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Beliefs, knowledge and attitudes as predictors of sunbathing habits and use of sun protection among Swedish adolescents.

In 1996, a random population sample of 2615 adolescents completed a questionnaire concerning habitual sun-related behaviours, attitudes towards sunbathing, and knowledge about skin cancer. Females, older adolescents, those with less sun-sensitive skin, those with higher knowledge and those with a positive attitude towards sunbathing were more likely to be frequent sunbathers. Younger adolescents, those who today sunbathe moderately, and those with sensitive skin were more likely to believe that they would sunbathe more often in the future. Males, adolescents with less sensitive skin, those with a positive attitude towards sunbathing and those sunbathing often, were less likely to use protection when sunbathing. Interventions to decrease sun exposure among adolescents should focus on changing attitudes toward sunbathing and having a tan, since knowledge of skin cancer and the damaging affect of sunbathing did not seem to effect current sunbathing habits, or use of sun protection.

Adolescent↗

A psychosocial model of sun protection and sunbathing in young women: the impact of health beliefs, attitudes, norms, and self-efficacy for sun protection.

A psychosocial model of sun protection and sunbathing as distinct behaviors was developed on 202 young Caucasian women and replicated in an independent sample (n = 207). Proximal outcomes were intention to sun protect and intention to sunbathe; distal outcomes included sun protection and sunbathing behavior measured 5 months later. Objective risk for skin cancer plus 4 classes of psychosocial variables (sun-protective health beliefs, self-efficacy for sun protection, attitudes toward sunbathing, and norms for sunbathing and sun protection) served as predictors. Sun-protective norms and self-efficacy for sun protection predicted only intention to sun protect; sunbathing norms predicted only intention to sunbathe. Susceptibility and advantages of tanning predicted both intention constructs, which, in turn, predicted behavior. These findings distinguish sun protection from sunbathing and provide a basis for intervention design.

Adolescent↗

Examination of cognitive variables relevant to sunbathing.

This study examined cognitions relevant to sunbathing decision-making in college-aged subjects. Using Jaccard's (1981) theory of alternative behavior as a guiding model, 263 subjects were recruited from psychology classes and administered questionnaires assessing their sunbathing behavioural tendencies, attitudes toward sunbathing, attitudes toward reasonable behavioral alternatives to sunbathing, and cognitive variables underlying these attitudinal variables. The fits of models predicting sunbathing attitudes and sunbathing behavioural tendencies (evaluated using covariate structural equations modeling techniques; LIS-REL VIII) were good for all models tested. In contrast to previous work, the results of this study support the notion that young people will make their decisions regarding sunbathing based on the behavioral alternatives available to them (i.e., generally the one that they prefer most). Furthermore, the multivariate approach used clearly delineates the specific cognitive beliefs and orientations that might be targeted to change these attitudes. The relevance of these findings to skin cancer prevention interventions is discussed.

Adult↗

Sunbathing and sun-protection behaviors and attitudes of young Swedish adults with hereditary risk for malignant melanoma.

The aim of the study was to describe attitudes toward sunbathing and sun protection, to examine sun-related behaviors, and to present an effort to change sun-related behaviors among young adults without a cancer diagnosis in melanoma-prone families. Ten patients were interviewed, and questionnaires were sent on 3 occasions during a 15-month period to the total population (n = 87) meeting the inclusion criteria. Data from interviews and questionnaires showed extensive ultraviolet-exposure behaviors in this high-risk group for melanoma, although not always expressed in terms of sunbathing. When asked about sunbathing, 1/3 reported sunbathing "Often" or "Very often," despite a decrease in sunbathing during the study period. In addition, 35% reported current sun bed use. The most important reason for sunbathing was attractiveness. The risk of getting skin cancer was the most important reason to refrain from sunbathing. The majority estimated their own risk for melanoma as equal or lower compared with the general population. The planned intervention failed due to low attendance. Ultraviolet exposure is extensive. The individual perception of personal risk and the motivation to change behaviors are important factors to consider when designing a preventive program. Interest for group information was low in this age group.

Adult↗

Predictors of sunbathing and sunscreen use in college undergraduates.

Sunbathing and sunscreen use, as well as related intentions, attitudes, beliefs, and knowledge, were assessed in 90 Southern Appalachian undergraduates. A large majority (75%) reported sunbathing, with more than half reporting sun lamp use. A slight majority (56.7%) reported some use of sunscreen. Subjects reporting an intention to tan spent more time sunbathing, both outside and under a sun lamp. Individuals reporting a sun protection intention had lighter tans and spent less time sunbathing. Sunbathing was predicted by perceptions of sunbathing as relaxing, while sun lamp use was predicted by more positive views of suntans. Sunscreen use was predicted by more positive sun protection attitudes and less negative sunscreen attitudes.

