Sun-protective Clothing Research Articles

Epidemiology of actinic keratoses.

The epidemiology of actinic keratoses (AKs) reflects their causation by cumulative sun exposure, with the highest prevalence seen in pale-skinned people living at low latitudes and on the most sun-exposed body sites, namely the hands, forearms and face. AKs are markers of increased risk of basal cell carcinoma, squamous cell carcinoma and melanoma, especially when they are numerous and have coalesced into an area of 'field cancerisation'. The major risk factors are male sex, advanced age, sun-sensitive complexion, high lifetime sun exposure and prolonged immunosuppression. Clinical counts of AKs enable the assessment and monitoring of AK burden, but accurate counting is notoriously difficult, especially when skin is severely sun damaged. AK counting has been repeatedly shown to be unreliable, even among expert dermatologists. Notwithstanding these challenges, qualitative assessment of the natural history of AKs shows a high turnover, with new lesions developing and with other lesions regressing. A very small proportion of AKs undergo malignant transformation, but the precise rate of transformation is unknown due to the inaccuracies in monitoring AK lesions over time. Primary prevention of AKs is achieved by limiting intense sun exposure through sun-protective behaviour, including seeking deep shade, wearing sun-protective clothing and applying sunscreen regularly to exposed skin, from an early age.

Sports-related dermatoses among road runners in Southern Brazil.

BACKGROUND Road running is a growing sport. OBJECTIVES: To determine the prevalence of sports-related dermatoses among road runners. METHODS Cross-sectional study of 76 road runners. Assessment was performed by means of a questionnaire, interview, and clinical examination. The chi-square and linear trend tests were used for analysis. RESULTS Most athletes were men (61%), aged 38±11 years, who ran mid- or long-distance courses (60.5%) for 45 to 60 minutes (79%), for a total of 25-64 km (42.1% ) or more than 65 km (18.4%) per week. The most prevalent injuries were blisters (50%), chafing (42.1%), calluses (34.2%), onychomadesis (31.5%), tinea pedis (18.4%), onychocryptosis (14.5%), and cheilitis simplex (14.5%). Among athletes running >64 km weekly, several conditions were significantly more frequent: calluses (p<0.04), jogger's nipple (p<0.004), cheilitis simplex (p<0.05), and tinea pedis (p<0.004). There was a significant association between the weekly running distance and the probability of skin lesions. Of the athletes in our sample, 57% trained before 10 a.m., 86% wore clothing and accessories for sun protection, 62% wore sunscreen, and 19.7% experienced sunburn. Traumatic and environmental dermatoses are common in practitioners of this outdoor sport, and are influenced by the weekly running distance. CONCLUSION In this group of athletes, rashes, blisters, sunburn, and nail disorders were recurrent complaints regardless of running distance. Calluses, athlete's foot, chapped lips, and jogger's nipple predominated in individuals who ran longer routes.

New advances in protection against solar ultraviolet radiation in textiles for summer clothing.

Clothing is considered one of the most important tools for photoprotection against harmful solar ultraviolet radiation (UVR). The standard for sun-protective clothing is based on erythema despite other biological effects of UVR on the skin. We analyzed the potential protection against UVR in fabrics destined for summer clothing based on several action spectra. We examined 50 garments classified by type of fabric composition, structure of the fiber yarn and color. The ultraviolet protection factor was calculated based on fabric ultraviolet transmittance corrected for erythema according to the EU standard E-13758 as well as the UVA transmittance of fabrics. UVR protection was also analyzed in base of different action spectra as for previtamin D3, nonmelanoma skin cancer, photoimmunosuppression and photoaging. Most knitted fabrics used for sports T-shirts offered excellent ratings for ultraviolet protection while normal shirts showed very low ratings, particularly against photoaging. The cover is the most influential variable in fabric photoprotection, having an exponential relationship with the UPF. The relation between cover and UVA protection was linearly negative. Information about ultraviolet protection in textiles used for summer clothing should be included in labeling as some types of fabrics, especially those used for shirts, offer very low UVR protection.

