Prevalence of sun exposure and its associated factors in southern Brazil: a population-based study

Duquia, Rodrigo Pereira; Menezes, Ana Maria Baptista; Almeida Jr, Hiram Larangeira de; Reichert, Felipe Fossati; Santos, Iná da Silva dos; Haack, Ricardo Lanzetta; Horta, Bernardo Lessa

doi:10.1590/abd1806-4841.20132122

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Investigation • An. bras. dermatol. 88 (4) • Aug 2013 • https://doi.org/10.1590/abd1806-4841.20132122 copy

Prevalence of sun exposure and its associated factors in southern Brazil: a population-based study^* * Work performed at Federal University of Pelotas - Pelotas (RS), Brazil.

Prevalência e fatores associados à exposição solar no sul do Brasil: um estudo de base populacional

Authorship SCIMAGO INSTITUTIONS RANKINGS

BACKGROUND:

Sunlight exposure is responsible for a large number of dermatological diseases.

OBJECTIVE:

We estimated the prevalence of sunlight exposure and its associated factors in adults from southern Brazil in a cross-sectional, population-based study.

METHODS:

We investigated a representative sample of individuals aged ≥ 20 years (n=3,136). Sunlight exposure and its associated factors were evaluated in two distinct situations: at leisure time and at work. The time period investigated ranged from December 2004 to March 2005, comprising 120 days of the highest ultraviolet index in the urban area of the city of Pelotas, in southern Brazil. The participants were asked about sunlight exposure for at least 20 minutes between 10 A.M. and 4 P.M. The analysis was stratified by sex, and sunlight exposure was grouped into five categories.

RESULTS:

Among the 3,136 participants, prevalence of sunlight exposure at the beach was 32.8% (95% CI, 30.3 - 35.2) and 26.3% (95% CI, 24.2 28.3) among men and women, respectively. The prevalence at work was 39.8% (95% CI, 37.2 - 42.4) among men and 10.5% (95% CI, 9.1 - 12.0) among women. Age was inversely associated with sunlight exposure. Family income and achieved schooling were positively associated with sunlight exposure at leisure time and inversely associated with sunglight exposure at work. Self-reported skin color was not associated. Knowledge of any friend or relative who has been affected by skin cancer was positively associated with sunlight exposure among men at work.

CONCLUSION:

Despite the media campaigns on the harmful effects of excessive sunlight exposure, we found a high prevalence of sunlight exposure during a period of high ultraviolet index.

Environment and public health; Precancerous conditions; Public health practice; Skin neoplasms; Sunbathing

Variables	Whole sample	LEISURE TIME			WORK
		Exposed The denominator for exposed individuals included the whole sample		P value	Exposed The denominator for exposed individuals included the whole sample		P value
		N	(%)		N	(%)
Total	3136	911	29.0		732	23.3
Age (years)				*<0.001^ * Wald test for linear trend.**			*<0.001^ * Wald test for linear trend.**
20 - 29	747	361	48.5		175	23.4
30 - 39	611	196	32.1		186	30.4
40 - 49	661	179	27.1		199	30.1
50 - 59	520	100	19.2		110	21.2
≥ 60	597	75	12.6		62	10.4
Sex				<0.001 Wald global association test.			<0.001 Wald global association test.
Male	1378	450	32.8		547	39.8
Female	1758	461	26.3		185	10.3
Self-reported skin color				*0.07^ * Wald test for linear trend.**			*0.02^ * Wald test for linear trend.**
Black	338	82	24.3		97	28.7
Brown (pardo)	227	63	27.8		57	25.1
White	2571	766	29.8		578	22.5
Achieved schooling (years)				*<0.001^ * Wald test for linear trend.**			*<0.001^ * Wald test for linear trend.**
0 - 4	783	99	12.6		208	26.6
5 - 8	1005	250	24.9		295	29.4
9 - 11	824	306	37.1		161	19.5
≥ 12	522	256	49.0		68	13.0
Per capita monthly family income in quartiles (U$)		*<0.001^ * Wald test for linear trend.**		*<0.001^ * Wald test for linear trend.**
1^st (0 to 70)	780	165	21.2	244	31.3
2^nd (70.1 to 133)	804	205	25.5	223	27.7
3^rd (133.1 to 267)	786	247	31.4	157	20.0
4^th (267.1 to 8889)	745	286	38.4	101	13.6
Knowledge of any friend or relative with skin cancer				0.06 Wald global association test.			0.06 Wald global association test.
No	2602	737	28.3		626	24.1
Yes	534	174	32.6		106	19.9

