Sun exposure and sun-protection behaviors and attitudes among U.S. youth, 11 to 18 years of age

Protocol for a cluster-randomized trial of a school-based skin cancer preventive intervention for adolescents

BACKGROUND

Adolescents infrequently use sun protection and engage in intentional tanning more frequently compared to other age groups, leading to increased ultraviolet radiation (UVR) exposure that heightens skin cancer risk across the lifespan. High schools are therefore an ideal setting for offering skin cancer preventive interventions. Yet, there are limited UVR protection interventions for high school students, especially those that are personalized, tested using randomized designs, and include long-term outcome assessment to determine the durability of intervention effects.

METHOD

The Sun-safe Habits Intervention and Education (SHINE) cluster-randomized trial will test a novel, personalized intervention that targets high school adolescents' sun protection and tanning behaviors, and tracks their outcomes for up to one year following intervention. Enrolled high schools will be randomized to receive either the personalized SHINE intervention, which includes facial UVR photographs and sun protection action planning, or standard education using publicly available materials. Students in both conditions will receive information about skin cancer, sun protection, and skin self-examination. Outcome variables will include students' sun protection and tanning behaviors and sunburn occurrence. Potential moderators (e.g., race/ethnicity) and mediators (e.g., self-efficacy) will also be assessed and tested.

CONCLUSIONS

This trial examines the efficacy of a personalized intervention targeting sun protection and tanning of high school students. The project will lead to new scientific understanding of the theoretical mechanisms underlying outcomes and moderators of the intervention effects, which will inform future intervention tailoring to meet the needs of vulnerable subgroups.

Investigation on the Awareness and Behavior of Primary School Students on Sunscreen Use in Beijing

Objective

This study aims to understand primary school students’ behavior and awareness of sun exposure and sunscreen in Beijing, China.

Methods

A questionnaire survey was conducted of 232 students in grades 4–6 at a public primary school in Beijing, including 129 boys (55.6%) and 103 girls (44.4%). The contents of the questionnaire included awareness about ultraviolet rays, sun exposure, sunscreen habits, and the understanding and use of sunscreen.

Results

The majority of the subjects (75.0%) said they had never been sunburned, and 26.3% had never been tanned. Only 7.3% of the primary school students had a comprehensive and correct understanding that sunlight will burn, cause cancer, tan, and age the skin. Sunscreen (47.8%), sunshades (47.4%), sun hats (44.4%), avoiding going out at noon (37.5%), and sunglasses (30.2%) were the most frequently used sunscreen means. Furthermore, 47.8% of primary school students used topical sunscreen for light protection, higher than other measures. The proportion of girls using sunscreen at least once a day was more than boys.

Conclusion

Primary school students in Beijing, China, do not have a comprehensive understanding of ultraviolet rays, and there are deficiencies in protective behavior. Their awareness and use of sunscreen need to be improved.

Assessment of Sun Protection Knowledge and Behaviors of US Youth

This survey study examines sun protection knowledge and behaviors among US youth aged 14 to 24 years.

Skin cancer protective behaviors among welders of west of Iran: Importance of access to protective equipment

BACKGROUND

Welders are normally at risk of skin cancer due to continuous contact with natural ultraviolet rays and welding radiation. Protective behaviors against the radiations are the most fundamental measures taken to prevent skin cancer in these individuals.

AIMS

This research aimed to evaluate the factors affecting the protective behaviors in welders.

PATIENTS/METHODS

In this cross-sectional research, participants were selected by the census method, and the research tool was a reliable and valid questionnaire filled by 154 welders in Yasuj, Iran. Data analysis was performed in SPSS version 16 using ANOVA, Pearson's correlation coefficient, and independent t test.

RESULTS

The highest age frequency was related to the age-group of 36-45 years, and the highest frequency of work experience was less than 10 years. In terms of the level of education, most welders had a diploma or a higher degree. In addition, most behaviors reported included using gloves, whereas the least applied method was using sunscreen cream, the most important cause of which was the high cost of the cream. In this regard, the Pearson's correlation coefficient demonstrated a negative association between skin cancer and job difficulty. In addition, performing of protective behaviors decreased in the target group by aging.

CONCLUSION

Given the unfavorable mean skin cancer protective behaviors in the welders, it is recommended that interventions, such as planned education, access to protective tools, and periodic skin examinations by a physician, be carried out to promote the health of these individuals and facilitate performing protective behaviors.

Association Between Perceived Skin Cancer Risk Reduction and Sunscreen Use

BACKGROUND

Understanding factors that influence people to use sunscreen would allow clinicians to counsel patients in a way that is influential. Perceived efficacy of sunscreen has been associated with sunscreen use, but it is unclear whether the degree of efficacy is important.

OBJECTIVE

To determine whether larger perceived efficacy of sunscreen (larger skin cancer risk reduction) is associated with increased sunscreen use.

MATERIALS AND METHODS

A cohort of 131 patients with a history of skin cancer visiting a Mohs micrographic surgery center were surveyed.

RESULTS

Participants believed sunscreen would reduce their risk of basal cell carcinoma (BCC) by 61.1% (95% confidence interval [CI] = 56.4-65.9), squamous cell carcinoma (SCC) by 59.4% (95% CI = 54.6-64.2), and melanoma by 59.5% (95% CI = 54.8-64.3). Perceived magnitude of risk reduction of BCC, SCC, and melanoma was significant independent predictors of sunscreen use (BCC: odds ratio [OR] 3.5, 95% CI 1.1-11.2, p = .04. Squamous cell carcinoma: OR 2.8, 95% CI 1.0-7.6, p = .05. Melanoma: OR 5.0, 95% CI 1.8-14.2, p = .002).

CONCLUSION

Larger perceived skin cancer (BCC, SCC, and melanoma) risk reduction was associated with increased sunscreen use.

