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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.

Abstract Objective: To inform skin cancer prevention policies and campaigns, we investigated changes over time in sun protection behaviours, sunburn, sun exposure and shade availability in public spaces among people living in New South Wales (NSW), Australia, between 2003 and 2016. Methods: We analysed cross‐sectional data from the NSW Population Health Survey collected in 2003, 2007, 2014 and 2016, which included approximately 15,000 respondents of all ages in each year. Logistic regression models were used to analyse overall changes over time and for different age, sex and sociodemographic groups. Results: The use of sunscreen and protective clothing and the availability of shade increased between 2003 and 2016, but sunburn and sun exposure during peak times of ultraviolet radiation also increased. In subgroup analyses, there was no improvement in sun protection behaviours among adolescents and increases in sunburn and sun exposure were observed only among adults, particularly women and in areas with less social disadvantage. Conclusions: Sun protection behaviours have improved over time among some population subgroups, but over‐exposure to ultraviolet radiation remains prevalent. Implications for public health: Skin cancer prevention initiatives that specifically target adolescents and sun exposure during peak times are needed to help reduce population skin cancer risk.

Prevention of skin cancer involves decreasing exposure to ultraviolet radiation (UVR) and avoiding sunburn, especially early in life. Individuals living in urban versus rural areas, as defined by the Rural Urban Commuting Area (RUCA) code classification, have different risks for skin cancer, likely due to differing patterns of outdoor activities and preventive behaviors employed when outdoors. However, few studies have examined differences in outdoor activities between rural and urban individuals and examined this among both adults and children. This study compared the outdoor activities, sun protection strategies, tanning behaviors, and sunburn occurrence of adults and children (n = 97 dyads) in rural versus urban settings in a Western region of the United States. The relationships between outdoor activities and sunburn occurrence were examined in both groups. Analyses employed Barnard’s Exact Test and logistic generalized estimating equations models. Individuals in rural and urban areas reported differences in sun protection strategies used, tanning behaviors, and outdoor activities. Individuals in urban areas more commonly reported use of certain forms of sun protection, such as sunscreen and shade, whereas long pants and skirt wearing were more common for children in rural areas. Individuals in rural areas were more likely than those in urban areas to engage in farm work, yard work, and youth sports. Gender differences in these outcomes were also identified. Skin cancer preventive interventions could be tailored for rural and urban families to target sun protection strategies to outdoor activities and to situations in which sunburns are likely to occur.

We assessed outplanting performance of N. glauca in two trials. In Trial 1, provenances from Pre- Andean (Linares, Longaví) and Coastal (Curanipe, Empedrado) origins were planted in a common garden under two sun protection treatments (i.e., black mesh shelter, and kaolin at 6% concentration), and a control treatment at full sun. In Trial 2, a local provenance was established under two site preparation treatments (i.e., old subsoiling from 4 years ago versus no-subsoiling). Growth, survival, gas exchange, and Chlorophyll fluorescence parameters were measured one year after outplanting. In Trial 1 survival was similar among treatments but larger seedlings were found under kaolin and in the local provenance Empedrado. The provenances varied by sun protection treatment in survival, and the Pre Andean provenance Linares tended to show the lowest survival at full sun. At the leaf-level physiology, provenances responded similarly in gas exchange and fluorescence parameters. In the sun protection treatments seedlings under kaolin increased stomatal conductance and electron transport, but decreased photosynthesis, water use efficiency, and efficiency of PSII. Provenances also varied by treatment in physiology. The Empedrado provenance exhibited the highest transpiration and stomatal conductance under kaolin whereas the Pre Andean provenance of Longaví showed the lowest photosynthesis and efficiency of PSII in the kaolin treatment. In Trial 2, root collar diameter, intercellular CO2 and water use efficiency were higher in the old-subsoiling treatment. As a potential adaptation tool, seed sources from Pre Andean origins can be established in Coastal origins with no detriments on seedling survival.

