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| Sunscreen users with more sun exposure apply more but still not enough sunscreen: the sunscreen paradox |
In a recent research endeavor featured in Cancers, investigators embarked on an exploration of the microsystem, mesosystem, exosystem, and macrosystem factors affecting sun exposure patterns as perceived by Atlantic Canadian residents.
Background
Sun exposure is a major modifiable risk factor for the occurrence of cutaneous melanoma (CM) globally, with varying rates across Canada's Atlantic provinces. New Brunswick (NB) has incidence rates that closely align with the national average, while Prince Edward Island (PEI) and Nova Scotia (NS) have rates exceeding the national mean. Conversely, Newfoundland and Labrador (NL) exhibit rates below the national mean.
These rates of sun exposure and CM development are influenced by sociodemographic factors including geographic latitude, climate, vegetation, Fitzpatrick cutaneous phototype, genetic susceptibility, socioeconomic status, profession, and behavioral patterns. Preventing skin cancer involves practices such as avoiding direct sunlight, sunburns, tanning, and employing sun protection methods, including sunscreen and appropriate clothing. Nonetheless, extensive qualitative research into the behavioral determinants of sun exposure and skin cancer awareness among Atlantic Canadian residents has been lacking.
About the Study
This study delved into the variables contributing to varying melanoma frequency in Canada's Atlantic provinces to enhance comprehension of participants' attitudes toward sun exposure and to inform public health recommendations for CM prevention.
A subset of the larger SunFit study, encompassing 7,500 participants, was included in this investigation, comprising both patients and the general public. The study employed inductive open-ended techniques and incorporated diverse perspectives, aiming to achieve consensus among involved parties. A total of 22 focus groups, comprising 95 individuals from Atlantic Canada, were convened and transcribed, guided by the social-ecological model (SEM).
From July to August 2022, one online and 22 offline focus groups were held, involving 95 participants. These individuals described their practices for mitigating sun exposure. Observations were conducted by a male college student and two female medical students experienced in qualitative analyses, who also served as moderators. Transcribed data were cross-verified using audio recordings, and the codes were structured into themes that encapsulated the core findings of the study.
Results
To comprehend the influence of sun exposure on CM incidence rates, focus groups were conducted in Nova Scotia, Prince Edward Island, New Brunswick, and Newfoundland and Labrador. Participants in these provinces exhibited heightened sun exposure awareness, frequently employed sunscreen and sun-protective attire, and adhered to the UV index. However, their higher UV exposure resulted from factors such as weather conditions, outdoor occupations, and cultural or recreational activities.
Conversely, individuals in regions with lower CM incidence rates used sunscreen and sun-protective clothing less frequently, engaged in vocations and activities with reduced sun exposure, and lived in colder climates. Notably, individuals in Prince Edward Island and Nova Scotia showed more frequent sunscreen use, potentially due to increased environmental awareness.
Participants in New Brunswick exhibited proactive sun protection behaviors, employing sun protection measures even during short outdoor activities. They displayed a greater awareness of ultraviolet indices and their relevance to sun protection.
Individuals in the Netherlands adopted an activity-based approach to sun protection, often disregarding less hazardous activities as requiring sun protection. They utilized sunglasses, umbrellas, and hats for sun protection. In contrast, residents of New Brunswick, Nova Scotia, and Prince Edward Island acknowledged the necessity of sunglasses for sun protection. The motivations for sun exposure avoidance varied between these groups.
Conclusion
The study unveiled a "sunscreen paradox," indicating that provinces with higher CM incidence, such as Nova Scotia and Prince Edward Island, exhibited better awareness of sun exposure risks and utilized sun protection measures more extensively despite facing higher sun exposure levels. This paradox underscores the importance of tailoring public health initiatives to account for regional habits and norms in Atlantic Canada. High-incidence provinces also feature major outdoor industries, a culture of outdoor activities, and elevated temperatures, all contributing to increased UV exposure.
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