Abstract
Understanding the behaviors that lead to sunburn is an important objective toward developing intervention strategies to reduce risk for skin cancers. Our cross-sectional study surveyed 400 college students aged 18 and older at a public state university in the northeastern US in 2018 to assess tanning behaviors, outdoor activities, sun protection, and sunburn over the past year. Sunburn was exceedingly common; over half reported one or more sunburns in the past 12 months. Outdoor intentional and unintentional tanning were also common. Male sex, White race, sun sensitive skin type, and outdoor intentional and unintentional tanning were independently associated with increased odds of sunburn. Water and non-water sports, sunbathing, and vacations were also associated with sunburn. These results indicate that tanning and outdoor activities such as sports are important behaviors on which to focus for sunburn prevention among college students. Understanding the behaviors that are associated with sunburn provides useful opportunities to prevent skin cancer among young people.
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References
ACS. (2019). American Cancer Society - Cancer Facts and Figures 2019. Retrieved December 9, 2019 from https://www.cancer.org/content/dam/cancer-org/research/cancer-facts-and-statistics/annual-cancer-facts-and-figures/2019/cancer-facts-and-figures-2019.pdf
Basch, C. H., Basch, C. E., Rajan, S., & Ruggles, K. V. (2014). Use of sunscreen and indoor tanning devices among a nationally representative sample of high school students, 2001–2011. Preventing Chronic Disease, 11, E144. https://doi.org/10.5888/pcd11.140191
Basch, C. H., Hillyer, G. C., Basch, C. E., & Neugut, A. I. (2012). Improving understanding about tanning behaviors in college students: A pilot study. Journal of American College Health, 60, 250–256. https://doi.org/10.1080/07448481.2011.596872
Brenner, M., & Hearing, V. J. (2008). The protective role of melanin against UV damage in human skin. Photochemistry and Photobiology, 84(3), 539–549. https://doi.org/10.1111/j.1751-1097.2007.00226.x
Cafri, G., Thompson, J. K., Jacobsen, P. B., & Hillhouse, J. (2009). Investigating the role of appearance-based factors in predicting sunbathing and tanning salon use. Journal of Behavioral Medicine, 32(6), 532–544. https://doi.org/10.1007/s10865-009-9224-5
Cust, A. E., Fenton, G. L., Smit, A. K., Espinoza, D., Dobbinson, S., Brodie, A., Cam Dang, H. T., & Kimlin, M. G. (2018). Validation of questionnaire and diary measures of time outdoors against an objective measure of personal ultraviolet radiation exposure. Photochemistry & Photobiology, 94(4), 815–820. https://doi.org/10.1111/php.12893
D’Orazio, J., Jarrett, S., Amaro-Ortiz, A., & Scott, T. (2013). UV radiation and the skin. International Journal of Molecular Sciences, 14(6), 12222–12248. https://doi.org/10.3390/ijms140612222
Daniel, C. L., Gassman, N. R., Fernandez, A. M., Bae, S., & Tan, M. C. B. (2018). Intentional tanning behaviors among undergraduates on the United States’ Gulf Coast. BMC Public Health, 18, 441. https://doi.org/10.1186/s12889-018-5345-5
Davis, K. J., Cokkinides, V. E., Weinstock, M. A., O’Connell, M. C., & Wingo, P. A. (2002). Summer sunburn and sun exposure among US youths ages 11 to 18: National prevalence and associated factors. Pediatrics, 110(1 Pt 1), 27–35.
Dennis, L. K., Vanbeek, M. J., Beane Freeman, L. E., Smith, B. J., Dawson, D. V., & Coughlin, J. A. (2008). Sunburns and risk of cutaneous melanoma: Does age matter? A Comprehensive Meta-Analysis. Annals of Epidemiology, 18(8), 614–627. https://doi.org/10.1016/j.annepidem.2008.04.006
FDA. (2018, 03/15/2018). The risks of tanning. Retrieved from https://www.fda.gov/RadiationEmittingProducts/RadiationEmittingProductsandProcedures/Tanning/ucm116432.htm
Fitzpatrick, T. (1988). The validity and practicality of sun-reactive skin type I through VI. Archives of Dermatology, 124, 869–871.
