Dermatology Research and Practice / 2018 / Article / Tab 1

Review Article

Skin Cancer Knowledge, Attitudes, and Practices among Chinese Population: A Narrative Review

Table 1

Summary of included studies.

First author, date, and locationData collection method, sample size , gender, and ageKnowledge, attitudes, and beliefs Skin cancer prevention practice

Cheng, 2008, and Beijing [21]Questionnaire, (patients and hospital staff) 424 females, mean age = 37 years (SD = 27.5), age range = 14–72 years49.3% knew that sunscreen could protect people from both UVA and UVB radiation
Groups within the populations of males, middle-aged, elderly, low-education, and people with skin phototype I and II had misunderstandings of sunscreen’s recognition and application
Sunscreen application
Use sunscreen very often: 40%
Reapply sunscreen in burning sun: 43.3%

Yang, 2009, and Nanjing [15]Direct observation, (dermatologists, 28 attending, 11 residents), 21 females, mean age = 35.3 years, age range = 27–48 years
(photosensitive patients), 23 females, mean age = 49 years, age range = 19–72
Fluorescent agent detection according to skin site
Dermatologists:
Hairline of forehead = 51.3%, forehead = 92.3%, temples = 74.4%, cheek = 100%, nose = 92.3%, perioral = 82.1% (male = 61% female = 100%  ), ears, neck, hands, and wrists: 0%
Photosensitive patients:
Hairline of forehead = 36.6%, forehead = 100%, temples = 41.5% (male = 28% female = 57%  ), cheek = 100%, nose = 75.6%, perioral = 73.2%, ears = 2.4%,
neck = 0%, hand and wrists = 4.9%
Density of fluorescent agent (mg/cm2)
Dermatologists:
Hairline of forehead: male = 0.5 (SD = 0.31), female = 0.5 (SD = 0.38), forehead: male = 1.0 (SD = 0.38), female = 1.5 (SD = 0.02), temples: male = 0.5 (SD = 0.41), females = 1.0 (SD = 0.29), cheek: male = 1.0 (SD = 0.29), female = 1.0 (SD = 0.25), nose: male = 0.5 (SD = 0.35), female = 1.0 (SD = 0.21), perioral: male = 0.5 (SD = 0.32), female = 1.0 (SD = 0.17), ears: 0%
Neck/V area of the chest = 0%, Hand and wrist: 0%
Photosensitive patients:
Hairline of forehead: male = 0.5 (SD = 0.47), female = 0.5 (SD = 0.44), forehead: male = 1.0 (SD = 0.33), female = 1.5 (SD = 0.36), temples: male = 0.5 (SD = 0.27), female = 0.2 (SD = 0.31), cheek: male = 1.0 (SD = 0.28), female = 1.0 (SD = 0.23), nose: male = 0.5 (SD = 0.26), female = 0.5 (SD = 0.35), perioral: male = 0.5 (SD = 0.36) female = 0.5 (SD = 0.25), ears: 0%
Neck/V area of the neck: 0%, Hand and wrist: male = 0.1, female = 0
Sunscreen cream application
Dermatologists:
28.2% put cream on the tip of finger
71.8% put cream in the palm of the hand and rubbed the hands together before applying to target skin sites
Photosensitive patients:
17.1% put cream on the tip of finger
82.9% put cream in the palm of the hand and rubbed the hands together before applying to target skin sites

