Patterns of sunscreen use on the face and other exposed skin among US adults

In the paper

“given previous findings that adults who are more physically active are more likely to experience sunburn.21”

What the sources say

• Supported

  The Results section reports a positive association between physical activity and adjusted sunburn prevalence (P < 0.001). Adults meeting both strength and aerobic activity guidelines had the highest reported prevalence (41.7%). (LLM, conf=0.94)

  cites [21] Holman, 2014, The association between demographic and behavioral characteristics and sunburn among U.S. adults - National Health Interview Survey, 2010, Prev Med source

In the paper

“The association between BMI and sunscreen use was consistent with other studies that have indicated higher BMI is positively associated with skin cancer risk behaviors27–28 and sunburn.21”

What the sources say

• Supported

  The Results report that BMI was significantly inversely associated with sunscreen use in both genders, supporting the cited association between higher BMI and a skin cancer risk behavior. The sentence cites a different source for sunburn, so that part is not attributed to this paper. (LLM, conf=0.88)

  cites [27] Wheless, 2009, The association between skin characteristics and skin cancer prevention behaviors, Cancer Epidemiol Biomarkers Prev source
• Supported

  The Age-Stratified Correlates section reports more skin cancer risk behaviors among overweight or obese individuals in several age groups, supporting the BMI association attributed to this source. The citing sentence attaches a separate citation (21) to the sunburn claim, so that claim is not assessed against this paper. (LLM, conf=0.91)

  cites [28] Coups, 2008, Multiple skin cancer risk behaviors in the U.S. population, Am J Prev Med source
• Supported

  Citation 21 is attached to the sunburn association, not the claim about other skin cancer risk behaviors. The Results (page not provided) report that adjusted sunburn prevalence was positively associated with being overweight or obese among U.S. adults. (LLM, conf=0.93)

  cites [21] Holman, 2014, The association between demographic and behavioral characteristics and sunburn among U.S. adults - National Health Interview Survey, 2010, Prev Med source

In the paper

“For example, consistent with previous findings, this study suggests that sunscreen use is low among non-Hispanic blacks and those who tend not to sunburn.1, 2, 4”

What the sources say

• Supported

  The “Sunburn and sun protection among racial minority groups” section reports sunscreen use of 9.1% among blacks and says sun protection was highest among people with the most sun-sensitive skin, including those more prone to sunburn. The “Sun protection” section also reports lower routine sunscreen use among blacks than among non-Hispanic whites. These findings support the cited sentence’s characterization of low use in both groups. (LLM, conf=0.90)

  cites [1] Buller, 2011, Prevalence of sunburn, sun protection, and indoor tanning behaviors among Americans: review from national surveys and case studies of 3 states, J Am Acad Dermatol source
• Not checked yetcites [2] Centers for Disease Control and Prevention, 2012, Sunburn and sun protective behaviors among adults aged 18-29 years–United States, 2000-2010, MMWR
• Not checked yetcites [4] National Cancer Institute. Cancer trends progress report – 2011/2012 update. Available from: URL: http://progressreport.cancer.gov/. Accessed September 2, 2014.

In the paper

“Those who met aerobic activity guidelines were significantly more likely to regularly use sunscreen than those who did not (all P values < 0.05), with the exception of male sunscreen use on other exposed skin (P = 0.056).”

In the paper

“whereas 19.9% (95% CI: 17.5–22.6) of men and 34.4% (95% CI: 31.5–37.5) of women regularly used sunscreen on other exposed skin”

In the paper

“and those who were overweight or obese were less likely to use sunscreen on the face or other exposed skin than their counterparts (all P values < 0.001).”

In the paper

“Overall, 18.1% (95% confidence interval [CI]: 15.8–20.6) of men and 42.6% (95% CI: 39.5–46.7) of women regularly used sunscreen on the face”

In the paper

“Overall, 18.1% (95% confidence interval [CI]: 15.8–20.6) of men and 42.6% (95% CI: 39.5–46.7) of women regularly used sunscreen on the face”

In the paper

“whereas 19.9% (95% CI: 17.5–22.6) of men and 34.4% (95% CI: 31.5–37.5) of women regularly used sunscreen on other exposed skin”

In the paper

“Most were non-Hispanic white (67.4%) and had an annual household income of $40,000 or more (66.8%).”

