Sunscreen Use Research Articles

The Effect of Sun Knowledge and Self-Efficacy on Sun Protection Behavior in Skin Cancer Among Young People.

Purpose: The aim of this study is to reveal the impact of skin cancer and sun knowledge on sun protection behavior in young people. In addition, identifying predictors influencing sun protection behaviors in young people is also aimed. Methods: A cross-sectional study was conducted with 424 young people in Turkey. Data were collected using Skin Cancer and Sun Knowledge Scale, Self-Efficacy Scale for Sun Protection, and Sun Protection Behavior Scale. The independent samples t-test was used to determine differences between the mean scores of sociodemographic characteristics, Bonferroni-corrected one-way ANOVA was used to determine differences among three or more groups, and the relationship between scale score means was analyzed using Pearson correlation analysis. Factors influencing sun protection behavior were identified using multiple linear regression. Results: Of the young people, 43.4% use sunscreen continuously throughout the year, 10.10% go to solarium, and 25.7% perform self-examinations of their skin. In youth, high sun protection self-efficacy (β = 0.486), being female (β = 0.077), regular use of sunscreen throughout the year (β = 0.464), and avoiding tanning beds (β = 0.075) positively influence sun protection behavior scores. Spending more than 6 hours in the sun during the summer months (β= -0.118) negatively affects sun protection behavior. Conclusion: The level of skin cancer sun knowledge, sun protection self-efficacy, and sun protection behaviors of young people are moderate and there is a positive correlation among them. The study's findings indicate the necessity to increase awareness of skin cancer risk factors among young people and initiate effective interventions to promote sun protection behaviors.

The current state of sunscreen development and analysis of its scientific application and safety

Regular and adequate use of broad-spectrum sunscreen has been proven to offer significant protection against acute Ultraviolet-induced photodamage, photoaging, immunosuppression, and the development of skin tumors. However, concerns regarding the safety and standardized use of sunscreens persist, including potential allergenicity and irritability of certain organic sunscreens, the impact of systemic absorption on the endocrine system, the effect on vitamin D synthesis and absorption, and environmental implications. Special caution is advised when using small molecule organic sunscreens and nanoparticle inorganic sunscreens, especially for infants, pregnant women, and areas with damaged skin.

Analysis Based on Three Aspects of Sunscreen

With the increasing awareness of health, people’s awareness of UV protection is also gradually improving. Sunscreen with UV protection has become an indispensable part of people’s daily lives. The market size of China’s sunscreen market will reach 74.2 billion yuan in 2023, and it is expected to grow to 95.8 billion yuan by 2026. The purpose of this paper is to analyze the safety, effectiveness, and environmental friendliness of sunscreen from three perspectives, and discuss the reliability of SPF human testing, improving the stability of sunscreen use, and the cost of new environmentally friendly materials. Through analysis, it is found that there are still shortcomings in the current SPF testing methods, production costs of environmentally friendly materials, and promotion of correct application methods for sunscreen. Subsequently, appropriate adjustments were made to the testing methods and material formulations of sunscreen, as well as recommendations for the selection and correct application of sunscreen. However, the long-term safety of nanomaterials still needs to be further explored. Due to the rapid development of research technology for sunscreen products and the diversification of market products, it is necessary to review the safety, effectiveness, and environmental friendliness of current sunscreen products.

Prevalence and Associated Risk Factors of Vitamin D Deficiency Among Female Adolescents in Sulaimaniyah, Iraq: A Community-Based Cross-Sectional Study

Objectives: This study aims to examine the prevalence and risk factors related to VD deficiency among female adolescents. Methods: This cross-sectional study was done in secondary and preparatory schools in Sulaimaniyah, Iraq, from May 2022 to July 2023. A total of 120 schools were included in the study, with a calculated sample size of 340 female adolescents using a probability multistage random sampling method. Data was collected through a validated questionnaire, and blood samples were analyzed for VD levels. Results: In a study of 340 female adolescents aged 14-18 years, the findings showed that 39.4% of participants had severe VD deficiency, 42.6% were deficient, and 17.9% had insufficiency. The mean VD level was 13.29±6.45 ng/mL. Seasonal variation significantly impacted VD level (p=0.001), with the highest levels seen in summer and the lowest in winter. Skin colour also significantly influenced VD level (p=0.020), as individuals with lighter skin have higher levels. There were positive correlations between VD levels, milk intake (r=0.138, p=0.011), and cheese consumption (r = 0.135, p=0.013). The use of sunscreen had mixed effects. Interestingly, there was a positive correlation between SPF 15 and VD level (r=0.132, p=0.015), while higher SPF values were associated with lower levels. Conclusion: The findings highlight the importance of seasonal adjustments, improved dietary habits, and lifestyle changes to address VD deficiency in the population effectively.