Living with xeroderma pigmentosum: comprehensive photoprotection for highly photosensitive patients

Xeroderma pigmentosum (XP) is a rare autosomal recessive disease of deoxyribonucleic acid (DNA) repair with ultraviolet (UV) radiation sensitivity and a 10 000-fold increased risk of skin cancer. Symptoms include: freckle-like pigmentation in sun-exposed skin before age 2 years, severe burns after minimal sun exposure (50% of patients) and damage to exposed surfaces of the eyes with loss of vision and ocular cancer. About 25% of patients develop a progressive neurodegeneration. The combination of an inherited inability to repair UV-induced DNA damage and environmental exposure to UV must occur for cutaneous and ocular symptoms to develop. There is no cure for XP, but many of its manifestations may be reduced or prevented through consistent UV protection; thus XP serves as a model for sun protection of patients with marked photosenstivity. Sun protective clothing including hats, sunglasses and face shields, sun screen lotions and avoidance of environmental sources of UV are cornerstones of prevention of skin and eye damage and cancer. Although XP is a serious disease with the potential for limitation of life expectancy, XP patients can live active lives while at the same time avoiding UV.

Psychosocial correlates of sun protection behaviors among U.S. Hispanic adults

The incidence of skin cancer among U.S. Hispanics increased 1.3% annually from 1992 to 2008. However, little research has focused on skin cancer prevention among the rapidly growing Hispanic population. In this study, we examined theory-driven, psychosocial correlates of sun protection behaviors in a population-based sample of 787 Hispanic adults (49.6% female, mean age = 41.0 years) residing in five southern or western U.S. states. Participants completed an English- or Spanish-language online survey in September 2011. The outcomes of focus were sunscreen use, shade seeking, and use of sun protective clothing. The correlates included suntan benefits, sun protection benefits and barriers, skin color preference, perceived natural skin protection, photo-aging concerns, perceived skin cancer risk, skin cancer worry, skin cancer fatalism, and sun protection descriptive norms. Results of multiple linear regression analyses revealed the following: sun protection barriers were negatively associated with each outcome; descriptive norms were positively associated with each outcome; perceived natural skin protection was inversely associated with sunscreen use; skin cancer worry was positively associated with shade seeking and use of sun protective clothing; skin cancer fatalism was negatively associated with shade seeking; and skin color preference was negatively associated with use of sun protective clothing. A number of additional statistically significant associations were identified in bivariate correlation analyses. This study informs the potential content of interventions to promote engagement in sun protection behaviors among U.S. Hispanics.

Concerns Regarding Results of a Randomized Controlled Trial to Promote Skin Self-Examination and Sun Protection Behaviors

To the Editor We write regarding 2 articles by Aneja and colleagues1- 2 describing results of a randomized trial to promote skin self-examination (SSE) and sun-protection behaviors among individuals attending dermatology clinics. A key concern is that imbalance in baseline levels of each behavioral outcome (ie, performance of SSE, use of sun-protective clothing, and sunscreen use) may explain or attenuate treatment arm differences at follow-up. For example, use of sun-protective clothing at the follow-up was significantly higher among intervention than control group participants.2 However, 40.2% of intervention group participants reported always or frequently using sun-protective clothing at baseline compared with 28.6% of control group participants.1 A prudent approach should include sensitivity regression analyses (akin to those summarized in Table 31 and the Table2) estimating intervention effects on behavioral outcomes at the 3-month follow-up after controlling for the baseline levels. If baseline adjustments yielded nonsignificant results, then intervention effects would need to be interpreted with more caution.

Linguistic Acculturation and Skin Cancer–Related Behaviors Among Hispanics in the Southern and Western United States

To examine the association between linguistic acculturation (assessed using the Language Use and Linguistic Preference subscales from the Bidimensional Acculturation Scale for Hispanics) and skin cancer-related behaviors among US Hispanic adults to determine whether, compared with Hispanics denoted as Spanish-acculturated, English-acculturated Hispanics would report less frequent shade seeking and use of sun protective clothing and higher rates of sunscreen use, sunbathing, and indoor tanning. Online survey study conducted in September 2011. Five southern and western US states. A population-based sample of 788 Hispanic adults drawn from a nationally representative web panel. Self-reported sunscreen use, shade seeking, use of sun protective clothing, sunbathing, and indoor tanning. Multivariate regression analyses were conducted to examine predictors of the skin cancer-related behaviors. As hypothesized, English-acculturated Hispanics had lower rates of shade seeking and use of sun protective clothing and reported higher rates of sunbathing and indoor tanning than Spanish-acculturated Hispanics. English-acculturated Hispanics and bicultural Hispanics (ie, those with high Spanish and high English acculturation) reported comparably high rates of sunbathing and indoor tanning. Results suggested that bicultural Hispanics seek shade and wear sun protective clothing less often than Spanish-acculturated Hispanics but more often than English-acculturated Hispanics. Acculturation was not associated with sunscreen use. Hispanic adults do not routinely engage in behaviors that reduce their risk of skin cancer. Bicultural and English-acculturated Hispanics are particularly in need of skin cancer prevention interventions.

