Sun awareness and sun protection practices in Malta

Assessment of prevalence of sunscreen use and related practices among people living in Saudi Arabia: A cross-sectional survey-based study

BACKGROUND

The use of sunscreen significantly reduces the risk of skin cancer and helps maintain skin health; however, improper use can decrease its effectiveness. This study aimed to investigate the prevalence and factors associated with sunscreen use in Saudi Arabia as well as identifying areas of weakness in sunscreen practices.

METHODS

A cross-sectional survey-based study was conducted with a diverse population sample in Saudi Arabia. Participants were asked about their sunscreen usage habits, motivations, and knowledge of proper application techniques. Demographic information, including age, gender, and skin type, were also collected.

RESULTS

A total of 2321 individuals participated in the study. More than two-thirds of the participants reported using sunscreen either always, regularly, or often, primarily to maintain a light skin color and prevent skin cancer. Factors associated with sunscreen use included younger age (18-40 years old), female gender, history of sunburn, and fair skin. Despite the majority reporting healthy sun exposure habits, several shortcomings were identified in sunscreen practices, including incorrect application and suboptimal reapplication frequency.

CONCLUSION

While sunscreen use is common among the study population, there is a need for improved education on proper application techniques. National awareness campaigns, especially those utilizing popular social media and digital platforms in Saudi Arabia, should focus on disseminating accurate sunscreen use guidelines to maximize sun protection and skin health.

Behaviors and Knowledge Related to Intentional Outdoor Tanning Among Adults in the Western Region of Saudi Arabia

BACKGROUND

Intentional outdoor tanning is the process through which people expose their skin to ultraviolet (UV) radiation to darken their skin color toward brown or bronze. UV radiation is a well-known modifiable risk factor for photoaging, photoallergic reactions, and phototoxicity.

OBJECTIVE

The aim of this study was to assess the behaviors and knowledge of intentional outdoor tanning among adults in the western region of Saudi Arabia.

METHODS

A cross-sectional study was conducted among 1023 adults from the general population who met the eligibility criteria. Data were collected in October and November 2022 using an electronic questionnaire to assess the sociodemographic data, behaviors, and knowledge of the participants related to intentional outdoor tanning.

RESULTS

Overall, 24.5% of the participants intentionally tanned outdoors, the majority of which (203, 80.9%) were exposed to the sun for more than 20 minutes. The participants who intentionally tan outdoors were significantly younger than those who do not (32 ± 10.7 vs. 38.4 ± 13.9, respectively, P <0.001). Most of the participants had good knowledge of the disadvantages of sun exposure on the skin (61.3%). Additionally, good knowledge was significantly more prevalent in women (70.3%) than men (48.6%) (P <0.001).

CONCLUSION

Individuals who intentionally tan outdoors engage in other behaviors or beliefs that increase exposure to UV rays. This points to the need for comprehensive interventions such as community-counseling campaigns to address these new trends and their relationship with photoaging and skin cancer.

Sun Protection and Tanning Behaviors in Caregivers: Prevalence, Determinants, and Associations with Children's Behaviors

The association between skin cancer and ultraviolet radiation (UVR) is well established, and sun protection behavior represents an important preventative measure. In children, caregivers play a key role in this regard. The subject of this study was threefold: whether caregivers of 1 to 11 year-old children are more likely to use sun protection measures compared to non-caregivers, whether considering oneself a role model is associated with sun protection behaviors, and whether their sun protection and risk behaviors are related to children’s behaviors. We used data from the 2020 wave of the National Cancer Aid Monitoring (NCAM) comprised of 4000 individuals (including 554 caregivers of at least one child aged 1−10 years) aged 16 to 65 years and living in Germany. Data were collected through telephone interviews between October and December 2020. No significant differences between caregivers and non-caregivers regarding sun protection and risk behaviors were identified (except tanning on vacation). In both groups, sun protection behaviors were deficient. Caregivers who considered themselves role models concerning sun safety were more likely to use sun protection measures (e.g., using sunscreen on the face: OR = 5.08, p < 0.001). In addition, caregivers’ sun protection behaviors were positively associated with children’s behaviors. Caregivers being highly protected against UVR were more likely to report the use of different measures by/in the child (mean = 4.03), compared to caregivers with medium (3.41) and low (2.97, p < 0.001) protection levels. However, we also found that caregivers’ risk behavior was associated with children’s reported risk behavior. For future prevention, it might be worth focusing on the aspect of caregivers serving as role models. A comprehensive public-health strategy is needed, including key figures such as pediatricians to prevent today’s children from developing skin cancer in later life.

