The medicalization of sunlight in the early twentieth century.

This paper traces the emergence of the therapeutic use of sunlight in medicine during the first half of the twentieth century. This was a period of considerable flux in medicine with various strands of practice and theory competing. Drawing on two case studies of sunlight therapy, both artificial (actinotherapy) and natural (heliotherapy), in the treatment of rickets and tuberculosis this paper will explore how medicine was constituted within these regimes. The paper will argue that therapeutic and clinical applications of sunlight helped establish an association between sunlight and health but also defined a particular and specific performance of medicine.

Does increased sunlight exposure work as a strategy to improve vitamin D status in the elderly: a cluster randomised controlled trial.

SUMMARY: Sunlight exposure by improving vitamin D status could be a simple public health strategy in reducing falls among frail elder people. In a randomised controlled trial, adherence to sunlight exposure was low (median adherence, 26%) and no effect of increased UV exposure on falls risk was observed (incidence rate ratio (IRR) 1.06, P = 0.73). INTRODUCTION: This study aimed to determine whether increased sunlight exposure was effective to improve vitamin D status and reduce falls in the elderly. METHODS: In a cluster randomised controlled trial (NCT00322166 at ClinicalTrials.gov), 602 residents aged 70 or more (mean age, 86.4 years; 71% female) were recruited from 51 aged care facilities in Northern Sydney, Australia. Participants were randomised by facility to receive either increased sunlight exposure (additional 30-40 min/day in the early morning) with (UV+) or without (UV) calcium supplementation (600 mg/day) or neither (control) for a year. The co-primary endpoints were change in serum 25 hydroxy vitamin D (25OHD) and falls incidence after 12 months. RESULTS: Adherence to sunlight exposure was low (median adherence, 26%; IQR, 7%-45%). Serum 25OHD levels were low at baseline (median, 32.9 nmol/L) and increased only slightly depending on the number of sunlight sessions attended over 12 months (P = 0.04). During the study, 327 falls occurred in 111 (54%) subjects in the control group, 326 falls in 111 (58%) subjects in the UV only group and 335 falls in 108 (52%) subjects in the UV+ group. By intention-to-treat analysis, there was no significant effect of increased UV exposure on falls risk (IRR, 1.06; 95% CI, 0.76-1.48; P = 0.73). However, in 66 participants who attended ≥130 sessions per year (adherence, ≥50% of 260 sessions-five per week), falls were significantly reduced (IRR, 0.52; 95% CI, 0.31-0.88; P = 0.01) compared with the control group. CONCLUSIONS: Increased sunlight exposure did not reduce vitamin D deficiency or falls risk in frail older people. This public health strategy was not effective most likely due to poor adherence to the intervention.

Literature review of theory-based empirical studies examining adolescent tanning practices.

Lifetime exposure to ultraviolet radiation is a major risk factor for all types of skin cancer. The purpose of this manuscript is to examine theory-guided empirical studies examining adolescent tanning practices.

Prevalence and correlates of sun protection and skin self-examination practices among cutaneous malignant melanoma survivors.

Little is known about the level of engagement and correlates of sun protection and skin self-exam among individuals diagnosed with melanoma. Participants (N = 229) completed measures of skin self-exam and sun protection practice and knowledge and attitudes. Approximately eighty-four percent of patients reported engaging in skin self-examination at least once in the past year. Engagement in sun protection practices was moderate. Self-exam practice was associated with gender, physician recommendation about self-exam, and perceived benefits and barriers of self-exam. Sun protection was associated with gender, age, medical status and health care access, physician recommendation, knowledge, and a number of psychological factors. Behavioral interventions to improve skin surveillance and sun protection may benefit from an emphasis on physician education regarding self-exam and sun protection, education regarding the efficacy of sunscreen and the risks associated with sunbathing, reducing perceived barriers to self-exam and sun protection, and reducing reliance on social influences on sun protection practices.

College students' knowledge and attitudes about cancer and perceived risks of developing skin cancer.

