Attitudes and perceptions regarding skin cancer and sun protection behaviour in an Irish population

Global burden and prediction study of cutaneous squamous cell carcinoma from 1990 to 2030: A systematic analysis and comparison with China

Background

China has the highest number of new cancer cases and deaths globally. Due to particularly low scores in health care quality for cutaneous squamous cell carcinoma (cSCC), the country's cSCC burden requires greater awareness. Consequently, we aimed to evaluate and predict the trend of the cSCC burden globally and in China from 1990 to 2030.

Methods

We retrieved data from the Global Burden of Disease 2019 study, which provided estimates of the incidence, mortality, prevalence, and disability-adjusted life years (DALYs) of cSCC from 1990 to 2019. We set up joint-point analyses and Bayesian age-period-cohort (BAPC) models to predict the disease burden of cSCC up to 2030.

Results

In 2019, China reported age-standardised rates of cSCC prevalence, incidence, mortality, and DALYs of 2.54, 2.12, 0.88, and 16.76 per 100 000 population, respectively. The country's prevalence and incidence rates from 1990 to 2019 were lower than the global levels, but its mortality and DALY rates were higher. The age-standardised rates were higher for males, and the disease burden increased with each age group globally and in China. Moreover, the average annual percentage change showed all indicators were growing faster than the global levels. According to the BAPC model, there will be an upward trend in the prevalence and incidence globally and in China between 2020 and 2030, with a decrease in mortality and DALYs.

Conclusions

We observed an upward trend in the cSCC burden over the past 30 years in China. Prevalence and incidence are expected to continue at a higher rate than the global average in the next decade, while mortality and DALYs are predicted to decrease. As the Chinese population ages, efforts toward managing and preventing cSCC should be targeted towards the elderly population.

Recommendations From a Chinese-Language Survey of Knowledge and Prevention of Skin Cancer Among Chinese Populations Internationally: Cross-sectional Questionnaire Study

BACKGROUND

There is a paucity of studies assessing awareness and prevention of skin cancer among Chinese populations.

OBJECTIVE

The aim of the study is to compare attitudes and practices regarding skin cancer risks and prevention between Chinese Asian and North American Chinese populations and between Fitzpatrick scores.

METHODS

A cross-sectional, internet-based, 74-question survey in Chinese was conducted focusing on Han Chinese participants internationally. The survey included Likert-type scales and multiple-choice questions. All participants were required to read Chinese and self-identify as being 18 years or older and Chinese by ethnicity, nationality, or descent. Participants were recruited on the internet over a 6-month period from July 2017 through January 2018 via advertisements in Chinese on popular social media platforms: WeChat, QQ, Weibo, Facebook, and Twitter.

RESULTS

Of the 113 completed responses collected (participation rate of 65.7%), 95 (84.1%) were ethnically Han Chinese, of which 93 (96.9%) were born in China and 59 (62.1%) were female. The mean age of these 95 participants was 35.8 (SD 13.3) years; 72 (75.8%) participants were born after 1975. Few but more North American Chinese reported that Chinese Asian populations received annual skin checks (4/30, 4.2% vs 0/65, 0%; P=.009) and believed that their clinician provided adequate sun safety education (13/30, 43.3% vs 15/65, 23.1%; P=.04). Participants with higher Fitzpatrick scores less frequently received sun safety education from a clinician (4/34, 11.8% vs 22/61, 36.1%; P=.02). More participants with lower Fitzpatrick scores used sunscreen (41/61, 67.2% vs 16/34, 47.1%; P=.05), but alternative sun protection use rates are similar across groups.

CONCLUSIONS

Cultural differences and Fitzpatrick scores can affect knowledge and practices with respect to sun protection and skin cancer among social media-using Chinese Asian and North American Chinese communities based on respondent demographics. Most participants in all groups understood that people of color have some risk of skin cancer, but >30% of all groups across regions and Fitzpatrick scores are unaware of current skin protection recommendations, receive insufficient sun safety education, and do not use sunscreen. Outreach efforts may begin broadly with concerted public and private efforts to train and fund dermatologists to perform annual total body skin exams and provide more patient education. They should spark community interest through mass media and empower Chinese people to perform self-examinations and recognize risks and risk mitigation methods.