Awareness of pharmacists and consumers towards protective effects of sunscreens against skin cancer

The objective of the present study was to assess the awareness level of individuals on the use of sunscreen products, and pharmacists' perception of sunscreen safety. A cross-sectional, descriptive study was conducted in the United Arab Emirates (UAE). Participants involved included 224 female undergraduates of Ajman University (aged 18-25 years old), 234 patients visiting numerous pharmacies, and 58 pharmacists from the private sector in Dubai. Questionnaires were designed and distributed to all participants. Data entry and analysis were performed using SPSS (Statistical Program for Social Sciences) version 20. Among female undergraduate students, 94.7% used sun protection, 81.1% understood what is meant by SPF (Sun Protection Factor) Value, and 70.2% used the optimal SPF (15-20). Additionally, 95.2% reported that sunscreens do not have any side effects. Out of the 234 patients who participated in the study, 86.8% used sun protection, 56.8% understood what is meant by SPF, and 43.2% used the optimal SPF. Furthermore, 93.2% stated that sunscreens do not have any side effects. Female patients were found to use sunscreens with higher SPF values (above 50) as compared to male patients (P ≤ 0.024). Patients above the age of 40 also used sunscreens with high SPF (P ≤ 0.001). As for pharmacists, they all agreed that sunscreens have a marked safety profile, with no side effects, and that the optimal SPF for use is 15-20. Most pharmacists (80%) reported that consumers are in fact aware and knowledgeable about the proper use and application of sunscreens. Optimal use of routine sunscreen is of paramount importance to prevent skin damage as well as cancer.

Predicting sun protection measures against skin diseases using machine learning approaches

BACKGROUND

The substantial growth rate of skin cancer has necessitated adequate protection from solar radiation. Consequently, analyzing sun protection practices is an imperative research area in dermatology and pharmacology.

AIMS

This paper aims to analyze public sun-protection manners in the Arabian Peninsula regions.

METHODS

A simple random survey was conducted to assess public sun protection manners. Artificial neural network (ANN) and support vector machine (SVM) were selected from several machine learning algorithms to create the models for predicting public sun protection measures based on the prediction accuracy. Model performances were evaluated based on several performance indicators depending on the confusion matrices and receiver operating characteristic curves.

RESULTS

51% of the respondents have a low level, and 49% have a high level of sun protection practices. The results showed that the SVM performed considerably amended than the ANN for predicting the response. The relative importance of the predictors for the best predictive SVM model was also analyzed. The predictors are ranked as: the number of times having sunburnt >gender > use seat belt while driving/riding a vehicle >considers the UV index for personal sun exposure >income based on the expenses >sports/exercise activities >consciousness of the chance for having sunburnt on extended exposure to the sun >age > having any skin problem >nationality > skin type.

CONCLUSION

These identified significant predictors might be considered for developing an effective policy to increase public consciousness using proper protection from solar radiation's detrimental effect to rule out skin diseases.

Protection of the Eye from Ultraviolet Radiation Damage Among Adults in Addis Zemen Town, Northwest Ethiopia

BACKGROUND

Ultraviolet radiation is electromagnetic radiation or light having a wavelength of less than 400 nm but greater than 100 nm. Ultraviolet radiation, majorly from sunlight, can potentially damage any organ that is exposed to any part of its spectrum. Aside from the skin, the organ most susceptible to sunlight-induced damage is the eye. Ultraviolet radiation is reported to be the cause of multiple ocular problems ranging from benign conditions like pterygium and pinguecula to ocular malignancies such as basal cell carcinoma which finally leads to visual impairment and blindness. Protection practice is mandatory to avoid the burden of diseases caused by ultraviolet exposure and maximizing the protection measures implementation is important. To maximize this, it is essential to know the current practice and the associated factors affecting the usage of protective devices in the study area.

METHODS

Community-based cross-sectional study was conducted from April to May 2019 on 453 study participants. The study participants were selected through a systematic random sampling method. Data were collected using a pretested structured questionnaire. The analyzed result was summarized and presented using texts, tables and charts. A Chi-square test was applied to assess the significant association.

RESULTS

A total of 430 study subjects were participated and completed the questionnaire with a response rate of 94.92%. The mean age of the study participants was 35.3 (SD±6.68). Two hundred forty-three (56.5%) study participants were males. About 228 (53%) of participants were married, and 356 (82.8%) were Christian in religion. From the total study participants, 173 (40.23%) had good practice in protecting the eye from ultraviolet radiation damages while the remaining 59.77% had poor practice. A significant association was found between sex and protection practice of the eye from ultraviolet radiation damages.

CONCLUSION

The majority of the study participants had poor protection practice of the eye from ultraviolet radiation damages. Improving awareness and protection practice are vital to reduce the burden of ocular abnormalities due to excessive exposure to ultraviolet radiation.

