Impact of Unit-Dosing of Sunscreen on Adherence at Golf Tournaments

Sun exposure—both mild and intense—can lead to non-melanoma skin cancers. ¹ Sunscreen may prevent skin damage, but adherence is low due to inconvenience of sunscreen application, leading to infrequent use. ^{2 -4} Providing consumers with sunscreen in unit-dose packaging might be an effective tool to improve use of sunscreen. Advancements in packaging of other medical treatments, such as oral contraceptives, allow patients to track their daily doses of medication. With these packaging methods, patients rarely miss doses and improve the outcome of their treatment. ⁵ In this study, we monitored sunscreen use in golfers. Our objective was to test the hypothesis that participants given sunscreen in unit-dose packages to be used at specified times would use more sunscreen than participants given sunscreen in a standard full sized, variable-dose bottle.

The study was conducted at golf courses in Winston-Salem, North Carolina, and the surrounding area. Eligible participants were 18 years old or older. Individuals were excluded if they were allergic to sunscreen or its ingredients, had lesions on the arms, were taking medications that increased photosensitivity, or already applied sunscreen. Participants completed a questionnaire regarding skin history, demographics, and sunscreen use. Participants were randomized between two groups. Group 1 received two unit-dose containers of zinc oxide-based sunscreen (SPF 30) weighing ~7 grams (g). Group 2 received one full-sized bottle of the same sunscreen weighing ~113 g. Participants applied the sunscreen to the face, neck, and arms prior to the first and tenth holes of golf. Bottles were weighed before administration and after finishing their round of golf.

Eighty-four participants participated in the study. Eleven participants did not return the sunscreen. Participants ranged from 24 to 78 years old (Supplemental Table 1). Most individuals were of White ethnicity (n = 60, 72%); 5 (6%) were Hispanic/Latino. Fifty-nine (70%) participants stated that sunscreen was necessary for their skin type; 35 participants (42%) reported that their skin burns moderately. Twenty-nine participants were randomized to the unit-dose group, and 44 were randomized to the variable dose group.

Participants randomized to the unit-dose package group used less (1.6 ± 1.7 g) sunscreen than participants in the variable-dose group (10.7 ± 12.0 g, P < .05). Two (7%) participants randomized to the unit-dose group and twenty-one (48%) participants randomized to the variable-dose group used at least 7 g of sunscreen. No participants reported sunburn at the end of the study (Supplemental Table 2).

Providing sunscreen in unit-dose packaging did not improve use in golfers. Participants randomized to the full sized, variable-dose bottle group used a greater amount of sunscreen than those randomized to the unit-dose packaging group. We anticipated that unit-dose packaging would promote better use of sunscreen, but it did not. Individuals use more topical medication when the medication is provided in a larger container. Limitations to this study include difficulty retrieving the sunscreen bottles at the end of each participant’s round of golf. We cannot exclude that a unit-dosed size one-time use container (one without a re-closable top that permits multiple uses) might better encourage optimal sunscreen use.