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PubMed1998

Phenotypic markers, sunlight-related factors and sunscreen use in patients with cutaneous melanoma: an Austrian case-control study.

Sunscreens have been advocated to prevent burning in the hope that this will decrease the chance of developing melanoma. In a single-centre case-control study in Styria, Austria, we examined the risk of cutaneous malignant melanoma in relation to phenotypic markers, sunlight-related factors and sunscreen use. In total, 193 melanoma patients and 319 control subjects answered a comprehensive questionnaire regarding phenotypic markers, a variety of sunlight-related factors and sunscreen use. Risk factors for melanoma were examined through the use of unconditional logistic regression analysis, controlling for age and sex. Screening for confounding factors was done by forward and backward elimination of non-significant variables (P < 0.05). The resulting set of factors were investigated further for effect modification by introducing interactions into the model. The factor most significantly associated with increased melanoma risk was the use of sunscreens. Subjects who often used sunscreens had an increased odds ratio (OR) of 3.47 (95% confidence interval [CI]1.81-6.64) compared with subjects who never used sunscreens (P = 0.001), after adjustment for sex, age and other significant sunlight-related factors. Skin colour and higher numbers of sunbaths were significant protective factors. Subjects with medium skin colour had an adjusted OR of 0.63 (95% CI 0.41-0.99) compared with subjects with light skin colour (P = 0.0022). Subjects who took more than 30 sunbaths per year and subjects who took 20-30 sunbaths per year had, in the absence of sunburn(s), a decreased OR of 0.09 (95% CI 0.02-0.39) and 0.28 (95% CI 0.13-0.64), respectively, compared with subjects who took less than 20 sunbaths per year (P = 0.0002). However, sunbaths had no protective value when they were associated with sunburns. Although we cannot exclude the presence of an unknown confounding factor, our results suggest that the use of sunscreens does not help prevent melanoma.

Adolescent↗

PubMed1995

Melanoma awareness and sun exposure in Leicester.

The city of Leicester, in conjunction with other centres throughout the U.K., was targeted for publicity about melanoma over a 3-year period from 1987 to 1989. We report the results of a survey to assess the level of awareness of melanoma, and to document current sunbathing practices subsequent to that period. The general level of awareness of melanoma in the community was good (74%). People who knew about melanoma were more likely to use a sunscreen at home and abroad (odds ratios 1.63, 95% CI 1.19-2.24 and 1.39, 95% CI 1.03-1.86), but paradoxically more likely to sunbathe than those who had never heard of melanoma (odds ratio 1.33, 95% CI 1.03-1.72). Females were more knowledgeable than males (odds ratio 1.74, 95% CI 1.26-2.22), but continued to sunbathe. Teenagers and young adults tended to be relatively ignorant of melanoma, and were less likely to protect themselves against sunburn while sunbathing than other age groups. Teenagers, young adults, and males need to be targeted more effectively in future publicity campaigns. Furthermore, many people who know about melanoma continue to put themselves at risk by sunbathing. New strategies need to be developed to influence behaviour as well as increasing awareness.

Adolescent↗

PubMed2000

Sunscreen use and malignant melanoma.

In a new population-based, matched, case-control study from southern Sweden of 571 patients with a first diagnosis of cutaneous malignant melanoma, between 1995 and 1997, and 913 healthy controls aged 16 to 80 years, the association between sunscreen use and malignant melanoma was evaluated. The median sun protection factor (SPF) used by both cases and controls was 6, range 2 to 25. Sunscreen users reported greater sun exposure than non-users. Persons who used sunscreens did not have a decreased risk of malignant melanoma. Instead, a significantly elevated odds ratio (OR) for developing malignant melanoma after regular sunscreen use was found, adjusted for history of sunburns, hair color, frequency of sunbathing during the summer, and duration of each sunbathing occasion ¿OR = 1.8, 95% confidence interval (CI) 1.1-2.9]. The OR was higher in subjects who reported that sunscreen use enabled them to spend more time sunbathing (adjusted OR = 8.7, 95% CI 1.0-75.8 for always vs. never use). The association appeared to hold for subjects who did not suffer from sunburns while using sunscreens, for subjects who used SPF of 10 or lower, and among men. The pattern of a significantly increased melanoma risk was seen only for lesions of the trunk. Our results are probably related mainly to earlier sunscreens of low SPF. They substantiate the hypothesis that sunscreen use, by permitting more time sunbathing, is associated with melanoma occurrence.

