Use Patterns of Leave-on Personal Care Products among Swiss-German Children, Adolescents, and Adults

In order to model exposure to ingredients contained in personal care products (PCPs) and assess their potential risks to human health, access to reliable PCP use data, including co-use patterns, is essential. A postal questionnaire survey was conducted to determine the use patterns of eight leave-on PCP categories among the German-speaking population of Switzerland (N = 1,196; ages 0–97 years), providing for the first time in Europe PCP use data for children <12 years of age. The majority of respondents (99%) reported having used at least one of the investigated PCP categories in the past year. Co-use of two or more PCP categories at the same time was common and more complex amongst adults. Regular use of face cream and body lotion was very high in the youngest group of children aged 0–4 years (more than 79% respondents) who may be more vulnerable to certain adverse effects of some PCP ingredients. A comparison with previously collected information on PCP use patterns in Germany and the Netherlands indicates differences in PCP use patterns among European consumers and suggests that surrogate PCP use data from other countries must be used with caution. This work extends the existing knowledge of PCP use patterns and will be useful for new exposure assessments for ingredients contained in PCPs used by the young consumers.


Filling out the Questionnaire for Children and Adolescents
The questionnaire should be filled out by the person, who knows best, how often your child used sunscreen in the past year. Adolescents between 14 and 17 years of age are allowed to fill out the questionnaire themselves.
Please indicate who is filling out the questionnaire.
Mother Father Adolescent aged between 14 and 17 years of age Other: Use of sunscreen 1. Have you used sunscreen on your child at least once during the past year (for adolescents: on yourself)?
Yes (please proceed to question 2) No (please proceed to question 4)

Frequency of Sunscreen Application
2. In this question we want to find out how often you used sunscreen on your child (for adolescents: on yourself) in the past year.
Please indicate on how many days (2.1.) and how frequently (2.2.) you applied sunscreen to the grey highlighted body areas:

Name and Sun Protection Factor of the Sunscreens Used
3. Please indicate as specifically and in as much detail as possible the name and the brand (e.g., Nivea Sun Spray; Daylong ultra, Sun Lotion etc.) and the sun protection factor (10, 15 etc.) of the sunscreen used most frequently on your child (for adolescents: on yourself) during the past summer-and autumn-months.

In summer and autumn (May to October)
Name and brand of the sunscreen Sun protection factor Please indicate as specifically and in as much detail as possible the name and the brand (e.g., Nivea Sun Spray; Daylong ultra, Sun Lotion etc.) and the sun protection factor (10, 15 etc.) of the sunscreen used most frequently on your child (for adolescents: on yourself) during the past winter-and springmonths.
3.2. In winter and spring (November to April) Name and brand of the sunscreen Sun protection factor 3.3. In general, are you using a special sun protection for the lips (e.g., stick or balm) for your child (for adolescents: for yourself)?
Yes 5. Please indicate for each product category as specifically and in as much detail as possible the name and the brand of the most used product. Please specify for each product, whether you have used it more or less often than every second time.
Used more than every second time.
Used less than every second time. Thank you very much for taking the time to fill out the survey!

Survey on the Use of Sunscreen in Adults
Please help us with the within-household random selection of the target respondent. This questionnaire is addressed to the household member whose birthday is next and who is 18 years of age or older.
Thank you very much for taking the time to fill out the survey! Please keep the following in mind:  Your responses will be kept completely confidential and anonymous and will be stored by the ETH Zürich (Consumer Behavior group).  The statistical evaluation will not allow any inference about individuals. We are interested in the attitudes and habits of the Swiss population.  Responses will be used for scientific non-commercial research and teaching.  You might have the impression that some questions are similar. This has been done on purpose to increase the accuracy of your answers. Please do not skip any questions.  Completing the survey will take around 30 min.
Your questionnaire will be read by an electronic scanning device. Therefore it is very important that you adhere to the following guidelines:  Please use a black/blue pen (no pencil).  Please make the cross to fit the size of the box provided.  Please do not skip any questions and check only one box per question (unless otherwise indicated).  If you make a mistake, please make a circle around the box and re-enter the correct information.

Name and Sun Protection Factor of the Sunscreens Used
3. Please indicate as specifically and in as much detail as possible the name and the brand (e.g., Nivea Sun Spray; Daylong ultra, Sun Lotion etc.) and the sun protection factor (10, 15 etc.) of the sunscreen you used most frequently during the past summer-and autumn-months.

In summer and autumn (May to October)
Name and brand of the sunscreen Sun protection factor Please indicate as specifically and in as much detail as possible the name and the brand (e.g., Nivea Sun Spray; Daylong ultra, Sun Lotion etc.) and the sun protection factor (10, 15 etc.) of the sunscreen you used most frequently during the past winter-and spring-months.
3.2. In winter and spring (November to April) Name and brand of the sunscreen Sun protection factor 3.3. In general, are you using a special sun protection for the lips (e.g., stick or balm)? Yes

5.
Please indicate for each product category as specifically and in as much detail as possible the name and the brand of the most used product. Please specify for each product, whether you have used it more or less often than every second time.
Used more than every second time.
Used less than every second time. Your Skin Type 6. Please indicate which of the following descriptions correspond best to your skin type. Skin type 1 is the most sensitive, skin type 6 is the least sensitive. Please check the box of only ONE skin type.

Celtic type (Skin type 1):
Red or ginger-blond hair, very fair skin (possibly with freckles), burns immediately, never tans.

Scandinavian type (Skin type 2):
Blond or light brown hair, fair skin, burns easily, the skin tans slowly and with difficulties to brown.

Mixed type (Skin type 3):
Dark blond or brown hair, light brown skin, burns moderately, tans slowly to brown.

Mediterranean type (Skin type 4):
Dark brown hair, dark skin, burns rarely, the skin tans fast to moderately brown

Dark brown and black types (Skin types 5 and 6):
Black hair, very dark skin, almost never burns, the skin tans fast to dark brown. Thank you very much for taking the time to fill out the survey!

Section S2. Study Population: Restriction Criteria
From the population sample of children and adolescents (N = 464) we excluded 18 respondents with missing age details and 11 respondents older than 17 years to ensure that all respondents belonged to our intended target population aged 0-17 years. A total of 6 respondents was excluded because they did not report their gender. Cases with missing or biologically unrealistic data on body height and weight were also deleted (N = 20). A total of 7 respondents did not indicate who filled out the questionnaire and 3 respondents were identified as not eligible to complete the questionnaire (e.g., children under 14 years of age who answered the questionnaire themselves) and hence their answers deleted. Finally, 2 respondents were deleted due to unrealistic data in sunscreen usage in one season. The number of days by season was: summer/autumn (May to October-184 days); winter/spring (November to April-181 days, with February having 28 days). Thus, the final study cohort of children and adolescents included 397 respondents. Similarly, from the population sample of adults (N = 864), we excluded 19 respondents with missing age and gender details, respectively. Cases with missing or biologically unrealistic data on body height and weight were also deleted (N = 11). We also excluded 5 respondents who returned empty/very incomplete questionnaires and 2 duplicate respondents. Further, 1 respondent was excluded as he/she indicated no sunscreen use in the past year but still answered questions on sunscreen use. Finally, 27 cases were deleted due to unrealistic data in sunscreen usage in one season (same criteria applied as discussed above for children). The remaining cohort of adults included 799 respondents. Table S1. Mean and percentile body weights (kg) for females.         Table S10. Prevalence and frequency of makeup foundation use in females and males by age group.