Sunscreen use and availability among female collegiate athletes.

Dubas LE, Adams BB. J Am Acad Dermatol. 2012 Feb 2. [Epub ahead of print]

College athletes participating in outdoor sports are exposed to large levels of ultraviolet radiation; which may increase their risk for skin cancer. Unfortunately, many athletes do not use sunscreen. Dubas et al evaluated the effect of sunscreen availability on sunscreen application among female college golfers from 10 Midwest colleges. Collegiate golfers were selected because their long tournaments tend to occur during peak sun months (August, September, May, and June) and peak sun hours (10am to 4pm). The 10 teams were randomly divided into two groups (treatment and control groups). Teams in the treatment group (44 athletes) received a 1-gallon container of sunscreen which was placed at the entrance of the locker room. Furthermore, each athlete in the treatment group was given 5 tubes of sunscreen and advised to use the locker room sunscreen daily and to keep at least one tube of sunscreen in their golf bag at all times. Both groups completed a 6-question survey about skin type (e.g., fair skin tone), school, age, and sunscreen use before the treatment period and 4-weeks later (first and last weeks of September). Research staff at each school recorded high temperature and cloud cover during practices or competitions (these were not difference between groups). Both groups had similar sunscreen use prior to the treatment period (i.e., ~3 days/week of sunscreen use, ~30% reapplied sunscreen during practice, ~50% reapplied sunscreen during competition). At the end of 4 weeks, the treatment group had increased their sunscreen use while the control group decreased their sunscreen use. When the authors accounted for how much sunscreen the athletes used at baseline they found that being given sunscreen accounted for an increase of 1.13 more days per week of sunscreen use. Interestingly, both groups did not differ in reapplication of sunscreen during practice. There may have been a small (20%) increase in reapplication during competitions among the treatment group but not the control group. In a free response section of the survey, the control group reported inaccessibility and inconvenience as the main barrier to daily sunscreen application. In contrast, the treatment group reported misinformation and lack of sun-protection education as their main reasons for not using sunscreen daily. Furthermore, the treatment participants also noted their ability to tan easily or psychosocial preference for tanned skin as reasons to forego sunscreen.

This study confirms that large number of athletes may not be using sufficient sunscreen and that the athletes consider inaccessibility, inconvenience, and misinformation as the main reasons for not using sunscreen. Providing sunscreen and advising athletes on proper sunscreen use provides some improvement in sunscreen use. This is an easy step most schools can do even while we wait for more research to further test programs to promote sunscreen use in larger populations, various sports, and among male athletes. As clinicians in sports medicine, this is an area of research and clinical work we need to address to prevent long-term conditions like skin cancer. We need to be advocates for not just preventing acute injuries (e.g., concussions, ankle sprains, ACL tears) but also preventing long-term health concerns (e.g., neurocognitive impairment among concussed athletes, osteoarthritis, skin cancer). It’s time for us to take a more active role in promoting the use of sunscreen. Do you currently provide sunscreen or education programs about sunscreen use to your athletes? Who reminds your athletes to reapply sunscreen during practice or competition? When covering practices or games are you remembering to apply and reapply your sunscreen?

Written by: Jeffrey Driban
Reviewed by:  Stephen Thomas

Dubas LE, & Adams BB (2012). Sunscreen use and availability among female collegiate athletes. Journal of the American Academy of Dermatology PMID: 22305043