Adult↗

Sunbathing and sunbed use related to self-image in a randomized sample of Swedish adolescents.

In 1996 a randomized sample of 4,020 Swedish adolescents from three birth cohorts were sent a questionnaire consisting of 50 items concerning habitual sun-related behaviours and attitudes, knowledge about melanoma, risk perception and self-image. A total of 2,615 questionnaires were returned. Girls sunbathed and used sunbeds more than boys at all ages. Sunbathing and sunbed use increased with age. Boys who were most satisfied and girls least satisfied with themselves sunbathed most. Those who were least satisfied with themselves used sunbeds most frequently. Girls reported a higher perceived susceptibility to melanoma than did boys. The perception of susceptibility increased with age. Those who were least satisfied with themselves reported feeling most susceptible. The overall main reason for sunbathing was appearance, both for own sunbathing, and to an even higher degree, as a supposed reason for other adolescents' behaviour, and was reported most frequently by girls and the older age groups. The second most 'important' reason for sunbathing was 'feeling warm and comfortable'. Preventive programmes aimed at a change of sun related behaviours among Swedish adolescents have to be tailored to the climate and cultural conditions and must take into account that having a tan, and the warmth of the sun, are highly valued by most adolescents.

Adolescent↗

Sunbathing habits and sunscreen use among white adults: results of a national survey.

OBJECTIVES: This study assessed current levels of sunbathing and sunscreen use in the United States. METHODS: From a general-population telephone survey of aquatic activities among adults in 3042 US households, we examined responses by the 2459 Whites. RESULTS: Most adults (59%) reported sunbathing during the past year, and 25% reported frequent sunbathing. Of the subsample who reported sunbathing during the month before the interview, 47% routinely used sunscreen. Of these individuals, almost half did not use sunscreens with a solar protection factor of 15 or higher. CONCLUSIONS: About a quarter of US White adults report frequent sunbathing, and only about a quarter of sunbathers use sunscreens at recommended levels. These results should help focus future sun protection educational efforts.

Adolescent↗

A survey of attitudes, beliefs, and behavior regarding tanning bed use, sunbathing, and sunscreen use.

BACKGROUND: Although cosmetic tanning and unprotected solar exposure are common, little is known about general attitudes, beliefs, and behavior regarding sunbathing, sunscreen use, and tanning salon use. OBJECTIVE: We sought to determine the frequency of UV exposure in a select sample and to assess the knowledge and beliefs of the effects of UV irradiation. METHODS: A written, anonymous questionnaire was distributed to a sample of 477 persons in a shopping mall, at a social gathering, and on a vacation cruise ship. The instrument explored demographic information, sunscreen use, sunbathing habits, tanning bed use, and cutaneous solar effects. RESULTS: Forty-two percent of respondents seldom or never used sunscreen, and 33% sunbathed at least once a week. Although the three sample populations differed in education, sunbathing habits, sunscreen use, and tanning bed use, they were equally informed about UV light hazards. Compared with those who had not used tanning beds, tanning bed users were more likely to be female and more knowledgeable about the long-term effects of UV. Tanning beds were most commonly used in tanning or hair salons, (mean 23 +/- 7 minutes at 2.3 +/- 1.1 times per week). Reported positive psychologic sequelae from tanning bed use were more common than negative physical sequelae. At least 10% would continue to use tanning beds if these were proved to cause skin cancer. CONCLUSION: In this select sample, sunbathing and tanning bed use were common. No group surveyed universally practiced sun protection and avoidance. Clientele of tanning beds may be aware of the damaging effects of the sun, but may not be aware that tanning bed use is associated with skin damage.

Adolescent↗

Psychosocial factors in sunbathing and sunscreen use.

Excessive exposure to the sun has been related to the development of various types of skin cancer, but use of sunscreen decreases the risk. The present project was designed to empirically examine psychosocial factors in sunbathing and sunscreen use. One hundred twenty sunbathing and nonsunbathing beachgoers were interviewed about their health practices, knowledge about skin cancer, moods, and social rewards obtained through sunbathing. They also completed several relevant personality questionnaires. Data were considered using a theoretical perspective combining aspects of health belief, social influence, social learning, and risk-taking models. Results indicate that sunbathing is clearly related to having a positive attitude toward risk taking, having little knowledge about skin cancer, reporting a relaxed mood, having friends who sunbathe, and engaging in activities related to maintaining a positive physical appearance. Sunscreen use is related to sex, having knowledge about skin cancer, knowing people who have had cancer, and reporting high levels of anxiety. The implications of these findings for the design of intervention strategies and for the future study of health-compromising behaviors are discussed.

