In the past 30 years, the Unites States has seen a rapid increase in the incidence of skin cancer and death due to outdoor exposure to ultraviolet radiation (UVR). Experts have been instructing people to engage in practices that reduce the risk of skin cancer such as limiting time spent in the sun, using sunscreen and wearing protective clothing. Author David L. O'Riordan, Ph.D. (University of Queensland, Brisbane, Australia) and colleagues write that, "Adults and adolescents are particularly at risk for intense, episodic sun exposure while on vacation or in 'high-risk' environments such as beaches."
Studying the relationship between levels of UVR exposure and sun protection behavior of vacationers, O'Riordan and colleagues conducted a study at a popular beach in Honolulu, Hawaii. Between February and March 2004, 88 participants completed two surveys: a sun habits survey before entering the beach, and an exit survey upon leaving the beach that asked about sun protection practices while at the beach. The researchers also tracked UVR levels every day.
Spending about three hours at the beach, on average, participants were exposed to levels of UVR equal to five times the amount required to burn unprotected fair-skinned people. The researchers also note that 70% of the participants intended to tan at the beach even though 40% reported having had a sunburn in the last 2 days. Nearly 23% of participants indicated that they had been to a tanning salon in the past 30 days.
O'Riordan and colleagues defined three distinct groups of people based on sun protection behaviors:
- Class 1 consisted of unconcerned and lower risk individuals. They used the least amount of sunscreen and shade and a small amount of clothing. The group came to the beach with the intention of tanning and had the fewest members with a high risk of skin cancer.
- Class 2 consisted of tan seekers, but ones who sunburn easily. This group used the most sunscreen coverage and the least clothing coverage. They also reported the most tanning salon use.
- Class 3 consisted of those who were concerned about UVR and
took precautionary measures. This group had the most clothing coverage
and shade use, as well as the smallest proportion of people who
intended to tan.
The researchers conclude that: "Specific strategies should target the subsets of the beach-going population (particularly those in group 2 - the tan seekers) that intend to tan and sunburn repeatedly, taking into account their relevant personal attributes and behavior patterns. A balance should be provided between messages that focus on the immediate detrimental effects (photoaging, soreness) as well as the long-term detrimental health effects (skin cancer) of excessive UVR exposure, all the time balancing the health interests of the public with the needs of local industry."
Sherry L. Pagoto, Ph.D., and Joel Hillhouse, Ph.D. (University of Massachusetts Medical School, Worcester, Mass.) write in an accompanying editorial that this taxonomy of tanning subtypes should improve our ability to choose appropriate health interventions. They write:
"The advantages of the development of a tanning typology will not be fully realized until brief assessments that can accurately classify patients are developed and empirically verified. We believe that the latent class analysis used by O'Riordan et al to identify and define their subtypes is an important step in this process. Such assessments, together with messages tailored to each subtype, will give clinicians a way to identify those patients in greatest need as well as the most effective messages to deliver to specific patients. Given the time constraints of the typical patient-clinician interaction, such systems may very well maximize the efficiency of delivering UV safety information. Public health skin cancer prevention programs may also benefit from the improved accuracy of risk identification as well as the ability to tailor messages to various tanning subtypes, perhaps using interactive online intervention programs."
A Day at the Beach While on Tropical Vacation: Sun Protection Practices in a High-Risk Setting for UV Radiation Exposure
David L. O'Riordan; Alana D. Steffen; Kevin B. Lunde; Peter Gies
Archives of Dermatology (2008). 144: pp. 1449 - 1455.
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