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PubMed2001

Implications of a utility model for ultraviolet exposure behavior.

Over the past several decades, the incidence of skin cancer has reached epidemic proportions. Despite numerous efforts to increase public awareness of the risks associated with solar radiation, people continue to sunbathe, use indoor tanning facilities, avoid photoprotective clothing, and fail to use sunscreen. We propose using an economic model, the utility model, to better understand how to reduce tanning behaviors. This model has been widely applied in financial decision-making as well as in analysis of risk-taking behaviors such as smoking. The model takes into account both the current perceived benefits of tanning and the future long-term risks. People tend to discount the future; they tend to weigh current benefits more heavily than future risks. As predicted by the model, past prevention efforts that have focused on long-term benefits gained by sun-protective behavior have been largely ineffective. In the current social environment, we cannot expect tanning reduction measures based solely on health education to be very effective. Only by changing public perceptions of a tan will efforts to decrease ultraviolet exposure behavior likely be successful.

Decision Making↗

PubMed2002

The evolution of current medical and popular attitudes toward ultraviolet light exposure: part 1.

Ultraviolet radiation is the most important carcinogenic agent related to the development of melanoma and nonmelanoma skin cancer, and primary prevention efforts focus on reducing exposure to sunlight and ultraviolet sunlamps. Favorable societal views of suntanning serve as an obstacle to skin cancer prevention. Although the education of patients and the public regarding the risks of excessive ultraviolet light exposure is an important goal in medicine today, few physicians have more than a vague knowledge of how current attitudes actually developed during the past century. Opinions about ultraviolet light exposure were not static, but evolved with increasing scientific knowledge and changing social mores. A critical interplay occurred between the prevailing medical and nonmedical views on the subject. In this article, we focus on the century's start (1900-1920)--a time when vigilance against significant sun exposure, a relic of the 19th century, was eroding, and the roots of later attitudes toward sunbathing were already manifest. Medically, the view of sunlight as salutary was bolstered by the success of phototherapy, which was introduced in the 1890s. The first clinical observations associating long-term sunlight exposure with skin cancer were also reported during this time. The association, however, was poorly understood, and this work was largely ignored by the medical profession and remained essentially unknown to the public.

Attitude to Health↗

PubMed2003

The evolution of current medical and popular attitudes toward ultraviolet light exposure: part 2.

The 1920s and 1930s represented an extraordinary time in the shaping of modern attitudes towards ultraviolet light. Dermatologists and other physicians today are still confronting the effects of changes in social behavior that occurred at this time. The discovery that ultraviolet wavelengths played a role in vitamin D synthesis in the skin ushered in a period of enormous popularity for ultraviolet light exposure. A variety of other medical claims were soon made for ultraviolet radiation, including that it increased resistance to disease. The field of phototherapy rapidly expanded, and its use was employed by proponents for a host of unlikely medical conditions. Exposure to sunlight or ultraviolet lamps was widely promoted as a form of preventive medicine. Home sunlamps gained popularity and were aggressively marketed to the public. A suntan, which had previously achieved limited popularity, now was viewed as de rigueur in the United States and Europe. The role that medical advocacy of ultraviolet light exposure played in initially advancing the practice of sunbathing is not commonly appreciated today. Ironically, public health recommendations of the time were often diametrically opposed to those being made at present, since sunlight exposure is currently recognized as the major preventable cause of cancer of the skin.

Advertising↗

PubMed2005

UVA radiation is highly mutagenic in cells that are unable to repair 7,8-dihydro-8-oxoguanine in Saccharomyces cerevisiae.

