Sun protective behaviours during maximum exposure to ultraviolet radiation when undertaking outdoor activities

Abstract

<p><b>Background:</b> Despite millions of dollars spent on sun safe campaigns in Australia over the last three decades, sun protective behaviours remain poor, and skin cancer rates have increased. The lack of expected success of the sun safe campaigns may be attributed to the difficulty to changing individual behaviour. Sun safe campaigns have undoubtedly raised awareness and increased knowledge of how to protect from ultra violet radiation, however, this has not translated into adequate individual sun protective behaviours. Given that individual behavioural and community-level interventions have had limited success to date, intervention at the public policy level may be necessary. </p><p><b>Aim:</b> The aim of the study was to describe the prevalence of observed sun protective behaviours of a high-risk population in New South Wales attending an outdoor event. A secondary aim was to make recommendations, based on the results, for targeted interventions to improve sun protective behaviours and subsequently reduce the incidence of skin cancer in this population. </p><p><b>Research question:</b> The study research question was: What is the prevalence of observed sun protective behaviours of people attending an outdoor entertainment event during a period of maximum UVR exposure? </p><p><b>Method:</b> A cross-sectional observational study was conducted at an outdoor event in Armidale, NSW. Event attendees were consecutively observed as they entered the event and sun protective behaviours (wearing of hats, long sleeves, and sunglasses) were recorded on a checklist. Data were entered into an SPSS v 23 database and analysed using descriptive statistics and chi square tests. This unobtrusive observational study replicates the design used by Nikles and Harrison (2014) who described the prevalence of sun protective behaviours in a cohort of people who attended an outdoor spectator sporting event in North Queensland, Australia. </p><p><b>Results:</b> Of the estimated 5,000 attendees, observational data were collected for 2,988. The sample had 2,946 adults, 45.6% were male and 54.4% were female. The total sample included 42 children, 45.6% were male and 54.4% were female. Visors were worn by a small number of adults, but not worn at all by children. Bucket hats were more commonly worn by children, at 35% for children and only 18.7% for adults, while wide brimmed hats were more common in adults, at 53.5% to 27.5%. 43.9% of adults wore either no hat at all, or a non-protective hat, compared with 38.1% of children not wearing hats. Females were more likely to not wear a hat. Of those who wore sun protective headwear, women were more likely than men to wear a visor or a broad-brimmed hat, while men were more likely to wear a cap or bucket hat. There were no significant differences in the type of sun protective sleeves worn between adults and children. The most popular sleeve length for both adults and children was short sleeves, followed by sleeveless. A larger proportion of adults wore sun protective sleeves than children. There was a difference in the type of sleeve worn by males and females. A greater proportion of women wore a sleeveless top, cap sleeves, and ¾ sleeves than men. By contrast, a greater proportion of men wore short sleeves, and long sleeves. A significantly larger proportion of females wore sun protective sleeves than males. Of the observed sample, 83% wore sunglasses, the majority wore them on their eyes. A greater proportion of adults wore sunglasses than children, but there was little difference between males and females in this category of sun protection. </p><p><b>Conclusions:</b> The results of this study indicate that even with multiple and regular health promotion campaigns about the danger of UVR exposure causing skin cancers, the message does not appear to be translating into observable behaviours among this sample. While it is important to increase education and awareness about the danger of UVR exposure and preventive actions, prevention of UVR exposure at an outdoor event is largely viewed as a personal rather than public health factor. Public health focuses on the entire spectrum of health and wellbeing including disease prevention, whereas public safety refers to the welfare and protection of the general public (WHO, 2016). Unsafe UVR exposure can be viewed as a both a public health and a public safety issue. While event organisers already have a responsibility for the safety of event attendees and employees, this does not include sun safety for event attendees. Adopting strategies to reduce UVR exposure is recommended to increase the responsibility of outdoor event organisers to ensure a safer environment for attendees. </p><p><b>Recommendations:</b> Lobbying of local and state governments to shift the onus of sun protection from the individual to the event organiser is recommended as a lever for achieving necessary change. It is recommended outdoor event organisers be responsible for providing sun protection at outdoor events. Policy change at the local and state government level is necessary to ensure outdoor event organisers provide portable shade structures where permanent structures are unavailable at outdoor events. In addition, the implementation of a range of strategies, including ensuring that effective, inexpensive sunscreen is widely available for event attendees (for example, 50+ SPF in sunscreen stations), will help to protect attendees from UV damage. There is also a need to create further public awareness and education around ozone depletion and increased UVR in elevated regions, even with cloud cover, while countering attitudes towards tanning. </p><p><b>Limitations:</b> The annual National Skin Cancer Action Week media campaign occurred between 14 and 21 November 2015, and this study took place on the 21 November. Previous media educational campaigns have been shown to improve sun protective behaviours immediately post campaign (Wakefield, 2010) and this may have positively skewed the results.</p><p> The data is from a cross-sectional study observed at one outdoor music festival event at one point in time. The recording of age and sex was subjective, based on appearance, and observations were recorded consecutively rather than randomly, which increases the risk of sampling bias. The observations were limited by what the observers could see. Event attendees may have had in their bag or pocket sunglasses or a hat that they put on later. Assumptions were made that the behaviour observed is usual sun protective behaviour, but people are more likely to wear sun protection to planned events than incidental exposure (Thomson, White & Hamilton, 2012), so there was possibly higher compliance than usual.</p>