Sunscreens With High Versus Low Sun Protection Factor and Cutaneous Squamous Cell Carcinoma Risk: A Population-Based Cohort Study.

Evidence on sunscreen use and cutaneous squamous cell carcinoma (cSCC) risk is limited. Most studies have not taken sun protection factor (SPF) into consideration and used nonusers of sunscreen as the reference group. Nonusers are likely a priori at lower cSCC risk than users. No study has investigated the effect of high- versus low-SPF sunscreens on cSCC, appropriately adjusting for time-varying confounding. Using data from the Norwegian Women and Cancer Study (1991-2016), we investigated whether use of SPF ≥15 versus SPF <15 sunscreens reduces cSCC risk. We used a marginal structural Cox proportional hazards model with inverse probability of treatment and censoring weights to estimate hazard ratios (HRs) and 95% confidence intervals (CIs). During follow-up of 148,781 women (mean follow-up, 14.3 years), 653 women were diagnosed with cSCC. The effect on cSCC risk of sunscreens with SPF ≥15 versus SPF <15 was close to the null when used at any latitudes (HR = 1.02, 95% CI: 0.82, 1.27) and when used in lower-latitude settings (HR = 1.05, 95% CI: 0.84, 1.32). In conclusion, we found no indication that sunscreens with SPF ≥15 reduced Norwegian women's cSCC risk more than sunscreens with SPF <15, suggesting that either there is no difference in their effects long-term or the difference is diluted by incorrect application.

Análise do perfil clínico de pacientes portadores de neoplasia ocular escamosa atendidos em hospital referência de oculoplástica / Analysis of the clinical profile of patients with squamous ocular neoplasms attended at a reference hospital of oculoplastics

RESUMO Objetivo Analisar o perfil clínico de pacientes portadores de neoplasias escamosas da superfície ocular. Métodos Foram avaliados os principais fatores de risco envolvidos na gênese das neoplasias escamosas da superfície ocular, as características clínicas dos pacientes e os hábitos comportamentais associados. Foram incluídos neste trabalho de coorte histórica 80 pacientes com diagnóstico anatomopatológico de neoplasia escamosa da superfície ocular atendidos entre os anos de 2010 e 2020 em um hospital referência em oculoplástica e segmento anterior de Santa Catarina. Os dados clínicos e desfechos foram avaliados por meio da análise de prontuário e entrevista, sendo posteriormente tabulados no Excel e submetidos à analise estatística por meio do software Statistical Pakage for the Social Sciences, versão 16. Resultados Foi observado que 73,8% (n=59) eram do sexo masculino. A média de idade da amostra foi de 62 anos. Quanto ao fototipo de pele, de acordo com a escala de Fitzpatrick, constatou-se que a maioria apresentou os fototipos 1 e 2 (22; 27,5% e 44; 55%, respectivamente). Em relação à exposição ocupacional ao sol/radiação, 48% (n=60) apresentaram história de exposição ocupacional, sendo que, destes, 28 pacientes trabalhavam no setor de agricultura. Dos pacientes da amostra, 33 (41,2%) apresentavam histórico pessoal de neoplasias de pele, sendo que, destes, três apresentavam diagnóstico de xeroderma pigmentoso. Quanto ao hábito de uso de fatores de proteção solar, 61% (n=49) da amostra negou o hábito. Foi evidenciada associação estatisticamente significativa entre o hábito de usar fatores de proteção solar e histórico pessoal de neoplasias de pele. Em relação ao tipo de neoplasia escamosa, a maioria dos pacientes (72; 90%) apresentou diagnóstico anatomopatológico de carcinoma espinocelular ocular. Conclusão O perfil clínico epidemiológico dos pacientes portadores de neoplasias escamosas da superfície ocular neste estudo, predominantemente de carcinoma espinoceular ocular, foi de homens, idosos, de pele clara (fototipo 2) e com histórico importante de exposição aos raios solares ultravioleta A e B. Comorbidades imunodepressoras (HIV e transplante de órgão sólido) e doenças dermatológicas (albinismo e xeroderma pigmentoso) associaram-se ao aparecimento das neoplasias escamosas da superfície ocular em idade mais precoce. Em pacientes com histórico pessoal prévio de neoplasias de pele, foi evidenciado o hábito de uso de fatores de protetor solar mais presente em relação aos demais.

