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Over the past 20 years, we have become very familiar with the Australian original sun protection strategy of Slip-Slop-Slap. Many of our children in Australia can still sing the song: Slip on a shirt, Slop on the sunscreen, Slap on a hat. The newer version is now: Slip on a shirt, Slop on the sunscreen, Slap on a hat, Seek shade or shelter, and Slide on some sunnies. While many of us know the need to protect ourselves from the sun, our knowledge does not translate into behavior.[1] Similar to many other health behaviors, we tend to know what to do, but we do not do it. As Rodriguez and colleagues point out in their article in this issue, skippers of rental boats revealed that they and the renters had quite good knowledge of sun protection, yet they had perfectible behavior.[2]

Sun protection continues to be an issue for many countries, including Australia. Recent epidemiological data demonstrate the continued increase in the incidence of new skin cancers.[3, 4] In their review, in this issue, Diaz and Nesbitt provide a review of the literature and point out the increase in skin cancer rates.[5] This has occurred during a period when individuals would have then been introduced to Slip-Slop-Slap campaigns as a youth.[6] This increase in skin cancer, including melanoma, demonstrates what we may be aware of as health professionals regarding the lack of prevention by individuals.

Individuals, including youth and young adults, have increased exposure to the sun during holidays. The incidence of sunburns has been reported to increase during holidays as many people travel from cooler to sunnier climates. As Rodriguez and colleagues state, passengers who hired the skipper boats frequently suffer serve sunburns.[2] Previous work in Australia has found an increase in sunburn for those traveling from temperate Victoria to tropical Queensland for holidays.[7] This was also found in a study of university students in America. These individuals tend to normally wear long-sleeve shirts and long pants to keep them warm from the cold.[8] On holiday, this clothing pattern is reversed, exposing to the sun skin that has been protected. Many men will go shirtless.[9] Yet, a loosely woven shirt not only provides protection but may also make you feel cooler.[10]

One of the main agendas when on holidays from a cold to warm climate is to come back looking tanned.[9] While this is understandable, as soon as the skin turns the shade of pink or red, damage has occurred, and the number of sunburns has been identified as a risk factor for developing melanoma and nonmelanoma skin cancer.[11] One very popular idea is that getting a spray tan prior to sunbathing can prevent sunburn. This is incorrect, and patients need to understand that this is a myth.[12, 13]

Diaz and Nesbitt's recommendation is identical to general sun protection strategies, but specific to traveling.[5] They go on to indicate the special populations and types of activities that need to be considered when making recommendations to patients.

Preparing to be sun safe is generally not at the top of many people's minds as they prepare for their holiday. Going to a cold climate, one is very aware of the need to pack enough clothes to be warm, but remembering to pack sunscreen, a hat, and even sunglasses is not as obvious when going on a holiday to a warm, sunny climate. The holiday period is even more important to practice sun safe behaviors as most holidays require extended exposures to the sun.[14]

It is also more difficult to travel in planes and cars with a hat, than with a coat. Most winter coats can be compacted and shoved into the overhead compartment on a plane or train. Unfortunately, most hats cannot be treated with the same casualness. Anyone who has ever traveled with a wide-brimmed hat on a plane can attest that if there is room to store a hat, the next person will almost always shove a briefcase or package on top of it!

Today, when traveling in many parts of the world, sunscreen can be obtained at the chemist, pharmacy, or grocery store. Some enlightened hotels stock small sachets of sunscreen in the minibar that you can purchase. While hats are difficult to travel with, umbrellas are something that you can pack in or buy at your destination. Unfortunately, in most cultures outside of some Asian countries, walking around with an umbrella on a sunny day is not a preferred way of practicing sun protection, but should be recommended to your patients to be considered as an option.

It all starts when a travel clinic, general practitioner, or specialist is aware that their patient is going on a holiday or traveling for any reason. It is the perfect time, during the injection of a required immunization, to discuss sun protection, similar to other preventative strategies that we would use, for example, for malaria. The use of sun protection by all patients needs to be in the forefront of their thinking as they plan their holidays. When the clinician finds out that a patient is traveling, whether they are at their current visit for that reason or not, it is an ideal opportunity to remind the patient to travel sun smart.

Declaration of Interests

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The author states that he has no conflicts of interest.

References

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  2. Declaration of Interests
  3. References