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Clin Dermatol 1998 Jul-Aug;16(4):487-501
Department of Dermatology and Cutaneous Surgery, University of Miami, School of Medicine, Florida, USA.
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PMID: 9699061, UI: 98364217
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Photodermatol Photoimmunol Photomed 1998 Apr;14(2):79-87
Photobiology Unit, University of Dundee, Ninewells Hospital & Medical School, UK.
As a result of increasing concern over the use of artificial tanning units, many local government recreation departments are phasing out the use of sunbeds on their premises, resulting in some clients switching to high street parlours about which little is known. An Environmental Health survey was conducted in all 32 tanning premises within a local government area (Perth & Kinross, Scotland). A number of significant problems emerged in the private sector. In this group, there was no form of cumulative UV exposure control in 89% of premises and 81% failed to give adequate advice and information to customers. We conducted UV spectral irradiation measurements in 38 tanning units using a double grating spectroradiometer. When a carcinogenic weighting factor was applied to these measurements, it was found that a 10 min exposure in a high intensity stand-up cabinet carried the same carcinogenic risk as approximately 30 min of local (56 degrees North) mid-day summer sunlight or 10 min of Mediterranean sunlight at mid-day. A questionnaire completed by 57 customers revealed a wide pattern of usage; 6 (10%) had more than 20 h exposure in the previous 12 months and 3 (5%) had made regular use of sunbeds for the previous 16 to 20 years. These results indicate that there is a need for continuing public education and surveillance of commercial artificial tanning units.
PMID: 9638731, UI: 98302587
Br J Dermatol 1997 Dec;137(6):950-4
Department of Psychiatry, University of Innsbruck, Austria.
Many people are keen on getting a skin tan despite being aware of warnings of health hazards. The present study investigates differences between women regularly using sunbeds and a control group of non-users in the areas of self-concept, narcissistic regulatory modalities, social assertiveness and generalized self-efficacy. Thirty women users of suntan salons and 34 women who never used one were investigated with standardized psychological questionnaires. In addition, their knowledge about the hazards of using sunbeds and attitudes to tanning were recorded. Statistical evaluation shows that sunbed users demonstrate more object devaluation: that is, other persons are devalued so that they are not even considered worthy of affection. Furthermore, they also display greater anxiety in their feelings and relationships with others. The results of this pilot study support the hypothesis that a tanned skin, by helping sunbed users to achieve their ideal of beauty, enables them to devalue other people and thus possibly to protect themselves from close relationships. As medical information about the hazards of ultraviolet irradiation fails to make an adequate impression on them, public relations campaigns must be undertaken in order to make them aware of the underlying motives of their behaviour.
PMID: 9470913, UI: 98131689
Br J Dermatol 1997 Nov;137(5):687-92
Dermatology Department, Brighton General Hospital, U.K. mrc.cmu@sussex.ac.uk
There is increasing concern about the adverse health effects associated with the use of sunbeds, particularly with respect to skin photocarcinogenesis. The induction of mutagenic DNA damage is a prerequisite for the development of skin tumours, and it is well established that direct types of damage such as cyclobutane pyrimidine dimers (CPDs) give rise to mutations in tumour suppressor genes and oncogenes. In addition, ultraviolet radiation may induce indirect types of DNA damage, including oxidative products, which are also potentially mutagenic. By using specific DNA repair enzymes (T4 endonuclease V and endonuclease III) and the comet assay we have been able to detect the induction of CPDs, oxidized or hydrated pyrimidine bases and single-strand breaks in cultured human fibroblasts (MRC-5) after exposure for between 15 s and 20 min on two different commercial sunbeds containing Philips 'Performance' 100W-R or Philips TL80W/10R lamps. The ratio of endonuclease III to T4 endonuclease V sensitive sites varied substantially between the two lamps and was 3.3% and 18%, respectively. The sunbed containing the 'Performance' 100W-R lamps was as potent at inducing CPDs as was natural sunlight in fine weather. These results establish that commercial tanning lamps produce the types of DNA damage associated with photocarcinogenesis in human cells, and complement epidemiological evidence indicating the potential risk of using sunbeds.
PMID: 9415225, UI: 98076933
J Am Acad Dermatol 1998 Jan;38(1):89-98
Epidemiological Monitoring Unit, London School of Hygiene & Tropical Medicine, England.
Sun exposure is a known cause of melanoma, and there are several reasons for concern that tanning lamp use may also cause melanoma, especially because of the spectral output of the lamps,the similarity of tanning lamp use to natural sun exposure (particularly sunbathing), the reported association of melanoma with PUVA therapy, and the positive results in several case-control studies of melanoma risk and tanning lamp use. We have reviewed the epidemiologic literature relevant to the relation between tanning lamp use and melanoma and have discussed methodologic issues that should be considered in interpreting these reports and designing improved studies. Although several investigations have found a positive relation between tanning lamp use and melanoma, in some instances including dose-response or duration-response effects, the methodologic limitations preclude any firm conclusion regarding a causative relation. Meta-analysis of existing data may provide better information, but several limitations could only be overcome by new studies collecting more precise exposure data. The popularity of tanning lamp use, especially in young persons, adds urgency to the quest for elucidation of the relation between the use of these devices and melanoma risk.
