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Observational study of free public sunscreen dispenser use at a major US outdoor event

      To the Editor: The American Academy of Dermatology and Centers for Disease Control and Prevention currently recommend sun protection measures in outdoor public spaces as part of a strategy to combat the rising incidence of skin cancer.
      • Bergfeld W.F.
      • Farris P.K.
      • Wyatt S.W.
      • et al.
      Executive summary of the national Partners in Prevention Skin Cancer Conference: American Academy of Dermatology and Centers for Disease Control and Prevention.

      Centers for Disease Control and Prevention. Protect your visitors and staff from skin cancer. Available from: http://www.cdc.gov/cancer/skin/pdf/skincancer_parks-recreation.pdf. Accessed August 9, 2016.

      However, few venues have opted to offer free sunscreen, and to our knowledge the use in such venues has not been described in detail.
      For the purpose of this study, the Minnesota State Fair, a 12-day long outdoor gathering that attracts over 1.7 million attendees each August, installed complimentary sunscreen dispensers at 10 information booths throughout the grounds. Titanium and zinc–based sunscreen with a sun protection factor of 30 was selected for its hypoallergenic properties. Volunteers inconspicuously observed sunscreen use at 4 of the stations over a sampling of days and times.
      A total of 2187 people were observed using free sunscreen over 93 observation hours. Demographics and skin types were noted. More females than males used the sunscreen (57%; P < .0001), which was out of proportion to the only slight female predominance (51%) in fair attendance. Thirty-three percent of people applied sunscreen to all sun-exposed areas of their skin. Those who did not apply sunscreen to all sun-exposed areas most frequently applied sunscreen to their upper extremities (51%), followed by their face (42%), chest (6%), and lower extremities (3.6%). Thirty-eight percent of observed sunscreen users did not have additional sun protective behaviors in place, such as a hat, sunglasses, or long-sleeved clothing. Rates of sunscreen use were significantly related to the amount of sun/lack of clouds (P < .0001). Sunscreen use when corrected for fair attendance had an overall positive correlation with ultraviolet (UV) index (Pearson's correlation coefficient, 0.44). However, there were days that the UV index was high and use was low, likely because of cloud cover (Fig 1).

      National Oceanic and Atmospheric Administration. Available from: http://www.cpc.ncep.noaa.gov/products/stratosphere/uv_index/Bulletin/. Accessed September 15, 2016.

      Figure thumbnail gr1
      Fig 1Relationship between sunscreen use, weather conditions, and ultraviolet index.
      Our observations highlight opportunities for improvement in public education. Sunscreen use decreased dramatically on completely overcast days, despite the UV index remaining at a dangerous level (>6) on one of those days. This reflects a common public misconception that there is no risk for sunburn on cloudy days. Our study also highlights the public's receptiveness to free sunscreen, with a calculated estimate of about 17,000 persons using the sunscreen over the course of the event.
      We encourage other venues to offer free sunscreen as part of a strategy to reduce UV exposure in their patrons. We recommend simple, bold signage to identify the product (as not to be mistaken for moisturizer or sanitizer) and a mirror to aid in application. Dispensers should be mounted in locations where they can be monitored and refilled when necessary. One can expect more sunscreen to be consumed near main entrances and on days with more sunshine.
      We thank the University of Minnesota Masonic Cancer Center for grant support, Pharmaceutical Specialties, Inc. for donation of the sunscreen, and the Minnesota State Fair for their enthusiastic support of this effort.

      References

        • Bergfeld W.F.
        • Farris P.K.
        • Wyatt S.W.
        • et al.
        Executive summary of the national Partners in Prevention Skin Cancer Conference: American Academy of Dermatology and Centers for Disease Control and Prevention.
        J Am Acad Dermatol. 1997; 36: 798-801
      1. Centers for Disease Control and Prevention. Protect your visitors and staff from skin cancer. Available from: http://www.cdc.gov/cancer/skin/pdf/skincancer_parks-recreation.pdf. Accessed August 9, 2016.

      2. National Oceanic and Atmospheric Administration. Available from: http://www.cpc.ncep.noaa.gov/products/stratosphere/uv_index/Bulletin/. Accessed September 15, 2016.