Athletes and sunscreen

Dermatologist Brian B. Adams, M.D., M.P.H., remembers avoiding sunscreen as a college athlete.

He says that he and other athletes did not use sunscreen, despite spending long hours at peak times exposed to ultraviolet light, because it would sting their eyes and they were not worried about long-term dangers associated with UV exposure.

"Today, I am a varsity high school cross country coach and, over the years, I have been amazed at how few high school kids who are chronically exposed to ultraviolet light during peak hours do not use sunscreen," he tells Dermatology Times.

In an unfunded study of 186 (89 women and 97 men) NCAA athletes in Cincinnati, Dr. Adams asked, in person with a questionnaire, how often these athletes had used sunscreen in the prior seven days and why they chose not to use sun protection.

"The reason I chose NCAA athletes was that there are nearly 250,000 NCAA athletes who are potentially exposed to ultraviolet radiation during peak times during the day each year," Dr. Adams says. "Demonstrating that they were not using sunscreen would make them an ideal group to target for sunscreen intervention or sun safety prevention programs."

The results

Dr. Adams and Erica Hamant, an intern who plans to start a dermatology residency in July, found an abysmal use of sunscreen among college athletes. Eighty-five percent had not once put on sunscreen in the prior seven days and only 6 percent had used sunscreen in at least three of the past seven days.

"So, 94 percent used sunscreen less than three days in the prior week, which was totally shocking to me. I knew it was not going to be a whole lot of people wearing sunscreen, but that so many did not wear it at all was very disturbing," he says.

The athletes' most common reasons - 50 percent of the total comments - were related to inconvenience and accessibility issues.

"Most of the athletes cited that they did not have it, forgot it or it was too expensive. So, basically, it just was not around," Dr. Adams says.

A third of respondents cited reasons based on bad information, including thinking that they did not need it because the weather was cloudy, or it was afternoon. Some said they had already burned during the summer so they did not need it; they had a base tan and did not need it; or they thought that it was good to be burned because it helped their acne.

There were various solo comments, as well. Dr. Adams says he was surprised that only one athlete in the study did not wear sunscreen because it burned the eyes.

"These findings are consistent with other studies that show that those under 21 do not use adequate sun protection. This is particularly disappointing since UV protection at this age is especially important to lower skin cancer risk later in life," says Darrell S. Rigel, M.D., clinical professor of dermatology at New York University, New York, NY.

Dr. Rigel also is among the authors of the textbook, Cancer of the Skin.

Easy fixes

The implications of the comments gleaned from the questionnaire are powerful, according to Dr. Adams.

"If 50 percent of the athletes who are potentially high risk are not using sunscreen because they do not have access to sunscreen, then that is an easy fix," he says.

Dr. Adams says that the image comes to mind of a Gatorade jug on every sports field.

"A decade or two ago, you might not have had water or Gatorade on every field, and you would have dehydration and other medical issues. Now you cannot find a practice or competition field that does not have plentiful hydration. Athletic trainers now remind everyone to stay hydrated and replenish their water and electrolytes," he says.