Adolescent↗

PubMed2003

Susceptibility to prostate cancer: studies on interactions between UVR exposure and skin type.

Recent studies have proposed that exposure to ultraviolet radiation (UVR) protects against development of some internal cancers including that in prostate. This effect may be mediated by UVR-induced cutaneous synthesis of vitamin D. It is also proposed that ability to pigment in response to UVR will influence susceptibility to prostate cancer through its effects on vitamin D synthesis. We wished to determine first, whether ability to pigment, as assessed by skin type, influences the extent of exposure to UVR, secondly, whether skin type is associated with prostate cancer susceptibility and thirdly, whether such an effect is mediated by the extent of UVR exposure. We studied 453 prostatic adenocarcinoma and 312 benign prostatic hypertrophy (BPH) patients using a validated questionnaire to assess two parameters of exposure; months of cumulative exposure per year and adult sunbathing score. We used analysis of variance to show that cancer cases with sun-sensitive skin (skin type 1) had lower cumulative exposure per year (P = 0.014) and sunbathing scores (P < 0.0001) than those with type 4, possibly because of a tendency to avoid exposure. Further, cumulative exposure per year and sunbathing score were significantly lower in cancer compared with BPH patients (P < 0.001 and P < 0.001, respectively). While the proportion of subjects with skin types 1 and 2 was lower in cancer than BPH patients, these were not significantly different (logistic regression analysis, skin type 1 versus type 4; P = 0.11). We used recursive partitioning to determine if skin type influenced susceptibility to prostate cancer in subgroups stratified by exposure. Analysis of the data showed that in men with low sunbathing scores, skin type 1 conferred protection compared with skin types 2-4 (OR = 4.78, 95% CI 3.01-8.25, P < 0.0009). These findings indicate that susceptibility to prostate cancer is in part determined by extent of exposure to UVR and that ability to pigment mediates this effect.

Adenocarcinoma↗

PubMedDate not supplied

Sunscreen use and environmental awareness among beach-goers in Cape Town, South Africa.

BACKGROUND: The potential impact on health of increased exposure to sunlight has caused increased concern in recent years. In South Africa little is known of peoples' sunbathing habits, use of sunscreens, and factors influencing these practices. AIMS: The aims of the study were to determine sunscreen usage among the South African beach-going public, to determine sunbathing practices of beach-goers and to determine factors influencing peoples' sunbathing habits. METHODS: Cluster sampling at 3 popular Cape Peninsula beaches was used to select a sample of 231 white adult beach-goers. Questionnaires were administered to obtain information on the use of sunscreens, frequency of use, peoples' sunbathing activities, their susceptibility to sunburn and ability to tan, whether there was a history of severe sunburn, and knowledge and awareness of environmental issues. Information was also obtained on personal characteristics and sociodemographic factors. RESULTS: 50% of respondents were using a sunscreen on the day of the interview. More women than men, and people over 25 years of age relative to younger persons, made frequent use of sunscreen lotions. A sun protection factor (SPF) of 15 or more was being used by 5% of the population. With respect to peoples' knowledge and awareness of the environment, 90% of the population cited skin cancer as a potential consequence of over-exposure to sunlight, although, in general, knowledge of environmental issues was poor. CONCLUSIONS: A major effort is needed to improve attitudes and practices in South Africa with respect to sun-tanning activities.

Adult↗

PubMed2005

Cosmic radiation increases the risk of nuclear cataract in airline pilots: a population-based case-control study.