Variables	Crude sunlight		Adjusted sunlight		Crude sunlight		Adjusted sunlight exposure
	Leisure time		Leisure time		Work		Work
	Odds ratio	P value	Odds ratio	P value	Odds ratio	P value	Odds ratio	P value
	95% CI ^a a 95% CI = 95% confidence interval		95% CI ^a a 95% CI = 95% confidence interval		95% CI ^a a 95% CI = 95% confidence interval		95% CI ^a a 95% CI = 95% confidence interval
Age (years)		*<0.001^ * Wald test for linear trend**		*<0.001^ * Wald test for linear trend**		*<0.001^ * Wald test for linear trend**		*<0.001^ * Wald test for linear trend**
20 - 29	1.00		1.00		1.00		1.00
30 - 39	0.58 (0.42 - 0.81)		0.66 (0.47 - 0.94)		1.97 (1.47 - 2.63)		1.70 (1.24 - 2.33)
40 - 49	0.52 (0.37 - 0.74)		0.57 (0.39 - 0.81)		1.75 (1.28 - 2.39)		1.56 (1.13 - 2.15)
50 - 59	0.35 (0.24 - 0.51)		0.36 (0.25 - 0.54)		0.97 (0.68 - 1.37)		0.89 (0.62 - 1.28)
≥ 60	0.21 (0.14 - 0.32)		0.24 (0.15 - 0.39)		0.43 (0.28 - 0.65)		0.33 (0.21 - 0.52)
Self-reported skin color		*0.04^ * Wald test for linear trend**		*0.3^ * Wald test for linear trend**		*0.08^ * Wald test for linear trend**		*0.5^ * Wald test for linear trend**
Black	1.00		1.00		1.00		1.00
Brown (pardo)	1.53 (0.93 - 2.50)		1.81 (1.02 - 3.19)		1.01 (0.55 - 1.85)		1.18 (0.63 - 2.18)
White	1.47 (1.05 - 2.06)		1.32 (0.92 - 1.88)		0.77 (0.54 - 1.08)		1.16 (0.79 - 1.70)
Achieved schooling (years)		*<0.001^ * Wald test for linear trend**		*<0.001^ * Wald test for linear trend**		*<0.001^ * Wald test for linear trend**		*<0.001^ * Wald test for linear trend**
0 - 4	1.00		1.00		1.00		1.00
5 - 8	2.41 (1.68 - 3.45)		1.76 (1.21 - 2.5)		1.06 (0.78 - 1.42)		0.83 (0.59 - 1.16)
9 - 11	3.00 (2.05 - 4.39)		1.77 (1.17 - 2.66)		0.55 (0.39 - 0.79)		0.51 (0.34 - 0.76)
≥ 12	4.90 (3.26 - 7.36)		2.81 (1.76 - 4.50)		0.28 (0.17 - 0.46)		0.30 (0.18 - 0.50)
Per capita monthly family income in quartiles (U$)		*<0.001^ * Wald test for linear trend**		*0.007^ * Wald test for linear trend**		*<0.001^ * Wald test for linear trend**		*<0.001^ * Wald test for linear trend**
1st (0 to 70)	1.00		1.00		1.00		1.00
2nd (70.1 to 133)	1.29 (0.94 - 1.77)		1.23 (0.88 - 1.71)		0.81 (0.60 - 1.09)		0.92 (0.66 - 1.28)
3rd (133.1 to 267)	1.70 (1.25 - 2.33)		1.62 (1.16 - 2.26)		0.52 (0.38 - 0.71)		0.76 (0.56 - 1.04)
4th (267.1 to 8889)	1.98 (1.36 - 2.87)		1.67 (1.09 - 2.57)		0.26 (0.18 - 0.37)		0.47 (0.32 - 0.68)
Knowledge of any friend or relative with skin cancer		0.4 Wald global association test		0.7 Wald global association test		0.9 Wald global association test		0.02 Wald global association test
No	1.00		1.00		1.00		1.00
Yes	1.13 (0.83 - 1.55)		1.07 (0.78 - 1.48)		1.02 (0.73 - 1.43)		1.52 (1.08 - 2.13)

