rity of the data and the accuracy of the data analysis. Study concept and design: Parker and Kirsner. Acquisition of data: Parker and Kirsner. Analysis and interpretation of data: Yin, Atlantic Ocean Parker, Hu, and Kirsner. Drafting of the manuscript: Yin and Parker. Critical revision of the manuscript for important in- tellectual content: Hu and Kirsner. Obtained funding: Kirsner. N Administrative, technical, and material support: Parker and W E Kirsner. Study supervision: Kirsner. S Financial Disclosure: None reported. Funding/Support: This study was supported by the Cen- ters for Disease Control and Prevention. Role of the Sponsors: The sponsors had no role in the design and conduct of the study; in the collection, analy- sis, and interpretation of data; or in the preparation, re- view, or approval of the manuscript. Hispanic population, % 9.5-35.2 1. Rouhani P, Hu S, Kirsner RS. Melanoma in Hispanic and black Americans. 35.3-50.4 Cancer Control. 2008;15(3):248-253. 2. Kirsner RS. Cancer among indigent populations in Miami-Dade County: fi- 50.5-69.2 nal report to the American Cancer Society, Florida Division, Inc. http://sfccc 69.3-92.4 .med.miami.edu/sfccc/FCCCIDownload/MiamiDadeZipCodeReportAug05 .pdf. Accessed July 30, 2010. Late-stage diagnoses, % 3. Sylvester Comprehensive Cancer Center; Florida Department of Health. 0 Florida Cancer Data System. http://fcds.med.miami.edu/inc/idea.shtml#. Ac- 0.1-12.9 cessed July 30, 2010. 4. National Cancer Institute. SEER Summary Stage 2000: melanoma of the skin, 13.0-23.1 vulva, penis and scrotum staging. http://training.seer.cancer.gov/melanoma 23.2-44.4 /abstract-code-stage/staging.html. Accessed July 30, 2010. Key Largo 5. Wang F, McLafferty S, Escamilla V, Luo L. Late-stage breast cancer diagno- sis and health care access in Illinois. Prof Geogr. 2008;60(1):54-69. Figure. Distributions of late-stage melanoma diagnoses and Hispanic 6. Ng E, Wilkins R, Perras A. How far is it to the nearest hospital? Calculating population by zip code, Miami–Dade County, Florida, 1997 through 2001. distances using the Statistics Canada Postal Code Conversion File. Health Rep. 1993;5(2):179-188. vious findings1 that Hispanics perceive themselves at lower 7. Parker EB, Campbell JL. Measuring access to primary medical care: some examples of the use of geographical information systems. Health Place. 1998; risk of developing melanoma, even after skin cancer risk 4(2):183-193. factors including skin type are controlled for. Hispanics 8. Knapp KK, Hardwick K. The availability and distribution of dentists in ru- also are less knowledgeable about melanoma, less likely ral ZIP codes and primary care health professional shortage areas (PCHPSA) ZIP codes: comparison with primary care providers. J Public Health Dent. 2000; to perform self-examinations, and often unaware of the 60(1):43-48. clinical signs of skin cancer; they have worse outcomes. 9. US Census Bureau. Your gateway to Census 2000. http://www.census.gov /main/www/cen2000.html. Accessed July 30, 2010. The worse outcomes are to result from issues of health 10. Lazarus W, Foust B, Hitt B; Florida Agency for Health Care Administration. care delivery, but the possibility exists that melanomas The Florida Health Insurance Study: Small Area Analysis. Tallahassee, FL: State in Hispanics may be more biologically aggressive. The of Florida Agency for Health Care Administration; 2000. 11. US Census Bureau. Summary file 3. http://www.census.gov/census2000 exact reasons underlying the correlation between geo- /sumfile3.html. Accessed July 30, 2010. graphic clustering of late-stage melanoma diagnoses and 12. Kulldorff M, Feuer EJ, Miller BA, Freedman LS. Breast cancer clusters in the Hispanics are not yet known and would be important to northeast United States: a geographic analysis. Am J Epidemiol. 1997;146 (2):161-170. investigate in future studies. 13. Eide MJ, Weinstock MA, Clark MA. Demographic and socioeconomic pre- dictors of melanoma prognosis in the United States. J Health Care Poor Natalie Yin, BS Underserved. 