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On-line version ISSN 1806-4841
An. Bras. Dermatol. vol.79 no.2 Rio de Janeiro Mar./Apr. 2004
CLINICAL, LABORATORY AND THERAPEUTIC INVESTIGATION
Evaluation of solar exposure and sun-protection behaviors among university students in the Metropolitan Region of Porto Alegre, Brazil*
Francine Batista CostaI; Magda Blessman WeberII
Graduated from Lutheran University of Brazil - Ulbra
IIMasters degree and Adjunct Professor of Dermatology, Medical course, Lutheran University of Brazil - Ulbra
It is known that changes in the habits of the world population with regard to
solar exposure, have caused an increased rate of skin cancer in the last few
decades. This information is especially relevant in the Southern region of Brazil,
due to the higher prevalence of Caucasians, who are more vulnerable to harm
from the sun, compared to other darker skinned Brazilians.
OBJECTIVES: To evaluate the habits of solar exposure and sun-protection among university students in the Metropolitan Region of Porto Alegre, from July to September 2001.
METHODS: 1030 questionnaires were answered by university students living in the Metropolitan Region of Porto Alegre.
RESULTS: On weekends, 38.4% of the students expose themselves to the sun for 2 to 6 hours daily. During the summer, 43.7% expose themselves to the sun between 10 am and 3 pm. Eighty-five per cent of the students affirmed that they use sunscreen, but 65% do not use it when practicing outdoor sports.
CONCLUSIONS: We observed that most university students expose themselves excessively to the sun at inappropriate times of the day and without effective protection against the sun.
Keywords: students; sunscreening agents.
Skin cancer has become a serious public health problem due to the increase in its incidence during the 20th century,1,2,3 caused mainly by changes in the behavior of the world population regarding solar exposure.4,5,6 From 1973 to 1994, the incidence of melanoma type skin cancer increased by 120.5% and its mortality rate by 38.9%.2 In the United States, the risk of developing melanoma rose from 1:500, in 1935; to 1:250, in 1980; and 1:74, in 2000.2,3
In recent decades, much knowledge has been acquired regarding the etiology of skin cancer, and ultraviolet radiation has been identified as one of the main agents involved.1,5,7,8,9 The greatest natural source of ultraviolet radiation is the sun, to which the skin is in constant exposure, whether during recreational activities or at work. Nowadays, artificial sources of ultraviolet radiation are used for therapeutic or esthetic purposes.1,3,10,11
The prevention of skin cancer, among adolescents and young adults, is important since this age group tends to spend the greatest part of their time outdoors.13,14 Major efforts are being made to modify children's behavior in relation to solar exposure,1,15 but few programs for the prevention of skin cancer are directed to adolescents.12,16
Although these prevention campaigns emphasize the risks of solar exposure, data in the literature demonstrates that 50% of the adolescents become tanned intentionally13 and, when in the sun, few apply sunscreen or use a hat and shirt, thereby exposing themselves excessively to radiation during summer.12,13,14 Bakos et al., during 1994 -1995, in the coastal city of Praia de Torres, Rio Grande do Sul, demonstrated that 36.9% of a population with a mean age of 20 years used sunscreen.4
The influence of fashion and the cosmetics industry has influenced the perception of the younger generation regarding the risks of unprotected and excessive solar exposure.9,12,14,17 It is important to educate the young, and this should begin with a parental model of solar protection from infancy.8,12,14,18-21
Use of sunscreen is an effective strategy10,22,23,24 to reduce the amount of ultraviolet radiation and sunburn, but other physical means of sun-protection and care regarding the time of exposure to the sun are also necessary to reduce the incidence of skin cancer.10,11,19,25 Identification of those individuals at highest risk is important for the development of efficient prevention programs.6,8,11,12,18,26
In order to implement effective prevention strategies, all the professionals in the health area have to understand the factors that affect the patients' decision to sunbathe, as well as to try to modify the public perceptions to reduce solar exposure.1,6,7,8,27,28,29
The objective of this work was to evaluate the habits regarding solar exposure and use of sunscreen of the university students' of the Metropolitan Region of Porto Alegre. The results of the research provide guidance for strategies to prevent skin cancer.
MATERIAL AND METHODS
A questionnaire was distributed among university students of the Metropolitan Region of Porto Alegre, State of Rio Grande do Sul. The study was conducted from July to September, 2001. The questionnaires were distributed in series, by the researchers, to 1,200 students of five universities during the intervals between classroom activities during the day and evening classes. The objective and the importance of the research was stated at the top of the questionnaires and these were presented to the students at the moment they were requested to participate in the study. A total of 1,030 questionnaires were completed. The subject area in which the university students were graduating was not taken into consideration.
The questionnaire was prepared by the authors of the present work and comprised 10 questions, including age, sex and general questions on behavior and relative to solar exposure, such as: 1. duration and time of exposure; 2. use of sunscreen; 3. solar protection factor used; 4. season in which sunscreen is used; 5. use of other physical means of solar protection; and 6. use of sunscreen during outdoor sports.