A cross-sectional analysis of TikTok content relating to sunscreen conspiracy theories and correlation with published evidence on sunscreen risks.

Skin cancer is the most common form of cancer in the UK and Ireland, with the number of skin cancers expected to increase further by 2038-2040. Conspiracy theories surrounding sunscreen use are becoming rampant across social media platforms. We aimed to further investigate the misinformation and conspiracy theories surrounding sunscreen use on TikTok by performing a cross-sectional analysis of relevant TikTok content. This analysis highlighted the presence of an alarming amount of sunscreen misinformation on the popular social media platform.

A Survey of Beachgoers to Estimate Sunscreen Coastal Water Input and Potential Eco-Label Consumption: Contributions to Sustainable Tourism

The rise of sun and beach tourism has led to concerns about the environmental impact of sunscreens on marine ecosystems. Although the contaminants included in sunscreens are being studied from various perspectives, there are still gaps in the understanding of beachgoers’ habits and sunscreen use, and their awareness of the problems these products can cause. But do we even know how much sunscreen ends up in the ocean when beachgoers apply it? To estimate the amount of sunscreen entering coastal waters during a summer season, a survey (n = 429) was conducted at two urban beaches in southern Spain (La Caleta and La Bajadilla). It was estimated that 76.3 to 109.3 mL of sunscreen per beachgoer enters the water during the season. For this estimation, it was crucial that we the analyze beachgoers’ behavior statistically. Additionally, our study calculated their willingness to pay (WTP) for eco-labeled sunscreen alternatives. The results showed significant differences between the two sites, with La Bajadilla reporting higher sunscreen usage (11.9 mL vs. 7.9 mL per application) and a greater WTP for eco-labeled sunscreen (€14.2 vs. €11.5). These findings highlight the need for more field studies to better understand the input of sunscreen into coastal waters, which is closely linked to beach use and its social factors. This approach, which considers specific sunscreen input and characterizes beachgoers’ habits, behaviors, and preferences for alternatives, provides valuable insights for decision-makers and may guide future research on the potential impact of sunscreens on marine ecosystems using behavioral data as well as alternative approaches to solving the problem.

Serum vitamin D concentration is inversely associated with matrix metalloproteinase‐9 level in periodontal diseases

AbstractBackgroundThe aim of this study was to investigate the potential association between vitamin D deficiency and matrix metalloproteinase‐9 (MMP‐9) levels in gingival crevicular fluid (GCF) across various periodontal health and disease statuses.MethodsA total of 200 volunteers were divided into two groups according to serum vitamin D concentration (25(OH)D < 10 ng/mL and 25(OH)D ≥ 10 ng/mL). Periodontal health status was determined based on a full‐mouth periodontal examination and radiographic evaluation. Participants in both groups were categorized according to periodontal diagnoses, encompassing periodontal health, gingivitis, and periodontitis. Following sampling, the MMP‐9 levels in GCF were determined by the enzyme‐linked immunosorbent assay (ELISA) method.ResultsThe GCF MMP‐9 levels were found to be higher in individuals with serum 25(OH)D < 10 ng/mL, in both the healthy and gingivitis and periodontitis groups, compared to those with 25(OH)D ≥ 10 ng/mL. Nevertheless, a statistically significant distinction was observed exclusively within the gingivitis and periodontitis groups. Correlation analysis and robust regression analyses provided additional evidence supporting the predictive role of periodontal disease status and vitamin D concentration in local MMP‐9 levels. These associations remained significant after adjusting for age and sex in robust regression analysis (p = 0.002). Furthermore, the inclusion of periodontal clinical parameters in the regression analysis revealed notable associations of clinical attachment loss with local MMP‐9 levels, along with periodontal disease status and serum vitamin D concentration (p < 0.001).ConclusionThe findings of our study suggest a potential mechanistic relationship between serum vitamin D levels and periodontitis.PLAIN LANGUAGE SUMMARYVitamin D deficiency is a widespread issue globally due to urban living, less outdoor time, seasonal changes, aging, and sunscreen use, leading to inadequate sun exposure. Low vitamin D levels are linked to several health problems, including hypertension, diabetes, heart diseases, and periodontal diseases, which affect the gums and bones around teeth and can cause tooth loss if untreated. Although the link between vitamin D and periodontal disease is unclear, it may involve the enzyme matrix metalloproteinase‐9 (MMP‐9). Our study examined 200 people, dividing them into two groups based on vitamin D levels. We assessed their gum health and measured MMP‐9 levels in their gingival crevicular fluid, a liquid that seeps out from the tiny space between gums and teeth. We found that people with lower vitamin D levels had higher MMP‐9 levels, especially those with gum disease. Our analysis showed that both vitamin D levels and gum health significantly impact MMP‐9 levels, with gum health being the more influential factor. Maintaining good gum health and adequate vitamin D levels is crucial for managing MMP‐9, an enzyme critical for tissue remodeling during healing and inflammation. However, excessive MMP may rapidly destroy periodontal tissues.

