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Ward J, Hardin-Fanning F, LaJoie AS, Harris L, Simpson A. Outdoor workers' perceptions of skin cancer prevention: a qualitative study. Ann Work Expo Health 2024; 68:636-646. [PMID: 38742833 DOI: 10.1093/annweh/wxae039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Accepted: 04/25/2024] [Indexed: 05/16/2024] Open
Abstract
OBJECTIVES Outdoor workers are at increased risk for skin cancer and melanoma. This qualitative study aimed to explore outdoor workers' perspectives and experiences of primary (i.e. sun protection) and secondary prevention, i.e. skin self-examination (SSE) of skin cancer. METHODS Purposive, snowball, and theoretical sampling was used to recruit outdoor workers in Kentucky and Indiana. Semi-structured interviews via telephone or videoconference of approximately 45 min were conducted with interviewer probes and questions about perceptions of cancer risk, prevention, and screening techniques conducted, perceived barriers and facilitators, and preferences for health dissemination venues. The recordings were transcribed verbatim and de-identified. Analysis involved constructivist grounded theory coding strategies. Using peer debriefing and consensus building around themes, the researcher established a codebook for all interviews to utilize within Dedoose software for systematizing and organizing data. RESULTS Eighteen interviews were conducted. Interviewees (N = 18) ranged in age from 35 to 78 yr, with 3 females. Outdoor industries included agriculture, maintenance, and grounds maintenance. Themes derived from the data showed the underlying factors and perceptions that influence outdoor workers to conduct primary and secondary cancer prevention activities. The level of alarm attributed to disease and the level of trust in information contribute to intentions to conduct activities. The intentions and trust toward healthcare institutions and providers drive the primary or secondary prevention behaviors. Cultural and contextual factors included masculinity and self-sufficiency, familial and occupational priorities, and community ties. CONCLUSIONS These data provide a basis for developing future communications and interventions to decrease skin cancer incidence in outdoor workers. They indicate that secondary prevention and building self-efficacy in conducting SSE should be emphasized in tandem or over primary skin cancer prevention methods in this population. Trusted local healthcare providers should primarily provide prevention information, and materials should utilize testimonials from the local community to best influence this population. Communications and training interventions are needed in this population to induce a proactive level of alarm about cancer and result in the performance of SSE.
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Affiliation(s)
- Jeanne Ward
- Department of Nursing, University of Louisville, 555 S. Floyd, Louisville, KY 40202, United States
| | - Frances Hardin-Fanning
- Department of Nursing, University of Louisville, 555 S. Floyd, Louisville, KY 40202, United States
| | - Andrew Scott LaJoie
- Department of Public Health and Information Sciences, University of Louisville, 485 E. Gray St., Louisville, KY 40202, United States
| | - Lesley Harris
- Department of Social Work, University of Louisville, 2217 S. Third St., Louisville, KY 40292, United States
| | - Anna Simpson
- Department of Public Health and Information Sciences, University of Louisville, 485 E. Gray St., Louisville, KY 40202, United States
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Thoonen K, Woodhouse S, Minto C, Blane S, Talati Z. Patterns of Sun Protection Behaviours among Australian Adolescents and Adults over a Six-Year Period. Curr Oncol 2023; 30:7178-7188. [PMID: 37623001 PMCID: PMC10453427 DOI: 10.3390/curroncol30080520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Revised: 07/17/2023] [Accepted: 07/21/2023] [Indexed: 08/26/2023] Open
Abstract
The major cause for skin cancer is the excessive and unprotected exposure to ultraviolet radiation (UVR), which can be prevented by engaging in sun protection behaviours. As longitudinal studies on both adolescents' and adults' performances of sun protection behaviours are limited, the current study aimed to investigate changes in sun protection in these population segments in Western Australia, a region with high annual UVR. During six summer seasons (2015/16 to 2020/21), cross-sectional surveys were conducted among 1806 adolescents (14 to 17 years old) and 1808 adults (18-45 years old), investigating the frequency of five sun protection behaviours (wearing clothing, applying sunscreen, wearing a hat, wearing sunglasses, and seeking shade) and sun avoidance (staying indoors). Over the six-year period, staying indoors increased in both groups. Among adolescents, a decrease in wearing clothing and sunglasses and an increase in seeking shade was demonstrated, and hat and sunscreen use remained relatively stable. Among adults, an increase in sunscreen use was shown, whereas all other sun-related behaviours remained consistent over the six-year period. The results from this study can provide directions for health communications focusing on improving sun protection behaviours among both adolescent and adult populations.