Occupational Sun Protection: Workplace Culture, Equipment Provision and Outdoor Workers' Characteristics

The aim of this study was to describe outdoor workers' sun-protective practices, workplace sun-safety culture and sun-protective equipment provision; investigate the association of demographic, personal and occupational factors with sun-protective practices; and identify potential strategies for improving workers' sun protection. The present study used a clustered survey design with randomly identified employers in nine occupations. Employees provided questionnaire measures of demographics, personal characteristics (skin type, skin cancer risk perceptions, tanning attitudes, sun-exposure knowledge), personal occupational sun protection practices (exposure reduction, use of sun-protective clothing, sunscreen and shade), workplace sun-protective equipment provision and perceived workplace sun-safety culture. Summative scores were calculated for attitudes, knowledge, workplace provision and culture. A multivariable model was built with worker and workplace variables as plausible predictors of personal sun protection. In this study, 1,061 workers (69% participation) from 112 workplaces provided sufficient information for analysis. Sex, age, prioritized ethnicity, education and risk perception differed significantly between occupational groups (p<0.001), as did workers' sun-protective practices and workplace sun-protection equipment provision and supportive culture. After adjustment, each one-point increase in Workplace Sun-safety Culture 2013Score (range 12 points) was associated with a 0.16 higher Personal Sun-Protection Score (p<0.001), and each one-point increase in Workplace Provision Score (range 4 points) was associated with a 0.14 higher score (p<0.001). Sun Protection Score was significantly associated with skin response to sun exposure (p<0.001), female sex (p=0.021), tanning attitudes (p=0.022) and occupation (p=0.049), but not ethnicity, age education, knowledge or skin cancer risk perception. Protective equipment provision and sun-protective workplace culture are promising components for the development of comprehensive programmes to improve outdoor workers' sun-protective practices.

Sun protection and exposure behaviors among Hispanic adults in the United States: differences according to acculturation and among Hispanic subgroups

BackgroundSkin cancer prevention interventions that target the growing number of U.S. Hispanics are lacking. The current study examined the prevalence and correlates of sun protection and exposure behaviors (i.e., sunscreen use, shade seeking, use of sun protective clothing, and sunburns) among U.S. Hispanics with sun sensitive skin, with a focus on potential differences according to acculturation and Hispanic origin.MethodsThe sample consisted of 1676 Hispanic adults who reported having sun sensitive skin (i.e., they would experience a sunburn if they went out in the sun for one hour without protection after several months of not being in the sun). Participants completed survey questions as part of the nationally representative 2010 National Health Interview Survey. Analyses were conducted in August 2012.ResultsGreater acculturation was linked with both risky (i.e., not wearing sun protective clothing) and protective (i.e., using sunscreen) sun-related practices and with an increased risk of sunburns. Sun protection and exposure behaviors also varied according to individuals’ Hispanic origin, with for example individuals of Mexican heritage having a higher rate of using sun protective clothing and experiencing sunburns than several other subgroups.ConclusionsSeveral Hispanic subpopulations (e.g., those who are more acculturated or from certain origins) represent important groups to target in skin cancer prevention interventions. Future research is needed to test culturally relevant, tailored interventions to promote sun protection behaviors among U.S. Hispanics. Such initiatives should focus on public health education and increasing healthcare provider awareness of the importance of skin cancer prevention among Hispanics.