BACKGROUND: Aviation involves exposure to ionizing radiation of cosmic origin. The association between lesions of the ocular lens and ionizing radiation is well-known. OBJECTIVE: To investigate whether employment as a commercial airline pilot and the resulting exposure to cosmic radiation is associated with lens opacification. METHODS: This is a population-based case-control study of 445 men. Lens opacification was classified into 4 types using the World Health Organization simplified grading system. These 4 types, serving as cases, included 71 persons with nuclear cataracts, 102 with cortical lens opacification, 69 with central optical zone involvement, and 32 with posterior subcapsular lens opacification. Control subjects are those with a different type of lens opacification or without lens opacification. Exposure was assessed based on employment time as pilots, annual number of hours flown on each aircraft type, time tables, flight profiles, and individual cumulative radiation doses (in millisieverts) calculated by a software program. Odds ratios were calculated using logistic regression. RESULTS: The odds ratio for nuclear cataract risk among cases and controls was 3.02 (95% confidence interval, 1.44-6.35) for pilots compared with nonpilots, adjusted for age, smoking status, and sunbathing habits. The odds ratio for nuclear cataract associated with estimation of cumulative radiation dose (in millisieverts) to the age of 40 years was 1.06 (95% confidence interval, 1.02-1.10), adjusted for age, smoking status, and sunbathing habits. CONCLUSION: The association between the cosmic radiation exposure of pilots and the risk of nuclear cataracts, adjusted for age, smoking status, and sunbathing habits, indicates that cosmic radiation may be a causative factor in nuclear cataracts among commercial airline pilots.

Aerospace Medicine↗

PubMed2004

Associations between UVR exposure and basal cell carcinoma site and histology.

While sunlight is critical in basal cell carcinoma (BCC) pathogenesis the relationship between exposure and tumor site and histology is unclear. We determined if tumor site (trunk or head/neck) or histology (nodular or superficial) is determined by exposure pattern. In 66 cases with truncal and 362 patients with head/neck BCC at first presentation, average hours exposure/year, intermittency score, childhood sunburning and skin type were not significantly associated with tumor site or histology. However, often sunbathing was associated with a five-fold increased risk of truncal BCC. Average sunbathing score was significantly greater in 22 cases with truncal compared with 325 cases with head/neck nodular tumors and also in 44 cases with superficial truncal compared with superficial head/neck BCC. Thus, sunbathing determined tumor site but not histology.

Abdomen↗

PubMed2004

Attitudes, subjective norms and perception of behavioural control as predictors of sun-related behaviour in Swedish adults.

BACKGROUND: Exposure to ultraviolet (UV) radiation is the major preventable cause of skin cancer. The aim of this study was to investigate the explanatory value of attitudes, subjective norms and perceived behavioural control on behaviours related to UV exposure. METHOD: A random population-based sample (n = 1752, 18-37 years of age) in the Stockholm County, Sweden, answered a questionnaire with items on sun related behaviours and beliefs. The items concerned issues influenced by the Theory of Planned Behaviour, that is, attitudes, subjective norms and perceived behavioural control. Logistic regression analysis was used to examine the associations between behaviours and beliefs. RESULTS: Positive attitudes towards being tanned and being in the sun were both strongly associated with time spent in the sun, intentional tanning, sunbed use, going on vacation to a sunny resort, intention to decrease sunbathing and use of protection against the sun. Perceiving sunbathing as risky was associated with using different ways to protect and intending to reduce sun exposure. Having people around oneself who frequently sunbathe was related to intentional tanning and vacations to sunny resorts. Finally, perceived behavioural control was associated with use of sunscreen and use of other ways to protect from the sun among women. CONCLUSION: The study identified factors on which primary preventive interventions towards decreasing sun exposure should be focused.

Adolescent↗

PubMed2006

Evaluation of a multicomponent appearance-based sun-protective intervention for young women: uncovering the mechanisms of program efficacy.

