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Background: In the past 2 decades, melanoma incidence among Hispanic individuals has risen by 20%. The mortality rate of Hispanic individuals is higher than that for non-Hispanic White individuals. Skin cancer can largely be prevented with regular sun protection, and skin cancer outcomes can be improved through early detection, for example, by skin self-examination. Alarmingly, Hispanic individuals are less aware of the symptoms and harms of skin cancers, tend to have misperceptions regarding the risks and benefits of skin cancer prevention behaviors, and engage in less sun protection behaviors than non-Hispanic White individuals., Objective: This study aimed to use a community-engaged approach and conduct both group and individual interviews among Hispanic individuals and relevant key stakeholders to explore the potential design of a mobile-based skin cancer prevention intervention for Hispanic individuals., Methods: This study used a qualitative design (focus groups and individual interviews). Participants were recruited from local community organizations' social media, local events, and contact lists (eg, email). Zoom interviews were conducted to examine whether Hispanic individuals would be interested in a mobile-based skin cancer intervention and to explore their preferences and suggestions to inform skin cancer prevention intervention design., Results: Five focus groups (2 in Spanish and 3 in English) among self-identified Hispanic individuals (n=34) and 15 semistructured, in-depth individual interviews among key stakeholders (health care providers and community leaders; eg, dermatologist, nurse practitioner, licensed social worker, and church leader) were conducted. The main themes and subthemes emerging from the group discussions and individual interviews were organized into the following categories: intervention platform, delivery frequency and format, message design, engagement plan, and activities. WhatsApp and Facebook were identified as suitable platforms for the intervention. Messages including short videos, visuals (eg, images and photographs), and simple texts messages were preferred. Recommendations for message design included personalized messages, personal stories and narratives, culturally relevant design (eg, incorporating family values), and community-trusted sources. Potential engagement and retention recommendations were also discussed. Additional details and exemplar quotes of each theme and subtheme are described., Conclusions: This study provides important insights and directions for the design of a mobile, digital skin cancer intervention to modify Hispanic individuals' sun protection and skin self-examination behaviors to help improve skin cancer outcomes. Insights gathered from community leaders and health care providers provided valuable additions to the community-derived data. Leveraging popular digital platforms among Hispanic individuals such as WhatsApp or Facebook could be a promising approach to skin cancer prevention. Recommendations from the community included the use of concise videos, illustrative images, clear text messages, tailored communications, narratives featuring personal experiences, designs that reflect cultural significance, and information from sources that are trusted by the community, which provided useful strategies for future intervention design among Hispanic individuals., (©Zhaomeng Niu, Yonaira M Rivera, Carolina Lozada, Shawna V Hudson, Frank J Penedo, Sharon L Manne, Carolyn J Heckman. Originally published in JMIR Formative Research (https://formative.jmir.org), 12.09.2024.)

Background: Ultraviolet (UV) radiation is the most important risk factor for skin cancer development. Sunlight is the main source of UV radiation in the general population. In addition, tanning beds are a source of artificial UV radiation. Since the incidence of skin cancer is increasing worldwide, it is necessary to monitor UV-related risk behaviors such as intentional indoor and outdoor tanning, as well as sun protection behavior in the general population and specific subgroups and settings. This is the aim of the National Cancer Aid Monitoring online (NCAM-online), a continuation and further development of the NCAM., Methods: The NCAM-online is a longitudinal trend study consisting of four annual survey waves. Each year, 4,000 individuals aged 16-65 years living in Germany will be surveyed using online questionnaires. Each year, intentional indoor and outdoor tanning will be assessed. In addition, varying specific topics regarding skin cancer prevention, such as the utilization of skin cancer screening, will be addressed in the questionnaires., Discussion: The findings of the NCAM-online will provide an important basis for the German Cancer Aid and Working Group on Dermatologic Prevention (Arbeitsgemeinschaft Dermatologische Prävention, ADP) to develop targeted prevention campaigns and projects aimed at preventing skin cancer. The explorative nature of the NCAM-online allows for the identification of new potential starting points for prevention and education. In addition, the longitudinal design allows for a description of the trend in the prevalence of intentional tanning. For tanning bed use, representative trend data from 2012 are available for Germany, to which NCAM-online will add annual data until 2027., (© 2024. The Author(s).)

The rapidly increasing skin cancer rates in Canada are alarming, with current data estimating that 1/3 of Canadians will be affected in their lifetime. Thus, deeper understanding of high-risk sun exposure behaviors is needed to help counter this trend. Only limited action has been taken by federal/provincial governments to reduce skin cancer incidence. A cross-sectional survey study was conducted in Manitoba, with frequency counts, means, and percentages used to encapsulate responses. Age- and gender-adjusted odds ratios were calculated using logistic regression analyses. Our study identified worrying inadequacies in sun protective behaviors and attitudes, with the threat of such high-risk behaviors amplified by a lack of skin cancer awareness. Alarming elements were noted in participants' sun exposure history (>65% reported a history of sunburns, >50% previously used a tanning bed, and >75% recently tanned for pleasure), beliefs and attitudes (>50% believe that they look better/healthier with a tan, and >40% believe that having a base tan is protective against further sun damage), and sun protection efforts (sun protective clothing was used <60% of the time, sunscreen was used by <50%, and there was a lack of knowledge about sunscreen characteristics in ~30% of respondents), in addition to significant differences being established between demographic subgroups (based on gender, age, skin phototype, income, and education attained). This study provides worrisome insight onto the grim landscape of sun protective behaviors and attitudes in Manitoba, which will inevitably translate into higher skin cancer rates and should serve as a call to action to promote targeted public health messaging in this jurisdiction and beyond.

Competing Interests: Conflicts of interest None disclosed.

Background: Protection from solar ultraviolet radiation (UVR) is paramount in light-skinned pig breeds such as Yorkshire or Landrace to avoid sunburn., Objectives: Determination of the UVR exposure of a pig and the sun protection abilities of shade cloths with different shade rates., Animals: Life-sized plastic model of a Landrace pig., Materials and Methods: The model was equipped with 20 UVR meters at various anatomical positions that recorded the erythemal effective solar irradiance. A turntable enabled irradiation from different directions. Solar irradiance was measured in direct sunlight as well as under three shade cloths with different shade rates (50%, 75% and 90%) and a camouflage net. The sun protection factors (SPF) were determined as the ratio of unshaded-to-shaded measurements at the same solar elevation. The exposure ratio to ambient (ERTA) was calculated for each body site with respect to ambient irradiance. It allows determination of when pigs are at risk of sunburn and protection is needed., Results: The calculated ERTA values show that some body parts may receive higher values than ambient UVR. Measurements showed that the SPF of shade cloths depends on textile denseness. Selected shade cloths reached values of 3.5 (shade rate 50%), 4.2 (75%) and 5.8 (90%). Protection by the camouflage net was poor. The highest SPF was gained on body sides where ERTA was highest., Conclusions and Clinical Relevance: Shade cloths can protect all body sites effectively and vulnerable sites in particular. The results of our study enable an estimation of when pigs are at risk of sunburn and provide quantitative metrics for sun protection. This allows effective prevention of UVR-caused skin damage and secondary disorders., (© 2024 The Author(s). Veterinary Dermatology published by John Wiley & Sons Ltd on behalf of ESVD and ACVD.)

