The North Queensland “Sun-Safe Clothing” Study: Design and Baseline Results of a Randomized Trial to Determine the Effectiveness of Sun-Protective Clothing in Preventing Melanocytic Nevi

Skin Cancer Research Group, North Queensland Center for Cancer Research, School of Public Health and Tropical Medicine, James Cook University, Townsville, Queensland, Australia 4811.
American Journal of Epidemiology (Impact Factor: 5.23). 04/2005; 161(6):536-45. DOI: 10.1093/aje/kwi081
Source: PubMed


In 1999, the authors began recruitment for a randomized controlled intervention trial aimed at preventing melanocytic nevi
(moles) by minimizing sun exposure through the use of sun-protective clothing. The study involves 652 Caucasian children (75.6%
response) aged 0–35 months from 25 child-care centers (n = 13 intervention and n = 12 control) living in the high-solar-irradiance environment of Townsville, Queensland, Australia. Children attending intervention
centers wear investigator-provided garments made from fabrics with ultraviolet protection factors rated very good to excellent.
Control centers continue to offer usual care. Three-year follow-up of all children will be completed in 2005. The main outcome
measure is the number of new melanocytic nevi. At baseline, the two groups were similar with respect to nevi, phenotype, age,
demographic characteristics, sun-protection habits, and history of sun exposure, except that more children from control versus
intervention centers (2% and 0%, respectively; p = 0.006) had experienced painful sunburn with blistering. Higher melanocytic nevus counts were associated with more time
spent outdoors and a history of sunburn, while sunscreen use, particularly during the mild winter months, appeared to have
a protective effect. These findings further substantiate the hypothesis that nevus development in young children is related
to sun exposure.

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    • "This may be attributed in part to the already high levels of awareness concerning sun-protection behavior in our population. Sunburn was reported by only 14% of children, a lower proportion than documented in other similar populations (Gallagher et al., 2000; Bauer et al., 2005; Harrison et al., 2005), whereas 71% of the sample used sunscreens regularly, again a larger proportion compared with estimates in similar age groups from other countries (Naylor and Robinson, 2005; Thieden et al., 2005). Recent surveys indicate that the use of sun-protection modalities has Table 2. ''SoleSi SoleNo-GISED'' project: subjects' sun-protection behavior at baseline and follow-up according to their randomization allocation. "
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    ABSTRACT: A history of sunburns in early life nearly doubles the risk of developing malignant melanoma in adulthood. From 2001 to 2004, we conducted a cluster-randomized trial of an educational intervention to reduce sunburn rates (primary outcome) and improve sun-protection behavior (secondary outcome) in schoolchildren. A total of 122 Italian primary schools (grades 2 and 3) were randomized to receive, or not, an intervention consisting of an educational curriculum at school, conducted by trained teachers, which included the projection of a short video and the distribution of booklets to children and their parents. Behavior while in the sun was assessed at baseline and 14-16 months after baseline. In a subgroup (44% of the total sample), melanocytic nevi were also counted. Of the 11,230 children enrolled, 8,611 completed the study. A total of 1,547 children (14%) reported a history of sunburns at baseline. At follow-up, no difference in sunburn episodes was documented between the study groups (odds ratio 0.97, 95% confidence interval 0.84-1.13) and similar sun-protection habits were reported. No significant impact of the proposed educational program was documented at 1-year follow-up. Innovative strategies need to be developed to increase the effectiveness of future educational interventions in this area.
    Full-text · Article · Sep 2007 · Journal of Investigative Dermatology