An appearance-based sun-protection intervention program was developed, implemented, and evaluated in a sample of 211 Caucasian women (ages 18-25) randomly assigned to the sun-protection program or to a stress management (control) program. The sun-protection program incorporated a novel construct of image norms of aspirational peers (i.e., female media figures, fashion models) approving paleness. The authors targeted these image norms as well as the advantages of tanning, health beliefs about photoaging and skin cancer, and self-efficacy for sun protection. The intervention produced significant differences across conditions favoring sun protection on all constructs but severity of skin cancer and barriers to sun protection. At follow-up, treatment participants exceeded controls both in intention to sun protect and sun-protective behavior and reported lower intention to sunbathe and fewer hours of sunbathing. A mediational model of intervention outcomes revealed distinct mediators for sun protection versus sunbathing.

Adolescent↗

PubMed1997

Assessment of sun-related behaviour in individuals with dysplastic naevus syndrome: a comparison between diary recordings and questionnaire responses.

In Sweden, individuals with dysplastic naevus syndrome (DNS-D2), a high risk group for malignant melanoma, are regularly screened and informed about self-examination and sun protection. During the summer of 1994, 54 out of 65 consecutive patients completed 1 month of daily self-recordings of sun-related behaviour. The diary report was compared with questionnaire responses obtained 6 months later concerning sun-related behaviour, both habitual and during the month of self-recording. The correspondence between the sun-related behaviour recorded in the diary and given in response to the questionnaire was fairly high, but 48% underestimated and 29% overestimated their actual number of sunbathing occasions in the questionnaire. Few patients indicated habitual high frequencies of sunbathing, although some of them recorded six or more occasions during 1 month in the diary. Those who recorded multiple sunburns reported the highest number of sunburns in the questionnaire. Patients who scored high on sunbed use also recorded high numbers of sunbathing occasions. Diaries should be used when detailed information about the magnitude of sun-related behaviour is essential, whereas questionnaires should be sufficient in studies aiming to differentiate between high and low frequencies of such behaviour.

Adolescent↗

PubMed2005

Ultraviolet radiation and the risks of cutaneous malignant melanoma and non-melanoma skin cancer: perceptions and behaviours of Danish and American adolescents.

The highest prevalence rates of skin malignancy in the northern hemisphere occur in Scandinavia and the United States (USA). Most Danes and Americans receive 50% of their lifetime ultraviolet (UV) radiation before the age of 21, making it important to address sun exposure risks with adolescents. The project was undertaken to determine differences between Danish and American adolescents in knowledge of sun exposure and skin malignancy, activities accounting for sun exposure, and means used for sun protection. Questionnaires regarding skin cancer and sun exposure were distributed to 674 secondary school age students in Hilleroed, Denmark, and to 483 similarly aged students in Winston-Salem, North Carolina, USA. Differences in responses between and within groups were compared. American adolescents had more knowledge of the characteristics and malignant potential of melanoma than did Danish adolescents. Danish youth and females from both countries were significantly more likely to engage in sunbathing and tanning bed use. Black Danish students reported significantly more sunburn and were more likely to sunbathe or use a tanning bed than were black American students. Danish students were more likely than Americans to use sunscreen, however, Americans were more likely to apply sun protective factor (SPF) 15 or greater. In conclusion, given that sunbathing and tanning bed use are associated with the development of precancerous lesions and skin malignancy, Danish teens are at increased risk. The rates of skin malignancy are relatively high in Scandinavia and efforts to improve understanding of exposure and cancer risks should be undertaken in adolescents.

Adolescent↗

PubMed2003

Double exposure: natural and artificial ultraviolet radiation exposure in beachgoers.

BACKGROUND: Although the beach is a high-risk environment for ultraviolet light exposure and subsequent skin damage, little is known about beachgoer tanning habits outside the beach setting. Our purpose was to evaluate indoor tanning and additional, nonbeach sunlight exposure in a beachgoing population. METHODS: We conducted an epidemiologic survey. RESULTS: There was more use of indoor tanning salons among sunbathing beachgoers who applied little or no skin protection from the sun (50.8% [31 of 61 respondents]) compared with nonsunbathing beachgoers (22.7% [5 of 22 respondents]). In addition to increased use of tanning salons, we observed that poorly protected sunbathers tanned at locations other than the beach on a regular basis (50.8% [31 of 61 respondents]) more than nonsunbathers did (9.1% [2 of 22 respondents]). CONCLUSION: Beachgoing sunbathers often used both natural sunlight and tanning beds, subjecting themselves to two forms of ultraviolet radiation exposure.

