Sun Protection Behaviors Research Articles

Prevalence and determinants of sunburns and sun protection behaviors among children: A nationwide cross-sectional survey in Switzerland

BACKGROUND: High exposure to solar ultraviolet radiation in early life increases the risk of developing skin cancer later, with increasing risk related to an increasing number of sunburns. Switzerland has high incidence rates of skin cancer compared to surrounding countries. We aimed to estimate the prevalence of sunburns and sun protection behaviors and their potential determinants among children in Switzerland. METHODS: In February 2019, we sent questionnaires to the parents of a random sample of 8,221 Swiss resident children. The questionnaires of 2,841 children were returned (response rate 35%). In spring and summer of the same year, follow-up questionnaires were sent to these children (response rate ~50%). Parents were asked about their child regarding protection measures, number of sunburns in the previous year, and skin phototype. We calculated the prevalence of sunburns and sun-protective behaviors (wearing a hat, seeking for shade, and use of sunscreen) by season, sociodemographic characteristics and skin phototype. RESULTS: Among participating children, 39.9% had at least one sunburn in the previous year, of whom 20.5% had a severe sunburn. When outside on a sunny day, 50.3% of the children wore a hat in summer (46.8% in spring), 21.1% (19.8%) sought shade more than half of the time, and 53.6% (43.5%) wore sunscreen. Prevalence of sunburns and of severe sunburns was higher among older children, boys, and children with sensitive skin. Protective measures were more frequent among younger children, girls, and children with sensitive skin. Prevalence of both outcomes varied substantially between regions. Sunburn prevalence was associated with lower use of sun protection. CONCLUSIONS: Compared to previous regional studies in Switzerland, we found a lower prevalence of sunburns and of protection behaviors, with important regional heterogeneity. Our results should help tailor sun exposure prevention measures to specific age groups and regions. KEYWORDS : sunburn, children, skin cancer

Ultraviolet radiation exposure in children, behavioral factors associated with measured doses and seasonality

BACKGROUND AND AIM Ultraviolet radiation (UVR) exposure is associated with both positive and adverse health, such as beneficial aspects of vitamin D and skin cancer, respectively. Childhood is a time of great variability for sun behaviours and increased sensitivity to UVR. However, the relationship between one’s received exposure and the level of ambient UVR is modified by activities. There is a need to document UVR exposure in relation to concurrent activities and sun protection behaviour for children and adolescents. While several studies have measured UVR exposure in children there has been no study conducted in Switzerland, where skin cancer incidence is one of the highest in Europe. METHODS UVR was measured in children aged 4-17 years (n=120) over 5 consecutive days using dosimeters worn on the chest. The dosimeter included an acceleration sensor, to identify periods during which it was worn. During measurement of UVR parents recorded children's activities in activity diaries. Measurements were related to reported activities and mean exposure (and spread) was assessed by activity type and season. RESULTS 4'058 hours of exposure measurements was assessed. The measured mean cumulative daily exposure was 0.46 standard erythmal dose (SED) per participant. The largest contribution to the total cumulative dose came from activities that involved playing outdoors (83.4 SED), followed by walking (32.6 SED), and hiking (25.7 SED), which had the highest mean exposures. The mean exposures were higher during midday hours and at higher altitudes; however, did not evidently vary by season during the measurement period. CONCLUSIONS Children’s UVR in Switzerland varies considerably by activity and whereabouts, and is highest during midday and early afternoon hours, with only modest variation between seasons. While measured UVR intensities are similar for different outdoor activities, the largest contribution to received doses comes from playing outdoors. KEYWORDS Ultraviolet radiation exposure, children, exposure assessment

Correlation between Objective Measures of Sun Exposure and Self-Reported Sun Protective Behavior and Attitudes in Predominantly Hispanic Youth.

Melanoma incidence is increasing, with poor prognosis cases growing faster in California Hispanics than in non-Hispanic whites. Ultraviolet Radiation (UVR) exposure as a child has been found to disproportionately increase the risk of melanoma. To determine correlates of UVR exposure in this high-risk population, we conducted a study in predominately Hispanic 4th and 5th grade classrooms in Los Angeles County, a high UVR environment, during the spring. To address potential reporting bias, electronic UV dosimeters were utilized to objectively measure the association between UVR exposure and constructs (acculturation, sun protective behavior and knowledge, family interventions) obtained on baseline questionnaires (n = 125). Tanning attitude (wanting to get a tan) was associated with lower median time spent outside (1.73 min versus 22.17, AUC 82.08, Sensitivity 0.78, Specificity 0.73) and standard erythemal dose (SED) on weekends, but positively associated with sun protective knowledge. Sun protective knowledge and family discussion of sunscreen were also inversely associated with objectively measured time outside. Students spent a median 30.61 (IQR 19.88) minutes outside per day (SED 0.30, IQR 0.20), with only 35.70% of it occurring in nonschool hours. We determined the majority of UVR exposure in this population occurs at school, providing valuable guidance for future interventions.

