Review of Fate, Exposure, and Effects of Sunscreens in Aquatic Environments and Implications for Sunscreen Usage and Human Health (2022) / Chapter Skim
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7 Sunscreen, Preventive Health Behaviors, and Implications of Changes in Sunscreen Use for Public Health
7 Sunscreen, Preventive Health Behaviors, and Implications of Changes in Sunscreen Use for Public Health
Pages 161-180
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From page 161... ...
. Other recommended behaviors for sun protection include seeking shade, wearing protective clothing and hats, and reducing outdoor activity during peak UVR hours (CDC, 2021)
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Merkel cell carcinoma, and squamous cell carcinomas of the ears and lips. Although melanoma accounts for only about 1 percent of all skin cancers, most skin cancer deaths are from melanoma (Rogers and Coldiron, 2013)
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Skin Cancer Causes and Risk Factors Skin cancer risk is strongly associated with UVR resulting from sun exposure and other sources of UV light, including tanning beds, with clear molecular pathways of UV-induced genetic mutations that can lead to cancer (Ciążyńska et al., 2021; Savoye et al., 2018; Wu et al.
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have a lower incidence attributed, in part, to the inherent sun protection provided by melanin (NCI, 2016) However, race and ethnicity are a poor proxy for skin cancer risk.
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Chapter 2 of this report describes the UV filters approved for use in the United States. The global sun care products market, of which 79 percent is sun protection products, was $11 billion to $13 billion in 2018–2019 and is expected to reach $16.8 billion to $24.4 billion in value in 2027–2029 (Fortune Business Insights, 2021; Ma and Yoo, 2021)
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. Studies have shown that regular sunscreen use is particularly important in vulnerable populations such as children and individuals with lighter skin types (Hall et al., 2001; Stern et al., 1986)
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The NOWAC study differed significantly from the Nambour Trial in Australia because most UV exposure in Norway is intentional rather than incidental, and detailed information on application and type of sunscreen use and other photoprotection behaviors was not available. The combined evidence from the Nambour Trial and the NOWAC study support the efficacy of broadspectrum sunscreen for prevention of melanoma.
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From page 168... ...
These were the first studies to clearly demonstrate systemic absorption under recommended sunscreen usage (previously absorption was assumed to be negligible) , thus exceeding the FDA threshold requirement for additional safety testing (Adamson and Shinkai, 2020; Califf and Shinkai, 2019)
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. Black and Hispanic adults report lower use of sunscreen and other sun protection behaviors (Calderón et al., 2019; Lunsford et al., 2018)
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From page 170... ...
However, the use of sunscreen for other recreational and occupational outdoor activities -- and in routine daily use -- can still result in rinse-off in the shower that enters wastewater and aquatic environments, albeit less directly. Here we briefly review UV exposure and the use of sunscreen and other UV protection behaviors related to aquatic activities and other outdoor activities, particularly recreation and sport.
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From page 171... ...
. Even populations at greater risk from UV radiation -- including melanoma survivors, transplant recipients, and those with photosensitive conditions -- have inadequate sun protection practices (Biswas et al., 2020; Idorn et al., 2014; Jewett et al., 2020; Sainsbury et al., 2018)
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. This campaign was designed to change social norms regarding sun protection and tanned skin and featured choices for sun protection, including using sunscreen with an SPF 15 or higher, wearing protective clothing, seeking shade, and wearing sunglasses and hats.
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A series of large, cluster-randomized trials at swimming pools and outdoor recreation programs for children tested educational and environment-policy strategies to increase the use of sun protection practices, including sunscreen, among parents, children and lifeguards. The early studies found that both education and environmental-policy strategies increased solar protection behaviors (Glanz et al., 2001)
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. Also, a recent longitudinal analysis in Australia found that, over time, sunscreen has been increasing in its role as the "most favored" form of sun protection among adolescents and adults, compared to use of protective clothing and shade (Koch et al., 2017)
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. Attitudes and Knowledge About Sunscreen and Environmental Impacts There are only a few empirical publications that report on attitudes and knowledge about sunscreen and potential effects on aquatic environments including coral reefs.
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For each scenario about possible changes in sunscreen choice and use, this section describes what the resulting human health outcomes may be expected to be. A restriction on certain UV filters may have negative impacts on the use of sunscreen to prevent skin cancer and photoaging if it leads to reduced sunscreen usage (Cassel and Glanz, 2018)
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Virgin Islands Oxybenzone, octinoxate, Bans sale, distribution, and use Passed July 20, 2019; in Bill No. 33-0043, Act octocrylene without a prescription.
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are unavailable, resulting in use of sunscreen at either reduced frequency or in reduced quantities with uptake of recommended compensating behaviors such as shade-seeking, use of hats and protective clothing, and sun avoidance. The practice of multiple UV protective behaviors in order to achieve substantial protection against UV radiation depends on individuals making well-informed choices consistently, and also supportive environments.
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FINDINGS AND KNOWLEDGE GAPS Based on the information reviewed in this chapter, the committee highlights the following areas as key findings from the information as well as gaps in knowledge pertinent to understanding the implications of changing sunscreen availability and usage on human health. Finding: Exposure to UVR causes sunburn and photoaging in human skin and is a risk factor for the development of skin cancers, both keratinocyte carcinomas and melanomas.
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From page 180... ...
In addition, risk prediction modeling studies (e.g., Rigotti and Wallace, 2015; Stern et al., 1986; van Dijk et al., 2013) could be designed to address these potential incidence, morbidity, and mortality outcomes related to skin cancers, given potential changes in sunscreen, effectiveness, availability, and use.
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