Variables	Crude sunlight		Adjusted sunlight		Crude sunlight		Adjusted sunlight exposure
	Leisure time		Leisure time		Work		Work
	Odds ratio	P value	Odds ratio	P value	Odds ratio	P value	Odds ratio	P value
	95% CI a		95% CI a		95% CI a		95% CI a
Age (years)		*<0.001^ * Wald test for linear trend**		*<0.001^ * Wald test for linear trend**		*0.006^ * Wald test for linear trend**		*0.02^ * Wald test for linear trend**
20 - 29	1.00		1.00		1.00		1.00
30 - 39	0.50 (0.37 - 0.67)		0.57 (0.41 - 0.81)		0.93 (0.54 - 1.59)		0.89 (0.52 - 1.53)
40 - 49	0.37 (0.27 - 0.51)		0.46 (0.33 - 0.63)		1.43 (0.88 - 2.31)		1.35 (0.83 - 2.17)
50 - 59	0.24 (0.16 - 0.35)		0.25 (0.17 - 0.38)		0.98 (0.57 - 1.66)		0.98 (0.58 - 1.65)
≥ 60	0.14 (0.10 - 0.21)		0.21 (0.13 - 0.32)		0.35 (0.19 - 0.62)		0.33 (0.18 - 0.61)
Self-reported skin color		*0.08^ * Wald test for linear trend**		*0.7^ * Wald test for linear trend**		*0.02^ * Wald test for linear trend**		*0.7^ * Wald test for linear trend**
Black	1.00		1.00		1.00		1.00
Brown (pardo)	1.12 (0.72 - 1.74)		1.08 (0.67 - 1.74)		0.77 (0.42 - 1.44)		0.84 (0.45 - 1.59)
White	1.37 (0.94 - 2.00)		0.95 (0.63 - 1.44)		0.70 (0.44 - 1.12)		0.90 (0.55 - 1.46)
Achieved schooling (years)		*<0.001^ * Wald test for linear trend**		*<0.001^ * Wald test for linear trend**		*0.06^ * Wald test for linear trend**		*0.1^ * Wald test for linear trend**
0 - 4	1.00		1.00		1.00		1.00
5 - 8	2.06 (1.40 - 3.02)		1.42 (0.97 - 2.08)		0.97 (0.60 - 1.56)		0.76 (0.47 - 1.25)
9 - 11	5.35 (3.59 - 7.96)		2.74 (1.80 - 4.16)		0.76 (0.46 - 1.26)		0.67 (0.40 - 1.13)
≥ 12	10.86 (7.30 - 16.15		4.93 (3.10 - 7.87)		0.61 (0.34 - 1.08)		0.66 (0.36 - 1.23)
Per capita monthly family income in quartiles (U$)		*<0.001^ * Wald test for linear trend**		*0.002^ * Wald test for linear trend**		*<0.001^ * Wald test for linear trend**		*0.006^ * Wald test for linear trend**
1st (0 to 70)	1.00		1.00		1.00		1.00
2nd (70.1 to 133)	1.23 (0.87 - 1.75)		1.10 (0.75 - 1.59)		0.90 (0.60 - 1.35)		0.99 (0.66 - 1.46)
3rd (133.1 to 267)	1.65 (1.14 - 2.39)		1.40 (0.91 - 2.16)		0.47 (0.30 - 0.72)		0.58 (0.37 - 0.91)
4th (267.1 to 8889)	3.15 (2.21 - 4.48)		2.02 (1.27 - 3.21)		0.40 (0.24 - 0.67)		0.52 (0.30 - 0.90)
Knowledge of any friend or relative with skin cancer		0.02 Wald global association test		0.3 Wald global association test		0.4 Wald global association test		0.7 Wald global association test
No	1.00		1.00		1.00		1.00
Yes	1.39 (1.07 - 1.81)		1.15 (0.87 - 1.51)		0.82 (0.54 - 1.25)		0.93 (0.61 - 1.42)

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Prevalence of sun exposure and its associated factors in southern Brazil: a population-based study* * Work performed at Federal University of Pelotas - Pelotas (RS), Brazil.

Prevalência e fatores associados à exposição solar no sul do Brasil: um estudo de base populacional

BACKGROUND:

OBJECTIVE:

METHODS:

RESULTS:

CONCLUSION:

Prevalence of sun exposure and its associated factors in southern Brazil: a population-based study^* * Work performed at Federal University of Pelotas - Pelotas (RS), Brazil.