Competing Interests: Conflicts of interest None disclosed.

Background: Young adults engage in behaviors that place them at risk for skin cancer. Dissemination of digital health promotion interventions via social media is a potentially promising strategy to modify skin cancer risk behaviors by increasing UV radiation (UVR) protection and skin cancer examinations., Objective: This study aimed to compare 3 digital interventions designed to modify UVR exposure, sun protection, and skin cancer detection behaviors among young adults at moderate to high risk of skin cancer., Methods: This study was a hybrid type II effectiveness-implementation randomized controlled trial of 2 active interventions, a digital skin cancer risk reduction intervention (UV4.me [basic]) compared with an enhanced version (UV4.me2 [enhanced]), and an electronic pamphlet (e-pamphlet). Intervention effects were assessed over the course of a year among 1369 US young adults recruited primarily via Facebook and Instagram. Enhancements to encourage intervention engagement and behavior change included more comprehensive goal-setting activities, ongoing proactive messaging related to previously established mediators (eg, self-efficacy) of UVR exposure and protection, embedded incentives for module completion, and ongoing news and video updates. Primary outcome effects assessed via linear regression were UVR exposure and sun protection and protection habits. Secondary outcome effects assessed via logistic regression were skin self-exams, physician skin exams, sunscreen use, indoor tanning, and sunburn., Results: The active interventions increased sun protection (basic: P=.02; enhanced: P<.001) and habitual sun protection (basic: P=.04; enhanced P=.01) compared with the e-pamphlet. The enhanced intervention increased sun protection more than the basic one. Each active intervention increased sunscreen use at the 3-month follow-up (basic: P=.03; enhanced: P=.01) and skin self-exam at 1 year (basic: P=.04; enhanced: P=.004), compared with the e-pamphlet. Other intervention effects and differences between the Basic and Enhanced Intervention effects were nonsignificant., Conclusions: The active interventions were effective in improving several skin cancer risk and skin cancer prevention behaviors. Compared with the basic intervention, the enhanced intervention added to the improvement in sun protection but not other behaviors. Future analyses will explore intervention engagement (eg, proportion of content reviewed)., Trial Registration: ClinicalTrials.gov NCT03313492; http://clinicaltrials.gov/ct2/show/NCT03313492., (©Carolyn J Heckman, Anna Mitarotondo, Yong Lin, Olga Khavjou, Mary Riley, Sharon L Manne, Amy L Yaroch, Zhaomeng Niu, Karen Glanz. Originally published in the Journal of Medical Internet Research (https://www.jmir.org), 02.07.2024.)

Objective: Skin cancer remains prevalent despite numerous studies reporting the benefits of sunscreen for reducing risk of skin cancer and sunburn. While the risks of not wearing sunscreen are well-documented, there are no effective interventions to promote sunscreen use across populations, and existing interventions have modest outcomes. The current study investigated a novel intervention to increase sunscreen use., Methods: Participants (n=15) first reported their baseline daily sunscreen use then completed sunscreen sampling and selection procedures that included testing sunscreen samples, choosing preferred sunscreens to take home and sample further, and ultimately selecting a preferred sunscreen to use for the remainder of the study. Participants then self-reported their daily sunscreen use for approximately two weeks (+/-5 days)., Results: All participants increased sunscreen use following intervention., Limitations: Data were collected between January and May; individuals may increase sunscreen use as temperatures increase (and time outdoors increases). Additionally, the current study relied on self-report of sunscreen use primarily., Conclusion: Our findings suggest that sampling and election procedures may be an effective strategy to promote sunscreen use. The findings of this study may inform future research examining sunscreen intervention strategies., Competing Interests: DISCLOSURES: The authors report no conflicts of interest relevant to the content of this article., (Copyright © 2024. Matrix Medical Communications. All rights reserved.)

Issue Addressed: While the links between sun exposure and skin cancer are well known, the benefits of sun exposure, particularly as a source of vitamin D, are less well known. This paper reports on a deliberative study exploring public perspectives about sun exposure harms and benefits., Methods: Two citizens' juries were conducted in Brisbane and Adelaide to consider questions about sun exposure, vitamin D and health promotion. Members of the general population (jurors) listened to evidence from expert witnesses about the harms and benefits of sun exposure. Most witness sessions extended for 60 min, with 6 sessions over 2 days. At each citizens' jury, jurors were asked to listen to expert testimony, consider the evidence and make policy recommendations. The planning and design of the citizens' juries were informed by well-established citizens' jury methods., Results: Jurors proposed that Australia needs improved public information about the harms and benefits of sun exposure. They argued for information that supports personal decision-making that accounts for differences in skin tone and geographical region. Jurors agreed that Australia needs an updated sun safety campaign that reflects new research and addresses diversity. A one-size-fits-all approach to sun protection may no longer be appropriate., Conclusions: While a new campaign should address both harms and benefits, jurors felt the need for skin cancer prevention outweighs the desirability of generating vitamin D through sun exposure. More nuanced public health messages are needed, which balance the need for skin protection and vitamin D, and acknowledge the diversity of Australia's population. SO WHAT?: Previous research studies are typically siloed into the separate areas of vitamin D or skin cancer research. This study incorporated both topics and pooled the views of participants in two citizens' juries who agreed on the need for improved information about the harms and benefits of sun exposure to reflect a modern Australian population., (© 2023 Australian Health Promotion Association.)

Background: It is well known that women have been plagued by various skin problems. However, research on the characteristics of women's skin at different ages is still inadequate. In addition, there is a lack of research on the extent of women's skincare habits and skin care awareness., Methods: A cross-sectional survey on skin was carried out in Shanghai, China, which was conducted by means of a questionnaire. 3678 women, aged 18-59 years, participated in the study. The information collected focused on the importance they place on their skin, the skin problems they have, and their use and perception of skin care products., Results: Before the age of 25, the most common skin problems that women face are dryness and oiliness, while after the age of 30, skin-ageing issues begin to appear and worsen with age. In addition, the higher the level of education, the higher the frequency of and compliance with sunscreen use, and the economy also affects women's use of sunscreen. Importantly, the importance women place on their skin and the level of sunscreen awareness affects women's use of sunscreen., Conclusions: This study was conducted to understand the skin characteristics of women of different age groups as well as to determine the factors that influence the use of sunscreens, which will not only promote women's skin care practices and product development, but also provide important clues for future activities on sunscreen use and health promotion., Competing Interests: Declaration of competing interest The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024. Published by Elsevier Ltd.)