School Sun‐Protection Policies: Measure Development and Assessments in 2 Regions of the United States

In 2002, the US Centers for Disease Control and Prevention recommended that schools adopt policies that reduce exposure of children to ultraviolet radiation to prevent skin cancer. We report here the development of a school sun-safety policy measure and baseline descriptive statistics from the assessment of written policies collected in 2005-2007 from public school districts that enrolled in a randomized trial evaluating a policy promotion program. Written policies were collected from 103 of 112 school districts in Colorado and Southern California prior to randomization. We developed methods for selecting policy headings/sections topics likely to contain sun-safety policies for students and for assessing the presence, strength, and intent of policies. Trained coders assessed the content of each policy document. Overall, 31% of districts had a policy addressing sun safety, most commonly, protective clothing, hats, sunscreen, and education at baseline. More California districts (51.9%) had these policies than Colorado districts (7.8%, p < .001). Policy scores were highest in districts with fewer Caucasian students (b = -0.02, p = .022) in Colorado (b = -0.02, p = .007) but not California (b = 0.01, p = .299). The protocol for assessing sun-safety policy in board-approved written policy documents had several advantages over surveys of school officials. Sun-protection policies were uncommon and limited in scope in 2005-2007. California has been more active at legislating school policy than Colorado. School district policies remain a largely untapped method for promoting the sun protection of children.

Identifying critical sun-protective beliefs among Australian adults

We investigated critical beliefs to target in interventions aimed at improving sun-protective behaviours of Australian adults, a population at risk for skin cancer. Participants (N = 816) completed a Theory of Planned Behaviour belief-based questionnaire and a 1-week follow-up of sun-protective behaviour. A range of behavioural, normative and control beliefs correlated with sun-protective behaviour, with no and only minimal differences observed in correlations between beliefs and behaviour by gender and age, respectively. A range of key beliefs made independent contributions to behaviour; however, the behavioural belief about being less likely to tan (β = 0.09); normative belief about friends (β = 0.20); and control beliefs about forgetfulness (β = -0.14), inconvenience (β = -0.17), knowing I will be in the sun for a long time (β = 0.16) and more fashionable sun-protective clothing (β = 0.13) were significant critical beliefs guiding people's sun-protective behaviour. Our study fills a gap in the literature by investigating an at-risk population for skin cancer and using an established theoretical framework to identify critical beliefs that guide Australian adults' decisions to sun protect. Attention to these critical beliefs will assist health campaigns and interventions aimed at combating the increasing rates of skin cancer for adults.

Likelihood of Dermatology Patients to Inquire about Sun Protection Measures during a Regular Clinic Visit

Health information-seeking behavior refers to ways individuals acquire health information. Few studies demonstrate its association with skin cancer. To determine the likelihood of patients to inquire about sun protection methods from dermatologists and whether such knowledge will affect their preventive behaviors. Over a 2-month period, 396 dermatology patients completed a survey assessing their sun awareness knowledge and inquiry about sun protection measures. Features associated with increased skin cancer risk were correlated with patients' inquiry about sun protection information and their future intentions to practice safe sun behavior. One in seven patients (13.8%) inquired about sun protection measures. Patients with features known to be associated with increased skin cancer risk infrequently inquired about sun protection methods (4.5-23.8%). Post-physician counseling, patients with previous sun awareness education had a greater intention to use sunscreen routinely (41.4% vs 28.3%, p = .01), avoid the sun (31.2% vs 18.2%, p = .004), and wear sun-protective clothing (32.5% vs 23.2%., p = .05). Patients' desire for medical information from physicians does not translate efficiently into seeking sun awareness information from dermatologists. Dermatologists should play a greater proactive role in skin cancer prevention through initiation of regular personalized discussions on sun awareness issues.

Studies on Nano – UV Protective Finish on Apparel Fabrics for Health Protection

There is a growing demand in the marketplace for textile apparel that offers comfort and protection from the harmful effects of ultraviolet (UV) radiation. The UV rays of the sun when they come into contact with skin lead to all kinds of skin problems. The accumulated effects damage the skin’s DNA and cell function. In addition to skin cancer, excessive sun exposure also causes pre-malignant actinic keratoses, wrinkles, dark and unsightly blotches, leathery skin and prone to destabilizing the immune system. Research has shown that sun (UV) protective clothing is one of the most effective ways to protect against skin cancer. Such fabrics are specifically designed for sun protection by covering a maximum amount of skin and made from a fabric rated for its level of UV protection. Throwing on a sun protective shirt with an ultraviolet protection factor (UPF) of 30+ value is a proactive decision, which can simply help to live a healthier life. Hence, an attempt has been made in this study to visualize the effect of an application of titanium dioxide nano finish onto cotton and its blends with viscose and polyester to provide nano UV protection, without hampering the strength of the substrate.