PMID: 9448211, UI: 98107900
Clin Plast Surg 1997 Oct;24(4):663-71
Department of Dermatology, University of Texas Medical School, Houston, USA.
Today, in many fields of medicine, the focus is on prevention. This discussion highlights the salient features of sunscreens, protective clothing, and education, as they relate to the hazards and potential sequelae of sun exposure and tanning parlors. It also includes information on the status of clinical and laboratory investigation in the development of agents to prevent skin cancer in high-risk individuals.
PMID: 9342509, UI: 98001861
J Am Acad Dermatol 1997 Aug;37(2 Pt 1):179-86
Northwestern University Medical School, Department of Dermatology, Chicago, IL 60611, USA.
BACKGROUND: The American Academy of Dermatology's national program Melanoma/Skin Cancer Detection and Prevention, developed in response to the rising incidence of invasive melanoma in the United States, has annually during the past decade produced extensive print, radio, and television coverage about the dangers of sun exposure and benefits of sun protection. OBJECTIVE: We measured the progress achieved in increasing the awareness and knowledge of skin cancer and changing the attitudes, beliefs, and behaviors that affect skin cancer risk. We also describe current sun-related behavior including sunburning, assess the likelihood of practicing sun protection strategies, and provide a baseline against which future changes in sun protection behavior may be evaluated. METHODS: A 1996 telephone survey repeated questions used in 1986 to evaluate change and used classifying questions to better define attitudes and behaviors. RESULTS: From 1986 to 1996, the knowledge of the perceived harmful effects of the sun significantly broadened, but the UV exposure behavior as measured by sunburning (30% to 39%) and regular use of a tanning booth (2% to 6%) also increased. There was a decline in the attitude that having a tan was healthy; however, in 1996 having a tan was still considered to enhance appearance, particularly by men. Sunscreen use increased (35% to 53%). Women, younger persons, persons residing in areas with fewer sunny days, and whites were more likely to tan intentionally, but men who lived in the South were more likely to sunburn. CONCLUSION: During the past decade, the early process of change involving cognitive and emotional activities began. With this study, high-risk population subsets performing specific adverse behavior were identified. In the future, they can be targeted with messages that promote attitudinal and behavioral change.
PMID: 9270501, UI: 97416551
Ophthalmology 1997 May;104(5):770-6
McMaster University, Division of Geriatric Medicine, Hamilton, Ontario, Canada.
BACKGROUND: The notion that sun exposure is a risk factor for age-related macular degeneration (AMD) is widespread, but studies have not shown this conclusively. METHODS: To test the hypothesis that AMD cases have greater ocular sun exposure than control subjects, the authors compared 409 cases with 286 control subjects resident in Newcastle, Australia. Sensitivity to sun and glare of the participants was characterized. Sun exposure was estimated from detailed histories and was validated against sun-seeking or avoidance behavior expected, given sun sensitivity and history of treatment for skin neoplasia. RESULTS: Contrary to the authors' hypothesis, control subjects had greater median annual ocular sun exposure (865 hours) than cases (723 hours), Mann-Whitney U (U) = 45704, z = -4.9, P > 0.0001. Cases had poorer tanning than did control subjects (mean 2 = 18.2, 4 df, P = 0.001) and as young adults were more sensitive to glare, odds ratio (OR), 2.5; 95% confidence intervals (CIs), 1.8 to 3.5. After stratifying by tanning ability, in the poor-tanning group, the median annual sun exposure of control subjects (685 hours) exceeded that of cases (619 hours), U = 6556, z = -1.9, P = 0.06. Among people who tanned well, control subjects also had significantly greater annual sun exposure than did cases (940 vs. 770 hours), U = 16263, z = -3.7, P = 0.0002. CONCLUSIONS: Sensitivity to glare and poor tanning ability are markers of increased AMD risk. Sun sensitivity confounds study of the postulated AMD-sunlight link. Despite analyses stratified by sun sensitivity, sun exposure was greater in control subjects than in cases with AMD.
PMID: 9160021, UI: 97303697
Mayo Clin Proc 1997 May;72(5):461-6
Department of Dermatology, Mayo Clinic Jacksonville, FL 32224, USA.
In ancient times, the sun was venerated as a source of life in some cultures. Scientifically, the relationship between vitamin D and sunlight and the deficiency of vitamin D in patients with rickets were ultimately discovered. In 1903, Niels Finsen was awarded the Nobel Prize in medicine or physiology for his "Finsen light therapy" for infectious diseases, especially lupus vulgaris. In the 1930s and 1940s, the medical profession promoted sunbathing as beneficial for children. From these bases, the popularity of suntanning emerged, promoted by the availability of more leisure time and, eventually, the development of sunlamps and commercial tanning salons. Although the precise role of ultraviolet light in the pathogenesis of melanoma is uncertain, a melanoma epidemic began to be noticed in the 1970s. During the past 15 years, campaigns have attempted to educate the public about the potential dangers of suntanning and exposure to ultraviolet light. Whether the melanoma epidemic can be reversed remains to be seen.
PMID: 9146690, UI: 97292150
Prev Med 1997 Jan-Feb;26(1):114-9
Department of Cancer Prevention, Karolinska Hospital & Institute, Stockholm, Sweden.