Competing Interests: None disclosed.

Objective: We investigated the association between sun protection behaviours and demographic and melanoma risk characteristics of patients attending Australian melanoma specialist clinics. This may assist in targeting and tailoring melanoma prevention patient education for people at high-risk and specific population subgroups., Methods: A cross-sectional analysis of questionnaire data collected from participants attending the dermatology clinics at two major melanoma centres in Sydney, Australia between February 2021 and September 2023. The primary outcome was Sun Protection Habits (SPH) index (a summary score measured as habitual past month use of sunscreen, hats, sunglasses, a shirt with sleeves that covers the shoulders, limiting midday sun exposure and seeking shade, using a Likert scale). The primary analysis considered the SPH index and its component items scored as continuous., Results: Data from 883 people were analysed. Factors associated with less frequent sun protection behaviours overall included male gender, no personal history of melanoma, lower perceived risk, lower calculated 10-year risk of developing melanoma, and no private health insurance. People aged >61 years reported lower use of sunscreen but higher use of hats and sleeved-shirts compared with people in the younger age group. There was no difference in overall sun protection behaviours according to family history of melanoma, country of birth or by lifetime melanoma risk among people without a personal history of melanoma., Conclusions: These findings highlight the potential for targeting high-risk individuals with less frequent use of sun protection for patient education, public health messaging and ultimately improving sun protection behaviours., (© 2024 The Author(s). Australasian Journal of Dermatology published by John Wiley & Sons Australia, Ltd on behalf of Australasian College of Dermatologists.)

Dermatological conditions and skin cancers are common health concerns that require early detection and intervention. Primary care physicians play a crucial role in recognizing these conditions and serving as the first line of defense against skin cancers. This guide provides a systematic approach to conducting thorough skin examinations and enhancing understanding of common presentations of precancerous and cancerous lesions. We emphasize the importance of performing annual full-body skin exams to facilitate early detection and management of skin conditions, including a step-by-step, systematic protocol for conducting these exams, comprising preparing the patient, documenting findings, educating the patient, and considering biopsy or referral for suspicious lesions. Furthermore, we explore the atypical features of skin lesions that raise clinical suspicion and warrant further investigation. We describe the characteristics of common skin cancers, such as basal cell carcinoma, squamous cell carcinoma, and melanoma. We stress the importance of patient education on self-skin checks and sun protection measures. By incorporating the knowledge and skills presented in this guide, primary care physicians can confidently perform thorough full-body skin checks, identify common dermatological findings and early signs of skin cancers, and provide comprehensive care to patients. This will help ensure optimal outcomes in dermatological health., Competing Interests: The authors report no funding or conflicts of interest., (Copyright © 2024 Baylor University Medical Center.)

Background: Organ transplant recipients (OTR) are more likely to develop skin cancer than the general population. One of the main components of the exposome that triggers the development of skin tumours is solar ultraviolet (UV) radiation. To reduce the incidence of harmful consequences of sun exposure, sun protection education is needed for patients taking long-term immunosuppressive drugs., Methods: In a previous study, we assessed the sun-safe behaviour of 221 OTR using a questionnaire before and after transplantation and personally educated the patients about proper sun protection. After the education, there were no further reminder presentations. Presently, the sun protection and sun seeking habits of the available 176 of these patients were questioned to assess the long-term effect of the previous sun protection education., Results: Two-four years after the education, more patients wore hats and protected their skin with long-sleeved clothing than before the education. In terms of sun seeking habits, both occupational and recreational sun exposure decreased significantly. Significantly fewer people went on holiday after transplantation, but those who went on holiday spent significantly less time in the sun., Conclusion: The long-term positive effects of education can be seen both in the patients' sun protection and in their sun seeking habits. However, the long-term goal is to maintain these results and thereby reduce the likelihood of skin tumours and consequently the associated tumour death., (© 2024 The Authors. Photodermatology, Photoimmunology & Photomedicine published by John Wiley & Sons Ltd.)

Objective: The aims of this study were to assess knowledge, attitudes, and practices regarding sun exposure and sun protection among the population of Kazakhstan., Method: A cross sectional study was conducted by administering an online questionnaire via social networking sites to residents of Kazakhstan. The questionnaire was designed to determine demographic information as well as knowledge, attitudes and practices regarding sun exposure and sun protection., Result: The responses of 249 participants were analysed.  Descriptive tests, bivariate analyses, and multiple linear regression were used to statistically analyse the data. The mean age of the participants was 31.7 ± 11.5 (SD) years. Most participants were of Kazakh nationality (88.7%), female (71.0 %), urban residents (93.9 %), and possessed higher education degrees (88.0 %). The level of knowledge and attitudes were found to be moderate amongst the population whilst practices were determined to be low.  Knowledge (p=0.002), attitudes (p=0.002), female gender (p=0.002), and having children educated in school about sun safety (p=0.018) were significantly associated with improved sun-protective practices., Conclusion: This study has demonstrated low adoption of sun protective practices in the Kazakhstan population, despite the identification of certain characteristics associated with higher rates of practice.

South Asians (SAs) are among the fastest growing populations in the USA. Colorism - the system of inequality that views lighter skin as more advantageous in society - is prevalent in SA culture. This study evaluates motivations of sun protection use, attitudes of colorism, and skin lightening (SL) practices among SA Americans. Two-hundred-four participants recruited from online forums and ResearchMatch completed a questionnaire. Over half (111/204) reported use of sunscreen, of which 39.6% (44/111) reported daily or frequent use. Nearly half of respondents (98/204) believed that they are not at risk for skin cancer, with 37.7% (77/204) reporting minimal knowledge of skin cancers and only 4.9% (10/204) receiving a total body skin exam. One-third (65/204) reported being more concerned about prevention of tanning than skin cancer. In total, 38.2% (78/204) of respondents reported use of SL products, of which 33.3% (26/78) reported hydroquinone-based products and 26.9% (21/78) were unaware of the ingredients in their SL product. Only 16.7% (13/78) consulted a medical professional before using SL products. While many agreed that SA culture places high importance on light skin with regards to beauty standards (82.3%, 168/204), less noted that lighter skin is more beautiful (37.0%, 74/204). SL users more strongly agreed with colorism attitudes than non-users. Limitations include a small sample size with younger participants. Dermatologists must be mindful of the cultural motivations for skin tone preferences, sun protection habits, and SL behaviors and provide culturally relevant education on sunscreen, skin cancer, and risks of SL for the SA community., (© 2024. W. Montague Cobb-NMA Health Institute.)

Competing Interests: None disclosed.

