Risk of non-Hodgkin's lymphoma and skin malignancies in patients diagnosed with cataract.

The rapid increase of non-Hodgkin's lymphoma (NHL) in industrialized countries is yet unexplained. Ultraviolet radiation (UVR) has been suggested as an aetiologic factor due to observed elevated risks of cutaneous malignancies after NHL and vice versa. Cataract, as related to UVR, was tested as a proxy variable to further elucidate this observation. Cataract in-patients (n = 49914) reported to the Swedish Patient Register and later developing NHL and cutaneous malignancies were identified by record linkage to the Swedish Cancer Registry. The observed number of malignancies among cataract patients did not differ significantly from that expected in the general population. In contrast, the risk of cutaneous malignant melanoma was lower than anticipated, based on Swedish background incidence figures. The results did not give support for a causal relationship between NHL and UVR.

Swedish pre-school children's UVR exposure - a comparison between two outdoor environments.

BACKGROUND: Overexposure to ultraviolet radiation (UVR) in childhood is a major risk factor for skin cancer. Shady environments are recommended as one method of protection. METHODS: Environmental exposure to UVR and environmental protection were assessed by dosimeter measurements on 64 children aged 1-6 years at two geographically close and topographically similar pre-schools outside Stockholm. Outdoor play constructions of site 1 (34 children) were mainly exposed to the sun, and those of site 2 (30 children) were mainly shaded. Dosimetry was carried out during 11 work days in May-June 2002 under clear weather conditions. The reliability of dosimeters was tested with meteorologically modelled data from SMHI, and with stationary dosimeters exposed to free sky, and compared with other UV instruments. The differences between children's outdoor stays were adjusted for. RESULTS: The children's average daily exposures were approximately 200 J(CIE)/m(2) erythemally effective UVR. The average relative UVR exposure (% total available UVR 08:30-18:30) was 6.4% (7.0% at site 1, 5.7% at site 2). Fractions of available UVR during outdoor stay were 14.4% (both sites), 15.3% (site 1), and 13.3% (site 2). In terms of relative differences, 5-6-year-old children at site 2 were exposed to 41% less UVR, and 1-4-year-old children 6% less than those at site 1. CONCLUSION: The difference can be explained by the children's outdoor pre-school environments, and the behaviors linked to these environments. It is recommended to consider the attractiveness of shady environments in the design of children's pre-school playgrounds, particularly if these are extremely exposed to the sun.

Tanning habits and sunburn in a Swedish population age 13-50 years.

As part of a skin cancer control programme, we studied the occurrence of self-reported outdoor tanning, sunbed use and ultraviolet (UV)-induced erythema in an urban area. A cross-sectional questionnaire study of 6000 adolescents aged 13-19 years, and 4000 adults aged 20-50 years was applied. Non-response was analysed for outdoor tanning and sunbed use. Results, in general, did not differ between responders and non-responders. Females aged 17-29 years tanned outdoors most frequently. Sunbed use and related erythema was twice as common in young females. In males, outdoor tanning was not age-related. In the past 12 months, 55% reported sunburn and/or burn from sunbed use, one-third were burned in Sweden, one-quarter on sunny resorts abroad. Sunburn occurs frequently. Compliance with recommendations for sunbed use is poor, especially among adolescents and young adults. To reduce the occurrence of erythema, the influence of risk settings upon behaviours is a critical issue for exploration.

Sunbed use in Swedish urban adolescents related to behavioral characteristics.