The Skin's Sun Story: Risks and Precautions

Background: The skin, representing the largest organ in the human body, serves numerous funtions crucial for homeostasis, as well as acts as the primary physical barrier protecting the organism from external environmental factors such as microorganisms, mechanical damage, heat or cold exposure, toxins, as well as solar radiation, posing various risks to the skin, including sunburn, photoageing and skin malignancies. Objectives: This study aims to explore the effects of solar radiation on the skin and to discuss preventive measures against its negative influence on the skin. Methods: An exhaustive search of references related to sun exposure and skin published in PubMed was undertaken, using the search terms: "solar exposure and skin, ultraviolet radiation and skin, visible light and skin, sunscreen, photoprotection”. Conclusions: Solar radiation, particularly ultraviolet radiation (UVR), induces acute and chronic damage to the skin, leading to conditions such as sunburn, photoaging, and skin malignancies. However, adequate exposure to sunlight is crucial for the synthesis of vitamin D3, which plays essential roles in calcium homeostasis, immune function, and potentially other physiological processes. Strategies such as proper sunscreen use and other photoprotection methods can mitigate the adverse effects of solar radiation while allowing for sufficient vitamin D synthesis.

Exercise-induced local sweating: Greater reduction in women than men with sunscreen use

ABSTRACT Sunscreens may affect thermoregulation and sweating during exercise in warm climates. In this study, we compared the effects of three sunscreens on local sweating rate (LSR) during exercise under controlled conditions (32°C, relative humidity 55%). Fifteen subjects (8 men, 7 women) underwent 20-min cycles in four randomized conditions: control (CON), sunscreen A (SSA), sunscreen B (SSB) and sunscreen C (SSC). LSR was measured by a patch on the scapular region (p < .001). CON showed higher LSR (182.21 μL/min·dm2, CI95% 168 to 195 μL/min·dm2) compared to SSA (142.10 μL/min·dm2, CI95% 128 to 155 μL/min·dm2), SSB (158.06 μL/min·dm2, CI95% 144 to 171 μL/min·dm2), and SSC (159.00 μL/min·dm2, CI95% 145 to 172 μL/min·dm2). In men, SSA showed lower LSR compared to CON, SSB, and SSC (p < .05). On the other hand, no statistically significant differences were found in LSR between SSB, SSC, and CON conditions. In women, CON was superior to all sunscreens in LSR (p < .001), and there was no difference between them (SSA, SSB, SSC, p > .05). Sunscreen reduced LSR during moderate exercise in a hot and moderate humidity environment compared to CON, especially SSA in men and all sunscreens in women.

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

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

Sunscreens prescribed to patients with skin of color and/or with melasma: A survey of 221 dermatologists and dermatology residents in Spain.

Dark-skinned individuals (DSI) present high rates of melasma and post-inflammatory hyperpigmentation. The use of sunscreens with mineral filters is essential for prevention and treatment. Our objective was to determine the preferences of dermatologists and dermatology residents in the prescription of sunscreens for DSI. An anonymous survey of attendees at an online photoprotection event held on March 31, 2022, in Spain. The survey was answered by 66.6% (221/332) of the attendees: 159 dermatologists (71.9%) and 62 dermatology residents (28.1%). Respondents reported recommending the use of sunscreen to a median of 80% of DSI [interquartile range (IQR), 50-90]. Physicians reported prescribing tinted sunscreens to a median percentage of 60% (IQR, 25-90) of DSI with acne; and to a median percentage of 90% (IQR, 58-99) of DSI with melasma. The most prescribed photoprotectors to DSI with melasma were organic broad-spectrum sunscreens with antioxidants: 102/220 (46.4%) and mineral broad-spectrum sunscreens (with iron oxides): 45/220 (20.4%). In DSI with melasma or other pigmentary disorders, the most preferred features of sunscreens were as follows: sun protection factor ≥ 30: 217/221 (98.2%), UVA protection: 214/221 (96.8%), color for camouflage: 150/220 (68.2%) and mineral filters such as titanium dioxide and zinc oxide: 151/220 (68.6%) or iron oxides: 131/220 (59.5%). Online survey, potential inclusion bias. Respondents reported to prescribe sunscreens to the majority of DSI, and tinted sunscreens for the majority of DSI with pigmentary disorders. However, the most frequently recommended sunscreens for DSI were organic broad-spectrum sunscreens with antioxidants.