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Affiliation(s)
- Karlijn Thoonen
- Melbourne Centre for Behaviour Change, Melbourne School of Psychological Sciences, The University of Melbourne, Melbourne 3010, Australia
| | - Sade Woodhouse
- School of Population Health, Curtin University, Perth 6845, Australia (Z.T.)
| | - Carolyn Minto
- Cancer Council Western Australia, Perth 6008, Australia;
| | - Sally Blane
- Cancer Council Western Australia, Perth 6008, Australia;
| | - Zenobia Talati
- School of Population Health, Curtin University, Perth 6845, Australia (Z.T.)
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Tang E, Fung K, Chan AW. Incidence and mortality rates of keratinocyte carcinoma from 1998-2017: a population-based study of sex differences in Ontario, Canada. CMAJ 2021; 193:E1516-E1524. [PMID: 34607845 PMCID: PMC8568084 DOI: 10.1503/cmaj.210595] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/21/2021] [Indexed: 01/10/2023] Open
Abstract
Background: Keratinocyte carcinoma is the most common malignant disease, but it is not captured in major registries. We aimed to describe differences by sex in the incidence and mortality rates of keratinocyte carcinoma in Ontario, Canada. Methods: We conducted a population-based retrospective study of adults residing in Ontario between Jan. 1, 1998, and Dec. 31, 2017, using linked health administrative databases. We identified the first diagnosis of keratinocyte carcinoma using a validated algorithm of health insurance claims, and deaths related to keratinocyte carcinoma from death certificates. We calculated the incidence and mortality rates of keratinocyte carcinoma, stratified by sex, age and income quintile. We evaluated trends using the average annual percentage change (AAPC) based on joinpoint regression. Results: After decreasing from 1998 to 2003, the incidence rate of keratinocyte carcinoma increased by 30% to 369 per 100 000 males and 345 per 100 000 females in 2017 (AAPC 1.9%, 95% confidence interval [CI] 1.7 to 2.1 from 2003 to 2017). The incidence rate was higher in females younger than 55 years, but higher in males aged 55 years or older. Between 2008 and 2017, the incidence rate rose faster in females than males aged 45–54 years (AAPC 1.2% v. 0.5%, p = 0.01) and 55–64 years (1.2% v. 0.1%, p < 0.01). The incidence was higher in males than females in the higher income quintiles. Between 1998 and 2017, the mortality rate of keratinocyte carcinoma was 1.8 times higher in males than females, on average, and rose 4.8-fold overall (AAPC 8.9%, 95% CI 6.4 to 11.4 in males; 8.0%, 95% CI 5.3–10.8 in females). Interpretation: The population burden of keratinocyte carcinoma is growing, and the incidence and mortality rates rose disproportionately among certain sex- and age-specific groups. This warrants further investigation into causal factors and renewed preventive public health measures.
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Affiliation(s)
- Evan Tang
- Faculty of Medicine (Tang), University of Toronto; ICES (Fung, Chan); Division of Dermatology, Department of Medicine (Tang, Chan), Women's College Research Institute, Women's College Hospital, Toronto, Ont
| | - Kinwah Fung
- Faculty of Medicine (Tang), University of Toronto; ICES (Fung, Chan); Division of Dermatology, Department of Medicine (Tang, Chan), Women's College Research Institute, Women's College Hospital, Toronto, Ont
| | - An-Wen Chan
- Faculty of Medicine (Tang), University of Toronto; ICES (Fung, Chan); Division of Dermatology, Department of Medicine (Tang, Chan), Women's College Research Institute, Women's College Hospital, Toronto, Ont.