33980 Skin cancer risk factors and screening among Asian Americans: Pooled cross-sectional surveys from 2000 to 2015

Asian Americans are underrepresented in health disparities research and little is known about skin cancer risk factors and screening among Asian Americans. We examined sunburns, sun-protective behaviors, indoor tanning, and total body skin examinations (TBSE) among Asian Americans as compared with non-Hispanic Whites. Cross-sectional survey data from the National Health Interview Survey were pooled from 2000-2015. Multivariate logistic regression models examined associations of skin cancer risk factors and screening with race. Models were weighed to provide nationally representative estimates and adjusted for survey year, sociodemographic factors, cancer-related health behaviors, and skin cancer history. Overall, 132,583 non-Hispanic Whites and 10,102 Asian Americans were included (2083 Chinese; 1928 Asian Indian; 2307 Filipino; 3784 other Asian). Asian Americans were more likely to seek shade, wear long clothing to ankles, and wear long-sleeved shirts but less likely to sunburn, apply sunscreen, tan indoors, and receive TBSE than non-Hispanic Whites (each P < .05). Asian Indians were less likely to sunburn (adjusted odds ratio 0.54; 95% CI 0.39-0.75) and more likely to wear long-sleeved shirts (1.54; 1.22-1.95) or long clothing to ankles (1.91; 1.53-2.40) than Chinese participants. Filipinos were more likely to engage in 1+ sun-protective behavior (1.30; 1.08-1.56) than Chinese participants. Limitations included self-reported data and no adjustment for skin tone. Asian American sun-protective behaviors may not be influenced by perceived skin cancer risk. Direct comparisons among Asian Americans subgroups revealed differences utilizable through culturally tailored interventions. Oversampling of Asian Americans will facilitate disaggregated analyses that may unmask health disparities among Asian American subgroups.

Maternal Vitamin D Status and Its Associated Environmental Factors: A Cross-Sectional Study.

Vitamin D deficiency is common among women during pregnancy. This study aims to determine the prevalence of vitamin D deficiency and their shared modifiable environmental factors among pregnant women in Indonesia and Malaysia. Blood samples of 844 third-trimester pregnant women (Indonesians: 311; Malaysians: 533) were collected to determine their serum 25(OH) D levels. Information on sun exposure and sun protection behaviours were obtained through face-to-face interviews. Dietary vitamin D intake was assessed by using a semiquantitative food frequency questionnaire. The prevalence of vitamin D deficiency (<30 nmol/L) among Indonesian and Malaysian pregnant women were 42.4% and 72.0%, respectively. Percentage of exposed body surface area was inversely associated with vitamin D deficiency among Indonesian pregnant women (OR = 0.21, 95% CI = 0.09-0.48). Among Malaysian pregnant women, higher intakes of dietary vitamin D were associated with lower risk of vitamin D deficiency (OR = 0.48, 95% CI = 0.29-0.81). Analysis of the combined cohorts revealed a lower risk of vitamin D deficiency among pregnant women who had a daily intake of at least 15 mcg vitamin D (OR = 0.58, 95% CI = 0.38-0.88) and exposure of more than 27% body surface area to the sunlight (OR = 0.30, 95% CI = 0.16-0.60). Despite abundant sunshine, vitamin D deficiency is prevalent among pregnant women in tropical countries. The present study suggests that nutrition education on vitamin D intake and sun exposure during pregnancy is necessary for primary prevention of vitamin D deficiency in pregnant women living in the tropical countries.

