[Use of sunglasses in everyday life, at work, and during outdoor sports: current results from nationwide surveys]. / Die Nutzung von Sonnenbrillen im Alltag, im Beruf und bei Sport im Freien: aktuelle Ergebnisse bundesweiter Befragungen.

BACKGROUND: Ultraviolet (UV) radiation can increase the risk of eye damage. Therefore, wearing sunglasses is recommended to protect the eyes from UV rays. OBJECTIVE: To report the latest data on the use of sunglasses in everyday life in adults, children, at work, and during outdoor sports. MATERIAL AND METHODS: We used data from waves 2020 and 2021 from the representative National Cancer Aid Monitoring (NCAM). The use of sunglasses in everyday life was assessed in 4000 participants aged 16-65 years. Data on use during outdoor work were obtained from 486 outdoor workers and the use of sunglasses during outdoor sports from 2081 participants. Additionally, 554 adults living in a household with at least 1 child aged 1-10 years reported the use of sunglasses by children. Descriptive results and associations with demographic characteristics are reported. RESULTS: Overall, 50.6% of the general population, 31.0% of outdoor workers, 44.3% of those who reported being engaged in outdoor sports and 12.5% of children wore sunglasses always or often while being outside for more than 10 min in summer. The infrequent use of sunglasses was associated with a younger age, male sex, and lower school education. CONCLUSION: Because of the relatively low use of sunglasses further education in various settings (e.g., at the workplace, kindergartens, and schools) seems necessary. The general public should also be made aware of the risks of UV radiation for the eyes, especially against the background of climate change.

Tanning bed use in Germany between 2015 and 2022: Representative data of 28,000 individuals on indoor tanning, risk awareness and reasons for use.

BACKGROUND: Tanning beds were classified as first-group carcinogens in 2009. Nonetheless, research shows that people in industrialized Western countries use tanning beds. Based on the National Cancer Aid Monitoring (NCAM) including representative data on 28,000 individuals from Germany, we quantified the prevalence as a trend from 2015 to 2022, identified determinants of tanning bed use and analysed risk awareness and reasons for use. METHODS: We used NCAM data from 2015 to 2022 to analyse the trends in the prevalence of tanning bed use (n = 28,000). To determine the characteristics of tanning bed users, risk awareness and reasons, we combined data from the waves 2019 to 2022 (n = 16,000, 49.2% female, 16-65 years) in a pooled dataset to have sufficient power to detect even smaller associations. RESULTS: Tanning bed use decreased to 5.1% in 2022. The use of tanning beds in spas, fitness and beauty facilities increased, except during the COVID-19 pandemic, while the use in tanning salons decreased. Typical tanning bed users were female, middle-aged, occupied, higher educated, had an immigrant background and were former or current smokers. Risk awareness was the lowest among the current users. The most frequently mentioned reasons were relaxation, enhancement of attractiveness and pre-tanning. DISCUSSION: Our nationwide representative data showed that the prevalence of indoor tanning has decreased. Of concern are the lower risk awareness among current users and the shift in place of use towards facilities associated with health and wellness. To further reduce the use of tanning beds, targeted information, educational campaigns and extended legislation are considered helpful.

S3 guideline "actinic keratosis and cutaneous squamous cell carcinoma" - update 2023, part 2: epidemiology and etiology, diagnostics, surgical and systemic treatment of cutaneous squamous cell carcinoma (cSCC), surveillance and prevention.

Actinic keratosis (AK) are common lesions in light-skinned individuals that can potentially progress to cutaneous squamous cell carcinoma (cSCC). Both conditions may be associated with significant morbidity and constitute a major disease burden, especially among the elderly. To establish an evidence-based framework for clinical decision making, the guideline "actinic keratosis and cutaneous squamous cell carcinoma" was updated and expanded by the topics cutaneous squamous cell carcinoma in situ (Bowen's disease) and actinic cheilitis. The guideline is aimed at dermatologists, general practitioners, ear nose and throat specialists, surgeons, oncologists, radiologists and radiation oncologists in hospitals and office-based settings, as well as other medical specialties, policy makers and insurance funds involved in the diagnosis and treatment of patients with AK and cSCC. A separate guideline exists for patients and their relatives. In this part, we will address aspects relating to epidemiology and etiology, diagnostics, surgical and systemic treatment of cutaneous squamous cell carcinoma (cSCC), surveillance and prevention.

Sunburn and sun protection during recreational outdoor sport in summer: Findings from the German general population aged 16-65 years.