The skin cancer incidence rate has been rising, and digital health interventions can promote skin cancer prevention and detection behaviors. A systematic review was conducted to investigate the outcomes of digital interventions that promote sun protection and skin self-examination (SSE). This review examined studies that utilized randomized controlled designs or quasi-experiments, included outcomes related to sun safety or SSE, employed at least one digital platform, and were published in English from January 2000 to October 2020. A total of 62 studies were included in the review. Digital modalities included web-based (e.g., websites) alone (n = 29), mobile-based (e.g., mobile apps) alone (n = 12), game-based (n = 1), emails or text messages alone (n = 8), videos alone (n = 6), social media (n = 3), both text messages and mobile apps (n = 2), or both text messages and video (n = 1). Most studies (n = 44) only evaluated sun protection-related outcomes, seven studies assessed SSE outcomes only, nine studies examined both, and two assessed other related outcomes. Digital interventions are effective compared to non-intervention control conditions in promoting sun safety or SSE. Almost all studies found digital interventions to be equally or more effective compared to non-digital interventions. This review suggests that although the digital interventions varied, they showed promising effects on improving sun protection or SSE outcomes. Future research should include more sophisticated phase-based and rigorous longitudinal research designs, additional investigation of social media and other newer technologies, as well as more detailed reporting of methods and results.

Resumen: Antecedentes y objetivos: El cáncer cutáneo está aumentando su incidencia de forma alarmante en nuestra sociedad, debido a la sobreexposición a la radiación ultravioleta solar (RUV), ya sea por motivos laborales o por ocio.El objetivo del presente estudio es valorar los conocimientos, actitudes y hábitos sobre la exposición solar y la fotoprotección en corredores participantes en una ultramaratón de montaña, así como estimar los factores de riesgo para sufrir quemadura solar. Material y métodos: Se realizó un estudio transversal, prospectivo descriptivo a los participantes de la «Gran Trail Aneto-Posets» (GTTAP). Se evaluaron las características sociodemográficas, la experiencia como corredor, la historia de quemadura solar en el verano previo y los hábitos y prácticas de exposición solar mediante una encuesta validada. Se realizó un análisis descriptivo, bivariado y multivariante, tomando como variable principal de resultado la presencia de quemadura solar, estableciendo un nivel de significación en p < 0,05. Resultados: Se incluyeron 657 corredores, 72,1% fueron hombres, con una media de edad de 39,71 años. El 45,1% de los encuestados reconocían haberse quemado en el último año. Las gafas fue el método fotoprotector más utilizado (74,7%), seguido del fotoprotector (factor de protección solar [FPS] > 15) (61,9%), el gorro/a (52,2%), y por último, la ropa (7,4%). Mientras que tener menos edad, fototipo bajo (I y II), correr durante tres o más horas al día y resguardarse a la sombra como medida de fotoprotección se comportaron como factores de riesgo para haber sufrido quemadura solar; las actitudes favorables al uso de cremas y a la búsqueda de la sombra al mediodía, en vez de estar al sol, se comportaron como factores protectores (p < 0,001). Conclusión: La incidencia de quemaduras solares es alta entre los corredores de trails de larga distancia en montaña, pese a que sus conocimientos y hábitos parecen adecuados. Se necesita diseñar estrategias para mejorar los hábitos de fotoprotección adaptados a su práctica deportiva. Abstract: Background and objectives: The incidence of skin cancer in our society is growing at an alarming rate due to overexposure to solar UV radiation in recreational and occupational settings. The aim of this study was to evaluate sun exposure and protection attitudes, behaviors, and knowledge among mountain ultramarathon runners and to assess risk factors for sunburn in this population. Material and methods: Cross-sectional survey of runners who participated in the «Gran Trail Aneto-Posets» race in Aragon, Spain. Using a validated questionnaire, we collected data on sociodemographic characteristics, running experience, sunburn in the previous summer, and sun exposure and protection behaviors. We calculated descriptive statistics and performed bivariate and multivariate analyses of associations using history of sunburn as the primary outcome. Statistical significance was set at a p level of less than 0.05. Results: We surveyed 657 runners (72.1% men) with a mean age of 39.71 years; 45.1% reported sunburn in the past year. The most common protective measures used were sunglasses (74.7%), sunscreen (sun protection factor ≥ 15) (61.9%), a hat (52.2%), and other protective clothing (7.4%). Risk factors for sunburn were younger age, low Fitzpatrick skin type (I and II), running for three or more hours a day, and staying in the shade as a protective measure. By contrast, protective factors were use of sunscreen and seeking shade rather than sun at midday (p < 0.001). Conclusions: Sunburn is common among long-distance mountain runners, despite what appears to be adequate sun protection knowledge and behaviors. Targeted strategies are needed to improve sun protection behaviors among mountain runners.

