Executive summary of the national "Sun Safety: Protecting Our Future" Conference: American Academy of Dermatology and Centers for Disease Control and Prevention. New York, New York, May 1 and 2, 1997

Skin aging and oxidative stress: Equol's anti-aging effects via biochemical and molecular mechanisms

Oxygen in biology is essential for life. It comes at a cost during normal cellular function, where reactive oxygen species (ROS) are generated by oxidative metabolism. Human skin exposed to solar ultra-violet radiation (UVR) dramatically increases ROS production/oxidative stress. It is important to understand the characteristics of human skin and how chronological (intrinsic) aging and photo-aging (extrinsic aging) occur via the impact of ROS production by cascade signaling pathways. The goal is to oppose or neutralize ROS insults to maintain good dermal health. Botanicals, as active ingredients, represent one of the largest categories used in dermatology and cosmeceuticals to combat skin aging. An emerging botanical is equol, a polyphenolic/isoflavonoid molecule found in plants and food products and via gastrointestinal metabolism from precursor compounds. Introductory sections cover oxygen, free radicals (ROS), oxidative stress, antioxidants, human skin aging, cellular/molecular ROS events in skin, steroid enzymes/receptors/hormonal actions and genetic factors in aging skin. The main focus of this review covers the characteristics of equol (phytoestrogenic, antioxidant and enhancement of extracellular matrix properties) to reduce skin aging along with its anti-aging skin influences via reducing oxidative stress cascade events by a variety of biochemical/molecular actions and mechanisms to enhance human dermal health.

Body-tanning attitudes among female college students

This study investigated the attitudes of body-tanning behaviors: suntanning, tanning bed, tanning spray, and sunless tanning product use. Data collected from 208 female college students (M age = 19.8 yr., SD = 2.0; M weight = 63.3 kg, SD = 2.0; M height = 165.9 cm, SD = 8.1) online. The questionnaire comprised four constructs: appearance-based, health-based, and emotion-based tanning attitudes, and body-tanning behaviors. Both appearance-based and emotion-based pro-tanning attitudes were associated with significantly higher body-tanning behaviors. However, health-based pro-tanning attitudes did not significantly affect body-tanning behaviors. The results from both UV- and non-UV exposure-related tanning behaviors provide future intervention strategies, such as establishing a positive body image without a tan and identifying negative emotional consequences as a result of tanning.

Does artificial UV use prior to spring break protect students from sunburns during spring break?

BACKGROUND

Dark-skinned individuals are less likely than light-skinned individuals to become sunburned or develop skin cancer. Some have extrapolated this relationship and surmised that developing and maintaining a tan will reduce the risk of sunburns and melanoma. In order to examine whether this strategy indeed protects against sunburns, we surveyed college students about both their tanning habits prior to spring break and their spring break activities.

METHODS

Sorority and fraternity students were recruited after spring break. Analyses examined associations between potential risk factors and the development of one or more sunburns during spring break.

RESULTS

As expected, the risk of obtaining a sunburn increased with: time spent in the sun during spring break; light complexion, as assessed by various sun-sensitivity factors; and lack of sunscreen use. We also found that tanning using an artificial UV source during the 10 weeks prior to spring break was not associated with reduced risk of sunburns during spring-break, but rather with a marginal increase in this risk.

CONCLUSIONS

These data provide evidence that maintaining a tan may not provide protection from sunburns. Public health messages need to address this misconception, stating clearly that a tan does not protect against or reduce the chances of developing a sunburn.

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.

Sun exposure and vitamin D sufficiency

Ultraviolet radiation is a carcinogen that also compromises skin appearance and function. Because the ultraviolet action spectra for DNA damage, skin cancer, and vitamin D(3) photosynthesis are identical and vitamin D is readily available from oral supplements, why has sun protection become controversial? First, the media and, apparently, some researchers are hungry for a new message. Second, the controversy is fueled by a powerful special interest group: the tanning industry. This industry does not target the frail elderly or inner-city ethnic minorities, groups for whom evidence of vitamin D(3) insufficiency is strongest, but rather fair-skinned teenagers and young adults, who are at highest risk of ultraviolet photodamage. Third, evolution does not keep pace with civilization. When nature gave humans the appealing capacity for cutaneous vitamin D(3) photosynthesis, life expectancy was <40 y; long-term photodamage was not a concern; and vitamin D(3) deficiency, with its resulting skeletal abnormalities (rickets), was likely to be fatal in early life. In the 21st century, life expectancy approaches 80 y in developed countries, vitamin D(3) is available at the corner store, and the lifetime risk of skin cancer is 1 in 3 among white Americans. Medical and regulatory groups should avoid poorly reasoned, sensationalistic recommendations regarding unprotected ultraviolet exposure. Instead, they should rigorously explore possible cause-and-effect relations between vitamin D(3) status and specific diseases while advocating the safest possible means of ensuring vitamin D(3) sufficiency.

Sun protection and Vitamin D: three dimensions of obfuscation

Ultraviolet (UV) radiation is a proven carcinogen, responsible for more than half of all human malignancies. It also compromises skin appearance and function. Since the UV action spectra for DNA damage, skin cancer and Vitamin D(3) (vit D) photosynthesis are identical and vit D is readily available from oral supplements, why has sun protection become controversial, now that some data suggest conventionally "sufficient" levels of vit D may be less than optimal for at least some population groups? First, the media and apparently some researchers are hungry for a new message. Nevertheless, after 50 years, UV exposure is still a major avoidable health hazard. Second, the controversy is fueled by a powerful special interest group: the indoor tanning industry. They target not the frail elderly or inner-city ethnic minorities, groups for whom evidence of vit D insufficiency is strongest, but rather fair-skinned teenagers and young adults, those at highest risk of UV photodamage. Third, evolution does not keep pace with civilization. When nature gave man the appealing capacity for vit D photosynthesis, the expected lifespan was far less than 40 years. Long-term photodamage was not a concern, and vit D was not available at the corner store. The medical community should avoid sensationalism and instead rigorously explore possible cause-and-effect relationships between vit D status and specific diseases while advocating the safest possible means of assuring vit D sufficiency.

