Use Sunscreen

OVERVIEW

Just about everyone should be aware that the sun may damage the skin. Sun exposure has been associated with the premature development of skin wrinkles as well as several types of skin cancer. For decades, dermatologists, the physicians who specialize in skin problems, have been advising people of all ages to wear sunscreen or products that contain a number of different ingredients that help prevent the sun’s ultraviolet (UV) radiation from harming the skin. Both types of ultraviolet radiation, UVA and UVB, may damage the skin and cause premature aging and skin cancer.

Sunscreen labels list their SPF or sun protector factor, a measure of their ability to protect the skin from UVB damage. Thus, if it takes 20 minutes for unprotected skin to start turning red, using a sunscreen with a SPF of 15 should multiply that amount of time by 15 or to about five hours. It is best to use a sunscreen with a SPF of at least 15. Many recommend higher numbers. Some sunscreens, known as broad-spectrum sunscreens, protect the skin from both UVA and UVB rays. Yet, while exact figures vary, according to the Skin Protection Foundation, less than one-third of the youth in America practice effective sun protection. 1

WHAT THE EXPERTS SAY

Some Programs Have Been Successful in Improving the Use of Sunscreen 2

A Smartphone Mobile Application Informs People That They Need to Reapply Sunscreen

In a study published in 2015 in JAMA Dermatology, researchers from Colorado and New Mexico evaluated the ability of a smartphone application to provide real-time sun protection advice, such as informing a person that he/she should reapply sunscreen. The trial, which was conducted in 2012, included a sample of 604 adults who owned Android smartphones. The treatment group included 305. Two hundred and thirty-two people downloaded the application, but only 125 actually used it. The researchers learned that users of the smartphone mobile application reported that they spent less time in the sun and employed more sun protective behaviors, such as the use of sunscreen and wearing protective clothing. The researchers noted that “use of the mobile app was lower than expected but associated with increased sun protection.” 3

An Appealing Appearance-Based Video May Foster More Sunscreen Use Than a Health-Based Video 4

Televised Advertising Campaigns May Increase Sun Protection Behaviors, Including the Use of Sunscreen

In a study published in 2015 in the American Journal of Preventive Medicine, researchers from Australia noted that an advertising campaign known as SunSmart has been encouraging people to use sun protection for decades. The researchers investigated these advertisements broadcast during the summers between 1987 and 2011. They wanted to determine if these advertisements were increasing the use of sun protective behaviors such as using sunscreen. Cross-sectional weekly telephone surveys of Melbourne residents were conducted over the summers from 1987-1988 to 2010-2011, and analyzed in 2012-2014. Twenty-one percent of the respondents were 14 to 24 years old. The researchers asked the participants about their sun-related attitudes and sun protection and sunburn on the weekend prior to the interviews. They were also questioned about their exposure to television advertising during the four weeks before the interviews. The researchers found that viewing of the advertisements was associated with increased sun protective behaviors, including the use of sunscreen. “After more than two decades of public education on skin cancer, the amount of exposure to SunSmart TV advertising continues to be strongly associated with improved compliance in sun-related attitudes and behaviors across time periods and age groups.” 5

BARRIERS AND PROBLEMS

Age and Gender Appear to Influence the Use of Sunscreen

In a multicenter, cross-sectional study published in 2015 in the American Journal of Clinical Dermatology, researchers from Australia evaluated age and gender differences and the use of sunscreen. The researchers were primarily interested in learning more about sunscreen knowledge, attitudes, and behaviors.

6

Parents of Children Who May Be at Increased Risk for Skin Cancer Are Not Using a Sufficient Amount of Sunscreen

In a study published in 2015 in Cancer Epidemiology, Biomarkers & Prevention, researchers from Los Angeles and Philadelphia wrote that first-degree relatives of melanoma survivors have a “substantially higher” lifetime risk for melanoma, the most serious type of skin cancer. As a result, parents of these children must be even more vigilant with their use of sunscreen. The researchers wanted to learn if these parents were actually using sufficient sunscreen. A survey was administered by mail, telephone, or online to 324 Latino and non-Latino survivors of melanoma and 324 of their children, who had an average age of 9 years. Eighty-four percent of the cohort were non-Latino white and 70 percent were females. The researchers learned that these children had high rates of exposure to the sun, and their rates of sunburn were equal to or higher than estimates from average-risk populations. The Latino children were less likely to wear sunscreen and hats and more likely to wear sunglasses. As the children grew older they were less likely to use sun protection, and they had an increased risk for sunburns. The researchers underscored the need for melanoma survivors to be aware that their children are at increased risk. Then, survivors could “consider discussing this issue with a health care provider.” The researchers noted that these discussions were infrequent occurrences in their sample. “Interventions to improve sun protection and reduce sun exposure and sunburns in high-risk children are needed.” 7

Not All Sun Protection Interventions Are Effective 8

Some College Students Are Exposing Themselves to Too Much Sun

In a pilot study published in 2012 in the Journal of American College Health, researchers from Wayne, New Jersey, and New York City noted that melanoma is the second most common cancer diagnosed among people between the ages of 15 and 29 years. That is why these researchers wanted to learn more about the behaviors, barriers, and beliefs relevant to sun exposure and protective behaviors. The initial cohort consisted of 153 undergraduate students at a large state university in western New York. One hundred and thirty-nine of the participants completed an online survey. According to the students, in the summer they spent more than three hours per day outside. But, only 17.3 percent reported using some type of sunblock. Meanwhile, 60 percent reported recent indoor tanning, and 41 percent reported having more than 10 lifetime sunburns. Most often, the students indicated that they forgot to use sunscreen. A smaller number noted that they did not burn, so there was no need for sunscreen. The researchers commented that “demographics coupled with inconsistent and low levels of sunblock use, high annual prevalence of indoor tanning, and multiple lifetime sunburns indicate that this sample is at high risk for skin cancer.” 9

NOTES

1. Skin Cancer Foundation, www.skincancer.org.

2. K. M. White, C. Starfelt, R. M. Young et al., “A Randomised Controlled Trial of an Online Theory-Based Intervention to Improve Adult Australians’ Sun-Protection Behaviours,” Preventive Medicine 72 (2015): 19-22.