ABSTRACT Objective To analyze the clinical profile of patients with ocular surface squamous neoplasms (OSSN). Methods The main risk factors involved in the genesis of the ocular surface squamous neoplasms, the clinical features, and the behavioral habits associated were evaluated. This historical cohort study included 80 patients with anatomopathological diagnosis of OSSN who were treated between 2010-2020 at a reference hospital in oculoplastic and anterior segment in Santa Catarina. The clinical data and outcomes were evalated through the analysis of medical records and interviews, being later tabulated in Excel and analyzed using the SPSS 16 software. Results Regarding the clinical profile of the patients in the sample, 73.8% (n = 59) were male. The mean age of the sample was 62 years old. As for the skin phototype, according to the Fitzpatrick scale, most of the sample presented the phototype 1 and 2 (27.5% n = 22; and 55% n = 44 respectively). Regarding occupational exposure to the sun / radiation, 48% (n = 60) had history of occupational exposure, and of these, 28 patients worked in the agricultural area. Of the patients of the sample, 33 (41.2%) had a personal history of skin neoplasms, and of these, 3 had diagnosis of xeroderma pigmentosum. As for the habit of using sun protection factors, 61% (n = 49) of the sample denied the habit. A statistically significant association was evidenced between the habit of using sun protection factors and people's history of skin cancer. Regarding the type of squamous neoplasia, most patients in the 90% sample (n = 72) had an anatomopathological diagnosis of ocular squamous cell carcinoma. Conclusion The clinical epidemiological profile of patients with OSSN in this study, predominantly ocular squamous cell carcinoma, was men, elderly, fair-skinned (phototype 2) and with an important history of exposure to UVA and UVB rays. Immunosuppressive comorbidities (HIV, solid organ transplant) and dermatological diseases (albinism, xeroderma pigmentosum) are associated with the appearance of OSSN at an early age. In patients with a previous personal history of skin neoplasms, the habit of using sunscreen factors was more present than in the other patients.

An Experimental Investigation of Human Presence and Mobile Technologies on College Students' Sun Protection Intentions: Between-Subjects Study.

BACKGROUND: Health promotion and education programs are increasingly being adapted and developed for delivery through digital technologies. With this shift toward digital health approaches, it is important to identify design strategies in health education and promotion programs that enhance participant engagement and promote behavior change. OBJECTIVE: This study aimed to examine the impact of an experiment testing various mobile health (mHealth) skin cancer prevention messages on sun protection intentions and message perceptions among American college students. METHODS: A sample of 134 college students aged 18 years or older participated in a 2×2×2 between-subjects experimental study, designed to examine the individual and combinatory effects of multiple dimensions (human presence, screen size, and interactivity) of digital technologies. The primary study outcome was intention to use sun protection; secondary outcomes included attitudes toward the information, two dimensions of trust, and information processing. RESULTS: Generally, intention to use sun protection was positively associated with the presence of human characters in the health educational messages (P<.001), delivering educational health messages on a large screen (ie, iPad; P<.001), and higher interactivity (P<.001). Only human presence produced more favorable attitudes (P=.02). Affective trust was positively associated with human presence (P=.006) and large screen size (P<.001), whereas cognitive trust was positively associated with human presence (P<.001) and small screen size (P=.007). Moreover, large screen size led to more heuristic processing (P=.03), whereas small screen size led to more systematic processing (P=.04). CONCLUSIONS: This experimental study demonstrates that the impact of mHealth skin cancer prevention messages differs based on platform and delivery design features. Effects on behavioral intentions, attitudes, and trust were found for conditions with human presence, highlighting the importance of including this feature in mHealth programs. Results from this experimental study can be used to optimize the design of mHealth educational interventions that promote sun protection.

