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Ultraviolet radiation exposure in children: A review of measurement strategies

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Annals of Behavioral Medicine

Abstract

Rates of skin cancer in the U.S. are high and have been increasing rapidly. Recommendations for primary prevention focus on the reduction of ultraviolet radiation (UVR) exposure, especially in childhood. Valid, reliable strategies are needed to measure UVR exposure in children, to document baseline levels, and to assess intervention impact. This article reviews strategies reported in observational and intervention studies and considers their potential usefulness for application with children. The strategies include verbal report (by self or parent), direct observation, visual inspection, ultraviolet (UV) sensitive film, the Erythema Meter, the spectrophotometer, and the colorimeter. Each strategy is described along several dimensions, including ease of use, cost, and whether it is suitable for measuring acute and cumulative exposure. The review describes the existing validity and reliability data and points out a need for further research assessing the reliability and validity of most of these measures. Additionally, suggestions for matching strategies with measurement and intervention objectives are presented.

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References

  1. American Cancer Society:Cancer Facts and Figures—1996. Atlanta, GA: American Cancer Society, 1996.

    Google Scholar 

  2. Marks R: An overview of skin cancers: Incidence and causation.Cancer. 1994,75: 607–612.

    Article  Google Scholar 

  3. Miller DL, Weinstock MA: Non-melanoma skin cancer in the United States: Incidence.Journal of the American Academy of Dermatology. 1994,30: 774–778.

    PubMed  CAS  Google Scholar 

  4. Rigel DS: The gender-related issues in malignant melanoma.Hawaii Medical Journal. 1993,52(5): 124–146.

    PubMed  CAS  Google Scholar 

  5. Giles GG, Marks R, Foley P: Incidence of non-melanotic skin cancer treated in Australia.British Medical Journal. 1988,296: 13–19.

    PubMed  CAS  Google Scholar 

  6. National Cancer Institute:Cancer Rates and Risks, DHHS Publication No. (NIH) 85–691. Bethesda, MD: U.S. Department of Health and Human Services, 1985.

    Google Scholar 

  7. McCarthy WH, Shaw HM: Skin cancer in Australia.Medical Journal of Australia, 1989,150: 469–470.

    PubMed  CAS  Google Scholar 

  8. Marks R: Non-melanotic skin cancer and solar keratoses: The quiet 20th century epidemic.International Journal of Dermatology. 1987.19: 1045–1052.

    Google Scholar 

  9. Stern RS, Weinstein MC, Baker SG: Risk reduction for nonmelanoma skin cancer with childhood sunscreen use.Archives of Dermatology. 1986,122: 537–545.

    Article  PubMed  CAS  Google Scholar 

  10. Taylor HR, West SK, Rosenthal FS, et al: Effect of ultraviolet radiation on cataract formation.New England Journal of Medicine. 1988,319(22): 1429–1433.

    PubMed  CAS  Google Scholar 

  11. Glass AG, Hoover RN: The emerging epidemic of melanoma and squamous cell skin cancer.Journal of the American Medical Association. 1989,262(15): 2097–2100.

    Article  PubMed  CAS  Google Scholar 

  12. Giese AC:Living with Our Sun's Ultraviolet Rays. New York: Plenum Press, 1976.

    Google Scholar 

  13. Lowe NJ:Physician's Guide to Sunscreens. New York: Marcel Dekker, Inc., 1991.

    Google Scholar 

  14. Lawler PE, Schreiber S: Cutaneous malignant melanoma: Nursing's role in prevention and early detection.Oncology Nursing Forum. 1989,16(3): 345–352.

    PubMed  CAS  Google Scholar 

  15. Rhodes AR: Public education and cancer of the skin: What do people need to know about melanoma and non-melanoma skin cancer?Cancer. 1994,75: 613–636.

    Article  Google Scholar 

  16. Marks R: Skin Cancer–Childhood protection affords lifetime protection. (Editorial).Medical Journal of Australia. 1987,147: 475–476.