Adolescent↗

Sunbathing intentions in Irish people travelling to Mediterranean summer holiday destinations.

As exposure to UV light is thought to be the most significant environmental and behavioural risk factor for avoiding skin cancer, we have analysed the sunbathing intentions and attitudes of Irish people travelling to Mediterranean and Iberian holiday destinations. Ninety per cent of respondents planned to get a suntan on their vacation with 44% likely to burn their skin in the process. Although all intended to apply sun cream on holiday only 40% would apply >SPF 15. Sixty-four per cent planned to sunbathe between 11.00 am and 3.00 pm, with 25% intending to spend <5 hours in the sun. One-third of those intending to sunbathe for >6 hours per day were aged between 16 and 24 years. Approximately eight out of 10 people thought suntans made them feel healthier or attractive. Fifty-six per cent regularly checked their moles but men were less likely to check their skin for pigment changes. The results provide baseline information on sunbathing attitudes of Irish people. They show that while most people feel they adopt a careful approach to sunbathing, the experiences and intentions, especially in younger people, are influenced by the desirability of a suntan, and reflect a behaviour that increases their risk of skin cancer.

Adolescent↗

Sun-protection behaviour and self-assessed burning tendency among sunbathers.

A total of 805 sunbathing Caucasians were interviewed about sunprotection behaviour and self-assessed burning tendency. Sixty-seven percent of the interviewed sunbathers used one or more sunscreen factors. Sunscreen-users and nonusers were exposed to the sun 206 min and 197 min (P = 0.186), respectively. The sunscreen users were exposed to a marginally higher UV dose than non-sunscreen users, 4.8 SED versus 4.5 SED (P = 0.0348). The rate of sunscreen users was significantly higher among subjects who stated that they always were sunburnt in the spring when not using a sunscreen than subjects who stated that they never were sunburnt in the spring when not using a sunscreen (P = 0.0001). However, when comparing subjects that always burn in the spring and subjects that never burn in the spring, we found no significant difference between level of the sun-protection factor (P = 0.11) nor the duration of sun exposure (P = 0.967), nor to which UV doses the subjects were exposed (P = 0,562). Furthermore we found that the interviewed sunbathers interpreted to "be sunburnt" as more severe than "to turn red". Public campaigns recommend the use of sun protection cream when sunbathing without using other sun protective strategies; however, the use of sun protection cream is inadequate among sunbathers. More education is required to persuade those with more sun-sensitive skin to use a higher protection-factor, to reduce sun exposure at times when UV radiation is most intense, and to reduce the duration of exposure.

Adult↗

Predictors of Norwegian adolescents' sunbathing and use of sunscreen.

A nationwide random sample of 15,169 Norwegian high school students completed a questionnaire about tanning habits, physical self-concept, attitudes, beliefs, and values. Although 90% of the adolescents did use sunscreen, less than 25% used an adequate sun-protection factor, and only 50% applied the sunscreen an adequate number of times when sunbathing. Multiple regression analyses identified these predictors of sunbathing: opportunity to sunbathe, tender skin, heavy smoking, playing down the risk for skin cancer, valuing physical appearance, friends' use of sunscreen (girls only), a positive attitude toward having a tan, favorable physical self-concept, friends' use of sunbeds, and friends' sunbathing. Sunscreen use was also predicted by opportunity to sunbathe and skin type. Furthermore, the effects of perceived risk for skin cancer and peers' use of sunscreen were particularly strong.

Adolescent↗

Changes in the immune system of female sunbathers due to the effect of natural UV radiation.

Exposure to UV radiation may cause health hazards and suppress immune responses. The aim of this study was to evaluate whether recurrent suberythemal doses of natural UV radiation can have a harmful effect on the lymphocyte subpopulations of local sunbathers. Sixteen healthy local female volunteers at the age of 23 to 44 recurrently sunbathed during the summer of 2000 in the Pärnu beach area (58 degrees 22'N, 24 degrees 31'E). They were informed of the actual UV index and encouraged to gather only suberythemal UV doses. Before and after the sunbathing period the CD3+, CD3+CD4+, CD3+CD8+, CD19+, CD3-CD16+ CD56+, CD4+CD25+, CD4+HLA-DR+ and CD3+HLA-DR+ cells were determined in the peripheral blood of the volunteers. A statistically significant increase in the CD4+CD25+ and CD3+HLA-DR+ cells and a decrease in the CD3-CD16+CD56+ cells were detected. However, all changes remained in the normal range and there were no serious deviations in the composition of lymphocyte subpopulations. It was concluded that suberythemal doses of UV radiation gathered by volunteers had apparently no harmful effect on the immune system.