Cancer burden in China: trends, risk factors and prevention

As the most populous country in the world, China has made strides in health promotion in the past few decades. With the aging population, the burden of cancer in China continues to grow. Changes in risk factors for cancer, especially diet, obesity, diabetes, and air pollution, continue to fuel the shift of cancer transition in China. The burden of upper gastrointestinal cancer in China is decreasing, but still heavy. The rising burden of colorectal, prostate, and breast cancers is also significant. Lung cancer became the top cause of cancer-related deaths, together with smoking as the most important contributor to cancer deaths. The Chinese government has taken several approaches to control cancer and cancer-related risk factors. Many achievements have been made, but some challenges remain. Health China 2030 is ambitious and depicts a bright vision of the future for cancer control in China. The decrease in the cancer burden in China will require cross-sector collaboration and coordinated efforts on primary and secondary preventions by governments, public health organizations, and individuals. In this review, we describe the trends of cancer burden and discuss cancer-related risk factors in China, identifying strategies to reduce the burden of cancer in China.

Sun Awareness and Sun Protection Practices

Background

The incidence of skin cancer has increased over the past few years, owing to excessive exposure to ultraviolet (UV) radiation. Over the past decade, protection against solar radiation has been highly encouraged in numerous public health education campaigns. The adopted sun protection practices include avoiding exposure to the sun, using protective clothing, and applying sunscreen. The aim of this paper was to analyze the awareness and attitudes towards sun protection practices in some regions of the Arabian Peninsula.

Objective

The main objective of this study is to estimate the level of sun protection practices and determine the factors that have a significant impact on the level of adoption of sun protection practices by residents in the Arabian Peninsula.

Methods

A 35-question self-reporting online questionnaire to evaluate the sun protection measures adopted by the residents was distributed in the Kingdom of Saudi Arabia and Kingdom of Bahrain. The survey was conducted from January 2018 to May 2019, and a total 830 responses were collected for analysis. The data were analyzed using the statistical software SPSS. The chi-squared test and Spearman's correlation were performed to determine the association of the sun protection level with factors concerning the socio-demographic characteristics, sun sensitivity, health-conscious lifestyle, adopted sun protection measures, and general awareness about the UV index, skin cancer, and vitamin D. Logistic regression classification was applied in developing the empirical model to predict the sun protection level of the residents.

Results

Based on the analysis, only 34% of the total 830 respondents use sunscreen and most of the sunscreen users are female. The three most popular sun protection practices are: 1) avoiding exposure to the sun during peak hours, 2) using protective clothing, and 3) using sunglasses. The results indicate that 22% of respondents use a low level of sun protection, 53% use a medium level of protection, while 25% of respondents use a high level of sun protection. Many of the respondents understand that exposure to the sun can cause skin cancer and skin aging, while 54% of the respondents still believe that a suntan can be healthy if sunburn is avoided. Thirty percent of the participants of this study are aware of the UV index, and only 20% of all respondents know the correct meaning of the UV index. The overall predictive accuracy of the constructed logistic regression model is 67%. Based on the results of the logistic regression model, the five most significant factors of the sun protection level are: 1) perception that the sun can cause skin aging, or not, 2) age, 3) awareness of the dangerous effects of sun exposure, 4) income with respect to expenses, and 5) taking the UV index into consideration during exposure to the sun.

Conclusion

Most of the respondents are aware about sun protection. However, the sun protection level of the residents is still inadequate. An efficient strategy of increasing the awareness of the effective use of sun protection systems must be established based on the significant factors to prevent skin cancer.

Personal ultraviolet Radiation exposure in a cohort of Chinese mother and child pairs: the Chinese families and children study

BACKGROUND

Few studies in China have examined personal ultraviolet radiation (UVR) exposure using polysulfone dosimetry.

METHODS

In this study, 93 mother and adolescent child pairs (N = 186) from two locations in China, one rural (higher latitude) and one urban (lower latitude), completed 3 days of personal UVR dosimetry and a sun/clothing diary, as part of a larger pilot study.

RESULTS

The average daily ambient UVR in each location as measured by dosimetry was 20.24 Minimal Erythemal Doses (MED) in the rural location and 20.53 MED in the urban location. Rural mothers had more average daily time outdoors than urban mothers (5.5 h, compared with 1.5 h, in urban mothers) and a much higher daily average personal UVR exposure (4.50 MED, compared with 0.78 MED in urban mothers). Amongst adolescents, rural males had the highest average daily personal UVR exposure, followed by rural females, urban females and urban males (average 2.16, 1.05, 0.81, and 0.48 MED, respectively).

CONCLUSIONS

Although based on small numbers, our findings show the importance of geographic location, age, work/school responsibilities, and sex of the adolescents in determining personal UVR exposure in China. These results suggest that latitude of residence may not be a good proxy for personal UVR exposure in all circumstances.

