Adverse effects of ultraviolet radiation from the use of indoor tanning equipment: Time to ban the tan

"I Think There Should Be Photos": Female Indoor Tanners' Perceptions of Health Warning Labels for Tanning Beds

This study explores female indoor tanners' perceptions of the current, text-only Canadian health warning label (HWL) for tanning equipment, as well as pictorial, evidence-based alternative HWLs. We created 10 test HWLs that depicted skin health effects, eye damage, premature aging, and death. Young women who had tanned indoors in the past year discussed these and the current federal HWL in focus groups. Although the current Canadian HWL was seen as informative, several participants did not recognize it, and many said that they would not read it due to the small text, wordiness, and lack of an image. Graphic images, particularly those depicting permanent conditions affecting the face, eyes, or appearance, were seen as effective. Common criticisms of the images were lack of believability, relatability, and comprehensibility. Although concise text was important for encouraging reading, many participants expressed a desire for more information in the test HWLs. Premature aging was of great concern to many participants, but the images selected for these HWLs were not perceived as effective. Although the text was seen as effective in the death HWLs, most participants dismissed the images. This research has implications for IT HWLs in Canada and globally. These results suggest that graphic images may be impactful in IT HWLs. Images must be supplemented with informative text that increases believability, relatability, and comprehensibility. These modifications would create HWLs that are engaging, informative, and that form part of a wider effort to spread awareness about the harmful effects of IT.

Toll-like receptor-4 deficiency inhibits ultraviolet radiation-induced tumor development by modulation of immune and inflammatory responses

Ultraviolet (UV) B irradiation of the skin induces acute inflammation, as characterized by erythema, edema, and immunosuppression, and is subsequently linked to the progression of skin cancer. Toll-like receptor 4 (TLR4), a component of innate immunity, has been shown to play an important role in cancer. To elucidate the role of TLR4 in UVB-induced tumor development, TLR4-proficient (C3H/HeN) and TLR4-deficient (C3H/HeJ) mice were exposed to multiple doses of UVB radiation (200 mJ/cm² ) for 40 weeks. Photocarcinogenesis was retarded in terms of tumor incidence, and tumor latency, in mice deficient in TLR4 compared with TLR4-proficient mice, whereas significantly greater numbers of tumors occurred in TLR4-proficient mice. There was significant upregulation of inflammatory markers like COX-2, PGE₂ , S100A8, and S100A9 in the skin of TLR4-proficient mice than the skin of TLR4-deficient mice. Furthermore, we found that TLR4-proficient mice had a significantly higher number of Gr1+CD11b+ myeloid cells CD4+CD25+ regulatory T-cells than TLR4-deficient mice. Furthermore, the levels of interferon (IFN)-γ cytokine was increased and the levels of interleukin (IL)-4, IL-10, and IL-17 cytokines were decreased in serum, skin, and tumor lysates of TLR4-deficient mice in comparison with samples from TLR4-proficient mice. Together, our data indicate that TLR4-mediated inflammation may cause suppression of antitumor responses and trigger the development of UVB-induced skin cancers. Thus, strategies to inhibit TLR4-mediated immune suppression may allow us to develop preventive and therapeutic approaches for the management of UVB-induced cutaneous tumors.

Dispelling myths about sunscreen

Sunscreens are an important tool used to protect the skin against harmful effects of ultraviolet (UV) radiation. Many different formulations of sunscreen exist today, which can be confusing to the consumer. In this article, we highlight and address many sunscreen myths that exist today including the benefits of higher SPF sunscreen, use of sunscreen in darker skin types, and the effects of sunscreen on vitamin D production.

Assessing the content and comprehensiveness of provincial and territorial indoor tanning legislation in Canada

INTRODUCTION

Canadian provincial and territorial governments have enacted legislation in response to health risks of artificial ultraviolet radiation from indoor tanning. This legislation, which differs from jurisdiction to jurisdiction, regulates the operation of indoor tanning facilities. The content and comprehensiveness of such legislation-and its differences across jurisdictions-have not been analyzed. To address this research gap, we conducted a systematic, comprehensive scan and content analysis on provincial and territorial indoor tanning legislation, including regulations and supplementary information.