Cheng, 2010, and Beijing [11]Questionnaire, (volunteers), 61.8% female, mean age = 24.6 (SD = 6.7), age range = 18–60 yearsTotal knowledge score of types of UV that can damage the skin = 29.7%, men = 12.6%, women = 40.3%
Total knowledge score that people should take precautions from the sun in the morning or at nightfall = 73.0%, men = 58.4%, women = 82.1%
Total knowledge score that people should take precautions from the sun on a cloudy day = 58.8%, men = 44.5%, women = 67.5%
Total knowledge score that UV-induced skin damage is accumulative = 80.3%, men = 71.4%, women = 85.7%
Meaning of SPF total knowledge score = 61.2%, men = 51.3%, women = 67.3%
Meaning of PA total knowledge score = 34.4%, men = 31.5%, women = 36.1%
Know how to use sunscreen correctly 74.2%, men = 58.8%, women = 83.6%
Awareness score of what types of skin damage the sun causes: burn (total = 81.2%, men = 70.2%, women = 88.1%), skin cancer (total = 79.3%, men = 73.1%, women = 83.1%), tan (total = 52.0%, men = 40.8%, women = 59.0%), skin aging (total = 65.8%, men = 53.8%, women = 73.3%), blemishes (total = 73.4%, men = 60.9%, women = 81.0%), do not know (total = 2.4%, men = 5.0%, women = 0.8%)
Sunscreen = 58.8%, men = 28.2%, women = 77.7%
Protective clothing = 49.3%, men = 59.7%, women = 42.9%
Hat = 42.2%, men = 39.5%, women = 43.9%
Parasol (sun umbrella) = 45.4%, men = 14.3%, women = 64.7%
Sunglasses = 45.3%, men = 42.9%, women = 46.8%
No protection = 9.0%, men = 16.4%, women = 4.4%
Have ever used sunscreen before = 80.3%, men = 59.2%, women = 93.2%
Correct sunscreen use among those who have ever used sunscreen before = 45.0%, men = 14.9%, women = 56.8%
Mean SPF value of sunscreen used = 27.7 (SD = 9.2), men = 30.7 (SD = 11.2), women = 26.7 (SD = 8.2)
Mean Protection Grade (PA) value of sunscreen used = 2.3 (SD = 0.6), men = 2.6 (SD = 0.7), women = 2.3 (SD = 0.6)

Fan, 2012, and Hefei [22]Questionnaire, (freshmen military cadets), 1488 males, mean age = 20.35 (SD = 2.13), age range = 15–2978.8% and 81.7% of the subjects did not know that the UV consists of three parts and the meaning of the PA and SPF, respectively.Sunscreen: 61.6%
Long-sleeved clothing and pants: 48%
Umbrella and hat: 61.8%
Sunglasses: 63.8%
32.7% had been taken protective measures, and only 50 cases did a professional skin examination.

He, 2012, and Beijing and Ningxia [23]Questionnaire, (all females) 66.4% females from Beijing and 33.6% from Ningxia, mean age = 32 years (SD = 9.7), age range = 17–59 yearsDespite the difference in cognition degrees between the two groups, both groups have high degrees of cognition on the damage of UV to skin
Both groups have low basic UV knowledge
24.9% of the two groups have correct knowledge about types of UV
22.6% of the participants were aware that sun protection should be started as early as in one’s infancy
People get access to knowledge of sunburn and sun protection from the same sources: television 40.2%, magazines 27.6%
27.6% knew the meaning of SPF
6.3% knew the mean of PA
Walking in shadows: 63.6%
Avoiding going out at noon: 60.8%
Sunscreen: 62.2%
Wearing long-sleeved t-shirts: 18.4%
Hats: 26.7%
Umbrellas: 53%
Sunglasses: 30.9%

Yan, 2015, and Shanghai [12]Questionnaires, (residents), 53.2% females, mean age = 43.2 years and age range = 20–60 yearsKnowledge about UV-induced risk by gender
Premature aging: male = 59.7%, female = 73.3%
Immune suppression: male = 47.8%, female = 58.5%
Skin cancer: male = 50.3%, female = 59.5%
Sun protection attitudes by gender
Need sun protection in winter: male = 27.8%, female = 43.1%
Need sun protection indoors or in the vehicle: male = 21.9%, female = 32.6%
Tanning attitudes by gender
Appears healthy: male = 11%, female = 10.2%
Looks attractive: male = 5.7%, female = 4.3%
Not favorable: male = 13.7%, female = 38.1%
Sun exposure behavior by gender
Avoid outdoor actives in strong sunlight: male = 71.2%, female = 82%
Avoid extensive exposure in sunny midday:
male = 72.2%, female = 84.2%
Average daily sun exposure time (min) by gender
7AM–5PM: male = 111.8 (SD = 105.7), female = 82.2 (SD = 64.7)
10AM–2PM: male = 31.1 (SD = 45.1), female = 20.1 (SD = 28.9)
21.3% of the participants have applied sunscreen with 93.3% of respondents female

Zhou, 2015, and Nanjing [13]Questionnaire, (college students) standard care group = 126, self-regulation group = 127, 97.6% females, mean age = 21.26 years (SD = 1.34), and age range = 18–24 yearsIntention to use sunscreen mean score
Standard care group: 2.64 (SD = 1.41)
Self-regulation group: 2.71 (SD = 1.09)
Sunscreen action planning mean score
Standard care group: 1.79 (SD = 0.89)
Self-regulation group: 1.87 (SD = 0.86)  
Sunscreen coping planning mean score
Standard care group: 1.83 (SD = 0.90)
Self-regulation group: 1.74 (SD = 0.81)
Mean sunscreen use:
Standard care group: 1.77 (SD = 1.15)  
Self-regulation group: 1.95 (SD = 1.21)