32867 Association of sun-protective behaviors with bone mineral density and osteoporotic bone fractures in the United States: National Health and Nutrition Examination Survey 2017-18

Introduction: Despite the reassuring emerging evidence on the lack of causality between sun protection and vitamin D deficiency, scarce data exist on whether multimodal sun protection is associated with the adverse bone-related outcomes. This may lead to excessive worry and suboptimal sun protection on the part of patients. We aimed to investigate the association of sun-protective behaviors (shade stay, wearing long-sleeved clothing, and sunscreen use) with bone mineral density (BMD) and the prevalence of osteoporotic fractures. Methods: In a population-based, cross-sectional setting, sampled participants’ data (n = 3418) representative of the United States adult population (aged ≥20 years old) were accessed from the National Health and Nutrition Examination Survey 2017-18 and analyzed. Results: The use of individual sun-protective modalities was not associated with diminished site-specific and total BMD z-scores in the multivariate models (estimate [95% confidence interval, P value] = frequent shade stay: −0.225 [−0.466 to 0.017, .182], wearing of long sleeves: −0.076 [−0.269 to 0.117, .724], and sunscreen use: −0.098 [−0.321 to 0.125, .153]). Moderate-to-frequent stay in the shade correlated with reduced prevalence of spine fractures in the multivariate model (odds ratio [95% confidence interval] for frequent shade stay: 0.193 [0.044 to 0.857], P = .017). Conclusions: Routine use of sun-protective modalities was not associated with decreased BMD or the osteoporotic fracture risk. Sun protection may be associated with a modest decrease in the prevalence of osteoporotic fractures, possibly due to risk-averse behaviors. These reassuring findings add to the growing body of evidence on the safety of sun protection, with no significant negative impact on bone health.

Knowledge, Behaviour and Attitudes Related to Sun Exposure in Sportspeople: A Systematic Review.

People who practice outdoor sports have an increased risk of skin cancer as they are exposed to high doses of ultraviolet (UV) radiation. Recent studies have shown that in many athletes, sun protection behaviours are inadequate, with the risk that this entails. The aim of this review is to collect the information published to date about the knowledge, attitudes and habits of athletes in relation to sun exposure and its risks. A systematic review was conducted using PubMed and Embase with the search algorithm “(skin cancer OR melanoma) AND (exercise OR sport OR athletes)”. All studies analysing the knowledge, attitudes and habits of photoprotection in athletes were included. A total of 2,365 publications were found, of which 23 were selected, including a total of 10,445 sportspeople. The majority of participants declared their voluntary intention to tan and stated that the sun made them feel better, although they also showed concern about possible damage associated with UV radiation. In most studies, less than half of the participants made adequate use of photoprotective measures. In general, most athletes had a high level of knowledge regarding the risk of skin cancer associated with sun exposure. In conclusion, most athletes are aware of the risks associated with UV radiation but do not make adequate use of photoprotective cream. New training programs on photoprotection could help improve athletes’ photoprotective behaviour, reducing the incidence of skin cancer and precancerous lesions in this population.

Sun-protective behaviors and skin cancer risk factors among American Indians and Alaskan Natives in the United States

To the Editor: According to the United States Census, over 9 million American Indians/Alaskan Natives (AIAN) are living in the United States.1 Despite AIANs encompassing a significant percentage of the United States population, research related to skin cancer among AIANs is limited. We sought to assess skin cancer risk behaviors and prevention in this underserved population.

Influence of Social and Psychosocial Factors on Summer Vacationers' Sun Protection Behaviors, the PRISME Study, France.

Objectives: Summer intermittent sun exposure is a major risk factor for melanoma. Socioeconomic position, cognitive and psychosocial factors play a role in sun protection behaviors but the underlying mechanisms are unknown. This study aimed to measure the influence of educational level on sun protection behaviors in French summer vacationers on the Mediterranean coastline, and to identify the mediating psychosocial factors in this pathway. Methods: In summer 2019, French vacationers aged 12–55 staying in coastline campsites were asked about their holiday sun protection behaviors, their knowledge, attitudes, perceived control, and social norm relative to sun protection. A structural equation model measured the direct and indirect effects of educational level on protection behaviors via cognitive and psychosocial factors. Results: Sun protection during vacation increased with educational level. Theoretical knowledge partially mediated this association, from 22% to 86%, particularly for intermediate educational levels. Conclusion: Our results highlight the importance of implementing suitable sun prevention interventions for vacationers, especially those with a lower socioeconomic position. Improving theoretical knowledge around sun protection may be an important part of broader efforts to encouraging improved preventive behaviors.

Engagement in sun-protective practices based on health insurance coverage: A cross-sectional analysis

To the Editor: Limiting UV exposure through sun-protective practices can serve as a primary prevention strategy against skin cancer.1 However, routine engagement in these behaviors may not be uniform across all groups. Evidence suggests insurance status as a predictor of skin cancer incidence and severity, with Medicaid patients diagnosed with late-stage melanoma at higher rates than non-Medicaid patients.2 One other study has sought to explore differences in sun protection behaviors based on insurance status, though its sample was limited in size and geography.