In the paper

“The resulting data were weighted using 9 factors: gender, age, household income, race/ethnicity, household size, education, census region, metro status, and prior internet access to be representative of the US population.”

In the paper

“Furthermore, a study of media coverage on skin cancer prevention found more content about sunscreen than other recommended prevention strategies.5”

What the sources say

• ?Not checked — no full text of the sourcecites [5] Cokkinides, 2012, A profile of skin cancer prevention media coverage in 2009, J Am Acad Dermatol source

In the paper

“The survey was sent to 6,102 adults aged 18 years or older. A total of 4,033 adults completed the survey (answered at least half the questions), yielding a response rate of 66%.”

In the paper

“Percentages were weighted to generalize results to the study population.”

In the paper

“Participants are from the GfK (http://www.gfk.com/us/) Knowledge Panel13, which is randomly recruited by probability-based sampling using both random-digit dialing and address-based sampling methods to reach respondents regardless of landline phone or Internet availability.”

What the sources say

• ?Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  cites [13] GfK. GfK Knowledge Panel. Available from: URL: http://www.gfk.com/us/Solutions/consumer-panels/Pages/GfK-KnowledgePanel.aspx. Accessed September 4, 2014.

In the paper

“Given the variety of cosmetics on the market that are labeled as providing sun protection, sunscreen use on the face is likely to be distinct from use on other exposed skin, particularly among women.”

In the paper

“In 2011, the U.S. Food and Drug Administration updated regulations on sunscreen labeling to help consumers select and properly use sunscreens.11”

What the sources say

• Not checked yetcites [11] U.S. Food and Drug Administration. Labeling and effectiveness testing; sunscreen drug products for over-the-counter human use. Federal Register 76(117): 21 CFR Parts 201 and 310. Available from: URL: http://www.gpo.gov/fdsys/pkg/FR-2011-06-17/pdf/2011-14766.pdf. Accessed September 2, 2014.

In the paper

“and prevent or delay photoaging of the skin.8–10”

What the sources say

• ?Not checked — no full text of the sourcecites [8] Fisher, 2002, Mechanisms of photoaging and chronological skin aging, Arch Dermatol source
• ?Not checked — no full text of the sourcecites [9] Wlaschek, 2001, Solar UV irradiation and dermal photoaging, J Photochem Photobiol B source
• ?Not checked — no full text of the sourcecites [10] Hughes, 2013, Sunscreen and prevention of skin aging: a randomized trial, Ann Intern Med source

In the paper

“According to National Health Interview Survey (NHIS) data, approximately one-third of adults usually or always use sunscreen when outdoors in the sun for one hour or more.4”

What the sources say

• Not checked yetcites [4] National Cancer Institute. Cancer trends progress report – 2011/2012 update. Available from: URL: http://progressreport.cancer.gov/. Accessed September 2, 2014.

In the paper

“The survey included a question previously used on the NHIS12 which asks about the skin’s reaction to being “out in the sun for an hour without sunscreen, a hat, or protective clothing.””

What the sources say

• ?Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  cites [12] Centers for Disease Control and Prevention. National Health Interview Survey. Available from: URL: http://www.cdc.gov/nchs/nhis.htm. Accessed September 2, 2014.

In the paper

“National surveys (e.g., NHIS12) have assessed sunscreen use among US adults but do not differentiate between use on the face versus other exposed skin and do not capture whether the sunscreen provides broad spectrum protection.”

What the sources say

• ?Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  cites [12] Centers for Disease Control and Prevention. National Health Interview Survey. Available from: URL: http://www.cdc.gov/nchs/nhis.htm. Accessed September 2, 2014.

In the paper

“Sunscreen products that provide a sun protection factor (SPF) of 15 or higher and broad spectrum protection (i.e., protection from both ultraviolet A [UVA] and ultraviolet B [UVB] radiation) are labeled as protecting against sunburn, and, if used as directed, reducing the risk for skin cancer and early skin aging.”