Skin cancer rates have risen over the past decades, making it imperative that adults understand the need for protection from sun exposure. Though some risk factors have been identified as predictive for skin cancers, there is a lack of synthesized information about factors that influence adults in their decisions to engage in sun protective behaviors. The purpose of this paper is to present the current state of the science on influential factors for sun protective behaviors in the general adult population. A rigorous literature search inclusive of a generally White, Caucasian, and non-Hispanic adult population was performed, and screening yielded 18 quantitative studies for inclusion in this review. Findings indicate that modifiable and non-modifiable factors are interdependent and play a role in sun protective behaviors. This study resulted in a proposed conceptual model for affecting behavioral change in sun protection including the following factors: personal characteristics, cognitive factors, family dynamics, and social/peer group influences. These factors are introduced to propose tailored nursing interventions that would change current sun protective behavior practice. Key implications for nursing research and practice focus on feasibility of annual skin cancer screening facilitated by advanced practice nurses, incorporating the identified influential factors to reduce skin cancer risk and unnecessary sun exposure.

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.)

Purpose: The aim of this research was to adapt the Sun Protection Behavior Scale (SPBS) to Turkish and to perform validity and reliability analyses. Methods: The scale was administered to a total of 900 adolescents, the retest to 91 adolescents. The construct validity of the scale was evaluated using exploratory (EFA) and confirmatory factor analysis (CFA). The EFA and CFA were applied to sample groups of 449 and 451 people, respectively. Results: The Cronbach alpha coefficients for the Turkish form of the SPBS (α = .74) and its sunscreen (α = .88) and hat use (α = .70) subscales were found to be ≥.70 while the sun avoidance subscale was calculated to be .67. The item-total score correlation between the scale and its subscales was ≥.26 and the test-retest correlations were found to be ≥.51. The CFA results verified the 8-item, 3-factor Turkish version of the SPBS. The confirmatory factor loadings for the scale were .45–.80 for sun avoidance, .72–.93 for sunscreen use, and .66–.83 for hat use. In particular, SPBS and sunscreen use (p

Abstract Objective: To observe the sun‐protective practices of students and staff and related aspects of the physical environment at secondary school athletics days. Methods: This observational study of 1,225 students and 215 adult supervisors examined the use of sun‐protective items (hats, clothing coverage, sunglasses), sunscreen provision and shade. Results: Sun‐protective behaviour was poor with only 3% of students and 25% of adult supervisors wearing a sun‐protective hat. Shade was not available to most students, either as competitors or while waiting to compete. Sunscreen provision was 50%. Conclusion: Portable shade for students waiting to compete should be available at competitive events. Students should be encouraged to wear sun‐protective hats and clothing while not competing and SPF30+ broad‐spectrum sunscreen should always be provided. Guidelines for adult supervisors should be developed so they role model appropriate sun protection.

Abstract Objective: This study investigated the differences between the amount of shade covering typical activity areas in playgrounds of higher and lower socioeconomic status (SES) areas within metropolitan Sydney, Australia. Methods: Using an established audit tool, surveyors visited 139 urban playgrounds and made 1,033 shade observations recording the estimated percentage of an activity area that was covered by shade and the type of shade available. Results: Shade coverage was significantly associated with SES of an area and with type of activity area (p

Purpose: To evaluate the ocular surface at the microstructural level of adults who habitually undertake indoor-suntanning utilising in vivo confocal microscopy., Methods: Participants were prospectively recruited and enrolled into either а study group (n = 75) with a history UV indoor tanning, or a control group (n = 75) with no prior history of artificial tanning. The study group participated in voluntary tanning sessions performed with standard equipment and maintained their usual routine for eye protection. Slit lamp biomicroscopy and in vivo confocal microscopy were performed at baseline before undertaking a series of suntanning sessions (10 sessions of 10 min duration over a 15 day period), within three days after the last session, and four weeks after the last session. Control group participants were examined at baseline and 8 weeks later and did not participate in tanning sessions., Results: All participants were female with a mean age of 25 ± 4 years and 24 ± 4 years in the study and control groups, respectively. No clinically significant changes were observed in either group over time using slit lamp biomicroscopy (all p ≥ 0.05), however, statistically significant differences were observed between the study and the control group for all corneal layers imaged using confocal microscopy (all p ≤ 0.03). Characteristic cystic conjunctival lesions with dark centres and bright borders were observed in 95% of the study group before and in 100% after the suntanning sessions., Conclusion: Indoor suntanning resulted in statistically significant microstructural changes in the cornea and the bulbar conjunctiva that are undetectable with slit lamp biomicroscopy., (Copyright © 2021 British Contact Lens Association. Published by Elsevier Ltd. All rights reserved.)