A characterization of sun protection attitudes and behaviors among children and adolescents in the United States

Children and adolescents may be vulnerable to increased ultraviolet radiation exposure and greater risk for subsequent sun-related pathologies. This study examined the demographic, geographic, and phenotypic factors influencing sun exposure and protective behaviors among children and adolescents living in the United States. A cross-sectional survey on perceived sun exposure and protective behaviors was administered at three sports medicine clinics in California, Colorado, and Hawaii. Responses were measured with a 5-item frequency scale: Never, Rarely (25% of the time or less), Sometimes (50% of the time), Often (75% of the time or more), and Always. Sun protective behavior was examined using univariate and multivariate analyses. In total, 860 surveys were collected (52% female, 48% male; mean age 12.7 years). Females reported significantly greater frequency of using sunscreen (p = 0.001), staying in the shade or using an umbrella while in the sun (p = 0.004), and tanning (p < 0.001). Age was inversely associated with sunscreen use frequency (p < 0.001); the percentage of participants who reported always wearing sunscreen decreased as age increased. Participants in Hawaii reported using sunscreen less frequently than those in California and Colorado (p < 0.001). These results identify high-risk populations such as males, older adolescents, and Hawaii's youth who may not be practicing frequent sun protective behaviors. While it is important for youth to stay active, they must also be reminded to adopt protective behaviors while outdoors to prevent unnecessary sun damage and lower the risk of sun exposure complications.

Beneath the surface: Abstract construal mindset increases receptivity to metaphors in health communications

Widespread messages use metaphoric language and imagery to prompt recipients to interpret health-related concepts in terms of dissimilar, familiar concepts (e.g., "fight the war on cancer"). When do these messages work? According to Conceptual Metaphor Theory, thinking metaphorically involves looking past concepts' superficial differences to identify their similarities at a structural level. Thus, we hypothesized that when people's general construal mindset is oriented to focus on information's abstract meaning, not its concrete details, they would process a metaphor's target health concept in ways that correspond to the dissimilar concept. Accordingly, after priming an abstract, but not concrete, construal mindset: framing sun exposure as enemy confrontation (vs. literally) increased cancer risk perceptions and sun-safe intentions (Study 1; N=186); and framing smoking cessation as an arduous journey (vs. literally) increased appreciation of quitting difficulties and interest in cessation tools (Study 2; N=244). We discuss practical and theoretical implications for improving health communication.

[The use of sunglasses during leisure time and work : Lack of prevention of sun-induced eye damage]

OBJECTIVE

This study aimed at collecting representative national data on the use of sunglasses on sunny summer days during leisure time or work as well as identifying population and professional groups with a pronounced lack of preventive measures to avoid sun-induced eye damage.

MATERIAL AND METHODS

Within the representative National Cancer Aid Monitoring, data on the use of sunglasses during leisure time was assessed among 3000 individuals aged 14-45 years in 2015, as well as on the use during outdoor work among 485 workers aged 14-45 years in 2016. Associations between the use of sunglasses and sociodemographic characteristics were assessed with the χ²-test. Additionally, descriptive and bivariate methods were used to assess connections between the use of sunglasses at work and each professional group.

RESULTS

While more than half of the general population normally or often wear sunglasses on a sunny summer day, only one third of outdoor workers do so. While approximately every seventh individual surveyed never wears sunglasses during leisure time, among outdoor workers it is one out of three. The use during leisure time increases with age.

DISCUSSION

Use of sunglasses during work could be supported by targeted information on UV-induced eye damage by ophthalmologists and company physicians with additional support from accident insurances and employers. Concerning preventive measures occupational groups such as landscapers, farmers and bricklayers who are strongly exposed to sunlight but rarely wear sunglasses are important groups.

Psychometric Testing of the Turkish Version of the Skin Cancer and Sun Knowledge Scale in Nursing Students

The present study aimed assesses the nursing students' knowledge of skin cancer and sun and their sun protection behaviors. This descriptive cross-sectional study was performed from May to June 2014 with a convenience sample of 376 undergraduate nursing students from one nursing faculty located in Izmir. Mean age of the students was 21.56 ± 1.96 years. The mean score that the females obtained from the level of knowledge and protection behaviors scales was significantly higher than that of the males. Older age group (≥22 years) obtained higher scores on the knowledge and protection behaviors scales than younger group (≤21 years). Nursing students' knowledge of, and behavior regarding, skin cancer and sun health were insufficient. Equipping them with the necessary knowledge and behaviors related to skin cancer and sun health by developing training programs and strategies on the issue is of utmost importance.

Sidewalk Landscape Structure and Thermal Conditions for Child and Adult Pedestrians

Walking is being promoted for health and transportation purposes across all climatic regions in the US and beyond. Despite this, an uncomfortable microclimate condition along sidewalks is one of the major deterrents of walking, and more empirical research is needed to determine the risks of heat exposure to pedestrians while walking. This study examined the effect of street trees and grass along sidewalks on air temperatures. A series of thermal images were taken at the average heights of adults and children in the US to objectively measure the air temperatures of 10 sidewalk segments in College Station, TX, USA. After controlling the other key physical environmental conditions, sidewalks with more trees or wider grass buffer areas had lower air temperatures than those with less vegetation. Children were exposed to higher temperatures due to the greater exposure or proximity to the pavement surface, which tends to have higher radiant heat. Multivariate regression analysis suggested that the configuration of trees and grass buffers along the sidewalks helped to promote pleasant thermal conditions and reduced the differences in ambient air temperatures measured at child and adult heights. This study suggests that street trees and vegetated ground help reduce the air temperatures, leading to more thermally comfortable environments for both child and adult pedestrians in warm climates. The thermal implications of street landscape require further attention by researchers and policy makers that are interested in promoting outdoor walking.

Do Metaphors in Health Messages Work? Exploring Emotional and Cognitive Factors

Health communicators publicize messages that use metaphors to compare abstract health-related concepts to concrete concepts in other domains. Such messages aim to change health attitudes and behavior, but do they work? According to Conceptual Metaphor Theory, metaphors can shape thought by transferring personalized knowledge of a concrete concept to understand and relate to an abstraction, despite their superficial differences. The authors extend this claim to specify emotional and cognitive factors potentially moderating the productivity (and counter-productivity) of metaphoric health messages. A source resonance hypothesis predicts that when a message frames a health risk metaphorically in terms of a concrete hazard (versus literally), individual differences in fear surrounding that particular hazard will differentially predict risk-related worry and thus prevention intentions. A metaphoric fit hypothesis predicts that a risk metaphor will be more persuasive when the recommended prevention response is itself framed metaphorically as addressing the concrete hazard (versus literally). These hypotheses were supported in three experiments conducted with online, undergraduate, and community samples (N = 539). With skin cancer as a case study, the studies tested the impact of messages framing sun exposure and sun-safe practices with or without metaphors of enemy combat. Findings illuminate how, when, and for whom metaphoric messages are persuasive, with theoretical and practical implications for health communication and metaphoric construal.