51298 An Evaluation of Sunscreen Use Among Medical Students

51298 An Evaluation of Sunscreen Use Among Medical Students

Knowledge, Attitudes and Practices to Sunscreen Use among Dermatology Patients at University Hospital Amman, Jordan: A Cross-Sectional Study

Background and Aims: Skin cancer is a significant public health concern globally. Jordan’s location and high exposure to UV radiation have led to an increase in the incidence rate of skin cancer. This study aimed to investigate the knowledge, attitudes, and practices of patients to sunscreen use in one of the major hospitals in Jordan, and identify demographic factors associated with regular sunscreen use. Methodology: An observational cross-sectional study was conducted at the dermatology clinic of Jordan University Hospital, Amman, Jordan, from February 2, 2023 to March 6, 2023. The study included 397 participants recruited from the clinic’s waiting area. A validated survey questionnaire was used to collect data on demographics, previous skin cancer history, sunscreen allergies, knowledge, attitudes, and practices related to sunscreen use. The data were analyzed using SPSS v. 26. Statistical significance was established at a p-value of &lt;0.05. Results: The majority of participants were female (67.0%) and aged 18–25 years (53.7%). Only 24.9% of participants reported using sunscreen regularly, while 34.0% reported never using it. Participants with higher education levels and income were more likely to use sunscreen regularly. The main sources of sunscreen recommendations were family and friends (48.1%), followed by dermatologists (32.7%). The most common reason for not using sunscreen was forgetfulness (40.1%). Conclusion: The study revealed that knowledge and practices related to sunscreen use among Jordanian dermatology patients are insufficient, and that there is a need for increased patient education regarding the importance of sunscreen use.

Body dissatisfaction widens the racial disparities of Benzophenone-3, a chemical biomarker of personal care and consumer product usage.

Body dissatisfaction can drive individuals to use personal care products, exposing themselves to Benzophenone-3 (BP3). Yet, no study has examined the link between body dissatisfaction and elevated chemical exposures. Our study examines how body dissatisfaction impacts the racial differences in BP3 exposures. Using NHANES 2003-2016 data for 3,072 women, we ascertained body dissatisfaction with a questionnaire on weight perception. We ran two generalized linear models with log10-transformed urinary concentrations of BP3 as the outcome variable and the following main predictors: one with race/ethnicity and another combining race/ethnicity and body dissatisfaction. We also conducted stratified analyses by race/ethnicity. We adjusted for poverty income ratio, BMI, urinary creatinine, and sunscreen usage. BP3 levels in Mexican American, Other Hispanic, Other Race, non-Hispanic White, and non-Hispanic Asian women were on average 59%, 56%, 33%, 16%, and 9% higher, respectively, compared to non-Hispanic Black women. Racial differences in BP3 levels are accentuated with body dissatisfaction. For example, Other Hispanic women perceiving themselves as overweight had 69% higher BP3 levels than non-Hispanic Black women (p-value = 0.01), while those perceiving themselves as at the right weight had 32% higher levels (p-value = 0.31). Moreover, minority women perceiving themselves as overweight tended to have higher BP3 levels than those who do not. For example, BP3 levels in Other Hispanic women perceiving themselves as overweight are significantly higher compared to those who do not (73%, p-value = 0.03). In contrast, such differences in the non-Hispanic White women are minimal (-0.5%, p-value = 0. 98). Minority women with body dissatisfaction show elevated BP3 exposure independent of sunscreen usage, implying that their elevated exposures may stem from using other personal care and consumer products. Further research is needed to determine if increases of exposure to potential toxicants occur among minority women with body dissatisfaction.