Objective: To inform skin cancer prevention policies and campaigns, we investigated changes over time in sun protection behaviours, sunburn, sun exposure and shade availability in public spaces among people living in New South Wales (NSW), Australia, between 2003 and 2016., Methods: We analysed cross-sectional data from the NSW Population Health Survey collected in 2003, 2007, 2014 and 2016, which included approximately 15,000 respondents of all ages in each year. Logistic regression models were used to analyse overall changes over time and for different age, sex and sociodemographic groups., Results: The use of sunscreen and protective clothing and the availability of shade increased between 2003 and 2016, but sunburn and sun exposure during peak times of ultraviolet radiation also increased. In subgroup analyses, there was no improvement in sun protection behaviours among adolescents and increases in sunburn and sun exposure were observed only among adults, particularly women and in areas with less social disadvantage., Conclusions: Sun protection behaviours have improved over time among some population subgroups, but over-exposure to ultraviolet radiation remains prevalent. Implications for public health: Skin cancer prevention initiatives that specifically target adolescents and sun exposure during peak times are needed to help reduce population skin cancer risk., (© 2021 The Authors.)

Background: Overexposure to sunlight is the main cause of skin cancer. Outdoor sports increased sun exposure times. Sun protection behaviors and attitudes are utmost importance to reduce sun exposure., Aims: To evaluate sun exposure habits, sun protection practices, and sun-related attitudes and knowledge among paralympic sailors., Methods: This descriptive observational study analysed the answers of a validated self-reported questionnaire of habits, attitudes and knowledge related to sun exposure and skin cancer completed by 56 elite sailors with disabilities from 19 countries which taking part in 2019 Para World Sailing Championships., Results: Three in four (76.8%) participants reported a history of sunburn in the previous season. Overall, participants showed an average for sport practice per week of 8.0 h (SD: 4.9). Participants reported a low adherence to sun protection practice, with the exception of using sunglasses (85.7%), sunscreen (83.9%) and hat (75%), having a very low rate (28.6%) of avoidance of midday sun and an inadequate sunscreen reapplication (33.9% reported "do not reapply" and 16.1% "reapply every one or 2 h"). Although 82.1% of participants reported to be worried about can get skin cancer out of the sun, they also presented excessive sun tanning attitudes (42.9% likes sunbathing and 57.1% sunbathing makes them feel well). The average score for sun-related knowledge was low (62.1 out 100 points; SD: 13.6)., Conclusions: Awareness campaigns on sun risk are needed specifically directed at this target group, in order to improve their sun protection habits and reduce the rates of sunburn associated with sports practice., Competing Interests: Declaration of competing interest The authors declare that they have no conflicts of interest., (Copyright © 2021 Elsevier Inc. All rights reserved.)

Background: We aimed to examine the prevalence and correlates of opportunistic skin check behaviours among Australians and whether changes over time might explain increasing underlying rates of melanoma in situ., Methods: The National Sun Protection Survey involved periodic telephone-based cross-sectional surveys during summer since 2003. Skin checks by a doctor in the past 12 months was asked in four summers over 2006-2017, and responses from 23,374 Australians aged 12-69 years were analysed. Prevalence estimates were weighted to be representative of the Australian population. Chi-square tests compared the prevalence over time and by characteristics., Results: The overall proportion reporting whole-body skin checks in the past 12 months was 20 % in 2006-07 and 2010-11, 21 % in 2013-14, and 22 % in 2016-17; but increased from 29 % in 2006-07 to 37 % in 2016-17 for those aged 45-69 years (p < 0.0001). In 2016-17, 5% reported a skin check of part-body and 9% for a specific mole or spot. The proportion reporting no skin checks increased from 61 % to 64 % over time (p < 0.0001). Whole-body skin checks were more common among older respondents, females, and also varied by residence location, skin sensitivity, skin colour, risk perception, and socio-economic index (all p < 0.001)., Conclusion: Approximately one third of Australians had their skin checked by a doctor within a 12-month period, but this varied across population sub-groups. Skin check behaviours were relatively stable over time, with modest increases in the prevalence of skin checks for those aged 45-69 years. These findings do not explain underlying large increases in rates of melanoma in situ., (Copyright © 2020 Elsevier Ltd. All rights reserved.)

