Multichannel efforts may be best approach for educating patients about sun exposure

December 1, 2007

The incidence of melanoma continues to rise, and that trend appears to be related to increasing UV exposure. Recent research provides insight into effective sun safety interventions. Going forward, public health information campaigns should convey a comprehensive, evidence-based approach that may encourage maintaining natural skin color, enjoying outdoors activity, and achieving adequate vitamin D levels through dietary supplements if needed.

Key Points

Dr. Weinstock notes that while the incidence of most common cancers in the United States decreased between 1995 and 2004, melanoma was one of two cancers that had a substantial increase of more than 1 percent a year. Stratification by age showed the incidence of melanoma was rising throughout the age spectrum.

"Various theories have been proposed to explain the trend, and a shift in diagnostic criteria or bias introduced by increased surveillance have been discussed. Although these are plausible theories, there is no convincing evidence that either is making a substantial contribution to the increased incidence of melanoma," Dr. Weinstock tells Dermatology Times.

"The difference between the two study years is within the margin of error of the survey, and so, the numbers show there was no substantial change over time. The rate of sunburns remains way too high if we are concerned about making a substantial impact on melanoma incidence," Dr. Weinstock says.

Dr. Weinstock adds that, interestingly, almost half of the respondents in the more recent survey who had had a sunburn were using an SP15 or greater sunscreen when they got their worst sunburn in the summer. That percentage was higher than in the earlier survey.

"Clearly, we have a lot of educating to do to get people to be using sunscreens correctly," Dr. Weinstock says.

Surveys conducted by the Centers for Disease Control show the prevalence of sunburn in adults also increased over a recent time span in the overall population.

Strategies that work

Several recently published papers have reported on studies investigating various strategies for modifying public behavior. A study from Australia found the frequency of sunburn and sunscreen use was not affected by adding information about the UV Index itself or combined with sun protection recommendations in broadcasted weekend weather reports.

More encouragingly, however, a community-based approach to encouraging sun safe behavior had a positive impact on adolescents, according to a United States study.

After two years, communities randomized to receive no intervention showed a normal deterioration in sun-safe practices as the targeted children (sixth grade at entry) grew older.

That trend was sharply attenuated in communities receiving an intensive multichannel, multicomponent intervention in which school personnel, athletic coaches, lifeguards, pediatricians and teen peer advocates were enlisted to support sun safety.

Framing effective messages

Since interest in pursuing a tan underlies inappropriate UV exposure, an appropriate positive message would be that the healthiest color for one's skin is the color one is born with, Dr. Weinstock says.

In addition, although there remains a lot of controversy about the benefits of vitamin D, public health messages should convey that nutritional supplements are safer than UV exposure for assuring optimal levels.

"Advocates may be claiming vitamin D is important for more things than in fact it is, but there is emerging evidence about its health benefits. Therefore, it is probably a mistake to be arguing against it. A positive message from dermatologists should be that if you need more vitamin D, it is safer to get the desired level of vitamin D through a vitamin supplement than by sun exposure," Dr. Weinstock says.

The "slip slop slap" campaign is also a good public health strategy, because it encourages sun protection without discouraging physical activity.