Skin cancer risk perception and sun protection behavior at work, at leisure, and on sun holidays: a survey for Danish outdoor and indoor workers

BACKGROUND

To prevent occupational skin cancer, it is essential that the sun-protective behavior of outdoor workers is adequate. The aim is to study the sun-protective behavior of Danish outdoor workers at work, at leisure, and on sun holiday and compare it to that of indoor workers.

METHODS

This is a cross-sectional study, based on a 53-item survey completed by Danish outdoor (n = 380) and indoor workers (n = 119) in 2016-2017. Status as outdoor or indoor worker was decided based on self-report and behavioral differences were tested using (paired) t tests and multiple regression adjusted for age, sex, educational level, history of smoking, and skin type.

RESULTS

Danish outdoor workers at work use sun protection less than they do at leisure and on sun holiday (α < .05) where their sun protection behavior is similar to that of indoor workers. The proportion of Danish outdoor workers that always/often use sun protection at work is for shade seeking around noon 4.2%, sunscreen 34.5%, wide-brimmed hat 25.3%, and long trousers and shirt with sleeves 42.4%. Of Danish outdoor workers, 49.5% do not think about the risk of occupational skin cancer and 11.8% think the risk is insignificant, 32.4% think that the use of sun protection is of low or no importance, 84.2% consider sunburn important as skin cancer risk factor still 88.9% have a history of sunburn at work, > 80.0% agree that risk of skin cancer is reduced by the use of sun protection, and only 4.0% dismiss the possibility of sun protection use at work.

CONCLUSIONS

Skin cancer risk and use of sun protection at work are largely neglected in Danish outdoor workers, more so than at leisure and on sun holiday where their risk behavior resembles that of indoor workers. This indicates an untapped workplace preventive potential.

The Prognostic Value of Age, Sex, and Subsite in Cutaneous Head and Neck Melanoma: A Clinical Review of Recent Literature

Context

Cutaneous head and neck melanoma is a challenging disease owing to its aggressive nature and often times advanced stage at presentation. Age, sex, and subsite are three prognostic indicators which can be determined prior to treatment or testing, and can allow the practitioner to counsel the patient before initiating therapy.

Evidence Acquisition

A PubMed search was conducted utilizing various terms relating to the subject matter. Articles over the past 25 years were analyzed and appropriately selected for review.

Results

It appears that patients older than 65 have a decreased overall 5 year survival compared to their younger counterparts. Male patients have poorer prognosis compared to female patients as noted by the decreased overall survival, decreased disease specific survival, and shorter time to distant metastasis. Scalp subsite was most uniformly accepted as having the worst prognosis in the head and neck, and may even serve as an independent prognostic indicator.

Conclusions

Advanced age, male sex, and scalp subsite all portend poor prognosis in patients with cutaneous head and neck melanoma.

Attitudes, Beliefs, and Measures Taken by Parents to Protect Their Children from the Sun in Guangzhou City, China

Excessive sun exposure can cause sunburn, suntan, skin photoaging, and even skin cancer. Skin photoaging conflicts with the human pursuit of a young and beautiful appearance. Some research data indicate that the incidence of skin cancer in the Chinese has been increasing, although it remains lower than in whites. To estimate the prevalence of sun protection used on Chinese children aged 3-13 years and identify its predictors, a population-based cross-sectional questionnaire was given to 3684 parents/guardians of children in Guangzhou, China, of which 3083 questionnaires were returned. Of those returned, 35.5% of parents/guardians reported regularly using sun protection on their children and the primary reason cited was to prevent sunburn. Hats and handheld umbrellas were the most frequently used measures; sunscreen was less common, and when used, 48.8% of parents/guardians still reapplied sunscreen on their children every 2.0-3.0 h. Parental age, parents using sun protection measures themselves when outdoors, and the child's sex were factors associated with regular use of sun protection on children. These results suggest that sun protection campaigns targeted toward parents and children need to be conducted in Guangzhou, or throughout China, to strengthen awareness about sun protection and address any inadequate protocols of sun protection.

Factors Influencing Anticipated Decisions about Sunscreen Use

The present study examined influences on the decision-making processes relevant to sun-damage preventive behaviour, namely sunscreen use. Participants were randomly assigned to a positive, a negative or a control group and underwent two successive experimental manipulations: (1) information and (2) focus.They made pre-experimental, post-information and post-focus ratings of likelihood of using sunscreen and susceptibility to skin cancer.The results suggested that decision making changes as a function of the information present, and the information which individuals focus on at the time of decision making.The findings are described with particular emphasis on the implications for future intervention strategies.

