Study Highlights Different Views Between Japanese, North Americans on Sun Protection

Habits related to sun protection and views on hazards are different in the Japanese population according to sex, age, and phototype, according to recent findings, with North Americans and Europeans being less cautious regarding sun exposure hazards.¹

These findings were the conclusion of recent research conducted in light of the growing recognition of the potential damage of the sun’ rays if exposure is extended for too long. Ultraviolet (UV) radiation is well-known to be a major cause of skin cancer, premature aging, immunosuppression, and the activation of latent conditions.

This research was led by A. Morita, from the Nagoya City University Graduate School of Medical Sciences’ department of geriatric and environmental dermatology in Japan. Morita and colleagues noted that despite the existence of climate factors on UV radiation levels, individual behavior is the most impactful as far as exposure.²

“Data on attitudes to sun exposure in Japan are lacking,” Morita and colleagues wrote. “The objective of our study was to assess attitudes and behaviors regarding sun exposure in Japan and compare them to those in Europe and North America.”

Background and Methods

The investigators implemented an online survey aimed at individuals who were 18 years and of age and older in North America, Japan, and Europe, with their work being carried out between September - October 2021. They specifically looked at 1000 people from Japan, 1000 from the US and Canada, and 6000 cumulatively from Italy, Germany, France, Russia, the UK, and Spain.

Ipsos online panels were used to find study participants, and a preliminary sample had been generated through the use of Ipsos software's automatic selection process. This was later adjusted with the aim of creating a final sample adhering to quotas based on age, sex, status of employment, and regional representation within each country.

The research team’s questionnaires would involve inquiries about personal medical histories, demographic data, and sun-exposure habits and actions, with the team also evaluating subjects' phototypes through the Fitzpatrick classification system as well as descriptions and images of their skin tones.

The investigators translated their questionnaires into the respective languages of each participants’ country and had them reviewed for accuracy by native speakers. Their data analyses involved the use of descriptive statistics, and their subgroup comparisons were done through the use of 2-sided chi-squared tests and a significance level of 0.05.

Findings

Overall, the research team found that those under 40 years old had been shown to be less likely (30.3%) to suggest that tanned skin was more attractive versus subjects who were aged 40 or older at a rate of 48.9% (P < .001). The team noted that 45.70% reported using sunscreen, though use 70.10% in women and 18.74% among men, indicating a sharp contrast (P < .001).

The investigators reported that 80.1% of participants had a belief that sunlight gave them energy and 61.1% indicated that a tanned appearance led to better health. They also found distinctions with gender, as 54.95% of men viewed tans as appealing compared to 34.67% of women (P < .001).

Doing protective behaviors such as remaining in shade was noted by the research team as occurring among 67.05% of women and 56.13% of those with fairer skin. Higher levels of concern about sun-related risks were identified among 84.8% of women expressing fear of premature skin aging versus 71.8% of men (P < .001).

There were also notable regional distinctions, with 44.30% of those in Japan reporting tanned skin to be attractive (P < .001), compared to 81.1% among Europeans and 77.6% of North Americans. Europeans were also shown to have a strong belief in the energizing impact of the sun's rays at a rate of 83.18%, also viewing the impacts of tanning as attractive (82.32%) and promoting health (73.15%).

North Americans also indicated a similar view of tanning at a rate of 77.65%, though they did not place as much emphasis on returning from their vacations with a tan (48.15%).

“One of the limitations in the study is the use of the Fitzpatrick classification,” they wrote. “The classification, used for Japanese people, utilizes the Japan phototypes I, II and III. While it might sometimes be difficult to classify the phototype of Japanese people using only the Fitzpatrick classification, but the same classification had to be used on all individuals of the study.”

References

1. Morita A, Lim HW, Passeron T, Goh CL, Kang HY, Ly F, et al. Attitudes and behaviors regarding sun exposure in Japan compared to Europe and North America. J Dermatol. 2024; 00: 1–6. https://doi.org/10.1111/1346-8138.17217.
2. Yan S, Xu F, Yang C, Li F, Fan J, Wang L, et al. Demographic differences in sun protection beliefs and behavior: a community-based study in Shanghai, China. Int J Environ Res Public Health. 2015; 12: 3232–3245.