What the sources say

• Not checked yetcites [11] U.S. Food and Drug Administration. Labeling and effectiveness testing; sunscreen drug products for over-the-counter human use. Federal Register 76(117): 21 CFR Parts 201 and 310. Available from: URL: http://www.gpo.gov/fdsys/pkg/FR-2011-06-17/pdf/2011-14766.pdf. Accessed September 2, 2014.

In the paper

“Similar to the Fitzpatrick scale,14 this variable measures sun sensitivity by assessing the skin’s tendency to burn, but the question also captures the severity of the burn.”

What the sources say

• ?Not checked — no full text of the sourcecites [14] Fitzpatrick, 1988, The validity and practicality of sun-reactive skin types I through VI, Arch Dermatol source

In the paper

“Our analyses were considered exempt by CDC’s Institutional Review Board because we used secondary data and personal identifiers were not included in the data.”

In the paper

“If used properly, regular sunscreen use can reduce risk for skin cancer6, 7”

What the sources say

• ?Not checked — no full text of the sourcecites [6] Green, 2011, Reduced melanoma after regular sunscreen use: randomized trial follow-up, J Clin Oncol source
• ?Not checked — no full text of the sourcecites [7] van der Pols, 2006, Prolonged prevention of squamous cell carcinoma of the skin by regular sunscreen use, Cancer Epidemiol Biomarkers Prev source

In the paper

“Calculations were performed with SAS-callable SUDAAN to account for the complex sampling design and non-response.”

In the paper

“Men may view sunscreen as non-masculine, messy, or inconvenient,22, 23 and sunscreen ads target women more often than men.24,25”

What the sources say

• ?Not checked — no full text of the sourcecites [22] Dadlani, 2008, Planning for a brighter future: a review of sun protection and barriers to behavioral change in children and adolescents, Dermatol Online J source
• ?Not checked — no full text of the sourcecites [23] Courtenay, 2000, Constructions of masculinity and their influence on men's well-being: a theory of gender and health, Soc Sci Med source
• ?Not checked — no full text of the sourcecites [24] George, 1996, Trends in photoprotection in American fashion magazines, 1983-1993. will fashion make you look old and ugly?, J Am Acad Dermatol source
• ?Not checked — no full text of the sourcecites [25] Lee, 2006, Sun care advertising in popular U.S. magazines, Am J Health Promot source

In the paper

“Sunscreen use is particularly low among certain groups such as men, non-Hispanic blacks, those with less sun-sensitive skin, and those with lower incomes.”

In the paper

“Two, the study had a 66% response rate and potential for non-response bias.”

In the paper

“Three, the study did not include data on other skin cancer risk-related behaviors or the context in which sunscreen was used (e.g., use of other forms of sun protection), all of which factor into ensuring adequate sun protection.”

In the paper

“Although seemingly contradictory, these findings may reflect increased time outdoors and greater total sun exposure among the more physically active, creating a need for more vigilant protection.”

In the paper

“Men may rely on protective clothing and shade more than sunscreen,2”

What the sources say

• Not checked yetcites [2] Centers for Disease Control and Prevention, 2012, Sunburn and sun protective behaviors among adults aged 18-29 years–United States, 2000-2010, MMWR

In the paper

“Sunscreen works best when used as directed and in combination with other forms of sun protection.29”

What the sources say

• ?Not checked — no full text of the sourcecites [29] Jansen, 2013, Photoprotection: part II. Sunscreen: development, efficacy, and controversies, J Am Acad Dermatol source

In the paper

“One, the study relies on self-reported information which is subject to error.”

In the paper

“When a sunscreen does not provide adequate protection, users may have a false sense of protection, possibly leading to more total sun exposure.30”

What the sources say

• Not checked yetcites [30] 2001, Sunscreens. Chapter 3. Human Use of Sunscreen

In the paper

“This pattern may reflect the many cosmetic products containing SPF that are marketed to women for use on the face.”

In the paper

“However, we weighted the data to the US population and accounted for non-response, which may have mitigated this effect.”