Adult↗

Attitudes toward health risks and sunbathing behavior.

Sunbathing confers the benefits of looking and feeling good but presents the long-term risk of skin cancer. In a disguised experiment exploring attitudes toward sunbathing by British adults, participants were asked to rate their willingness to take a hypothetical new drug (with different levels of risk) that would make them look and feel good. One aspect of the resulting risk profiles was significantly related to a positive attitude to open-air sunbathing but not to sunbed use, possibly because it was erroneously thought that using a sunbed is not risky. The well-established finding that women are more cautious was confirmed; the risk function for men was curvilinear, in contrast to women, who were willing to increase their risk linearly over their lifetime.

Adolescent↗

Sunbathing: college students' knowledge, attitudes, and perceptions of risks.

This study assessed the knowledge, attitudes, and behaviors of college students regarding intentional sun exposure (sunbathing). Results are based on responses of 296 Caucasian students to the Sun and Skin Inventory. Frequent sunbathers were more likely than infrequent sunbathers to be women and to report fewer self-perceived risk factors, and were less likely to use sunscreen. They were also more likely to believe that they look better with a tan, that suntanned skin is more attractive, and that suntans look healthy. Forty-three percent of the female respondents and 61% of the men rarely, if ever, used sunscreens, and only 9% of all respondents reported they used sunscreens with every intentional sun exposure of 30 minutes or longer. These results suggest that concern with attractiveness appears to be a major motivation for frequent intentional sun exposure. Consequently, educational strategies that stress health outcomes only may be less effective than those that also stress photoaging, the detrimental cumulative effect to appearance of suntanning.

Adolescent↗

Application of Azjen's theory of planned behavior to predict sunbathing, tanning salon use, and sunscreen use intentions and behaviors.

Ajzen's (1988) theory of planned behavior (TOPB) was used to examine psychological determinants of high-risk UV radiation exposure-related behaviors (sunbathing, tanning salon use, and sunscreen use). Undergraduates at a midsized southeastern university were assessed on their psychological and behavioral tendencies toward high-risk UV radiation exposure-related behaviors. The results generally supported the utility of the TOPB as an explanatory model for high-risk behavior. Attitudes were strongly associated with high-risk intentions (e.g., not utilize sunscreen, use salons), whereas subjective norms were less so. Perceived behavioral control was found to moderate the relationship among attitudes, norms, and intentions to sunbathe and tan at a salon. Implications for intervention strategies and future model building in this area are discussed.

Adolescent↗

What do young people think about the dangers of sunbathing, skin cancer and sunbeds? A questionnaire survey among Italians.

Previous experience in Australia and Sweden showed that public education programs produced substantial changes in people's opinions, attitudes and perceptions about melanoma, non-melanoma skin cancer, sunlight, sunbeds and suntanning. In order to organize effective prevention campaigns, more must be known about the sunbathing habits of children and adolescents. The aim of our study was to assess the knowledge that young people in a southern European country have about sun exposure. A total of 764 young people ranging from 16 to 22 years old (mean age: 19.3+/-1.2 years) responded to a questionnaire. Our study indicates that young people are very aware of the risks associated with sunbathing but that they continue to expose themselves without taking precautions. This suggests that: a) the majority of young Italians are reasonably well-informed but they do not take preventative measures; b) one effective measure could be promotion of the idea that an untanned body is more esthetically pleasing than a tanned one; c) a crucial point in the programming of future safety measures in suntan centers involves rigorous and regular controls.

Adolescent↗

Fatal hyperthermia secondary to sunbathing in a patient with multiple sclerosis.

A 27-year-old white woman with a history of multiple sclerosis was found dead lying on a lounger, clad in a bathing suit. She had been sunbathing for 4 hours. Significant autopsy findings consisted of numerous variably sized demyelinated plaques involving the periventricular cerebral white matter and cerebellum. Elevation of core temperature in patients with multiple sclerosis leading to transient or permanent adverse neurologic signs and symptoms has been documented for more than 60 years. This case illustrates that a modestly increased core body temperature, even from a usually innocuous activity such as sunbathing, may be fatal in patients with multiple sclerosis.

Adult↗