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.
This is a preview of subscription content, access via your institution.
Buy single article
Instant access to the full article PDF.
Tax calculation will be finalised during checkout.
Subscribe to journal
Immediate online access to all issues from 2019. Subscription will auto renew annually.
Tax calculation will be finalised during checkout.
Armstrong, B. K., & Kricker, A. (1993). How much melanoma is caused by sun exposure? Melanoma Research, 3(6), 395–401.
Balk, S. J. (2011). Ultraviolet radiation: A hazard to children and adolescents. Pediatrics, 127(3), e791–e817.
Banerjee, S., Hoch, E. G., Kaplan, P. D., & Dumont, E. L. (2017). A comparative study of wearable ultraviolet radiometers. Paper presented at the 2017 IEEE Life Sciences Conference (LSC).
Bathrellou, E., Lazarou, C., Panagiotakos, D. B., & Sidossis, L. S. (2007). Physical activity patterns and sedentary behaviors of children from urban and rural areas of Cyprus. Central European Journal of Public Health, 15(2), 66.
Bodekær, M., Petersen, B., Philipsen, P. A., Heydenreich, J., Thieden, E., & Wulf, H. C. (2015). Sun exposure patterns of urban, suburban, and rural children: a dosimetry and diary study of 150 children. Photochemical & Photobiological Sciences, 14(7), 1282–1289.
Brábek, J., Mierke, C. T., Rösel, D., Veselý, P., & Fabry, B. (2010). The role of the tissue microenvironment in the regulation of cancer cell motility and invasion. Cell Communication Signaling, 8, 22.
Cassidy, P. B., Liu, T., Florell, S. R., Honeggar, M., Leachman, S. A., Boucher, K. M., et al. (2017). A phase II randomized placebo-controlled trial of oral n-acetylcysteine for protection of melanocytic Nevi against UV-induced oxidative stress in vivo. Cancer Prevention Research, 10(1), 36–44. https://doi.org/10.1158/1940-6207.Capr-16-0162.
Dennis, L. K., Vanbeek, M. J., Freeman, L. E. B., Smith, B. J., Dawson, D. V., & Coughlin, J. A. (2008). Sunburns and risk of cutaneous melanoma: does age matter? A comprehensive meta-analysis. Annals of Epidemiology, 18(8), 614–627.
Diffey, B., Jansen, C., Urbach, F., & Wulf, H. (1997). The standard erythema dose: a new photobiological concept. Photodermatology, Photoimmunology & Photomedicine, 13(1–2), 64–66.
Duncan, M. J., Kerry Mummery, W., & Kift, R. L. (2008). Geographical location and sunburn in Queensland adults. Australian Journal of Rural Health, 16(3), 181–182. https://doi.org/10.1111/j.1440-1584.2008.00971.x.
Fritschi, L., Green, A., & Solomon, P. J. (1992). Sun exposure in Australian adolescents. Journal of the American Academy of Dermatology, 27(1), 25–28. https://doi.org/10.1016/0190-9622(92)70150-E.
Geller, A. C., Colditz, G., Oliveria, S., Emmons, K., Jorgensen, C., Aweh, G. N., et al. (2002). Use of sunscreen, sunburning rates, and tanning bed use among more than 10 000 US children and adolescents. Pediatrics, 109(6), 1009–1014. https://doi.org/10.1542/peds.109.6.1009.
Godar, D. E., Wengraitis, S. P., Shreffler, J., & Sliney, D. H. (2001). UV doses of Americans. Photochemistry and Photobiology, 73(6), 621–629. https://doi.org/10.1562/0031-8655(2001)0730621UDOA2.0.CO2.
Kalia, S., Kwong, Y. K. K., Haiducu, M. L., & Lui, H. (2013). Comparison of sun protection behaviour among urban and rural health regions in Canada. Journal of the European Academy of Dermatology and Venereology, 27(11), 1452–1454. https://doi.org/10.1111/jdv.12084.
Køster, B., Søndergaard, J., Nielsen, J. B., Christensen, K. B., Allen, M., Olsen, A., et al. (2017). Knowledge deficit, attitude and behavior scales association to objective measures of sun exposure and sunburn in a Danish population based sample. PLoS ONE, 12(5), e0178190.
Matz, C. J., Stieb, D. M., & Brion, O. (2015). Urban-rural differences in daily time-activity patterns, occupational activity and housing characteristics. Environmental Health: A Global Access Science Source, 14, 88–88. https://doi.org/10.1186/s12940-015-0075-y.
Rural Urban Commuting Area Codes. (2017). Retrieved from https://depts.washington.edu/uwruca/
Sandercock, G., Angus, C., & Barton, J. (2010). Physical activity levels of children living in different built environments. Preventive Medicine, 50(4), 193–198. https://doi.org/10.1016/j.ypmed.2010.01.005.
Target Prospects. Retrieved from https://www.experian.com/corporate/about-experian.html
Thieden, E., Philipsen, P. A., Heydenreich, J., & Wulf, H. C. (2004). UV radiation exposure related to age, sex, occupation, and sun behavior based on time-stamped personal dosimeter readings. Archives of Dermatology, 140(2), 197–203. https://doi.org/10.1001/archderm.140.2.197.
United State Cancer Statistics: Data Visualizations. (2019). Retrieved from https://gis.cdc.gov/grasp/USCS/DataViz.html
Utah's Behavioral Risk Factor Surveillance System (BRFSS). (2018). Retrieved from https://ibis.health.utah.gov/query/result/brfss/LandlineCellAgeAdj5_SunSafety/SunSafety.html
Watson, M., Holman, D. M., & Maguire-Eisen, M. (2016). Ultraviolet radiation exposure and its impact on skin cancer risk. Seminars in Oncology Nursing, 32(3), 241–254. https://doi.org/10.1016/j.soncn.2016.05.005.
Whiteman, D. C., Whiteman, C. A., & Green, A. C. (2001). Childhood sun exposure as a risk factor for melanoma: A systematic review of epidemiologic studies. Cancer Causes and Control, 12(1), 69–82.
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.
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
About this article
Cite this article
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
- Ultraviolet radiation exposure
- Geographical health disparities
- Melanoma prevention
- Wearable technology