We evaluate the effect of cationic nanocapsules containing dihydromyricetin (DMY) flavonoid for safe topical use in photoprotection against UV-induced DNA damage. The stability was investigated for feasibility to produce hydrogels containing cationic nanocapsules of the flavonoid DMY (NC-DMY) for 90 days under three different storage conditions (4 ± 2 °C, 25 ± 2 °C, and 40 ± 2 °C), as well as evaluation of skin permeation and its cytotoxicity in skin cell lines. The physicochemical and rheological characteristics were maintained during the analysis period under the different aforementioned conditions. However, at 25 °C and 40 °C, the formulations indicated yellowish coloration and DMY content reduction. Therefore, the ideal storage condition of 4 °C was adopted. DMY remained in the stratum corneum and the uppermost layers of the skin. Regarding safety, all formulations demonstrated to be safe for topical application. NC-DMY exhibited a 50% Solar Protection Factor (SPF-DNA) against DNA damage caused by UVB radiation and demonstrated 99.9% protection against DNA lesion induction. These findings establish a promising formulation containing nanoencapsulated DMY flavonoids with a photoprotective and antioxidant potential of eliminating reactive oxygen species formed by solar radiation., (Copyright © 2020 Elsevier B.V. All rights reserved.)

Purpose: This study investigated whether genetic counseling and test reporting for the highly penetrant CDKN2A melanoma predisposition gene promoted decreases in sun exposure., Methods: A prospective, nonequivalent control group design compared unaffected participants (N = 128, M age  = 35.24, 52% men) from (1) families known to carry a CDKN2A pathogenic variant, who received counseling about management recommendations and a positive or negative genetic test result and (2) no-test control families known not to carry a CDKN2A pathogenic variant, who received equivalent counseling based on their comparable family history. Changes in daily ultraviolet radiation (UVR) exposure (J/m 2 ), skin pigmentation (melanin index), and sunburns between baseline and one year following counseling were compared among carriers (n = 32), noncarriers (n = 46), and no-test control participants (n = 50)., Results: Both carriers and no-test control participants exhibited a decrease one year later in daily UVR dose (B = -0.52, -0.33, p < 0.01). Only carriers exhibited a significant decrease in skin pigmentation at the wrist one year later (B = -0.11, p < 0.001), and both carriers and no-test control participants reported fewer sunburns than noncarriers (p < 0.05). Facial pigmentation did not change for any group. Noncarriers did not change on any measure of UVR exposure., Conclusions: These findings support the clinical utility of disclosing CDKN2A test results and providing risk management education to high-risk individuals.

>1.2 million people in the United States have a personal history of melanoma skin cancer and are at increased risk for disease recurrence and second primary melanomas. Many of these individuals do not follow recommendations to conduct regular, thorough skin self-examinations that facilitate early disease detection and do not sufficiently engage in sun protection behaviors. In this project, we are conducting a randomized controlled trial of an innovative, tailored, theory-driven Internet intervention-called mySmartSkin-to promote these behaviors among melanoma patients. This paper outlines the study design and characteristics of the study sample. A total of 441 patients were recruited (40.9% response rate) and randomized to the mySmartSkin or a Usual Care condition. Participants complete surveys at baseline and 8 weeks, 24 weeks, and 48 weeks later. The primary aim of the project is to examine the impact of mySmartSkin versus Usual Care on skin self-examination and sun protection behaviors. The secondary aim focuses on identifying mediators of the intervention's effects. In an exploratory aim, we will examine potential moderators of the impact of the intervention. At baseline, the recruited participants had a mean age of 61 years, 49% were female, 7.5% met criteria for having conducted a recent, thorough skin self-examination, and the mean score on the index of sun protection behaviors was 3.3 (on a scale from 1 to 5). The results of the project will determine whether the mySmartSkin intervention is efficacious in promoting skin self-examination and sun protection behaviors among individuals diagnosed with melanoma. Trial registration: ClinicalTrials.govNCT03028948., (Copyright © 2019 Elsevier Inc. All rights reserved.)

