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Teen indoor tanning drops, but schools fall short on sun safety

Explore best practices for public education campaigns “For more than 10 years, much effort has been made to educate the public on sun-safety practices, including warnings about the harmful effects of indoor tanning on those at higher risk, such as young adults and children. In this issue of JAMA Dermatology, 2 important articles describe the progress made toward sun safety,” wrote Henry W. Lim, MD, and Samantha L. Schneider, MD, in the accompanying editorial.

Data from a study of indoor tanning showed a significant decrease in prevalence of indoor tanning among adolescents, from 16% in 2009 to 7% in 2015. Although these results are encouraging, public education is needed for further improvement, they said. “One myth is that UV radiation prevents vitamin D deficiency; however, oral vitamin D supplementation is known to be a safer alternative. Another myth is that obtaining a baseline tan before the summer or a vacation reduces the risk of sunburn. However, as Guy and colleagues observed, those who tanned indoors were more likely to develop sunburn than students who did not engage in indoor tanning.”

Dr. Henry Lim

A second study highlighted the limitations of current sun safety practices in schools. “Identifying systems in which a community can stage interventions could be a highly effective method for decreasing UV radiation exposure and, ultimately, improving skin health. The school system may represent an ideal area of focused intervention on sun safety,” the editorialists wrote. To that end, the American Academy of Dermatology has developed a range of programs aimed at educating children about sun safety and has worked to establish shade structures on school playgrounds. However, a public awareness campaign outside of school also may be effective, they noted. They cited a program in Portugal in which sun safety messages were printed on small sugar packets, where they were widely seen by the Portuguese public as part of their daily coffee-drinking routines.

“Clearly, both the dermatology and medical communities need to continue public awareness campaigns regarding photoprotection, including sun-safety practices such as seeking shade when outdoors and wearing photoprotective clothing, wide-brimmed hats, and sunglasses,” they emphasized.

In addition, “A highly effective means of public education may be to identify a campaign, such as Portugal’s sugar packet initiative, that makes sun-safety awareness and practice a part of everyone’s daily routine,” they said (JAMA Dermatol. 2017. doi: 10.1001/jamadermatol.2016.6272).

Dr. Lim and Dr. Schneider are affiliated with the department of dermatology at Henry Ford Hospital in Detroit. Dr Lim disclosed serving as an investigator or coinvestigator on clinical research projects for Ferndale Pharma, Estée Lauder, and Allergan. Dr. Schneider had no relevant conflicts to disclose.



Indoor tanning among adolescents in the United States has dropped significantly, but fewer than half of schools in the United States reported sun safety practices to help minimize students’ UV exposure in the school setting, based on data from two studies presented at the annual meeting of the American Academy of Dermatology and published simultaneously in JAMA Dermatology.

“Data suggest that intermittent, recreational exposure (vs. chronic exposure, as with outdoor workers) more often leads to sunburn,” wrote Sherry Everett Jones, PhD, MPH, and Gery P. Guy Jr, PhD, MPH, of the Centers for Disease Control and Prevention. “Although a small proportion of school districts and schools have adopted policies to address sun safety, most have not, even though it is common for students to be outside during the midday hours or after school when the sun is still at peak intensity.”

To characterize sun safety practices at schools, the researchers reviewed data from the 2014 School Health Policies and Practices Study Healthy and Safe School Environment questionnaire including 577 elementary, middle, and high schools (JAMA Dermatol. 2017. doi: 10.1001/jamadermatol.2016.6274).

Overall, 48% of schools reported that teachers allowed students time to apply sunscreen at school (the most frequent sun safety practice). However, only 13% made sunscreen available, 16% asked parents to ensure sunscreen application before school, and 15% made an effort to avoid scheduling outdoor activities during times of peak sun intensity. High schools were less likely than elementary or middle schools to follow sun safety practices.

“None of the sun safety policies or practices were statistically significantly associated with metropolitan status,” the researchers noted. However, the findings were limited by the cross-sectional nature of the study and lack of data about natural shade and man made shade structures in outdoor areas of the schools.

“Interventions driven by the public health and medical community educating school leadership and policy makers about the importance of sun safety are needed regardless of level, location, size, and poverty concentration of the school. These efforts could be instrumental in increasing the adoption of sun safety practices among schools,” Dr. Jones and Dr. Guy emphasized.

However, data from another study showed a significant reduction in the prevalence of indoor tanning among adolescents.

In particular, indoor tanning among non-Hispanic white females (the group at highest risk for skin cancer) dropped from 37% in 2009 to 15% in 2015. CDC researchers led by Dr. Guy pooled data from the 2009, 2011, 2013, and 2015 national Youth Risk Behavior Surveillance System Surveys (JAMA Dermatol. 2017. doi:10.1001/jamadermatol.2016.6273). Overall, the prevalence of indoor tanning among U.S. high school students decreased from 16% in 2009 to 7% in 2015.

“Despite declines in indoor tanning, continued efforts are needed,” the researchers wrote. “Public health efforts could help address the misconception that indoor tanning protects against sunburn. The medical community also can play a key role in counseling adolescents and young adults in accordance with the U.S. Preventive Services Task Force guidelines.”

The findings were limited by several factors including the use of self-reports and the inability to control for skin type, the researchers wrote. However, “Reducing the proportion of youth who engage in indoor tanning and experience sunburns presents an important cancer prevention opportunity.”

None of the researchers on either study had relevant financial conflicts to disclose.

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