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Rönsch H, Rocholl M, Ludewig M, Staudt A, Langner M, Steeb T, Wilke A, John SM, Berking C, Beissert S, Bauer A. Sonnenschutz bei Beschäftigten im Freien. Entwicklung und Validierung von standardisierten Fragebögen für Verhalten und Wissen. J Dtsch Dermatol Ges 2024; 22:665-674. [PMID: 38730530 DOI: 10.1111/ddg.15378_g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 01/11/2024] [Indexed: 05/13/2024]
Abstract
BACKGROUND AND OBJECTIVES Outdoor workers are at increased risk of developing non-melanoma skin cancer. We aimed to address the lack of validated German-language measurement instruments for outdoor workers' sun safety behavior and knowledge by compiling and validating two questionnaires. PARTICIPANTS AND METHODS By expert consensus, items for the assessment of protective behavior (OccuSun) were compiled based on existing instruments. For knowledge, a translation of the Skin Cancer and Sun Knowledge (SCSK) scale was selected. After a pre-test, a validation study including 68 outdoor workers (62% female) was conducted in 2020. RESULTS The retest reliability was r = 0.93 (95% confidence interval: 0.86-0.96) for the protection score and rs = 0.78 (0.67-0.86) for the knowledge score. Protective behaviors were correlated with respective diary data (0.38 ≤ rs ≤ 0.74, p < 0.001) and skin pigmentation changes (-0.23 ≥ rs ≥ -0.42, 0.007 ≤ p ≤ 0.165) but not with self-reported sunburn frequency (0.21 ≥ rs ≥ -0.04). CONCLUSIONS Among German outdoor workers, two questionnaires for the assessment of sun protection behavior (OccuSun) and knowledge (SCSK) demonstrated good reliability. The OccuSun had generally good validity. Both instruments are fit for subsequent validation to determine their sensitivity to change.
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Affiliation(s)
- Henriette Rönsch
- Klinik für Dermatologie, Universitätsklinikum Carl Gustav Carus, Technische Universität Dresden
| | - Marc Rocholl
- Institut für Gesundheitsforschung und Bildung, Abteilung für Dermatologie, Umweltmedizin und Gesundheitstheorie, Universität Osnabrück
- Institut für interdisziplinäre Dermatologische Prävention und Rehabilitation (iDerm) an der Universität Osnabrück
| | - Michaela Ludewig
- Institut für Gesundheitsforschung und Bildung, Abteilung für Dermatologie, Umweltmedizin und Gesundheitstheorie, Universität Osnabrück
- Institut für interdisziplinäre Dermatologische Prävention und Rehabilitation (iDerm) an der Universität Osnabrück
| | - Andreas Staudt
- Institut und Poliklinik für Arbeits- und Sozialmedizin, Medizinische Fakultät, Technische Universität Dresden
- Abteilung für Methoden der Community Medicine, Institut für Community Medicine, Universitätsmedizin Greifswald
| | - Mathias Langner
- Institut für Klinische Chemie und Laboratoriumsmedizin (IKL), Universitätsklinikum Carl Gustav Carus, Technische Universität Dresden
| | - Theresa Steeb
- Klinik für Dermatologie, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität (FAU) Erlangen-Nürnberg, Comprehensive Cancer Center Erlangen, Europäische Metropolregion Nürnberg, Erlangen
| | - Annika Wilke
- Institut für Gesundheitsforschung und Bildung, Abteilung für Dermatologie, Umweltmedizin und Gesundheitstheorie, Universität Osnabrück
- Institut für interdisziplinäre Dermatologische Prävention und Rehabilitation (iDerm) an der Universität Osnabrück
| | - Swen Malte John
- Institut für Gesundheitsforschung und Bildung, Abteilung für Dermatologie, Umweltmedizin und Gesundheitstheorie, Universität Osnabrück
- Institut für interdisziplinäre Dermatologische Prävention und Rehabilitation (iDerm) an der Universität Osnabrück
| | - Carola Berking
- Klinik für Dermatologie, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität (FAU) Erlangen-Nürnberg, Comprehensive Cancer Center Erlangen, Europäische Metropolregion Nürnberg, Erlangen
| | - Stefan Beissert
