Sunscreen Use and Benefits
Introduction
Skin cancer is the most common form of cancer in the United States, with 3.5 million cases and around 2 million cases diagnosed each year (Ahmedin, et al., 2006). The incidence rate of both melanoma and non-melanoma skin cancer is increasing with cutaneous malignant melanoma incidence rising 81% over the course of 30 years (Planta, 2011) and non-melanoma skin cancer (NMSC) incidence rising 77% between 1992 and 2006 (Rigel, 2014) However, both of these types of skin cancer are largely preventable by use of protective behaviors (“Recommendations”, 2004). The two most effective health behaviors for preventing skin cancer are sunscreen use (Pols, Williams, Pandeya, Logan, & Green, 2006) and limiting one’s exposure to ultra violet rays (“Recommendations”, 2004). Sunscreen use is easier to change because it has less effects on daily life and has a large potential to decrease cancer incidence. According to a study done by Van Der Pols, J., Williams, G., Pandeya, N., Logan, V., & Green, A. (2006), with regular sunscreen use over a long period of time (eight years in this study), tumor incidence of squamous cell carcinoma decreased 38% and squamous cell carcinoma incidence decreased 35% in the sunscreen treatment group versus the control group which only sporadically applied sunscreen. Unfortunately in the United States, regular facial sunscreen use by adults is low with only 18.1% of men and 42.6% of women applying sunscreen to their face daily and even lower values for areas other than the face (Holman, et al., 2015). Sunscreen use in the United States is low (Holman, et al., 2015), but with increased use as a society we can decrease the incidence rate of skin cancer (Pols, Williams, Pandeya, Logan, & Green, 2006).
Literature Review
Education and Behavioral Engagement
Sunscreen use among children and teenagers is low. One study, which surveyed 220 teenagers found that 31% applied sunscreen 25% of the time they were exposed to the sun and 33% didn’t apply it at all (Banks, Silverman, & Schwartz, 1992). Another study done on children had similar findings with only 33% of children using sunscreen routinely during the summer (Geller, et al., 2002). Also reapplication of sunscreen after one hour of sun exposure was extremely low in male teens, 13%, and relatively low in female teens, 40% (Banks, Silverman, & Schwartz, 1992). The top reason given by teens as to why sunscreen was not used was they “tanned easy and rarely burned” (Banks, Silverman, & Schwartz, 1992). The same study also stated 88% of teenagers believed skin damage only occurs when a sun burn occurs.
Melanoma has genetic links, which means some individuals are predisposed to acquire melanoma due to their genes (Aspinwall, Taber, Kohlman, Leaf & Leachman, 2014). Family history of skin cancer has no significant impact on whether children apply sunscreen, and surprisingly parents of children with a genetic risk are only 7% more likely to insist on sunscreen use (Banks, Silverman, & Schwartz, 1992). Interestingly when genetically tested and educated about being at high-risk for melanoma, adults reported spending less time of daily sun exposure and a significant decrease in sunburn incidence (Aspinwall, Taber, Kohlman, Leaf & Leachman, 2014). Both the incorrect answers from the teens and the immense disparity between those genetically tested and educated versus the predisposed uneducated children, show the colossal importance of education.
Promotion of Sunscreen Use
Prior research has demonstrated multiple techniques for promoting the use of sunscreen. One study, which investigated how to influence high school students to wear sunscreen, found appearance-based videos to be more useful than health-based videos. Teenagers were more influenced by imagery of the consequences of not engaging in sunscreen use versus the health benefits of sunscreen use (http://eprints.cdlib.org/uc/item/5w96b4p0#page-2). Another study found a surprisingly successful route to promote positive health behaviors in college-aged women; short online surveys. The survey found a reduction of tanning bed use by 83% simply by having individuals take a survey and providing educational feedback (http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4721326/). Both of these studies used education as a means of promoting sunscreen use.
Gender and demographics are an extremely important aspect of promoting sunscreen use. Young men and women have many different beliefs about sunscreen use. Females are more likely to participate in preventative behaviors, while males change behavior after a perceived consequence is present. Overall, males are much less likely to use sunscreen than their female counterparts (http://heb.sagepub.com/content/30/1/29.full.pdf+html). There are also different attitudes among different demographics. Spanish speaking U.S. citizens have a lower level of skin care awareness when compared to US-born or non-U.S. born English speakers (http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4575745/). Both of these studies present the importance to having a gender and demographic based intervention when attempting to promote sunscreen use.
