to determine the effectiveness of interventions for behavioural change for sun...

Does counseling have an effect on sun protection behaviors and early detection of skin cancer in middle-aged and older Turkish people?

Does counseling have an effect on sun protection behaviors and early detection of skin cancer in middle-aged and older Turkish people?

Effects of an unconventional skin cancer prevention campaign : Impacts on the sun protection behavior of outdoor workers

The disease burden of actinic keratoses and keratinocyte carcinoma can be reduced by primary and secondary prevention. However, these measures are often poorly received, especially among the high-risk group of outdoor workers. The aim of this follow-up study was to investigate whether an improvement in sun protection and awareness of skin changes could be observed among the study population, especially outdoor workers, one year after aprevention campaign focusing on this topic. In 2017, all participants who initially participated in astudy at the Bavarian Central Agricultural Festival 2016 and agreed to participate in the follow-up study were contacted by mail and received the same questionnaire and evaluation questions regarding possible behavioral changes. Atotal of 400 people took part in the follow-up study (response rate 52.8%). Of the 240 outdoor workers, 45.0% said they were more conscious of protecting themselves from the sun and 68.8% said they were more aware of skin changes. About 85.0% of outdoor workers indicated that they would consult adermatologist earlier and 65.8% desired further prevention campaigns regarding skin cancer and sun protection. Overall, the majority of participants reported that they had improved sun protection behavior and awareness of skin changes after the intervention. Based on the participants' self-disclosure, especially outdoor workers tended to use sun protection measure more frequently. These findings underline the importance of target group-oriented awareness and prevention campaigns to reduce the burden of skin cancer.

University Student Health and Wellbeing Study: A test-retest reliability study of a web-based survey investigating undergraduate student health and wellbeing.

Understanding the health behaviours of Australian university students and their impact on wellbeing and academic success is important; however, there are limited reliable, population level survey tools to measure student health across a range of domains. The purpose of the research was to determine the reliability of the web-based University Student Health and Wellbeing Study (USHWS) survey via a test-retest reliability study within a large Australian university student population. A test-retest of the measurement instrument was completed by a sample of university students (n=195) over a two-week period. The instrument assessed alcohol and tobacco use, mental health, sexual health, physical activity, nutrition and sun protective behaviours. Test-retest reliability was analysed using two-way random effects model of intraclass correlations (ICC) and AC1 coefficient for individual measurements with 95% confidence intervals (95% CI). Questions on demographics, general health, nutrition, sun protection, alcohol and tobacco use, mental health and sexual health had fair to high reliability (ICCs range from 0.32 to 1.00). Reliability of some physical activity items were poor with large variability (ICC=0.15, 95% CI 0.01-0.28 to 0.86, 95% CI 0.82-0.89). A majority of the USHWS survey items represented a moderate to high test-retest reliability. Variability and poor reliability of physical activity questions may be due to survey implementation time and usual behaviour changes. SO WHAT?: The USHWS survey is reliable instrument to assess Australian university student health at a population level with the aim of informing effective programming, policy and initiatives. The University Student Health and Wellbeing Study (USHWS) survey is a foundational tool to understand university student's health in Australia. The USHWS reported fair to high reliability with few physical activity items showing lower reliability. Greater variability may be due to usual day-to-day fluctuations in behaviour.

Secondary prevention of UV-induced skin cancer: development and pilot testing of an educational patient counseling approach for individual sun protection as standard procedure of patient care

ObjectiveTo outline the development and pilot testing of a patient counseling approach for individual sun protection for patients in outdoor professions diagnosed with squamous cell carcinoma or multiple actinic keratosis due to solar UV radiation. This is a secondary prevention measure as part of the standard procedure of patient care by the respective statutory accident insurance.MethodsResults of guideline-based qualitative interviews with seven outdoor workers and a search of literature formed the basis for the counseling approach, which was compiled in a manual. Interdisciplinary experts (dermatologists and educators) reviewed and consented the final manual. The pilot testing was conducted in consecutive steps (N1 = 36 patients and N1 = 2 counselors; N4 = 12 patients and N4 = 6 counselors). The first two stages of the revised guideline ‘Criteria for Reporting the Development and Evaluation of Complex Interventions in healthcare (CReDECI 2)’ serve as background and structure for presenting the results.ResultsThe ‘counseling approach for individual sun protection (ILB: Individuelle Lichtschutz-Beratung)’ consists of seven general and eight add-on modules. These can be combined and tailored according to the patient’s individual needs. Interactive, educational components (e.g. haptic experiments) are crucial elements of the counseling approach.ConclusionsThe special requirements of outdoor workers are hardly taken into consideration in Germany, even though the interest for an improved sun protection behavior of some occupational groups is high. The advantage of the presented approach is that the heterogeneous needs of patients can be specifically addressed with its various modules.