Higher Ultraviolet Radiation Exposure Among Rural-Dwelling Versus Urban-Dwelling Adults and Children: Implications for Skin Cancer Prevention


Ultraviolet radiation (UVR) exposure is a primary risk factor for the development of melanoma. However, adults and adolescents often do not engage in preventive behaviors to reduce UVR exposure. Rural residents may be at higher risk for melanoma due to lower use of sun protection strategies, which increases their overall UVR exposure compared to those who live in urban areas. The purpose of this study was to evaluate differences in UVR exposure between rural and urban residents in a geographic area with high incidence of melanoma. Children (aged 8–17 years) and adults (≥ 18 years) from rural and urban areas of Utah were asked to wear a UVR monitoring device for 14 days. The sample included 97 children and 97 adults. Data was collected from June to October 2018. Non-parametric Mann–Whitney tests and quantile regression were used to compare UVR exposure levels between urban and rural participants, separately for adults and children. For adults, rural residence significantly increased total UVR dose ( β: 24.6; 95% CI 3.75, 42.74) and the UVR dose during peak UVR hours among participants with the highest UVR doses (β: 16.3; 95% CI 17.4, 24.63). Rural children exhibited significantly higher UVR doses for peak UVR hours for the entire study period (β: 4.14; 95% CI 0.83, 7.46) and on weekdays (β: 0.39; 95% CI 0.05, 0.73). The findings from this study indicate that rural residents may receive higher levels of UVR exposure than urban residents, and that prevention efforts could be tailored to address these geographical differences.

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We greatly appreciate Peter Kaplan and Emmanuel Dumont for their guidance on using the Shade device. We also greatly appreciate Jared Luther for his assistance with data cleaning.


This work was supported by the National Cancer Institute of the National Institutes of Health (K07CA196985; Y.P.W.). This work was also supported in Pilot Project Award from the American Cancer Society (ACS) Huntsman Cancer Institute Institutional Research Grant (129785-IRG-16-190-01-IRG; Y.P.W.), and an NIH New Innovator Award (1DP2EB022360-01; J.D.J). Data for this project was collected using REDCap, which is supported by the National Cancer Institute of the National Institutes of Health (8UL1TR000105, formerly UL1RR025764). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

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Correspondence to Yelena P. Wu.

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Nagelhout, E.S., Lensink, R., Zhu, A. et al. Higher Ultraviolet Radiation Exposure Among Rural-Dwelling Versus Urban-Dwelling Adults and Children: Implications for Skin Cancer Prevention. J Community Health 46, 147–155 (2021). https://doi.org/10.1007/s10900-020-00860-6

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  • Ultraviolet radiation exposure
  • Geographical health disparities
  • Melanoma prevention
  • Wearable technology