Brian Køster

Sunbed use in the Danish population in 2007: a cross-sectional study.

BACKGROUNDnIn Denmark, the incidence of all types of skin cancer, including malignant melanoma, has been increasing since the 1960s. Exposure to ultraviolet (UV) radiation is the main preventable cause of skin cancer. We describe current sunbed use in the Danish population.nnnMETHODSnA population-based sample of 3437 persons aged 15-59 years completed a questionnaire that included items on artificial and natural exposure to UV. We examined relations between sunbed use, outdoor tanning, knowledge about associated health risks and demographic factors with logistic regression analysis.nnnRESULTSnWithin the past 12 months, 29% of all Danes aged 15-59 had used a sunbed, including 59% females aged 15-19, even though knowledge about the relation between exposure to UV and cancer was more frequent in this group. A larger proportion of persons aged 15-18 had first used a sunbed before the age of 14 than older groups. Single males, frequent outdoor sunbathers, persons who experienced sunburns and less educated persons were more likely to use sunbeds.nnnCONCLUSIONSnFuture campaigns to reduce the Danes sunbed use should target initiation by young people and the high prevalence among them. The results suggest a legislative solution, with a minimum age of 18 years for indoor tanning.

Prevalence of sunburn and sun-related behaviour in the Danish population: a cross-sectional study.

Background: In Denmark, the incidence of melanoma has been increasing since the 1960s. Intermittent exposure to ultraviolet radiation and a history of sunburn and sunbed use are known risk factors. We describe the association between use of protective measures, sun-related behaviour and experience of sunburn in the Danish population three months after the start of the campaign. Method: A population-based sample of 3,499 persons aged 15—59 years completed a questionnaire that included items on exposure to ultraviolet radiation. We examined the relations between sunburn and sun-related behaviour by logistic regression analysis. Results: Within the previous 12 months, 35% of the study population had experienced sunburn. Sunburn became less frequent with age (odds ratio (OR) 4.44; 15—19 vs. 50—59) and skin type (OR 2.57; I vs. III). Sunburn was negatively associated with shade and clothing and positively with use of sunscreens. We found no significant difference in sunscreen use between intentional tanners who experienced sunburn and those who did not. A larger fraction of unintentional tanners with sunburn than those who were not sunburnt had used sunscreen. Sunscreen was used to prolong the time spent in the sun by 66% of sunburnt people; however, we found no association between duration of sun exposure and sunscreen use. Conclusions: Future campaigns to reduce the prevalence of sunburn in the Danish population must especially target young persons and intentional tanning, and they should emphasize that sunscreen cannot be used to extend the time spent in the sun and that shade and clothing provide the best protection against sunburn.

Vacations to sunny destinations, sunburn, and intention to tan: a cross-sectional study in Denmark, 2007-2009.

Background: Denmark has experienced an increase in melanoma incidence since the 1960s. Exposure to ultraviolet radiation is the main preventable cause of this cancer. We examined current travel to, and sun-related behaviour of Danes at, sunny destinations in relation to their risk for sunburn. Method: A population-based sample of 11,158 respondents aged 15—59 years completed three questionnaires in 2007—2009 that included items on exposure to ultraviolet radiation. Using logistic regression analysis we examined the relations between sunny vacations, sun-related behaviour, demographic factors and risk for sunburn. Results: During 2007—2009, 44.8—45.8% of the respondents travelled to a sunny destination at least once a year; 24% became sunburnt, and 69% tanned intentionally. The odds ratio for sunburn in general for people who went on a sunny vacation as compared with those who did not was 1.6 (1.5—1.7). Sunscreen use (1.9; 1.4—2.6) and intentional tanning (3.4; 2.8—4.1) were positively associated with sunburn on vacation. Conclusions: Taking a vacation in a sunny place is a risk factor for sunburn, especially for young people. The recommendation for sunscreen use should be re-evaluated, as intention to tan is the most important factor in sunburn on vacation and should be targeted more strategically.