BACKGROUND: Sunbed use among Swedish adolescents has not been extensively studied, nor has the social learning process associated with it. The purpose of this study was to explore Swedish adolescents' sunbed use in relation to sex, age, smoking, perceived physical attractiveness, attitudes to artificial and natural UV exposure, psychosomatic symptoms, and risk knowledge. METHODS: In the spring of 1993, 60 school classes comprising 1,502 students ages 14-19 were randomly selected to answer a questionnaire concerning sunbed use and sunbathing habits, smoking, perceived physical attractiveness, psychosomatic symptoms, and need for information about and knowledge of the risks of UV exposure. RESULTS: Of 1,252 respondents, 57% had used sunbeds (females 70%, males 44%) > or = four times during the previous year. A marked increase (P < 0.001) in both sunbed use and smoking was detected between the 8th and the 9th grade (at ages 14-15). Sunbed use was also significantly correlated with sex, age, excessive tanning in natural sunlight, and low perceived physical attractiveness. The need for information on risks of high UV exposure was greatest among the best informed students and among students with high UV exposure (sunbed use, excessive tanning in natural sunlight). CONCLUSIONS: It seems doubtful whether further information on UV risks would result in altered behavior among highly exposed students, who seem receptive to information and have good knowledge. For a better understanding of the mechanisms underlying the association between sunbed use, smoking, and self-esteem, more in-depth, qualitative studies are required.
PMID: 9010906, UI: 97164183
Br J Dermatol 1996 Nov;135(5):712-6
Department of Cancer Prevention, Karolinska Hospital, Stockholm, Sweden.
Sunbed use was studied in relation to phenotype, erythema, sunscreen use and skin disease. The study population comprised 14-19 year-old Stockholm adolescents in 60 randomly selected classes, with 1252 students providing information. More than half (57%) reported sunbed use > or = 4 times during the previous year. Skin type III dominated (64%). Excessive exposure (> or = 10 times/year) was not correlated to skin type. Sunscreens were most commonly used by sunbed users. Of all sunbed users, 44% reported erythema. Adolescents with acne/seborrhoca, eczema or psoriasis used sunbeds more than others without skin diseases. The proportion with sunbed erythema (44%) indicates an unrecognized susceptibility to artificial ultraviolet radiation (UVR) among adolescents. The association between high exposure to UVR and sunscreen use stresses the importance of sunscreens being used as supplementary protection, not as a tool for tanning.
PMID: 8977669, UI: 97132213
Dermatol Surg 1996 Jul;22(7):613-6
Department of Dermatology, University of Arkansas for Medical Sciences, Little Rock 72205, USA.
BACKGROUND. The continuing development of new types and applications of lasers has appeared to surpass the development of specific eye protection for these lasers. There are a variety of eye shields on the market, but few are specifically designed for laser protection. OBJECTIVE. Our purpose was to test a variety of eye shields by two parameters, light transmission and temperature rise, and to determine from these measurements the most protective shield for patients. METHODS. We tested four plastic shields, one metal shield, and two sets of tanning goggles for temperature rise and light transmission when irradiated with a beam from a flashlamp-pumped, pulsed-dye laser. RESULTS. The temperature rise at the surface of the shield opposite the laser impacts was no more than 0.2 degree C in any case. White light was transmitted at significant levels through several of the shields, but yellow light transmittance was noted only through the green eye shield. CONCLUSION. Our measurements indicate that all except the green shield appeared safe from transmission of the 585-nm radiant energy. However, the optimal laser eye shield, in our opinion, would be a composite of several different shields' characteristics.
PMID: 8680783, UI: 96295535
J Am Acad Dermatol 1996 Mar;34(3):424-8
University of Minnesota, Department of Dermatology, Minneapolis, USA.
BACKGROUND: During the past 50 years recreational sun exposure has greatly increased in the United States. OBJECTIVE: The purpose of this study was to examine the photoprotecion message of American fashion magazines and to identify recent trends. METHODS: We evaluated models for tan, skin exposure, and other sun-related criteria in six leading fashion magazines between 1983 and 1993. We also recorded the number of sunscreen advertisements and sun awareness articles. RESULTS: We evaluated 3031 models. Adult models had darker tans and greater skin exposure than adolescents and children. Men had darker tans than women. We noted trends toward lighter tans, more women wearing hats, more sunscreen advertisements, and sun awareness articles. Many sunscreen advertisements glorified tanning. Their models had darker tans and more skin exposure, and fewer wore a hat than did nonadvertisement models. CONCLUSION: The fashion industry and especially sunsreen manufacturers promote excessive sun exposure. Although we found encouraging trends, gains were modest, especially in men's magazines.
PMID: 8609253, UI: 96178010
Dermatol Nurs 1995 Dec;7(6):355-7, 386
History has demonstrated many dangerous beauty fads, including tanning, which have evolved into a false concept of beauty. A teaching tool, which emphasizes tanning as just a fashion trend rather than a beauty enhancer, can help discourage people from suntanning their skin.
PMID: 8703606, UI: 96337651
Environ Health Perspect 1995 Nov;103 Suppl 8:255-7
Cancer Prevention and Control Center, Boston University Schools of Medicine and Public Health, Massachusetts, USA.