Are sunscreens luxury products?

The incidence of skin cancers is rapidly increasing in Western countries. One of the main sun-protection measures advocated is application of sunscreen. Some studies report a failure to comply with sunscreen application guidance. One explanation is their cost. To evaluate the true cost of sunscreen in two situations: a 4-member family spending 1 week at the beach and a transplant patient respecting all the sun protection recommendations. We performed an analysis of prices of sunscreens sold via Internet drugstores in Europe and North America. Standard sunscreen application recommendations were followed. We tested the recommended amount of sunscreen to be applied (ie, 2 mg/cm(2)). Six hundred seven sunscreens from 17 drugstores in 7 countries were evaluated. Median price of sunscreen was $1.7 US per 10 grams. The price decreased with the size of the bottle. The median price for a family varied from $178.2 per week to $238.4 per week. The price decreased by 33% if the family wore UV-protective T-shirts and by 41% if large-volume bottles were used. The median price for a transplant patient varied from $245.3 per year to $292.3 per year. Anti-UVA activity and topical properties were not evaluated. We tested the recommended amount (2 mg/cm(2)) rather than the amount actually used (1 mg/cm(2)). Under acute sun exposure conditions (a week at the beach), the cost of sun protection appears acceptable if sun protective clothing is worn and large-format bottles and low-cost sunscreens are used. Conversely, in a sun-sensitive population requiring year-round protection, the annual budget is relatively high and patients may require financial assistance to be compliant with sun protection guidelines.

Preliminary Evidence for Mediation of the Association Between Acculturation and Sun-Safe Behaviors

To identify and test mediators of the relationship between acculturation and sun-safe behaviors among Latinos in the United States. We hypothesized that the effect of acculturation on use of sunscreen, shade, and sun-protective clothing would be mediated by perceived health status, educational level, access to health care, and contact with social networks regarding health matters. The 2005 Health Information National Trends Survey, implemented by the National Cancer Institute. Nationwide survey. A probability-based sample of the US civilian, noninstitutionalized adult population, comprising 496 Latino respondents. Use of sunscreen, shade, and sun-protective clothing when outdoors on sunny days, assessed by self-report on frequency scales. The positive association between acculturation and sunscreen use and the negative association between acculturation and use of sun-protective clothing were mediated by educational level (P < .05 for both). Perceived health status and contact with social networks regarding health matters were supported as mediators for sunscreen use only (P < .05). Health care access was not supported as a mediator for any of the outcomes. Structural equation models revealed distinct direct and indirect paths between acculturation and each sun-safe practice. Our findings emphasize behavior-specific mediated associations and could inform sun safety programming for Latinos with low and high levels of acculturation. The models support educational level, contact with social networks regarding health matters, and perceived health status as mediators primarily for sunscreen use. Future research should test different mediators for use of shade or sun-protective clothing.

Risk factors in a cohort of patients with multiple primary melanoma

There are various known familial and environmental risk factors that influence the risk for melanoma. This study sought to define the risk factors for multiple primary melanoma. A telephone survey of patients with multiple primary melanomas was conducted from a private practice in south-east Queensland, in order to examine various risk factors in this cohort. Our findings of high rates of family history of melanoma (37%), and of dysplastic naevi (42%) support the influence of genotype in this high-risk group. A family history of multiple primary melanomas, seen in 17% of our patients, is a risk factor not previously reported in similar cohort studies. Sixty-eight per cent of patients had an equal or lesser degree of invasive malignancy in subsequent melanomas. Most multiple primary melanoma patients in this group (86.6%) were conducting self skin examination at least once per month. With regards to sun-protective behaviour, 85% reported regular sunscreen use and 92% reported regular use of sun-protective clothing; however, fewer had done this in childhood. Enhanced knowledge of the genetic and environmental risk factors for multiple primary melanomas can assist clinicians in assessing risk and planning surveillance of patients.