The data were collected in the program SPSS (Statistical Package for Social Sciences), and statistical analysis was performed in a descriptive manner using absolute (n) and relative (%) frequencies.
A total of 1,030 questionnaires were completed. The sample was composed of 343 male (33.3%) and 687 female (66.7%) students, with a mean age of 22.7 years (±5.4) (Chart 1).
As for the period of solar exposure, the following results were found: 70.7% of the students were exposed to the sun for a maximum of up to two hours per day during the week (Monday to Friday). At the weekend, 4.9% of the students exposed themselves to the sun for more than six hours a day, and 38.4% exposed themselves for between two to six hours a day. The most frequent time for solar exposure during the summer was after 15:00 (70.6% of the students), and of these individuals, 43.7% also exposed themselves between 10:00 and 15:00 (Chart 1).
As for solar protection, the following results were found: 85.2% of the sample use sunscreen. Of these, 84.9% choose a sun protection factor over eight, 65% do not use it during outdoor sports, and 17.9% apply it during all the seasons of the year. The use of other physical means for solar protection presented the following frequency: shirts (42%), hats (34.8%), and beach umbrella (38.4%) (Chart 2).
Of the participants that affirmed they do not use sunscreen, most were male (62.5%) and under 25 years of age (84.9%), besides not using other means of solar protection, such as hat (55.9%), shirt (45.4%) and beach umbrella (85.5%) (Chart 3).
In the present work, the university students were questioned regarding their solar exposure and the frequency with which they use sunscreen. The results, in terms of duration of exposure and use of physical means of solar protection, are similar to data in the literature.8,10,12,28
Seventy percent of the students exposed themselves to the sun during the period of least risk, after 15:00. However, 43.7% of the students also subjected themselves to the period of greatest ultraviolet radiation intensity, between 10:00 and 15:00. The literature justifies this behavior, during the summer, on the grounds of social factors, such as eating a late lunch; more outdoor sports; and to take maximum advantage of holidays.4 Thus, outdoor activities tend to take place mainly during inappropriate times, in relation to the sun.
This work was undertaken in 2001, and found that 85.2% of the university students use sunscreen. A study from 1994 to 1995 demonstrated that 36.9% used sunscreen, in a population with a mean age of 20 years.4 Thus an increase was verified in the use of sunscreen from 1994-1995 to 2001 in populations with a similar mean age.
Sixty one percent of those that completed the questionnaire use sun protection factor (SPF) less than 15, which is below that recommended by skin cancer prevention campaigns. Only 17.9% of the students use sunscreen during each of the four seasons, suggesting that this habit seems to be associated with the false conception that the sun is only intense in the summer. It was observed that, of the university students that affirmed they normally use sunscreen (85.2%), only 35% apply it while participating in outdoor sports. Consequently, it appears that sunscreen is only remembered and applied when they intend to "get a tan".
In this study, it was verified that irrespective of the use of sunscreen, most of the students do not use other physical means of solar protection, such as a shirt, hat and beach umbrella. Effective solar protection, consisting of the use of sunscreen together with physical means of protection and strategies to avoid the sun, is not habitually practiced.10 Even when using the most common form of solar protection - sunscreen - a risk behavior is observed for the harmful effects of the sun.
Most of the students that do not use sunscreen are male and under 25 years of age. The literature shows that females use suntan lotion with greater frequency.21 Based on these data, we could raise the hypothesis that, since most women are more vain or concerned with esthetics, they take better care of themselves and avoid the harmful effects of the sun more than men do.
The data of this work serves to obtain knowledge regarding the solar exposure and sun protection behaviors of a student population in the Metropolitan Region of Porto Alegre and, in this manner, to be more attentive to counseling on an individual and collective level.
Studies have emphasized the importance of a greater awareness regarding the dangers of excessive exposure to the sun, through the participation of the media in prevention campaigns,4 school counseling programs,13 and other strategies to modify factors involved in the individual's decision to sun bathe27 and of the parental model and education from infancy.14 Besides the identification of individuals at high risk of developing skin cancer 11 and effective solar protection.10
In this work, the behavior of young adults was evaluated regarding solar exposure and sunscreen and it was verified that most exposed themselves excessively to the sun, at inappropriate times and without resorting to effective solar protection.