Awareness, knowledge, and attitudes towards sun protection among patients with melanoma and atypical mole syndrome

BACKGROUND

Patients with atypical mole syndrome (AMS) have a 3- to 20-fold higher risk of developing malignant melanoma (MM) than individuals without. The most modifiable risk factor for developing MM is the ongoing ultraviolet exposure.

AIM

To assess awareness, knowledge, and attitudes towards sun protection among patients with MM and AMS.

METHODS

From January 2020 till December 2021, a written survey was administered to patients with MM and AMS and a control group who attended a specialist mole clinic at the Dermatology Department of the University Hospital of Heraklion in Heraklion, Crete, Greece. Demographic data and photoprotective practices, knowledge, and perceived barriers were collected. Relevant statistical analyses were performed using SPSS IBM 25.

RESULTS

In total, 121 subjects consented and participated in the survey. Their mean age was 43.92 ± 12.55 years. There were 66 (54.4%) females and 55 (45.4%) males. Forty-seven (38.8%) patients had AMS, 26 (21.5%) had a past medical history of MM, and 48 (39.7%) attended the clinic for a full skin checkup for their naevi without having AMS or MM. Although 104 (86%) participants reported using sunscreen with the majority of them (59/121 = 48.8%) wearing sunscreen with a sun protection factor of > 50, only 22 (18.2%) patients did so every day and only 20 (16.5%) all year round. Approximately 74.4% of patients recalled having received advice on how to protect their skin from sunlight, and 73% were interested in receiving education about sun protection. The most mentioned barriers in photoprotection were concerns over adequate vitamin D and lack of time.

CONCLUSION

Despite mentioning having received adequate education in photoprotection, adherence to photoprotection practices is suboptimal in patients with MM and AMS.

Knowledge, attitude, and practices toward sun exposure and use of sun protection among non-medical, female, university students in Saudi Arabia: A cross-sectional study

Excessive unprotected sun exposure is a significant risk factor for skin damage and skin cancers. In recent decades, the incidence of skin cancer has increased dramatically worldwide, reaching epidemic proportions. Skin cancer is the most common type of cancer worldwide, and the ninth most common malignancy in Saudi Arabia. Sun protection is a key primary preventive strategy against skin cancer and skin damage induced by sun exposure.

Herein, a cross-sectional study was made to evaluate the knowledge, attitude, and practices toward sun exposure, and the use of sun protection among non-medical female students on the Sulaymaniyah campus of the King Abdul-Aziz University. Also, we identified the reasons that prevented the students from using sun protection measures. A special-designed, self-administered questionnaire was applied on a sample size of 501 students. We found that most students were aware of the risks of unprotected sun exposure. Nevertheless, a view of sunscreen as harmful was reported (34.1%). Seeking shade and wearing protective clothing were the most used sun protection methods (58.1% and 43.1%, respectively). Sunscreen users made up only one third of our sample (23.6%). However, the majority of students (64.9%) did not know about the sun protection factor of sunscreen products. Discomfort felt on the skin was the most commonly reported reason for avoiding the use of sunscreen (40.7%). When comparing our study with Western studies, we found a high level of awareness among our sample of students. Significant differences in the attitude toward the application of suntan and sun protection products might be due to differences in cultural background. Our results spotted the need for future health education programs for our society that focus on the significant importance of sunscreen, as well as the correct methods of application.

Approach/avoidance motivation, message framing and skin cancer prevention: a test of the congruency hypothesis

The congruency hypothesis posits that approach-orientated individuals are persuaded to engage in prevention behaviours by positively framed messages; conversely, negatively framed messages are more persuasive in encouraging those who are avoidance-orientated. A 2 (frame: loss vs gain) × 2 (motivation: avoidance vs approach) design examined the effects of skin cancer information on sun-protective intentions and free sunscreen sample requests among 533 young adults. Gain-framed messages had the strongest effect on sun-protective intentions for approach-oriented individuals, whereas loss-framed messages had the strongest effect on avoidance-oriented individuals. Message framing effects on precautionary sun behaviour intentions were moderated by motivational differences.

