{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T04:45:42Z","timestamp":1787028342120,"version":"build-2736575974"},"reference-count":26,"publisher":"MDPI AG","issue":"5","license":[{"start":{"date-parts":[[2022,2,25]],"date-time":"2022-02-25T00:00:00Z","timestamp":1645747200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>Skin cancer is the most common form of cancer in the United States, and regular use of broad-spectrum sunscreens can prevent skin cancer. However, a new law in Hawaii that limits sunscreen choices due to the belief that some UV (ultraviolet) filters may damage coral reefs may reduce sunscreen use and increase skin-cancer risk. Because of this, there is a need for measurement tools to help understand consumer behavior and determinants of sunscreen purchase and use. The objectives of this study were (1) to test new questionnaire measures relevant to the Hawaii Sunscreen Ban; and (2) to assess adults\u2019 knowledge, attitudes, and habits related to sunscreen in two other coastal states. This survey of adult residents of California and Florida was conducted in the summer of 2019. Newly developed scales addressed beliefs about effects of sunscreens on aquatic\/marine environments and awareness of the Hawaii sunscreen ban. Respondents completed the survey twice to evaluate the test\u2013retest reliability. Respondents (n = 162) were mainly female, White, and college-educated. New scales had moderate-to-high internal consistency and high test\u2013retest reliability. Sunscreen use was high, sunburn was common, and knowledge and attitudes about sunscreen were modest. Most respondents did not know the specifics of the Hawaii Sunscreen Ban. In multivariate models, significant predictors of sunscreen use were being older, female, and having higher sunscreen knowledge. Sunscreen beliefs were not significantly associated with sunscreen use or sunburn. The findings support the use of the newly developed survey and suggest that more education about sunscreen and sunscreen ingredients is needed.<\/jats:p>","DOI":"10.3390\/ijerph19052677","type":"journal-article","created":{"date-parts":[[2022,2,25]],"date-time":"2022-02-25T10:00:40Z","timestamp":1645783240000},"page":"2677","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":17,"title":["Development of a Survey of Sunscreen Use and Attitudes among Adults in Two Coastal States, 2019"],"prefix":"10.3390","volume":"19","author":[{"given":"Karen","family":"Glanz","sequence":"first","affiliation":[{"name":"Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA"},{"name":"School of Nursing, University of Pennsylvania, Philadelphia, PA 19104, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pui L.","family":"Kwong","sequence":"additional","affiliation":[{"name":"Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jade","family":"Avelis","sequence":"additional","affiliation":[{"name":"Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kevin","family":"Cassel","sequence":"additional","affiliation":[{"name":"Population Sciences in the Pacific, University of Hawaii Cancer Center, Honolulu, HI 96813, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2022,2,25]]},"reference":[{"key":"ref_1","first-page":"591","article-title":"Vital signs: Melanoma incidence and mortality trends and projections\u2014United States, 1982\u20132030","volume":"64","author":"Guy","year":"2015","journal-title":"MMWR Morb. Mortal. Wkly. Rep."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"257","DOI":"10.1200\/JCO.2010.28.7078","article-title":"Reduced melanoma after regular sunscreen use: Randomized trial follow-up","volume":"29","author":"Green","year":"2011","journal-title":"J. Clin. Oncol."},{"key":"ref_3","unstructured":"National Cancer Institute (2019, March 13). Cancer Trends Progress Report, Online Summary of Trends in US Cancer Control Measures, Available online: https:\/\/www.progressreport.cancer.gov\/prevention\/sun_protection."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"83","DOI":"10.1016\/j.jaad.2015.02.1112","article-title":"Patterns of sunscreen use on the face and other exposed skin among US adults","volume":"73","author":"Holman","year":"2015","journal-title":"J. Am. Acad. Dermatol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"140","DOI":"10.1111\/bjd.16079","article-title":"How many melanomas might be prevented if more people applied sunscreen regularly?","volume":"178","author":"Olsen","year":"2018","journal-title":"Br. J. Dermatol."},{"key":"ref_6","unstructured":"(2021, November 12). State of Hawaii, Twenty-Ninth Legislature, S.B. No. 2571. A Bill for an Act Relating to Water Pollution, Available online: https:\/\/www.capitol.hawaii.gov\/Archives\/measure_indiv_Archives.aspx?billtype=SB&billnumber=2571&year=2018."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"175","DOI":"10.1007\/s10646-013-1161-y","article-title":"Toxicological effects of the sunscreen UV filter, benzophenone-2, on planulae and in vitro cells of the coral, Stylophora pistillata","volume":"23","author":"Downs","year":"2014","journal-title":"Ecotoxicology"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"265","DOI":"10.1007\/s00244-015-0227-7","article-title":"Toxicopathological Effects of the Sunscreen UV Filter, Oxybenzone (Benzophenone-3), on Coral Planulae and Cultured Primary Cells and Its Environmental Contamination in Hawaii and the U.S. Virgin Islands","volume":"70","author":"Downs","year":"2016","journal-title":"Arch. Environ. Contam. Toxicol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"967","DOI":"10.1002\/etc.4948","article-title":"A Critical Review of Organic Ultraviolet Filter Exposure, Hazard, and Risk to Corals","volume":"40","author":"Mitchelmore","year":"2021","journal-title":"Environ. Toxicol. Chem."