Sunscreen Use during Childhood
As with nearly all health behaviors, attitudes about and likelihood of engaging in sunscreen use are developed during childhood. One study analyzed the effect of high-level sun exposure at different age periods. The study found high-level of sun exposure at a young age is a strong determinant of melanoma risk later in life, although adult sun exposure also play a role (http://ck8zf4yc8t.scholar.serialssolutions.com/?sid=google&auinit=DC&aulast=Whiteman&atitle=Childhood+sun+exposure+as+a+risk+factor+for+melanoma:+a+systematic+review+of+epidemiologic+studies&id=doi:10.1023/A:1008980919928&title=Cancer+causes+%26+control&volume=12&issue=1&date=2001&spage=69&issn=0957-5243). The same study also found that in children there is an inverse relationship between age and positive attitudes towards sun protection. At a young age, parents are the primary influence for protecting their child from the sun. Research suggests the ideal time to implement a sun protection intervention during childhood is 6th through 8th grade. At this point, attitudes and behaviors become less favorable toward sun protection, parental influence decreases, and sun burn rates increase (http://ck8zf4yc8t.scholar.serialssolutions.com/?sid=google&auinit=H&aulast=Dixon&atitle=Sun+protection+and+sunburn+in+primary+school+children:+the+influence+of+age,+gender,+and+coloring.&id=doi:10.1006/pmed.1998.0392&title=Preventive+medicine&volume=28&issue=2&date=1999&spage=119&issn=0091-7435). Parental attitudes toward tanning and sunscreen use play a large role in shaping children’s attitudes and behaviors. One study quantified parental attitudes towards their child tanning. The study found many parents have a neutral opinion about their children tanning. 40% of the respondents would let their child tan in the coming year and a surprising 30% believed their child looks healthier with a tan. This is staggering because the children tanning have an increased risk of burning and therefore an increased risk of skin cancer later in life (http://ck8zf4yc8t.scholar.serialssolutions.com/?sid=google&auinit=DC&aulast=Whiteman&atitle=Childhood+sun+exposure+as+a+risk+factor+for+melanoma:+a+systematic+review+of+epidemiologic+studies&id=doi:10.1023/A:1008980919928&title=Cancer+causes+%26+control&volume=12&issue=1&date=2001&spage=69&issn=0957-5243).
Discussion
In order to decrease the incidence of skin cancer in the United States, as a society, we need to increase our use of sunscreen (http://cebp.aacrjournals.org/content/15/12/2546.full.pdf+html). The most effective way of doing this is through educating children and parents about the risks associated with sun exposure along with the benefits of sunscreen (http://ck8zf4yc8t.scholar.serialssolutions.com/?sid=google&auinit=DC&aulast=Whiteman&atitle=Childhood+sun+exposure+as+a+risk+factor+for+melanoma:+a+systematic+review+of+epidemiologic+studies&id=doi:10.1023/A:1008980919928&title=Cancer+causes+%26+control&volume=12&issue=1&date=2001&spage=69&issn=0957-5243). In order to promote sunscreen use, educational, appearance based videos should be used in teenage populations (http://eprints.cdlib.org/uc/item/5w96b4p0#page-2). Interventions aimed at increasing adult sunscreen use should be gender and demographic specific because attitude vary between gender and population (http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4575745/) (http://heb.sagepub.com/content/30/1/29.full.pdf+html). Interventions aimed at children should be implemented during grades 6th through 8th in order to target the period when the child is most at risk of sunburn (http://ck8zf4yc8t.scholar.serialssolutions.com/?sid=google&auinit=H&aulast=Dixon&atitle=Sun+protection+and+sunburn+in+primary+school+children:+the+influence+of+age,+gender,+and+coloring.&id=doi:10.1006/pmed.1998.0392&title=Preventive+medicine&volume=28&issue=2&date=1999&spage=119&issn=0091-7435).
Conclusion
Skin cancer is a major health concern in the United States and its incidence rate continues to increase (http://ck8zf4yc8t.scholar.serialssolutions.com/?sid=google&auinit=H&aulast=Dixon&atitle=Sun+protection+and+sunburn+in+primary+school+children:+the+influence+of+age,+gender,+and+coloring.&id=doi:10.1006/pmed.1998.0392&title=Preventive+medicine&volume=28&issue=2&date=1999&spage=119&issn=0091-7435) (http://www.jabfm.org/content/24/6/735.long). Considering both types of skin cancer are largely avoidable by use of protective behaviors, it is possible curb or decrease the incidence rate (http://ck8zf4yc8t.scholar.serialssolutions.com/?sid=google&aulast=Task+Force+on+Community+Preventive+Services&atitle=Recommendations+to+prevent+skin+cancer+by+reducing+exposure+to+ultraviolet+radiation&id=doi:10.1016/j.amepre.2004.08.003&title=American+journal+of+preventive+medicine&volume=27&issue=5&date=2004&spage=467&issn=0749-3797). The best way to achieve this is through education and gender/demographic specific interventions (http://heb.sagepub.com/content/30/1/29.full.pdf+html) (http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4575745/). Further research need to be done in order to investigate specific demographics’ attitudes towards sun protective behaviors, most were done in the United States and Australia.
Safety On Sunscreen 