Do adolescent indoor tanners exhibit dependency?

BACKGROUND

Indoor tanning is a common adolescent risk behavior that has been hypothesized to be motivated and maintained by the mood-altering effects of ultraviolet light.

OBJECTIVE

Our purpose was to explore heretofore anecdotal reports that indoor tanning leads to dependency.

METHODS

A telephone interview was conducted among 1275 adolescents, ages 14 to 17 years. Self-reported difficulty in quitting indoor tanning was assessed among 267 adolescents (20.9% of total) who tanned indoors more than once in the previous year in relation to age of initiation, frequency of use, and positive or negative consequences of the practice.

RESULTS

Difficulty in quitting was more likely with younger age at initiation (age 13 years or younger vs ages 16 to 17; odds ratio = 4.3, 95% confidence interval 1.3-14.7) and higher frequency of use (P = .009), even after accounting for positive or negative consequences of indoor tanning and other demographic characteristics.

LIMITATIONS

This was a cross-sectional study design with a limited outcome measure.

CONCLUSION

Although preliminary, our findings for age at initiation and frequency of use in relation to difficulty in quitting indoor tanning are consistent with other potentially addictive behaviors taken up during adolescence.

Photoprotection in adolescence

Physical changes and the establishment of personal values are characteristics of adolescence. Despite being well informed regarding sun protection and the skin cancer risks related to sun exposure, teenagers usually make little use of sunscreens and remain out in the sun for long periods. Besides the social appeal and the impression that a nice tan provides a healthy appearance, the tendency to deny long-term risks seems to influence sun exposure behaviors in this life period. Due to the strong relation between skin cancer and sun exposure in childhood and adolescence, it is important to encourage the adoption of photoprotection measures early in life. Adolescents have difficulty accepting guidance through official educational messages, and very few of them follow family recommendations. Celebrities, fashion, and the entertainment industry exert a greater influence on their choices. Thus, it is fundamental to incorporate photoprotection counseling into the medical routine, in an adolescent-driven way. This article reviews peculiarities of sun protection in adolescence and discusses the type of advice to be given to patients in this age group.

Indoor tanning by adolescents: prevalence, practices and policies

Despite known acute and chronic health effects from the use of indoor tanning, including the potential for all forms of skin cancer, the practice is popular in the United States (US) and Europe. A review of the scientific literature that examines adolescents and indoor tanning use was undertaken, summarising what is known about prevalence and practices among adolescents, characteristics associated with adolescent use, and policies that regulate adolescent access to indoor tanning facilities. The prevalence of indoor tanning is consistently found to be higher among girls than boys and to increase with age in both Europe and the US. An examination of other demographic characteristics, skin cancer risk factors, knowledge, attitudes and social factors points to higher prevalence of the behaviour among adolescents with positive attitudes towards tans and whose friends or parents also tan indoors. Adolescent access to indoor tanning is rarely regulated in the US or Europe, and where regulations exist, business compliance is low. In addition, businesses actively market their product to adolescents as they organise to limit further regulations prohibiting adolescent access. Pricing, licensure, advertising restrictions and media campaigns, in combination with adolescent-targeted interventions, are possible strategies that could be tested for their effectiveness to reduce adolescent indoor tanning use. Harm reduction policies, such as eye protection, that reduce risk for adolescents who choose to tan indoors, are also important.

Maternal/female caregiver influences on adolescent indoor tanning

PURPOSE

To identify aspects of maternal/female caregiver (MFC) influences on adolescents' indoor tanning, including modeling, cognitions (MFC knowledge and attitudes about indoor tanning), and gatekeeping/monitoring (MFC permissiveness and concern) of indoor tanning.

METHODS

A telephone survey of adolescents aged 14-17 years and their female parent/caregiver in Minnesota and Massachusetts was conducted in 2000-2001 (n = 1284 matched pairs). Logistic regression was used to obtain odds ratios for relationships between measures of MFC influence and teens' indoor tanning practices, adjusting for demographic and sun sensitivity differences.

RESULTS

Separately, each of the five MFC influence variables was significantly associated with adolescents' indoor tanning practices. In a multivariate model, significant independent contributors were parents' behavior, parents' concern about their children's indoor tanning practices, and MFC permissiveness of teen indoor tanning. Using a combined summed scale of the 5 influence factors, there was a monotonically increasing likelihood of tanning with each incremental scale increase: (in comparison to none, 1 factor aOR = 4.1, 95% CI: 1.3, 12.8; any 2 factors aOR = 8.3, 95% CI: 2.8, 24.6; any 3 factors aOR = 14.3, 95% CI = 4.9, 41.8; any 4 factors aOR = 30.5, 95% CI: 10.3, 90.3; all 5 factors aOR = 66.0, 95% CI: 20.0, 217.6).

CONCLUSIONS

Mothers/female caregivers may be a powerful influence on their teenagers' indoor tanning use, and are an important target for future health promotion efforts to discourage youth indoor tanning.