Issue Addressed: Strategies that support the implementation of the SunSmart program in primary schools are essential to optimising policy uptake. Evidence outlining the type of support required, however, is lacking. This project explored the usefulness of an implementation support approach to sun safe hat-wearing in schools., Methods: Formative research was undertaken with 16 primary schools in Greater Western Sydney to explore current sun protection behaviours and practices, perceived barriers and motivators of sun safe hat-wearing, and resource needs. Based on these insights, a resource toolkit was developed and tested in 14 demonstration sites. Follow-up interviews evaluated the usefulness of the toolkit and implementation support approach., Results: Sun safe hat-wearing practices varied among schools. Commonly reported motivators included school policies, role modelling, incentives and knowledge. Commonly reported barriers included negative social norms, forgetfulness, cost and lack of understanding. Formative insights informed the development of the 'Motivation, Access, Triggers' Model and a 23-resource toolkit. Following toolkit rollout, champions reported that the ability to select resources according to local needs was useful, and most found that the toolkit supported their school with sun safe hat-wearing., Conclusions: A toolkit with local champions and leadership buy-in has the potential to improve policy implementation. The opportunity to prioritise resource selection enables schools to address their specific needs in line with their sun protection policy. SO WHAT?: The provision of policy implementation support can help schools overcome the challenges of transforming a written SunSmart policy into practice., (© 2023 The Authors. Health Promotion Journal of Australia published by John Wiley & Sons Australia, Ltd on behalf of Australian Health Promotion Association.)

The incidence of skin cancer has risen steadily over recent decades. Childhood and adolescent sun exposure remains a critical risk factor in skin cancer development, making education of high schoolers imperative for promoting sun-safe behaviors. Medical students in North Carolina recognized this need and designed a skin cancer education program focused on portraying skin cancer in individuals with all Fitzpatrick skin phototypes. Eighty-seven students completed the pre-survey, and 84 completed the post-session survey. In the post-survey, 88% of students listed actionable behavioral changes they plan to make following the presentation. Following an educational session, students were able to demonstrate their new knowledge and provide meaningful behavioral changes. This program navigated challenges posed by COVID-19 and addressed the need for more inclusive skin cancer educational material., (© 2023. The Author(s) under exclusive licence to American Association for Cancer Education.)

This research letter assesses male skin care content on social media in order to bring to light the lack of content regarding skin cancer prevention posted on Instagram for male audiences., (©Alexa Carboni, Olnita Martini, Jessica Kirk, Nathaniel A Marroquin, Corinne Ricci, Melissa Cheng, Mindy D Szeto, Kayd J Pulsipher, Robert P Dellavalle. Originally published in JMIR Dermatology (http://derma.jmir.org), 13.03.2024.)

Background: Skin cancers resulting from excessive exposure to solar ultraviolet (UV) radiation are on the rise. This study aims to investigate the impact of facial-aging app intervention on promoting safe and healthy behaviors and its influence on reducing students' UV exposure., Method: Utilizing a Pretest-Posttest repeated-measures design, we developed a theory-guided web app on the WhatsApp platform, named the Sunshine and Skin Health app. This app allows users to visualize their altered faces in three stages of adolescence, middle age, and old age based on sun protection behavior. The intervention continued within WhatsApp, incorporating 27 health messages grounded in the PMT theory, eight educational files, and a skin cancer video clip. The primary outcome is the change in sun protection behavior between the two groups (intervention and control) immediately after the intervention (T2) and the secondary outcome is the change in sun protection behavior between the two groups at 3 months follow-up (T3). The data are analyzed in SPSS 22 and a significance level of 0.05 is considered., Results: The results revealed no significant difference between the two groups before the intervention. However, in the intervention group, there were significant differences in the utilization of sunglasses, hats, and sunscreen in the last month, as well as sunscreen reapplication after washing their hands and face, both immediately after the intervention and at the 3-month follow-up, compared to the control group (P = 0.001). Furthermore, a significant intervention effect, time effect, and interaction effect between group and time were observed in behaviors related to using sunscreen in the last month and sunscreen reapplication after washing hands and face (P = 0.001). Specifically, the intervention group exhibited a significant difference from Time 1 to 2 and from Time 1 to 3 (p = 0.001), but no significant difference from Time 2 to 3. In contrast, the control group did not show any significant differences over time., Conclusions: This study indicated that the Facial-Aging web app can effectively encourage safe behaviors in sunlight. To ensure the maintenance and sustainability of these behaviors over the long term, it is crucial to consider implementing booster sessions., Trial Registration: Iranian Registry of Clinical Trials IRCT20200924048825N1. Registered prospectively on 8 February 2021., (© 2024. The Author(s).)

Introduction Skin photoaging is caused by prolonged exposure to sunlight, particularly ultraviolet rays (UV). High cumulative levels of UV radiation may cause burning, photoallergic or phototoxic reactions, pigmentary changes, photoaging, and even immunosuppression and skin cancers. Therefore, this study aims to assess knowledge, attitude, reception, and preventive practices towards skin photoaging among the Jazan general population in Saudi Arabia and its determinants. Methods A descriptive cross-sectional study was conducted among the general population of Jazan, Saudi Arabia, who were aged 18 years and above and agreed to participate in the study. The calculated minimum sample size was 385. An online, semi-structured, self-administered questionnaire was distributed conveniently in Google Forms through social media platforms. It included four sections: The first section was about sociodemographic characteristics. The second section assessed the smoking, exercise, and healthy diet behavior of participants and the use of sunscreen. The third section assessed the knowledge regarding the photoaging process and its preventive measures utilization using three-point Likert scale questions. The fourth section assessed attitudes towards the photoaging process and its preventive measures through three-point Likert scales. Results The study included 452, of which 243 (53.76%) were aged 18-30 years, 258 (57.08%) were females, and 272 (60.18%) had white skin color. Approximately 417 (92.26%) were nonsmokers. Sixty-eight percent (372) spent 1-3 hours in the sun. Social media was the primary source of information on photoaging 81 (17.92%). Around 234 (51.77%) defined photoaging correctly. Regarding sunscreen usage, 58 (12.83%) always use sunscreen, and 177 (39.16%) never use it. However, 191 (42.26%) recognized the correct sunscreen application. Approximately 233 (51.5%) and 240 (53.1%) of respondents had fair knowledge and a positive attitude regarding photoaging and sunscreen use. Being female, pursuing university and postgraduate education, and taking information on photoaging from a physician were linked to a higher knowledge of photoaging (p<0.05). Participants who never use sunscreen had lower knowledge than those who always use it (p<0.001). None of the demographic factors was associated with the attitude towards sunscreen use (p>0.05). Conclusion There is a substantial gap in knowledge and preventive practices related to skin photoaging among the Jazan general population in Saudi Arabia. Gender, education level, and information sources influence knowledge levels. Targeted educational interventions are needed to enhance awareness and promote healthier practices, particularly sun exposure and photoaging prevention., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2024, Assiri et al.)

