Minimizing ultraviolet radiation (UVR) exposure during childhood and adolescence may be the most important factor in preventing skin cancer. The risk for this cancer is particularly strongly associated with cumulative UV exposure and sunburn early in life. From 25% to 50% of an individual’s lifetime sun exposure occurs before ages 18 to 21 years. The challenge is twofold: getting parents and other caregivers to change their sun protection behavior, and motivating adolescents to adopt safer sun-related practices. A review article in the Journal of the European Academy of Dermatology and Venereology examines several aspects of this topic.
For Younger Children
Over the 12 years since it was first launched in kindergartens in Germany, the SunPass program has proven its efficacy. This brief, standardized educational intervention on sun protection is aimed at young children, their parents, and the childcare staff. After being invited to the center, the program coordinator makes a first visit to provide information and educational material. The coordinator presents and proposes actions aimed at promoting protection from sun exposure and sunstroke.
During an evening program, parents fill out questionnaires for the purpose of gathering data on the demographic characteristics of the children, their sun protection practices, sunburn history, holidays in sunny countries, and knowledge about skin cancer risk factors. A “sun protection agreement” is signed by the kindergarten management. Among the 10 rules to be followed are that children should wear a hat and appropriate clothes while they’re outside, long-lasting sunscreen should be applied daily, and activities should be held inside or in the shade from late morning to mid-afternoon.
An unannounced site inspection is carried out to check whether the agreed-upon actions have been implemented. If the recommended UV-protective measures have been successfully applied, the kindergarten is awarded the SunPass accreditation symbol. The gains in knowledge and changes in sun behavior are quantified by questionnaires administered before and after the SunPass interventions.
In Germany, the program has been a success. Up to 40,000 children have participated across more than 2500 accredited kindergartens. With support and assistance from the European Skin Cancer Foundation, SunPass has been implemented beyond Germany in Spain, Greece, Italy, and Romania. The program’s success shows that it possible to implement wide-scale prevention initiatives that target young people, a group with higher rates of exposure to UVR and who are therefore at risk for the development of skin cancer later in life.
What About Adolescents?
Although teenagers often have a high level of awareness of the risks of sun exposure, many adolescents feel better and feel they look healthier with a tan. In general, many adolescents tend to focus more on the here and now than on possible hypothetical risks that may or may not arise in the future. These perceptions have been evaluated in a small study of adolescent girls in England. The investigators concluded that the participants believed looking tanned in the short term was worth the risk of cosmetic and health consequences in the long term. For many adolescents, sun exposure is a constant positive reminder of leisure, vacations, and health, and the reactivation of positive experiences can enhance their mood.
In addition, a growing body of literature has provided evidence that frequent or excessive tanning may be related to the addictive and reinforcing properties of UVR. This is shown primarily in research involving UVR-emitting tanning beds. So-called “tanorexia” could not be linked solely to psychological factors. In a study, mice were exposed to levels of UVR comparable to spending 20 to 30 minutes in the midday sun in Florida for 5 days per week for 6 weeks. The mice were found to have high plasma levels of endorphins. In a blinded study, 14 young adults used UVR-emitting tanning beds or UVR-filtered beds (with blue light). They consistently reported having greater feelings of relaxation and reduced tension after using the tanning beds.
There is also evidence suggesting that tanning addiction may be related to other psychiatric conditions. For persons with body dysmorphic disorder, the desire to tan may be driven by a desire to improve a perceived defect in appearance. For patients with seasonal affective disorder, UVR exposure may help to regulate melatonin levels.
Sun protection measures taken by adolescents are often inadequate. They find it hard to avoid sun exposure during peak hours, they don’t comply with the recommendations for sunscreen use, or they have a sunscreen that lacks the appropriate sun protective factor. These difficulties have been described in various studies, which have also noted that parental influence and protective behaviors during early childhood are a significant predictor of sunscreen use in adolescence.
To develop effective sun protection interventions, characteristics specific to adolescence must be taken into account. Approaches may include focusing campaigns on matters of appearance (skin aging), promoting safe alternatives (self-tanning creams), and involving their peers to educate and raise awareness. As for managing the more serious factors that contribute to excessive tanning, many approaches can be implemented, from the use of brief motivational interventions to, in the case of addictive behaviors, cognitive-behavioral therapy.
This article was translated from Univadis France.
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