Compliance with sunscreen advice in a survey of adults engaged in outdoor winter recreation at high-elevation ski areas

Abstract

Background Adults are advised to wear sunscreen with a sun protection factor of 15+, apply it up to 30 minutes prior to sun exposure, and reapply it after two hours to reduce exposure to ultraviolet (UV) radiation in sunlight for the prevention of skin cancer. Objective This study investigated the extent to which adults comply with sunscreen advice. Methods A survey was conducted with 4,837 adult skiers and snowboarders at 28 high-altitude ski areas in Western North America in January – April 2001-02. Respondents self reported use of sunscreen, its SPF, time of first application, and reapplication. Results Only 4.4% (95% CI=±0.6) of adults were in full compliance with all sunscreen advice. Half (49.8% [95% CI=±1.4]) complied with SPF 15+ advice. Of those wearing sunscreen, 73.2% (95% CI=±1.8) applied the sunscreen 30 minutes before beginning skiing/snowboarding, but only 20.4% (95% CI=±2.0) complied with advice to reapply it after 2 hours. Total compliance was lowest during inclement weather, on low-UV days, by males, and among respondents who believed skin cancer was unimportant and with low sun sensitive skin. It was positively associated with wearing lip balm and hats with a brim. Limitations The sample was predominantly male and of high socio-economic status; the results apply most to winter recreation when UV radiation levels are low, and sunscreen use was assessed by self-report. Conclusion While the recommendation to use SPF 15+ sunscreen has reached many adults, the reapplication advice is heeded by few adults and needs to be highlighted in future sun safety promotions.

Prevalence of Sun Protection at Outdoor Recreation and Leisure Venues at Resorts in North America

“…23,25–27 Same-day self-reported sun protection has been validated by observation 31 and observations of sun protection have had adequate reproducibility in previous studies. 31,32 Vacationers were asked if they were wearing sunscreen with SPF 15 or higher and if so, what time they first applied it and if they had reapplied it.…”

“…In each case the team was headed by the Principal Investigator or a Co-principal Investigator that had each conducted thousands of such observations over the past 20 years in outdoor recreation environments. 25–27 Other team members were trained in real and simulated field collections before collecting data for this study and began the study by observing the investigators.…”

Time to Get Serious About Skin Cancer Prevention

“…Studies that assessed how well these sunscreen directions are followed indicate low compliance (Table 1; ref. 23,30). Finally, it is important to note that SPF only describes level of protection from UVB, (99).…”

Taking a Stand: Health Educators should Promote Skin Health among Athlets

“…Winter sport athletes may also face an increased risk for skin cancer. Buller et al [3] surveyed adult skiers and snowboarders (N=4,837) to determine that only 4.4% of participants reported full compliance with sunscreen recommendations provided by the American Cancer Society. Although 73.2% of athletes who reported using sunscreen applied it 30 minutes prior to sun exposure, only 20.4% of athletes effectively reapplied sunscreen as recommended [4].…”