- Klinik für Dermatologie, Universitätsklinikum Carl Gustav Carus, Technische Universität Dresden
| | - Andrea Bauer
- Klinik für Dermatologie, Universitätsklinikum Carl Gustav Carus, Technische Universität Dresden
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Rocholl M, Hannappel J, Ludewig M, John SM. UV-Induced Skin Cancer Knowledge, Sun Exposure, and Tanning Behavior among University Students: Investigation of an Opportunity Sample of German University Students. J Skin Cancer 2021; 2021:5558694. [PMID: 35003809 PMCID: PMC8731302 DOI: 10.1155/2021/5558694] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 12/04/2021] [Accepted: 12/15/2021] [Indexed: 12/03/2022] Open
Abstract
Ultraviolet radiation (UVR) is the most important risk factor for developing skin cancer. University students can be considered as a particularly high-risk group for long- and short-term adverse effects of UVR due to intensive solar UVR exposure and high rates of sunburn. While validated questionnaires for assessing solar UVR exposure and sun protection behavior are available in German, a questionnaire for assessing the level of knowledge about this topic is still missing. We conducted a literature search for cross-sectional studies assessing skin cancer and sun protection knowledge among university students in Medline (via PubMed) and analyzed existing questionnaires and topics contained therein. We chose to translate the "Skin Cancer and Sun Knowledge Scale" referring to the TRAPD method into the German language and pilot-tested the translation with an opportunity sample of German students. The literature search revealed 36 eligible studies. Four major topics were identified within the studies: knowledge on skin cancer, risk factors, UVR, and sun protection measures. One hundred and seven German university students (86.0% female) with a mean age of 26.25 years (SD ± 4.58; range: 19-46) participated in our pilot study. The internal reliability of the scale was KR-20 = 0.624. We discovered an improvable level of knowledge in terms of skin cancer among the study population. Statistical analyses revealed no significant associations between the level of knowledge and UVR exposure or tanning behavior, respectively. The skin cancer and sun protection knowledge of German university students should be examined thoroughly. While the psychometric properties of the SCSK require further thorough investigation, first empirical experiences indicate the suitability of the tool to assess the level of knowledge regarding skin cancer and sun protection.
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Affiliation(s)
- Marc Rocholl
- Institute for Health Research and Education, Department of Dermatology, Environmental Medicine and Health Theory, University of Osnabrück, Am Finkenhügel 7a, Osnabrück 49076, Germany
- Institute for Interdisciplinary Dermatological Prevention and Rehabilitation (iDerm), University of Osnabrück, Am Finkenhügel 7a, Osnabrück 49076, Germany
| | - Julia Hannappel
- Institute for Health Research and Education, Department of Dermatology, Environmental Medicine and Health Theory, University of Osnabrück, Am Finkenhügel 7a, Osnabrück 49076, Germany
| | - Michaela Ludewig
- Institute for Health Research and Education, Department of Dermatology, Environmental Medicine and Health Theory, University of Osnabrück, Am Finkenhügel 7a, Osnabrück 49076, Germany
- Institute for Interdisciplinary Dermatological Prevention and Rehabilitation (iDerm), University of Osnabrück, Am Finkenhügel 7a, Osnabrück 49076, Germany
| | - Swen Malte John
- Institute for Health Research and Education, Department of Dermatology, Environmental Medicine and Health Theory, University of Osnabrück, Am Finkenhügel 7a, Osnabrück 49076, Germany
- Institute for Interdisciplinary Dermatological Prevention and Rehabilitation (iDerm), University of Osnabrück, Am Finkenhügel 7a, Osnabrück 49076, Germany