UVA (320-400 nm) radiation constitutes >90% of the environmentally relevant solar UV radiation, and it has been proposed to have a role in skin cancer and aging. Because of the popularity of UVA tanning beds and prolonged periods of sunbathing, the potential deleterious effect of UVA has emerged as a source of concern for public health. Although generally accepted, the impact of DNA damage on the cytotoxic, mutagenic, and carcinogenic effect of UVA radiation remains unclear. In the present study, we investigated the sensitivity of a panel of yeast mutants affected in the processing of DNA damage to the lethal and mutagenic effect of UVA radiation. The data show that none of the major DNA repair pathways, such as base excision repair, nucleotide excision repair, homologous recombination, and postreplication repair, efficiently protect yeast from the lethal action of UVA radiation. In contrast, the results show that the Ogg1 DNA glycosylase efficiently prevents UVA-induced mutagenesis, suggesting the formation of oxidized guanine residues. Furthermore, sequence analysis of UVA-induced canavanine-resistant mutations reveals a bias in favor of GC-->TA events when compared with spontaneous or H(2)O(2)-, UVC-, and gamma-ray- induced canavanine-resistant mutations in the WT strain. Taken together, our data point out a major role of oxidative DNA damage, mostly 7,8-dihydro-8-oxoguanine, in the genotoxicity of UVA radiation in the yeast Saccharomyces cerevisiae. Therefore, the capacity of skin cells to repair 7,8-dihydro-8-oxoguanine may be a key parameter in the mutagenic and carcinogenic effect of UVA radiation in humans.

Aging↗

PubMed2006

Vitamin D and its binding protein Gc: long-term variability in peri- and postmenopausal women with and without hormone replacement therapy.

OBJECTIVE: Measurement of plasma 25-hydroxyvitamin D (25OHD) level is often used to evaluate a patient's vitamin D status. The purpose of this study was to investigate the variability in individual plasma 25OHD- and vitamin D-binding protein- (Gc) levels over a 5-year period in postmenopausal women with and without hormone replacement therapy (HRT). MATERIAL AND METHODS: A total of 187 women were followed-up for 5 years. At baseline, 89 women were allocated to treatment with HRT, given orally. Measurements were performed at baseline and after 1, 2 and 5 years of follow-up. RESULTS: At baseline, 25OHD levels were positively associated with sunbathing and use of vitamin D supplements, and inversely associated with smoking. HRT therapy increased plasma levels of Gc (+8 %) but did not affect 25OHD levels or the free 25OHD index (molar ratio of 25OHD- to Gc levels). Among those classified in the lowest 25OHD tertile at baseline, 40 % remained in the lowest tertile during all subsequent measurement time-points. Similarly, 32 % of those classified in the highest baseline tertile remained in the highest tertile during all subsequent measurements. Use of the free 25OHD index showed similar results. No independent predictors of changes in vitamin D tertiles during follow-up were identified, which suggests that the observed variation was caused by the intra-individual variation in measured parameters. For all participants, the within-patient variability in 25OHD measurements was between 13 % and 19 %. CONCLUSIONS: In healthy postmenopausal women, HRT increases Gc levels. Owing to the high intra-individual variation in plasma 25OHD, it seems questionable to use a single estimate as a predictor of individual vitamin D status.

Analysis of Variance↗

PubMed1999

Cancer prevention.

Over 70% of human cancers are associated with lifestyle and about half of cancer deaths could be prevented by relatively simple individual actions: no smoking, moderate consumption of alcohol, increased consumption of fruit and vegetables, avoidance of sunbathing, obesity and a too high consumption of saturated lipids. Most of these efforts would also markedly decrease the incidence of cardiovascular and respiratory diseases. However, the concept of prevention is currently neither well accepted nor understood by the medical community and the general public. It is often felt that it restricts freedom, imposes a choice between pleasure and duty, and that passing judgement on lifestyle is a form of intolerance. The case of tobacco illustrates the difficulties encountered by prevention, notably among adolescents. The fight against smoking requires information, a societal approach (ban on advertising, increase in price), and a reduction of the example given by adult smoking (parents, peers, teachers, physicians, TV presenters, movie stars, have a great influence on adolescents), while tobacco cessation programs must be promoted. The various approaches should be integrated into a global program of health prevention, including health education at school from 5 to 12 years of age. The efficacy of each of the global program's components should be evaluated. Misconceptions such as overestimation of the impact of pollution on health should also be corrected. Health is created and experienced by people within the setting of their daily lives, in particular during childhood. Prevention is the responsibility of individual members of the community but also of the community as a whole.

