Vitamin D and sun protection: The impact of mixed public health messages in Australia

Abstract

Exposure of the skin to sunlight can cause skin cancer and is also necessary for cutaneous Vitamin D production. Media reports have highlighted the purported health benefits of Vitamin D. Our aim was to examine attitudes and behaviours related to sun protection and Vitamin D. A cross-sectional study of 2,001 residents in Queensland, Australia, aged 20-70 years was undertaken. Information collected included the following: skin cancer risk factors; perceptions about levels of sun exposure required to maintain Vitamin D; belief that sun protection increases risk of Vitamin D deficiency; intention, and actual change in sun protection practices for adults and children. Multivariate models examined predictors of attitudinal and behavioural change. One-third (32%) believed a fair-skinned adult, and 31% thought a child required at least 30 min/day in summer sun to maintain Vitamin D levels. Reductions in sun protection were reported by 21% of adults and 14% of children. Factors associated with the belief that sun protection may result in not obtaining enough Vitamin D included age of 60 years (OR 5 1.35, 95% CI 1.09-1.66) and having skin that tanned easily (OR 5 1.96, 95% CI 1.38-2.78). Participants from low-income households, and those who frequently used sun-protective clothing were more likely to have reduced sun protection practices (OR 5 1.33, 95% CI 1.10-1.73 and OR 5 1.73, 95% CI 1.36-2.20, respectively). This study provides evidence of reductions in sun protection practices in a population living in a high UV environment. There is an urgent need to refocus messages regarding sun exposure and for continued sun protection practices. ' 2008 Wiley-Liss, Inc.Key words: Vitamin D; skin cancer; sun protection; ultraviolet Vitamin D, commonly referred to as the ''sunshine vitamin'', is required for the preservation of calcium and phosphate blood levels and hence the maintenance of bone health.1 While there are dietary sources of Vitamin D, the main source (over 95%) is through exposure of 7-dehydrocholesteraol in the skin to ultraviolet (UV) radiation followed by 2 hydroxylation steps.2 It has been estimated that Vitamin D production is maximised following exposure to one-third of a minimal erythemal dose (MED).2 Increasing the surface of the skin exposed to UV radiation also decreases the amount of time required to synthesise a given amount of Vitamin D. It is known that UV-induced DNA damage increases linearly with total exposure to sunlight. However, the concentration of preVitamin D reaches a threshold after less than 1 MED. Thus, increasing exposure of the skin to the sun does not necessarily result in increased Vitamin D production.

Knowledge and Attitudes about Vitamin D and Impact on Sun Protection Practices among Urban Office Workers in Brisbane, Australia

“…Due to the cross-sectional study design, we could not determine whether lack of knowledge about vitamin D resulted in reduced sun protection practices or whether people justified reduced sun protection behavior on the basis of perceived vitamin D requirements. However, these findings are consistent with the results of a recent survey in Queensland (11), suggesting that increasing knowledge may lead to improved sun protection practices.…”

“…However, 11% of our sample believed that sun protection might lead to a lack of vitamin D. This is lower than the 32% reported by Youl and colleagues (11) and might be due to the difference in sampling frame. Nevertheless, as in the previous study, we also found that this attitude was more common among people with a lower frequency of sunscreen use.…”

“…Cancer Epidemiol Biomarkers Prev; 19(7) July 2010 www.aacrjournals.orgstatements that were similar to those used in previous surveys (7,11). These were (a) "If I regularly protect myself from the sun, I am in danger of not getting enough vitamin D"; (b) "I am concerned that my vitamin D levels might be too low."…”

“…There have been previous surveys in Queensland which suggest that a high proportion of the population is unaware of the current recommendations (7,11). However, these surveys have had relatively low response rates and have not targeted a specific population.…”

Vitamin D supply: from sun or pill? - Attitudes and recommendation on vitamin D and impact on sun protection practices among German general practitioners evaluated by the network of dermato-oncologists, Onkoderm e.V.

“…No less than 20 studies were recently published on this issue. These deal with items such as: the calculated UV exposure levels for a healthy vitamin D status (1); the high prevalence of vitamin D insufficiency (2); the vitamin D supplement doses and serum 25-hydroxyvitamin D in the range associated with cancer prevention (3); the knowledge and attitudes concerning vitamin D and impact of sun protection practices among urban office workers (4); the need for future sun protection campaigns to address the issue of vitamin D and present strategies to achieve sufficient vitamin D levels in countries with high UV radiation throughout the year (5); the attitudes, practices and knowledge of general practitioners with regard to vitamin D in relation to prescribing sunshine (6); the impact of public health messages in terms of vitamin D and sun protection, as well as protection against skin cancer (7); the hazard of UV radiation for children and adolescents (8); the evaluation, treatment and prevention of vitamin D deficiency considered in a clinical practice guideline (9); the effects of ambient sunlight and photoprotection on vitamin D status (10); the common genetic determinants of vitamin D insufficiency (11); an overview analysis of the time individuals spend outdoors (12); the effectiveness of casual exposure to summer sunlight for maintaining adequate vitamin D status (13); the possible reduction of vitamin D production to insufficient levels resulting from the widespread use of sun creams, particularly those with high sun protection factors (14); the optimal exposure to sunlight (16). In Germany, the matter under consideration was also far from being ignored.…”