Issue Addressed: It is unknown whether SunSmart health promotion campaigns in Western Australia are still effectively reaching their target audience of young people (under 45 years). This study examined trends over time in awareness, relevancy and believability of SunSmart advertisements and identified socio-demographic characteristics and risk factors associated with campaign awareness., Method: Linear regression and log-binomial modelling were undertaken using data from the annual SunSmart post-campaign evaluation surveys between 2008/2009 and 2021/2022. SunSmart campaigns were analysed and categorised into the following themes: (1) personal real-life stories; (2) daily activities/sun exposure leads to skin cancer; or (3) cartoon/animated., Results: Between 2008 and 2022, there were declines in total awareness (74.2% to 20.4%), unprompted awareness (33.7% to 4.9%) and relevancy (89.5% to 54.8%) of SunSmart advertisements (representing annual percent decreases of 3.6%, 3.1% and 1.8%, respectively). However, believability remained high over time (>94% in each annual survey). Trends were inconsistent between the awareness of campaign themes and socio-demographic characteristics and risk factors. Several campaigns had greater awareness in their subsequent years, compared with the first campaign year., Conclusion: In more recent years, SunSmart advertisements and campaigns may not have reached their target audience. In addition to socio-demographic characteristics, particularly age, advertisement factors may also affect the awareness of specific campaigns. SO WHAT?: Given the changing advertising landscape and its rising costs, ongoing funding is pertinent to increase the reach of future SunSmart campaigns. Increasing advertisements on alternative platforms and designing campaigns which separately target adolescents and adults need to be considered., (© 2024 The Authors. Health Promotion Journal of Australia published by John Wiley & Sons Australia, Ltd on behalf of Australian Health Promotion Association.)

Background: Skin cancer incidence and prognosis vary by ethnicity and gender, and previous studies demonstrate ethnic and gender differences in sun-related cognitions and behaviors that contribute to this disease. The current study sought to inform skin cancer interventions tailored to specific demographic groups of college students. The study applied the prototype willingness model (PWM) to examine how unique combinations of ethnic and gender identities influence sun-related cognitions., Method: Using data from a survey of 262 college students, the study tested whether self-reported sun-related cognitions were different for White women, Hispanic women, White men, and Hispanic men. Path modeling was also used to identify which PWM cognitions (e.g., prototypes, norms) were the strongest predictors of risk and protection intentions and willingness in each demographic group., Results: Several differences in sun-related cognitions and PWM pathways emerged across groups, emphasizing the need for tailored skin cancer education and interventions. Results suggest that, for White women, interventions should primarily focus on creating less favorable attitudes toward being tan., Conclusion: Interventions for Hispanic women may instead benefit from manipulating perceived similarity to sun-related prototypes, encouraging closer personal identification with images of women who protect their skin and encouraging less identification with images of women who tan. For White men, skin cancer interventions may focus on creating more favorable images of men who protect their skin from the sun. Lastly, interventions for Hispanic men should increase perceived vulnerability for skin cancer., (© 2024. International Society of Behavioral Medicine.)

This audience segmentation of visitors at coastal parks in Hawaii and North Carolina addresses an emergent natural resource management concern and risk to aquatic ecosystems: sunscreen chemical pollution. Four audiences were identified that correspond to different behavioral profiles: sunscreen protection tourists, multimodal sun protection tourists, in-state frequent park visitors, and frequent beachgoers who skip sunscreen. The second-largest audience, sunscreen protection tourists, represents 29% of visitors at Cape Lookout National Seashore and 25% at Kaloko-Honokōhau National Historical Park. This group ranks of most concern for chemical pollution because they use sunscreen, but not typically mineral formulations or other methods such as protective clothing, and they have lower levels of sunscreen chemical issue awareness. The identification of similar audience segments across regions with differing cultural characteristics and sunscreen regulation status suggests the robustness of the model and its indicator variables, with implications for both environmental protection and public health. Further, coastal visitors' interest in enacting pro-environmental sun protection behaviors during their next park or beach visit indicates the potential for natural resource managers to holistically address risks in both domains through targeted interventions with audiences of most concern., (© 2023 The Authors. Risk Analysis published by Wiley Periodicals LLC on behalf of Society for Risk Analysis. This article has been contributed to by U.S. Government employees and their work is in the public domain in the USA.)

Excessive exposure to ultraviolet (UV) light leads to acute and chronic UV damage and is the main risk factor for the development of skin cancer. In most countries with western lifestyle, the topical application of sunscreens on UV-exposed skin areas is by far the most frequently used preventive measure against sunburn. Further than preventing sunburns, increasing numbers of consumers are appreciating sunscreens with a medium- to high-level sun protective factor (SPF) as basis for sustainable-skin ageing or skin cancer prevention programs. However, recent investigations indicate that clinically significant DNA damages as well as a lasting impairment of cutaneous immunosurveillance already occur far below the standard of one minimal erythema dose (MED) sunburn level, which contributes to the current discussion of the clinical value of high-protective SPF values. Ex vivo investigations on human skin showed that the application of SPF30 reduces DNA damage for a day long sun exposure (24 MED) drastically by about 53% but is significantly surpassed by SPF100 reducing DNA damage by approx. 73%. Further analysis on different SPF protection levels in UV-exposed cell culture assays focusing on IL-18, cell vitality and cis/trans-urocanic acid support these findings. Whereas SPF30 and SPF50 + sunscreens already offer a solid UVB cover for most indications, our results indicate that SPF100 provides significant additional protection against mutagenic (non-apoptotic-) DNA damage and functional impairment of the cutaneous immunosurveillance and therefore qualifies as an optimized sunscreen for specifically vulnerable patient groups such as immunosuppressed patients, or skin cancer patients., (© 2024 The Authors. Experimental Dermatology published by John Wiley & Sons Ltd.)

Introduction: Skin cancer is currently the most common cancer type worldwide, and numbers are rapidly increasing. To improve primary prevention, individualised prevention strategies may be of interest as this enhances the chance of long-term behavioural change. The Sun Exposure and Protection Index (SEPI), previously validated in multiple languages, is a tool that could help identify individuals with risky behaviour and tailor interventions to the person's propensity to change. The aim of the present study was to investigate the reliability and validity of a Dutch version of the SEPI for both usage in daily clinical practice and research., Methods: Patients were included at primary care settings and dermatology outpatient settings in a 1:1 ratio. Participants were asked to fill out the SEPI together with some baseline characteristics and the previously validated FACE-Q Skin Cancer - Sun Protection module. Construct validity was tested by comparing SEPI part I and the FACE-Q module using Spearman's Rho. Internal consistency was assessed with Cronbach's Alpha for both SEPI parts separately. To assess test-retest reliability, the SEPI was again filled out 3 weeks later, and scores were compared with Cohen's weighted Kappa., Results: Of the 171 participants completing the first questionnaire, 147 (86.0%) participants also completed the follow-up questionnaire. Comparison between the corresponding SEPI part I and FACE-Q module questions showed good correlations regarding sun exposure habits (correlation coefficients ranging from 0.61 to 0.85). Internal consistency of SEPI part I was 0.63 and SEPI part II was 0.65. The test-retest analysis indicated reproducibility over time (weighted Kappa ranging from 0.38 to 0.76)., Conclusion: In conclusion, the Dutch version of the SEPI is shown to be a valid and reliable tool for both usages in daily clinical practice and research to evaluate individual ultraviolet exposure and measure a person's propensity to limit it., (© 2023 The Author(s). Published by S. Karger AG, Basel.)