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Amano K, Xiao K, Wuerger S, Meyer G. A colorimetric comparison of sunless with natural skin tan. PLoS One 2020; 15:e0233816. [PMID: 33315862 PMCID: PMC7735640 DOI: 10.1371/journal.pone.0233816] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Accepted: 11/23/2020] [Indexed: 11/18/2022] Open
Abstract
The main ingredient of sunless tanning products is dihydroxyacetone (DHA). DHA reacts with the protein and amino acid composition in the surface layers of the skin, producing melanoidins, which changes the skin colour, imitating natural skin tan caused by melanin. The purpose of this study was to characterise DHA-induced skin colour changes and to test whether we can predict the outcome of DHA application on skin tone changes. To assess the DHA-induced skin colour shift quantitatively, colorimetric and spectral measurements of the inner forearm were obtained before, four hours and 24 hours after application of a 7.5% concentration DHA gel in the experimental group (n = 100). In a control group (n = 60), the same measurements were obtained on both the inner forearm (infrequently sun-exposed) and the outer forearm (frequently sun-exposed); the difference between these two areas was defined as the naturally occurring tan. Skin colour shifts caused by DHA tanning and by natural tanning were compared in terms of lightness (L*), redness (a*) and yellowness (b*) in the standard CIELAB colour space. Naturalness of the DHA-induced skin tan was evaluated by comparing the trajectory of the chromaticity distribution in (L*, b*) space with that of naturally occurring tan. Twenty-four hours after DHA application, approximately 20% of the skin colour samples became excessively yellow, with chromaticities outside the natural range in (L*, b*) space. A principal component analysis was used to characterise the tanning pathway. Skin colour shifts induced by DHA were predicted by a multiple regression on the chromaticities and the skin properties. The model explained up to 49% of variance in colorimetric components with a median error of less than 2 ΔE. We conclude that the control of both the magnitude and the direction of the colour shift is a critical factor to achieve a natural appearance.
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Affiliation(s)
- Kinjiro Amano
- Department of Psychology, University of Liverpool, Liverpool, United Kingdom
| | - Kaida Xiao
- School of Design, University of Leeds, Leeds, United Kingdom
| | - Sophie Wuerger
- Department of Psychology, University of Liverpool, Liverpool, United Kingdom
| | - Georg Meyer
- Department of Psychology, University of Liverpool, Liverpool, United Kingdom
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5
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Buller DB, Reynolds KD, Buller MK, Massie K, Berteletti J, Ashley J, Meenan R. Parent reports of sun safety communication and behaviour for students in a randomised trial on a school policy implementation intervention. Aust N Z J Public Health 2020; 44:208-214. [PMID: 32459394 DOI: 10.1111/1753-6405.12987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Revised: 02/01/2020] [Accepted: 03/01/2020] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE Schools are an important setting for skin cancer prevention. An intervention for implementation of school sun safety policy, Sun Safety Schools (SSS), was evaluated. METHODS Primary schools (n=118) in California school districts that had already adopted a sun safety policy were enrolled in a study with a randomised controlled design. Half of the schools were randomised to SSS intervention (N=58). Parents completed an online post-test. RESULTS More parents in intervention schools received information about sun safety (mean=26.3%, sd=3.1%, p=0.017) and children more frequently wore sun-protective clothing when not at school (mean=2.93, sd=0.03, p=0.033) than in control schools (mean=18.0%, sd=2.5%; mean=2.83, sd=0.03, respectively). In schools where principals reported implementing sun safety practices, parents reported that children spent less time outdoors at midday (mean=14.78 hours, sd=0.25, p=0.033) and fewer were sunburned (mean=12.7%, sd=1.1%, p=0.009) than in non-implementing schools (M=16.3 hours, sd=0.67; mean=21.2%, sd=3.8%, respectively). Parents who received sun safety information (mean=3.08, sd=0.04, p=0.008) reported more child sun protection than parents not receiving information (mean=2.96, sd=0.02). CONCLUSIONS A school district sun protection policy and support for implementation increased dissemination of sun safety information to parents and student sun safety. Implications for public health: Technical assistance for sun safety policies may increase sun protection of children.