Tanning and Teens: Is Indoor Exposure the Tip of the Iceberg?

Because of recent state regulations and the reduced availability of free-standing tanning salons, indoor tanning (IT) prevalence is beginning to decline. This may lead to unintended consequences, such as increases in outdoor intentional tanning. We advance a series of research directions to track and intervene to address all forms of intentional tanning. First, we advocate for enforcement of IT regulation and encourage collection of data on tanning salon compliance and alternative IT strategies. Second, we suggest questions about outdoor and IT should be included in national surveys. Third, we need to understand the potentially complex patterns of indoor and outdoor tanning that may exist among those who tan. Fourth, research examining changing motivations for intentional tanning is needed. Finally, IT intervention studies should include outdoor tanning as an outcome to examine the effect of interventions on these related risk behaviors. These advances will ensure the development of novel interventions to address intentional tanning through multiple routes, and to avoid any unintended negative consequence of IT regulation. The promising downward direction of IT use in the United States should now lead the public health field to sharpen its focus on outdoor tanning. Cancer Epidemiol Biomarkers Prev; 26(8); 1170-4. ©2017 AACR.

College Students' Perceptions of Worry and Parent Beliefs: Associations with Behaviors to Prevent Sun Exposure

More research is needed to understand how attitudes impact behaviors that afford sun protection. The current study examined the impact of students' perceptions of parental beliefs about sun exposure and its influence on their practiced sun protection behaviors and worry about sun exposure. Participants were college students (N = 462) at a large Midwestern university. They completed a survey to examine their perceptions of risks and messages about sun exposure and sun exposure behaviors. Results indicated that gender and students' perceptions of parental beliefs about sun exposure were related to sun protection behaviors and their own worry over sun exposure. Specifically, males showed lower levels of sun protection behaviors, with the exception of wearing a hat with a brim, and lower levels of worry about sun exposure compared to females. Roughly a third of our sample had a family history of skin cancer, and this variable was related to worry about sun exposure and parental beliefs. Prevention messages and interventions to reduce sun risk for college students should address risks of sun exposure as well as educating young adults about the importance of wearing sunscreen, protective clothing, and hats to improve sun protection.

Prevalence of sun-protective behaviour and intentional sun tanning in German adolescents and adults: results of a nationwide telephone survey

BACKGROUND

The incidence rate of melanoma in the Caucasian population is rising worldwide. One of the major environmental risk factors for melanoma is the exposure to ultraviolet (UV) radiation. To prevent skin damage caused by UV exposure, several organizations recommend wearing protective clothing, staying in the shade, avoiding the outdoors during midday and using sunscreen.

OBJECTIVE

To provide representative data on factors associated with sun-protective behaviours and intentional sun exposure during summertime in the German population.

METHODS

A population-based sample of 3000 German residents aged 14-45 years (response: 32.1%) was interviewed via telephone from October to December 2015. Survey participants provided data on the use of recommended sun-protective measures on a sunny summer day and their intentional sun exposure during summertime. Data were weighted by age, sex, educational level and federal state to ensure the national representativeness of the sample.

RESULTS

Wearing long-sleeved clothes was the most frequently reported protective measure (53.9%), while wearing headgear was the least common (17.9%). Significantly lower frequencies of almost all recommended sun-protective measures were identified for males, participants between 14 and 25 years, those with an immigrant background and those with low levels of education. Using sun protection was positively associated with female gender (OR = 1.62), higher levels of education (OR_high = 1.27), sunburn during childhood (OR = 1.33) and paying attention to healthy nutrition (OR = 1.64; all P < 0.05). Sun tanning behaviour was associated with female gender (OR = 1.42), younger age, lower level of education, sunbed use (OR = 5.24) and smoking status (OR = 1.50; all P < 0.001).

CONCLUSION

As individual sun-protective measures are easy to implement and provide effective protection against high-risk UV exposure, campaigns on skin cancer prevention in Germany should put a stronger focus on young adults, men, less educated individuals and those with immigration background.

Rationale, design, and baseline data of a cross-national randomized trial on the effect of built shade in public parks for sun protection

Environments can be structured to reduce solar ultraviolet radiation (UV) exposure to prevent skin cancer. A prospective randomized trial is being conducted to test whether introducing shade sails in passive recreation areas (PRAs) in public parks will increase use and decrease UV exposure in the shaded compared to unshaded PRAs. Shade effects will be compared between Melbourne, Australia and Denver, USA. The trial enrolled 145 public parks with PRAs suitable for shade construction and randomized parks to intervention or control in a 1:3 ratio. Use of PRAs and UV levels were recorded at each park by trained observers during 30-minute periods on four weekend days in each of two summers (pretest and posttest). Shade sails were constructed between the summers. Given low numbers of users at pretest, the outcome measure was modified to use of the PRA (use vs. no use) and unit of analysis to the individual observation. Observations (n=580) occurred on average 29days from the summer solstice and 55min from solar noon in warm weather (mean=26.2°C) with some cloud cover but only slight or no wind. Typically, PRAs had benches and picnic tables and were located near playgrounds. PRAs were in use during 13.3% of observations (mean=0.41 users). UV over 30-minutes at the PRA boundary (mean=3.2 standard erythemal dose [SED]) and center (mean=3.3 SED) was high. Shade for skin cancer prevention has been understudied. This study will address this gap by determining whether purpose-built shade structures promote greater use of shaded areas within public parks.

Correlates of sun protection behaviors among Hispanic children residing in a high UVR environment

BACKGROUND/PURPOSE

Rates of melanoma are rising in Hispanics in the United States. Excessive sun exposure in childhood increases the risk of melanoma in adulthood, and little is known about the factors motivating sun protection behaviors among Hispanic youth.