Ultraviolet (UV)-associated cancer is the most common cancer in the United States. Approximately 90% of nonmelanoma skin cancer and 65% of melanoma are attributable to UV exposure and theoretically could be eliminated by primary prevention measures. Safe sun strategy includes use of sunscreens, use of protective clothing, minimization of exposure from 10 A.M. to 3 P.M., and avoidance of tanning parlors. Although more definitive data in human populations on the effectiveness of sunscreens to prevent melanoma and skin cancer are needed, sunscreens are thought to reduce risk. Safe sun prevention must start in childhood and adolescence when people receive most of their UV exposure. Secondary prevention through professional and public education and early detection may further reduce melanoma mortality.
PMID: 8741794, UI: 96343287
Dermatol Nurs 1995 Oct;7(5):307-12
The use of artificial tanning devices to achieve year-round tanned skin has become big business. Clear and overwhelming evidence proves that skin exposure to natural or artificial ultraviolet radiation is harmful. Skin which has been exposed to ultraviolet light ages prematurely and has an increased risk of developing skin cancer. Education may be the best tool in preventing problems related to ultraviolet exposure.
PMID: 8695323, UI: 96337647
Epidemiology 1995 Sep;6(5):538-43
Department of Epidemiology and Biostatistics, School of Medicine, University of California San Francisco 94109, USA.
We studied 338 Caucasian women with superficial spreading melanoma (hereafter called melanoma) and 872 control subjects ages 25-59 years and compared characteristics of women who reported that they tanned with sun exposure with those who reported that they burned. The purpose of the study was to investigate how skin type, as measured by tendency to burn or tan, modified the effect of other melanoma risk factors. There was a clear relation between tendency to burn and prevalence of red hair, light complexion, freckles, and history of sunburns during elementary school and high school. Host factors such as light complexion and increased number of self-assessed large nevi elevated risk of melanoma among women of all skin types. Increased risk for melanoma associated with frequent sunburns during childhood and adolescence was most pronounced for women who burned and then tanned; risk was not substantially elevated for women who burned without tanning. Women who had a history of sunburns had an increased melanoma risk even if they reported tanning.
PMID: 8562632, UI: 96042829
J Am Acad Dermatol 1995 Aug;33(2 Pt 1):288-98
Division of Dermatology, University of Tennessee, USA.
The indoor tanning industry is a $1 billion-a-year business in the United States, and use of these high-intensity UVA tanning devices continues to grow. Many members of the medical community are concerned about the safety of these largely unregulated devices, but tanning salon operators state such concerns are unfounded and unproved. A comprehensive review of current knowledge of the operation and effects of indoor tanning is presented. The effects of UV radiation (especially UVA) on experimental animals and human beings are examined. Both acute and chronic effects are delineated from experimental sources as well as from epidemiologic studies and clinical observations. Existing safety regulations are described. Information on operator knowledge and compliance with existing safety regulations is reviewed.
PMID: 7622658, UI: 95348300
Int J Cancer 1995 Jun 9;61(6):749-55
Use of sunscreens is widely advocated as a preventive measure against sun-induced skin cancers. However, to date, no epidemiologic study has reported a decreased melanoma risk associated with sunscreen use. We have conducted a case-control study aimed at evaluating the influence of sunscreen use on the occurrence of cutaneous malignant melanoma. In 1991 and 1992, 418 melanoma cases and 438 healthy controls were interviewed in Germany, France and Belgium. The questionnaire used differentiated between regular sunscreens, psoralen sunscreen (prepared with 5-methoxypsoralen, a tanning activator and photocarcinogen), and self-tanning cosmetics (which produce a tan without ultraviolet radiation). After adjusting for age, sex, hair colour and holiday weeks spent each year in sunny resorts, the melanoma risk was of 1.50 (95% Cl:1.09-2.06) for regular sunscreens, and of 2.28 (95% Cl: 1.28-4.04) for psoralen sunscreens. No melanoma risk was associated with use of self-tanning cosmetics. Among subjects with a poor ability to tan, psoralen sunscreen users displayed a melanoma risk of 4.45 (95% Cl: 1.25-15.8) when compared with regular sunscreen users. There was a significant negative interaction between regular sunscreen use and sunburns experienced in adulthood. Use of sunscreens, especially psoralen sunscreen, was associated with higher density of pigmented lesions of the skin. Although we cannot exclude the presence of an unknown confounding factor, our results support the hypothesis that sunscreens do not protect against melanoma, probably because of their ability to delay or avoid sunburn episodes, which may allow prolonged exposure to unfiltered ultraviolet radiation. Serious doubts are raised regarding the safety of sunscreens containing psoralens.
PMID: 7790106, UI: 95310049
J Am Osteopath Assoc 1995 Jun;95(6):358, 360
PMID: 7615406, UI: 95340365
N Engl J Med 1995 May 25;332(21):1450-1
PMID: 7723815, UI: 95240699
J Pediatr Health Care 1995 May-Jun;9(3):103-8
Although sunlight is beneficial to provide light and warmth and aids the body in the formation of vitamin D, tanning is potentially damaging to an individual's health. The incidence of skin cancer and retinal damage from both natural and artificial light is on the rise. This article explores the concept of tanning, types of ultraviolet rays and related health hazards. Health care provider interventions for prevention and client education are also emphasized.
PMID: 7769553, UI: 95287332
Riv Eur Sci Med Farmacol 1995 Mar-Jun;17(2-3):53-62
Auroral Observatory, University of Tromso, Norway.
