Taken together, two new studies provide a mixed bag of news on the effectiveness of public health measures and messages aimed at decreasing skin cancer risk and improving sun safety behaviors.

One study shows that indoor tanning among high school students is starting to decline, but is still common among some students, while another study shows that, by and large, schools are not promoting sun safety practices.

Both reports appear in JAMA Dermatology and are published online to coincide with their presentation at the American Academy of Dermatology annual meeting in Orlando.

In the first study, researchers from the U.S. Centers for Disease Control and Prevention in Atlanta (CDC) report that indoor tanning decreased among students overall (from 15.6 percent in 2009 to 7.3 percent in 2015) but it was still common among some students, especially non-Hispanic white females where the prevalence of indoor tanning dropped from 37.4 percent in 2009 to 15.2 percent in 2015.

Indoor tanning also was associated with an increased likelihood of sunburn, although it was not possible to determine if the sunburns occurred because of indoor tanning or were related to the general behavior of indoor tanners who may incorrectly believe that a base tan reduces the risk of sunburn, the study showed. To arrive at their findings, researchers examined the prevalence of indoor tanning in the past year from 2009 to 2015 and its association with sunburn in 2015 among U.S. high school students.

A second article looked at the prevalence of sun safety practices at schools and identified school characteristics associated with having policies in place to promote sun safety. The authors, also from the CDC, analyzed nationally representative school-level data from 2014.

Sun safety practices were not common among schools and high schools were less likely than elementary and middle schools to adopt several policies, according to the report.

For example, the most frequent practice (47.6 percent) was teachers giving time to students to apply sunscreen at school, although few schools (13.3 percent) made sunscreen available for students to use. 

“Although skin cancer is the most common form of cancer in the United States, school practices that could protect children and adolescents from exposure to UV radiation from the sun while at school, and that could change norms about sun safety practices, are not common. … Many practices would cost little to implement and would support other messages targeted toward children, adolescents, adults and parents with an aim to reduce skin cancer morbidity and mortality,” the article concludes.

“The articles … continue the conversation about sun safety by demonstrating the decreasing prevalence of indoor tanning and the lack of sun-safety practices in schools, respectively,” writes Henry W. Lim, MD, a dermatologist at Henry Ford Hospital in Detroit and a colleague, in an accompanying editorial. “Clearly, both the dermatology and medical communities need to continue public awareness campaigns regarding photoprotection, including sun-safety practices such as seeking shade when outdoors and wearing photoprotective clothing, wide-brimmed hats, and sunglasses. Broad-spectrum sunscreens with SPF (sun protection factor) of at least 30 should be generously applied (and reapplied) to sun-exposed areas when outdoors.” Dr. Lim is the new president of the American Academy of Dermatology.