Purpose: To evaluate and describe the microstructural changes at the ocular surface in response to habitual ocular sun exposure, correlate them with the UV protection habits and follow their dynamics using in vivo confocal microscopy(ICM)., Methods: For a period of minimum 4 months 200 subjects (400 eyes), aged 28 ± 7.3 years, were recruited with the agreement that they will spend their summer exclusively in the region of the Black Sea coast at 43 °N latitude and will be examined before and after the summer. All subjects filled in a questionnaire about habitual UV protection and were examined clinically and by ICM., Results: Questionnaire results demonstrated that 83.5% (167 participants) of the subjects considered the sun dangerous for their eyes, but 78% (156 subjects) believed that there is danger exclusively during the summer period. Although no clinical changes were detected, microstructural analysis of the cornea demonstrated statistically significant (p = 0.021) decrease of the basal epithelial density - from 6167 ± 151 cells/mm 2 before to 5829 ± 168 cells/mm 2 after the summer period. Microstructural assessment of the conjunctiva demonstrated characteristic cystic lesions with dark centres and bright borders encountered in only 25 eyes(6%) before, and affecting 118 eyes(29.5%) after the summer. The total area of the cysts after the summer increased fivefold. Spearman analysis proved negative correlation between sun protection habits and number of cysts., Conclusion: Summer sun exposure for one season leads to clinically undetectable, microstructural changes affecting the cornea, bulbar and palpebral conjunctiva with transient, but possibly cumulative nature., (Copyright © 2018 British Contact Lens Association. Published by Elsevier Ltd. All rights reserved.)

Objectives: To prevent skin cancer, the general population is recommended to limit time in the sun, to wear clothes and to seek shade around noon. This study aimed to investigate the number of beachgoers, the duration of sun exposure, and clothing worn during the day on a beach in Copenhagen., Study Design: Observational, descriptive study., Methods: On 11 beach days in 2014 and 2015, beachgoers were counted every hour from 8:00 to 20:00. It was noted if they wore clothes or swimwear. To estimate the duration of sun exposure, it was noted how long cars were parked by the beach., Results: Of the counted beachgoers 46% were present from noon to 15:00. The number of beachgoers peaked at 15:00 on weekend days (Saturdays and Sunday) and at 16:00 on working days (Monday to Friday). Both on weekend days and working days, the percentage of beachgoers wearing clothes was lowest at 13:00 when about 90% wore only swimwear. Cars were parked for 117 min on average. Around noon, the mean time expanded to 142 min. We assume this to reflect the duration of a beach visit., Conclusion: The results indicate a weak tendency to limit time in the sun and to seek shade when the ultraviolet radiation is strongest in the midday sun. Hopefully information about actual sun behaviour can be used to adjust campaigns., (Copyright © 2017 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.)

Despite extensive warnings from health authorities regarding the dangers of direct sunlight exposure, most people still turn to sun bathing to get a golden tan. Unfortunately, that pleasant tan appearance is often lost because of over exposure to sunlight, resulting in painful red sunburns. In this paper we are reporting a case with significant sunburn injuries that required hospitalization and treatment in a burn center. Concurrently a pilot study was conducted to assess the knowledge about sun protection among the adult population and the results are discussed. The results obtained from the study revealed the lack of knowledge regarding sun protection and sun seeking behaviour among the responders. Deeper burns are rarely caused by direct sunlight exposure and are underreported in literature. Despite extensive health education and warnings, there are significant numbers of sunburn injuries reported annually. On most occasions, these are superficial and are in the form of erythema. Nonetheless, the public is unaware of the impending risks of developing deep sunburn injuries that can occur especially during protracted holiday exposures. Therefore, it is crucial to escalate public awareness and to implement preventive measures to reduce the short and long-term risks of sun exposure., (Copyright © 2017 Elsevier Ltd and ISBI. All rights reserved.)

Environments can be structured to reduce solar ultraviolet radiation (UV) exposure to prevent skin cancer. A prospective randomized trial is being conducted to test whether introducing shade sails in passive recreation areas (PRAs) in public parks will increase use and decrease UV exposure in the shaded compared to unshaded PRAs. Shade effects will be compared between Melbourne, Australia and Denver, USA. The trial enrolled 145 public parks with PRAs suitable for shade construction and randomized parks to intervention or control in a 1:3 ratio. Use of PRAs and UV levels were recorded at each park by trained observers during 30-minute periods on four weekend days in each of two summers (pretest and posttest). Shade sails were constructed between the summers. Given low numbers of users at pretest, the outcome measure was modified to use of the PRA (use vs. no use) and unit of analysis to the individual observation. Observations (n=580) occurred on average 29days from the summer solstice and 55min from solar noon in warm weather (mean=26.2°C) with some cloud cover but only slight or no wind. Typically, PRAs had benches and picnic tables and were located near playgrounds. PRAs were in use during 13.3% of observations (mean=0.41 users). UV over 30-minutes at the PRA boundary (mean=3.2 standard erythemal dose [SED]) and center (mean=3.3 SED) was high. Shade for skin cancer prevention has been understudied. This study will address this gap by determining whether purpose-built shade structures promote greater use of shaded areas within public parks., (Copyright © 2017 Elsevier Inc. All rights reserved.)