Adult↗

PubMed1998

Acceptance by Swedish users of a multimedia program for primary and secondary prevention of malignant melanoma.

BACKGROUND: In Sweden, the incidence of malignant melanoma of the skin is rapidly increasing, and the disease is now one of the ten most common tumor types. The objectives were to apply multimedia techniques to increase public knowledge about malignant melanoma and its risk factors, to increase awareness of preventive measures, and to make people more disposed to change their sunbathing habits. METHODS: A trilingual (Swedish, English, and German) multimedia program was developed for two target groups, health care personnel and the general public, with a total of >500 "pages" in each language. User reactions were studied on-site at a municipal pharmacy and library, where the program was available in a kiosk with touch-screen. RESULTS: Practically all 274 users interviewed found the program easy to use and understand. 92% identified one or more of the recommendations given. 66% found the program information "worrying," and 29%--mainly young women-instantly declared that they were going to change their sun-exposure behaviors. No correlation to skin type was found. CONCLUSIONS: A multimedia program of the present design seems to be a useful tool for health promotion.

Adult↗

PubMed1992

Effect of diet and lifestyle on bone mass in Asian young women.

The relationship between bone mineral content (BMC) divided by bone width (BW) and diet and lifestyle in early adulthood were investigated from the view point of preventing osteoporosis at a young age in Asian women. BMC/BW of 161 healthy Asian women aged 19-25 y were measured by single-photon absorptiometry. Current and past dietary habits and physical activity were also studied. BMC/BW varied from 0.21 to 0.48 g/cm2. Bone density correlated well with dietary habit from infancy to the present especially with calcium and past physical activity. These two factors showed additive effects on BMC/BW. In multiple-regression analysis, liking sports, body mass index, no milk intake in childhood, protein intake, frequency of dieting, and skipping meals were contributors to bone density and predictive of 23% of the variability in BMC/BW in the total group. The multiple-regression coefficient was 0.518. Smoking, drinking, and duration of sunbathing might have no effect on BMC/BW in early adulthood.

Adult↗

PubMed2007

Measures of cumulative exposure from a standardized sun exposure history questionnaire: a comparison with histologic assessment of solar skin damage.

Ultraviolet radiation exposure is the dominant environmental determinant of all major forms of skin cancer; however, the nature of the association is incompletely understood. Existing instruments to capture sun exposure history tend to yield reproducible results, but the validity of these responses is unknown. To address this question, the authors examined the relation between responses to a standardized sun exposure instrument and histologic evidence of actinic damage in a population-based study of keratinocyte cancers from New Hampshire diagnosed from July 1, 1997, through March 31, 2000. A single study dermatopathologist histologically reviewed the adjacent skin of 925 skin cancer biopsies for the presence of solar keratoses and the extent of solar elastosis. The authors compared these measures with responses to a personal interview on history of sunburns, sunbathing, and time spent outdoors. Focusing on site-specific exposure, they found variables that estimated cumulative exposure related to histologic evidence of actinic damage. In contrast, measures of acute/intermittent exposure were generally unrelated to solar damage histologically. Findings suggest that cumulative, but not intermittent, measures of sun exposure derived from a personal interview appear to reflect a person's exposure history based on histologic evidence.

Aged↗

PubMed2004

Primary prevention of skin cancer: a review of sun protection in Australia and internationally.