Dermatologic manifestations in patients with the Hermansky–Pudlak syndrome types 1 and 3

BackgroundThe Hermansky–Pudlak syndrome (HPS) is a genetically heterogeneous group of diseases characterized by oculocutaneous albinism, bleeding diathesis, and systemic complications. It is the most common genetic disorder in Puerto Rico. These patients are at a significant risk of developing a variety of skin complications and little is known about the prevalence of dermatologic diagnoses in this population.ObjectivesTo report dermatologic manifestations in patients with Hermansky–Pudlak syndrome (HPS). Secondary aims include skin concerns, sun protection habits, barriers to dermatologic care, and skin cancer knowledge.MethodsCross-sectional study with twenty-nine Puerto Rican patients who carried a clinical diagnosis of HPS type 1 or type 3 through a telephonic questionnaire.ResultsTwenty-nine patients participated with a mean (SD) age of 37.3 (16.8) years and the majority were female (69%). The most common diagnoses were skin cancer (34.5%), acne (34.5%), bacterial skin infections (34.5%), warts (24%), urticaria (17.2%), and psoriasis (17.2%). The most common skin concerns were dry skin (62.1%), hair loss (58.9%), redness (34.5%), moles (31%), and rash (31%). The most common sun protection behavior was wearing a shirt that covers the shoulders (93.1%, often or always) and the least common was wearing a hat (24.1%, often or always). Higher income was significantly associated with being more likely to use sunscreen often or always (OR = 3.38, 95% CI 1.02–11.18, p = 0.04). Those in northern urban areas were significantly less likely to report barriers to dermatologic care (OR = 0.13, 95% CI 0.02–0.76, p = 0.02).ConclusionsThis study provides an important overview of the most common self-reported skin manifestations in patients with HPS. Unfortunately, a high prevalence of cutaneous malignancy was reported. The results stress the need for adequate care and potential interventions to promote sun protection behaviors and skin cancer prevention.

210 How to serve those who serve us: Sun protection behaviors among veterans vs non-veterans in a nationally representative sample

Military veterans are a unique, predominantly male population at increased risk for skin cancer due to factors such as occupational sun exposure and special environments. Little is known about the use of sun protective behaviors in this population. This study examined sun protective behaviors among male veterans (20-59 YO) using the National Health and Nutrition Examination Survey (NHANES) from 2003-2006. 23,864,665 male veterans and 125,365,819 male non-veterans were included (weighted sample).

LB1009 Sun protection behaviors among Hispanic subgroups

Introduction: The Hispanic population is rapidly growing in the United States, but the grouping of these individuals into one category can obscure heterogeneity. This in turn may limit our understanding of sun protective behaviors among Hispanics, especially given the significant variations in sun protection practices among subpopulations. We aim to explore these nuances. Methods: For the years 2005, 2010, and 2015, sun protection behaviors, skin cancer risk factors and demographic characteristics were obtained from the National Health Interview Survey (NHIS).

340 Benzene in sunscreen: Do sensationalizing dermatology reports have a lasting effect on google trends and reddit engagement?

Skin cancer is the most common form of cancer and has continued to rise in the past decade. Sunscreen has been shown to decrease the risk of developing melanoma by 50%, and squamous cell carcinoma by 40%. Australia has a robust sun-safety program which was implemented in 1988 and has shown to be effective in increasing sun protection behaviors and a decline in melanoma incidence. Behavior change is hard and complex and important for dermatologists to understand to help modify a patient's sun protective behaviors.

382 Skin cancer-related behaviors and perceptions in cyclists: A cross-sectional survey

Exercise was the most common activity reported during recent sunburns in US adults. Cycling, an increasingly popular sport, includes long periods of sun exposure. This cross-sectional survey aimed to examine sun-protective behaviors and beliefs related to tan skin within the context of cycling tans in a population of road cyclists in Atlanta. 57 recreational to competitive cyclists in the Atlanta Peloton “ATLPLN” group participated in a pilot survey distributed via email and Instagram. Sun-protective behaviors including applying sunscreen before rides, reapplying after two hours, and carrying sunscreen on rides.