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Affiliation(s)
| | - Kim D Reynolds
- School of Community and Global Health, Claremont Graduate University, California, US
| | | | - Kim Massie
- School of Community and Global Health, Claremont Graduate University, California, US
| | | | | | - Richard Meenan
- Kaiser Permanente Center for Health Research, Oregon, US
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Thoonen K, Schneider F, Candel M, de Vries H, van Osch L. Childhood sun safety at different ages: relations between parental sun protection behavior towards their child and children's own sun protection behavior. BMC Public Health 2019; 19:1044. [PMID: 31382940 PMCID: PMC6683475 DOI: 10.1186/s12889-019-7382-0] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Accepted: 07/26/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Sunburns during childhood are strongly associated with development of melanoma in later life. While parents play an important role in children's sun protection, insight in possible shifts in behavioral responsibility from parents towards their children and the possible effect of children's sex is important for targeting sun safety interventions throughout childhood and adolescence. METHODS This cross-sectional survey study was conducted among a representative sample of Dutch parents (N = 1053) of children aged between 4 and 13 years old. Questionnaires measured both parental and children's own sun safety behavior during planned (e.g. going to the beach) and incidental (e.g. bycicling) sun exposure situations. Analyses of variance were used to test for age group differences and linear regression models were computed to detect behavioral shifts in executive behavior. RESULTS Parents applied all sun safety behaviors (i.e. sunscreen use, wearing UV-protective clothing and seeking shade) more often on younger children, except for supportive behavior (facilitating children's own sun safety behavior), which remained relatively stable over the years. Older children and girls were more likely to execute sun safety behaviors themselves. A behavioral shift was found in wearing UV-protective clothing during planned situations among 11 year old children. For other behaviors, shifts were predicted after the age of 13. CONCLUSIONS Older children execute sun safety behaviors more often than younger children, although they still largely depend on their parents' protection. Specific attention for boys in the primary school years, and for both boys and girls in the years adjacent to adolescence is warranted in skin cancer prevention interventions.
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Affiliation(s)
- Karlijn Thoonen
- Department of Health Promotion, School CAPHRI, Maastricht University, Maastricht, the Netherlands.
| | - Francine Schneider
- Department of Health Promotion, School CAPHRI, Maastricht University, Maastricht, the Netherlands
| | - Math Candel
- Department of Methodology and Statistics School CAPHRI, Maastricht University, Maastricht, the Netherlands
| | - Hein de Vries
- Department of Health Promotion, School CAPHRI, Maastricht University, Maastricht, the Netherlands
| | - Liesbeth van Osch
- Department of Health Promotion, School CAPHRI, Maastricht University, Maastricht, the Netherlands
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Daniel CL, Gassman NR. A truly safer alternative? Sunless tanning products and the unknown. Prev Med 2018; 112:45-46. [PMID: 29626559 DOI: 10.1016/j.ypmed.2018.04.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Revised: 02/24/2018] [Accepted: 04/02/2018] [Indexed: 11/29/2022]
Affiliation(s)
- Casey L Daniel
- University of South Alabama, Mitchell Cancer Institute, United States
| | - Natalie R Gassman
- University of South Alabama, Mitchell Cancer Institute, United States.
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8
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Intentional outdoor tanning in the United States: Results from the 2015 Summer ConsumerStyles survey. Prev Med 2017; 101:137-141. [PMID: 28601617 PMCID: PMC5664932 DOI: 10.1016/j.ypmed.2017.06.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2016] [Revised: 06/01/2017] [Accepted: 06/05/2017] [Indexed: 10/19/2022]
Abstract
There is limited literature about adults in the United States who usually or always spend time outdoors for the purpose of developing a tan, defined as intentional outdoor tanning. Using data from the 2015 Summer ConsumerStyles, an online cross-sectional survey weighted to the US adult population (n=4,127), we performed unadjusted and adjusted multivariable logistic regressions to examine the associations between demographic characteristics, behaviors, and belief factors related to skin cancer risk and intentional outdoor tanning. Nearly 10% of the study population intentionally tanned outdoors. Outdoor tanning was more prevalent among women (11.4%), non-Hispanic white individuals (11.5%), those aged 18-29years (14.1%), those without a high school diploma (12.7%), and those in the northeast United States (13.2%). The adjusted odds of outdoor tanning were significantly higher among women than men (adjusted odds ratio [AOR] 1.51, 95% confidence interval [CI] 1.12-2.04); those with a history of indoor tanning or recent sunburn than those without (AOR 2.61, CI 1.94-3.51; AOR 1.96, CI 1.46-2.63, respectively); those who agreed they looked better with a tan than those who did not (AOR 6.69, CI 3.62-12.35); and those who did not try to protect their skin from the sun when outdoors than those who did (AOR 2.17, CI 1.56-3.04). Adults who engaged in other risky behaviors that expose a person to ultraviolet (UV) radiation were more likely to tan outdoors, further increasing their risk of skin cancer. These findings may guide potential interventions to reduce UV exposure from outdoor tanning.