Objective: To observe the sun-protective practices of students and staff and related aspects of the physical environment at secondary school athletics days., Methods: This observational study of 1,225 students and 215 adult supervisors examined the use of sun-protective items (hats, clothing coverage, sunglasses), sunscreen provision and shade., Results: Sun-protective behaviour was poor with only 3% of students and 25% of adult supervisors wearing a sun-protective hat. Shade was not available to most students, either as competitors or while waiting to compete. Sunscreen provision was 50%., Conclusion: Portable shade for students waiting to compete should be available at competitive events. Students should be encouraged to wear sun-protective hats and clothing while not competing and SPF30+ broad-spectrum sunscreen should always be provided. Guidelines for adult supervisors should be developed so they role model appropriate sun protection., (© 2016 Public Health Association of Australia.)

Purpose: The incidence of melanoma has been increasing dramatically among teenage and young adult women over the past several decades. Despite a causal link between ultraviolet light exposure and melanoma, a significant proportion of young women intentionally tan. Furthermore, we know very little about the family's role in melanoma-related risk practices., Methods: This study examined 22 interviews of adolescent girls and their mothers discussing topics related to sun protection and tanning behavior., Results: Qualitative analysis elicited four primary themes: (1) high rates of prior discussion about indoor tanning; (2) discussion of other risky behaviors that are considered more important than tanning; (3) a desire for increased knowledge of risky tanning behavior; and (4) change in tanning behavior with relevant life experience., Conclusions: Results emphasize the value of educational interventions designed to raise melanoma-related risk awareness and suggest the potential benefit of improving knowledge maintenance and family engagement through information sharing., (Copyright © 2016 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.)

Background: Vacationing at sunny, warm weather locations is a risk factor for excessive solar ultraviolet (UV) radiation exposure and skin cancer., Objectives: This study examined the association of environmental variables related to UV levels with vacationers' sun protection., Methods: Vacationers at 41 summer resorts in 17 states and 1 Canadian Province were interviewed (n=3531) and observed (N=4347) during 2012 and 2013. Clothing coverage, sunglasses, and shade use were observed. Use of sunscreen and sunburns were self-reported. Environmental information was recorded by research staff or acquired from ground stations and the weather service., Results: Temperature was positively associated with sun protection behaviors; however clothing coverage was negatively associated with temperature. Cloud cover was negatively associated with sun protection, with the exception of clothing coverage which was positively associated with it. Elevation showed a mixed pattern of associations with vacationer's sun protection. Latitude of a resort was negatively associated with most sun protection behaviors, such that sun protection increased at more southerly resorts. Similarly, the farther south a vacationer traveled to the resort, the less sun protection they employed. The UV index showed a weak, positive relationship with some sun protection behaviors even when controlling for temperature., Conclusions: Vacationers appeared aware that UV is higher at southern latitudes and may learn UV is intense when living in southern regions. However, many used temperature, an unreliable cue, to judge UV intensity and seemed to adjust clothing for warmth not UV protection. Efforts are needed to help individuals make more accurate sun safety decisions., (Copyright © 2016. Published by Elsevier Inc.)