Adolescent↗

PubMed1979

Effect of frequent sun exposure on bacterial colonization of skin.

The bacteria colonizing the surface of the skin of a group of frequent sunbathers and a group of infrequent sunbathers were surveyed. Frequent sunbathing does not greatly affect the total number of organisms on the skin, but does tend to increase the proportion of bacteria containing carotenoid pigments.

Adult↗

PubMed2006

Social cognitive predictors of sun protection intention and behavior.

The authors investigated sunbathing behavior and intention prospectively using the Theory of Planned Behavior (TPB). Before summer, 85 young adults who intended to sunbathe completed a TPB questionnaire. After summer; 46 of them completed a second questionnaire about their summertime sunbathing behavior The proposed model was successful in predicting both behavior and intention to use sun protection, with 45% of the variance of self-reported sunscreen use and 32% of the variance in intention explained by the TPB. Items designed to measure self-efficacy and perceived control loaded onto different factors and demonstrated discriminant validity. Self-efficacy predicted both intention and behavior (after controlling for all other TPB variables), but perceived behavioral control did not. The authors discuss the implications of the findings for potential interventions to improve sun protection behavior

Adult↗

PubMed1987

Analysis of the risk of skin cancer from sunlight and solaria in subjects living in northern Europe.

The risk of non-melanoma skin cancer in northern Europeans who indulge in sunbathing or use a UVA solarium was estimated using a mathematical model of skin cancer incidence that makes allowance for childhood, occupational and recreational sun exposure. This model demonstrates that the cumulative incidence of skin cancer in indoor workers is about 2-3% by the age of 70, yet this risk can increase 5-fold if they indulge in a two-week sunbathing vacation each summer. The use of a UVA solarium is also shown to increase the risk of skin cancer. Because risk increases with the approximate square of annual solarium exposure, it is not possible to define a 'safe' level of exposure. Instead, it is shown that weekly use of a UVA solarium from age 20 until middle age (40-50) gives a relative cumulative incidence of 1.3 compared with non-users of sun beds and sun canopies. The risk begins to increase rapidly for more frequent use, particularly when solaria are used in combination with sunbathing.

Adolescent↗

PubMed2004

UV radiation exposure related to age, sex, occupation, and sun behavior based on time-stamped personal dosimeter readings.

OBJECTIVE: To assess individual time-related (time-stamped) UV radiation (UVR) dose pattern and sun exposure behavior. DESIGN: Open prospective observational study. SETTING: University hospital. Study Subjects Two hundred eighty-five Danish volunteers with apparently healthy skin: children, adolescents, indoor workers, sun worshippers, golfers, and gardeners (age range, 4-68 years). Measurements We developed a personal electronic UVR dosimeter in a wristwatch (SunSaver) and measured continuously time-related UVR doses in standard erythema dose (SED) and corresponding sun exposure behavior from diaries, resulting in 346 sun-years (median, 119 days). The estimated yearly UVR doses were calculated based on personal and ambient measured doses. RESULTS: The median estimated yearly UVR dose was 173 SEDs (range, 132 SEDs [indoor workers]-224 SEDs [gardeners]), with no significant difference by age (P =.25) or sex (P =.75). The SED of girls (175 SEDs) was significantly (P =.04) higher than that of boys (116 SEDs). Subjects younger than 20 years had an increase of 5 SEDs per year (P =.03). Sunbathing or exposing shoulders (risk behavior) outside the beach resulted in a median of 2.5 SEDs per day in northern Europe and 3.2 SEDs per day in southern Europe; however, at the beach, corresponding values were 4.6 and 6.9 SEDs per day. Children and adolescents received more than half their total UVR dose at the beach. Sunburning doses above 10 SEDs per day were connected with sunbathing or exposing shoulders. Of the UVR dose, 50% was received between noon and 3 PM. Only the gardeners received most of their UVR dose (55%) on working days. CONCLUSIONS: High UVR doses are connected with risk behavior, except for outdoor workers. There is no need to change sun exposure habits on days without risk behavior.