UV spectra of old sun lamps have been measured and found to contain significant amounts of UVC in addition to UVB and UVA irradiances. Their spectra are compared with that of a modern sunbed, a solar spectrum obtained with a solar elevation of 29.3 degrees and the extraterrestrial UV spectrum. The effects of UVC on human skin is rarely studied, but we know that UVB can be harmful. Old UVR lamps for cosmetic tanning irradiate significant amounts of UVB and UVC, and are therefore not recommendable. However, several action spectra indicate small health risks with limited UVA exposure, but a drastic increase in the UVA doses may be one reason for the increasing skin malignancies observed in western countries. Further research to clarify these observations has to be carried out.
PMID: 8545556, UI: 96093660
Can J Public Health 1994 Nov-Dec;85(6):393-6
Radiation Protection Services Branch, British Columbia Ministry of Health.
A two-page questionnaire was administered to 37 tanning operators in five municipalities in BC's lower mainland. The results were analyzed to determine the knowledge base of the participants as it related to ultraviolet radiation (UVR), tanning equipment, biological effects of exposure and the advice given to clients. Only 19% of the participants scored high enough to meet Alberta's criteria for adequate knowledge to operate a tanning facility. Participants seemed knowledgeable about skin type, premature skin aging effects, skin cancer, cataracts and skin and eye irritation. The greatest knowledge deficiencies identified were 1) the definition of UVA and UVB; 2) the biological role of UVA and UVB as it relates to tanning; 3) the degree to which UVA and UVB is emitted by sunbeds; and 4) knowledge of common drugs and medications that cause photosensitivity. Follow-up activity is briefly described.
PMID: 7895213, UI: 95202633
Am J Epidemiol 1994 Oct 15;140(8):691-9
Department of Surgery, University Hospital, Lund, Sweden.
In a population-based, matched case-control study from the South Swedish Health Care Region, which has the highest risk for melanoma in Sweden, the relation between the use of sunbeds or sunlamps and malignant melanoma was investigated. Between July 1, 1988, and June 30, 1990, a total of 400 melanoma patients and 640 healthy controls aged 15-75 years answered a comprehensive questionnaire containing different epidemiologic variables. Questions regarding the use of sunbeds or sunlamps were included. The odds ratio for developing malignant melanoma after ever having used sunbeds or sunlamps was 1.3. Considering all age groups, the odds ratio was significantly elevated after exposure more than 10 times a year to sunbeds or sunlamps (odds ratio (OR) = 1.8). When the study was restricted to patients and controls younger than age 30 years because the use of tanning devices is much more common among young persons, the odds ratio was higher (OR = 7.7 for more than 10 times a year vs. none). These findings were independent of constitutional factors and factors regarding sun exposure. A dose-response relation was evident. Furthermore, among melanoma patients in this young age group, the ratio of females to males was significantly higher than in older patients. When different melanoma presentation sites were considered, only lesions of the trunk were significantly associated with sunbed or sunlamp use (OR = 4.2 for more than 10 times a year vs. none).
PMID: 7942771, UI: 95029289
Int J Cancer 1994 Sep 15;58(6):809-13
Oeuvre Belge du Cancer, Brussels, Belgium.
The study objective was to assess whether exposure to sunlamps and sunbeds represents a risk factor for cutaneous malignant melanoma (CMM). A 1-to-1 unmatched case-control study was conducted among subjects 20 years old or more with naturally non-pigmented skin in Germany, France and Belgium. A total of 420 consecutive patients with CMM diagnosed from 1 January 1991 onward were derived from hospital registers; 447 controls with no history of skin cancer were chosen at random in the same municipality as the cases. Exposure to sunlamps or sunbeds starting before 1980 is associated with a crude estimated risk of CMM of 2.71 (95% CI: 1.06-7.78) for at least 10 hr of accumulated exposure. This risk is of 2.12 (95% CI: 0.84-5.37) after adjustment for age, sex, hair colour and average number of holiday weeks each year in sunny resorts. Subjects who experienced skin-burn due to sunlamps or sunbeds, and who had accumulated at least 10 hr of exposure, displayed a crude estimated CMM risk of 4.47 (95% CI: 1.45-13.7), which rose to 8.97 (95% CI: 2.10-38.6) for those who exposed their skin for tanning purposes. The risk associated with skin-burn is only marginally modified after multiple adjustments for host characteristics and recreational exposure to sunlight. Apparently, sunlamps and sunbeds share the increased risk of CMM, which seems to concentrate in subjects exhibiting hazardous behaviour towards ultraviolet radiation sources. However, although it is reasonable to believe that high doses of pure ultraviolet A radiation can be dangerous, this is not firmly established by this study. Most exposures to ultraviolet A tanning devices began after 1980; therefore, epidemiologic studies have difficulty in revealing any increase in risk of CMM starting after 1980 because of the latent period between exposure and occurrence of melanoma. Public health authorities should have a cautious approach towards the rapidly developing fashion of tanning under sunlamps or sunbeds.
PMID: 7927872, UI: 95012817
Health Psychol 1994 Sep;13(5):412-20
Center for Youth Research, Research Council of Norway, Oslo.