The concept of modern human sun protection is no more than one hundred years, but real development of it, including protection against UVA + UVB radiation (and more recently also the IR and blue light), has been no more than 30 years. One fundamental issue while formulating sunscreens is the photostability of the UV filters, which is particularly feeble for the UVA. The gold standard for the determination of sunscreen UVA protection "in vitro" is ISO 24443:2021. Still, interlaboratory results are not as consistent as expected. The Technical Committee for Cosmetics (ISO TC 217) has tried to standardize the method with precise specifications for the materials and equipment used. In particular, the standardization of UV exposure sources based on Xe arc lamps. This fact requires expensive equipment out of the reach of many laboratories to achieve adequate temperature control on the samples. In this paper, it will be shown that, within the experimental error, satisfactory results were achieved with a cheap commercial LED source irradiating only in the UVA spectra. Evidence is presented to conclude that other more relevant factors must be considered as the main cause of uncertainties., (© 2023 American Society for Photobiology.)

The incidence of cutaneous melanoma continues to rise despite the increased use of sunscreens within the last several decades. Some research even suggests that the use of sunscreen is associated with increased rates of melanoma. Given the aggressive, and often deadly, nature of cutaneous melanoma, the aim of this communication is to better elucidate the relationship between sunscreen use and melanoma development and if there are other preventative measures to be aware of. A search was performed to identify the studies that have investigated melanoma development in individuals who used sunscreen and those who did not. Study limitations and possible confounding variables were identified, which guided a subsequent search to determine what data were available to support that these limitations and confounding variables may explain the perplexing association between sunscreen use and melanoma development. Five hypotheses were generated, which were related to increased awareness and reporting, the relationship between sunscreen use and the duration of sun exposure, the importance of broad-spectrum protection, and the effect of sunscreen on reactive oxygen species formation. The main conclusion is that more recent studies that control for confounding variables are required to determine the true effect of adequate broad-spectrum sunscreen use today on the development of melanoma.

Background: In the contemporary era, people are extracting medical information from content-sharing means on the Internet, and the most popular virtual platforms authorize users to access knowledge, guidance, and exchange opinions. Doctors have massively joined online communities and developed educational accounts to meet the informational necessities of general users. The aim of the current study is to identify the role of social media in augmenting the awareness of melanoma., Methods: For this observational study, questionnaires were disseminated to the general population over eight weeks consecutively, through online channels, represented by Facebook (Meta Platforms, Inc., Menlo Park, California, United States) and Instagram (Meta Platforms, Inc., Menlo Park, California, United States), to extract qualitative data related to the relationship between social media, the epidemiological variables, and melanoma-associated/sun protection behaviors. The inclusion criteria comprised constant Facebook and Instagram users, aged between 18-65., Results: The study included 221 individuals, primarily aged 26 to 35 (47.1%), mostly females (77.82%). Urban dwellers (>200,000 inhabitants) constituted the majority (71.94%), contrasting with a small rural representation (3.61%). Nearly half actively followed medical educational content online (44.79%), while 12.66% avoided online medical advice. Sun-protective habits were prevalent, with 80.99% using SPF (sun protection factor), 54.29% wearing UV-filter (ultraviolet-filter) sunglasses, and 53.84% avoiding sun exposure between 10 AM and 4 PM. Respondents rated sun-protective measures, with the highest average for avoiding sun exposure during peak hours being 7.3 on a scale of 1 to 10. Dermatological advice from social media influenced behaviors, such as SPF use (50.67%) and sun exposure avoidance (45.7%). Dermatological check-ups were infrequent, with 49.32% sporadically visiting a dermatologist. Dermoscopic evaluations were rare (36.66%), with 27.14% using it preventively. Personal and family history of dysplastic nevi and melanoma were low., Conclusions: This study provides insights into the dermatological behaviors and education of individuals engaging with social media medical content. The results suggest that constant users of social media harbor a receptive attitude toward dermatological advice provided on specific platforms, hence creating an ideal environment for further dissemination and organization of online skin cancer awareness campaigns., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Boșoteanu et al.)

Introduction Prolonged sun exposure has been linked with the development of numerous medical and dermatological complications, such as skin cancer. Photoprotection can help reduce ultraviolet radiation (UVR)-induced skin damage and skin cancer. This study aims to assess the knowledge about and attitude toward the use of sun protection to prevent laser adverse events among the general population in Saudi Arabia. Methodology This is a cross-sectional, analytical, community-based study carried out among the general population (sunscreen users) in Saudi Arabia. A total of 600 participants were enrolled in the study. Data were collected using a validated online self-administered questionnaire using Google Forms. Data were analyzed using IBM SPSS Statistics for Windows, Version 21.0 (IBM Corp., Armonk, NY). Results A total of 600 sunscreen users were enrolled in this study, with an overall poor knowledge rate of 471 (78.5%) regarding the use of sun protection methods. Their ages ranged from 18 years to >55 years. The majority of them were females (537, 89.5%), had Saudi Nationality (533, 88.8%), and had skin type III (313, 52.2%). Almost all the participants (491, 81.9%) had undergone laser treatment before; the most reported reason was hair removal (522, 87%). In addition, 267 (44.5%) participants used sunscreens five to six times a week, with 440 (73.3%) also using sunglasses. Notably, only 91 (15.2%) of the study participants were aware that sunscreen covers UVA and UVB, and 34 (5.7%) knew that PA+++ is used in sunscreen. A total of 149 (24.8%) reported that sunscreen should be applied 20 to 30 minutes before sun exposure, while 153 (25.5%) stated that it should be reapplied every two hours. Moreover, 484 (80.7%) participants reported using topical steroid application after laser treatment. The results also showed that young participants ( P  = 0.001), single participants ( P  = 0.001), post-graduate participants ( P  = 0.010), students rather than the unemployed group ( P  = 0.002), and those who used sunscreens five to six times per week compared to those who never used sunscreens ( P  = 0.001) demonstrated an overall good knowledge about sunscreens and laser treatment. Conclusions The study showed poor knowledge among the participants regarding the use of sun protection to prevent adverse laser events. Therefore, an increase in awareness among the general public about the protection through campaigns is highly recommended., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Alamri et al.)

