Abstract
Purpose
Sunlight exposure is responsible for a large number of dermatological diseases. The purpose of this study was to estimate the prevalence of hazardous sun exposure and adherence to sun protective behaviours and its associated factors in adults from the Portuguese population.
Methods
A total of 4,797 participants aged between 25 and 74 years old answered the sun exposure module of the National Health Examination Survey questionnaire, which was performed in 2015. Hazardous sun exposure and sun protective behaviours were assessed for a typical summer day during leisure time. Descriptive statistics and Poisson regression were used to examine associations between hazardous sun exposure and adherence to sun protective behaviours with population characteristics.
Results
Among the 4,797 participants, prevalence of hazardous sun exposure was 76.4 and 67.4% among men and women, respectively. It was mainly associated with younger age, lower education level and practice of regular physical activity. The prevalence of nonadherence to sun protective behaviours was 38.6 and 22.3%, among men and women, respectively. Education and income were inversely associated with adherence to sun protective behaviours. Individuals residing in regions displaying higher UV indexes had higher prevalence of sun protective practices.
Conclusions
The prevalence of hazardous sun exposure and nonadherence to sun protective behaviours is considerable in the Portuguese population. The association between these indicators and sociodemographic factors in the population, reinforces the importance of developing sun protection messages directed at specific target audiences.
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References
Abda N, El K, Obtel M, Bendahhou K, Zidouh A, Bennani M, Bekkali R, Nejjari C (2012) Determinants of self-reported sun protection practices among Moroccan population. Prev Med (Baltim) 54:422–424. https://doi.org/10.1016/j.ypmed.2012.03.011
Bränström R, Kasparian NA, Chang Y-M, Affleck P, Tibben A, Aspinwall LG, Azizi E, Baron-Epel O, Battistuzzi L, Bergman W, Bruno W, Chan M, Cuellar F, Dębniak T, Pjanova D, Ertmański S, Figl A, Gonzalez M, Hayward NK, Hocevar M, Kanetsky PA, Leachman SA, Heisele O, Palmer J, Peric B, Puig S, Schadendorf D, Gruis NA, Newton-Bishop J, Brandberg Y (2010) Predictors of sun protection behaviours and severe sunburn in an international on-line study. Cancer Epidemiol Biomark Prev 19:2199–2210. https://doi.org/10.1158/1055-9965.EPI-10-0196
Coups EJ, Stapleton JL, Hudson SV, Medina-Forrester A, Natale-Pereira A, Goydos JS (2012) Sun protection and exposure behaviors among Hispanic adults in the United States: differences according to acculturation and among Hispanic subgroups. BMC Public Health 12:985
D’orazio J, Jarrett S, Amaro-Ortiz A, Scott T (2013) UV radiation and the skin. Int J Mol Sci 14:12222–12248. https://doi.org/10.3390/ijms140612222
Direção-Geral da Saúde Cuidados a ter com a exposição solar. https://www.dgs.pt/saude-ambiental-calor/exposicao-solar.aspx. Accessed 15 Jan 2019
Djaja N, Janda M, Lucas RM, Harrison SL, Van Der Mei I, Ebeling PR, Neale RE, Whiteman DC, Nowak M, Kimlin MG (2016) Self-reported changes in sun-protection behaviors at different latitudes in Australia. Photochem Photobiol 92:495–502. https://doi.org/10.1111/php.12582
Elwood JM, Diffey BL (1993) A consideration of ambient solar ultraviolet radiation in the interpretation of studies of the aetiology of melanoma. Melanoma Res 3:113–122
English DR, Armstrong BK, Kricker A, Winter MG, Heenan PJ, Randell PL (1998) Demographic characteristics, pigmentary and cutaneous risk factors for squamous cell carcinoma of the skin: a case-control study. Int J Cancer 76:628–634. https://doi.org/10.1002/(SICI)1097-0215(19980529)76:5<628::AID-IJC3>3.0.CO;2-S
Fitzpatrick TB (1988) The validity and practicality of sun-reactive skin types I through VI. Arch Dermatol 124:869. https://doi.org/10.1001/archderm.1988.01670060015008
Gordon R (2013) Skin cancer: an overview of epidemiology and risk factors. Semin Oncol Nurs 29:160–169. https://doi.org/10.1016/J.SONCN.2013.06.002
Harris PA, Taylor R, Thielke R, Payne J, Gonzalez N, Conde JG (2009) Research electronic data capture (REDCap): a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform 42:377–381. https://doi.org/10.1016/j.jbi.2008.08.010
Holick MF (2016) Biological effects of sunlight, ultraviolet radiation, visible light, infrared radiation and vitamin D for health. Anticancer Res 36:1345–1356
International Agency for Cancer Research (2018) Cancer today. http://gco.iarc.fr/today/online-analysis-map?v=2018&mode=population&mode_population=continents&population=900&populations=900&key=asr&sex=0&cancer=16&type=0&statistic=5&prevalence=0&population_group=0&ages_group%5B%5D=0&ages_group%5B%5D=17&nb_items=5&grou. Accessed August 2019
Kalia S, Kwong YKK, Haiducu ML, Lui H (2013) Comparison of sun protection behaviour among urban and rural health regions in Canada. J Eur Acad Dermatol Venereol 27:1452–1454. https://doi.org/10.1111/jdv.12084