Ultraviolet Radiation Exposure: Public Health Concerns

The North American public maintains an attitude that equates the acquisition of a suntan with health. However, prolonged exposure to ultraviolet radiation from the sun can lead to sunburn, premature skin aging, immunosuppression, and skin cancer. Misconceptions about the risks of tanning beds and the effectiveness of sunscreens are common. The public must be better informed about the importance of and the need for effective sun protection by means of clothing and hats, the proper use of sunscreen, and the avoidance of prolonged sun exposure during the time of maximal solar insolation.

Comparison of sun protection modalities in parents and children

BACKGROUND

Routine sun protection is recommended to prevent skin cancer. The aims of the present analysis were to assess and compare modalities of sun protection in parents and their children.

METHODS

EDIFICE Melanoma is a French nationwide observational survey. It was conducted through phone interviews among a representative sample of 1502 individuals aged ≥18 years, using the method of quotas. The survey took place shortly after the summer, from 28 September to 20 October 2011.

RESULTS

Of the 1502 subjects interviewed, 1067 reported sun exposure (SE) at least 10 days per year, 748 were parents and 319 had no children. Sun protection measures seemed adequate in both the 'parents' and 'non-parents' groups: 74% used clothing and 43% used sunscreen, which was reapplied regularly in 57% of cases. Sun protection measures used by SE parents for SE children were superior, both qualitatively and quantitatively, to those used for themselves, i.e., 50% of parents reported using clothing, sunglasses and hats for their children vs. 23% for themselves. In 87% of cases, parents reported regular re-application of sunscreen for their children vs. 44% for themselves. The sunscreen SPF (Sun Protection Factor) was significantly lower for parents than for their children.

CONCLUSIONS

Sun protection awareness appears to be globally satisfactory in the French population, with no difference between adults who are parents and those who are not. From both qualitative and quantitative standpoints, French parents use sun protective measures more efficiently for their children than for themselves.

Skin cancer preventative behaviors in state park workers: a pilot study

OBJECTIVES

Considering the potential for occupational sun exposure among state park workers, the purpose of this pilot study was to identify skin cancer knowledge, health beliefs, self-efficacy, and sun protection behaviors (SPBs) among state park employees.

METHODS

The current study used a cross-sectional survey research design with state park workers in a Southern state. Of the 94 possible employees who could have participated in the study, 87 completed the survey.

RESULTS

Assessment of the participants' skin cancer knowledge demonstrated an average correct response rate of 68.8 %. While the vast majority (87.4 %) believed that skin cancer is a serious disease, a minority (42.5 %) believed they would develop skin cancer sometime during their lifetime, and even fewer (35.6 %) believed their risk was higher than average. Collectively, workers reported low levels of SPBs. The most commonly reported barriers to sun protection were "inconvenient," "too hot to wear," and "forget to protect." Half of the participants (50.6 %) were highly confident in their ability to wear long pants while in the sun. About the same proportion of participants was highly confident they could wear a wide-brimmed hat (21.8 %) and sunscreen (20.7 %).

CONCLUSIONS

Based on available evidence, a need exists to develop individual and worksite programs and interventions to increase skin cancer prevention behaviors among this occupational group. This data could serve as a baseline to monitor and evaluate the efficacy of these interventions.

Uptake of skin self-examination and clinical examination behavior by outdoor workers

This study investigated the association between outdoor work and response to a behavioral skin cancer early detection intervention among men 50 years or older. Overall, 495 men currently working in outdoor, mixed, or indoor occupations were randomized to a video-based intervention or control group. At 7 months post intervention, indoor workers reported the lowest proportion of whole-body skin self-examination (wbSSE; 20%). However, at 13 months mixed workers engaged more commonly in wbSSE (36%) compared with indoor (31%) and outdoor (32%) workers. In adjusted analysis, the uptake of early detection behaviors during the trial did not differ between men working in different settings. Outdoor workers compared with men in indoor or mixed work settings were similar in their response to an intervention encouraging uptake of secondary skin cancer prevention behaviors during this intervention trial.

Awareness of and attitudes towards skin-cancer prevention: a survey of patients in the UK presenting to their general practice

BACKGROUND

The rate of skin cancer in the UK continues to rise.

AIM

To identify the current knowledge and awareness of and attitudes towards the avoidance of skin cancer among a variety of patient groups to aid the design of future UK sun-awareness campaigns.

METHODS

Patients aged ≥ 16 years presenting to one of three general practices (two urban, one rural) in the UK during the period 1 June to 31 July 2010 were invited to complete a paper-based questionnaire collecting data on their sun-exposure behaviour, with significance assessed by the Fisher exact test.