Differences in Sun Protection Behaviors Between Rural and Urban Communities in Texas.

PURPOSE: The increasing incidence of skin cancer is a global health issue. In order to identify at-risk populations in Texas, we compared sun protection behaviors and sunburn history across rural and urban counties. METHODS: An online health screening survey collected data from a nonprobability sample of Texas residents in 2018. Data were weighted by sex, age, race, and ethnicity. Multinomial multivariable logistic regression identified key factors associated with sun protection behaviors and sunscreen use. Weighted Pearson's χ2  test identified differences between urban and rural respondents in strength of sunscreen used and sunburn history. FINDINGS: Rural residents in Texas were less likely to seek shade (OR = 0.58; P = .004) and less likely to use sunscreen lotion (OR = 0.65; P = .013) compared to their urban counterparts. Sunscreen use was also lower among current versus never smokers (OR = 0.67; P = .034) but higher in those with personal versus no cancer history (OR = 2.14; P = .004). Although rural versus urban residents were more likely to use higher SPF sunscreen (P < .002), they had more blistering sunburns over the course of their life (P < .001) and these injuries were more likely to occur at an earlier age, between 5 and 14 years old (P < .001). CONCLUSIONS: Increased attention to sun protective behaviors among rural communities in Texas is vital to help reduce the high prevalence of sunburn injury and incidence of skin cancer.

Sunscreen use at Danish beaches and how to improve coverage.

Exposure to ultraviolet radiation (UVR) from the sun is the main risk factor for development of skin cancer. The incidence of skin cancer in Denmark and worldwide is high and increasing. The overall aim was to achieve basic knowledge about sun protection with sunscreen among beachgoers in Denmark. Other aims were to establish a method to investigate sunscreen distribution on the body and to test two approaches to optimize the used amount and body distribution of sunscreen. Furthermore, time and duration of a beach visit and use of protective clothes among beachgoers were determined to investigate the risk the beachgoers expose themselves to. 
Of the counted number of beachgoers 46% were at the beach between noon and 3 p.m. where the UVR is strongest and a mean beach visit lasted 142 minutes. In the middle of the day 90% of the beachgoers wore swimwear and sunscreen application was their only possible sun protection. More beachgoers wore protective clothes in the morning and late afternoon.
 Seventy-eight percent of women wearing swimwear reported sunscreen use at the beach and 49% of men reported sunscreen use. They used a sunscreen with a median sun protection factor (SPF) of 20 (interquartile range: 15-30). The effective SPF probably decreases exponentially with decreasing quantity of sunscreen applied. Users at the beach applied a mean quantity of 0.57 mg/cm2 (standard deviation 0.31 mg/cm2) to their sun accessible skin, i.e. skin not covered by swimwear or scalp hair, providing a mean effective SPF of 2.3. Both SPF chosen and quantity applied were independent of sex. 
Two approaches to increase sunscreen use was tested; the rule of thumb: "Fill up a handful of sunscreen and spread it all over your body", and a recommendation to apply sunscreen two consecutive times. Both strategies increased the total amount of sunscreen significantly. The instruction: "Fill up a handful of sunscreen and spread it all over your body" increased the median quantity of sunscreen to 0.87 mg/cm2 whereas double application increased the quantity to 1.10 mg/cm2. Sunscreen with a label SPF of 20 applied in a quantity of 0.87 mg/cm2 provided an effective SPF of 3.7. Applied in a quantity of 1.10 mg/cm2 provided an effective SPF of 5.2. 
A method based on a link between darkness of skin in black light illumination and the quantity of sunscreen applied was established and made it possible to investigate the distribution of sunscreen on the body. Sunscreen was very unevenly applied both after application of a handful and after double application. The face and the front of the trunk were generally well covered whereas the back of the trunk was poorly covered. After a single application, either as at the beach or with the use of a handful of sunscreen, about one fifth of the total accessible skin was left without sunscreen. After double application only about a 9% of the accessible skin was left uncovered. As especially missed areas are at risk of getting sunburned double application seems to be the better of the two tested strategies to improve coverage.

