Table 1

 Summary of results from studies on recreation, vacation, and/or occupation sun exposure during childhood and adolescence and melanoma skin cancer

First author (reference), year, locationStudy designAssessment of sun exposure and comparisonCritical age periods investigatedRR/OR (95% CI)Adjusted RR/OR (95% CI)Comments
No. cases/controls
Recreation, vacation, and/or occupation
Paffenbarger,52 1978, USARetrospective cohort
>45/180		Outdoor employment (yes v no)Prior to college3.9 (N/A)N/APurpose of study to generate hypotheses
Lew,68 1983, USACase-control
>111/107		Length of vacation in sunny places (⩾30 days v <28 days)Childhood2.5 (1.1–5.8)N/ANo adjustment for confounders
Green,36 1986, AustraliaCase-control
>153/154		Total hours of sun exposure (⩾5000 v <500)Childhood
>Adolescence
>(age 10–19 y)		1.8 (N/A)4.4 (1.8–184.5)Adjusted for age and nevi
Holman,45 1986, AustraliaCase-control
>507/507		Outdoor exposure proportion (⩾60% v <29%)Childhood
>Adolescence
>(age 10–24 y)		N/A1.57 (0.87–2.83)Limited to SSM; adjusted for acute, chronic skin reaction, hair colour, origin, and age at arrival
Weinstock,69 1991, USANested case-control
>130/300		Swimsuit use outdoors (most v least frequent use)Adolescence
>(age 15–20 y)		N/A3.5 (1.3–9.3) (sun-sensitive)Adjusted for age, sun sensitivity, and latitude of residence
0.3 (0.1–0.8) (sun-resistant)
Zanetti,70 1992, ItalyCase-control
>260/416		Beach holidays (1–59 weeks v zero)Childhood
>Adolescence		N/A2.8 (1.6–4.6)Adjusted for sex and age
Nelemans,60 1993, NetherlandsCase-control
>141/183		Sunbathing (yes v no)Adolescence
>(age 15–25 y)		N/A3.00 (1.43–6.30) (indoor worker)Adjusted for age, sex, education, tendency to burn, hair colour, and freckling. Effect modification apparent: increased risk in sun sensitive individuals
0.76 (0.32–1.80) (outdoor worker)
Nelemans,601993, NetherlandsCase-control
>141/183		Water sports (yes v no)Adolescence
>(age 15–25 y)		N/A2.20 (0.75–6.49) (indoor worker)Adjusted for age, sex, education, tendency to burn, hair colour, and, freckling. Effect modification apparent: increased risk in sun sensitive individuals
2.61 (0.65–10.49) (outdoor worker)
Nelemans,60 1993, NetherlandsCase-control
>141/183		Vacations in sunny countries (yes v no)Adolescence
>(age 15–25 y)		N/A2.44 (1.09–5.42) (indoor worker)Adjusted for age, sex, education, tendency to burn, hair colour, and, freckling. Effect modification apparent: increased risk in sun sensitive individuals
0.77 (0.31–1.93) (outdoor worker)
White,62 1994, USACase-control
>256/273		Sun exposure index (based on days of sun exposure and amount of clothing worn for protection) high v lowChildhood
>(age 2–10 y)		N/A0.30 (0.17–0.55) (childhood)Limited to “deep/moderate tanners”; adjusted for age, sex, and education; dose response effect
Adolescence
>(age 11–20 y)		0.31 (0.16–0.59) (adolescence)
Nelemans,71 1994, NetherlandsCase-control
>128/168		Swimming pools v noneChildhood
>Adolescence (age <15 y)		3.11 (1.66–5.75) (swimming pools)2.20 (1.05–4.62) (swimming pools)Adjusted for age, gender, education, hair colour, freckling, tendency to burn, and sunlight exposure
Open waters v none2.24 (1.11–4.52) (open waters)2.41 (1.04–5.58) (open waters)
Walter,61 1999, CanadaCase-control
>583/608		Days of outdoor activity (>100 v ⩾100)Adolescence
>(age 10–20 y)		0.67 (0.53–0.85)0.67 (0.52–0.85)Adjusted for age, gender, and skin reaction to sun
Walter,61 1999, CanadaCase-control
>583/608		Beach vacations (yes v no)Age 12 y1.63 (1.29–2.07)1.67 (1.31–2.12)Adjusted for age, gender, and skin reaction to sun
Age 18 y1.26 (0.98–1.63)1.29 (1.00–1.67)
Kaskel,72 2001, GermanyCase-control
>271/271		Outdoor activities (at least one of walking, playing soccer, cycling, athletics, or gardening v none)Childhood
>(age ⩽12 y)		N/A0.3 (0.1–1.1)Adjusted for age, gender and residence