Development of a Survey of Sunscreen Use and Attitudes among Adults in Two Coastal States, 2019
Abstract
:1. Introduction
2. Materials and Methods
3. Results
3.1. Sample
3.1.1. Internal Consistency of New Scales and Test–Retest Reliability
3.1.2. Behaviors, Beliefs and Knowledge
4. Discussion
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
- Guy, G.P., Jr.; Thomas, C.C.; Thompson, T.; Watson, M.; Massetti, G.M.; Richardson, L.C. Vital signs: Melanoma incidence and mortality trends and projections—United States, 1982–2030. MMWR Morb. Mortal. Wkly. Rep. 2015, 64, 591–596. [Google Scholar] [PubMed]
- Green, A.C.; Williams, G.M.; Logan, V.; Strutton, G.M. Reduced melanoma after regular sunscreen use: Randomized trial follow-up. J. Clin. Oncol. 2011, 29, 257–263. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- National Cancer Institute. Cancer Trends Progress Report, Online Summary of Trends in US Cancer Control Measures. Available online: https://www.progressreport.cancer.gov/prevention/sun_protection (accessed on 13 March 2019).
- Holman, D.M.; Berkowitz, Z.; Guy, G.P., Jr.; Hawkins, N.A.; Saraiya, M.; Watson, M. Patterns of sunscreen use on the face and other exposed skin among US adults. J. Am. Acad. Dermatol. 2015, 73, 83–92.e1. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Olsen, C.M.; Wilson, L.F.; Green, A.C.; Biswas, N.; Loyalka, J.; Whiteman, D.C. How many melanomas might be prevented if more people applied sunscreen regularly? Br. J. Dermatol. 2018, 178, 140–147. [Google Scholar] [CrossRef] [PubMed]
- State of Hawaii, Twenty-Ninth Legislature, S.B. No. 2571. A Bill for an Act Relating to Water Pollution. 2018. Available online: https://www.capitol.hawaii.gov/Archives/measure_indiv_Archives.aspx?billtype=SB&billnumber=2571&year=2018 (accessed on 12 November 2021).
- Downs, C.A.; Kramarsky-Winter, E.; Fauth, J.E.; Segal, R.; Bronstein, O.; Jeger, R.; Lichtenfeld, Y.; Woodley, C.M.; Pennington, P.; Kushmaro, A.; et al. Toxicological effects of the sunscreen UV filter, benzophenone-2, on planulae and in vitro cells of the coral, Stylophora pistillata. Ecotoxicology 2014, 23, 175–191. [Google Scholar] [CrossRef] [PubMed]
- Downs, C.A.; Kramarsky-Winter, E.; Segal, R.; Fauth, J.; Knutson, S.; Bronstein, O.; Ciner, F.R.; Jeger, R.; Lichtenfeld, Y.; Woodley, C.M.; et al. Toxicopathological Effects of the Sunscreen UV Filter, Oxybenzone (Benzophenone-3), on Coral Planulae and Cultured Primary Cells and Its Environmental Contamination in Hawaii and the U.S. Virgin Islands. Arch. Environ. Contam. Toxicol. 2016, 70, 265–288. [Google Scholar] [CrossRef] [PubMed]
- Mitchelmore, C.L.; Burns, E.E.; Conway, A.; Heyes, A.; Davies, I.A. A Critical Review of Organic Ultraviolet Filter Exposure, Hazard, and Risk to Corals. Environ. Toxicol. Chem. 2021, 40, 967–988. [Google Scholar] [CrossRef] [PubMed]
- U.S. Food and Drug Administration (FDA). Proposed Order (OTC000008): Amending Over-the-Counter (OTC) Monograph M020: Sunscreen Drug Products for OTC Human Use. 2021. Available online: https://www.fda.gov/drugs/news-events-human-drugs/otc-monograph-reform-otc-sunscreen-drugs-12152021-12152021 (accessed on 24 November 2021).
- Xu, S.; Kwa, M.; Agarwal, A.; Rademaker, A.; Kundu, R.V. Sunscreen Product Performance and Other Determinants of Consumer Preferences. JAMA Dermatol. 2016, 152, 920–927. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Prado, G.; Ederle, A.E.; Shahriari, S.R.K.; Svoboda, R.M.; Farberg, A.S.; Rigel, D.S. Online sunscreen purchases: Impact of product characteristics and marketing claims. Photodermatol. Photoimmunol. Photomed. 2019, 35, 339–343. [Google Scholar] [CrossRef] [PubMed]
- Sushma, M. US Virgin Islands Bans Sunscreens Harming Coral Reefs. Down to Earth. 2020. Available online: https://www.downtoearth.org.in/news/wildlife-biodiversity/us-virgin-islands-bans-sunscreens-harming-coral-reefs-70158 (accessed on 24 November 2021).