Kite-surfers' sun risk in the tropics.

A preliminary inquiry, conducted on Martinique Island, sought to determine kite-surfers' sun-protection knowledge and behaviours. Results revealed good levels of knowledge and behaviours, but very frequent sunburns (74% had at least one sunburn during the last 6 months), with particularly severe sunburns exclusively among vacationers. These results argue for the double need to focus sunburn-prevention programs on vacationers and technically adapt sun-protection means to a tropical maritime environment.

Hydrolyzed collagen interferes with in vitro photoprotective effectiveness of sunscreens

ABSTRACT The chronological skin aging is a progressive and natural process with genetic and physiological changes. However, ultraviolet (UV) radiation may accelerate the oxidative stress, generating carcinogenesis and photoaging. Natural compounds and their applications are considered a trend in the cosmetic market. The protein-based film-forming compounds play an important role, once it collaborates for the better distribution of sunscreens on the skin. Here we investigated the in vitro photoprotective effectiveness of sunscreens containing the hydrolyzed collagen associated with UVA, UVB and/or inorganic filters. Sunscreens were developed with octocrylene (7.5%), butyl methoxydibenzoylmethane (avobenzone) (3.0%) and/or titanium dioxide (5.0%), associated or not with the hydrolyzed collagen (3.0%). In vitro photoprotective effectiveness was determined in a Labsphere(r) UV2000S by the establishment of the sun protection factor (SPF) and critical wavelength (nm) values. Physicochemical and organoleptic characteristics were also assayed. The hydrolyzed collagen subjectively improved the formulation sensory characteristics. However, this bioactive compound led to a decrease of the SPF values of the photoprotective formulations containing octocrylene alone and octocrylene + butyl methoxydibenzoylmethane + TiO2. This inadequate interaction may be considered during the development of new sunscreens intended to contain protein-based components.

Sunscreen use and skin protection behaviour on the Belgian beach: a comparison 9 years later.

Public health campaigns encourage people to protect themselves against skin cancer by using sunscreens and taking other protective measures. The objective is to estimate the impact of these campaigns on the rise of awareness among the general public. This study explores the prevalence and predictors of solar protection behaviour in a sample of beachgoers and compares these results to another similar study carried out 9 years earlier (i.e. summer 2001). During the month of August 2010, a total of 408 participants (144 men and 264 women) were randomly selected on their way to the Belgian beach in the city of Ostend, Belgium. The solar protection behaviour of each participant was assessed by direct observation and an interview. The exact same questions were asked as in 2001. The general risk awareness stays the same for skin aging and skin cancer but gets higher for sunburn. When we control these results for sex, the overall higher general awareness is completely because of the higher awareness of the female subgroup. As in 2001, risk awareness is considerably higher in the female subgroup than in the male one. As in 2001, sunscreen cream was the most popular preventive behaviour in 2010 (use of sunscreen with sun protection factor 15 or higher reported by 66.4%), followed by timed sun exposure (46.8%), use of clothing and hats (36.8%) and shade (34.1%). As in summer 2001 the sunscreen use is more popular in the female population. The use of protective clothing and hats is more popular in the male group. As solar protection has become part of the beach behaviour routine, there is room for improvement for their more frequent application, the use of a higher sun protection factor (15+), timed sunbathing, more use of clothing and hats and seeking shade. The results of this study can assist in evaluating the effectiveness of present sun-protection campaigns and health education programmes.