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Cluster Randomized Trial: Sun Protection Intervention 'Clever in Sun and Shade for Preschools'-Effectiveness and Dissemination. CHILDREN-BASEL 2021; 8:children8080651. [PMID: 34438542 PMCID: PMC8391804 DOI: 10.3390/children8080651] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 07/23/2021] [Accepted: 07/24/2021] [Indexed: 11/22/2022]
Abstract
Skin cancer is one of the most common types of cancer and UV radiation is one of the main risk factors. Therefore, sun protection, especially in childhood, is strongly recommended. We examined the effectiveness of the ‘Clever in Sun and Shade for Preschools’ program (CLEVER) in promoting sun protection behavior among preschool staff (trial registration: DRKS00023468) and describe its dissemination. Within a cluster randomized trial with 24 preschools (n = 273 staff members) stating a high need for sun protection measures, an educational workshop for preschool staff and a project kit with materials applicable in preschool groups was provided. Staff members of preschools taking part in CLEVER report significantly stronger sun protection behavior to avoid the sun (effect size [ES] 0.70, 95% confidence interval [CI] 0.04 0.71, p < 0.05) and less perceived impediments to avoid the sun (ES −0.56, CI −0.82 −0.17, p < 0.01) after 12 months as well as higher self-efficacy to avoid the sun (ES 1.09, CI 0.39 1.07, p < 0.001) and to use sunscreen (ES 0.71, CI 0.03 0.88, p < 0.05) after 1 month. Compared to the control group, there was no significant effect on sunscreen use and further psychosocial outcomes. The effectiveness of CLEVER may be underrated due to a high drop-out rate. Within three years, an enhanced free-of-charge program kit, including a media-based workshop and materials, had reached over 4000 preschools, i.e., 7.1% of all daycare centers in Germany. The results show that CLEVER can strengthen sun protection, offer high-quality information at low cost, and is easily disseminable.
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Görig T, Schneider S, Seuffert S, Greinert R, Diehl K. Does sunscreen use comply with official recommendations? Results of a nationwide survey in Germany. J Eur Acad Dermatol Venereol 2019; 34:1112-1117. [PMID: 31746063 DOI: 10.1111/jdv.16100] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Accepted: 11/12/2019] [Indexed: 11/27/2022]
Abstract
BACKGROUND The use of sunscreen can reduce the risk of UV-induced skin lesions. Health authorities have provided recommendations for the correct use of sunscreen use: Sufficient amount of sunscreen should be applied at least 30 min before the sun exposure and should be reapplied every 2 h. OBJECTIVE We aimed to research the practice of sunscreen use in a population-based and representative sample in Germany. METHODS For this cross-sectional survey, 3000 German residents aged 14-45 years were surveyed in standardized telephone interviews in 2018. Survey participants provided data on the frequency of sunscreen use in summer, timing of (re-)application and their skin characteristics. The data were weighted by age, sex, educational level and federal state to ensure the national representativeness of the sample. RESULTS Overall, 79.4% of respondents used sunscreen always, often or sometimes when being exposed to the sun. However, 87.2% of sunscreen users did not follow the recommendations on timing of application, 59.5% did not comply with the timing of reapplication. We also saw, that people potentially used too little sunscreen. These data did not differ noticeably by skin types of participants. CONCLUSION Our study revealed deficits in use of sunscreen in Germany, indicating that people here pay little attention to the recommendations of health authorities, regardless of their skin type. There is therefore an urgent need for targeted public information on this issue. Improving public knowledge on correct sunscreen use through educational campaigns or individual counselling by health professionals could be a first step.