BACKGROUND: Sunburn can increase one's risk of developing skin cancer. We aimed to quantify the prevalence of sunburn during recreational outdoor sport (ROS) in summer, to explore the use of different sun protection measures, and to examine factors associated with sunburn during ROS using a population-based sample from Germany. METHODS: For this cross-sectional study, 2081 individuals aged 16-65 years who reported being engaged in ROS in summer were surveyed via standardized telephone interviews in 2020 (National Cancer Aid Monitoring, NCAM). RESULTS: Overall, 16.7% reported experiencing at least one sunburn during ROS in the past twelve months. Sunburn occurrence was negatively associated with the age of the participants (e.g. OR = 0.49 in 56-65 year-olds, p < .001), and positively associated with skin type I/II (OR = 1.55, p < .001) and with having a higher number of nevi (OR = 1.42, p = .005). While wearing sleeved shirts was the most frequently-used sun protection measure during ROS (74.9%), wearing headgear was least common in our sample (29.0%). In multivariate analyses, sunburn was positively associated with the use of sun protection measures (e.g. OR = 1.32 for wearing sleeved shirts, p = .02). CONCLUSIONS: Our nationwide data show that ROS is one of the settings where sun protection should play a greater role. Especially in organized sports, particular attention should be devoted to organizational (e.g. exercise outside peak hours) or contextual measures (e.g. shade by the natural or built environment) to prevent skin cancer in later life.

Setting-based skin cancer prevention at the workplace: A survey among German outdoor workers.

BACKGROUND: Outdoor workers are at increased risk of developing skin cancer. Setting-based prevention at the workplace can reduce the UV exposure of outdoor workers through appropriate technical or organizational measures. We explored the implementation of setting-based UV protection at the workplace in Germany from the perspective of outdoor workers. METHODS: A Germany-wide sample of 319 outdoor workers from different employment sectors (64.3% male) was surveyed via telephone on different technical and organizational measures for UV protection at the workplace. Bivariate analyses were performed to explore associations with job-related characteristics. RESULTS: In general, 28.0% were rarely or never provided with a place in the shade during working hours, and 27.4% rarely or never provided with a shaded place during breaks. One-third had rarely or never the opportunity to work in the shade on hot summer days. Overall, 51.9% reported receiving protective clothing from their employer, 45.5% were provided with headgear, and 25.1% with sunscreen. About one-third had often or always the option of starting work earlier in the morning on hot summer days to work less in the sun, while 18.6% had to work overtime on such days. One-third (35.4%) had been educated at work about risks of solar radiation and sun protection measures. CONCLUSIONS: Our study is among the first to present findings on the implementation of different setting-based UV protection measures at the workplace and provides starting points for employers and policy makers to improve UV protection at the workplace.

Sun Protection in German Outdoor Workers: Differences by Sex and Job-Related Characteristics.

BACKGROUND: Ultraviolet (UV) exposure during outdoor work increases the risk of developing skin cancer. Therefore, the uptake of recommended sun protection behaviors is important to prevent UV-related skin damage in the population of outdoor workers. To develop targeted prevention campaigns, information on the use of sun protection behaviors in different industries is needed. METHODS: A total of 486 outdoor workers were surveyed on the use of several sun protection measures as part of the 7th wave of the National Cancer Aid Monitoring. Furthermore, details on job-related characteristics, sociodemographics, and skin type were assessed. Descriptive analyses stratified by sex were conducted. RESULTS: In general, use of sun protection was insufficient (e.g. 38.4% used sunscreen on the face). Sun protection behavior differed between female and male outdoor workers with females being more likely to use sunscreen and males being more likely to wear sun protective clothes and headgear. For male outdoor workers, we revealed several associations with job-related characteristics. For instance, those who were employed full time were more likely to wear sun protective clothes (e.g. shoulder-covering shirt: 87.1% versus 50.0%, P < 0.001). DISCUSSION: We identified deficits in sun protection behavior in outdoor workers and differences by sex- and job-related characteristics. These differences offer starting points for targeted prevention measures. In addition, the findings may inspire qualitative research.

Nationwide Analysis on Intentional Indoor and Outdoor Tanning: Prevalence and Correlates.