The incidence of skin cancer is increasing worldwide. Protecting the skin from the sun by wearing protective clothing, using a sunscreen with appropriate sun protection factor, wearing a hat, and avoiding the sun are recommended as primary preventive activities by cancer agencies. In this paper the recent data relating to skin cancer primary preventive behaviour in Australia and other countries is reviewed. Comparison of the studies in a table format summarizing the methods, objectives, participants, findings and implications may be obtained from the corresponding author. The sun protection knowledge, attitudes and behaviour patterns observed in Australia are similar in other countries, although Australian studies generally report higher knowledge levels about skin cancer and higher levels of sun protection. The findings suggest that sunscreen is the most frequent method of sun protection used across all age groups, despite recommendations that it should be an adjunct to other forms of protection. While young children's sun protective behaviour is largely influenced by their parents' behaviours, they are still under protected, and sun protective measures such as seeking shade, avoiding the sun and protective clothing need to be emphasized. Adolescents have the lowest skin protection rates of all age groups. Within the adult age range, women and people with sensitive skin were most likely to be using skin protection. However, women were also more likely than men to sunbath deliberately and to use sun-tanning booths. The relationship between skin protection knowledge and attitudes, attitudes towards tanning and skin protection behaviour needs further investigation. Further studies need to include detailed assessments of sunscreen use and application patterns, and future health promotion activities need to focus on sun protection by wearing clothing and seeking shade to avoid increases in the sunburn rates observed to date.

Age Factors↗

PubMed1999

Sunscreen use and duration of sun exposure: a double-blind, randomized trial.

BACKGROUND: In epidemiologic studies, sunscreen use is associated with increased risk of cutaneous melanoma, basal cell skin cancer, and higher numbers of nevi. It has been proposed that sunscreens may encourage prolonged sun exposure because they delay sunburn occurrence. We examined whether, under habitual conditions of sunscreen use, the sun-protection factor (SPF) had an influence on sun-exposure duration. METHODS: Before the 1997 summer holidays, we randomly assigned 87 French and Swiss participants who were 18-24 years of age to receive an SPF 10 or an SPF 30 sunscreen. Neither medical personnel nor study participants were aware of their sunscreen assignment. Participants were asked to complete daily records of their sun exposure. To avoid influencing the recreational sun-exposure habits of the study participants, no recommendation was made about sun exposure or sun protection. Furthermore, participants were told that the trial end point was the number of pigmented skin lesions before and after the holidays. One subject was lost to follow-up. All statistical tests were two-sided. RESULTS: The SPF 10 (n = 44) and SPF 30 (n = 42) groups had equivalent mean holiday durations (19.4 days versus 20.2 days) and mean quantities of sunscreen used (72.3 g versus 71.6 g). The mean cumulative sun exposures for the two groups were 58.2 hours and 72.6 hours, respectively (P =.011). The mean daily durations of sunbathing were 2.6 and 3.1 hours, respectively (P =.0013), and, for outdoor activities, they were 3.6 and 3.8 hours, respectively (P =.62). There was no difference in sunburn experience between the two groups. CONCLUSIONS: Use of higher SPF sunscreen seems to increase the duration of recreational sun exposure of young white Europeans.

Adult↗

PubMed2002

Use of tanning devices and risk of basal cell and squamous cell skin cancers.

Use of artificial tanning devices that emit UV radiation, such as tanning lamps and tanning beds, has become increasingly popular in the United States. Although an excess risk of nonmelanoma skin cancers might be predicted from this exposure, little epidemiologic data exist. We conducted a population-based, case-control study that included 603 basal cell carcinoma (BCC) case patients, 293 squamous cell carcinoma (SCC) case patients, and 540 control subjects. Study participants were interviewed in person to obtain information on tanning device use, sun exposure history, sun sensitivity, and other risk factors for skin cancer. Overall, any use of tanning devices was associated with odds ratios of 2.5 (95% confidence interval [CI] = 1.7 to 3.8) for SCC and 1.5 (95% CI = 1.1 to 2.1) for BCC. Adjustment for history of sunburns, sunbathing, and sun exposure did not affect our results. Our findings suggest that the use of tanning devices may contribute to the incidence of nonmelanoma skin cancers. They highlight the need to further evaluate the potential risks of BCC and SCC that are associated with tanning lamp exposure and the appropriate public health response.

Adult↗

PubMed1992

Variation and covariates of the number of benign nevi in adolescents.