RESULTS

In total, 1000 patients (327 male, 673 female) responded. Those aged 16-30 years were significantly more likely to get sunburn than the older age groups. The understanding of ways to avoid skin cancer in 16-30-year-olds was also rated as significantly worse than that of all other age groups. Compared with the older age groups, this group was also less likely to avoid midday sun exposure (P < 0.001) or to cover up in the sun (P < 0.001). There was no significant difference in sun exposure or frequency of sunburn between those with or without a personal or family history of skin cancer. Those with a positive history were more likely to wear sunscreen (P < 0.01), but not to cover up or avoid the midday sun.

CONCLUSIONS

UK-based sun-awareness programmes should target younger age groups. In addition, healthcare professionals must ensure that opportunities are taken to reinforce the importance of safe sun exposure for patients presenting with skin cancer.

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.

Evaluation of sun awareness with an emphasis on ultraviolet protection by clothing: a survey of adults in Western Germany

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.

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.

Sun safety: what are the health messages?

Solar ultraviolet radiation (UVR) is a human carcinogen. The UK and the worldwide incidence of cutaneous (skin) melanoma are rising. It is now the second most common cancer in 15-34 year-olds in the UK, increasing by 49% in 1991—2000. The UK government prioritized skin cancer in 1992 in their public health strategy The Health of the Nation, and set the target for reducing the yearly rise in skin cancer incidence by 2005. In 1998 in the Saving Lives: Our Healthier Nation strategy, targets were set to reduce the death rate from cancer, including skin cancer, by 20% by 2010. As a consequence of these targets, since the mid-1990s public health campaigns to reduce sun exposure and skin cancer incidence in the UK have used specific interventions for at-risk groups and the mass media to reach the general population. Evidence indicates a shift in knowledge, with further work required to increase change in behaviour and attitudes.

An associate health problem is vitamin D deficiency, which is prevalent across certain UK population groups. The main childhood health problem associated with vitamin D deficiency is the development of rickets, with evidence indicating those at high risk are exclusively breastfed dark-skinned infants, the elderly, those with dark skin pigmentation, and certain cultural groups that cover their bodies in clothing. Adolescents are the group with the highest incidence of low vitamin D status in the UK, with children of Asian descent at higher risk than Caucasian children. Increasing the outdoor activity levels of children in winter and during the cooler hours in summer is one way of increasing safe sun exposure. It is imperative to educate the general public on the risk of vitamin D deficiency, and offer advice on safe sun exposure, dietary sources of vitamin D, and dietary supplements. More research is required on recommendations for daily vitamin D supplements to determine optimal vitamin D levels in different population groups. There also needs to be reliable and accessible evidence on the links between vitamin D deficiency and lack of sun exposure, with sun safe messages adjusted accordingly.

Reducing ultraviolet radiation exposure among outdoor workers: state of the evidence and recommendations

OBJECTIVE

Outdoor workers have high levels of exposure to ultraviolet radiation and the associated increased risk of skin cancer. This paper describes a review of: 1) descriptive data about outdoor workers' sun exposure and protection and related knowledge, attitudes, and policies and 2) evidence about the effectiveness of skin cancer prevention interventions in outdoor workplaces.

DATA SOURCES

Systematic evidence-based review.

DATA SYNTHESIS

We found variable preventive practices, with men more likely to wear hats and protective clothing and women more likely to use sunscreen. Few data document education and prevention policies.

CONCLUSION

Reports of interventions to promote sun-safe practices and environments provide encouraging results, but yield insufficient evidence to recommend current strategies as effective. Additional efforts should focus on increasing sun protection policies and education programs in workplaces and evaluating whether they improve the health behavior of outdoor workers.

Skin phototypes of a Maltese sample population

BACKGROUND AND AIM

Skin phototyping is a clinical classification system based on a patient's historical reporting of the acute skin response to sunlight. We carried out a simple study to estimate the skin phototypes of the Maltese people in order to acquire more information on the relative risk of the general Maltese population to sun burning and to the more chronic effects of sun exposure, including photoaging and skin cancers.

METHOD

A consultant dermatologist and dermatology trainees determined the skin phototype of patients seen with skin infections or skin tags at dermatology outpatients in Malta by carrying out a short interview.

RESULTS

Data were collected on 756 patients. The commonest reported skin phototype in both sexes was type III (48.0% overall; 52.4% in males, 43.8% in females); this was followed by type IV in males (30.4%) and type II in females (32.3%). Only 1.2% of the total was of skin type I.

CONCLUSION

Approximately one half of the Maltese population is at moderate risk of sun damage; about one quarter is at low risk; and the other quarter is at high risk, the latter group needing more thorough sun avoidance and better surveillance for skin tumours. Social desirability can influence responses to such questionnaires and might have contributed to the difference between males and females noted in our study.

Photoprotection: where do we stand?

