More Skin, More Sun, More Tan, More Melanoma
Attitudes and behaviors shape exposures. We have used a multidisciplinary approach including socioeconomic factors, such as more revealing fashion styles, social norms encouraging the desirability of tanned skin, medical paradigms first promoting the benefits of but then warning against the dangers of UV radiation, and increased outdoor recreational activities, to elucidate the evolution of behaviors maximizing UV exposure. Although causation cannot be made in an analysis such as this one, we have provided a historical framework for the changing attitudes promoting increased UV exposure and the rising incidence of melanoma throughout the past century. Although changes in UV exposure may have occurred at different rates in different subpopulations, the overall effect encompassed a broad cultural change that diffused across the entire US population over time. The desire to be tan, which has its roots in the medical profession, retains its popularity today despite evidence linking UV exposure to skin cancer. How public health measures will positively affect long-term melanoma incidence rates remains to be seen.
More broadly, the approach used in this analysis (i.e., studying the attitudes and behaviors that drive public health issues) also could be applied to areas such as tobacco cessation, alcohol use, and obesity. Identifying the roles of cultural and historical forces (including gender and social class differences) that contribute to the growth and persistence of public health problems may help target interventions to affect disease epidemiology in a positive fashion.
Conclusions
Attitudes and behaviors shape exposures. We have used a multidisciplinary approach including socioeconomic factors, such as more revealing fashion styles, social norms encouraging the desirability of tanned skin, medical paradigms first promoting the benefits of but then warning against the dangers of UV radiation, and increased outdoor recreational activities, to elucidate the evolution of behaviors maximizing UV exposure. Although causation cannot be made in an analysis such as this one, we have provided a historical framework for the changing attitudes promoting increased UV exposure and the rising incidence of melanoma throughout the past century. Although changes in UV exposure may have occurred at different rates in different subpopulations, the overall effect encompassed a broad cultural change that diffused across the entire US population over time. The desire to be tan, which has its roots in the medical profession, retains its popularity today despite evidence linking UV exposure to skin cancer. How public health measures will positively affect long-term melanoma incidence rates remains to be seen.
More broadly, the approach used in this analysis (i.e., studying the attitudes and behaviors that drive public health issues) also could be applied to areas such as tobacco cessation, alcohol use, and obesity. Identifying the roles of cultural and historical forces (including gender and social class differences) that contribute to the growth and persistence of public health problems may help target interventions to affect disease epidemiology in a positive fashion.