3. D. B. Buller, M. Berwick, K. Lantz et al., “Smartphone Mobile Application Delivering Personalized, Real-Time Sun Protection Advice: A Randomized Clinical Trial,” JAMA Dermatology 151, no. 5 (2015): 497-504.

4. W. Tuong and A. W. Armstrong, “Participant Satisfaction with Appearance-Based Versus Health-Based Educational Videos Promoting Sunscreen Use: A Randomized Controlled Trial,” Dermatology Online Journal 21, no. 2 (February 2015).

5. Suzanne J. Dobbinson, Angela Volkov, and Melanie A. Wakefield, “Continued Impact of SunSmart Advertising on Youth and Adults’ Behaviors,” American Journal of Preventive Medicine 49, no. 1 (2015): 20-28.

6. Andrew Lee, Kieran Benjamin Garbutcheon-Singh, Shreya Dixit et al., “The Influence of Age and Gender in Knowledge, Behaviors, and Attitudes Towards Sun Protection: A Cross-Sectional Survey of Australian Outpatient Clinic Attendees,” American Journal of Clinical Dermatology 16 (2015): 47-54.

7. B. A. Glenn, T. Lin, L. C. Chang et al., “Sun Protection Practices and Sun Exposure Among Children with a Parental History of Melanoma,” Cancer Epidemiology, Biomarkers & Prevention 24, no. 1 (2015): 169-77.

8. K. A. Miller, B. M. Langholz, T. Ly et al., “SunSmart: Evaluation of a Pilot School-Based Sun Protection Intervention in Hispanic Early Adolescents,” Health Education Research 30, no. 3 (2015): 371-79.

9. Corey Hannah Basch, Grace Clarke Hillyer, Charles E. Basch, and Alfred Neugut, “Improving Understanding About Tanning Behaviors in College Students: A Pilot Study,” Journal of American College Health 60, no. 3 (2012): 250-56.

REFERENCES AND RESOURCES

Magazines, Journals, and Newspapers

Basch, Corey Hannah, Danna Ethan, Grace Clarke Hillyer, and Alyssa Berdick. “Skin Cancer Prevention Coverage in Popular US Women’s Health and Fitness Magazines: An Analysis of Advertisements and Articles.” Global Journal of Health Science 6, no. 4 (2014): 42-48.

Basch, Corey Hannah, Grace Clarke Hillyer, Charles E. Basch, and Alfred I. Neugut. “Improving Understanding About Tanning Behaviors in College Students: A Pilot Study.” Journal of American College Health 60, no. 3 (2012): 250-56.

Buller, D. B., M. Berwick, K. Lantz et al. “Smartphone Mobile Application Delivering Personalized, Real-Time Sun Protection Advice: A Randomized Clinical Trial.” JAMA Dermatology 151, no. 5 (2015): 497-504.

Dobbinson, Suzanne J., Angela Volkov, and Melanie A. Wakefield. “Continued Impact of SunSmart Advertising on Youth and Adults’ Behaviors.” American Journal of Preventive Behaviors 49, no. 1 (2015): 20-28.

Glenn, B. A., T. Lin, L. C. Chang et al. “Sun Protection Practices and Sun Exposure Among Children with a Parental History of Melanoma.” Cancer Epidemiology, Biomarkers & Prevention 24, no. 1 (2015): 169-77.

Gould, M., M. D. Farrar, R. Kift et al. “Sunlight Exposure and Photoprotection Behaviour of White Caucasian Adolescents in the UK.” Journal of the European Academy of Dermatology and Venereology 29, no. 4 (2015): 732-37.

Lee, Andrew, Kieran Benjamin Garbutcheon-Singh, Shreya Dixit et al. “The Influence of Age and Gender in Knowledge, Behaviors and Attitudes Towards Sun Protection: A Cross-Sectional Survey of Australian Outpatient Clinic Attendees.” American Journal of Clinical Dermatology 16 (2015): 47-54.

Miller, K. A., B. M. Langholz, T. Ly et al. “SunSmart: Evaluation of a Pilot School-Based Sun Protection Intervention in Hispanic Early Adolescents.” Health Education Research 30, no. 3 (2015): 371-79.

Tuong, W., and A. W. Armstrong. “Participant Satisfaction with Appearance-Based Versus Health-Based Educational Videos Promoting Sunscreen Use: A Randomized Controlled Trial.” Dermatology Online Journal 21, no. 2 (February 2015).

White, K. M., C. Starfelt, R. M. Young et al. “A Randomised Controlled Trial of an Online Theory-Based Intervention to Improve Adult Australians’ Sun-Protection Behaviours.” Preventive Medicine 72 (2015): 19-22.

Web Site

Skin Cancer Foundation. www.skincancer.org .

  This information is not a tool for self-diagnosis or a substitute for professional care.