Fogel, J., & Krausz, F. (2013). Watching reality television beauty shows is associated with tanning lamp use and outdoor tanning among college students. Journal of the American Academy of Dermatology, 68, 784–789. https://doi.org/10.1016/j.jaad.2012.09.055
Gambla, W. C., Fernandez, A. M., Gassman, N. R., Tan, M. C. B., & Daniel, C. L. (2017). College tanning behaviors, attitudes, beliefs, and intentions: A systematic review of the literature. Preventive Medicine, 105, 77–87. https://doi.org/10.1016/j.ypmed.2017.08.029
Glanz, K., Gies, P., O'Riordan, D. L., Elliott, T., Nehl, E., McCarty, F., & Davis, E. (2010). Validity of self-reported solar UVR exposure compared with objectively measured UVR exposure. Cancer Epidemiology Biomarkers & Prevention, 19, 3005–3012. https://doi.org/10.1158/1055-9965.epi-10-0709
Glanz, K., Yaroch, A. L., Dancel, M., Saraiya, M., Crane, L. A., Buller, D. B., & Robinson, J. K. (2008). Measures of sun exposure and sun protection practices for behavioral and epidemiologic research. Archiches of Dermatology, 144(2), 217–222. https://doi.org/10.1001/archdermatol.2007.46
Guy, G. P., Berkowitz, Z., Everett Jones, S., Watson, M., & Richardson, L. C. (2017a). Prevalence of indoor tanning and association with sunburn among youth in the United States. JAMA Dermatology, 153(5), 387–390. https://doi.org/10.1001/jamadermatol.2016.6273
Guy, G. P., Watson, M., Seidenberg, A. B., Hartman, A. M., Holman, D. M., & Perna, F. M. (2017b). Trends in indoor tanning and its association with sunburn among US adults. Journal of the American Academy of Dermatology, 76(6), 1191–1193. https://doi.org/10.1016/j.jaad.2017.01.022
Hay, J. L., Riley, K. E., & Geller, A. C. (2017). Tanning and teens: Is indoor exposure the tip of the iceberg? Cancer Epidemiology Biomarkers & Prevention, 26, 1170–1174. https://doi.org/10.1158/1055-9965.EPI-17-0095
Heckman, C. J., Darlow, S., Cohen-Filipic, J., Kloss, J. D., Manne, S. L., Munshi, T., & Perlis, C. S. (2012). Psychosocial correlates of sunburn among young adult women. International Journal of Environmental Research and Public Health, 9(6), 2241–2251. https://doi.org/10.3390/ijerph9062241
Holman, D. M., Ding, H., Berkowitz, Z., Hartman, A. M., & Perna, F. M. (2019a). Sunburn prevalence among US adults, National Health Interview Survey 2005, 2010, and 2015. Journal of the American Academy of Dermatology, 80(3), 817–820. https://doi.org/10.1016/j.jaad.2018.10.044
Holman, D. M., Julian, A. K., Perna, F. M., & Ragan, K. (2019b). Activities and sun protection behaviors adults are often engaging in when they get a sunburn. Annals of Behavioral Medicine, 53, s391–s391.
Hosmer, D. W., Lemeshow, S., & Sturdivant, R. X. (2013). Applied Logistic Regression: Wiley.
Jones, S. E., Saraiya, M., Miyamoto, J., & Berkowitz, Z. (2012). Trends in sunscreen use among U.S. high school students: 1999–2009. Journal of Adolescent Health, 50(3), 304–307. https://doi.org/10.1016/j.jadohealth.2011.04.024
Lazovich, D., Stryker, J. E., Mayer, J. A., Hillhouse, J., Dennis, L. K., Pichon, L., & Thompson, K. (2008). Measuring nonsolar tanning behavior: Indoor and sunless tanning. Archives of Dermatology, 144(2), 225–230. https://doi.org/10.1001/archdermatol.2007.45
McLeod, G. F. H., Reeder, A. I., Gray, A. R., & McGee, R. (2017). Unintended sunburn: A potential target for sun protection messages. Journal of Skin Cancer, 2017, 6902942–6902942. https://doi.org/10.1155/2017/6902942
Noone AM, Howlader N, Krapcho M, Miller D, Brest A, Yu M, Ruhl J, Tatalovich Z, Mariotto A, Lewis DR, Chen HS, Feuer EJ, Cronin KA (eds). SEER Cancer Statistics Review, 1975–2015, National Cancer Institute. Bethesda, MD, https://seer.cancer.gov/csr/1975_2015/, based on November 2017 SEER data submission, posted to the SEER web site, April 2018.