METHODS

Correlates of sun protection were examined among Hispanic children residing in Los Angeles, California (N = 1891). Associations between multiple constructs (psychosocial, familial, and cultural) and sun protection outcomes (use of sunscreen, protective clothing, and shade seeking/sun avoidance) were examined.

RESULTS

Family variables were associated with more frequent sun protection among Hispanic children across outcomes, as were perceived peer norms, perceived self-efficacy, and fewer sun protection barriers. Skin cancer risk factors such as lighter skin and sunburn experience, and level of acculturation were not associated with greater sun protection.

CONCLUSION

Family sun protection habits are instrumental to Hispanic children's sun safe behaviors, and interventions that engage the family may be most effective. Increasing risk communication to high-risk subgroups of Hispanic children (those with lighter, more sun reactive skin) is important when developing intervention strategies. However, there is overlap between Hispanic children's sun protection correlates and those observed among non-Hispanic white children, suggesting that interventions to improve sun protection may generalize across cultural contexts.

Suntans and Sun Protection in Australian Teen Media: 1999 to 2000

In this study, the portrayal of tanned skin and sun protection in magazines, television programs, and movies popular with Australian adolescents were analyzed. Images of models in magazines ( n = 1,791), regular/supporting characters in television programs ( n = 867), and regular/supporting characters in cinema movies ( n = 2,836)for the 12-monthperiod August 1999to July 2000were coded and analyzed. A light tan was the most predominant tan level, and protective clothing was the most common sun protection measure displayed across all forms of media. There were significant associations between gender and tan levels in the television and movie samples. Although it is important to monitor the portrayal of tan levels and sun protection measures in media targeting adolescents, overall, the authors’ findings revealed a media environment generally supportive of sun protection objectives.

Melanoma Incidence in Children and Adolescents: Decreasing Trends in the United States

OBJECTIVE

To assess trends in the incidence of melanoma in children and adolescents in the US from 2000-2010.

STUDY DESIGN

Using the Surveillance, Epidemiology, and End Results cancer registry data, we calculated age-adjusted incidence rates of melanoma in children and adolescents (age <20 years) from 2000-2010, as well as annual percent changes. We analyzed incidence trends using joinpoint regression models. We further stratified incidence rates and trends by age group, sex, race, and melanoma-specific characteristic (histology, anatomic site, Breslow depth, ulceration status, lymph node involvement, and presence of metastasis).

RESULTS

We included 1185 pediatric patients (age <20 years) diagnosed with melanoma from 2000-2010. In patients age <20 years overall, we found a significant decreasing incidence (11.58% per year) from 2004-2010. Overall, significant decreasing incidence trends were also noted in males, melanoma located on the trunk, melanoma located on the upper extremities, superficial spreading melanoma, and melanoma with good prognostic indicators. When further subdividing the pediatric population by age group, these significant decreasing incidence trends were most notable in adolescents (age 15-19 years), decreasing 11.08% per year from 2003-2010. Furthermore, in 15- to 19-year-olds, decreasing trends were found to be significant in melanoma located on the trunk, superficial spreading melanoma, and melanoma with good prognostic indicators.

CONCLUSIONS

Decreasing trends in melanoma incidence in the pediatric population from 2000-2010 stand in contrast to previous reports of increasing long-term incidence trends. Possible contributors to these decreasing trends include effective public health initiatives, decreased time spent outdoors, and increased sunscreen use.

Predicting Australian adults' sun-safe behaviour: examining the role of personal and social norms

OBJECTIVES

To address the scarcity of comprehensive, theory-based research in the Australian context, this study, using a theory of planned behaviour (TPB) framework, investigated the role of personal and social norms to identify the key predictors of adult Australians' sun-safe intentions and behaviour.

DESIGN

The study used a prospective design with two waves of data collection, 1 week apart.

METHODS

Participants were 816 adults (48.2% men) aged between 18 and 88 years recruited from urban, regional, and rural areas of Australia. At baseline, participants completed a questionnaire assessing the standard TPB predictors (attitude, subjective norm, and perceived behavioural control [PBC]), past behaviour, behavioural intention, and additional measures of group norm for the referent groups of friends and family, image norm, personal norm, personal choice/responsibility, and Australian identity. Seventy-one per cent of the participants (n = 577) reported on their sun-safe behaviour in the subsequent week.

RESULTS

Via path modelling, past behaviour, attitude, group norm (friends), personal norm, and personal choice/responsibility emerged as independent predictors of intentions which, in turn, predicted sun-safe behaviour prospectively. Past behaviour, but not PBC, had direct effects on sun-safe behaviour. The model explained 61.6% and 43.9% of the variance in intention and behaviour, respectively.

CONCLUSIONS

This study provides support for the use of a comprehensive theoretical decision-making model to explain Australian adults' sun-safe intentions and behaviours and identifies viable targets for health-promoting messages in this high-risk context. Statement of contribution What is already known on this subject? Identifying determinants of sun-safe behaviour is vital in high-risk cancer areas like Australia. For young Australians, friendship group norm is a key influence of intentions and behaviour. Little is known about drivers of sun safety, especially norms, among Australian adults in general. What does this study add? This study drew on qualitative data and reconceptualized norms for Australians' sun-safe decisions. Friendship group norm and personal norm, not family group norm, influence sun-safe intentions. Perceived responsibility and choice to be sun safe also impact on people's intentions.

Sun protection counseling by pediatricians has little effect on parent and child sun protection behavior

OBJECTIVE

To compare counseling concerning sun protection and outdoor exercise with the parent's report of the behavior of a child aged 9-16 years old.

STUDY DESIGN

Structured interviews of medical personnel in 3 Chicago area practices elicited information about counseling methods and recommendations. In each practice, a convenience sample of parents completed a self-reported survey of their and their child's behavior.

RESULTS

Sun protection counseling occurred more frequently than exercise counseling in all practices (P = .014). Sun protection counseling was associated with parental prompting (P = .004), performing a summer camp physical (P = .002), and the child having a sunburn (P = .003). After controlling for the child's age, sex, and skin tone, sun protection counseling was not associated with the child's use of sun protection. In multivariate analysis of the child's sun protection behavior, parental sunburns, indoor tanning in the last 12 months, perception of skin cancer risk, and sun protection self-efficacy were significant (P = .02). Children who pursued outdoor sports were twice as likely to use inadequate sun protection and sustain sunburns (CI 1.3-1.7).