A nationwide random sample of 15,169 Norwegian high school students completed a questionnaire about tanning habits, physical self-concept, attitudes, beliefs, and values. Although 90% of the adolescents did use sunscreen, less than 25% used an adequate sun-protection factor, and only 50% applied the sunscreen an adequate number of times when sunbathing. Multiple regression analyses identified these predictors of sunbathing: opportunity to sunbathe, tender skin, heavy smoking, playing down the risk for skin cancer, valuing physical appearance, friends' use of sunscreen (girls only), a positive attitude toward having a tan, favorable physical self-concept, friends' use of sunbeds, and friends' sunbathing. Sunscreen use was also predicted by opportunity to sunbathe and skin type. Furthermore, the effects of perceived risk for skin cancer and peers' use of sunscreen were particularly strong.
PMID: 7805636, UI: 95104159
Am Fam Physician 1994 Aug;50(2):327-32, 334
State University of New York Health Science Center at Brooklyn.
Overexposure to ultraviolet and visible radiation causes sunburn. Aspirin and other nonsteroidal anti-inflammatory drugs, cool baths and topical steroids offer only mild relief. Long-term sun exposure causes chronic inflammatory skin changes. Photodamage, rather than the normal aging process, may account for 90 percent of age-associated cosmetic skin problems. Physicians should stress to their patients that all ultraviolet exposure (including sun beds and tanning salons) causes skin damage. Regular sunscreen use during childhood and adolescence may result in an 80 percent reduction in the lifetime incidence of ultraviolet-induced skin damage, including nonmelanoma skin cancers.
PMID: 8042567, UI: 94317594
Arch Dermatol 1994 Jun;130(6):804-6
PMID: 8002660, UI: 94270854
Am J Epidemiol 1994 May 1;139(9):857-68
Constitutional factors and sun exposure were examined among 256 cases of melanoma and 273 controls in three counties of western Washington State. Cases were individuals diagnosed with melanoma at ages 25-65 years during 1984-1987 who were identified from a Seattle-Puget Sound cancer registry. Population controls were identified through random digit dialing and were randomly selected, stratified by age, sex, and county. Participants completed a telephone interview with questions on demographic, sun exposure, and constitutional factors. Risk factors for melanoma were examined through the use of logistic regression, controlling for age, sex, and educational level, and data on each exposure variable were tested for the significance of trends across levels of exposure. The constitutional factor most strongly associated with melanoma risk was sun sensitivity, measured as either reaction to chronic sun exposure (for no tan vs. deep tan, odds ratio (OR) = 9.0, 95% confidence interval (CI) 3.8-21.1; p < 0.001 for trend across four categories) or reaction to acute sun exposure (for severe burn vs. tan, OR = 5.7, 95% CI 2.6-12.6; p < 0.001 for trend across four categories). The number of raised nevi counted on both arms by subjects was also associated with increasing risk (for > or = 10 nevi vs. none, OR = 5.7, 95% CI 2.2-14.6; p for trend < 0.001). Sun exposure in adulthood and occupational sun exposure were not related to melanoma risk. The effect of sun exposure in childhood on melanoma risk was modified by tanning ability. Poor tanners showed no effect of sun exposure at ages 2-10 years or ages 11-20 years. In contrast, people who reported a deep or moderate tan in reaction to chronic sun exposure appeared to be protected from melanoma with increasing sun exposure at ages 2-10 years (for upper third vs. lower third, OR = 0.3, 95% CI 0.2-0.6; p for trend < 0.001), with identical results for exposure at ages 11-20 years. The finding that childhood sun exposure is protective only among those able to tan supports the hypothesis that developing a tan during childhood may reduce the risk of melanoma by offering protection from the effects of sunlight exposure.
PMID: 8166136, UI: 94219458
Am J Public Health 1994 Mar;84(3):476-8
Johnson County Department of Public Health, Iowa City, Iowa.
In 1991, 1008 suburban St. Paul, Minn, high school students were surveyed via self-administered questionnaire regarding use of commercial tanning facilities, injuries experienced from tanning, use of protective measures while tanning indoors, and knowledge of the risks of tanning. Overall, 34% of the respondents had used commercial tanning facilities. Fifty percent said they had not been warned by tanning facility operators about the risks of tanning indoors, 28% reported not being told to wear goggles, and 17% reported never wearing goggles. The results indicate that these adolescents use commercial tanning services at high rates, and often in ways that increase their risk for a variety of health problems.
PMID: 8129071, UI: 94175199
Intensive Care Med 1994;20(2):145-7
Department of Intensive Care, Sir Charles Gairdner Hospital, Nedlands, Western Australia.
A woman ingested 400 ml of leather tanning solution containing 48 g of basic chromium sulphate (CrOHSO4). This substance forms hydrogen ions and trivalent chromium when it reacts with tissue proteins. The patient died of cardiogenic shock, complicated by pancreatitis and gut mucosal necrosis and haemorrhage. There are no reported cases of toxicity due to oral ingestion of trivalent chromium. Toxicity of hexavalent and trivalent chromium is discussed and suggestions made for management of future cases.
PMID: 8201096, UI: 94259935
J Cancer Educ 1994 Fall;9(3):155-62
University of Arizona Cancer Center, Tucson.