- Carreon, B. Palau Bans ‘Reef Toxic’ Sunscreen. Science X. 2020. Available online: https://phys.org/news/2020-01-palau-reef-toxic-sunscreen.html (accessed on 24 November 2021).
- Thailand Bans Coral-Damaging Sunscreens. Science X. 2021. Available online: https://phys.org/news/2021-08-thailand-coral-damaging-sunscreens.html (accessed on 24 November 2021).
- Glanz, K.; Yaroch, A.L.; Dancel, M.; Saraiya, M.; Crane, L.A.; Buller, D.B.; Manne, S.; O’Riordan, D.L.; Heckman, C.J.; Hay, J.; et al. Measures of sun exposure and sun protection practices for behavioral and epidemiologic research. Arch. Dermatol. 2008, 144, 217–222. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Glanz, K.; McCarty, F.; Nehl, E.J.; O’Riordan, D.L.; Gies, P.; Bundy, L.; Locke, A.E.; Hall, D.M. Validity of self-reported sunscreen use by parents, children, and lifeguards. Am. J. Prev. Med. 2009, 36, 63–69. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Levine, A. Sunscreen use and awareness of chemical toxicity among beach goers in Hawaii prior to a ban on the sale of sunscreens containing ingredients found to be toxic to coral reef ecosystems. Mar. Policy 2020, 117, 103875. [Google Scholar] [CrossRef]
- Nunnally, J.C. Introduction to Psychological Measurement; McGraw Hill: New York, NY, USA, 1970. [Google Scholar]
- Tavakol, M.; Dennick, R. Making sense of Cronbach’s alpha. Int. J. Med. Educ. 2011, 2, 53–55. [Google Scholar] [CrossRef] [PubMed]
- Landis, J.R.; Koch, G.G. The measurement of observer agreement for categorical data. Biometrics 1977, 33, 159–174. [Google Scholar] [CrossRef] [Green Version]
- Statistical Analysis Software V 9.4. SAS Institute: Cary, NC, USA. Available online: www.sas.com (accessed on 15 September 2021).
- Glanz, K.; Schoenfeld, E.R.; Steffen, A. A randomized trial of tailored skin cancer prevention messages for adults: Project SCAPE. Am. J. Public Health 2010, 100, 735–741. [Google Scholar] [CrossRef] [PubMed]
- Glanz, K.; Lew, R.A.; Song, V.; Cook, V.A. Factors Associated with Skin Cancer Prevention Practices in a Multiethnic Population. Health Educ. Behav. 1999, 26, 344–359. [Google Scholar] [CrossRef]
- Hughes, T. There’s Insufficient Evidence Your Sunscreen Harms Coral Reefs. The Conversation. 2019. Available online: https://theconversation.com/theres-insufficient-evidence-your-sunscreen-harms-coral-reefs-109567 (accessed on 22 August 2019).
- Schneider, S.L.; Lim, H.W. Review of environmental effects of oxybenzone and other sunscreen active ingredients. J. Am. Acad. Dermatol. 2019, 80, 266–271. [Google Scholar] [CrossRef]
Characteristic | Total |
---|---|
(n = 162) | |
Sun-Protection Behavior and Sunburn (Mean + Standard Deviation) | |
% One or more sunburn in the last year | 58.0% (94) |
Sun-Protection Habits Index (M ± SD; range 1–5) | 3.4 (0.6) |
Use Sunscreen (M ± SD; range 1–5) | 3.5 (1.2) |
Seek Shade (M ± SD; range 1–5) | 3.2 (0.9) |
Wear Sunglasses (M ± SD; range 1–5) | 4.0 (1.2) |
Wear a Shirt With Sleeves (M ± SD; range 1–5) | 3.1 (1.1) |
Wear a Hat (M ± SD; range 1–5) | 3.0 (1.3) |
Limit Midday Hours in the Sun (M ± SD; range 1–5) | 3.7 (1.0) |
Sunscreen application score (M ± SD; range 1–9) | 5.4 (2.3) |
Knowledge and Beliefs | |
Sunscreen Knowledge Score (M ± SD; range 0–7) | 5.7(1.3) |
General Sunscreen Beliefs Score (M ± SD; range 1–5) (positive direction) | 2.8 (0.8) |
Negative Sunscreen Beliefs Score (M ± SD; range 1–5) (negative direction) | 2.8 (0.8) |
Sunscreen Choice and Purchasing (n = 156; 6 do not purchase) | |
Most important features when purchasing sunscreen (% very important/critical) | |
Broad Spectrum | 66.3% |
SPF 15+ | 63.0% |
SPF 50+ | 51.9% |
Ingredients | 43.3% |
Usual sunscreen type | |