Adolescent↗

PubMed2005

Randomized controlled trial testing the impact of high-protection sunscreens on sun-exposure behavior.

OBJECTIVE: High-protection sunscreens have been suspected to prompt people to increase sun exposure, and thus to increase skin cancer risk. We tested the influence of both the actual protection (sun protection factor [SPF]) and the information about protection (label) on sun-exposure behavior. DESIGN: Randomized controlled trial. SETTING: Four French seaside resorts during summer 2001. PARTICIPANTS: A total of 367 healthy subjects during their 1-week holiday. Outcome was assessable in 98% of them. INTERVENTION: Subjects were offered free sunscreens, with randomization into the following study arms: (1) SPF 40 labeled as "high protection"; (2) SPF 40 labeled as "basic protection"; and (3) SPF 12 labeled as "basic protection." Arm 4, ie, SPF 12 labeled as "high protection," was not implemented for ethical reasons. Subjects were not aware of the real target of the study and were blinded to the SPF value. MAIN OUTCOME MEASURE: Duration of sunbathing exposure during 1 week. Secondary outcomes were occurrence of sunburns and amount of sunscreen used. Influences of SPF and label were assessed separately. RESULTS: Compared with the low-SPF group, the high-SPF group did not have longer sunbathing exposure (12.9 +/- 7.2 h/wk for high SPF vs 14.6 +/- 6.7 h/wk for low SPF; P = .06), experienced fewer sunburns (14% vs 24%; P = .049), and used less sunscreen (median, 30 g vs 109 g; P<.001). The label "high protection" or "basic protection" had no influence on these end points. CONCLUSIONS: In this adult population, higher SPF had no influence on duration of sun exposure and offered better protection against sunburns. Although higher SPF may increase sun exposure duration in specific populations, this effect cannot be viewed as a universal side effect of high-SPF sunscreens.

Adolescent↗

PubMed2005

Sunscreen use related to UV exposure, age, sex, and occupation based on personal dosimeter readings and sun-exposure behavior diaries.

OBJECTIVES: To examine during what behaviors people apply sunscreen and to assess the relationship to UV exposure monitored by personal dosimetry and diaries. DESIGN: Open prospective observational study. SETTING: University hospital. PARTICIPANTS: A convenience sample of 340 Danish volunteers: children, adolescents, indoor workers, sun worshippers, golfers, and gardeners (age range, 4-68 years). Intervention Subjects recorded sunscreen use and sun-exposure behavior in diaries and carried personal, electronic UV dosimeters, measuring time-stamped UV doses continuously, during a median of 119 days covering 346 sun-years (1 sun-year equals 1 subject participating during 1 summer season). MAIN OUTCOME MEASURES: Associations between sunscreen use and age, sex, skin type, occupation, sunburn, UV exposure doses, and behavior; and adequate application density and sun protection factor required to prevent sunburn. RESULTS: There were great variations in sunscreen use, which was highly correlated with risk behavior (sunbathing or exposing the upper body) (r = 0.39; P<.001). Sunscreens were used on a median of 5 days per sun-year (range, 1 day for gardeners to 16 days for sun worshippers). Ten percent of females and 41% of males never used sunscreens. Females used sunscreens more but also had more unprotected risk behavior than males (8 days vs 4 days; P<.001). Sunscreen use was not correlated with age, and children had as much unprotected risk behavior as adults. Sunscreens were used on 86% of the days with risk behavior in southern Europe vs 20% in northern Europe (P<.001). The UV doses were significantly higher on days with sunscreen (P< or = .03) and on sunburn days (P<.001). The median sun protection factor was 10.5. The sun-protecting effect corresponded to an application density of 0.5 mg/cm2. CONCLUSION: Days with sunscreen correlated not with days without risk behavior, but with days "sunbathing with the intention to tan," indicating that sunscreens were used as tanning aids to avoid sunburn.

Adolescent↗