Outdoor and indoor tanning are considered as risk factors for the development of skin cancer. The aims of this nationwide representative study were to quantify both behaviors in a sample with a wide age range, to identify those showing both behaviors and to explore and compare determinants of both behaviors. We used data from the fifth wave (2019) of the National Cancer Aid Monitoring (NCAM). We surveyed the representative sample including 4000 individuals, aged 16-65 years, living in Germany. Data were collected through telephone interviews. In addition to descriptive statistics, we used logistic regression analyses to identify determinants. The one-year-prevalence of tanning bed use was 7.5%, while 31.9% tanned (very) often intentionally outdoors in at least one situation (weekdays, holidays, and weekends). A total of 3.2% reported both risk behaviors. Regression analyses revealed that tanning bed use is associated with employment, an increased number of naevi, and lack of risk awareness. Intentional outdoor tanning was associated with male sex, younger age, past tobacco use, and low risk awareness of UV radiation. Our findings suggest that only a minority of subjects showed both risk behaviors. This implies that individuals seem to perform either one behavior or the other. In addition, the associated determinants differed between both behaviors, implying that specific preventive measures tailored to address to each tanning behavior are needed.

Sun Protection and Tanning Behaviors in Caregivers: Prevalence, Determinants, and Associations with Children's Behaviors.

The association between skin cancer and ultraviolet radiation (UVR) is well established, and sun protection behavior represents an important preventative measure. In children, caregivers play a key role in this regard. The subject of this study was threefold: whether caregivers of 1 to 11 year-old children are more likely to use sun protection measures compared to non-caregivers, whether considering oneself a role model is associated with sun protection behaviors, and whether their sun protection and risk behaviors are related to children's behaviors. We used data from the 2020 wave of the National Cancer Aid Monitoring (NCAM) comprised of 4000 individuals (including 554 caregivers of at least one child aged 1−10 years) aged 16 to 65 years and living in Germany. Data were collected through telephone interviews between October and December 2020. No significant differences between caregivers and non-caregivers regarding sun protection and risk behaviors were identified (except tanning on vacation). In both groups, sun protection behaviors were deficient. Caregivers who considered themselves role models concerning sun safety were more likely to use sun protection measures (e.g., using sunscreen on the face: OR = 5.08, p < 0.001). In addition, caregivers' sun protection behaviors were positively associated with children's behaviors. Caregivers being highly protected against UVR were more likely to report the use of different measures by/in the child (mean = 4.03), compared to caregivers with medium (3.41) and low (2.97, p < 0.001) protection levels. However, we also found that caregivers' risk behavior was associated with children's reported risk behavior. For future prevention, it might be worth focusing on the aspect of caregivers serving as role models. A comprehensive public-health strategy is needed, including key figures such as pediatricians to prevent today's children from developing skin cancer in later life.

Sun Protection and Sunburn in Children Aged 1-10 Years in Germany: Prevalence and Determinants.

Seeking shade, the use of textile sun protection and sunscreen, and protecting one's eyes by wearing sunglasses are recommended sun protection measures in children. We aimed to quantify the use of these measures as well as the prevalence of sunburn in children aged 1 to 10 years in Germany and to identify their determinants. Data collected via telephone interviews in a nationwide sample of 554 parents or caregivers in family were analyzed. Use of sunscreen was the most common measure applied (77.8%), while sunglasses were least frequently used (12.5%). The prevalence of sunburn during the past year was 21.8%, and it was positively associated with children's age. The use of sun protection measures was significantly associated with the age and skin color of the child, while characteristics and tanning behaviors of the caregivers only played a minor role. The use of sun protection measures was higher when caregivers perceived themselves as a role model (Odds Ratio (OR) = 4.33, p < 0.001). Our nationwide data show that there remains a need for the improved use of sun protection measures, especially in children aged 7 to 10 years. In educational material, parents should be encouraged to become positive role models for their children regarding sun protection.

Is the quality of skin cancer screening in Germany related to the specialization of the physician who performs it?: Results of a nationwide survey among participants of skin cancer screening.

BACKGROUND: Skin cancer screening (SCS) is an important measure for secondary prevention of skin cancer, which is the most common cancer type worldwide. This study aimed to describe patient-reported quality of SCS in Germany according to the specialization of the performing physician and different patient characteristics. METHODS: Data from 1260 participants 35-65 years of age (54.4% female) who underwent SCS and participated in National Cancer Aid Monitoring in 2019 were evaluated using chi-squared tests. RESULTS: Waiting times for SCS from a dermatologist were significantly longer than those for other physicians (31.1 versus [vs.] 15.7 days; P < .001). Each body area examined during the standardized inspection was examined significantly more frequently by dermatologists than by other physicians (eg, upper body, 96.6% vs. 91.7%; P < .001). Dermatologists more often offered consultation for skin cancer prevention (74.0% vs. 67.6%; P = .026) and provided written information (47.8% vs. 34.8%; P < .001). Patients with statutory insurance had to pay more frequently for additional services during SCS from a dermatologist than from other physicians (24.7% vs. 17.1%, P = .012). CONCLUSION: Results of this study revealed differences in the provision of preventive information and the quality of visual examination during SCS between dermatologists and other physicians. These results highlight the need for quality assurance measures.