Psychosocial correlates of sunburn among young adult women

Skin cancer is an increasingly common disease, particularly among young adult women. Sunburn early in life is a risk factor for skin cancer. Few studies have reported on psychosocial correlates of sunburn. The current study consisted of an online survey of undergraduate women from a university in the northeastern part of the USA. A logistic regression demonstrated that young women who reported a history of four or more sunburns were significantly more likely to report fair skin, higher perceived susceptibility to skin cancer, greater perceived benefits of tanning (e.g., appearance enhancement), lower perceived control over skin protection, and more frequent sunscreen use. Sunbathing was not associated with a greater number of sunburns. These results suggest that young women who sunburn more often possess other skin cancer risk factors, are aware of their susceptibility to skin cancer, and try to use sunscreen, but feel limited control over their skin protection behavior and are not less likely to sunbathe than others. Therefore, interventions are needed to assist high risk young women in asserting more control over their sun protection behavior and perhaps improve the effectiveness of the sunscreen or other skin protection methods they do employ.

Sun protection advice mediated by the general practitioner: an effective way to achieve long-term change of behaviour and attitudes related to sun exposure?

OBJECTIVE

To investigate, in primary health care, differentiated levels of prevention directed at skin cancer, and how the propensity of the patients to change sun habits/sun protection behaviour and attitudes towards sunbathing were affected, three years after intervention. Additionally, the impact of the performance of a phototest as a complementary tool for prevention was evaluated.

DESIGN

Randomized controlled study. Setting and subjects. During three weeks in February, all patients ≥ 18 years of age registering at a primary health care centre in southern Sweden were asked to fill in a questionnaire mapping sun exposure habits, attitudes towards sunbathing, and readiness to increase sun protection according to the Transtheoretical Model of Behaviour Change (TTM) (n = 316). They were randomized into three intervention groups, for which sun protection advice was given, in Group 1 by means of a letter, and in Groups 2 and 3 orally during a personal GP consultation. Group 3 also underwent a phototest to demonstrate individual skin UV sensitivity.

MAIN OUTCOME MEASURES

Change of sun habits/sun protection behaviour and attitudes, measured by five-point Likert scale scores and readiness to increase sun protection according to the TTM, three years after intervention, by a repeated questionnaire.

RESULTS

In the letter group, almost no improvement in sun protection occurred. In the two doctor's consultation groups, significantly increased sun protection was demonstrated for several items, but the difference compared with the letter group was significant only for sunscreen use. The performance of a phototest did not appear to reinforce the impact of intervention.

CONCLUSION

Sun protection advice, mediated personally by the GP during a doctor's consultation, can lead to improvement in sun protection over a prolonged time period.

Sun-exposure knowledge and protection behavior in a North Chinese population: a questionnaire-based study

BACKGROUND

Sun exposure can cause a range of skin disorders. Skin damage can be prevented by following certain sun-protection measures. However, the majority of reported studies regarding sun-exposure knowledge and behavior have involved Caucasian populations.

METHODS

A self-administered multiple-choice questionnaire was administered. The questionnaire consisted of 13 questions aimed at evaluating people's knowledge, awareness, and protection behavior regarding sun exposure, and their knowledge of sunscreens and sunscreen use.

RESULTS

A total of 623 volunteers were enrolled, including 238 men (38.2%) and 385 women (61.8%). The percentages of correct answers regarding sun-exposure knowledge and awareness ranged from 50% to 80%. Overall, 58.8% used sunscreen as a sun-protection measure in daily life, followed by use of protective clothes (49.3%), sun umbrella (45.4%), sunglasses (45.3%), and hat (42.2%). Fifty-two percent thought that suntan was harmful or not attractive. The mean sun-protection factor (SPF) of the sunscreens used was 27.7 +/- 9.2 and the mean UVA protection grade (PA) was 2.3 +/- 0.6.

CONCLUSIONS

Knowledge and awareness concerning the harmful effects of sun exposure are widespread among the Chinese population. Sunscreens with high SPF and PA are the most commonly used among Chinese people. Clear sex differences were observed. There is a significant difference in the attitude toward suntan between Chinese and Caucasian populations.

Body Consciousness Moderates the Effect of Message Framing on Intentions to Use Sunscreen

The objective of this study was to investigate the impact of messages differing in focus (health vs appearance) and frame (gain vs loss) on intentions for sunscreen use and sunbed use, and the potential moderating role of body consciousness. Questionnaire data from 390 young adults were analysed using factorial ANOVA. Results showed a significant interaction between message frame and body consciousness, such that gain-framed health or appearance messages had the strongest effect on sunscreen use intentions for those high in body consciousness, compared to those low in body consciousness. We conclude that message framing effects on precautionary sun behaviour intentions are moderated by body consciousness.