The skin we live in: pigmentation traits and tanning behaviour in British young adults, an observational and genetically-informed study.

Background: Skin cancer incidence has been increasing worldwide, representing a particularly high burden for populations of European ancestry. Outdoor and indoor tanning using ultraviolet radiation (UVR) devices are major risk factors for skin cancer. While tanning behaviours can be modified by targeted interventions to reduce skin cancer rates, there is insufficient evidence on the motivations for tanning preferences and their relationship with pigmentation phenotypes. The present observational and genetically-informed study investigates motives for tanning and the role that pigmentation phenotypes play on outdoor and indoor tanning behaviour in British young adults. Methods: This study included 3722 participants from the Avon Longitudinal Study of Parents and Children in South West England. Skin, hair and eye colour features, and tanning ability and preferences were collected using a questionnaire applied when participants were ~25 years of age. Genotypes for 41 single nucleotide polymorphisms (SNPs) associated with pigmentation were obtained from a subset of participants who provided a biological sample, and used to estimate the probability of having particular pigmentation traits with the HIrisPlex-S system. Results: Liking to tan and outdoor tanning were strongly influenced by skin, hair and eye pigmentation, and tanning ability. However, the association of these traits with UV indoor tanning was weaker. Conversely, females, participants of lower socioeconomic position, individuals who were unhappy with their pigmentation phenotype during adolescence, and participants who believed that tanning helps prevent sunburn were more likely to have used UVR-based tanning devices. Conclusion: Our results provide evidence to support the implementation of skin cancer preventative interventions that consider individual biological characteristics and motives for undergoing outdoor and indoor tanning.

Public Health Communication: Skin Cancer Prevention Implications

Research question: What are the characteristics of the target population which public health messages should be tailored to, in order to contribute to skin cancer prevention and early detection? Motivation: The implementation of preventive behaviour is of key importance taking into account the global increase in the incidence of skin cancer over the past decades. Communication campaigns represent an effective tool in creating awareness and education of population on harmful effects of exposure to UVR and a necessity of conducting preventive measures. The basis for creating such campaigns is to examine the knowledge, behaviour and information habits of target population. Idea: To examine the knowledge and attitudes regarding harmful effects of exposure to UVR, as well as preventive practices of adult urban population and determine the main sources of information on this topic. Data: The research took place in the period March-May 2018 in Belgrade and was based on surveing of 237 adult respondents from Belgrade. The sample was acquired by using the method of convenience sampling. Tools: The questionnaire consited of close-type questions with multiple choices of answers regarding socio-demographic characteristics, knowledge about risks of UVR exposure, preventive behaviour and preferred information sources. It was distributed in paper to patients while waiting for their appointments. Obtained data were manually coded and analysed by using SPSS. Results: A majority of both women (45.6%) and men (42.9%) report that they use sunscreens regularly, but a larger percentage of men (25% vs. 11.9%), as well as older respondents did not use sunscreens at all. Women reported to spend longer hours sunbathing (41.9% vs. 33%) and using indoor tanning than men (17.6% vs. 5.2%). Youngest respondents (age 20-30) also claim to practice excessive sunbathing (52.6%) and use indoor tanning (23.2%). Older respondents consider them being at higher risk of skin cancer (68.2% of those older than 60). There is a higher level of awareness of female in comparison with male respondents regarding the importance of skin cancer screening (62.3% vs. 44.7%), as well as of university educated respondents. Television has been noted to be the most significant source of information (57.8%), followed by internet sources (43.5%) and printed media (40.5%). Contribution: Knowledge, attitudes and behaviour, as well as preferred sources of information differ by gender, age and education of respondents so targeted public health campaigns should be tailored to specific characteristics of target groups.

Factors associated with sunbed use among 3692 outpatients in 18 centers of the Italian Cancer League (LILT)

Indoor tanning is associated with an increased risk of skin cancer. Nonetheless, its use is still widespread. We aimed to investigate the socio-demographic and clinical characteristics of sunbed users in a group of participants in the skin cancer prevention campaign organized by the Italian Cancer League (LILT). During almost 2 years, 4409 individuals were screened in 18 centers. Participants reported having used sunbeds before the age of 15 years in 2.2% of cases, while after age 15 the prevalence of use was 22.2%. Participants with complete information were 3692. Sunbed users aged > 15 years were significantly more frequently females, young, living in Northern Italy, highly educated, and current or former smokers. They had darker phototype, more common nevi, had used sunbeds more frequently before the age of 15, reported a history of sunburns, and use of sunscreens. Indoor tanning is an important public health issue and a relevant target for primary prevention. However, not all countries have adopted the recommendations issued by the World Health Organization (WHO) on health risks associated with artificial tanning. A deeper insight into the topic may contribute to identify the best prevention strategies.

Indoor Tanning and the Risk of Overall and Early-Onset Melanoma and Non-Melanoma Skin Cancer: Systematic Review and Meta-Analysis

The aim of this study was to examine the association between indoor tanning use and the risk of overall and early-onset (age < 50) melanoma and non-melanoma skin cancer (NMSC). To evaluate the association between indoor tanning and skin cancer, a systematic review of the literature published until July 2021 was performed using PubMed, EMBASE, and MEDLINE. Summary relative risk (RR) from 18 studies with 10,406 NMSC cases and 36 studies with 14,583 melanoma cases showed significant association between skin cancer and indoor tanning (melanoma, RR= 1.27, 95% CI 1.16–1.39; NMSC, RR = 1.40, 95% CI 1.18–1.65; squamous cell carcinoma (SCC), RR = 1.58, 95% CI 1.38–1.81; basal cell carcinoma (BCC), RR = 1.24, 95% CI 1.00–1.55). The risk was more pronounced in early-onset skin cancer (melanoma, RR = 1.75, 95% CI 1.14–2.69; NMSC, RR = 1.99, 95% CI 1.48–2.68; SCC, RR = 1.81, 95% CI 1.38–2.37; BCC, RR = 1.75, 95% CI 1.15–2.77). Moreover, first exposure at an early age (age ≤ 20 years) and higher exposure (annual frequency ≥ 10 times) to indoor tanning showed increasing risk for melanoma (RR = 1.47, 95% CI 1.16–1.85; RR = 1.52, 1.22–1.89) and NMSC (RR = 2.02, 95% CI 1.44–2.83; RR = 1.56, 95% CI 1.31–1.86). These findings provide evidence supporting primary prevention policies regulating modifiable behaviors to reduce the additional risk of skin cancer among younger adults.

Factors associated with sunbed use among 3692 outpatients in 18 centers of the Italian Cancer League (LILT)

Indoor tanning is associated with an increased risk of skin cancer. Nonetheless, its use is still widespread. We aimed to investigate the socio-demographic and clinical characteristics of sunbeds users in a group of participants in the skin cancer prevention campaign organized by the Italian Cancer League (LILT). During almost two years, 4409 individuals were screened in 18 centers. Participants reported having used sunbeds before the age of 15 years in 2.2% of cases, while after the age of 15 years the prevalence of use was 22.2%. Participants with complete information were 3692. Sunbeds users aged > 15 years were significantly more frequently females, young, living in Northern Italy, highly educated, and ever smokers. They had darker phototype, more common nevi, had used sunbeds more frequently before the age of 15, reported a history of sunburns, and the use of sunscreens. Indoor tanning is an important public health issue and a relevant aspect of primary prevention. However, not all countries have adopted the recommendations by the World Health Organization (WHO) on health risks associated with artificial tanning. A deeper insight into the topic may contribute to identify the best prevention strategies.