Improved patient satisfaction and diagnostic accuracy in skin diseases with a Visual Clinical Decision Support System-A feasibility study with general practitioners.

Patient satisfaction is an important indicator of health care quality, and it remains an important goal for optimal treatment outcomes to reduce the level of misdiagnoses and inappropriate or absent therapeutic actions. Digital support tools for differential diagnosis to assist clinicians in reaching the correct diagnosis may be helpful, but how the use of these affect patients is not clear. The primary objective of this feasibility study was to investigate patient experience and satisfaction in a primary care setting where general practitioners (GPs) used a visual clinical decision support system (CDSS) compared with standard consultations. Secondary objectives were diagnostic accuracy and length of consultation. Thirty-one patients with a dermatologist-confirmed skin diagnosis were allocated to consult GPs that had been randomized to conduct either standard consultations (SDR, n = 21) or CDSS (n = 16) on two separate study days one week apart. All patients were diagnosed independently by multiple GPs (n = 3-8) in both the SDR and CDSS study arms. Using the CDSS, more patients felt involved in the decision making (P = 0.05). In addition, more patients were exposed to images during the consultations (P = 6.8e-27), and 83% of those that were shown images replied they felt better supported in the consultation. The use of CDSS significantly improved the diagnostic accuracy (34%, P = 0.007), and did not increase the duration of the consultation (median 10 minutes in both arms). This study shows for the first time that compared with standard GP consultations, CDSS assist the GP on skin related diagnoses and improve patient satisfaction and diagnostic accuracy without impacting the duration of the consultations. This is likely to increase correct treatment choices, patient adherence, and overall result in better healthcare outcomes.

Trends in Tanning Bed Use, Motivation, and Risk Awareness in Germany: Findings from Four Waves of the National Cancer Aid Monitoring (NCAM).

Indoor tanning is an important risk factor for the development of melanoma and non-melanoma skin cancer. With our nationally representative monitoring, we aimed at describing tanning bed use, user characteristics, reasons for use, and risk awareness over time. In the framework of the National Cancer Aid Monitoring (NCAM), we collected representative data on 12,000 individuals aged 14 to 45 years in annual waves of n = 3,000 participants in Germany between 2015 and 2018. We used descriptive statistics and chi²-tests to uncover group differences. To compare data from the different waves, we calculated confidence intervals. The use of tanning beds decreased from 2015 (11.0%, 95%-CI: 9.9%-12.1%) to 2018 (8.8%, 95%-CI: 7.8%-9.8%). However, this decrease did not affect all subgroups. For instance, there was an (non-significant) increase in minors and the prevalence remained stable for individuals with immigrant background and males. Attractiveness was an important reason for tanning bed use in each wave. Over time, there was an increase in medical-related reasons for use. Furthermore, monitoring showed a decrease in risk awareness regarding tanning bed use and ultraviolet (UV) radiation. While it is a positive development that the overall use of tanning beds in Germany has decreased over time, the increasing use by minors despite the legal ban is alarming. Due to the declining risk awareness it is necessary to implement prevention and education campaigns specifically targeted at this group.

Profile of sunless tanning product users: Results from a nationwide representative survey.

BACKGROUND: Sunless tanning products (STPs) are often seen as "healthy alternative" to sunbathing and indoor tanning. However, STP use may entail indirect risks such as overestimating an individual's natural skin type, resulting in risky (natural and artificial) tanning behavior. We aimed to explore STP use in combination with other health-related risk behaviors (eg, smoking), skin cancer risk, risk awareness of ultraviolet radiation, and preventive behavior. METHODS: We used data from the NCAM, a nationwide representative cross-sectional sample (n = 3000, aged 14-45, 48.6% female) interviewed via telephone. Differences between STP users and nonusers regarding the abovementioned aspects were identified using chi²-test. RESULTS: The 1-year prevalence of STP use was 7.5%. Tanning bed users showed a higher prevalence of STP use than past and never users (16.1% vs 9.6% vs 5.8%, P < 0.05). Although STP users had a higher skin cancer risk based on individual characteristics, they were less likely to have participated in a skin cancer screen. CONCLUSION: The identified parallel use of STPs and tanning beds can have severe health consequences, since the "fake tan" of STPs may lead to an overestimation of the individual's skin type, which may result in overdosed UV exposure. The lower risk awareness among STP users accompanied with their higher skin cancer risk calls for target group-specific prevention.