Feasibility of smartphone diaries and personal dosimeters to quantitatively study exposure to ultraviolet radiation in a small national sample

In 2007, a national skin cancer prevention campaign was launched to reduce the UV exposure of the Danish population. To improve campaign evaluation a questionnaire validation using UV‐dosimeters was initiated.

'Neighbour smoke'--exposure to secondhand smoke in multiunit dwellings in Denmark in 2010: a cross-sectional study.

Background ‘Neighbour smoke’ is transfer of secondhand smoke between apartments including shared areas, such as hallways, community rooms and stairwells in multiunit dwellings and is an emerging issue for public health and health equity. Objective To describe the prevalence of exposure to neighbour smoke in Denmark. Methods A population-based sample of 5049 respondents (2183 in multiunit dwellings) living in Denmark aged ≥15u2005years completed a questionnaire in 2010 on tobacco-related behaviour and exposure to secondhand smoke. The authors examined the relations between exposure to neighbour smoke, own smoking, smoking inside the home, type of residence and demographic factors with descriptive statistics and logistic regression analysis. Results In this sample, 22% of those living in multiunit dwellings reported exposure to neighbour smoke. Of respondents living in apartments, 41% preferred to live in a building in which smoking is banned. Smoke-free buildings were preferred by 58% of persons exposed to neighbour smoke compared with 37% of persons not exposed. Of the smokers (daily and occasional), 14% preferred to live in a smoke-free building; 31% never smoked indoors in their own home. Conclusions The only way to avoid absorbing tobacco smoke from neighbours is to live in a smoke-free multiunit dwelling. There is great demand for such dwellings, especially by young people, people with children and people exposed to neighbour smoke, as well as by people who smoke.

Sunbed use by children aged 8–18 years in Denmark in 2008: a cross‐sectional study

of sepsis 14 months after presentation. Bowman et al. proposed the following criteria for the diagnosis of MFB: (i) clinically apparent vesiculobullous lesions; (ii) typical histological features of MF with blisters (intraepidermal or subepidermal); (iii) negative immunofluorescence; and (iv) exclusion of other causes of vesiculobullous lesions. The mechanism of blister formation in MF has not been elucidated, although several hypotheses have been proposed. One possibility is that epidermotropism and accumulation of neoplastic cells in the basal layer of the epidermis may induce the loss of coherence between the basal lamina and the basal keratinocytes. On the other hand, cytokines released from neoplastic cells were also suspected of intruding into the normal connection between keratinocytes. However, the current electron microscopic observations show a normal cohesion between the basal lamina and the basal keratinocytes, and a normal connection between keratinocytes. Numerous blisters and atypical cells were observed in the subepidermis of the present case. These findings suggest the possibility that neoplastic cells directly and ⁄or indirectly induced the degeneration of collagen bundles, and therefore, the blisters that appeared in MF. In addition, the infiltration of neutrophils and ⁄or eosinophils was observed in the lesions of MFB in previous reports, similar to the present case. Because these cells could produce inflammatory cytokines and matrix metalloproteinases, they might also be associated with the blister formation. Although the significance of the blister formation in patients with MF is still unclear, MFB should nevertheless be regarded as an important clinical subtype of MF.

The validated sun exposure questionnaire - Association of objective and subjective measures of sun exposure in a Danish population based sample.

Few questionnaires used in monitoring sun‐related behaviour have been tested for validity.