CONCLUSIONS

The child's sun protection behavior was influenced by parental sun protection, parental perception of skin cancer risk, and parental sun protection self-efficacy; therefore, sun protection for children needs to be aimed at parents as well as children. Communication with parents in a way that incorporates the principles of motivational interviewing may be more effective in promoting behavioral change than admonitions to use sunscreen.

Predicting sun protection behaviors using protection motivation variables

Protection motivation theory components were used to predict sun protection behaviors (SPBs) using four outcome measures: typical reported behaviors, previous reported behaviors, current sunscreen use as determined by interview, and current observed behaviors (clothing worn) to control for common method bias. Sampled from two SE Queensland public beaches during summer, 199 participants aged 18-29 years completed a questionnaire measuring perceived severity, perceived vulnerability, response efficacy, response costs, and protection motivation (PM). Personal perceived risk (similar to threat appraisal) and response likelihood (similar to coping appraisal) were derived from their respective PM components. Protection motivation predicted all four SPB criterion variables. Personal perceived risk and response likelihood predicted protection motivation. Protection motivation completely mediated the effect of response likelihood on all four criterion variables. Alternative models are considered. Strengths and limitations of the study are outlined and suggestions made for future research.

Training program to raise consciousness among adolescents for protection against skin cancer through performance of skin self examination

BACKGROUND

Overexposure to sunlight in childhood and the adolescent period and associated sunburns significantly increase the risk of skin cancer in adulthood. In Turkey, the incidence of skin cancer in the general population is 0.8%. The incidence is 0.6% and the mortality rate is 0.4% for men, while these rates are 1.0% and 0.7%, respectively, for women. If skin cancer is found early, its treatment is facilitated. Therefore, personal skin examination is important for early diagnosis.

OBJECTIVES

Our aim was to determine the effects of training for raising consciousness among adolescents to protect against skin cancer by influencing skin self examination behavior.

METHOD

This quasi experimental intervention study was conducted between February and April 2012 in Izmir. The study population consisted of students attending 6th, 7th and 8th classes of a primary school (n:302). No sampling was performed. Data were collected with a form developed by the researchers based on the literature. The first part of form is aimed to determine demographic characteristics of adolescents (3 questions) and their risk status of skin cancer (6 questions). The second part was prepared for skin cancer risks of adolescents (8 questions) and indications of skin cancer (12 questions). The last part was intended to determine their knowledge about skin self examination (4 questions) and behavioral stages of skin self examination (1 question). Data collection was achieved with a questionnaire form in three phases. In the 1st phase, data about demographic characteristics of students, risk status of skin cancer, knowledge level of skin cancer and behavior stages were collected. In the 2nd phase, skin self examination training based on the transtheoretical model was performed within the same day just after obtaining preliminary data. In the 3rd phase, adolescents were followed up three times to establish the efficacy of the training (on the 15th day after training program and at end of the 1st and 2nd months). Follow-up data were evaluated by questioning skin self examination performing behavior stages through electronic mail.

RESULTS

Half of the adolescents (50.5%) are male, and 58.4% of them are 13 years old with a mean age of 12 ± 1.15 years. About 29.4% of adolescents had brown hair color, 37.9% had brown/ hazel eye color, 29.4% had white skin, and 47.2% had fewer than 10 moles in their body. The pretest mean score on knowledge level about risks of skin cancer was found to be 4.19 ± 1.96, while the post-test mean score was 6.79 ± 1.67 (min:0, max:8).The pretest mean score about indications of skin cancer was 7.45 ± 3.76, while the post-test mean score was 10.7 ± 2.60 (min:0, max:12). The increases were statistically significant (p<0.05). The behavior "I do not perform skin self examination regularly in every month and I do not think to perform it in the next 6 months" was reduced from 52.8 to 35.5% after training.

CONCLUSION

The training program organized to raise consciousness among adolescents for protection against skin cancer increased the knowledge level about risks and indications of skin cancer and it also improved the behavior of performing skin self examination.

Assessment of knowledge of skin cancer prevention and its relation with sun exposure and photo protection amongst gym academy members on the south of Santa Catarina, Brazil

BACKGROUND

Skin cancer is the most frequent neoplasia in several parts of the world and also in Brazil. There is evidence of an increase in morbidity and mortality from skin cancer. Although the incidence of skin cancer is increasing, it is estimated that 45% of all preventable cancers worldwide are skin neoplasias. Several studies have emphasized the need for campaigns to encourage sun protection.

OBJECTIVE

To assess the knowledge about skin cancer prevention and its association with sun exposure and photo protection in gym members.

METHODS

We conducted a cross-sectional, descriptive and quantitative study during January to July 2009, including gym members of both sexes in the city of Criciuma. A self-administered questionnaire was used. The statistical analysis was conducted in a descriptive way in regards to the absolute and relative frequencies of the variables under study.

RESULTS

Of the 317 questionnaires studied, 62% were from women and 38% from men. Skin types II and III predominated, and the average age was 27.6 years. 94.3% of the participants reported that they had heard about the risks of sun exposure, mostly in terms of skin cancer risk (80.8%). Most participants, especially women, reported some form of sun protective measure.

CONCLUSION

The population studied, similar to that in other regions of Brazil and the world, is aware of the risks of excessive sun exposure and skin cancer prevention, but has not yet incorporated appropriate sun protection measures into their daily habits.

Evaluating a measure of tanning abuse and dependence

OBJECTIVE

To evaluate the Structured Interview for Tanning Abuse and Dependence (SITAD).

DESIGN

Longitudinal survey.

SETTING

College campus.

PARTICIPANTS

A total of 296 adults.

MAIN OUTCOME MEASURES

The SITAD modified items from the Structured Clinical Interview for DSM-IV Axis I Disorders that focus on opiate abuse and dependence. Indoor tanning (IT) behavioral patterns and opiate-like reactions to tanning were measured, and IT behavior was measured 6 months later.