Skin cancer is the most commonly occurring cancer in the United States. Primary prevention practices for skin cancer are fully documented in the literature for reducing the damaging effects of ultraviolet radiation on skin. Late adolescents, inherent to their young age and risk-taking behaviors, are more likely to sunbathe. The cancer attitudes and suntanning knowledge, attitudes, perceptions, beliefs, and behaviors among college students were examined. Gender-specific interventions for educating this age group are recommended.

Sunbathing intentions in Irish people travelling to Mediterranean summer holiday destinations.

As exposure to UV light is thought to be the most significant environmental and behavioural risk factor for avoiding skin cancer, we have analysed the sunbathing intentions and attitudes of Irish people travelling to Mediterranean and Iberian holiday destinations. Ninety per cent of respondents planned to get a suntan on their vacation with 44% likely to burn their skin in the process. Although all intended to apply sun cream on holiday only 40% would apply >SPF 15. Sixty-four per cent planned to sunbathe between 11.00 am and 3.00 pm, with 25% intending to spend <5 hours in the sun. One-third of those intending to sunbathe for >6 hours per day were aged between 16 and 24 years. Approximately eight out of 10 people thought suntans made them feel healthier or attractive. Fifty-six per cent regularly checked their moles but men were less likely to check their skin for pigment changes. The results provide baseline information on sunbathing attitudes of Irish people. They show that while most people feel they adopt a careful approach to sunbathing, the experiences and intentions, especially in younger people, are influenced by the desirability of a suntan, and reflect a behaviour that increases their risk of skin cancer.

Modeling tanning salon behavioral tendencies using appearance motivation, self-monitoring and the theory of planned behavior.

The constructs of appearance motivation and self-monitoring were added to the Theory of Planned Behavior in the prediction of tanning salon use in young people. The variables of the Theory of Planned Behavior proved effective at predicting tanning salon behavioral intentions and tendencies. Intentions and perceived behavioral control predicted tanning salon behavioral tendencies, while attitudes, subjective norms and perceived behavioral control predicted tanning salon behavioral intentions. Appearance motivation did not show any direct or interaction effects in the prediction of tanning salon behavioral intentions. It did, however, prove superior to health orientation in the prediction of tanning salon attitudes. Self-monitoring interacted with subjective norms in the prediction of tanning salon intentions, with high self-monitors showing stronger subjective norm-intention relationships than low self-monitors. These results imply that appearance-related interventions could prove efficacious in reducing young people's tanning salon behavioral tendencies. Furthermore, it may be important to consider individual's self-monitoring status when targeting skin cancer prevention information to young people.

Attitudes, beliefs and behaviour regarding the use of sunbeds amongst healthcare workers in Bradford.

Although cosmetic tanning and unprotected solar exposure are common, little is known about general attitudes, beliefs and behaviour regarding the use of sunbeds. We sought to determine the frequency of sunbeds use in a select sample and to assess the knowledge and beliefs regarding this behaviour. A self-administered anonymous questionnaire was distributed to a sample of 648 employees work for Bradford Hospitals NHS Trust. The questionnaire explored demographic information (including hair and skin type, family history with skin cancer), frequency of sunbeds use, knowledge about the risks of UV exposure and motivations for practising this behaviour. Four hundred and eighteen women and 52 men completed the questionnaire, making a response rate of 73%. Nearly half of respondents (207; 44%) reported using sunbeds to some extent; of those 12% reported frequent use. Appearance ('to look better') was the most popular reason given by respondents for using sunbeds, followed by 'feel healthy'. Frequency of using sunbeds was found to be negatively correlated with the age of respondents and the existence of family experience with skin cancer, and strongly associated with the opinion that it is safer to use a sunbed than subathing outdoors, the female sex and smoking. It is clear from this study that the psychological factors that influence sunbeds use are complex and that so far public education campaigns have had little impact on it. This study highlights some of these psychological factors.

Sun-safety behavior among elementary school children: the role of knowledge, social norms, and parental involvement.