Effects of smartphone diaries and personal dosimeters on behavior in a randomized study of methods to document sunlight exposure

Dosimeters and diaries have previously been used to evaluate sun-related behavior and UV exposure in local samples. However, wearing a dosimeter or filling in a diary may cause a behavioral change. The aim of this study was to examine possible confounding factors for a questionnaire validation study. We examined the effects of wearing dosimeters and filling out diaries, measurement period and recall effect on the sun-related behavior in Denmark in 2012. Our sample included 240 participants eligible by smartphone status and who took a vacation during weeks 26–32 in 2012, randomized by gender, age, education and skin type to six groups: 1) Control + diary, 2) Control, 3) 1-week dosimetry measurement, 4) 1-week dosimetry measurement + diary, 5) 3-week dosimetry measurement and 6) 1-week dosimetry measurement with 4 week delayed questionnaire. Correlation coefficients between reported outdoor time and registered outdoor time for groups 3–6 were 0.39, 0.45, 0.43 and 0.09, respectively. Group 6 was the only group not significantly correlated. Questionnaire reported outdoor exposure time was shorter in the dosimeter measurement groups (3–6) than in their respective controls. We showed that using a dosimeter or keeping a diary seems to increase attention towards the behavior examined and therefore may influence this behavior. Receiving the questionnaire with 4 week delay had a significant negative influence on correlation and recall of sunburn. When planning future UV behavior questionnaire validations, we suggest to use a 1-week interval for dosimetry measurements, no diary, and to minimize the time from end of measurement to filling out questionnaires.

Sun Exposure Guidelines and Serum Vitamin D Status in Denmark: The StatusD Study

Little is known on how vitamin D status is affected by adherence to UVB-limiting sun exposure guidelines. Our aim was to investigate the relationship between adherence to the Danish sun exposure guidelines and vitamin D status. In total, 3194 Danes (2625 adults, 569 children) were recruited among the general population, and more than 92% had blood samples taken both autumn and spring. Using linear regression, we associated serum vitamin D concentrations to questionnaire responses on: seeking shade, wearing a sunhat, wearing protective clothing or using sunscreen. The odds ratio (OR) of either low (<25 or 50 nmol/L) or adequate/high (≥50 nmol/L) vitamin D status was examined using logistic regression. For adults, those who always sought shade or wore protective clothing compared to those who did not had lower levels of vitamin D (autumn concentrations for shade: 7.2 nmol/L lower (−11.0–−3.6 nmol/L); for protective clothing: 9.9 nmol/L lower (−13.6–−6.2 nmol/L). Adherence to all four guidelines was also associated with lower vitamin D concentrations (autumn: 9.7 nmol/L lower (−14.3–−5.1 nmol/L). Use of sunscreen was associated with adequate vitamin D status, as those who always sought shade compared to those who did not had an OR (95% CI) of 1.68 (1.25–2.35) of having ≥50 nmol/L during both spring and autumn. No associations were found with wearing a sunhat, and there were no clear associations for children. In conclusion, adherence to the sun exposure guidelines on shade and protective clothing was associated with lower vitamin D status among Danish adults, but not children.

Sunbed use among 64,000 Danish students and the associations with demographic factors, health-related behaviours, and appearance-related factors

Sunbed use is associated with an increased risk for skin cancer and is particularly dangerous for younger persons. The objective of this study was to assess how demographic factors, health-related behaviours and appearance-related factors are associated with sunbed use. Cross-sectional data from the Danish National Youth Study collected by the National Institute of Public Health during 2014 was used. A total of 64,382 students aged 15-25years were included in the present study. Multilevel logistic regression analyses were used to determine associations. Sunbed use during the past 12months was reported by 22% of students, with a higher proportion among females (29%) than males (12%). Factors associated with sunbed use were older age, studying at a vocational college or a higher preparatory examination school compared to upper secondary school, and lower parental education. Furthermore, being a smoker, been binge-drinking, longer duration of exercise and been dieting were also associated with sunbed use. For females, poor dietary habits were also associated with sunbed use. Feeling overweight was associated with lower odds for sunbed use for males, but with higher odds for females. Lower body satisfaction was associated with higher odds of sunbed use, except for overweight males. Students who were underweight had lower odds for sunbed use, than normal weight students. Conclusively, we found evidence of associations between demographic factors, health-related behaviours and appearance-related factors and sunbed use. Understanding these relations could help to identify high-risk groups and guide preventive strategies for sunbed use and skin cancer prevention.