Predictors of sunscreen use in United States high‐school students

Dear Editor, Skin cancer is the most common malignancy experienced worldwide with the incidence of melanoma increasing yearly.1 Although rates of skin cancer are higher among Caucasians, skin cancer in people of colour is often found at later stages and is associated with higher mortality.2 Therefore, prevention through education and behaviour modification is of the utmost importance, with the American Academy of Dermatology recommending the use of daily sunscreen to all individuals. Sunscreen helps protect the skin from the harmful effects of ultraviolet (UV) radiation using UV absorbers. Without this protection, UV damage can induce epidermal and dermal DNA mutations, leading to skin cancer development.1 Sunscreen has been shown to reduce of the risk of both melanoma and non-melanoma skin cancers.3 Therefore, prevention campaigns are essential to educating the public on the importance of sunscreen use. Programs such as Sun Protection Outreach Teaching by Students (SPOTS), which teaches school children about the importance of sun protection, are crucial given that an estimated 40%–50% of UV damage is obtained by the age of twenty.4, 5 The goal of this review is to summarise predictors of sunscreen use among high-school adolescents in the United States (U.S.). The Preferred Reporting Items for Systematic Reviews and Meta-Analysis were used to conduct this review. A comprehensive literature search was done using PubMed, Embase, and Web of Science in November of 2021 using the terms ('sunscreen' or 'spf' or 'sun protection') and ('high school' or 'teen' or 'teenager' or 'adolescent'). Non-English articles and those without full-text were excluded. Articles were included if they met the following criteria: (1) provided quantitative data on predictors of sunscreen use (2) adolescent population (3) conducted in the U.S. The data was collected by three researchers (C.S., M.G., and K.H.). Initial screening of articles was done using title and abstracts. The final screen was done using full-text to determine which articles met all inclusion criteria. Any discrepancies were settled by an outside researcher (S.C.). The quantitative data collected was on predictors of sunscreen use in U.S. high-school students. The initial database search returned 468 articles. Title and abstract screening yielded 108 relevant articles which underwent full-text review. Twenty studies were included for qualitative review (Table 1). Studies examining gender showed increased sunscreen use in females compared to males (n = 11). Increased sunscreen usage was found in younger adolescents compared to older adolescents (n = 4). Caucasian students were more likely to use sunscreen compared to other ethnicities (n = 4). Studies also showed increased sunscreen use in populations that believed that were more susceptible to sun damage (n = 4). Higher rates of sunscreen use were correlated with higher levels of perceived self-efficacy, as well as social and familial use of sunscreen (n = 2, n = 4). UVR is the number one preventable risk factor for skin cancer. However, daily sunscreen use is not routinely followed by most individuals. Overall, sunscreen use in adolescents was relatively low, with males, non-Caucasians, and older adolescents at the greatest risk for not using sunscreen. Males utilised lower levels of sun protection, and they were found to have lower levels of skin cancer knowledge, lower perceptions of being susceptible to skin cancer, and were more likely to view sunscreen as a beauty product rather than a health product.6 Non-Caucasian adolescents and those with less sensitive skin are less likely to believe that spending time in the sun would increase the chances of developing skin cancer, with studies reporting associated risk factors of societal messaging, misinformation, or other social-cultural norms.7, 8 Studies analysed demonstrated that older adolescents utilised sunscreen less than younger students, with one study showing a 5% decrease every 1-year increase in age.9 Additionally, adolescent males experience significantly more sun exposure during summer months compared to females.10 Skin cancer prevention campaigns can target specific populations in order to generate the most significant impact on changing sunscreen habits. For example, following the SPOTS programme education, one-third of adolescent participants reported having attempted to increase sunscreen use in a 1-month post-programme survey.4 With the continued expansion of virtual teaching platforms, more communities are accessible by skin cancer prevention campaigns. Overall, this review shows the need for enhanced sun protection education that can better reach males, non-Caucasian students, and older adolescents. Not applicable. The authors declare no conflicts of interest. Carly R. Stevens: Conceptualization (lead); investigation (lead); writing—original draft (lead). Maxwell Green: Conceptualization (supporting); investigation (supporting); methodology (lead); writing—original draft (supporting); writing—review and editing (equal). Kimberly Hinh: Conceptualization (supporting); investigation (supporting); writing—review and editing (supporting). Sofia Chaudhry: Project administration (equal); supervision (lead); writing—review and editing (supporting). This article received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors. Not applicable. Data sharing not applicable to this article as no datasets were generated or analysed during the current study.