98 children in Grades 4, 5, and 6 were surveyed in 1997 for their knowledge of sunlight's harmful effects, attitude toward and frequency of usage of sun-safety devices, perceived peer pressure against sun-safe behavior, and parental encouragement for practicing sun-safe behavior. Children exhibited low knowledge of harmful effects of sun exposure and perceived the threat as remote. Of the two primary determinants of sunscreen usage, parental reminders and a positive attitude towards sunscreen use, the former was dominant. The knowledge of harmful effects of sun exposure, the primary focus of most interventions, does not appear to be the most critical variable influencing children's sun-safety behavior; parental involvement does.

Predictors of sun protective behaviors among school students.

A random sample of students (N = 3,655) in Grades 7, 9, and 11 from 55 schools in Queensland (Australia) were surveyed about their sun protection knowledge, attitudes, and behaviors. An aggregate sun protection behavior index (SPBI) was developed from self-reported behaviors on a school day and a weekend day. Repeated measures regression analyses revealed that negative views of sun protection measures were associated with low scores on the SPBI, an association that was strongest among older students and in larger schools. Low perceived parental sun protective behaviors were associated with low SPBI ratings, and this association was greatest in small schools and on Saturdays. Older students had lower SPBI ratings, but their scores increased on Saturdays. Gender did not appear to be independently related to the SPBI after adjustment for the other variables. These findings reinforce the need for adolescent sun protection programs to address the complex interactions among psychological, social, and environmental factors that influence different subgroups of the student population.

Sunbathing and sunbed use related to self-image in a randomized sample of Swedish adolescents.

In 1996 a randomized sample of 4,020 Swedish adolescents from three birth cohorts were sent a questionnaire consisting of 50 items concerning habitual sun-related behaviours and attitudes, knowledge about melanoma, risk perception and self-image. A total of 2,615 questionnaires were returned. Girls sunbathed and used sunbeds more than boys at all ages. Sunbathing and sunbed use increased with age. Boys who were most satisfied and girls least satisfied with themselves sunbathed most. Those who were least satisfied with themselves used sunbeds most frequently. Girls reported a higher perceived susceptibility to melanoma than did boys. The perception of susceptibility increased with age. Those who were least satisfied with themselves reported feeling most susceptible. The overall main reason for sunbathing was appearance, both for own sunbathing, and to an even higher degree, as a supposed reason for other adolescents' behaviour, and was reported most frequently by girls and the older age groups. The second most 'important' reason for sunbathing was 'feeling warm and comfortable'. Preventive programmes aimed at a change of sun related behaviours among Swedish adolescents have to be tailored to the climate and cultural conditions and must take into account that having a tan, and the warmth of the sun, are highly valued by most adolescents.

Examination of cognitive variables relevant to sunbathing.

This study examined cognitions relevant to sunbathing decision-making in college-aged subjects. Using Jaccard's (1981) theory of alternative behavior as a guiding model, 263 subjects were recruited from psychology classes and administered questionnaires assessing their sunbathing behavioural tendencies, attitudes toward sunbathing, attitudes toward reasonable behavioral alternatives to sunbathing, and cognitive variables underlying these attitudinal variables. The fits of models predicting sunbathing attitudes and sunbathing behavioural tendencies (evaluated using covariate structural equations modeling techniques; LIS-REL VIII) were good for all models tested. In contrast to previous work, the results of this study support the notion that young people will make their decisions regarding sunbathing based on the behavioral alternatives available to them (i.e., generally the one that they prefer most). Furthermore, the multivariate approach used clearly delineates the specific cognitive beliefs and orientations that might be targeted to change these attitudes. The relevance of these findings to skin cancer prevention interventions is discussed.

Summer sun exposure: knowledge, attitudes, and behaviors of Midwest adolescents.