Skin cancer rates are increasing. Instilling preventive behavior in youngsters is essential to prevent overexposure during childhood. The effectiveness of a curriculum for increasing knowledge and skills, creating supportive attitudes, and engendering a supportive environment to enhance skin cancer prevention was tested on 139 fourth-, fifth-, and sixth-graders. One class in each grade was assigned to treatment (curriculum) and another to control. The curriculum increased knowledge of the effects of exposure to sunlight, skin cancer, and prevention immediately and eight weeks later, across all grades. It also cultivated less favorable attitudes toward tanning and, among fourth-graders, reduced unfavorable attitudes toward sunscreen. Behavioral changes were less consistently evident, with students reporting less suntanning, fourth-graders more frequently using sunscreen, and fifth- and sixth-graders more frequently wearing protective clothing compared with controls. The curriculum was more effective at influencing knowledge and attitudes than changing behavior, highlighting the need for student- and parent-oriented cues to action.
PMID: 7811604, UI: 95110708
J Am Acad Dermatol 1993 Dec;29(6):959-62
Bowman Gray School of Medicine, Wake Forest University, Winston-Salem, North Carolina.
BACKGROUND: Although cosmetic tanning and unprotected solar exposure are common, little is known about general attitudes, beliefs, and behavior regarding sunbathing, sunscreen use, and tanning salon use. OBJECTIVE: We sought to determine the frequency of UV exposure in a select sample and to assess the knowledge and beliefs of the effects of UV irradiation. METHODS: A written, anonymous questionnaire was distributed to a sample of 477 persons in a shopping mall, at a social gathering, and on a vacation cruise ship. The instrument explored demographic information, sunscreen use, sunbathing habits, tanning bed use, and cutaneous solar effects. RESULTS: Forty-two percent of respondents seldom or never used sunscreen, and 33% sunbathed at least once a week. Although the three sample populations differed in education, sunbathing habits, sunscreen use, and tanning bed use, they were equally informed about UV light hazards. Compared with those who had not used tanning beds, tanning bed users were more likely to be female and more knowledgeable about the long-term effects of UV. Tanning beds were most commonly used in tanning or hair salons, (mean 23 +/- 7 minutes at 2.3 +/- 1.1 times per week). Reported positive psychologic sequelae from tanning bed use were more common than negative physical sequelae. At least 10% would continue to use tanning beds if these were proved to cause skin cancer. CONCLUSION: In this select sample, sunbathing and tanning bed use were common. No group surveyed universally practiced sun protection and avoidance. Clientele of tanning beds may be aware of the damaging effects of the sun, but may not be aware that tanning bed use is associated with skin damage.
PMID: 8245261, UI: 94064953
J Am Acad Dermatol 1993 Nov;29(5 Pt 1):787-8
PMID: 8227556, UI: 94043989
Int J Radiat Biol 1993 Oct;64(4):445-50
Department of Dermatology, Rigshospitalet, Copenhagen University Hospital, Denmark.
In legislation the CIE human erythema action spectrum is used to assess the risk of UV radiation appliances for household use. The most popular type of UV radiation source for private use is the low pressure 'UVA' radiation source, which mainly emits in the UVA area, but also has some emission in the UVB area. Recently reports have raised doubt whether the CIE erythema action spectrum is a good approximation for the carcinogenic risk. Therefore, it was investigated whether the carcinogenic potential of differing UV tanning sources, which mainly emit in the UVA area, could be assessed by using the CIE erythema spectrum. Two groups of lightly pigmented C3H/Tif mice were initially exposed to broad spectrum UV radiation with a high output of UVB (UVB emission 16.7%) during 84 days, in a daily dose of 4.67 Basic minimal erythema doses (Basic-MED). Subsequently, one group was exposed to Bellarium-S SA-1-12 (UVB emission 6.9%), the other to Philips TL 09R (UVB emission 2.2%), in a daily dose of 1 Basic-MED. The time to occurrence of seven tumour end-points was almost identical in the two groups, p > 0.4. To obtain further information on the relationship between the daily dose of common UV tanning sources measured in Basic-MED and tumour development, we combined the result of this experiment with the results of two others. There existed a negative correlation between the daily exposure dose measured in Basic-MED and the tumour induction time, p < or = 0.05. This inverse relationship was observed both when the UV tanning sources were administered with or without a prior exposure to broad spectrum UV irradiation. Our results indicate that the carcinogenic risk of UV tanning sources in the hairless C3H/Tif mouse can be estimated by the CIE erythema action spectrum.
PMID: 7901306, UI: 94045117
Cancer Nurs 1993 Apr;16(2):139-44
Presbyterian Hospital, Charlotte, NC 28233-3549.
Skin cancer may be a very preventable malignancy, yet the incidence is increasing at an epidemic rate. Solar ultraviolet radiation is the major carcinogenic agent. The expression "a good healthy tan" is a contradiction; tanning is the biological process of the skin responding to injury. Regular use of a properly selected and applied sunscreen is one of the essential primary prevention strategies for reducing the incidence of skin cancer. Nurses can be instrumental in helping patients/clients understand the dangers of suntanning and the need for protection against solar ultraviolet radiation (UVR).
PMID: 8477402, UI: 93238210
J Am Acad Dermatol 1993 Apr;28(4):665-6
Comments:
PMID: 8463479, UI: 93217028
Am J Prev Med 1992 Nov-Dec;8(6):381-3
School of Public Health, Division of Sociomedical Sciences, Columbia University, New York, NY 10032.