    PubMed  CAS  Google Scholar 

  17. Weinstock MA: The epidemic of squamous cell carcinoma. (Editorial).Journal of the American Medical Association. 1989,262: 2138–2140.

    Article  PubMed  CAS  Google Scholar 

  18. U.S. Department of Health and Human Services:Healthy People 2000, DHHS Publication No. (PHS) 91-50212. Washington, DC: U.S. Department of Health and Human Services, 1990.

    Google Scholar 

  19. Marks R, Jolley D, Lectsas S, Foley P: The role of childhood exposure to sunlight in the development of solar keratoses and non-melanocytic skin cancer.Medical Journal of Australia. 1990,152: 62–66.

    PubMed  CAS  Google Scholar 

  20. Marks R, Whiteman D: Sunburn and melanoma: How strong is the evidence? (Editorial).British Medical Journa., 1994,308: 75–76.

    CAS  Google Scholar 

  21. Elwood JM, Whitehead SM, Davison J, Stewart M, Galt M: Malignant melanoma in England: Risks associated with naevi, freckles, social class, hair colour, and sunburn.International Journal of Epidemiology. 1990,19: 801–810.

    Article  PubMed  CAS  Google Scholar 

  22. Westerdahl J, Olsson H, Ingvar C: At what age do sunburn episodes play a crucial role for the development of malignant melanoma.European Journal of Cancer. 1994,30A(11): 1647–1654.

    Article  PubMed  CAS  Google Scholar 

  23. American Academy of Dermatology and Centers for Disease Control and Prevention:National Conference to Develop a National Skin Cancer Agenda: Executive Summary and Proceedings. American Academy of Dermatology: Washington, DC, 1995.

    Google Scholar 

  24. Campbell HS, Birdsell JM: Knowledge, beliefs, and sun protection behaviors of Alberta adults.Preventive Medicine. 1994,23: 160–166.

    Article  PubMed  CAS  Google Scholar 

  25. Fusaro RM, Johnsen LR, Hoden RH, Lynch HT: A questionnaire survey of Midwest dermatologists on the clinical-genetic aspects of patients with multiple atypical nevi.Nebraska Medical Journal. 1993,78: 132–137.

    PubMed  CAS  Google Scholar 

  26. Keesling B, Friedman HS: Psychosocial factors in sunbathing and sunscreen use.Health Psychology. 1987,6(5): 477–493.

    Article  PubMed  CAS  Google Scholar 

  27. Miller AG, Ashton WA, McHoskey JW, Gimbel J: What price attractiveness? Stereotype and risk factors in suntanning behavior.Journal of Applied Social Psychology. 1990,20(15): 1272–1300.

    Article  Google Scholar 

  28. Osborne P: Out in the mid-day sun? Nurses' perceptions of the dangers of sun exposure.The Professional Nurse. 1989,4: 496–500.

    PubMed  CAS  Google Scholar 

  29. Borland R, Theobald T: A picture of sun protection.Australian Cancer Society Cancer Forum. 1990,14(3): 171–174.

    Google Scholar 

  30. Hughes BR, Altman DG, Newton JA: Suncool: A health education programme for secondary schools. (Abstract).Melanoma Research. 1993,3:(Suppl. 1): 56.

    Google Scholar 

  31. Girgis A, Sanson-Fisher RW, Tripodi DA, Golding T: Evaluation of interventions to improve solar protection in primary schools.Health Education Quarterly. 1993,20(2): 275–287.

    PubMed  CAS  Google Scholar 

  32. Johnson EY, Lookingbill DP: Sunscreen use and sun exposure: Trends in a White population.Archives of Dermatology. 1984,120: 727–731.

    Article  PubMed  CAS  Google Scholar 

  33. Girgis A, Sanson-Fisher RW, Watson A: A workplace intervention for increasing outdoor workers' use of solar protection.American Journal of Public Health. 1994,84(1): 77–81.

    Article  PubMed  CAS  Google Scholar 

  34. Ramstack JL, White SE, Hazelkorn KS, Meyskens FL: Sunshine and skin cancer: A school-based skin cancer prevention project.Journal of Cancer Education. 1986,1(2): 169–176.