Background: In both Sweden and Australia high incidence rates of skin cancer have become a major health problem. In prevention and risk communication, it is important to have reliable ways for identifying people with risky sun habits. In this study the validity and reliability of the questionnaire Sun Exposure Protection Index (SEPI), developed to assess individual's sun habits and their propensity to increase sun protection during routine, often brief, clinical encounters, has been evaluated. The aim of our study was to evaluate validity and reliability of the proposed SEPI scoring instrument, in two countries with markedly different ultraviolet radiation environments (Sweden and Australia)., Method: Two subpopulations in Sweden and Australia respectively were asked to fill out the SEPI together with the previously evaluated Readiness to Alter Sun Protective Behaviour questionnaire (RASP-B) and the associated Sun-protective Behaviours Questionnaire. To test reliability, the SEPI was again filled out by the subjects one month later., Results: Comparison between SEPI and the questions in the Sun-protective Behaviours Questionnaire, analyzed with Spearman's Rho, showed good correlations regarding sun habits. Comparison between SEPI and RASP-B regarding propensity to increase sun protection showed concurrently lower SEPI mean scores for action stage, but no difference between precontemplation and contemplation stages. The SEPI test-retest analysis indicated stability over time. Internal consistency of the SEPI, assessed with Cronbach's alpha estimation showed values marginally lower than the desired >0.70 coefficient value generally recommended, and was somewhat negatively affected by the question on sunscreen use, likely related to the classic "sunscreen paradox". There were some differences in the performance of the SEPI between the Swedish and Australian samples, possibly due to the influence of "available" sunlight and differing attitudes to behaviour and protection "at home" and on vacation., Conclusions: SEPI appears to be a stable instrument with an overall acceptable validity and reliability, applicable for use in populations exposed to different UVR environments, in order to evaluate individual sun exposure and protection., (Copyright © 2015 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Purpose: To examine the joint effect of sun exposure and sunburn on nevus counts (on the natural logarithm scale; log nevi) and the role of sun sensitivity., Methods: We describe an analysis of cross-sectional data from 443 children enrolled in the prospective Study of Nevi in Children. To evaluate the joint effect, we partitioned the sum of squares because of interaction between sunburn and sun exposure into orthogonal components representing (1) monotonic increase in log nevi with increasing sun exposure (rate of increase of log nevi depends on sunburn), and (2) nonmonotonic pattern., Results: In unadjusted analyses, there was a marginally significant monotonic pattern of interaction (P = .08). In adjusted analyses, sun exposure was associated with higher log nevi among those without sunburn (P < .001), but not among those with sunburn (P = .14). Sunburn was independently associated with log nevi (P = .02), even though sun sensitivity explained 29% (95% confidence interval: 2%-56%, P = .04) of its effect. Children with high sun sensitivity and sunburn had more nevi, regardless of sun exposure., Conclusions: A program of increasing sun protection in early childhood as a strategy for reducing nevi, when applied to the general population, may not equally benefit everyone., (Copyright © 2015 Elsevier Inc. All rights reserved.)

Purpose: The aim of this research was to adapt the Sun Protection Behavior Scale (SPBS) to Turkish and to perform validity and reliability analyses., Methods: The scale was administered to a total of 900 adolescents, the retest to 91 adolescents. The construct validity of the scale was evaluated using exploratory (EFA) and confirmatory factor analysis (CFA). The EFA and CFA were applied to sample groups of 449 and 451 people, respectively., Results: The Cronbach alpha coefficients for the Turkish form of the SPBS (α = .74) and its sunscreen (α = .88) and hat use (α = .70) subscales were found to be ≥.70 while the sun avoidance subscale was calculated to be .67. The item-total score correlation between the scale and its subscales was ≥.26 and the test-retest correlations were found to be ≥.51. The CFA results verified the 8-item, 3-factor Turkish version of the SPBS. The confirmatory factor loadings for the scale were .45-.80 for sun avoidance, .72-.93 for sunscreen use, and .66-.83 for hat use. In particular, SPBS and sunscreen use (p < .001) exhibited significantly high mean scores among girls and economically better backgrounds (p = .007, p < .001, respectively). In addition, SPBS (p = .004) and hat use (p < .001) revealed that the mean scores were significantly high in younger adolescents., Conclusions: The SPBS was found to be valid and reliable and its psychometric characteristics acceptable. The scale can be used to measure the behavior of Turkish adolescent populations with respect to sun protection., (Copyright © 2015. Published by Elsevier B.V.)

A trial installing shade sails at secondary schools found increased students' use of newly shaded areas, but relatively low use overall. We examined site features and weather related to use of these shaded areas. Tables with seats and temperatures ≥27°C increased student use of shaded areas, presence of grass decreased use. Focus groups at eight schools suggest students were unaware of changes to their habitual use of favoured locations. Results infer careful selection of locations for built-shade and provision of tables with seats will assist in maximising student use and investments in shade sails., (Copyright © 2014 Elsevier Ltd. All rights reserved.)