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Affiliation(s)
- T Görig
- Mannheim Institute of Public Health, Social and Preventive Medicine (MIPH), Mannheim Medical Faculty, Heidelberg University, Mannheim, Germany
| | - S Schneider
- Mannheim Institute of Public Health, Social and Preventive Medicine (MIPH), Mannheim Medical Faculty, Heidelberg University, Mannheim, Germany
| | - S Seuffert
- Mannheim Institute of Public Health, Social and Preventive Medicine (MIPH), Mannheim Medical Faculty, Heidelberg University, Mannheim, Germany
| | - R Greinert
- Association of Dermatological Prevention, Hamburg, Germany.,Center of Dermatology, Elbe Clinics, Buxtehude, Germany
| | - K Diehl
- Mannheim Institute of Public Health, Social and Preventive Medicine (MIPH), Mannheim Medical Faculty, Heidelberg University, Mannheim, Germany
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Schneider S, Görig T, Schilling L, Schuster A, Diehl K. [The use of sunglasses during leisure time and work : Lack of prevention of sun-induced eye damage]. Ophthalmologe 2019; 116:865-871. [PMID: 30689024 DOI: 10.1007/s00347-019-0850-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
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.
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Affiliation(s)
- S Schneider
- Mannheimer Institut für Public Health, Sozial- und Präventivmedizin, Medizinische Fakultät Mannheim, Universität Heidelberg, Ludolf-Krehl-Str. 7-11, 68167, Mannheim, Deutschland.
| | - T Görig
- Mannheimer Institut für Public Health, Sozial- und Präventivmedizin, Medizinische Fakultät Mannheim, Universität Heidelberg, Ludolf-Krehl-Str. 7-11, 68167, Mannheim, Deutschland
| | - L Schilling
- Mannheimer Institut für Public Health, Sozial- und Präventivmedizin, Medizinische Fakultät Mannheim, Universität Heidelberg, Ludolf-Krehl-Str. 7-11, 68167, Mannheim, Deutschland
| | - A Schuster
- Augenklinik und Poliklinik, Universitätsmedizin Mainz, Johannes Gutenberg-Universität Mainz, Mainz, Deutschland
| | - K Diehl
- Mannheimer Institut für Public Health, Sozial- und Präventivmedizin, Medizinische Fakultät Mannheim, Universität Heidelberg, Ludolf-Krehl-Str. 7-11, 68167, Mannheim, Deutschland
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Görig T, Diehl K, Greinert R, Breitbart EW, Schneider S. Prevalence of sun-protective behaviour and intentional sun tanning in German adolescents and adults: results of a nationwide telephone survey. J Eur Acad Dermatol Venereol 2017; 32:225-235. [PMID: 28573745 DOI: 10.1111/jdv.14376] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Accepted: 05/08/2017] [Indexed: 12/17/2022]
Abstract
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 (ORhigh = 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.
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Affiliation(s)
- T Görig
- Mannheim Institute of Public Health, Social and Preventive Medicine, Heidelberg University, Mannheim, Germany
| | - K Diehl
- Mannheim Institute of Public Health, Social and Preventive Medicine, Heidelberg University, Mannheim, Germany
| | - R Greinert
- Association of Dermatological Prevention, Hamburg, Germany.,Center of Dermatology, Elbe Clinics, Buxtehude, Germany
| | - E W Breitbart
- Association of Dermatological Prevention, Hamburg, Germany
| | - S Schneider
- Mannheim Institute of Public Health, Social and Preventive Medicine, Heidelberg University, Mannheim, Germany
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Hoskin AK, Philip SS, Yardley AME, Mackey DA. Eye Injury Prevention for the Pediatric Population. Asia Pac J Ophthalmol (Phila) 2016; 5:202-11. [PMID: 27183290 DOI: 10.1097/apo.0000000000000193] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Each year an estimated 3.3 to 5.7 million pediatric eye injuries occur worldwide. It is widely reported that 90% of ocular injuries are preventable. Our aim was to identify legislation and policies, education, and mandatory eye protection strategies that have successfully contributed to reducing rates of children's eye injuries. A literature search was conducted using the terms "pediatric" or "children" or "adolescent" and "ocular" or "eye" and "protection" or "injury prevention." Articles were retrieved based on titles and abstracts and assessed in the context of our research question. Strategies identified aimed at reducing ocular trauma fell into 3 broad categories: legislation and policies, education, and personal eye protection. Policies including restrictions on the sale and supply of certain consumer products, mandatory vehicle seatbelts, and laminated windscreens in vehicles have assisted in reducing children's eye injuries. Educational tools aimed at children and their caregivers have been effective in changing attitudes to eye health and safety. Effective pediatric eye injury prevention systems require a multifactorial approach combining legislation, policies, standards, education, and personal eye protection to limit exposure to ocular hazards. A paucity of standardized measurement and lack of funding have limited advances in the field of children's eye injury prevention. Improved eye injury surveillance and research funding along with collaboration with health care providers are important components for strategies to prevent pediatric ocular trauma.