METHODS

Legislative information was collected from the Canadian Legal Information Institute database and an environmental scan was conducted to locate supplementary information. Through a process informed by the content of the legislation, previous research and health authority recommendations, we developed a 59-variable codebook. Descriptive statistics were calculated.

RESULTS

All provinces and one of three territories have legislation regulating indoor tanning. Areas of strength across jurisdictions are youth access restrictions (n = 11), posting of warning signs (n = 11), penalties (n = 11) and restrictions on advertising and marketing targeted to youth (n = 7). Few jurisdictions, however, cover areas such as protective eyewear (n = 4), unsupervised tanning (n = 4), provisions for inspection frequency (n = 4), misleading health claims in advertisements directed toward the general public (n = 2) and screening of high-risk clients (n = 0).

CONCLUSION

All provinces and one territory have made progress in regulating the indoor tanning industry, particularly by prohibiting youth and using warning labels to communicate risk. Legislative gaps should be addressed in order to better protect Canadians from this avoidable skin cancer risk.

A cancer registry-based analysis on the non-white populations reveals a critical role of the female sex in early-onset melanoma

PURPOSE

Most melanoma studies have been performed in the white population who exhibits the highest incidence rate due to their skin sensitivity to UV radiation. Previous publications have shown that young women (approximately under the menopausal age) exhibit higher incidence rates than men of the same age, and the causes are mostly attributed to their sun behavior or indoor tanning. In our recent publications, we suggested that higher risk in younger women was due to pathophysiological factors, such as hormonal impact, and thus this higher risk in young women should be shared across ethnicities regardless of their skin color or UV behavior.

METHODS

A total of 13,208 non-white melanoma patients from SEER and 15,226 from WHO CI5-Plus were extracted for analysis. Age-specific incidence rates, female-to-male incidence rate ratios, and p values were calculated.

RESULTS

As observed in the white population, younger women and older men showed higher melanoma incidence rates than their peers of the other gender in all ethnic groups. The highest female-to-male incidence rate ratios were observed in the pubescent and reproductive ages. Previously this gender discrepancy in the white population was attributed to the preference of skin tanning in young females. There is no evidence to show that darker-skinned young females adopt a similar tanning preference. Thus the age-dependent gender difference in the risk of melanoma is shared across ethnic groups and is perhaps independent of UV behavior.

CONCLUSIONS

Our results highlight the importance of gender as one of the melanoma risk factors beyond traditional UV radiation, which warrants further investigation and may provide a base for an improved prevention strategy.

Knowledge and attitudes of UK university students in relation to ultraviolet radiation (UVR) exposure and their sun-related behaviours: a qualitative study

OBJECTIVES

To explore whether knowledge about the harms of ultraviolet radiation (UVR) influences UK university students' sun-related behaviours and examine in depth their attitudes towards: sun protection, natural and artificial tanning behaviours.

DESIGN

Qualitative methodology with 15 semistructured, individual interviews. Thematic analysis using the Framework Method with analyst triangulation and member validation.

SETTING

One university in the West Midlands, UK.

PARTICIPANTS

15 Caucasian male (n=4) and female (n=11) students, aged 18-22 years, from a UK university. Participants were recruited using convenience sampling from the university's main campus followed by purposive sampling for: gender, course and sun-related behaviours.

RESULTS

Five main themes emerged: (1) knowledge of UVR; (2) sun-protection practices; (3) attitudes towards tanning; (4) external influences and (5) internal influences. All students knew the associated skin cancer risks from the sun and sunbed use, but this did not appear an important influence in their sun-related behaviours. Body image strongly motivated sun-protection practices and the desire to tan naturally or artificially, across both genders. However, participants' final decision-making appeared to be influenced by their beliefs that practising known harmful sun-related behaviours would not affect them or the perceived susceptibility to sunburn. Beliefs about sunbathing and sunscreen use prompted improper use of sun protection and inadvertently caused more harmful practices. Participants' peers, family and the media had dual roles influencing the development of attitudes towards sun protection and tanning, which contributed to how participants behaved in the sun and their engagement in tanning methods.