Ultraviolet sun radiation can cause several deleterious effects on the skin, including photoaging and carcinogenesis. Physical protection and sunscreens are currently the two main types of photoprotection. Overall, people seem informed about the dangers of sun exposure, but sometimes they are not willing to implement the right sun-protection measures. Sunscreens are reported to be the most frequently used method worldwide, but they cannot substitute physical protection and a proportion of people do not apply them correctly. Public campaigns, together with fashion and the right role models, can still offer a lot in persuading people to change their habits towards a more sun-protected life.

Parents' knowledge and behaviour concerning sunning their babies; a cross-sectional, descriptive study

Background

For centuries, sunlight has been used for therapeutic purposes. Parents still sun their infants to treat neonatal jaundice, nappy rash or mostly to supply vitamin D for bone development as a consequence of health beliefs. In this study we aimed to assess knowledge and behaviour of parents about benefits of sunlight and sun protection.

Methods

In this study, parents attending to governmental primary healthcare units for their children's routine vaccinations, upon their informed consent, were consecutively enrolled during one month. Data were collected by a semi-structured questionnaire.

Results

The mean age of 118 enrolled parents and their babies were 27.9 ± 6.5 years and 8.3 ± 5.8 months, respectively. Most of the participants were mothers (93.2%), housewives (81.4%) with an educational level of ≥6 years (71.2%). Sunlight was considered beneficial for bone development (86.4%), diaper rash (5.9%) and neonatal jaundice (12.7%). In case of neonatal jaundice 72.0% of the participants reported that they would consult a physician. Most of the participants (82.2%) were sunning their babies outdoors. Nearly half (49.7%) of them got this information from medical staff. Fifty two percent of the parents were sunning their babies before 10–11 a.m. and/or after 3 p.m. Only 13.6% of parents reported using sunscreen for their babies, and the majority of them were using sun protecting factor ≥ 15. One forth of the sunscreen users was using sunscreen according to their physicians' advice.

Conclusion

Most of the participants were aware of the benefits of sunlight; especially for bone development. However they were displaying inappropriate behaviour while sunning their babies for health reasons. More education should be given to parents about the danger of sunlight at primary health care units while advising to sun their babies, if any.

A profile of invasive cutaneous malignant melanoma in Malta: 1993–2002

BACKGROUND

The incidence of malignant melanoma of the skin has risen in every part of the world where reliable cancer registration data are found.

OBJECTIVE

Our study aims to describe the changing incidence of and survival from invasive cutaneous malignant melanoma in Malta, by analysing the data from the 211 cases that were registered at the Malta National Cancer Registry between 1993 and 2002.

RESULTS

The age standardized incidence rates for invasive cutaneous malignant melanoma rose from 3.7 per 100,000 population per year for males and 5.1 for females in the first 5-year period, to 8.0 per 100,000 population per year for males and 5.9 for females in the second 5-year period. In both sexes, numbers of thin (< or = 1.0 mm) invasive melanomas increased significantly between 1993 and 2002; males also registered a significant increase in intermediate-thickness (1.01-4.0 mm) melanomas. The increase in numbers of thin and intermediate-thickness melanomas between the two 5-year periods was greatest in patients aged 60 years and over. The overall absolute 5-year survival rate for the first period was 74% and for the second period 92%.

CONCLUSION

Numbers of reported cases of invasive cutaneous malignant melanoma in Malta have more than doubled during the 10-year study period. This is mostly due to a marked rise in the diagnosis of thin melanomas in both sexes, occurring mainly in patients aged 60 years and over. As thin melanomas are of low metastasizing potential, this has resulted in an increase in survival between the two 5-year study periods.

Is head and neck melanoma a distinct entity? A clinical registry-based comparative study in 5702 patients with melanoma

BACKGROUND

The head and neck region is more heavily exposed to ultraviolet (UV) radiation than any other body site. Therefore, cutaneous malignant melanoma (CMM) of the head and neck area is proposed to have notable differences from melanoma at other body sites regarding clinicopathological features and survival of patients.

OBJECTIVES

The present retrospective study based on clinical registry data aims to compare clinical features and prognostic factors of head and neck melanoma (HNM) vs. melanoma at other anatomical regions (MOR) in order to detect differences which may be associated to the mode of sun exposure.

METHODS

The clinical records and histopathological findings of 844 patients with clinical stage I and II invasive HNM were compared with the data of 4858 patients with MOR. Survival analysis was performed using the Kaplan-Meier estimate, and the multivariate Cox proportional hazard model was used to evaluate independent prognostic factors.