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Cheetham I, Ogden J. Enhancing sun safety in young women: The relative impact of format and temporal framing on beliefs and behaviour. COGENT PSYCHOLOGY 2016. [DOI: 10.1080/23311908.2016.1210069] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Affiliation(s)
- Indiana Cheetham
- School of Psychology, University of Surrey, Guildford, GU2 7XH, UK
| | - Jane Ogden
- School of Psychology, University of Surrey, Guildford, GU2 7XH, UK
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10
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Ashrafioun L, Bonar EE. Psychometric assessment of the craving to tan questionnaire. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2014; 41:74-81. [PMID: 25140759 DOI: 10.3109/00952990.2014.939754] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Researchers and clinicians suggest that excessive tanning may be a behavioral addiction. Given the significance of craving in substance use, craving may be a useful construct to assess in those who tan. OBJECTIVE We designed this study to assess the psychometric properties of an alcohol craving measure adapted to measure past-week craving to tan. METHODS Undergraduate students (n = 421) who reported past-month tanning completed a battery of questionnaires that assessed demographics, tanning-related characteristics, and psychopathology, in addition to the Craving to Tan Questionnaire (CTQ). RESULTS Analyses provided support for a single factor CTQ with good internal consistency, construct validity and convergent validity. CTQ scores were significantly higher among problematic versus non-problematic and dependent versus non-dependent tanners. CTQ scores were also associated with several tanning-related characteristics, such money spent on tanning in a typical month, frequency of tanning, and frequency of tanning-related problems. Additional analyses found that past-week craving to tan was significantly associated with greater obsessive compulsive and body dysmorphic symptoms. CONCLUSIONS It may be useful in clinical settings to identify those experiencing problems with tanning and in research to further clarify the conceptualization of addiction-like tanning. However, the CTQ needs further evaluation.
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Affiliation(s)
- Lisham Ashrafioun
- Department of Psychology, Bowling Green State University , Bowling Green, OH
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Wehner MR, Chren MM, Nameth D, Choudhry A, Gaskins M, Nead KT, Boscardin WJ, Linos E. International prevalence of indoor tanning: a systematic review and meta-analysis. JAMA Dermatol 2014; 150:390-400. [PMID: 24477278 DOI: 10.1001/jamadermatol.2013.6896] [Citation(s) in RCA: 195] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Indoor tanning is a known carcinogen, but the scope of exposure to this hazard is not known. OBJECTIVE To summarize the international prevalence of exposure to indoor tanning. DATA SOURCES Studies were identified through systematic searches of PubMed (1966 to present), Scopus (1823 to present), and Web of Science (1898 to present) databases, last performed on March 16, 2013. We also hand searched reference lists to identify records missed by database searches and publicly available data not yet published in the scientific literature. STUDY SELECTION Records reporting a prevalence of indoor tanning were eligible for inclusion. We excluded case-control studies, reports with insufficient study information, and reports of groups recruited using factors related to indoor tanning. Two independent investigators performed searches and study selection. Our search yielded 1976 unique records. After exclusions, 161 records were assessed for eligibility in full text, and 88 were included. DATA EXTRACTION AND SYNTHESIS Two independent investigators extracted data on characteristics of study participants, inclusion/exclusion criteria, data collection format, outcomes, and statistical methods. Random-effects meta-analyses were used to summarize the prevalence of indoor tanning in different age categories. We calculated the population proportional attributable risk of indoor tanning in the United States, Europe, and Australia for nonmelanoma skin cancer (NMSC) and melanoma. MAIN OUTCOMES AND MEASURES Ever and past-year exposure to indoor tanning. RESULTS The summary prevalence of ever exposure was 35.7% (95% CI, 27.5%-44.0%) for adults, 55.0% (33.0%-77.1%) for university students, and 19.3% (14.7%-24.0%) for adolescents. The summary prevalence of past-year exposure was 14.0% (95% CI, 11.5%-16.5%) for adults, 43.1% (21.7%-64.5%) for university students, and 18.3% (12.6%-24.0%) for adolescents. These results included data from 406 696 participants. The population proportional attributable risk were 3.0% to 21.8% for NMSC and 2.6% to 9.4% for melanoma, corresponding to more than 450 000 NMSC cases and more than 10 000 melanoma cases each year attributable to indoor tanning in the United States, Europe, and Australia. CONCLUSIONS AND RELEVANCE Exposure to indoor tanning is common in Western countries, especially among young persons. Given the large number of skin cancer cases attributable to indoor tanning, these findings highlight a major public health issue.