Melanocytic nevi of diameter greater than or equal to 2 mm were counted on most of the skin surface of 349 adolescents aged 14-15 years of European race or ethnicity in Dunedin, New Zealand. Total counts are described by means of a form of Poisson-error log-linear modeling suitable for data showing unexplained variation (NE Breslow, Appl Statist 1984;33:38-44). There were marked interpersonal variation in the number of nevi; only some was attributable to observed factors. The mean and median counts were 23.8 and 18 nevi, respectively. The estimated ratio of the number of nevi for females compared with males was 0.7 (95% confidence interval (CI) 0.6-0.8). Greater amounts of sunbathing were associated with greater numbers of nevi. Hair and eye color, socioeconomic status, and sunburn history did not show statistically significant effects. Time since menarche and shaving status also showed no effects. Lack of suntan was associated with lower counts. Freckling was positively correlated with higher counts; the severe freckling group had an estimated ratio of 1.9 (95% CI 1.3-2.8) compared with those with no or very few freckles. The results are consistent with the hypothesis that ultraviolet radiation exposure from recreational sun exposure positively influences the total burden of nevi in normal subjects. Comparison with other epidemiologic studies suggests that the typical ultraviolet radiation dose-nevus yield curve might be steeper in males than females. Unexplained variation of nevus count may reflect heterogeneity of constitutional factors not yet measured in epidemiologic studies.

Adolescent↗

PubMed1995

Sunburn and tanning in a British population.

BACKGROUND: The prevalence of sunburn and tanning, and associated attitudes were investigated in a national sample of adults in Great Britain. METHODS: A randomly selected cross-sectional sample of 2025 adults aged 16 or over living in England, Scotland and Wales were interviewed in October 1993 in the Office of Population Censuses and Surveys Omnibus Survey. RESULTS: The response rate was 77 per cent. Thirty-seven per cent reported at least one episode of sunburn in the past 12 months, the highest frequencies being found in young age groups, in those with skin that tans poorly (p < 0.001), and in those who specifically tried to tan in this period (p < 0.001). Sunbathing was the most frequent activity associated with most severe episodes of sunburn, and occurred most frequently at the beginning of the summer, 46 per cent of episodes occurring abroad. Thirty-three per cent had tried to tan in the past 12 months, the proportion being highest in younger age groups and women (p < 0.001). Among those with severe sunburn more men (34 per cent) expected to burn when trying to tan than women (17 per cent). CONCLUSIONS: The results provide background information with which to develop and evaluate primary prevention initiatives for skin cancer. These should take into account the strong association between sunburn and the desire to tan, particularly in young adults and men.

Adolescent↗

PubMed1997

Thermal injuries following TRAM flap breast reconstruction.

Following transverse rectus abdominis musculocutaneous (TRAM) flap breast reconstruction there are predictable sensory changes in both the abdominal skin and the skin of the reconstructed breast. Cutaneous anesthesia and dysesthesias are troublesome and annoying for many patients. More importantly, these sensory changes can lead to burn injury in the uninformed patient. Over the past 9 years 5 of our patients have sustained third-degree burn injuries to the skin following breast reconstruction with the TRAM flap. Four of these occurred while sunbathing while wearing a black bathing suit and one was the result of a direct thermal injury. Two patients sustained injuries to the breast, 2 patients experienced injuries to the abdomen, and 1 patient experienced injuries to both sites. All of these untoward events occurred within the initial 4 months following surgery. Four patients healed with topical wound treatment but 1 patient required a full-thickness skin graft to optimize cosmesis of the reconstructed breast. Patient examples illustrating burn injuries and treatment outcomes are shown. Mechanisms involved are sensory and thermoregulatory loss locally at the anterior abdominal wall and at the reconstructed breast. The reinnervation potential according to experimental and clinical studies is reviewed. There are sensory and thermoregulatory changes in the skin at the donor and recipient site during TRAM flap breast reconstruction. Patients should be carefully informed about these and warned to avoid prolonged contact with hot objects and sun exposure, especially when wearing a dark-colored swimsuit.