Chemical (e.g., oxybenzone and octinoxate) | 20.3% (60.1% not sure) |
Mineral (e.g., zinc oxide and titanium dioxide) | 24.8% (47.8% not sure) |
Variable | Total |
---|---|
(n = 162) | |
Heard about the 2018 law passed in Hawaii: | |
Yes | 34.0% |
No | 58.6% |
Not sure | 7.4% |
Believe it is against the new law for stores to sell sunscreen containing oxybenzone or octinoxate in Hawaii (true) | |
Correct | 42.0% |
Incorrect | 1.9% |
Don’t Know | 56.2% |
Believe it is against the law for consumers in Hawaii to purchase sunscreen containing oxybenzone or octinoxate on the internet (false) | |
Correct | 9.3% |
Incorrect | 19.1% |
Don’t Know | 71.6% |
Believe visitors to Hawaii can bring sunscreen containing oxybenzone or octinoxate with them (true) | |
Correct | 17.3% |
Incorrect | 12.4% |
Don’t Know | 70.4% |
Total number correct (of the three items above) | |
Zero | 54.3% |
1 | 27.8% |
2 | 13.0% |
3 | 4.9% |
Variable | Odds Ratio (95% CI) | p-Value |
---|---|---|
Age (by year) | 1.03 (1.01, 1.06) | 0.005 |
Gender, (male vs. female) | 0.34 (0.13, 0.93) | 0.035 |
Race (Others vs. Caucasian/White) | 1.31 (0.43, 4.01) | 0.635 |
Residential State (Florida vs. California) | 0.95 (0.45, 2.04) | 0.903 |
Education (non-college graduated vs. college graduated) | 0.91 (0.38, 2.14) | 0.824 |
Sunscreen knowledge score (from 0 to 7) | 1.51 (1.06, 2.16) | 0.024 |
Skin cancer knowledge score (from 0 to 6) | 0.94 (0.64, 1.38) | 0.748 |
Negative sunscreen beliefs score (somewhat agree vs. somewhat disagree) | 1.01 (0.32, 3.18) | 0.983 |
General sunscreen beliefs score (somewhat agree vs. somewhat disagree) | 4.03 (0.52, 31.35) | 0.182 |
Sunscreen apply count (from 1 to 9) | 1.08 (0.91, 1.27) | 0.370 |
Variable | Odds Ratio (95% CI) | p-Value |
---|---|---|
Age (by year) | 0.94 (0.91, 0.96) | <0.0001 |
Gender, (male vs. female) | 1.40 (0.44, 4.49) | 0.569 |
Race (Others vs. Caucasian/White) | 0.22 (0.06, 0.76) | 0.017 |
Residential State (Florida vs. California) | 0.75 (0.33, 1.74) | 0.508 |
Education (non-college graduated vs. college graduated) | 1.56 (0.61, 4.00) | 0.354 |
Sunscreen knowledge score (from 0 to 7) | 1.07 (0.73, 1.55) | 0.735 |
Skin cancer knowledge score (from 0 to 6) | 0.76 (0.5, 1.15) | 0.189 |
Negative sunscreen beliefs score (somewhat agree vs. somewhat disagree) | 2.14 (0.53, 8.59) | 0.283 |
General sunscreen beliefs score (somewhat agree vs. somewhat disagree) | 0.19 (0.03, 1.32) | 0.092 |
Sun-protection behavior score (usually vs. sometimes) | 0.33 (0.13, 0.82) | 0.017 |
Sunscreen apply count (from 1 to 9) | 1.13 (0.94, 1.34) | 0.190 |
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Glanz, K.; Kwong, P.L.; Avelis, J.; Cassel, K. Development of a Survey of Sunscreen Use and Attitudes among Adults in Two Coastal States, 2019. Int. J. Environ. Res. Public Health 2022, 19, 2677. https://doi.org/10.3390/ijerph19052677
Glanz K, Kwong PL, Avelis J, Cassel K. Development of a Survey of Sunscreen Use and Attitudes among Adults in Two Coastal States, 2019. International Journal of Environmental Research and Public Health. 2022; 19(5):2677. https://doi.org/10.3390/ijerph19052677
Chicago/Turabian StyleGlanz, Karen, Pui L. Kwong, Jade Avelis, and Kevin Cassel. 2022. "Development of a Survey of Sunscreen Use and Attitudes among Adults in Two Coastal States, 2019" International Journal of Environmental Research and Public Health 19, no. 5: 2677. https://doi.org/10.3390/ijerph19052677
APA StyleGlanz, K., Kwong, P. L., Avelis, J., & Cassel, K. (2022). Development of a Survey of Sunscreen Use and Attitudes among Adults in Two Coastal States, 2019. International Journal of Environmental Research and Public Health, 19(5), 2677. https://doi.org/10.3390/ijerph19052677