RESULTS

Of 296 participants, 32 (10.8%) met the SITAD criteria for tanning abuse (maladaptive pattern of tanning as manifested by failure to fulfill role obligations, physically hazardous tanning, legal problems, or persistent social or interpersonal problems) and 16 (5.4%) for tanning dependence as defined by 3 or more of the following: loss of control, cut down, time, social problems, physical or psychological problems, tolerance, and withdrawal. The IT frequency in dependent tanners was more than 10 times the rate in participants who do not meet the SITAD criteria for tanning abuse or dependence. Tanning-dependent participants were more likely to report being regular tanners (75%; odds ratio, 7.0). Dependent tanners scored higher on the opiate-like reactions to tanning scale than did abuse tanners, who scored higher than those with no diagnosis.

CONCLUSIONS

The SITAD demonstrated some evidence of validity, with tanning-dependent participants reporting regular IT, higher IT frequency, and higher scores on an opiate-like reactions to tanning scale. A valid tanning dependence screening tool is essential for researchers and physicians as a tanning-dependent diagnosis may facilitate a better understanding of tanning motivations and aid in the development of efficacious intervention programs.

Sun exposure and sun protection habits in high school students from a city south of the country

BACKGROUND: Effective solar protection is an uncommon practice among young people, increasing the likelihood of sunburn, sunstroke and skin cancers. This fact is more significant in the south of Brazil, where the prevalence of white skinned population is larger, being more prone to sun damage. OBJECTIVES: To study the practices of sun exposure and sun protection in high school students from the city of Carlos Barbosa - RS. METHODS: Cross-sectional study involving 775 students, enrolled on the first half of 2010, who had signed the consent form. We used a non-identifiable, self-administered questionnaire, with questions about related topics. Statistical analysis was performed using Chi-square or Fisher exact and t-Student tests. The study was approved by the Research Ethics Committee under the number 2010-115H. RESULTS: Most students are exposed to the sun at the more critical periods, remaining exposed for more than an hour. Five hundred and seventy-six students (74,3%) reported using sunscreen, but less than 10% did it during all months of the year. Female teenagers are most likely to use sunscreen (p <0.001) and to spend less time exposed to sunlight (p <0.001). CONCLUSION: Most high school students from Carlos Barbosa had unsuitable sun exposure and sun protection habits, characterizing a high risk behavior for skin diseases. The existence of public programs for clarification of the risks to the population and the subsidization of sun protection products were suggested by these young people.

Prospective study of sunburn and sun behavior patterns during adolescence

OBJECTIVES

Early childhood UV light radiation (UVR) exposures have been shown to be associated with melanoma development later in life. The objective of this study was to assess sunburn and changes in sunburn and sun behaviors during periadolescence.

METHODS

A prospective, population-based study was conducted in fifth-grade children (∼10 years of age) from Framingham, Massachusetts. Surveys were administered at baseline (September-October 2004) and again 3 years later (September-October 2007). Surveys were analyzed to assess prevalence of reported sunburn and sun behaviors and to examine changes in response over the follow-up period.

RESULTS

Data were analyzed from 360 participants who had complete information regarding sunburn at both time points. In 2004, ∼53% of the students reported having at least 1 sunburn during the previous summer, and this proportion did not significantly change by 2007 (55%, P = .79), whereas liking a tan and spending time outside to get a tan significantly increased (P < .001). In 2004, 50% of students reported "often or always" use of sunscreen when outside for at least 6 hours in the summer; this proportion dropped to 25% at the follow-up evaluation (P < .001).

CONCLUSIONS

With at least 50% of children experiencing sunburns before age 11 and again 3 years later, targeting children in pediatric offices and community settings regarding unprotected UV exposure may be a practical approach. Because periadolescence is a time of volatility with regard to sun behaviors, learning more about children who receive sunburns versus those who avoid them is a critical research task.

A randomised controlled trial of a theory-based intervention to improve sun protective behaviour in adolescents ('you can still be HOT in the shade'): study protocol

BACKGROUND

Most skin cancers are preventable by encouraging consistent use of sun protective behaviour. In Australia, adolescents have high levels of knowledge and awareness of the risks of skin cancer but exhibit significantly lower sun protection behaviours than adults. There is limited research aimed at understanding why people do or do not engage in sun protective behaviour, and an associated absence of theory-based interventions to improve sun safe behaviour. This paper presents the study protocol for a school-based intervention which aims to improve the sun safe behaviour of adolescents.

METHODS/DESIGN

Approximately 400 adolescents (aged 12-17 years) will be recruited through Queensland, Australia public and private schools and randomized to the intervention (n = 200) or 'wait-list' control group (n = 200). The intervention focuses on encouraging supportive sun protective attitudes and beliefs, fostering perceptions of normative support for sun protection behaviour, and increasing perceptions of control/self-efficacy over using sun protection. It will be delivered during three × one hour sessions over a three week period from a trained facilitator during class time. Data will be collected one week pre-intervention (Time 1), and at one week (Time 2) and four weeks (Time 3) post-intervention. Primary outcomes are intentions to sun protect and sun protection behaviour. Secondary outcomes include attitudes toward performing sun protective behaviours (i.e., attitudes), perceptions of normative support to sun protect (i.e., subjective norms, group norms, and image norms), and perceived control over performing sun protective behaviours (i.e., perceived behavioural control).

DISCUSSION

The study will provide valuable information about the effectiveness of the intervention in improving the sun protective behaviour of adolescents.

A randomised controlled trial of a theory-based intervention to improve sun protective behaviour in adolescents ('you can still be HOT in the shade'): study protocol

BACKGROUND

Most skin cancers are preventable by encouraging consistent use of sun protective behaviour. In Australia, adolescents have high levels of knowledge and awareness of the risks of skin cancer but exhibit significantly lower sun protection behaviours than adults. There is limited research aimed at understanding why people do or do not engage in sun protective behaviour, and an associated absence of theory-based interventions to improve sun safe behaviour. This paper presents the study protocol for a school-based intervention which aims to improve the sun safe behaviour of adolescents.

