0
We're unable to sign you in at this time. Please try again in a few minutes.
Retry
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
Retry
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
Research Letter |

Rates of Sunburn Among Dermatology Patients FREE

Kimberly A. Mallett, PhD1; Sarah Ackerman, MS1; Rob Turrisi, PhD1; June K. Robinson, MD2,3
[+] Author Affiliations
1Prevention Research Center, Department of Biobehavioral Health, Pennsylvania State University, University Park
2Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
3editor, JAMA Dermatology
JAMA Dermatol. 2015;151(2):231-232. doi:10.1001/jamadermatol.2014.3092.
Text Size: A A A
Published online

The association between excessive UV light (UVL) exposure and skin cancer is well documented.1 Therefore, it is essential that individuals with a history of skin cancer or other risk factors are able to successfully implement precautions to protect their skin. While studies show that many dermatology patients, particularly those who have a history of skin cancer, are motivated to engage in UVL protective behaviors,2 it is unclear how successful they are in avoiding excessive UVL exposure (ie, frequency of sunburns). Patients who are motivated to use sun protection may encounter a range of barriers preventing the successful use of sunscreen that result in unintended sunburns (eg, they forget to reapply it). Other patients do not use sun protection despite awareness of the risks associated with unprotected UVL exposure.2 A recent study3 found that dermatologists assessed patients’ sunscreen use in 30% of office visits involving a skin examination; however, they did not assess frequency of sunburns. Identifying patients who vary in their ability to successfully protect their skin and avoid sunburns is an important step in reducing overall risk by allowing physicians to provide behavioral intervention.

The present study had 3 aims: (1) to identify whether dermatology patients report lower rates of high-risk UVL exposure compared with the general population, (2) to examine the frequency of sunburns reported by dermatology patients over the course of a year in relation to the general population to determine the need for additional sun protection counseling, and (3) to examine the relationship between a history of skin cancer and frequency of sunburns to assess if higher-risk patients use UVL protection more proficiently.

Sixty participants (75% were female) were recruited from 2 research sites: Penn State Hershey Medical Center (PSHMC) and Northwestern University Faculty Foundation (NMFF) as part of a larger study,4 and the institutional review board at each site approved the research protocol. Data were collected during a routine office visit that included a skin examination. Participants were adult individuals who did not meet study exclusion criteria, which consisted of (1) history of psoriasis, and/or (2) demonstrated communication barriers (eg, mental disability). Participants at each site completed identical 5-minute surveys that assessed history of skin cancer and number of times sunburned in the past year as part of a larger survey.

Participants who had an appointment that included a skin examination were recruited and provided consent on the day of their office visit. All patient surveys were anonymous, and participants were informed their physicians would not have access to the data in order to minimize demand characteristics. Participants provided written consent at both sites. Participants at PSHMC received a $20 gift card in return for their participation; those at NMFF did not receive compensation.

A 97% response rate was consistently observed across sites. Nearly 50% of participants experienced at least 1 sunburn during the past year. These rates were markedly higher compared with those observed in a population study5 that found 32% of adults 18 years or older had experienced at least 1 sunburn in the past year. Approximately 27% of patients reported 2 or more sunburns (Table). In addition, 33% of participants reported a history of skin cancer. No significant differences were observed in reported sunburn rates between individuals with a history of skin cancer and those without (t = −1.17; P = .25).

Table Graphic Jump LocationTable.  Number of Patient-Reported Sunburns in Past Year

Findings suggest a significant portion of dermatology patients continue to receive risky amounts of UV exposure that are higher than amounts received in the general population5 and need to enhance their UV protection. Furthermore, individuals seeking dermatological care with or without a history of skin cancer are not more proficient at protecting their skin from the sun compared with lower-risk individuals. The underlying reason for patients’ lack of successful UV protection (eg, they were unwilling, did not use properly) was not evaluated and should be examined in future studies.

Dermatologists have the unique opportunity to identify patients who continue to report sunburns and provide helpful tips to reduce their future UV exposure. Mallett et al3 developed the ABC (Addressing Behavior Change) intervention for use by dermatologists during a skin examination. The brief intervention assesses UVL exposure as well as sunscreen use. It also provides a platform for dermatologists to explore patients’ barriers to using sunscreen and ways to resolve those barriers, as well as provide additional tips for successful sun protection. Studies4 have shown that both patients and dermatologists responded positively toward the intervention, and dermatologists successfully delivered the intervention to a variety of patients across a sustained period of time. Future studies will examine the efficacy of the ABC intervention on reducing the number of sunburns experienced by patients.