},{"key":"ref_10","unstructured":"U.S. Food and Drug Administration (FDA) (2021, November 24). Proposed Order (OTC000008): Amending Over-the-Counter (OTC) Monograph M020: Sunscreen Drug Products for OTC Human Use, Available online: https:\/\/www.fda.gov\/drugs\/news-events-human-drugs\/otc-monograph-reform-otc-sunscreen-drugs-12152021-12152021."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"920","DOI":"10.1001\/jamadermatol.2016.2344","article-title":"Sunscreen Product Performance and Other Determinants of Consumer Preferences","volume":"152","author":"Xu","year":"2016","journal-title":"JAMA Dermatol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"339","DOI":"10.1111\/phpp.12480","article-title":"Online sunscreen purchases: Impact of product characteristics and marketing claims","volume":"35","author":"Prado","year":"2019","journal-title":"Photodermatol. Photoimmunol. Photomed."},{"key":"ref_13","unstructured":"Sushma, M. (2021, November 24). US Virgin Islands Bans Sunscreens Harming Coral Reefs. Down to Earth. Available online: https:\/\/www.downtoearth.org.in\/news\/wildlife-biodiversity\/us-virgin-islands-bans-sunscreens-harming-coral-reefs-70158."},{"key":"ref_14","unstructured":"Carreon, B. (2021, November 24). Palau Bans \u2018Reef Toxic\u2019 Sunscreen. Science X. Available online: https:\/\/phys.org\/news\/2020-01-palau-reef-toxic-sunscreen.html."},{"key":"ref_15","unstructured":"(2021, November 24). Thailand Bans Coral-Damaging Sunscreens. Science X. Available online: https:\/\/phys.org\/news\/2021-08-thailand-coral-damaging-sunscreens.html."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"217","DOI":"10.1001\/archdermatol.2007.46","article-title":"Measures of sun exposure and sun protection practices for behavioral and epidemiologic research","volume":"144","author":"Glanz","year":"2008","journal-title":"Arch. Dermatol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"63","DOI":"10.1016\/j.amepre.2008.09.012","article-title":"Validity of self-reported sunscreen use by parents, children, and lifeguards","volume":"36","author":"Glanz","year":"2009","journal-title":"Am. J. Prev. Med."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"103875","DOI":"10.1016\/j.marpol.2020.103875","article-title":"Sunscreen use and awareness of chemical toxicity among beach goers in Hawaii prior to a ban on the sale of sunscreens containing ingredients found to be toxic to coral reef ecosystems","volume":"117","author":"Levine","year":"2020","journal-title":"Mar. Policy"},{"key":"ref_19","unstructured":"Nunnally, J.C. (1970). Introduction to Psychological Measurement, McGraw Hill."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"53","DOI":"10.5116\/ijme.4dfb.8dfd","article-title":"Making sense of Cronbach\u2019s alpha","volume":"2","author":"Tavakol","year":"2011","journal-title":"Int. J. Med. Educ."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"159","DOI":"10.2307\/2529310","article-title":"The measurement of observer agreement for categorical data","volume":"33","author":"Landis","year":"1977","journal-title":"Biometrics"},{"key":"ref_22","unstructured":"(2021, September 15). Statistical Analysis Software V 9.4. SAS Institute: Cary, NC, USA. Available online: www.sas.com."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"735","DOI":"10.2105\/AJPH.2008.155705","article-title":"A randomized trial of tailored skin cancer prevention messages for adults: Project SCAPE","volume":"100","author":"Glanz","year":"2010","journal-title":"Am. J. Public Health"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"344","DOI":"10.1177\/109019819902600305","article-title":"Factors Associated with Skin Cancer Prevention Practices in a Multiethnic Population","volume":"26","author":"Glanz","year":"1999","journal-title":"Health Educ. Behav."},{"key":"ref_25","unstructured":"Hughes, T. (2019, August 22). There\u2019s Insufficient Evidence Your Sunscreen Harms Coral Reefs. The Conversation. Available online: https:\/\/theconversation.com\/theres-insufficient-evidence-your-sunscreen-harms-coral-reefs-109567."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"266","DOI":"10.1016\/j.jaad.2018.06.033","article-title":"Review of environmental effects of oxybenzone and other sunscreen active ingredients","volume":"80","author":"Schneider","year":"2019","journal-title":"J. Am. Acad. Dermatol."}],"container-title":["International Journal of Environmental Research and Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1660-4601\/19\/5\/2677\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T22:27:21Z","timestamp":1760135241000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1660-4601\/19\/5\/2677"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,2,25]]},"references-count":26,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2022,3]]}},"alternative-id":["ijerph19052677"],"URL":"https:\/\/doi.org\/10.3390\/ijerph19052677","relation":{},"ISSN":["1660-4601"],"issn-type":[{"value":"1660-4601","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,2,25]]}}}