Competing Interests: None.

Background: Sunburn can increase one's risk of developing skin cancer. We aimed to quantify the prevalence of sunburn during recreational outdoor sport (ROS) in summer, to explore the use of different sun protection measures, and to examine factors associated with sunburn during ROS using a population-based sample from Germany., Methods: For this cross-sectional study, 2081 individuals aged 16-65 years who reported being engaged in ROS in summer were surveyed via standardized telephone interviews in 2020 (National Cancer Aid Monitoring, NCAM)., Results: Overall, 16.7% reported experiencing at least one sunburn during ROS in the past twelve months. Sunburn occurrence was negatively associated with the age of the participants (e.g. OR = 0.49 in 56-65 year-olds, p < .001), and positively associated with skin type I/II (OR = 1.55, p < .001) and with having a higher number of nevi (OR = 1.42, p = .005). While wearing sleeved shirts was the most frequently-used sun protection measure during ROS (74.9%), wearing headgear was least common in our sample (29.0%). In multivariate analyses, sunburn was positively associated with the use of sun protection measures (e.g. OR = 1.32 for wearing sleeved shirts, p = .02)., Conclusions: Our nationwide data show that ROS is one of the settings where sun protection should play a greater role. Especially in organized sports, particular attention should be devoted to organizational (e.g. exercise outside peak hours) or contextual measures (e.g. shade by the natural or built environment) to prevent skin cancer in later life., (© 2023 The Authors. Photodermatology, Photoimmunology & Photomedicine published by John Wiley & Sons Ltd.)

Sun exposure is harmful to the skin and increases the risk of skin aging and skin cancer. Here we examined the effects of daily exposure to sun radiation on the skin microbiome in order to determine whether skim microbiome bacteria can contribute to protection from solar damage. Skin swabs were collected from ten lifeguards before and after the summer to analyse the skin microbiome. The results indicate that specific skin microbiome bacteria were enriched following the seasonal sun exposure. Especially interesting were two bacterial families - Sphingomonas and Erythrobacteraceae - which may have the ability to protect against UV radiation as they produce potentially protective compounds. We concentrated on a Sphingomonas strain and could show that it was highly resistant to UV irradiation and was able to reduce reactive oxygen species levels in human keratinocytes. These results provide a proof-of-concept for the role of the skin microbiome in protection from solar radiation., Competing Interests: Declaration of competing interest We declare that there is no conflict of interest., (Copyright © 2023 Institut Pasteur. Published by Elsevier Masson SAS. All rights reserved.)

Globally, cutaneous melanoma (CM) incidence is increasing, with sun exposure identified as a key modifiable risk factor. The Atlantic provinces of Canada display varied CM incidence rates: New Brunswick aligns with the national average, while Nova Scotia and Prince Edward Island exceed it, and Newfoundland and Labrador fall below this benchmark. We investigated the relationship between sun exposure and CM in these provinces. Twenty-two focus groups encompassing 95 Atlantic Canada residents were conducted and transcribed. A thematic analysis was conducted in MAXQDA using the social-ecological model as a framework. Residents of high-CM incidence provinces demonstrated greater sun exposure awareness, consulting UV indices, and using sunscreen and sun-protective clothing. However, they received greater UV exposure due to warmer climates and outdoor work and cultural activities. Conversely, those in low-incidence provinces used sunscreen and sun-protective clothing less often, engaged in occupations and hobbies affording less sun exposure, and lived in cooler climates. Our data supports a possible "sunscreen paradox", whereby increased sunscreen use is correlated with augmented sun exposure, leading to a deceptive sense of security. Public health initiatives in Atlantic Canada promoting sun safety must address this paradox while integrating community-specific behaviors and norms in order to develop tailored campaigns.

Purpose: The objective was to explore the relationship of sun behavior patterns with the risk of developing non-Hodgkin lymphoma (NHL)., Methods: Sun behavior information from Alberta's Tomorrow Project, CARTaGENE, and Ontario Health Study were utilized. The relationship between time in the sun during summer months and risk of NHL was assessed using Cox proportional hazard models with age as the time scale and adjustment for confounders. Cohorts were analyzed separately and hazard ratios (HR) pooled with random effects meta-analysis. Joint effects of time in the sun and use of sun protection were examined. Patterns of exposure were explored via combinations of weekday and weekend time in the sun., Results: During an average follow-up of 7.6 years, 205 NHL cases occurred among study participants (n = 79,803). Compared to < 30 min daily in the sun, we observed HRs of 0.84 (95% CI 0.55-1.28) for 30-59 min, 0.63 (95% CI 0.40-0.98) for 1-2 h, and 0.91 (95% CI 0.61-1.36) for > 2 h. There was suggestive evidence that > 2 h was protective against NHL with use of sun protection, but not without it. Compared to < 30 min daily, moderate exposure (30 min to 2 h on weekdays or weekend) was associated with a lower risk of NHL (HR 0.63, 95% CI 0.43-0.92), while intermittent (< 30 min on weekdays and > 2 h on weekends) and chronic (> 2 h daily) were not., Conclusion: This study provides evidence of a protective effect of moderate time spent in the sun on NHL risk., (© 2023. The Author(s), under exclusive licence to Springer Nature Switzerland AG.)

Objectives: Self-affirmation approaches for health behaviour demonstrate consistent small to medium effects on message acceptance, health intentions and behaviour change. There are several forms of self-affirmation (e.g., values affirmations, implementation intentions), but few empirical comparisons to guide selection in empirical work. Further, there has been little emphasis on the putative mechanisms of self-affirmation driving behaviour change. The current investigation compared a control and four self-affirmation approaches: values, social, implementation intention, and perspective taking., Methods: Participants were recruited through CloudResearch (N = 666) and reported baseline sun exposure and protection behaviour at Time 1. One week later (Time 2), returning participants (N = 535) were randomly assigned to condition, viewed a message conveying risks of sun exposure, and reported sun exposure and protection intentions for the next week. Follow-up one week later (Time 3; N = 449) assessed past week sun exposure (i.e., number of days spent outside during peak hours), sun protection behaviour (e.g., sunscreen use), future sun exposure and protection intentions and engagement with resources conveying further health information (i.e., viewing infographics, following links to websites with more information). The association of putative mechanisms with self-affirmation conditions and health outcomes was also examined., Results: Unexpectedly, there were few differences between self-affirmation conditions and the control on intentions, information seeking, or behaviour at follow-up. At follow-up, perspective circle participants reported fewer days spent outside, spent longer viewing infographics, and, along with social values participants, followed more weblinks seeking information than control participants. The putative mechanisms were unrelated to health outcomes., Conclusions: The current investigation was a first step in comparing novel online self-affirmation approaches and had largely null findings. Results suggest that the perspective circle performed best at promoting information seeking and, to some extent, behaviour change. Suggestions for future directions are discussed., (© 2023 British Psychological Society.)

