Predictors of higher sun exposure, poorer sun protection identified

Men and young adults may have greater sun exposure, but are also less likely to use sun protection, according to a study from Singapore.

“The study has identified that men, young adults, Indians, dark-skinned individuals, and those with lower education are most vulnerable to poor sun safety habits and prolonged sun exposure, and may benefit the most from sun safety health promotions,” said the researchers.

The study population comprised 2,328 adults (mean age 42.6 years, 48.5 percent male) enrolled in the Singapore Health study who completed surveys on their sun exposure and safety habits. Using these surveys, the researchers compiled average daily hours (ADH; mean 1.45 hours) of sun exposure and a composite Sun Protection Score (SPS; mean score 3.31)*.

Use of sun protection was relatively low with only 14.2 percent of the study population using protective headgear, 18.8 percent using umbrellas, and 23.9 percent using sunscreen (SPF ≥30).

Age and sex were factors associated with longer ADH of sun exposure, with longer ADH among younger adults (β, -0.02) and men (β, 0.80; p<0.001 for both). Individuals with darker skin type** (β, 0.27) and those with lower education levels were also more likely to have longer ADH of sun exposure (β, 0.27 and β, -0.18, respectively; p<0.001 for both). [Ann Acad Med Singapore 2019;48:412-428]

SPS was significantly lower among men (β, -1.43; p<0.001), individuals of Indian ethnicity (β, -1.03; p<0.001), those with a history of diabetes (β, -0.56; p=0.007), and those who do not consume alcohol (β, 0.31; p=0.03).

There were several groups that appeared at higher risk of sun exposure and reduced sun protection. Men had an average 53 minutes additional sun exposure per day, an average 1.5-point lower SPS, and an 86 and 92 percent lower likelihood of sunscreen and umbrella use, respectively. Compared with Chinese participants, Indian participants had an average 1-point lower SPS and were 57 and 61 percent less likely to use protective attire and sunscreen, respectively. Individuals with darker skin spent more time under the sun, as did younger adults and those with lower education levels. The latter two groups also had poorer sun safety habits.

“It is not surprising to find men and young adults at greater risk as they are more likely to perform manual labour, work outdoors, or engage in outdoor sports,” noted the researchers. As for the findings among Indians and darker-skinned individuals, “ethnicity-specific or cultural practices” may be behind the poorer sun safety habits. For example, there may be a belief that dark skin offers sun protection, they added. Moreover, discomfort in the local climate as well as lack of awareness on the potential dangers of sun exposure may play a role in poor sun protection habits. 

The researchers acknowledged that self-reporting of sun exposure and protection habits may be subject to bias, and that the study cannot establish cause and effect, with confounders explaining some of the initial findings.