"Lost in the sun"-The key role of perceived workplace support for sun-protective behavior in outdoor workers.

BACKGROUND: Previous studies show that workplace support for sun-protective behaviors plays an important role in the actual sun-protective behavior of outdoor workers. Therefore, our aim was to examine perceived workplace support (organizational and social support) in relation to different sun-protective behaviors. METHODS: A Germany-wide sample of outdoor workers (n = 485) was surveyed via telephone. We analyzed associations of workplace support with sun-protective behaviors, sociodemographic, and occupational characteristics, occupational sun exposure, and concerns about sun. RESULTS: A large number of outdoor workers perceived no workplace support for sun protection (eg, 17.8% agreed that sun protection is enforced at their workplace). We found that those who do not get any support are less likely to show sun-protective behaviors. CONCLUSIONS: A starting point for a better organizational support is the implementation of mandatory sun protection policies in the workplace. Social support for protection against solar UV exposure can be promoted through safety training and education.

Association between risk factors and detection of cutaneous melanoma in the setting of a population-based skin cancer screening.

Early detection is considered to improve the prognosis of cutaneous melanoma. The value of population-based screening for melanoma, however, is still controversial. The aim of this study was to evaluate the predictive power of established risk factors in the setting of a population-based screening and to provide empirical evidence for potential risk stratifications. We reanalyzed data (including age, sex, risk factors, and screening results) of 354 635 participants in the Skin Cancer Research to provide Evidence for Effectiveness of Screening in Northern Germany (SCREEN)project conducted in the German state of Schleswig-Holstein (2003-2004). In multivariable analysis, atypical nevi [odds ratio (OR): 17.4; 95% confidence interval (CI): 14.4-20.1], personal history of melanoma (OR: 5.3; 95% CI: 3.6-7.6), and multiple (≥40) common nevi (OR: 1.3; 95% CI: 1.1-1.6) were associated with an increased risk of melanoma detection. Family history and congenital nevi were not significantly associated with melanoma detection in the SCREEN. The effects of several risk-adapted screening strategies were evaluated. Hypothesizing a screening of individuals aged more than or equal to 35 years, irrespective of risk factors (age approach), the number needed to screen is 559 (95% CI: 514-612), whereas a screening of adults (aged ≥20) with at least one risk factor (risk approach) leads to a number needed to screen of 178 (95% CI: 163-196). Converted into one screen-detected melanoma, the number of missed melanomas is 0.15 (95% CI: 0.12-0.18) with the age approach and 0.22 (95% CI: 0.19-0.26) with the risk approach. The results indicate that focusing on individuals at high risk for melanoma may improve the cost-effectiveness and the benefit-to-harm balance of melanoma screening programs.

Are tanning salons in compliance with German law? An evaluation based on a nationwide representative survey.

BACKGROUND: Given the evidence for increased skin cancer risk due to the sunbed use, a regulation of hazardous artificial ultraviolet radiation (UVR regulation) was passed in Germany in 2012. The aim of this study was to explore the advisory services in tanning studios as reported by sunbed users and to evaluate the information provided by the personnel of tanning salons after the UVR regulation was enacted. METHODS: The first wave of the representative National Cancer Aid Monitoring on Sunbed Use included a subgroup of 357 German citizens between 14 and 45 years who had used sunbeds since the UVR regulation was implemented. The participants provided data on sunbed use and related issues in telephone interviews. RESULTS: Although sunbed operators are mandated to offer their customers certain services at least once since the implementation of the UVR regulation, 15.4% of sunbed users were never advised to use protective eyewear during tanning and 13.1% were not provided with eyewear during their last sunbed use. Overall, 66.0% were never offered to develop a tanning schedule, 56.9% were never advised on the risks of UVR, 43.4% were never offered a determination of their skin type and 40.0% of users were never advised on how to use a sunbed safely. CONCLUSIONS: The data showed that 3 years after the UVR regulation was enacted, compliance with this legislation is still not optimal. Binding wording in the legal text and making them applicable to unsupervised sunbeds as well is necessary to extend the impact of this legislation.