The majority of the university students use sunscreen, however not while participating in outdoor sports. Most of those researched do not use any other physical means of solar protection, such as a hat, shirt and beach umbrella. Of those that do not use sunscreen, the great majority are men under 25 years of age. q
1. Gruijl FR. Skin cancer and solar UV radiation. Eur J Cancer 1999;35(14):2003-9. [ Links ]
2. Hall HI, Miller DR, Rogers JD et al. Update on the incidence and mortality from melanoma in the United States. J Am Acad Dermatol 1999;40(1):35-42. [ Links ]
3. Lim HW, Cooper K. The health impact of solar radiation and prevention strategies. J Am Acad Dermatol 1999;41(1):81-99. [ Links ]
4. Bakos L, Sukster E, Blanco LFO et al. Estudo comparativo sobre o conhecimento e comportamento de adolescentes e adultos frente à exposição solar. An Bras Dermatol 1997;72(3):241-5. [ Links ]
5. Andreassi L, Flori ML, Rubegni P. Role of phototype and skin colour. Adv Exp Med Biol 1999;455:469-75. [ Links ]
6. Garvin T, Eyles J. Public health responses for skin cancer prevention: the policy framing of sun safety in Australia, Canada and England. Soc Sci & Med 2001;53(9):1175-89. [ Links ]
7. Jackson KM, Aiken LS. A phychosocial model of sun protection and sunbathing in young women. The impact of health beliefs, attitudes, norms, and self-efficacy for sun protection. Health Psychol 2000;19(5):469-78. [ Links ]
8. Lucci A, Citro HW, Wilson L. Assessment of knowledge of melanoma risk factors, prevention, and detection principles in Texas teenagers. J Surg Res 2001;97(2):179-83. [ Links ]
9. Wang SQ, Setlow R, Berwick M et al. Ultraviolet A and melanoma: a review. J Am Acad Dermatol 2001;44(5):837-46. [ Links ]
10. Wright MW, Wright ST, Wagner RF. Mechanisms of sunscreen failure. J Am Acad Dermatol 2001;44(5):781-4. [ Links ]
11. Rigel DS, Carucci JA. Malignant melanoma: prevention, early detection, and treatment in the 21st century. CA Cancer J Clin 2000;50(4):215-40. [ Links ]
12. Cokkinides VE, Weinstock M, O'Connell MC et al. Sun exposure and sun-protection behaviors and attitudes among U.S. youth, 11 to 18 years of age. Prev Med 2001;33(3):141-51. [ Links ]
13. Kuhl ICP. Fotoproteção na adolescência. An Bras Dermatol 1998;73(supl. 1):38. [ Links ]
14. Marcoux D. Appearance, cosmetics, and body art in adolescents. Dermatol Clin 2000;18(4). [ Links ]
15. Etzel RA, Balk SJ, Bearer CF et al. Ultraviolet light: a danger for children. Pediatrics 1999;104(2):328-33. [ Links ]
16. Pfahlberg A, Kölmel KF, Gefeller O. Timing of excessive ultraviolet radiation and melanoma: epidemiology does not support the existence of a critical period of high susceptibility to solar ultraviolet radiation-induced melanoma. Br J Dermatol 2001;144(3):471-5. [ Links ]
17. Rhainds M, Guire L, Claveau J. A population-based survey on the use of artificial tanning devices in the Province of Quebec, Canada. J Am Acad Dermatol 1999;40(4):572-6. [ Links ]
18. Santmyire BR, Feldman SR, Fleischer AB. Lifestyle high-risk behaviors and demographics may predict the level of participation in sun-protection behaviors and skin cancer primary prevention in the United States. Cancer 2001;92(5):1315-24. [ Links ]
19. Coogan PF, Geller ARN, Adams MMS et al. Sun protection practices in preadolescents and adolescents: a school-based survey of almost 25,000 Connecticut schoolchildren. J Am Acad Dermatol 2001;44(3):512-9. [ Links ]
20. Glanz K, Maddock JE, Lew RA et al. A randomized trial of the Hawaii SunSmart program's impact on outdoor recreation staff. J Am Acad Dermatol 2001;44(6):973-8. [ Links ]
21. Banks BA, Silverman RA, Schwartz RH et al. Attitudes of teenagers toward sun exposure and sunscreen use. Pediatrics 1992;89(1):40-2. [ Links ]
22. Diffey B. Has the sun protection factor had its day?. Br Med J 2000;320:176-7. [ Links ]
23. Draelos ZD. A dermatologist's perspective on the final sunscreen monograph. J Am Acad Dermatol 2001;44:109-10. [ Links ]
24. Autier P, Boniol M, Severi G et al. Quantity of sunscreen used by European students. Br J Dermatol 2001;144(2):288-91. [ Links ]
25. Damian DL, Halliday GM, Barnetson RS. Sun protection factor measurement of sunscreens is dependent on minimal erythema dose. Br J Dermatol 1999;141:502-7. [ Links ]
26. Cestari TF. Fotobiologia do melanoma. An Bras Dermatol 1998;73(supl.1):7. [ Links ]
27. Feldman SR, Dempsey JR, Grummer S et al. Implications of a utility model for ultraviolet exposure behavior. J Am Acad Dermatol 2001;45(5):718-22. [ Links ]
28. Michel JL, Magant E et al. Evaluation de la compréhension du risque solaire chez 241 adolescents. Ann Dermatol Venereol 2000;127(4):317-5. [ Links ]
29. Howell JB. The power of prevention. J Am Acad Dermatol 1999;40(4):623-5. [ Links ]
Francine Batista Costa
Av. Nilo Peçanha, 2863/603
91330-001 Porto Alegre RS
Tel.: (51) 3328-3271
in June, 09th of 2003
Approved by the Consultive Council and accepted for publication in October, 16th of 2003
* Work done at "Universidade Luterana do Brasil".