Adult↗

PubMed2001

The value of tan lines: vulvar melanoma and ultraviolet rays.

Recreational sun exposure of the general population has increased. There is less clothing on the beaches, increased accessibility to tropical beaches, and increased use of artificial suntanning equipment. The vulva, traditionally, has been protected from sun exposure. In this age of nude sunbathing, particularly within the confines of a tanning bed, it is interesting to ponder whether such exposure would affect the incidence of melanoma of the vulva.

Adult↗

PubMed1994

Recreational exposure to sunlight and lack of information as risk factors for cutaneous malignant melanoma. Results of an European Organization for Research and Treatment of Cancer (EORTC) case-control study in Belgium, France and Germany. The EORTC Malignant Melanoma Cooperative Group.

This study addressed the impact of exposure to ultraviolet radiation on the risk of cutaneous malignant melanoma (CMM), as well as the behavioral components at stake in its occurrence. We performed a one-to-one unmatched case-control study among subjects aged 20 years or more with naturally non-pigmented skin in Germany, France and Belgium. Four-hundred and twenty consecutive patients with CMM diagnosed from 1 January 1991 on were derived from hospital registries; 447 controls were chosen randomly in the same municipality as cases. Subjects unaware of the dangers of exaggerated exposure to sunlight display an estimated CMM risk of 3.72% (95% confidence interval 2.63-5.26). The number of holiday weeks spent annually in sunny resorts and sunbathing during the hot hours of the day are strong risk factors in the three countries, but not the number of years spent outdoors, as farmers or building workers. Multiple logistic adjustments on the host characteristics increases the CMM risk associated with recreational exposure to sunlight, as well as the adjustment on the unawareness of the dangers of exaggerated exposure to sunlight. Recreational exposure to sunlight and sunburn early in life seem capable of fostering the proliferation of pigmented lesions of the skin. Our data support the hypothesis that most CMM develop from pigmented lesions of the skin containing initiated melanocytes, and that the cell proliferation due to brutal, intermittent exposures to solar radiation amplifies the likelihood of a melanocyte entering into a malignant process.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMed1999

Cutaneous malignant melanoma and sun exposure in Spain.

Cutaneous malignant melanoma has an increasing importance all over the world. However very few epidemiological studies have been published from Spain, and Spanish people have not become aware of the problem. This study was designed to examine sun exposure patterns and other related items among 116 consecutive patients with melanoma and 235 controls. Each subject answered a questionnaire covering the place of residence, sun exposure details and other risk factors, and underwent a skin examination. Continuous sun exposure due to residence or occupation was associated with an odds ratio (OR) of 2.0 (95% confidence interval [CI] = 1.2-3.3). People who lived in the city but spent 50% of their time in rural areas for holidays had an OR of 2.2 (95% CI = 1.3-3.8) when compared with those living in urban and rural areas. The OR for people who sunbathed more than 30 times a year was 1.8 (95% CI = 1.2-2.8), and outdoor leisure time was also associated with melanoma appearance when exposure was greater than 60 units in the last 2 years, with an OR of 3.0 (95% CI = 1.6-5.5); 1 unit is equivalent to total body sun exposure for at least 2 h. These OR estimates were adjusted for age, skin type and the number of naevi. Construction workers (OR = 1.6; 95% CI = 0.5-5.6) had increased risk after adjustment for skin type, age and freckle count (OR = 4.3; 95% CI = 1.8 9.9) or mole count (OR = 2.8; 95% CI = 1.4-5.8). Working as a farmer was a protective factor after adjustment (OR = 0.5; 95% CI = 0.3-0.8). The use of sunscreens was a protective factor against melanoma (OR = 2.6; 95% CI = 1.6-3.6 for non-users). Campaigns should focus on advising people to avoid sun exposure in sunny places and to use sunscreens every time they are exposed to the sun.

Adult↗