2009;20(1):227-245. Dorothy F. Parker, MHS Shasa Hu, MD Robert S. Kirsner, MD, PhD ONLINE FIRST Accepted for Publication: November 8, 2010. Lack of UV-A Protection Published Online: January 17, 2011. doi:10.1001 in Daily Moisturizing Creams /archdermatol.2010.412 Author Affiliations: Department of Dermatology and Cu- rotection from excessive UV exposure is an impor- taneous Surgery (Ms Yin and Drs Hu and Kirsner), Syl- tant step in preventing skin cancer and photoag- vester Comprehensive Cancer Center, Disparities and P ing. Motivated by the anti-aging benefits associ- Community Outreach Core (Ms Parker and Drs Hu and ated with photoprotection, most daily facial cream products Kirsner), University of Miami Miller School of Medi- (day creams) include UV filters. These products display the cine, Miami, Florida. sun protection factor (SPF) on the label and claim to have Correspondence: Dr Kirsner, Department of Dermatol- ogy and Cutaneous Surgery, University of Miami Miller See Practice Gaps School of Medicine, 1600 NW 10th Ave, RMSB, Room at end of letter 2023-A, Miami, FL 33136 ([email protected]). Author Contributions: Dr Kirsner had full access to all of broad-spectrum UV-B and UV-A coverage. Currently, there the data in the study and takes responsibility for the integ- is no regulatory guideline on the testing and labeling of UV-A ARCH DERMATOL/ VOL 147 (NO. 5), MAY 2011 WWW.ARCHDERMATOL.COM 618 ©2011 American Medical Association. All rights reserved. Downloaded From: https://jamanetwork.com/ on 09/29/2021 Table. Description of the 29 Sunscreen-Containing Day Creams Studieda Active Ingredients, % UV-B/UV-A2 Protection UV-A1/Broad-Spectrum Protection Product Price/ Titanium Zinc No. SPF oz, $ Homosalate Octinoxate Octisalate Octocrylene Oxybenzone Dioxide Ensulizole Avobenzone Oxide Ecamsule 1b 15 8.81 10 2 2 2b 15 3.00 10 3 3 15 64.71 7.5 4 4 25 8.35 6 7.5 1.5 3 5 15 1.88 3 5 2.6 3 6 15 5.20 7.5 5 7b 15 11.76 10 2 2 8 15 3.75 7.5 2 3 9b 15 9.00 2.55 3 10 15 2.34 7.5 5 3 11 15 4.81 7.5 2 3 12b 30 13.71 2.5 6.5 13 15 10.48 6.7 2.7 4.5 14b 30 8.23 3 3.9 15b 30 7.29 7.5 7.5 2 1.9 16 15 7.60 4 1.25 1 2 17 15 3.23 12 5 2.7 3 18 15 27.06 7 8.5 19b 50 16.00 7.5 7 5.3 20 15 15.00 7 3 3 1 21 30 7.64 12 5 1.7 3 3 22 15 11.76 7.5 2 2 3 23 15 11.76 4 1 1 2 24b 20 12.00 7 4 2 25 30 7.20 12 5 1.7 3 3 26 15 17.64 7.5 2 2 3 27 15 14.05 4 1 1 2 28 15 3.89 7.5 4 3 29b 30 5.75 7.5 5 7 Abbreviation: SPF, sun protection factor. a Blank table cell indicates that the product did not contain the ingredient. b Product with adequate UV-A protection. protection in sunscreens, and likewise, the degree of UV-A ents with UV-A1 protection. Seven of the 23 products protection in these day creams is unknown. In this study, contained zinc oxide, but only 3 products contained con- we report the estimated long-range UV-A1 (340 to 400 nm) centrations greater than 5%. Sixteen products con- protection in popular day creams. tained avobenzone, but only 3 (products 1, 2, and 7) had the adequate concentration of octocrylene (Ͼ3.6%) to Methods. Twenty-nine facial day creams with claims of prevent photodegradation of avobenzone. Seven (prod- broad-spectrum UV coverage were selected on the basis ucts 5, 16, 17, 21, 23, 25, and 27) of the 16 avobenzone of their sales volume reported on the Web site www products had very low concentrations of octocrylene .amazon.com. The UV-A protection is estimated based (mean concentration, 1.7%), and 6 of the 16 (products on the concentration and types of UV filters in the prod- 8, 11, 22, 26, and 28) contained octinoxate. ucts. The criteria for assessing products with adequate The degree of UV-A protection does not correlate with UV-A1 protection are (1) the combination of avoben- the price of the product. In fact, product 3, the most ex- zone (Ͼ2%) and octocrylene (Ͼ3.6%), with or without pensive product contained no UV-A1 filter. ecamsule (2%) and/or (2) the presence of zinc oxide (Ͼ5%). These criteria were chosen based on previous Comment. Day creams with sunscreens need to provide work in analyzing degree of UV-A protection in sun- UV-A1 protection. Many consumers, especially women, screens via an in vitro assay.1,2 apply these products on their face as the only source of sunscreens. Unaware that the SPF value does not reflect Results. The SPF values and UV ingredients of the 29 tested the degree of UV-A protection, consumers using these products are listed in the Table. The label SPF values products believe they are fully protected from the entire ranged from 15 to 50, and the price of these products ranged UV spectrum. In fact, for many women who spend most from $3 to $64 per ounce. The Figure illustrates the dis- of their time indoors, shielded from sunlight by win- tribution of products according to the UV ingredients.