Introduction:  Excess ultraviolet (UV) radiation exposure during childhood poses a particular long-term risk of developing skin cancer later in life however recent studies have called attention to the absorption of chemical sunscreen ingredients into the bloodstream with unclear significance. This has led to recommendations to consider sun protection in the form of clothing to reduce the need for sunscreen products., Methods:  Ten brands of routine summer clothing not labeled as sun protective from five distributors marketed for children were identified with varying price ranges. Summer clothing items consisting of T-shirts and tops were evaluated for fiber composition, cost, and UPF testing was performed to determine UVA and UVB transmittance.  Results: Around 88.2% of blended textile compositions compared to 60% of 100% cotton textiles offered adequate UV protection with an Ultraviolet Protection Factor (UPF) greater than 15. 58% of blended fabrics compared to 50% of cotton textiles offered a UPF greater than 30. There was no correlation between brand and cost with UPF values.  Conclusions: In the absence of regulations for testing and labeling of all children's garments for UV protection, guidelines for the pediatric population for choosing clothing for the summer should reflect the information available to consumers that is easy to understand and more likely to result in higher UPF values. Based on fiber composition, blended textiles are more likely to have adequate UV protection compared to 100% cotton or 100% polyester., Competing Interests: US Patent Pending for UV protective textile., (Copyright © 2023, Cole et al.)

Introduction: The impact of ultraviolet (UV) light on the skin is well-established to have both immediate and delayed effects with increasing awareness of the impact of visible light (VL) on the skin with regard to photoaging and dyspigmentation. The effects of VL disproportionately impact the skin of color with regard to discoloration of the skin leading to guidelines for photoprotection that include the use of iron oxides in sunscreen products that impart a tint., Methods: Commercially available sunscreen products found in the suncare and sun protection displays at local stores, pharmacies, and grocery stores were cataloged, and ingredients were reviewed for the presence of iron oxides., Results: Of the 410 commercially available sunscreen products cataloged, 1.7% of facial sunscreen products available offered iron oxides, and 0.5% of non-lip products offered shade matching., Conclusion: With only 1.7% of commercially available facial sunscreen products offering iron oxides in addition to traditional broad-spectrum UV protection, there is a clear gap in the market for iron oxide-containing sunscreen products to meet the photoprotection needs for the skin of color., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Cole et al.)

Incorporation of melanoma prevention behaviors into daily lifestyles is difficult. Data suggest that high school educational programs on skin cancer prevention can be successful and should incorporate evidence-based teaching and learning strategies to achieve greatest impact. The goal of this systematic review is to describe evidence-based educational practices for a high-school melanoma curriculum through a comprehensive review of the literature. Ovid MEDLINE, Embase, CINAHL, and PyscINFO were searched in June 2020 for all original articles published between June 18, 1946 and June 17, 2020. All studies that used an educational curriculum to promote sun safety, skin exams, and early detection to high school students were included. A total of 25 studies with 22,683 adolescent participants were analyzed. Sixteen studies showed a significant increase in knowledge, twenty-one studies showed changes in behavior, and fifteen studies showed significant changes in attitudes. Limitations of this review include the heterogeneity of implementation and outcome reporting of educational curricula. These findings support incorporating active learning strategies as key aspects of creating an effective curriculum aimed at the prevention and early detection of melanoma., (© 2023. The Author(s).)

Carotenoids have shown beneficial applications in cosmetology, pharmacology, and medicine. However, environmental stress in the marine environment can trigger the production of unique secondary metabolites, such as carotenoids. These compounds can also be sustainably produced by symbiotic bacteria. We hypothesized that the soft corals in tropical regions may produce diverse biological secondary metabolites, including carotenoids, both by the host organism and their bacterial symbiont. The unique carotenoids may provide promising biological activity such as antioxidant, UV photoprotector, and antibacterial activities. To this end, we isolated and characterized the carotenoids isolated from the bacterial symbiont of Sinularia sp., a soft coral from Panjang Island, North Java Sea, strain 19. PP.Sc.13. Bacterial identification was performed using DNA barcoding of the 16S rRNA region. Identification of carotenoids was carried out using a spectrophotometer, High-Performance Liquid Chromatography (HPLC), and attenuated total reflection fourier-transformed infrared (ATR-FTIR) spectroscopy. The antioxidant activity was estimated using the diphenylpicrylhydrazyl (DPPH) method, while the Sun Protection Factor (SPF) and % transmission of erythema and pigmentation were determined based on colorimetric methods. The antibacterial activity assay was carried out using the agar diffusion method against two multidrug-resistant bacteria. The bacterial symbiont was identified as Virgibacillus sp. and the carotenoids isolated from this symbiont exhibited significant antioxidant activity and extra sun protection effect, thus categorized as UVA sunblock. Furthermore, the isolated carotenoids exhibited antibacterial activities against Methicillin Resistant- Staphylococcus aureus (MRSA) and Multidrug-resistant (MDR) Escherichia coli . This study provides evidence of the carotenoids produced by the soft coral bacterial symbiont Virgibacillus sp., which may be used as an antioxidant, sun protection, and antibacterial agent. Further investigation of the de novo biological production of carotenoids by Virgibacillus sp. is warranted., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2023 The Author(s).)

Individuals can reduce the risk of developing skin cancer by minimizing ultraviolet sunlight exposure, though recent trends in sun-protective behaviors remain to be investigated. To evaluate sun-protective behaviors and sunburn among US adults. We analyzed data from the 2010, 2015, and 2020 National Health Interview Survey (NHIS), an annual, cross-sectional survey conducted by the US Census Bureau. Multivariable regression models were stratified by demographic variables and constructed to evaluate sun-protective behaviors and sunburn avoidance across time. From 2010 through 2020, US adults had significantly increased prevalence of seeking shade (p value, 0.003), wearing wide-brimmed hats (< 0.001), wearing long-sleeved shirts (< 0.001), using sunscreen (< 0.001), and avoiding sunburns (< 0.001) and significantly decreased prevalence of sun avoidance (< 0.001). Disparities in sun-protective behaviors also exist among different sexes, ages, education levels, and those reporting higher sun sensitivity. This cross-sectional study found that by 2020, US adults had an increased prevalence of wearing sun-protective clothing and sunscreen use, though decreased prevalence of sun avoidance. Although certain sun-protective behaviors have become more prevalent, the incidence of skin cancer continues to rise. Efforts to understand drivers of sun-protective behaviors and targeted intervention efforts are needed., (© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)