BACKGROUND: Extensive print, radio, and television coverage about the dangers of sun exposure and benefits of sun protection occurred over the past decade. Illinois teen knowledge and attitudes about sun exposure/protection, sun-exposure/protection behavior, and information sources were determined by a summer telephone survey. METHODS: Telephone interviews with 658 teenagers between ages 11 and 19 included African-American, Asian, Hispanic, Native American, and white teenagers. RESULTS: Teens knew that too much sun was harmful as it caused skin cancer and sunburn. Sunburn was mentioned more often by those with skin types that burned easily and tanned poorly (I,II) (P < 0.001), was better known to girls than to boys (P < 0.001), and was recognized more by those with higher socioeconomic status (P < 0.001) but was not associated with age. Widely held sun exposure attitudes were socializing with friends and feeling better when outdoors. On weekdays, boys averaged 5.3 hr (SD, 1.65 hr) outside compared with 3.9 hr (SD, 0.75 hr) for girls (P < 0.001). Teenage boys were more likely to obtain occupational sun exposure, and girls sunbathed. Subjects with skin types I and II reported an average of 3.3 sunburns in the past year. During unprotected sun exposure, extensive numbers of teens with moderate-risk skin type experienced at least 1 sunburn per year. Indoor tanning use was more prevalent among older girls and those with skin types I and II. Sunscreen use was associated with water recreational activities (swimming, water sports, and going to the beach) by girls slightly more than by boys (P < 0.001). Hat-wearing was more common among boys than among girls. CONCLUSIONS: Teen knowledge that excessive sun exposure causes skin cancer and sunburns and that wearing sunscreens and hats were sun-protective methods did not enable sun protection that prevented burning. This is particularly troublesome because severe sunburns in youth are associated with an increased risk of melanoma. Existing teen sunscreen use could be broadened by educating teens to use adequate quantities of sunscreen prior to daily sun exposure to prevent painful burns. Messages to teens that emphasize the short-term consequence of painful sunburns because of inadequate protection during outdoor occupational and non-water-related recreational exposure would increase the relevance of the message and may enable behavioral change. Parents and physicians need to be included in messages that are directed to teens and to become part of their education. Parents could ensure an adequate sunscreen supply for daily use by the family, encourage teens not to deliberately tan, and serve as role models for the use of protective clothing.

Attitudes toward health risks and sunbathing behavior.

Sunbathing confers the benefits of looking and feeling good but presents the long-term risk of skin cancer. In a disguised experiment exploring attitudes toward sunbathing by British adults, participants were asked to rate their willingness to take a hypothetical new drug (with different levels of risk) that would make them look and feel good. One aspect of the resulting risk profiles was significantly related to a positive attitude to open-air sunbathing but not to sunbed use, possibly because it was erroneously thought that using a sunbed is not risky. The well-established finding that women are more cautious was confirmed; the risk function for men was curvilinear, in contrast to women, who were willing to increase their risk linearly over their lifetime.

A survey of sunbathing practices on three Connecticut State beaches.

In order to analyze sunbathing practices, a survey was conducted during the summer of 1995 on three Connecticut state beaches, with 1,003 interviews completed. The majority (65.8%) of respondents were women. Almost 70% of respondents were visiting the beach to get or maintain a tan. While the intended beach stay averaged four hours, only 55.7% of respondents were using sunscreen, 6.9% were sitting under shade, 12.7% were wearing hats, and 17.1% were wearing clothes other than a bathing suit. More than half (55%) of the sunscreen used had a sun protection factor of less than 15. Children were provided with greater protection than adults. The survey indicates the need for greater educational efforts to motivate protective behavior. Primary-care physicians could have an important role in these efforts.

Seasonal variations in the severity of acne vulgaris.

BACKGROUND AND OBJECTIVE: The improvement of acne in summertime or the aggravation of acne in winter is a traditional dermatologic opinion. Ultraviolet rays are thought to be beneficial in the treatment of acne. In the existing literature there is no proof of this. The purpose of this study was to find out whether or not acne generally worsens in winter. PATIENTS AND METHOD: One hundred and thirty-nine patients were asked if their acne worsens in winter or in summertime, whether it improves seasonally, or if they didn't notice any change with the seasons. RESULTS: About one-third of the patients reported an aggravation of their acne in winter, but also approximately one-third of the patients complained about an aggravation of their acne in summer. Another third did not notice any change. CONCLUSIONS: Sun-bathing may be beneficial for psychologic reasons and may produce euphoric effects, but we do not see any reason to treat acne with ultraviolet radiation because of all its negative effects on the skin.