    PubMed  CAS  Google Scholar 

  35. Boutwell WB: The undercover skin cancer prevention project: A community-based program in four Texas cities.Cancer. 1995,75:657–660.

    Article  PubMed  CAS  Google Scholar 

  36. Bolognia JL, Berwick M, Fine JA, Simpson P, Jasmin M: Sun protection in newborns.American Journal of Diseases of Children, 1991,145: 1125–1129.

    PubMed  CAS  Google Scholar 

  37. Cody R, Lee C: Behaviors, beliefs, and intentions in skin cancer prevention.Journal of Behavioral Medicine. 1990,13(4):373–388.

    Article  PubMed  CAS  Google Scholar 

  38. Robinson JK: Behavior modification obtained by sun protection education coupled with removal of a skin cancer.Archives of Dermatology. 1990,126: 477–481.

    Article  PubMed  CAS  Google Scholar 

  39. Robinson JK: Compensation strategies in sun protection behaviors by a population with non-melanoma skin cancer.Preventive Medicine. 1992,21: 754–765.

    Article  PubMed  CAS  Google Scholar 

  40. Lombard D, Neubauer TE, Canfield D, Winett RA: Behavioral community interventions to reduce the risk of skin cancer.Journal of Applied Behavior Analysis. 1991,24: 677–686.

    Article  PubMed  CAS  Google Scholar 

  41. Cristofolini M, Bianchi R, Boi S, et al: Effectiveness of the health campaign for early diagnosis of cutaneous melanoma in Trentino, Italy.Journal of Dermatologic Surgical Oncology. 1993,19:117–120.

    CAS  Google Scholar 

  42. Rivers JK, Gallagher RP: Public education projects in skin cancer: Experience of the Canadian Dermatology Association.Cancer. 1995,75: 661–666.

    Article  PubMed  CAS  Google Scholar 

  43. Rossi JS, Blais LM, Weinstock MA: The Rhode Island Sun Smart Project: Skin cancer prevention reaches the beaches.American Journal of Public Health. 1994,84: 672–674.

    PubMed  CAS  Google Scholar 

  44. Melville SK, Rosenthal FS, Luckmann R, Lew RA: Quantitative ultraviolet skin exposure in children during selected outdoor activities.Photodermatology, Photoimmunology and Photomedicine. 1991,8: 99–104.

    PubMed  CAS  Google Scholar 

  45. Holman CD, Gibson IM, Stephenson M, Armstrong BK: Ultraviolet irradiation of human body sites in relation to occupation and outdoor activity: Field studies using personal UVR dosimetersClinical and Experimental Dermatology. 1983,8: 269–277.

    Article  PubMed  CAS  Google Scholar 

  46. Wong CF: Scattered ultraviolet radiation underneath a shade-cloth.Photodermatology, Photoimmunology and Photomedicine. 1994,10: 221–224.

    PubMed  CAS  Google Scholar 

  47. Gies HP, Roy CR, Herlihy E, Rivers J: Personal dosimetry of solar UVB using polysulphone film.Proceedings of the 8th International Congress of the International Radiation Protection Association. 1992,I: 791–794.

    Google Scholar 

  48. Herlihy E, Gies PH, Roy CR, Jones M: Personal dosimetry of solar UV radiation for different outdoor activities.Photochemistry and Photobiology. 1994,60: 288–294.

    Article  PubMed  CAS  Google Scholar 

  49. Rosenthal FS, West SK, Munoz B, et al: Ocular and facial skin exposure to ultraviolet radiation in sunlight: A personal exposure model with application to a worker population.Health Physics, 1991,16(1): 77–86.

    Article  Google Scholar 

  50. Westerhof W, Estevez-Uscanga O, Meens J, et al: The relation between constitutional skin color and photosensitivity estimated from UV-induced erythema and pigmentation dose-response curves.Journal of Investigative Dermatology. 1990,94: 812–816.

    Article  PubMed  CAS  Google Scholar 

  51. Mayer JA, Sallis JF, Eckhardt L, et al: Assessing children's ultraviolet radiation exposure: Use of parental recall via telephone interviews.American Journal of Public Health. 1997,87: 1046–1049.