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Affiliation(s)
- Annette K Hoskin
- From the *Lions Eye Institute, Perth; †Centre for Ophthalmology and Visual Science, University of Western Australia, Crawley; and ‡Princess Margaret Hospital for Children, Perth, Western Australia, Australia
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Surber C. [Children, adolescents, young adults and sun protection]. MMW Fortschr Med 2012; 154:43-6. [PMID: 22693755 DOI: 10.1007/s15006-012-0518-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Christian Surber
- Dermatologischen Universitätsklinik, Universitätsspital Basel, Schweiz.
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Abstract
Sun protection is a central measure to avoid the development of skin cancer and premature aging of the skin. In this context skin protection of children is of particular relevance since children spend a lot of time outdoors and they cannot provide themselves with sun protection measures as adults can. In addition to this sunburn reactions in childhood are particularly important in the development of melanoma skin cancer. This special situation of children with regards to sun protection has not only become aware to dermatologists but also to politicians, which is why a recent recommendation of the European Union explicitly points out the necessity of stringent sun protection of children. This review summarizes the current knowledge about sun protection of children. Underlying mechanisms of skin carcinogenesis in children, available sun protection measures as well as practical advice on daily sun protection of children are discussed.
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Affiliation(s)
- M Berneburg
- Universitäts-Hautklinik, Eberhard Karls Universität, D- 72076 Tübingen, Germany.
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Gambichler T, Dissel M, Altmeyer P, Rotterdam S. Evaluation of sun awareness with an emphasis on ultraviolet protection by clothing: a survey of adults in Western Germany. J Eur Acad Dermatol Venereol 2009; 24:155-62. [PMID: 19627409 DOI: 10.1111/j.1468-3083.2009.03368.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Little is known about the sun habits of the population in Germany. OBJECTIVE We aimed to assess the sun awareness and notion on ultraviolet (UV) radiation protection by fabrics in adult subjects from North Rhine-Westphalia in Germany. METHODS During regular skin cancer screening campaigns, 1206 subjects completed and returned a structured questionnaire on constitutional parameters and the respondents' sun habits. RESULTS Staying in the shade and the use of high-factor sunscreens are the most commonly performed sun-protective measures reported by the respondents. Males and lower-educated people use clothing in conjunction with sunscreens more infrequently. Most respondents, particularly females, know that sun protection provided by clothing is variable. However, the elderly more frequently consider sun protection by clothing as excellent. Notably, more than two-thirds of the respondents would prefer clothing with a labelled ultraviolet protection factor. The respondents of this survey mainly considered baby wear, children wear, and leisure wear for sun-protective clothing, whereby light-weighted, breathable, natural fabrics preferably made of cotton and linen were the most frequently reported protective textiles. CONCLUSIONS Given the lack of epidemiological observations on people's sun habits and protection in Germany, the present relatively large survey provides useful information and implications for counselling in sun protection and marketing of UV-protective clothing.
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Affiliation(s)
- T Gambichler
- Department of Dermatology, Ruhr-University of Bochum, Gudrunstr. 56, D-44791 Bochum, Germany.
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Loss J, Nagel E. Probleme und ethische Herausforderungen bei der bevölkerungsbezogenen Gesundheitskommunikation. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2009; 52:502-11. [DOI: 10.1007/s00103-009-0839-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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