MLHU - Health Status Resource

Ultraviolet Radiation Exposure

Melanoma is the most deadly form of skin cancer in Canada and nearly all melanomas are related to ultraviolet radiation (UVR) exposure from the sun or indoor tanning.¹ About one third of Middlesex-London residents reported having a sunburn in 2017 however, less than 5% reported using artificial tanning beds. About half of adults in Middlesex-London reported that they always or often avoid the sun between 11:00 a.m. and 4:00 p.m. when the sun’s ultraviolet rays (UV) are at their strongest. When in the sun, protection through wearing sunglasses was common, however, wearing protective clothing and applying sun screen were not as common. Younger people, males and those in lower socio-economic groups were less likely to report sun protection behaviours.

Sunburn in Past Year

More than 30% of the population of Middlesex-London reported having a sunburn in the past year when asked on a survey in 2017. This rate was significantly lower than rates seen in 2012 and 2013 (Figure 6.5.1).

The percent who reported having a sunburn in the past 12 months decreased as age increased. Differences by age group were statistically significant. Nearly 65% of those aged 18–24 reported a sunburn compared to 12.0% of those aged 65 and older (Figure 6.5.2).

There was also a relationship between having had a sunburn and income group. Those in the highest income group had nearly two times the rate of sunburn (38.2%) than those in the lowest income group (20.8%). The difference was statistically significant. Income has been grouped into three equal categories with the RRFSS data. This differs from the more common presentation in this Community Health Status Resource of five equal categories. Both give information about differences across income groups (Figure 6.5.3).

Education level was also significantly related to having had a sunburn. Those with post-secondary education had a much higher percent of people who had a sunburn in the past year (33.7%) compared to those with less than secondary school education (11.9%) (Figure 6.5.4).

Interpretation
A large study from the US looking at survey data about sunburns showed similar patterns to Middlesex-London.² Individuals within higher socio-economic groups experienced a higher rate of sunburn. Younger people had a higher sunburn prevalence than older people.

Tanning Bed Use

A very small percent of the population aged 18 and older (3.6%) reported using a tanning bed in the previous year when asked in 2015/16. The rates were similar to those of the province and the Peer Group (Figure 6.5.5).

Rates in the youth population (aged 12-17) are too small to be reported (not shown).

Interpretation
In a sun awareness survey conducted in 2017 by the Canadian Dermatology Association, 4% of people reported always going tanning at a tanning salon and another 8% reported doing it occasionally. This was higher than the 3.6% who reported use in the past year in Middlesex-London.³

Protective Behaviours Against Sun

Females (48.9%) were significantly more likely to avoid the sun during peak times of 11 a.m. to 4 p.m., when the sun’s UV rays are strongest, compared to males (37.2%). Males were much more likely to report that they rarely or never avoid the sun during peak times compared to females (Figure 6.5.6).

Wearing sunglasses was the most common behaviour reported by the population for protection against UV radiation. In 2017, nearly two-thirds of the population (65.5%) reported wearing sunglasses always or often. About half the population of adults 18 and older reported wearing protective clothing (50.5%) and 39.2% reported wearing sunscreen always or often (Figure 6.5.7).

Females were significantly more likely to report wearing sunscreen always or often (50.6%) compared to males (35.8%). Males were much more likely to report rarely or never wearing sunscreen compared to females (Figure 6.5.8).

Those with more education reported always or often applying sunscreen when exposed to the sun. More than half of those with post-secondary education reported the application of sunscreen always or often when exposed to the sun (52.9%) compared to 20.3% of those with less than a secondary school education. Those in the lowest education group had much higher rates of reporting rarely or never wearing sunscreen (Figure 6.5.9).

A higher percent of males (65.2%) wore protective clothing always or often compared with females (34.3%). The difference was statistically significant (Figure 6.5.10).

A higher percent of females (71.3%) wore sunglasses always or often compared with males (61.5%). The difference was statistically significant (Figure 6.5.11).

Those in the youngest age group (18-24) had a significantly lower rate of use of sunglasses always or often (46.3%) compared to the other age groups (not shown).

Interpretation
Recommendations for sun safety behaviours have changed over time. Using a sunscreen with a sun protection factor (SPF) value of 30 is now recommended compared to SPF 15 in the past. Peak times for sun exposure have changed to 11 a.m. to 3 p.m from 11 a.m. to 4 p.m.⁴ It is valuable to observe long term behavioural trends in the population. Showing the percent of the population avoiding sun between 11 a.m. and 4 p.m. and those using SPF 15, in the past, gives a sense of peoples’ adherence to past recommendations.

A worldwide study looking at primary prevention of skin cancer through behaviours such as wearing sunglasses and applying sunscreen found that younger people, males and those in lower income and education groups were less likely to engage in protective behaviours.⁵

Interestingly, while the pattern of sunscreen use indicates that those that had attained higher levels of education were more likely to always or often take protective measures against the sun, they were also the group that was most likely to report a sunburn in the past year.

Figure 6.5.1: Having a sunburn in the past 12 months

Figure 6.5.2: Having a sunburn in the past 12 months by age group

Figure 6.5.3: Having a sunburn in the past 12 months by household income

Figure 6.5.4: Having a sunburn in the past 12 months by education

Figure 6.5.5: Used a tanning bed in the past 12 months

Figure 6.5.6: Avoiding sun during peak times by sex

Figure 6.5.7: Wearing sunglasses, protective clothing and sunscreen always or often

Figure 6.5.8: Using sunscreen by sex

Figure 6.5.9: Using sunscreen by education

Figure 6.5.10: Wearing protective clothing by sex

Figure 6.5.11: Wearing sunglasses by sex