Although the Maltese people’s level of sun-related knowledge is increasing, they are increasingly putting themselves at risk by spending more time outside during the peak hours of sunlight.
This emerges from a study by Susan Aquilina, Lawrence Scerri, Neville Calleja, Andrew Amato-Gauci entitled “Trends in sun exposure awareness and protection practices in Malta: 1999-2004,” published in the Malta Medical Journal in 2007.
The study compares the results of two surveys on Maltese people’s attitudes towards sun exposure held in the space of five years.
While in the 2004 survey, 85.9% admitted spending at least some of their leisure activities in the sun between 10 am and 3pm in spring or summer only 62.4% admitting this in 1999.
In both surveys the youngest age group (16-25) were the most likely to spend more than three days a week in the sun. These were twice as likely to spend more time in the sun as the older age groups.
There was no significant change in the overall reported use of sunscreen during leisure activities between the two surveys. Sunscreen was still more popular with females than males. While 64.2% of females made regular use of sunscreen only 27.3% of males did likewise.
A comparison of the two surveys showed a significant drop in regular hat use from 32.4% in 1999 to 18.4% in 2004. Sun protection during outdoor work activities also deteriorated in 2004, despite government measures to provide free sunscreen to various occupational sectors involving outdoor activity, including postal workers, members of the police force, and hospital security personnel.
Only 9.3% reported using sunscreen regularly compared to 25.0% in 1999. Rates of regular hat wearing among outdoor workers also saw a significant drop from 37.5% in 1999 to just 9.3% in 2004.
People occupationally exposed to the sun are at an especially high risk for squamous cell carcinoma which is linked to cumulative sun exposure.
In the 2004 survey 96.1% of all parents regularly applied sunscreen on their children when these were out in the peak hours of sunlight. Only 87% did likewise in 1999.
On the other hand while parents were more likely to apply sunscreen they were less likely to make their children wear a hat than in 1999. Only 66.2% claimed that their children regularly wore a hat when out in the sun in 2004-a 12% drop since 1999.
Although people were more likely to put themselves at risk, knowledge about sun effects on the skin kept improving since 1999.
More people were appreciating that having a suntan is not good for your health even if one avoids getting sunburnt – 62.8% in 2004 versus 37.0% in 1999.
Practically all those interviewed knew that the sun can cause skin cancer and photo ageing, and a high percentage knew that skin cancer can be fatal. The proportion that consider a suntan as a sign of health also decreased.
Why is the knowledge not being converted into behavioural change?
“For some it could be that looking tanned is worthwhile whatever the price paid in the future, or perhaps some people just love relaxing in the sun so much that they would rather risk skin cancer and photo aging than give it up?”
The only improvement since 1999 was the universal application of sunscreen on young children.
Sunscreen use seems to have become the rule among young children (96.1% in 2004, 87.0% in 1999), although rates of regular hat use dropped from 78.4% to 66.2%.
As regards the use of sunscreen among children, Malta fares even better than other European countries.
A study in Belgium, Germany, France and Italy carried out in 1995-1997 showed that only 25% of children always used sunscreen. A more recent study in Italy showed that 80% of children aged 6-14 years used sunscreen, but only 38% used it on a regular basis. The shows a marked success of educational campaigns which have always emphasised sun protection in children. Campaigns have focused on children because the incidence of cutaneous malignant melanoma is mostly related to intermittent burning sun exposure in childhood and adolescence.
But the high level of sun protection enjoyed by children is all but lost when these children become adolescents, as sun exposure during leisure activities and sun protection rates
remain the worst amongst the 16-25 year olds.
“The positive influence of parents seems to be replaced by negative peer pressure,” the study warns.
Studies show that college students are more likely to change their behaviour when the immediate risks to appearance are emphasized rather than cancer risks, which are psychologically remote.
“In several studies, the viewing of UV- filtered photographs that show an individual’s early skin changes from photo damage, along with written or video educational information about photo ageing, have resulted consistently in changes in planned and reported sun protection motivation and behaviours.”
On the other hand with the older people, skin cancer-related concerns may be more relevant.
The study recommends shifting some of the focus of Maltese campaigns from children who are being adequately sun-protected by their parents onto adolescents and outdoor workers.
Maltese skin types A study carried out to estimate the skin photo-types of the Maltese showed that approximately one half of the Maltese population is at moderate risk of sun damage; about one quarter is at low risk; and the other quarter is at high risk, the latter group needing more thorough sun avoidance and better surveillance for skin tumours.
The data was collected from 756 patients. The commonest reported skin photo-type in both sexes was type III (48.0% overall; 52.4% in males, 43.8% in females) which is considered to be at moderate risk.
Another study conducted between 2000 and 2004 showed that Melanoma incidence in Malta is lower than that in high-incidence countries and northern Europe and is similar to that in southern Europe. However, incidence appears to be increasing.
Rates for invasive melanoma were set at 8.81 per 100,000 for males and 7.29 per 100,000 for females and were found to increase with age.
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