LB922 Sun protection and vitamin D deficiency among racial groups

Introduction: Sun protection plays a role in skin cancer prevention, but there are concerns it increases the risk of vitamin D (VD) deficiency. Here, we examine sun protection dependent differences in VD deficiency among racial groups. Methods: Serum 25(OH)D levels and sun protective behaviors staying in the shade, wearing long sleeves, and using sunscreen) questionnaire responses of 9143 adults were extracted from the US National Health and Nutrition Examination Survey 2011–2016. VD deficiency was compared between rare and frequent users of sun protection with age, sex, education, VD supplementation, milk consumption and BMI covariates using logistic regression.

Knowledge, attitudes and practices of the general puplic toward the harmful effects of sun exposure and protection

Background; Excessive unprotected sun exposure is a significant risk factor for skin damage and skin cancers. In recent decades, the incidence of skin cancer has increased dramatically worldwide, reaching epidemic proportions. Sun protection is a key primary preventive strategy against skin cancer and skin damage induced by sun exposure. Aim and objectives; was to determine the knowledge, attitudes and behaviors of individuals on the harmful effects of the sun and protection ways. Subjects and methods; this study was a cross-sectional study conducted on 104 males and 316 females who attended Menoufia university dermatology clinic and some of the employments (physicians , nurses and officers)in the Menoufia university hospitals and some of the students. Result; the mean age of the studied participant was 31.30±7.55 and the majority of them were females (75.2%). There were significant bad sun habits and lower sun protection behavior (indicated by increasing SEPI part I score which was 10.22±3.63). Also, there was significant decreasing propensity to increase sun protection (indicated by increasing SEPI score part II) in males than females, unmarried than married persons, with low levels of education in the studied participants.

Sun Protection and Tanning Behaviors in Caregivers: Prevalence, Determinants, and Associations with Children's Behaviors.

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

Incongruence between Physician, Patient, and Medical Chart Report of Skin Cancer Prevention Counseling.

Skin cancer incidence in the United States has risen rapidly in recent decades, underscoring the need for accessible and effective prevention practices. Skin cancer prevention counseling can lead to increased sun protective behavior and early detection; however, little is understood regarding the frequency and content of counseling among primary care providers (PCPs). We performed multi-center cross-sectional surveys among 53 providers and 3343 of their patients and chart review asking whether skin cancer prevention counseling occurred and details of that counseling. Only 10–25% of patients reported that counseling occurred. Among the providers who reported counseling, there were higher odds that their patients recollected they were advised to use sunscreen or protective clothing, on how to use sunscreen, on signs of skin cancer, to perform a self-skin exam (all p < 0.001), and were provided with written materials (p < 0.01). Eight percent of prevention counseling was chart documented despite being highly associated with patient and physician recollection of counseling (p < 0.001). These results highlight the need for consistent and clear delivery of skin cancer primary prevention.

Encouraging sun protection early in life: from a successful prevention programme in children to the identification of psychological barriers in adolescents

AbstractChildren and adolescents have high rates of sunburn and high levels of ultraviolet radiation (UVR) exposure and are therefore at risk of developing skin cancer in later life. Minimizing UVR exposure in childhood and adolescence may be the most important component of skin cancer prevention efforts. Thus, age‐adapted prevention campaigns, targeting children, adolescents and caregivers, are needed to change sun protection behaviour among individuals in these age groups. In the first part of this review, we describe the ‘SunPass’ programme, which was initiated in Germany in 2010 as the first nationwide educational intervention for sun safety designed to teach kindergarten children and their caregivers how to protect themselves from overexposure to the sun. Implemented in 55 kindergartens, this programme has been shown to be effective at improving sun protection behaviour (P &lt; 0.001) and hat use (P = 0.029) among kindergarten children, as well as at improving shade practices and increasing demand for protective clothing (P &lt; 0.001). Up to 40 000 children, 50 000 parents/grandparents and 2500 kindergarten caregivers took part in the SunPass programme in Germany from 2019 to June 2021. The programme has also been adapted and implemented in several other European countries and could be readily adapted for use elsewhere. In the second part of this review, we discuss the specific challenges faced by adolescents and consider how these issues may impact their sun protection behaviour. Adolescents have difficulties suppressing responses to reward‐related cues and projecting themselves into the future. They also place a lot of importance on social acceptance and cosmetic appearance, and their higher risk of depression, addiction and impulsivity make them vulnerable to tanning addiction. These specificities need to be acknowledged by dermatologists, so they can adapt their therapeutic relationship and develop effective sun protection interventions for this generation.