Edukasi Penggunaan Sunscreen dalam Kehidupan Sehari-Hari di SMK Farmasi Al-Furqon Banjarmasin

Sunscreen is a cosmetic was used with the aim of actively reflecting or absorbing sunlight, especially in areas with ultraviolet and infrared wave emissions, so as to prevent skin disorders due to UV rays. This educational activity aims to describe students' knowledge regarding the importance of using sunscreen to prevent skin cancer at Al-Furqon Vocational School, Banjarmasin Utara, Banjarmasin City, South Kalimantan. The activity was carried out using the socialization method using Power Point Presentation (PPT) and leaflets to present material related to the importance of using sunscreen and how to use it. a questionnaire was used after giving the material to measure the level of knowledge of the students, Based on the pre-test results, only 15 out of 17 students answered the questions correctly, then the post-test results showed that 17 students answered all the questions correctly. Community Service Activities in the context of providing information and education to vocational school students about the use of sunscreen to prevent skin cancer have been carried out well and have increased students' knowledge regarding the importance of using sunscreen in everyday life.

Mono-n-hexyl phthalate: exposure estimation and assessment of health risks based on levels found in human urine samples

Mono-n-hexyl phthalate (MnHexP) is a primary metabolite of di-n-hexyl phthalate (DnHexP) and other mixed side-chain phthalates that was recently detected in urine samples from adults and children in Germany. DnHexP is classified as toxic for reproduction category 1B in Annex VI of Regulation (EC) 1272/2008 and listed in Annex XIV of the European chemical legislation REACH; thereby, its use requires an authorisation. Health-based guidance values for DnHexP are lacking and a full-scale risk assessment has not been carried out under REACH. The detection of MnHexP in urine samples raises questions about the sources of exposure and concerns of consumer safety. Here, we propose the calculation of a provisional oral tolerable daily intake value (TDI) of 63 µg/kg body weight/day for DnHexP and compare it to intake levels corresponding to levels of MnHexP found in urine. The resulting mean intake levels correspond to less than 0.2% of the TDI, and maximum levels to less than 5%. The TDI was derived by means of an approximate probabilistic analysis using the credible interval from benchmark dose modelling of published ex vivo data on reduced foetal testosterone production in rats. Thus, for the dose associated to a 20% reduction in testosterone production, a lower and upper credible interval of 14.9 and 30.0 mg/kg bw/day, respectively, was used. This is considered a conservative approach, since apical developmental endpoints (e.g. changed anogenital distance) were only observed at higher doses. In addition, we modelled various scenarios of the exposure to the precursor substance DnHexP from different consumer products, taking measured contamination levels into account, and estimated systemic exposure doses. Of the modelled scenarios including the application of sunscreen (as a lotion or pump spray), the use of lip balm, and the wearing of plastic sandals, and considering conservative assumptions, the use of DnHexP-contaminated sunscreen was highlighted as a major contributing factor. A hypothetical calculation using conservative assumptions for the latter resulted in a margin of safety in relation to the lower credible interval of 3267 and 1007 for adults and young children, respectively. Most importantly, it was found that only a fraction of the TDI is reached in all studied exposure scenarios. Thus, with regard to the reported DnHexP exposure, a health risk can be considered very unlikely.

The Role of Health Literacy in Skin Cancer Preventative Behavior and Implications for Intervention: A Systematic Review.

Health literacy is essential for individuals to access, understand, and utilize information and services to inform health related decisions and actions. As one of the most diagnosed and preventable forms of cancer, skin cancer disease risk can be reduced through preventative behavior. Currently, there is no focused study looking specifically at health literacy and skin cancer. An understanding of how health literacy affects skin cancer-related preventive behaviors can improve current practices in skin cancer prevention. To systematically identify, synthesize, and summarize findings on the role of health literacy in skin cancers (including cutaneous squamous cell carcinoma, basal cell carcinoma, and melanoma), with a focus on preventive behaviors using studiesthat utilized quantifiablehealth literacy measurements. A literature search was performed by searching PubMed, Embase, PsycINFO, and CINAHL from inception until September 26, 2023 to identify cross-sectional, case-control, cohort, or randomized controlled studies that investigated the association between health literacy and skin cancer prevention and diagnosis. Health literacy levels varied across geographic regions, specific populations, and ethnicities. Most of the included studies found a positive association between higher health literacy and better skin cancer preventative behaviors. This included sun-protective behaviors such as: wearing sleeved shirts or shirts with collars, using gloves, covering head and face, limiting sun exposure, more sunscreen use, and less sunbathing or indoor tanning. Higher health literacy was associated with increased likelihood to engage in genetic testing and less family influence on health in one study which assessed determinants of interest in skin cancer genetic testing. Another study investigating family communication about skin cancer found that higher health literacy was associated with increased family communication regarding general cancer risk. One sun protection interventional education program was effective at increasing participants' knowledge, awareness of skin cancer risk, willingness to change sun protection, and use of sun protection, but results varied between ethnic groups. Skin cancer-related educational interventions can be effective in improving health literacy and potentially lessen the impact of skin cancer through positive behavior modification, early detection, and disease knowledge and awareness. Interventions need to be tailored to its target population to maximize effectiveness due to thevarying baseline of health literacy identified across different geographic and ethnic groups. Protocol Registration PROSPERO CRD42022340826.

