To the Editor: In 2014, the US surgeon general called for increased opportunities for sun protection in outdoor settings.1US Department of Health and Human ServicesThe Surgeon General's Call to Action to Prevent Skin Cancer. U.S. Dept of Health & Human Services, Office of the Surgeon General, Washington, DC2014Google Scholar One response to this call was the implementation of free community sunscreen dispensers. IMPACT Melanoma, a national nonprofit organization dedicated to skin cancer prevention, has facilitated installation of such dispensers nationwide since inception of their Practice Safe Skin program in 2015. Although public receptiveness to free sunscreen has been previously highlighted,2Wood M. Raisanen T. Polcari I. Observational study of free public sunscreen dispenser use at a major US outdoor event.J Am Acad Dermatol. 2017; 77: 164-166Abstract Full Text Full Text PDF PubMed Scopus (5) Google Scholar little information exists regarding sunscreen dispenser deployment. We performed a retrospective analysis of IMPACT Melanoma's distribution records from January 2017 to August 2019. Analyzed data included requisitions for dispensers, sunscreen, and associated messaging displays, in addition to sponsor characteristics and funding sources. Results demonstrated that the cumulative product distributed during the 32-month timeframe amounted to a total of 1,558 dispensers and 2,186 cases (8,744 L) of sunscreen (Table I). Distribution by state revealed that New Hampshire, Wyoming, and Massachusetts received the most Impact Melanoma–distributed dispensers per capita, followed by Rhode Island and Vermont (Fig 1). During the study, the percentage of chemical sunscreen ordered steadily decreased, which we hypothesize may reflect recent public concern about use of chemical ingredients. The percentage of mineral sunscreen ordered also declined, whereas the percentage of hybrid sunscreen ordered increased significantly. According to IMPACT Melanoma, the mineral product's propensity to clog dispensers and perceived lack of cosmetic elegance may explain sales trends. Schools and universities sponsored less than 6% of products each year, suggesting educational institutions as an area for improved early intervention. The percentage of product donated to sponsors by IMPACT Melanoma diminished over time and was replaced by purchases and grants, which reflects stakeholder buy-in and speaks to the sustainability of such programs.Table IIMPACT Melanoma requisition data by year, January 2017 to August 2019IMPACT Melanoma requisition datum elementYear 2017Year 2018Year 2019 (Jan–Aug)Time period Jan 2017 to Aug 2019Dispenser unit, No. Dispensers ordered6675643271558 Adjunct displaysNA∗Product not offered by company in a given year.9363156Cases of sunscreen,†Case contains 4 individual 1-L bags of sunscreen. No. (%)‡Percentages may not add up to 100.0% because of rounding. Chemical§Chemical: Coppertone Sport Sunscreen (active ingredients: avobenzone 3%, homosalate 8%, octisalate 4.5%, and octocrylene 6%).659 (83.7)702 (68.2)172 (46.6)1533 (70.1) MineralǁMineral: BrightGuard Natural Sunscreen (active ingredients: titanium dioxide 6% and zinc oxide 6%).128 (16.3)184 (17.9)24 (6.5)336 (15.4) Hybrid¶Hybrid: Hybrid Sport Sunscreen (active ingredients: octyl methoxy cinnamate 7%, titanium dioxide 1.25%, zinc oxide 1.25%, and octyl salicylate 1.0%).NAǁMineral: BrightGuard Natural Sunscreen (active ingredients: titanium dioxide 6% and zinc oxide 6%).144 (14.0)173 (46.9)317 (14.5) Total78710303692186Funding source, % product‡Percentages may not add up to 100.0% because of rounding. Donated by IMPACT Melanoma31.328.41.4 Purchased by sponsor68.738.592.5 Grants0.0033.16.2Sponsor type, % product‡Percentages may not add up to 100.0% because of rounding. Healthcare org11.49.312.3 Local government14.12.73.7 Nonprofit org8.910.011.7 Parks and rec40.440.625.8 Private business9.618.88.3 Public health dept7.25.227.3 School/university4.55.72.8 Other3.97.68.1Aug, August; dept, department; Jan, January; NA, not available; org, organization; rec, recreation.∗ Product not offered by company in a given year.† Case contains 4 individual 1-L bags of sunscreen.‡ Percentages may not add up to 100.0% because of rounding.§ Chemical: Coppertone Sport Sunscreen (active ingredients: avobenzone 3%, homosalate 8%, octisalate 4.5%, and octocrylene 6%).ǁ Mineral: BrightGuard Natural Sunscreen (active ingredients: titanium dioxide 6% and zinc oxide 6%).¶ Hybrid: Hybrid Sport Sunscreen (active ingredients: octyl methoxy cinnamate 7%, titanium dioxide 1.25%, zinc oxide 1.25%, and octyl salicylate 1.0%). Open table in a new tab Aug, August; dept, department; Jan, January; NA, not available; org, organization; rec, recreation. Emerging themes from the recent Interdisciplinary Perspectives on Skin Cancer meeting include the need for nuanced messages for at-risk populations and creation of scalability for sun safety interventions.3Geller A.C. Jablonski N.G. Pagoto S.L. et al.Interdisciplinary perspectives on sun safety.JAMA Dermatol. 2018; 154: 88-92Crossref PubMed Scopus (22) Google Scholar Sunscreen dispensers provide opportunities for targeted messaging to low-use groups (eg, men, skin of color, low income)4Holman D.M. Berkowitz Z. Guy Jr., G.P. Hawkins N.A. Saraiya M. Watson M. Patterns of sunscreen use on the face and other exposed skin among US adults.J Am Acad Dermatol. 2015; 73: 83-92.e1Abstract Full Text Full Text PDF PubMed Scopus (57) Google Scholar and the potential for widespread increases in sunscreen use. A 2018 study modeling a 5% yearly increase in prevalence of sunscreen use from 2012 to 2022 estimated that cumulatively to 2031, 231,053 fewer melanomas would be diagnosed in the US white population; this illustrates the conceivable benefit from large-scale initiatives such as community dispenser programs.5Olsen C.M. Wilson L.F. Green A.C. Biswas N. Loyalka J. Whiteman D.C. How many melanomas might be prevented if more people applied sunscreen regularly?.Br J Dermatol. 2018; 178: 140-147Crossref PubMed Scopus (19) Google Scholar Study limitations include data that did not comprise 2015 and 2016 requisitions and were limited to a single organization; thus, the total number of dispensers and amount of sunscreen used nationwide are higher. Additionally, sunscreen distributed serves as a surrogate measure for use and does not necessarily indicate exact usage patterns. Despite recent trends in dispenser implementation, further investigation is required to determine effects on photoprotective perceptions and behavior. Future research should assess value as a population health initiative by quantifying use, evaluating effect on specific user subgroups, and providing estimates of skin cancers prevented. Our observations highlight the increasing prominence of free sunscreen dispensers and discuss their potential utility in primary skin cancer prevention. We thank Deb Girard, MBA, and Laurie Seavey from IMPACT Melanoma for access to their data and input on this project, and mapchart.net for use of its map-builder application.