    PubMed  CAS  Google Scholar 

  52. Seitz JC, Whitmore CG: Measurement of erythema and tanning responses in human skin using a tri-stimulus colorimeter.Dermatologica. 1988,177: 70–75.

    PubMed  CAS  Google Scholar 

  53. Porges SB, Kaidbey KH, Grove GL: Quantification of visible light-induced melanogenesis in human skin.Photodermatology. 1988,5: 197–200.

    PubMed  CAS  Google Scholar 

  54. Levine N, Sheftel SN, Eytan T, et al: Induction of skin tanning by subcutaneous administration of a potent synthetic melanotropin.Journal of the American Medical Association. 1991,266(19): 2730–2736.

    Article  PubMed  CAS  Google Scholar 

  55. Sallis JF: Self-reported measures of children's physical activity.Journal of School Health. 1991,61(5): 215–219.

    Article  PubMed  CAS  Google Scholar 

  56. Rampen FHJ, Fleuren BAM, de Boo TM, Lemmens WAJG: Unreliability of self-reported burning tendency and tanning ability.Archives of Dermatology. 1988,124: 885–888.

    Article  PubMed  CAS  Google Scholar 

  57. Foot G, Girgis A, Boyle CA, Sanson-Fisher RW: Solar protection behaviors: A study of beachgoers.Australian Journal of Public Health. 1993,17(3): 209–214.

    PubMed  CAS  Google Scholar 

  58. Daniels F, Imbrie JD: Comparison between visual grading and reflectance measurements of erythema produced by sunlight.Journal of Investigative Dermatology. 1958,30: 295–304.

    PubMed  Google Scholar 

  59. Alsins J, Claesson S, Fischer T, Juhlin L: Development of high intensity narrow-band lamps and studies of the irradiation effect on human skin.Acta Dermato-Venereologica. 1975,55: 261–271.

    PubMed  CAS  Google Scholar 

  60. Tronnier H: Evaluation and measurement of ultraviolet erythema. In Urbach F (ed),The Biologic Effects of Ultraviolet Radiation (with Emphasis on the Skin). New York: Pergamon Press, 1969, 255–266.

    Google Scholar 

  61. Farr PM, Diffey BL: Quantitative studies on cutaneous erythema induced by ultraviolet radiation.British Journal of Dermatology. 1984,111: 673–682.

    Article  PubMed  CAS  Google Scholar 

  62. Diffey BL, Oliver RJ, Farr PM: A portable instrument for quantifying erythema induced by ultraviolet radiation.British Journal of Dermatology. 1984,111:663–672.

    Article  PubMed  CAS  Google Scholar 

  63. Chan SY, Li Wan Po A: Quantitative evaluation of drug-induced erythema by using a tristimulus color analyzer: Experimental design and data analysis.Skin Pharmacology. 1993,6: 298–312.

    PubMed  CAS  Google Scholar 

  64. Diffey BL:Radiation Measurement, in Photobiology. San Diego, CA: Academic Press, 1989, 135–159.

    Google Scholar 

  65. Diffey BL: A comparison of dosimeters used for solar ultraviolet radiometry.Photochemistry and Photobiology. 1987,46: 55–60.

    Article  PubMed  CAS  Google Scholar 

  66. Davis A, Diffey BL, Tate TK: A personal dosimeter for biologically effective solar UV-B radiation.Photochemistry and Photobiology. 1981,34: 283–286.

    PubMed  CAS  Google Scholar 

  67. Syndenham MM, Hirst LW, Collins MJ: The stability of CR-39 and polysulphone for ocular solar ultraviolet dosimetry. (Abstract).Investigative Ophthalmology and Visual Science Supplement. 1994,35: 1327.

    Google Scholar 

  68. Elwood JM, Gallagher P: Site distributions of malignant melanoma.Canada Medical Association Journal. 1983,128: 1400–1404.