Leiter U, Eigentler T, Garbe C (2014) Epidemiology of skin cancer. Adv Exp Med Biol 810:120–140
Nunes B, Barreto M, Gil AP, Kislaya I, Namorado S, Antunes L, Gaio V, Santos AJ, Rodrigues AP, Santos J, Roquette R, Alves-Alves C, Castilho E, Cordeiro E, Dinis A, Prokopenko T, Silva AC, Vargas P, Lyshol H, Dias CM (2018) The first Portuguese National Health Examination Survey (2015): design, planning and implementation. J Public Health (Bangkok), pp 1–7. https://doi.org/10.1093/pubmed/fdy150
Organisation for Economic Co-operation and Development OECD (20190 Project on Income Distribution and Poverty. https://www.oecd.org/social/income-distribution-database.htm#targetText=To%20benchmark%20and%20monitor%20income,after%20taxes%20and%20transfers%2C%20etc.. Accessed August 2019
Pereira Duquia R, Maria Baptista Menezes A, Larangeira de Almeida H Jr, Fossati Reichert F, da Silva dos Santos I, Lanzetta Haack R, Lessa Horta B (2013) Prevalence of sun exposure and its associated factors in southern Brazil: a population-based study [Prevalência e fatores associados à exposição solar no sul do Brasil: um estudo de base populacional]. An Bras Dermatol 88:554–561. https://doi.org/10.1590/abd1806-4841.20132122
Perera E, Gnaneswaran N, Staines C, Win AK, Sinclair R (2015) Incidence and prevalence of non-melanoma skin cancer in Australia: a systematic review. Aust J Dermatol 56:258–267. https://doi.org/10.1111/ajd.12282
Pinault L, Fioletov V (2017) Sun exposure, sun protection and sunburn among Canadian adults. Health Rep 28:12–19
Qureshi AA, Laden F, Colditz GA, Hunter DJ (2008) Geographic variation and risk of skin cancer in US women: differences between melanoma, squamous cell carcinoma, and basal cell carcinoma. Arch Intern Med 168:501. https://doi.org/10.1001/archinte.168.5.501
Ribeiro C, Relvas A, Costa V, Costa M (2017) Proteção solar: conhecimentos e hábitos na população pediátrica. Nascer Crescer vol 26 n.1 pp 31–35
Rodriges Â, Fernandes-Machado S, Neves Alves M, de Paula CM, Correia O, Césarini P (2014) Proteção solar em crianças e jovens portugueses: um estudo transversal. Psicol saúde doenças 15:828–841
Sassolas B, Grange F, Touboul C, Lebbe C, Saiag P, Mortier L, Lhomel C, Robert C (2015) Sun exposure profile in the French population: results of the EDIFICE melanoma survey. J Eur Acad Dermatol Venereol 29:6–10. https://doi.org/10.1111/jdv.12895
Sivamani RK, Crane LA, Dellavalle RP (2009) The benefits and risks of ultraviolet tanning and its alternatives: the role of prudent sun exposure. Dermatol Clin 27:149–154, vi. https://doi.org/10.1016/j.det.2008.11.008
StataCorp (2017) Stata statistical software: release 15. StataCorp, College Station
Torres V, Isabel Herane M, Costa A, Piquero Martin J, Troielli P (2017) Refining the ideas of “ethnic” skin. An Bras Dermatol 92:221–226. https://doi.org/10.1590/abd1806-4841.20174846
Webb AR, Engelsen O (2006) Calculated ultraviolet exposure levels for a healthy vitamin D status. Photochem Photobiol 82:1697–1703. https://doi.org/10.1562/2006-09-01-RA-670
World Health Organization (2019) World Health Organization Sun protection. In: UV Expo. https://www.who.int/uv/sun_protection/en/. Accessed August 2019
World Health Organization, World Meteorological Organization, United Nations Environment Programme, International Commission on Non-Ionizing Radiation (2002) Global solar UV index: a practical guide. WHO, Geneva
Zahnd WE, Goldfarb J, Scaife SL, Francis ML (2010) Rural-urban differences in behaviors to prevent skin cancer: an analysis of the health information national trends survey. J Am Acad Dermatol 62:950–956. https://doi.org/10.1016/j.jaad.2009.08.058
Funding
The National Health Examination Survey (INSEF) was developed as part of the project “Improvement of epidemiological health information to support public health decision and management in Portugal. Towards reduced inequalities, improved health and bilateral cooperation”, funded by the Public Health Initiatives Program, within the European Economic Area Financial Mechanism (EEA Grants) 2009–2014, and by the Portuguese Government.
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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. This study was approved by the ethical committee of the National Health Institute Doutor Ricardo Jorge and by the ethical committees of the Portuguese Regional Health Administrations and of the ethical committees of the Regional Health Secretariats of the Autonomous Regions of Madeira and Azores.
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Informed consent was obtained from all individual participants involved in the study.
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Barreto, M., Kislaya, I., Santos, A.J. et al. Sun exposure and sun protective behaviours in Portugal: results from the first National Health Examination Survey (INSEF 2015). J Public Health (Berl.) 29, 375–385 (2021). https://doi.org/10.1007/s10389-019-01133-w
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DOI: https://doi.org/10.1007/s10389-019-01133-w