Little is known about the safety information tanning salon operators provide to customers or the extent to which artificial tanning salons adhere to federal regulations designed to protect customers from excessive ultraviolet radiation (UVR) exposure. We surveyed the operators of 20 artificial tanning salons in New York City from 1988 to 1989 concerning salon operating procedures and information provided to potential customers. Results revealed a disparity between known health risks of UVR exposure and safety information provided to tanning salon customers. For example, 75% of salon operators informed potential customers that artificial tanning would not cause a sunburn, and 80% informed potential customers that they would not get skin cancer from artificial tanning. Artificial tanning salons are a rapidly growing industry in the United States, with over two million customers annually. Results from this survey indicate a need for greater regulation of the tanning salon industry and for education of tanning salon operators in the risks associated with the use of artificial tanning devices.
PMID: 1482579, UI: 93129466
Prev Med 1992 Nov;21(6):754-65
Department of Dermatology, Northwestern University Medical School, Chicago, Illinois 60611.
BACKGROUND. Initiation of sun protection strategies can be promoted, to some extent, by educational efforts, but little is known about the merit of continuing education interventions in sustaining the desired behaviors or adding new behaviors. This prospective study clarifies the choices individuals make among the four strategies that allow them to maintain lifestyle changes. METHODS. From 1983 to 1987, the population received education about sun protection coupled with the removal of a nonmelanoma skin cancer. One year later, their choice of sun protection methods was determined. Then annually from 1985 to 1989, they received written recommendations about sun protection for a period of 2-6 years after the initial education. The maintenance, cessation, and addition to the initial sun protection behaviors were ascertained by a questionnaire, as was the intention to change. Frequency of physician visits and development of subsequent nonmelanoma skin cancer were evaluated by medical chart review for the 2-6 year phase of continued education. RESULTS. One percent of the population consisting mostly of women described ceasing tanning after 2-6 years of education. The population related a greater use of protective clothing and/or sunscreen with an SPF of 15 or greater as their reported restrictions on outdoor activities ceased. An emerging new strategy of some of the population (n = 185) was the use of sunscreens with an SPF less than 15 in association with attempts to deliberately tan and longer daily outdoor exposure. Neither frequency of physician visits nor numbers of subsequent nonmelanoma skin cancers influenced continuation or addition of sun protection behaviors. CONCLUSIONS. While the greatest reported change in behavior was temporarily associated with educational intervention linked to removal of the skin cancer, continued educational efforts may have recruited some individuals to cease tanning and encouraged others to adopt the use of protective clothing or more frequent sunscreen use as they were unable to maintain the limitations on outdoor activities. It is not possible to structure a control group restricted from mass media education; therefore, the effectiveness of specific behavior-directed education cannot be precisely determined. Nonetheless, the population described using knowledge to develop compensation sun protection strategies that preserved lifestyle.
PMID: 1438120, UI: 93066084
N Z Med J 1992 Oct 14;105(943):401-3
Hugh Adam Cancer Epidemiology Unit, University of Otago Medical School, Dunedin.
AIM: to examine adolescents' sun behaviours and use of sun protection measures, attitudes to tanning, and awareness of melanoma, in the light of the Cancer Society's Sun-smart campaign in the summer of 1990-1. METHODS: a sample of 345 fourth formers from schools in Auckland, Wellington and Christchurch was surveyed regarding their experiences and beliefs about tanning, and their use of sun protection measures including sunblock lotions, hats and clothing; their knowledge of melanoma and risks for melanoma; and their exposure to the educational campaign and its message. RESULTS: despite relatively high awareness of melanoma as a dangerous form of cancer, a significant proportion of the sample showed high positive attitudes towards tanning and high levels of sun exposure without adequate sun protection. On the positive side, reports of exposure to sources of information about melanoma were correlated with melanoma awareness, which in turn predicted use of sun protection measures. CONCLUSION: the findings suggest that campaigns such as those of the Cancer Society have an important role to play in reducing high levels of sun exposure among adolescents. Continued efforts need to be directed at adolescents to increase the acceptability and use of sun protection measures.
PMID: 1461594, UI: 93096413
J Am Acad Dermatol 1992 Aug;27(2 Pt 1):199-203
BACKGROUND: Previous small studies have demonstrated that operators of commercial tanning equipment may not be adequately trained. Most states have no training requirements for tanning operators. This study was designed to assess the medically relevant knowledge of cosmetic tanning salon operators and relate these to demographic variables. METHODS: A written, anonymous questionnaire was distributed to 984 attendees of the first required operator training seminars conducted in North Carolina. Between July 1990 and June 1991, proprietors and their employees of the commercial tanning industry who attended these seminars were surveyed. No conference attendee refused to complete the questionnaire. Demographic information and responses to the medical information section of the questionnaire were scored by computer. RESULTS: Important findings included that 71% of surveyed operators had never received any training for their current position. Operators of cosmetic tanning equipment were often unaware of contraindications to tanning such as photosensitizing drugs and specific medical conditions. Few operators recognized methoxsalen (26%) or trisoralen (34%) or their respective proprietary names as contraindications to tanning. Operator knowledge was not related to their educational achievement, previous tanning salon experience, or prior tanning industry-sponsored training. Children younger than 10 years old were tanned by 2.6% of the operators. CONCLUSION: These data suggest that the public may be at risk for UV light-induced diseases and burns because of operator lack of knowledge.
PMID: 1430356, UI: 93055630
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