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    ABSTRACT: xviii, 210 p. : ill. (some col.) ; 30 cm. PolyU Library Call No.: [THS] LG51 .H577P ITC 2009 Yao Skin is the largest organ of human body that acts as the interface between the internal tissues of the body and the external environment to provide barrier function and protection. Clothing, called 'the second skin', covers most parts of the body, most of time, in majority of the places not only providing additional shield for the body but also creating a portable living microclimate for its survival. Chinese ancient wisdoms identified clothing as the first most essential item for human living and health. However, how the skin and 'the second skin' interact with each other to serve the protective and biological functions is indeed a mystery and a scientific understanding of the phenomenon is still in its infancy. The aim of this research is to fill the knowledge gaps and establish a theoretical framework for delineating the effects of clothing on skin physiology. This aim has been achieved through a systematic study to establish theoretical framework based on a thorough literature review and by undertaking a series of wear trials in mildly cold and hot environmental conditions, as well as under solar exposure. A theoretical framework of effects of clothing on skin physiology was developed by considering the potential mechanisms involved in physics, biochemistry, physiology, neuropsychology and immunology. A set of hypotheses were then proposed to explain the possible physiological interactions between clothing and skin. This theoretical framework and hypotheses were further tested by a series of wear trials conducted in mildly cold and hot environmental conditions as well as under solar exposure. A parallel cross-over blinded wear trial was designed and conducted in mildly cold condition to study the influence of clothing material on skin physiology. It is found that stratum corneum water content (SCWC) level is significantly higher when one wears cotton garment rather than polyester garments. Clothing material seems to significantly influence subjective sensation of coldness and stress level. Cotton fabric, with higher moisture sorption capacity and lower thermal diffusivity, has a positive effect on SCWC. Perception of coldness has a negative effect on SCWC. To identify the effects of fabric moisture and liquid water transport properties on the skin physiology in the context of daily wear, a parallel blinded wear trial was carried out in a mildly cold environment. The results suggested that hygroscopicity of fabric significantly influences SCWC and transepidermal water loss (TEWL) in mildly cold condition. Additionally, hygroscopicity of fabric tended to influence sebum, although no significant effect on skin surface acidity has been noted. Generally speaking hydrophilicity of fabric did not significantly affect skin physiology in mildly cold environment. To explore the mechanisms of the effects of fabric properties on skin physiological status in daily wear in mildly cold condition, statistical methods such as factor analysis and Hierarchical Linear Regression (HLR) were applied to obtain the relationships between fabric properties and skin physiological parameters such as SCWC, TEWL, sebum and skin surface acidity. A framework was developed to describe the clothing-body interactions among fabric physical properties, sensory responses, skin physiological and neuropsychological responses in mild cold environment. It was found that hygroscopic fabric significantly increases SCWC and TEWL and decreases sebum in mildly cold condition. Fabric transport capability significantly reduces skin surface acidity by promoting heat release and reducing heat accumulation. Fabric transport capability seems to increase the overall comfort sensation and reduces stress. Meanwhile, fabric shearing resistance reduces overall comfort sensation and increases stress level. Fabric compressibility and overall moisture management capacity (OMMC) appear to enhance overall comfort sensation. Overall comfort sensation is positively related to SCWC and TEWL, while stress level is positively related to sebum. To study effects of clothing on skin physiological response in hot environment, a cross-over blinded wear trial was also conducted, the results were analyzed statistically by using Repeated Measure-ANOVA, and its mechanisms were explored by using HLR. It was found that fabric transport capability, shearing resistance and compressibility influence human thermoregulation by affecting heat release, and microclimate humidity. Fabrics with higher transport capability significantly reduce core and skin temperature by promoting heat release from the human body to the external environment. Fabric with higher shearing resistance increases skin temperature. A framework was thus developed to describe the clothing-body interactions in terms of fabric physical properties, skin physiological, neuropsychological and thermophysiological responses in a typical hot environment. To investigate the effects of UV blocking fabric on skin physiology, another parallel wear trial was carried out under solar exposure. It was found that that fabric with UV blocking capability reduces the acute effects of solar exposure, inhibits melanin content and erythem level as well as protects circadian rhythmicity, and increases stratum corneum hydration under UV radiation. To reiterate, in this study, the clothing-body interactions in mild cold and hot environments as well as under solar exposure have been investigated. Two comprehensive frameworks have been developed to describe the mechanisms of the ways in which physical properties of fabric influence skin physiology, thermophysiology and neuropsychology. The outcomes of this research should contribute towards developing a scientific understanding on how clothing affects skin physiological health, comfort and protection of the body under different environmental conditions. Ph.D., Institute of Textiles and Clothing, The Hong Kong Polytechnic University, 2009
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