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Affiliation(s)
- Mackenzie R Wehner
- Department of Dermatology, University of California, San Francisco2Stanford University School of Medicine, Stanford, California3Department of Public Health and Primary Care, University of Cambridge, Cambridge, England
| | - Mary-Margaret Chren
- Department of Dermatology, University of California, San Francisco4Department of Dermatology, San Francisco Veterans Affairs Medical Center, San Francisco, California
| | | | - Aditi Choudhry
- Department of Internal Medicine, John Muir Medical Center, Walnut Creek, California
| | - Matthew Gaskins
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, England
| | - Kevin T Nead
- Stanford University School of Medicine, Stanford, California
| | - W John Boscardin
- Department of Epidemiology and Biostatistics, University of California, San Francisco
| | - Eleni Linos
- Department of Dermatology, University of California, San Francisco
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Wehner MR, Chren MM, Nameth D, Choudhry A, Gaskins M, Nead KT, Boscardin WJ, Linos E. International prevalence of indoor tanning: a systematic review and meta-analysis. JAMA Dermatol 2014. [PMID: 24477278 DOI: 10.1001/jamadermatol.2013.6896.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Indoor tanning is a known carcinogen, but the scope of exposure to this hazard is not known. OBJECTIVE To summarize the international prevalence of exposure to indoor tanning. DATA SOURCES Studies were identified through systematic searches of PubMed (1966 to present), Scopus (1823 to present), and Web of Science (1898 to present) databases, last performed on March 16, 2013. We also hand searched reference lists to identify records missed by database searches and publicly available data not yet published in the scientific literature. STUDY SELECTION Records reporting a prevalence of indoor tanning were eligible for inclusion. We excluded case-control studies, reports with insufficient study information, and reports of groups recruited using factors related to indoor tanning. Two independent investigators performed searches and study selection. Our search yielded 1976 unique records. After exclusions, 161 records were assessed for eligibility in full text, and 88 were included. DATA EXTRACTION AND SYNTHESIS Two independent investigators extracted data on characteristics of study participants, inclusion/exclusion criteria, data collection format, outcomes, and statistical methods. Random-effects meta-analyses were used to summarize the prevalence of indoor tanning in different age categories. We calculated the population proportional attributable risk of indoor tanning in the United States, Europe, and Australia for nonmelanoma skin cancer (NMSC) and melanoma. MAIN OUTCOMES AND MEASURES Ever and past-year exposure to indoor tanning. RESULTS The summary prevalence of ever exposure was 35.7% (95% CI, 27.5%-44.0%) for adults, 55.0% (33.0%-77.1%) for university students, and 19.3% (14.7%-24.0%) for adolescents. The summary prevalence of past-year exposure was 14.0% (95% CI, 11.5%-16.5%) for adults, 43.1% (21.7%-64.5%) for university students, and 18.3% (12.6%-24.0%) for adolescents. These results included data from 406 696 participants. The population proportional attributable risk were 3.0% to 21.8% for NMSC and 2.6% to 9.4% for melanoma, corresponding to more than 450 000 NMSC cases and more than 10 000 melanoma cases each year attributable to indoor tanning in the United States, Europe, and Australia. CONCLUSIONS AND RELEVANCE Exposure to indoor tanning is common in Western countries, especially among young persons. Given the large number of skin cancer cases attributable to indoor tanning, these findings highlight a major public health issue.
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Affiliation(s)
- Mackenzie R Wehner
- Department of Dermatology, University of California, San Francisco2Stanford University School of Medicine, Stanford, California3Department of Public Health and Primary Care, University of Cambridge, Cambridge, England
| | - Mary-Margaret Chren
- Department of Dermatology, University of California, San Francisco4Department of Dermatology, San Francisco Veterans Affairs Medical Center, San Francisco, California
| | | | - Aditi Choudhry
- Department of Internal Medicine, John Muir Medical Center, Walnut Creek, California
| | - Matthew Gaskins
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, England
| | - Kevin T Nead
- Stanford University School of Medicine, Stanford, California
| | - W John Boscardin
- Department of Epidemiology and Biostatistics, University of California, San Francisco
| | - Eleni Linos
- Department of Dermatology, University of California, San Francisco
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