RESULTS

Melanoma density was clearly higher for HNM than for MOR: this was particularly true for the face, where it was elevated by a factor of 2.6. There was a higher male/female ratio in patients with HNM and they were significantly older than patients with MOR (P < 0.0001). Breslow tumour thickness did not differ between HNM and MOR. However, CMMs at the scalp were significantly thicker and to a higher degree ulcerated. Concerning clinicopathological CMM subtypes, there was an increased proportion of lentigo maligna melanoma among HNM and of nodular melanoma in the scalp and neck regions. Excision margins were narrower and the rate of complete primary excision was lower in HNM than in MOR. Overall, there was no significant statistical difference in cumulative 10-year survival rates according to Kaplan-Meier estimates among patients with HNM (84.6%) and MOR (87.8%). Tumour thickness turned out to be the variable with the highest prognostic impact followed by ulceration in both HNM and MOR.

CONCLUSIONS

In relation to the skin surface significantly more CMMs were found in the head and neck area than in other anatomical regions. This might indicate, but does not prove, that UV exposure promotes the development of CMM. Although HNM showed specific clinicopathological features, prognosis remained unaffected. Thus HNM seems not to be a distinct subtype of CMM.

Postal workers' occupational and leisure-time sun safety behaviors (United States)

OBJECTIVES

United States Postal Service letter carriers are exposed to long bouts of UVR and thus are vulnerable to skin cancer. While previous studies have shown that occupational sun protection is often deficient, few studies have examined outdoor workers' behavior during leisure time.

METHODS

Subjects (n = 2,660) self-reported widebrim hat and sunscreen use over the past five workdays and past two non-working days using Likert-type scales. Generalized linear mixed models and generalized estimating equations were used to compare hat and sunscreen rates and predictors during occupational and leisure time.

RESULTS

On average, carriers spent 3.9 h outside during workdays and 3.3 h during non-working days. Sunscreen and widebrim hat use during the workday is low and rates of use are significantly lower during non-working days.

CONCLUSIONS

Sun safety interventions for carriers should encourage sun protection at all times when outdoors.

Science and society: the communications revolution and cancer control

Advances in communications technology, particularly with regards to computer-based media, have opened up exciting possibilities to intervene and influence the trajectory of cancer control, from disease prevention to survivorship, and to reduce the cancer burden. The resulting explosion in cancer information in the mass media and on the Internet, however, also offers challenges in terms of equality in access to information and the ability to act on it, as well as in making sure that it is accurate, readily available and easy to use.

Ethnoracial differences among outdoor workers in key sun-safety behaviors

BACKGROUND

Few sun-safety studies have included ethnoracially diverse groups. Comparison across such groups of sun-safety behaviors was the main objective of this analysis.

METHODS

Postal workers (n =2543) self-reported frequency of sunscreen, wide-brim hat, and sunglasses use during the last 5 workdays on 5-point Likert-type scales ranging from "never" to "always." Responses were dichotomized by "always" versus all other responses. Generalized estimating equations were used to assess the association between ethnicity/race and frequency of each sun safety behavior. The baseline data reported in this paper were collected in the summer of 2001, and the randomized trial was completed in the summer of 2004.

RESULTS

Ethnicity/race was significantly related to sunscreen and sunglasses use. For both sunscreen and sunglasses, the white group had significantly higher "always" rates than the other four groups (30% vs 14% to 23% and 63% vs 44% to 52%, respectively).

CONCLUSIONS

The results of this study indicated that although non-Latino white employees tended to have higher rates of sun-safety behaviors, the rates of adequate protection of all groups were low.

Sun awareness in Maltese secondary school students

BACKGROUND

Studies indicate that reducing exposure to ultraviolet light during childhood and adolescence decreases the risk of skin cancer. From a young age, children need to be educated about the sun's harmful effects on the skin and how best to protect themselves.

OBJECTIVE

To help in the design of school-based interventions to raise sun awareness, a school survey was carried out to identify students' stereotypes and misconceptions.

STUDY DESIGN

A total of 965 students attending Maltese secondary schools in forms 1, 2 and 3 were surveyed in May 2002, using a structured questionnaire designed to examine students' sun-related attitudes and knowledge.

RESULTS

A high level of sun awareness among students was demonstrated, with high scores on knowledge of the effects of the sun on the skin, knowledge of skin cancer and knowledge of sun protection. Girls were clearly more knowledgeable than boys. However, of all the students surveyed, 55% thought that a suntan made them look better and 70% thought that their friends would desire a tan. These views were commoner among the older students. Skin type and hair or eye colour had no bearing on attitudes towards tanning or sun-related knowledge. The commonest misconceptions were that 'the sun is bad for your skin only when you get sunburnt' and that 'you cannot get too much sun on a cloudy day'. Deliberate suntanning was more frequently reported by girls than by boys and by students in the higher forms.

CONCLUSION

Attitude change lags behind knowledge. Future school sun awareness interventions need to take into account gender and age differences in students' attitudes and perspectives. They should aim at motivating attitude change and preventive behaviour through consistent and repeated sun-education messages that are supported by a sun-conscious school environment.