Sunscreens: A narrative review

AbstractSunscreens are topical formulations incorporating filters that protect our skin against ultraviolet radiation (UVR) emitted by the sun. Sunscreen use has been increasingly encouraged to protect against sunburn, skin cancer and photoaging that can occur because of prolonged and cumulative sun exposure. However, sunscreens and their constituent UVR filters have been purported to be problematic themselves. In this narrative review, we will describe the history of sunscreens, types of UVR filters and how sunscreens are classified and rated. We will also explore some of the controversies regarding sunscreens, including concerns about their safety and environmental impact. Awareness of these potential consequences is paramount to the process of informed decision‐making.

Knowledge, attitudes and practices (KAP) of medical university students towards vitamin D deficiency in Saudi Arabia: a cross-sectional study.

Vitamin D deficiency is a serious health problem that is associated with many health consequences. The study aimed to assess the knowledge, attitudes, and practices of medical students at Qassim University, Saudi Arabia, regarding vitamin D deficiency. An observational cross-sectional study was conducted among students of Unaizah Colleges of Pharmacy (UCP) and Medicine (UCM) at Qassim University, Saudi Arabia, over a period of 3 months. A well-structured self-administered questionnaire was used for the data collection. Statistical analysis was applied by using SPSS version 22. A 0/1 scoring process was employed to assess the KAP of the participants. The midpoint is considered the cutoff point. A total of 337 complete responses were received. The majority of participants (62.3%) were female. 291 (86.3%) were considered to have good knowledge, with a mean score of 6.326 out of 9. Moreover, 220 (65.2%) of participants had positive attitudes, with a mean score of 4.077 out of 7. Unfortunately, only 9 (2.6%) participants demonstrated satisfactory practices, with a mean score a 0.911 out of 6. Female participants were significantly better than male participants in terms of knowledge and attitudes, but worse in terms of practices. Sun exposure during safe daytime hours is considered the main cause of vitamin D deficiency. Nearly 60% confirmed that KSA indoor activities and the COVID-19 lockdown might maximise vitamin D deficiency. The study reveals a gap in vitamin D knowledge among participants influenced by gender and study year. It suggests educational initiatives for male students to enhance their knowledge regarding vitamin D, while female students are encouraged to prioritise safe sun exposure, minimising the use of umbrellas and sunscreen. It also highlights the role of educational institutions as reliable sources of information and the influence of the COVID-19 pandemic on participants' attitudes and practices towards vitamin D.

Cost-effectiveness analysis and return on investment of SunSmart Western Australia to prevent skin cancer.

Each year, malignant melanoma accounts for 57 000 deaths globally. If current rates continue, there will be an estimated 510 000 new cases annually and 96 000 deaths by 2040. Melanoma and keratinocyte cancers (KCs) incur a large societal burden. Using a mathematical population model, we performed an economic evaluation of the SunSmart program in the state of Western Australia (WA), a primary prevention program to reduce the incidence of skin cancer, versus no program. A societal perspective was taken combining costs to the health system, patients and lost productivity. The model combined data from pragmatic trial evidence of sun protection, epidemiological studies and national cost reports. The main outcomes modelled were societal and government costs, skin cancer counts, melanoma deaths, life years and quality-adjusted life years. Over the next 20 years, the model predicted that implementing the WA SunSmart program would prevent 13 728 KCs, 636 melanomas and 46 melanoma deaths per 100 000 population. Furthermore, 251 life years would be saved, 358 quality-adjusted life years gained and AU$2.95 million in cost savings to society per 100 000 population would be achieved. Key drivers of the model were the rate reduction of benign lesions from sunscreen use, the costs of purchasing sunscreen and the effectiveness of reducing KCs in sunscreen users. The likelihood of WA SunSmart being cost-effective was 90.1%. For the WA Government, the estimated return on investment was $8.70 gained for every $1 invested. Primary prevention of skin cancer is a cost-effective strategy for preventing skin cancers.