What level of protection can be obtained using sun protective clothing? Determining effectiveness using an in vitro method

It has been clearly demonstrated that ultraviolet radiation is harmful to the skin and can cause helioderma and cancers. There are different methods of combating ultraviolet radiation: sunscreens formulated with filters and/or screens as well as clothing. For this work, the authors studied different fabrics to evaluate what effect the type, color and thickness of an article of clothing might have in terms of providing UVB (UPF) and UVA (UPF–UVA) protection. This study was conducted using a spectrophotometer equipped with an integrating sphere and allowed the authors to discover that certain fabrics have UPF values which exceed 500, making them vastly superior to sunscreen creams. Synthetic fabrics appear to provide the highest level of sun protection.

Evaluation of sun awareness with an emphasis on ultraviolet protection by clothing: A survey of adults in Western Germany

Little is known about the sun habits of the population in Germany. We aimed to assess the sun awareness and notion on ultraviolet (UV) radiation protection by fabrics in adult subjects from North Rhine-Westphalia in Germany. During regular skin cancer screening campaigns, 1206 subjects completed and returned a structured questionnaire on constitutional parameters and the respondents' sun habits. Staying in the shade and the use of high-factor sunscreens are the most commonly performed sun-protective measures reported by the respondents. Males and lower-educated people use clothing in conjunction with sunscreens more infrequently. Most respondents, particularly females, know that sun protection provided by clothing is variable. However, the elderly more frequently consider sun protection by clothing as excellent. Notably, more than two-thirds of the respondents would prefer clothing with a labelled ultraviolet protection factor. The respondents of this survey mainly considered baby wear, children wear, and leisure wear for sun-protective clothing, whereby light-weighted, breathable, natural fabrics preferably made of cotton and linen were the most frequently reported protective textiles. Given the lack of epidemiological observations on people's sun habits and protection in Germany, the present relatively large survey provides useful information and implications for counselling in sun protection and marketing of UV-protective clothing.

Sun-protective behaviours of beach goers in the North-West

The study investigates the sun-protective behaviours of beach goers in the north-west of Western Australia as the basis for a new health promotion intervention to be implemented in the area. A cross-sectional, observational survey of 1,498 beach goers in 25 beach locations across northwest Western Australia. Details of sun-protective clothing (none, hat with no shirt, shirt with no hat and full coverage) were recorded, as was time on beach, age and gender. Environmental audits were also completed to characterise the effects of the natural and built environments on sun-protective behaviours. Both females and children had the lowest rates of sun protection - 33.7% of females were found to wear shirts with no hats, compared to 29.0% of males, and they were less likely to be fully covered than males (30.3% compared to 41.5%). Children were more likely to wear shirts with no hats (43.1%) compared to adults (28.2%). Female and child beach goers represent two groups that are at a higher risk of developing skin cancer and, therefore, should become targets for a sustainable, effective and multi-component health promotion program.

The Association between Skin Characteristics and Skin Cancer Prevention Behaviors

Behaviors such as sunscreen use and wearing sun-protective clothing are thought to prevent certain types of skin cancer and precancerous lesions, but few studies have examined differences in these prevention behaviors by skin type. We carried out a cross-sectional study (n = 6,858) nested within a community-based prospective cohort in Washington County, Maryland. We measured the associations between skin type, complexion, freckling, and eye color, and sunscreen and sun-protective clothing use. The prevalence of regular sunscreen use was 23% and regular sun-protective clothing use was 21%. There were consistent trends indicating those with the most sun-sensitive skin type were most likely to engage in prevention behaviors. For example, compared with those who tan without burning, those who develop blistering sunburns were more likely to use sunscreen [odds ratio (OR), 6.04; 95% confidence interval (95% CI), 2.82-12.95 men; OR, 4.89; 95% CI, 3.34-7.16 women] and sun-protective clothing (OR, 2.87; 95% CI, 1.71-4.80 men; OR, 4.44; 95% CI, 2.88-6.85 women). Health-related characteristics such as body mass index and cigarette smoking were also significantly inversely associated with prevention behaviors. The overall prevalence of prevention behaviors was low. Those with phenotypic risk factors for skin cancer were most likely to use sunscreen and sun-protective clothing. Those with high-risk skin cancer phenotypes may also be those who are most receptive to skin cancer prevention educational interventions.