BACKGROUND: Sunbed use among Swedish adolescents has not been extensively studied, nor has the social learning process associated with it. The purpose of this study was to explore Swedish adolescents' sunbed use in relation to sex, age, smoking, perceived physical attractiveness, attitudes to artificial and natural UV exposure, psychosomatic symptoms, and risk knowledge. METHODS: In the spring of 1993, 60 school classes comprising 1,502 students ages 14-19 were randomly selected to answer a questionnaire concerning sunbed use and sunbathing habits, smoking, perceived physical attractiveness, psychosomatic symptoms, and need for information about and knowledge of the risks of UV exposure. RESULTS: Of 1,252 respondents, 57% had used sunbeds (females 70%, males 44%) > or = four times during the previous year. A marked increase (P < 0.001) in both sunbed use and smoking was detected between the 8th and the 9th grade (at ages 14-15). Sunbed use was also significantly correlated with sex, age, excessive tanning in natural sunlight, and low perceived physical attractiveness. The need for information on risks of high UV exposure was greatest among the best informed students and among students with high UV exposure (sunbed use, excessive tanning in natural sunlight). CONCLUSIONS: It seems doubtful whether further information on UV risks would result in altered behavior among highly exposed students, who seem receptive to information and have good knowledge. For a better understanding of the mechanisms underlying the association between sunbed use, smoking, and self-esteem, more in-depth, qualitative studies are required.

Sunbed use in relation to phenotype, erythema, sunscreen use and skin diseases. A questionnaire survey among Swedish adolescents.

Sunbed use was studied in relation to phenotype, erythema, sunscreen use and skin disease. The study population comprised 14-19 year-old Stockholm adolescents in 60 randomly selected classes, with 1252 students providing information. More than half (57%) reported sunbed use > or = 4 times during the previous year. Skin type III dominated (64%). Excessive exposure (> or = 10 times/year) was not correlated to skin type. Sunscreens were most commonly used by sunbed users. Of all sunbed users, 44% reported erythema. Adolescents with acne/seborrhoca, eczema or psoriasis used sunbeds more than others without skin diseases. The proportion with sunbed erythema (44%) indicates an unrecognized susceptibility to artificial ultraviolet radiation (UVR) among adolescents. The association between high exposure to UVR and sunscreen use stresses the importance of sunscreens being used as supplementary protection, not as a tool for tanning.

Primary prevention of malignant melanoma in the Stockholm Cancer Prevention Programme.

Malignant melanoma is the most rapidly increasing tumour in Sweden. Sunburns in childhood and adolescence are considered a major risk factor. The Stockholm Cancer Prevention Programme addresses strategies to establish sun awareness in the population of Stockholm county by using existing networks of standardized child health and preschool services, educational systems including schools, colleges of nursing sciences and preschool teaching (integration of sun awareness in curricula, and in a new syllabus for environmental theory), the Federation of Swedish Pharmacies, and media. Health education is designed for key persons in these organizations and the media, who in turn diffuse sun awareness via their respective organizations. The education programme only deals with primary prevention by behavioural changes in exposure to UV rays, ie excessive exposure to sun, and it is primarily intended to raise sun awareness. Experiences have shown that information diffusion was good in spite of limited staff resources.

Primary prevention of malignant melanoma in a Swedish urban preschool sector.

Malignant melanoma is the most rapidly increasing tumor in Sweden. Sunburns in childhood are considered a major risk factor. In the spring of 1989, a health education program was therefore initiated in Stockholm County in cooperation with the local preschool authorities in the area. Lectures on malignant melanoma, hazards of sunburns in childhood, and the importance of sun awareness were arranged for the nursery school matrons in the preschool sector. Thirty-five of 42 authorities (83%) wanted a lecture for their nursery school matrons, whereas 17% of the authorities wanted to spread information on their own. Of 1,991 nursery schools, 1,783 (90%) took part in the information program. These, the Stockholm nonparticipants, and the rest of the country received written information from the Federation of Swedish Municipalities by initiative of the Department of Cancer Prevention. A questionnaire distributed to 574 randomly selected nursery schools in Stockholm county and to 100 in a reference area outside Stockholm showed that sun awareness was reported high in both places. Face-to-face information disseminated by an established organization was more effective in increasing sun awareness in the preschool sector than mailed information alone. In the areas where lectures were given, the message of sun awareness practice was passed on to nursery school staff and parents twice as effectively as in the reference area (p less than 0.01).