CONCLUSIONS

Knowledge about the risk of skin cancer associated with UVR did not strongly influence sun-related behaviours, whereas body image appeared as a key motivator. Attitudes towards sun protection and tanning stemmed from the media, peers and family, and particularly from childhood habits. Public health strategies may benefit from appearance-related skin cancer prevention campaigns, encouraging safer parental sun-related habits and correcting sun-related misconceptions.

Photocarcinogenesis: an epidemiologic perspective on ultraviolet light and skin cancer

Photocarcinogenesis is the result of a complex interplay between ultraviolet radiation, DNA damage, mutation formation, DNA repair, apoptosis, and the immune system. Recent trends show an increase in incidence of both melanoma and nonmelanoma skin cancers. Some individuals have a genetic predisposition toward increased risk for skin cancer, whereas others experience increased risk through ultraviolet exposure and subsequent mutation formation. The initiation and propagation pathways of melanoma and nonmelanoma skin cancers differ but have some elements in common. The increase in incidence of skin cancer has been discovered to vary among age groups and gender.

UV and dietary predictors of serum 25-hydroxyvitamin D concentrations among young shift-working nurses and implications for bone density and skin cancer

OBJECTIVE

In 2011, the U.S. Institute of Medicine updated the definition of vitamin D inadequacy to serum 25-hydroxyvitamin D (25(OH)D) concentration of 30-<50 nmol/l and of deficiency to serum 25(OH)D < 30 nmol/l. We describe the prevalence of these conditions according to these definitions, seasonal variation in 25(OH)D and predictors of serum 25(OH)D concentrations among working, white women.

DESIGN

Participants recorded lifestyle factors and dietary intake and provided fasting blood samples for measurement of serum 25(OH)D in both summer and winter. Predictors of serum 25(OH)D variation were analysed using linear regression and generalized linear mixed models.

SETTING

Kingston General Hospital in Kingston, Ontario, Canada, from April 2008 to July 2009.

SUBJECTS

Female premenopausal nurses (n 83) working full-time rotating shifts.

RESULTS

Deficient or inadequate vitamin D status was observed in 9% of participants following summer/autumn and in 13% following winter/spring. Predictors of serum 25(OH)D concentration were vitamin D supplement use, tanning bed use and season. Tanning bed use increased serum 25(OH)D by 23.24 nmol/l (95% CI 8.78, 37.69 nmol/l, P = 0.002) on average.

CONCLUSIONS

According to the 2011 Institute of Medicine bone health guidelines, over 10% of nurses had deficient or inadequate vitamin D status following winter. Higher serum concentrations were associated with use of tanning beds and vitamin D supplements. As health promotion campaigns and legal restrictions are successful in reducing tanning bed use among women, our data suggest that increased prevalence of vitamin D inadequacy and deficiency may be a consequence, and that low vitamin D status will need to be countered with supplementation.

Effects of solar radiation on the skin

No one would underestimate the importance of sunlight to the evolution of life on the earth and its role in human development. However, all humans - especially individuals who are lightly pigmented or whose occupation or lifestyle exposes them to excessive amounts of sunlight - are potentially susceptible to its deleterious effects. These effects can range from acute biological responses, such as sunburn and skin tanning, to conditions resulting from chronic exposure such as photoaged skin and potentially life-threatening conditions such as skin cancer. The objective of this review is to present a concise and up-to-date perspective on the effects of UVB, UVA, visible, and infrared radiation on cutaneous biochemistry and physiology.

A dermatologist's perspective on vitamin D

Vitamin D is a fat-soluble steroid hormone that is crucial for human health and has recently generated controversy regarding its role in human health and disease. In this Special Article, we discuss our dermatologic perspective on vitamin D in a question-and-answer format. We discuss methods of obtaining vitamin D, including cutaneous photobiosynthesis, diet, and supplements and include the recent US Institute of Medicine recommendations. Other reviewed topics include the associations among skin pigmentation, climate, photoprotection, and vitamin D levels. We also elaborate on the popular interest in sun exposure as a method of normalizing vitamin D levels in the context of the risks of solar and artificial radiation. We also discuss groups at risk for vitamin D inadequacy, the need for testing serum vitamin D levels, and the role of phototherapy in patients with malabsorption conditions and hypervitaminosis D, with a focus on patients with sarcoidosis. Finally, we summarize our recommendations on vitamin D.