Corresponding Author: Kimberly A. Mallett, PhD, Prevention Research Center, Department of Biobehavioral Health, Pennsylvania State University, 320 Biobehavioral Health Building, University Park, PA 16802 (kmallett@psu.edu).

Published Online: October 29, 2014. doi:10.1001/jamadermatol.2014.3092.

Accepted for Publication: August 14, 2014.

Author Contributions: Drs Mallett and Turrisi had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

Study concept and design: Mallett, Turrisi.

Acquisition, analysis, or interpretation of data: All authors.

Drafting of the manuscript: Mallett, Ackerman.

Critical revision of the manuscript for important intellectual content: Mallett, Turrisi, Robinson.

Statistical analysis: Mallett, Ackerman.

Obtained funding: Mallett.

Administrative, technical, or material support: Ackerman.

Study supervision: Mallett.

Conflict of Interest Disclosures: None reported.

Funding/Support: This study was supported in part by National Cancer Institute grant R03 CA144435 to Dr Mallett.

Role of the Sponsor: The National Cancer Institute had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

Disclaimer: Dr Robinson was not involved in the editorial review of or decision to publish this Research Letter.

Whiteman  D, Green  A.  Melanoma and sunburn. Cancer Causes Control. 1994;5(6):564-572.
PubMed   |  Link to Article
Soto  E, Lee  H, Saladi  RN,  et al.  Behavioral factors of patients before and after diagnosis with melanoma: a cohort study: are sun-protection measures being implemented? Melanoma Res. 2010;20(2):147-152.
PubMed   |  Link to Article
Mallett  KA, Turrisi  R, Guttman  K, Read  A, Billingsley  E, Robinson  J.  Assessing dermatologists’ ability to deliver a novel intervention to improve patients’ use of sun protection: the ABC method of physician-patient communication. Arch Dermatol. 2011;147(12):1451-1453.
PubMed   |  Link to Article
Mallett  KA, Turrisi  R, Billingsley  E,  et al.  Enhancing patients’ satisfaction and sun-protective behaviors using the ABC method of physician-patient communication. Arch Dermatol. 2012;148(9):1087-1089.
PubMed   |  Link to Article
Saraiya  M, Hall  HI, Uhler  RJ.  Sunburn prevalence among adults in the United States, 1999. Am J Prev Med. 2002;23(2):91-97.
PubMed   |  Link to Article

Figures

Tables

Table Graphic Jump LocationTable.  Number of Patient-Reported Sunburns in Past Year

References

Whiteman  D, Green  A.  Melanoma and sunburn. Cancer Causes Control. 1994;5(6):564-572.
PubMed   |  Link to Article
Soto  E, Lee  H, Saladi  RN,  et al.  Behavioral factors of patients before and after diagnosis with melanoma: a cohort study: are sun-protection measures being implemented? Melanoma Res. 2010;20(2):147-152.
PubMed   |  Link to Article
Mallett  KA, Turrisi  R, Guttman  K, Read  A, Billingsley  E, Robinson  J.  Assessing dermatologists’ ability to deliver a novel intervention to improve patients’ use of sun protection: the ABC method of physician-patient communication. Arch Dermatol. 2011;147(12):1451-1453.
PubMed   |  Link to Article
Mallett  KA, Turrisi  R, Billingsley  E,  et al.  Enhancing patients’ satisfaction and sun-protective behaviors using the ABC method of physician-patient communication. Arch Dermatol. 2012;148(9):1087-1089.
PubMed   |  Link to Article
Saraiya  M, Hall  HI, Uhler  RJ.  Sunburn prevalence among adults in the United States, 1999. Am J Prev Med. 2002;23(2):91-97.
PubMed   |  Link to Article

Correspondence

CME
Also Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
Please click the checkbox indicating that you have read the full article in order to submit your answers.
Your answers have been saved for later.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.

Multimedia

Some tools below are only available to our subscribers or users with an online account.

677 Views
1 Citations
×

Related Content

Customize your page view by dragging & repositioning the boxes below.

Articles Related By Topic
Related Collections
PubMed Articles
Jobs