O’Hara, M., Horsham, C., Koh, U., & Janda, M. (2019). Unintended sunburn after sunscreen application: An exploratory study of sun protection. Health Promotion Journal of Australia. https://doi.org/10.1002/hpja.301
Pfahlberg, A., Kolmel, K. F., & Gefeller, O. (2001). Timing of excessive ultraviolet radiation and melanoma: Epidemiology does not support the existence of a critical period of high susceptibility to solar ultraviolet radiation- induced melanoma. British Journal of Dermatology, 144(3), 471–475.
Sheehan, J. M., Cragg, N., Chadwick, C. A., Potten, C. S., & Young, A. R. (2002). Repeated ultraviolet exposure affords the same protection against DNA photodamage and erythema in human skin types II and IV but is associated with faster DNA repair in skin type IV. Journal of Investigative Dermatology, 118(5), 825–829. https://doi.org/10.1046/j.1523-1747.2002.01681.x
Shoveller, J. A., Lovato, C. Y., Young, R. A., & Moffat, B. (2003). Exploring the development of sun-tanning behavior: A grounded theory study of adolescents’ decision-making experiences with becoming a sun tanner. International Journal of Behavioral Medicine, 10(4), 299–314. https://doi.org/10.1207/S15327558IJBM1004_2
Thrift, A. P., & Gudenkauf, F. J. (2019). Melanoma incidence among non-Hispanic whites in all 50 United States from 2001 through 2015. Journal of the National Cancer Institute, 112, 533–539. https://doi.org/10.1093/jnci/djz153
Tribby, C. P., Berrigan, D., & Perna, F. M. (2019). Cross-sectional association between walking and sunburn: A potential trade-off between cancer prevention and risk factors. Annals of Behavioral Medicine. https://doi.org/10.1093/abm/kaz028
USDHHS, US Department of Health and Human Services. (2014). The Surgeon General's Call to Action to Prevent Skin Cancer. Office of the Surgeon General (US).
Ward, E., Sherman, R. L., Henley, S. J., Jemal, A., Siegel, D. A., Feuer, E. J., & Cronin, K. (2019). Annual report to the nation on the status of cancer, 1999–2015, featuring cancer in men and women ages 20–49. Journal of the National Cancer Institute, 111(12), 1279–1297. https://doi.org/10.1093/jnci/djz106
WHO. (2018). The known health effects of UV. Retrieved December 9, 2019 from www.who.int/uv/faq/uvhealtfac/en/
Yockey, R. A., Nabors, L. A., Oluwoye, O., Welker, K., & Hardee, A. M. (2017). College students’ perceptions of worry and parent beliefs: Associations with behaviors to prevent sun exposure. Journal of Skin Cancer, 2017, 4985702. https://doi.org/10.1155/2017/4985702
Acknowledgements
We acknowledge the useful input on statistical approach provided by Yuelin Li, Ph.D. and Elizabeth Schofield, M.P.H.
Funding
This work was funded by the National Cancer Institute, Grant Numbers T32 CA009461 (JMB) and P30 CA008748 (JGH, JLH).
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Bowers, J.M., Hamilton, J.G., Lobel, M. et al. Sun Exposure, Tanning Behaviors, and Sunburn: Examining Activities Associated With Harmful Ultraviolet Radiation Exposures in College Students. J Primary Prevent 42, 425–440 (2021). https://doi.org/10.1007/s10935-021-00638-z
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DOI: https://doi.org/10.1007/s10935-021-00638-z