METHODS/DESIGN

Approximately 400 adolescents (aged 12-17 years) will be recruited through Queensland, Australia public and private schools and randomized to the intervention (n = 200) or 'wait-list' control group (n = 200). The intervention focuses on encouraging supportive sun protective attitudes and beliefs, fostering perceptions of normative support for sun protection behaviour, and increasing perceptions of control/self-efficacy over using sun protection. It will be delivered during three × one hour sessions over a three week period from a trained facilitator during class time. Data will be collected one week pre-intervention (Time 1), and at one week (Time 2) and four weeks (Time 3) post-intervention. Primary outcomes are intentions to sun protect and sun protection behaviour. Secondary outcomes include attitudes toward performing sun protective behaviours (i.e., attitudes), perceptions of normative support to sun protect (i.e., subjective norms, group norms, and image norms), and perceived control over performing sun protective behaviours (i.e., perceived behavioural control).

DISCUSSION

The study will provide valuable information about the effectiveness of the intervention in improving the sun protective behaviour of adolescents.

Demographic and Tumor Characteristics of Patients Diagnosed with Nonmelanoma Skin Cancer: 13-Year Retrospective Study

Background:

The incidence of basal cell carcinoma (BCC) and squamous cell carcinoma (SCC) is increasing worldwide; however, this varies by region. To date, there are limited data about trends of nonmelanoma skin cancer (NMSC) in Canada.

Objective:

To determine the demographic and tumor characteristic changes in patients diagnosed with BCC and SCC from 1993 to 2005 in a dermatology practice in Vancouver, British Columbia.

Method:

A retrospective chart review was conducted on patients with biopsy-confirmed NMSC between 1993 and 2005. Demographic and tumor characteristics were documented for the first two incident BCCs and SCCs per patient, and a descriptive data analysis was undertaken.

Results:

A total of 1,177 NMSCs were identified from 885 patient charts. The number of BCCs increased from 1993 to 2003 and then decreased until 2005. BCCs and SCCs were generally diagnosed in older people (60+ years); however, an important group of younger patients (20–39 years) was also diagnosed with BCCs. BCCs and SCCs were most commonly seen on the head and neck, but the leg was a common location for SCC in women.

Conclusion:

NMSC is prevalent in British Columbia. These results highlight the fact that NMSC can affect individuals younger than 40 years old. Prevention strategies are warranted to reduce the burden of NMSC in British Columbia.

Effects of gain- and loss-framed messages on the sun safety behavior of adolescents: the moderating role of risk perceptions

This study examined how message framing effects can be moderated by two types of risk: (a) perceived effectiveness in preventing a risk and (b) perceived susceptibility to the risk. The results indicate that the perceived effectiveness moderated framing effects on the intention to use sunscreen such that a loss-framed message was more effective when perceived effectiveness was low, whereas a gain-framed message was more effective when perceived effectiveness was high. In addition, perceived susceptibility to skin cancer moderated framing effects on the intention to use sunscreen and the intention to wear long pants such that a loss-framed message was more effective when perceived susceptibility was high.

Ultraviolet radiation: a hazard to children and adolescents

Sunlight sustains life on earth. Sunlight is essential for vitamin D synthesis in the skin. The sun's ultraviolet rays can be hazardous, however, because excessive exposure causes skin cancer and other adverse health effects. Skin cancer is a major public health problem; more than 2 million new cases are diagnosed in the United States each year. Ultraviolet radiation (UVR) causes the 3 major forms of skin cancer: basal cell carcinoma; squamous cell carcinoma; and cutaneous malignant melanoma. Exposure to UVR from sunlight and artificial sources early in life elevates the risk of developing skin cancer. Approximately 25% of sun exposure occurs before 18 years of age. The risk of skin cancer is increased when people overexpose themselves to sun and intentionally expose themselves to artificial sources of UVR. Public awareness of the risk is not optimal, compliance with sun protection is inconsistent, and skin-cancer rates continue to rise in all age groups including the younger population. People continue to sunburn, and teenagers and adults are frequent visitors to tanning parlors. Sun exposure and vitamin D status are intertwined. Adequate vitamin D is needed for bone health in children and adults. In addition, there is accumulating information suggesting a beneficial influence of vitamin D on various health conditions. Cutaneous vitamin D production requires sunlight, and many factors complicate the efficiency of vitamin D production that results from sunlight exposure. Ensuring vitamin D adequacy while promoting sun-protection strategies, therefore, requires renewed attention to evaluating the adequacy of dietary and supplemental vitamin D. Daily intake of 400 IU of vitamin D will prevent vitamin D deficiency rickets in infants. The vitamin D supplementation amounts necessary to support optimal health in older children and adolescents are less clear. This report updates information on the relationship of sun exposure to skin cancer and other adverse health effects, the relationship of exposure to artificial sources of UVR and skin cancer, sun-protection methods, vitamin D, community skin-cancer-prevention efforts, and the pediatrician's role in preventing skin cancer. In addition to pediatricians' efforts, a sustained public health effort is needed to change attitudes and behaviors regarding UVR exposure.

Associations between authoritative parenting and the sun exposure and sun protective behaviours of adolescents and their friends

Associations between the sun exposure and sun protective behaviours of adolescents and their friends were examined along with the role played by authoritative parenting and other family and peer socialisation factors. Four hundred and two adolescents (198 males, 204 females) participated in the research. It was found that these adolescents and their friends shared similar sun exposure and sun protective behaviours and had similar parenting backgrounds. Parental authoritativeness was positively associated with the use of sun protection, even after the effects of other familial and peer variables were controlled, but not with the time spent sunbathing which was associated with friends' behaviours. The theoretical and practical implications of these findings are discussed.

Magazine exposure, tanned women stereotypes, and tanning attitudes

This study investigated whether magazine exposure is related to stereotypical beliefs about tanned women. A survey of White college women (n=205) assessed their exposure to beauty/fashion and health/fitness magazines. Outcome variables were the beliefs that tanned women are fashionable, fit, and shallow. Attention to the tanned women's images in health magazines positively predicted the belief that tanned women are fit and that tanned women are shallow; in contrast, attention to the images in beauty magazine negatively predicted the belief that tanned women are fit. Number of beauty magazines women read negatively predicted the belief that tanned women are shallow. The belief that tanned women are fit was unrelated, but the belief that tanned women are shallow was negatively related, with tanning attitudes.

Testing a belief-based intervention encouraging sun-safety among adolescents in a high risk area

OBJECTIVE

To provide a preliminary test of a theory of planned behavior (TPB) belief-based intervention to increase adolescents' sun-protective behaviors in a high risk area, Queensland, Australia.