    CAS  Google Scholar 

  69. Wakelee H, Minolta Representative, Vanslager Associates, Inc.: Personal communication, August 22, 1996.

  70. Van Oort RP, Borsboom PCF: The variation of skin color in different areas of the human body in a Caucasian population in CIE 1976 L*, u*, v* color space.Journal of the Society of Cosmetic Chemists. 1981,32: 1–14.

    Google Scholar 

  71. Takiwaki H, Overgaard L, Serup J: Comparison of narrow-band reflectance spectrophotometric and tristimulus colorimetric measurements of skin color: Twenty-three anatomical sites evaluated by the Dermaspectrometer and the Chroma Meter CR-200.Skin Pharmacology. 1994,7: 217–225.

    PubMed  CAS  Google Scholar 

  72. Takiwaki H, Serup J: Measurement of color parameters of psoratic plaques by narrow-band reflectance spectrophotometry and tristimulus colorimetry.Skin Pharmacology. 1994,7: 145–150.

    PubMed  CAS  Google Scholar 

  73. Wakelee H, Minolta Representative, Vanslager Associates, Inc.: Personal communication, April 10, 1996.

  74. Serup J, Agner T: Colorimetric quantification of erythema—A comparison of two colorimeters (Lange Micro Color and Minolta Chroma Meter CR-200) with a clinical scoring scheme and laser-Doppler flowmetry.Clinical and Experimental Dermatology. 1990,15: 267–272.

    Article  PubMed  CAS  Google Scholar 

  75. Minolta Camera Company, Ltd.:Chroma Meters. (Brochure). Osaka, Japan: Minolta Camera Company, Ltd., 1991.

    Google Scholar 

  76. Robertson AR: The CIE 1976 color-difference formulae.Color Research and Application. 1977,2(1): 7–11.

    Google Scholar 

  77. Minolta Camera Company, Ltd.:Precise Color Communication: Color from Feeling to Intrumentation. (Brochure). Osaka, Japan: Minolta Camera Company, Ltd., 1990.

    Google Scholar 

  78. Babulak SW, Rhein LD, Scala DD, Simion A, Grove GL: Quantitation of erythema in a soap chamber test using the Minolta Chroma (reflectance) Meter: Comparison of instrumental results with visual assessments.Journal of the Society of Cosmetic Chemists. 1986,37: 475–479.

    Google Scholar 

  79. Westerhof W, van Hasselt BAAM, Kammeijer A: Quantification of UV-induced erythema with a portable computer controlled chromameter.Photodermatology. 1986,3: 310–314.

    PubMed  CAS  Google Scholar 

  80. Eckhardt L, Mayer JA, Creech L, Johnston MR, Lui KJ: Assessing children's ultraviolet radiation exposure: The potential usefulness of a colorimeter.American Journal of Public Health. 1996,86: 1802–1804.

    PubMed  CAS  Google Scholar 

  81. Olson RL, Sayre RM, Everett MA: Effect of anatomic location and time on ultraviolet erythema.Archives of Dermatology. 1966,93: 211–215.

    Article  PubMed  CAS  Google Scholar 

  82. Fitzpatrick TB: The validity and practicality of sun-reactive skin types I through IV.Archives of Dermatology. 1988,124: 869–871.

    Article  PubMed  CAS  Google Scholar 

  83. Friedman RJ, Rigel DS, Berson DS, Rivers J: Skin cancer: Basal cell and squamous cell carcinoma. In Holleb AI, Fink DJ, Murphy GP (eds),American Cancer Society Textbook of Clinical Oncology. Atlanta, GA: American Cancer Society, 1991, 290–305.

    Google Scholar 

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  1. Graduate School of Public Health, San Diego State University, 92182-4162, San Diego, CA

    Lorri L. Creech & Joni A. Mayer

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  1. Lorri L. Creech
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  2. Joni A. Mayer
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Preparation of this manuscript was supported in part by grant # AR 43025 from the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS).

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Creech, L.L., Mayer, J.A. Ultraviolet radiation exposure in children: A review of measurement strategies. ann. behav. med. 19, 399–407 (1997). https://doi.org/10.1007/BF02895159

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