Zhou, 2016, and Nanjing [24]Questionnaire, (medical students), 73.2% femalesMean knowledge score of men = 2.41 (SD = 1.51) and women = 2.56 (SD = 1.38) out of maximum total score of 6, no gender difference among scores
Highest rate of correct responses 68.0%, lowest rate 9.6%
Students that thought sun exposure was enough = 67.5%
Students with negative sun exposure response = 32.5%
Most common reasons among 44 male students for inadequate sun exposure: 43.2% avoiding dark skin, 18.2% no desire to go out, 13.6% skin cancer
Most common reasons among 124 female students for inadequate sun exposure: 75.0% avoiding dark skin, 16.1% skin cancer, 12.1% accelerated aging
Student knowledge of Vitamin D obtained from:
media = 59.9%, health professionals = 43.3%, classmates and friends = 25%, parents = 8.8%
68% of students correctly knew that the human body can get vitamin D through sun exposure
3.0% of students had no desire to learn about vitamin D
Female students had greater desire to learn compared to male students (88.3% versus 78.5%)
Male students had greater indifferent attitude than female students (18.5% versus 8.7%)
Most students lacked sun exposure because they did not want to get tan
Length of sun exposure:
<15 mins/d = 6.8%
15–30 mins/d = 31.8%
30–45 min/d = 27.4%
Not in sun for >45 min/day = 34.0%
82.7% of students used some sun protections
Frequency of sun protection use
Never: male = 49.3%, female = 5.6%
Rarely: male = 29.4%, female = 23.0%
Sometimes: male = 13.2%, female = 36.1%
Often: male = 8.1%, female = 30.2%
Always: male = 0%, female = 5.1%
Types of sun protection
Sunscreen: male = 33%, female = 75%
Hats; male = >50%, female = 42%
Umbrellas: male = 20%, female = 72%

Wan, 2016, and Guangzhou City [14]Questionnaire, (parents/guardians and their children), 51.6% male children, children mean age = 7.70 years (SD = 2.78), children age range = 3–13 years, mean rent/guardian age = 36.72 years (SD = 5.95), 70.5% femaleReasons why parents supported their children in preventing sun exposure: 50.9% protecting from suntan, 75.6% protecting from sunburn, 15.3% preventing skin photoaging, 4.9% unclear, 3.1% other
Reasons why parents did not support their children in preventing sun exposure: 23.2% UV is beneficial to the child’s skin, 11.7% UV is no harm to the child’s skin, 30.7% benefits of UV to the child’s skin are greater than its harm, 52.5% the child’s skin does not need sun protection
Parent’s opinions on using a different sunscreen for children than for parents:
69.7% the child’s skin is different from the parent’s skin, 27.7% the child’s skin is easily allergic, 2.6% other
Parent’s opinions on the nonuse sunscreen for children:
44.4% sunscreen is not suitable for children, 27.9% do not know how to choose the sunscreen for children, 28.2% use alternative sun protection methods, 44.3% worried that the child’s skin is allergic to sunscreen, 9.2% other
Sources of sun protection information for increasing parents/guardians knowledge: 52% television advertisements 37.6% newspapers, 37% magazines, 31.1% friends, 28.2% books, 17.5% beauty parlors, 16.2% family members, 12.4% radio advertisements, 10.3% relatives, 10% dermatologist, 12.5% others
Mean time spent in the sunshine per day:
<2 h: 49.8%, male = 47.7%, female = 52.1%
2–4 h: 43.9%, male = 44.6%, female =
43.1%
>4 h: 6.3%, male = 7.7%, female = 4.8%
Weather in which protective measures were taken:
Sunny day: 93.6%
Cloudy day: 8.3%
Rainy day: 8.4%
Cloudy to sunny day: 17.5%
Occasions for sun protection:
Travel: 57.8%
Outdoor leisure activities: 56.4%
Swimming: 36.5%
Playing ball: 16.1%
Physical education: 9.8%
Others: 3.2%
Stayed under shade: 12.8%, male = 12.3%, female = 13.4%
Sunscreen: 38.2%, male = 30.2%, female = 46.6%
Long-sleeved shirt: 27.6%, male = 23.8%, female = 31.7%
Hat: 61.9%, male = 60.7%, female = 63.2%
Umbrella: 53.2%, male = 40.8%, female = 66.4%
Sunglasses: 26.8%, male = 25%, female = 28.7%

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