METHODS

In the period of October-November, 2007 and May-June, 2008, 80 adolescents (14.53 ± 0.69 years) were recruited from two secondary schools (one government and one private) in Queensland after obtaining student, parental, and school informed consent. Adolescents were allocated to either a control or intervention condition based on the class they attended. The intervention comprised three, one hour in-school sessions facilitated by Cancer Council Queensland employees with sessions covering the belief basis of the TPB (i.e., behavioral, normative, and control [barrier and motivator] sun-safe beliefs). Participants completed questionnaires assessing sun-safety beliefs, intentions, and behavior pre- and post-intervention. Repeated Measures Multivariate Analysis of Variance was used to test the effect of the intervention across time on these constructs.

RESULTS

Students completing the intervention reported stronger sun-safe normative and motivator beliefs and intentions and the performance of more sun-safe behaviors across time than those in the control condition.

CONCLUSION

Strengthening beliefs about the approval of others and motivators for sun protection may encourage sun-safe cognitions and actions among adolescents.

Predictors of summer sun safety practice intentions among rural high school students

OBJECTIVE

To investigate the association between theoretically grounded psychosocial motivators and the sun safety practice intentions of rural youth.

METHODS

A survey was given to 219 members of FFA (Future Farmers of America) at high schools in the rural Midwest (average age = 16).

RESULTS

Perceived self-efficacy, peer norms, response efficacy, and susceptibility predicted protective clothing and sunscreen use intentions. Among boys, perceived norms among same-sex peers; but among girls, norms among both same- and opposite-sex peers, were significant.

CONCLUSIONS

Self-efficacy should be an important component of sun safety education for rural youth. Gender-specific peer norms should also be addressed.

Fotoexposição e fatores de risco para câncer da pele: uma avaliação de hábitos e conhecimentos entre estudantes universitários

FUNDAMENTOS: O câncer da pele é a neoplasia mais frequente no Brasil. Compreender as atitudes que influenciam a proteção e a exposição aos raios solares é extremamente importante para sua prevenção. OBJETIVOS: Avaliar hábitos de fotoexposição e fotoproteção, bem como conhecimento de fatores de risco para câncer da pele, tendo por fim delinear os padrões de comportamento dos jovens perante os efeitos solares. MÉTODOS: Distribuíram-se questionários autoaplicativos a 368 universitários, na faixa etária dos 20 anos, dos cursos de Medicina, Educação Física, Direito e Comunicação Social de instituição de ensino privada em Taguatinga (DF). RESULTADOS: O uso diário de fotoprotetor foi significativamente maior entre as mulheres. A prática de bronzeamento artificial foi baixa (3,5%), referida apenas por mulheres. O uso de filtro solar com fator de proteção maior do que 15 ou igual a 15 foi referido por 278 estudantes. De modo geral, mais de 90% dos estudantes acreditam na associação entre radiação ultravioleta e câncer da pele. Apesar disso, apenas 43,5% acreditam na genética como fator de risco. Entre os que rejeitam a hipótese do fator de risco genético para carcinogênese cutânea, 86,2% são acadêmicos das Ciências Humanas (Direito e Comunicação Social). CONCLUSÃO: Esses dados permitem orientar medidas nos níveis individual e coletivo, colaborando para a prevenção de lesões cutâneas.

Adolescent attitudes towards tanning: does age matter?

Adolescents seem to be obsessed with tanning. One third of both adolescents and adults report sunbathing. On average, about 20% of adolescents report ever-using of artificial UV tanning devices with 15% currently using them. Tanning attitudes appear similar for adolescents and adults. The top three reasons for tanning included beliefs that a tan makes them more comfortable socializing with friends, looks better and is attractive. The top reason for using artificial UV tanning devices is also aesthetics, followed by relaxation. Other reasons for using artificial UV tanning devices include vacation preparation and to gain a protective base. Attitudes related to appearance that result in more frequent tanning may be difficult to change.

Tanning behavior among young frequent tanners is related to attitudes and not lack of knowledge about the dangers

OBJECTIVE: To examine the importance of tanning among students in relation to attitudes and knowledge regarding skin cancer prevention. DESIGN: A cross-sectional survey. SETTING: College students at a major Midwestern university METHODS: Students were recruited to complete a self-administered questionnaire that included information on sun-sensitivity, knowledge and tanning attitudes and behaviors. Survey sampling statistical techniques that account for clustering among the 163 students recruited were used. RESULTS: We found a high level of skin cancer prevention knowledge; however knowledge was not related to a reduction in the importance of tanning. In many cases, higher levels of knowledge corresponded to a greater emphasis on the importance of tanning. Sunscreen use was low among this population. Those who placed an importance on tanning more often checked that they believed that "sunless tanning creams are safer than the sun". CONCLUSIONS: This population's belief that they look healthier and feel better with a tan strongly influences the desire to tan. Therefore, future cancer information campaigns or other prevention efforts should directly address the desire to tan by encouraging the use of sunless tanning products as an alternative method of tanning.

Skin cancer-related prevention and screening behaviors: a review of the literature

Primary prevention and early detection continue to be of paramount importance in addressing the public health threat of skin cancer. The aim of this systematic review was to provide a comprehensive overview of the prevalence and correlates of skin cancer-related health behaviors in the general population. To achieve this aim, 91 studies published in international peer-reviewed journals over the past three decades were reviewed and synthesized. Reported estimates of sunscreen use varied considerably across studies, ranging from 7 to 90%. According to self-report, between 23 and 61% of individuals engage in skin self-examination at least once per year, and the documented prevalence of annual clinical skin examination ranges from 8 to 21%. Adherence to sun protection and screening recommendations is associated with a range of factors, including: female gender, sun-sensitive phenotype, greater perceived risk of skin cancer, greater perceived benefits of sun protection or screening, and doctor recommendation for screening. The literature suggests that a large proportion of the general population engage in suboptimal levels of sun protection, although there is substantial variability in findings. The strongest recommendation to emerge from this review is a call for the development and widespread use of standardized measurement scales in future research, in addition to more studies with a population-based, multivariate design. It is also recommended that specific targeted interventions are developed to increase the prevalence of preventative and early intervention behaviors for the control of skin cancer.