title: Health literacy, sunscreen and sunbed use: an uneasy association.
abstract: BACKGROUND
  Skin cancer can largely be prevented by avoiding unsafe ultraviolet radiation (UVR) exposure. The evidence on potential drivers of sunscreen and sunbed use is extensive, yet in some cases, such as education, remains rather unclear. Health literacy is receiving increasing attention, but its effect on tanning decisions has not yet been explored.
  
  
  OBJECTIVE
  To explore the association between health literacy and tanning behaviour, in terms of sunscreen and sunbed use.
  
  
  METHODS
  Self-reported data were collected through a common questionnaire in eight European countries under a common protocol. A three-item measure was used to assess health literacy; one item was collected to measure current sunscreen use and one item to measure current sunbed use. Descriptive statistics and analysis of variance tests were applied to explore the profile of sunbed and sunscreen users and health literacy among a number of variables. Univariate and multivariate logistic regressions were used to assess the relation between health literacy and sunscreen and sunbed use.
  
  
  RESULTS
  Univariate results suggested that health literacy has opposite effects on sunscreen use vs. sunbed use. Increased health literacy was associated with the skin cancer protective practice of using sunscreen, but also with more sunbed use. In the multivariate models, health literacy had a significant effect only on sunscreen use.
  
  
  CONCLUSIONS
  The findings suggest that health literacy can be an interesting approach for influencing sunscreen use. In the case of sunbeds, based on the findings and contrary to what was expected, it can be argued that interventions targeting health literacy seem less likely to reduce sunbed use. More research is needed to elucidate the effect of health literacy on sunscreen and sunbed use in order to improve UVR prevention strategies.
authors.affiliation: Department of Dermatology, Venerology and Allergology, Skin Cancer Centre Charité, Charité-Universitätsmedizin Berlin, Berlin, Germany. efthymios.a@gmail.com
authors.forename: E
authors.initials: E
authors.lastname: Altsitsiadis
authors.forename: T
authors.initials: T
authors.lastname: Undheim
authors.forename: E
authors.initials: E
authors.lastname: de Vries
authors.forename: B
authors.initials: B
authors.lastname: Hinrichs
authors.forename: E
authors.initials: E
authors.lastname: Stockfleth
authors.forename: M
authors.initials: M
authors.lastname: Trakatelli
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D016022:Case-Control Studies; D005060:Europe; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D057220:Health Literacy; D006801:Humans; D008297:Male; D008875:Middle Aged; D009381:Neoplasms, Radiation-Induced / Q000517:prevention & control* / Q000523:psychology; D012044:Regression Analysis; D012878:Skin Neoplasms / Q000517:prevention & control* / Q000523:psychology; D055108:Sunbathing / Q000523:psychology*; D013473:Sunscreening Agents / Q000627:therapeutic use*; D055815:Young Adult
chemical_list: D013473:Sunscreening Agents