Attitudes and behaviors regarding sun exposure in Japan compared to Europe and North America

The objective of our study was to assess the attitudes and behaviors in Japan regarding sun exposure and compare them to those in Europe and North America. The study population was a representative sample of individuals aged >18 years from Ipsos panels in Japan (N = 1000), North America (N = 1000), and Europe (N = 6000) using the quota method. Questionnaires covered habits, practices, and perceptions regarding sun exposure. Results revealed that the majority of people (80.1%) believed that the sun gives them energy, and 61.1% considered that being tanned made them look healthier. However, there was a significant difference between men and women regarding the appeal of tanned skin, with 54.95% of men versus 34.67% (p < 0.001) of women seeing a tan as an aesthetic asset. People aged <40 years were less likely to find a tan attractive (30.3%) compared to those aged ≥40 years (48.9%) (p < 0.001). Of those questioned, 45.70% of used sunscreen with a much higher use among women (70.10%) than men (18.74%) (p < 0.001). Almost 54% of people said they stayed in the shade to protect themselves from the sun with this behavior being more prevalent among women (67.05%) and fair‐skinned individuals (56.13%). Fear of the risks of sun exposure was more common among women, with 84.8% fearing premature skin aging, compared to 71.8% of men (p < 0.001). In Japan, 44.30% of those questioned said tanned skin was attractive (p < 0.001); for Europeans and North Americans the proportions were 81.1% and 77.6%, respectively. Only a quarter (25.80%) thought it essential to return from vacation with a tan. On the other hand, Europeans showed a strong recognition of the energy the sun brings (83.18%), and widely believed that tanned skin is attractive (82.32%) and healthy (73.15%). In North America, attitudes were similar to those in Europe regarding the attractiveness of tanned skin (77.65%) and the importance of returning tanned from vacation (48.15%). Compared to Europeans and North Americans, the Japanese seemed to be more cautious about sun‐induced hazards and considered lighter skin to be more attractive.


| INTRODUC TI ON
Protection of the skin from sun exposure is increasingly being recognized as a major public health issue 1 as knowledge about the risks of ultraviolet (UV) radiation is growing.It is well documented that UV radiation causes skin cancer, sunburn, premature aging, immunosuppression, and activation of latent viruses.While climate factors may influence the level of UV radiation at the earth's surface, it is individual behavior that has the greatest impact on exposure to UV radiation. 1,2Data on attitudes to sun exposure in Japan are lacking.
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.

| ME THODS
The survey was conducted online from 28 September to 18 October 2021.The study population, selected from Ipsos online panels, included men and women aged ≥18 years from Japan (N = 1000), North America (USA & Canada, N = 1000), and Europe (France, Germany, Italy, Russia, Spain, and the UK N = 6000).
Eligibility required that all participants had not recently taken part in a similar survey.A preliminary sample population was compiled using the automatic selection process of the Ipsos software (eMethodology).The preliminary sample was adjusted, giving a final sample population that fit the quotas 3,4 based on sex, age, employment status, and regions of the individual countries.The final sample size made allowances for country-specific variations in response rates.
The questionnaires covered demographics, personal medical history, and sun-exposure habits and practices.Information on phototypes (skin types) was documented using the Fitzpatrick classification, together with a description of the color of the skin and color picture representations.The questionnaires were translated into the appropriate languages for each country and proofread by a native speaker.
Data were analyzed using descriptive statistics, including frequency tables, means, standard deviations, and 95% confidence intervals.Two-sided chi-squared tests with a 0.05 significance level were used to compare subgroups.The Cosi software (M.L.I., France, 1994) was used for all analyses.This survey was conducted in accordance with the ICC/ESOMAR code of conduct.

| RE SULTS
Table 1 shows the results of a survey of 1000 individuals in Japan on sun-related perceptions, protection habits and their knowledge of the impact and risks of sun exposure, comparing responses by sex, age, and skin type.
The results revealed that the majority of people (80.1%) believed that the sun gives them energy, and 61.1% considered that being tanned made them look healthier.However, there was a significant difference between men and women regarding the appeal of tanned skin, with 54.9% of men versus 34.7% (p < 0.001) of women seeing it as an aesthetic asset.People <40 years were less likely to find a tan attractive (30.3%) compared to those aged ≥40 years (48.9%)(p < 0.001).
In terms of sun protection habits, 45.7% of people used sunscreen with much higher use among women (70.10%) than men (18.74%) (p < 0.001).It is also interesting to note that 53.9% of people said they stayed in the shade to protect themselves from the sun.This behavior was more prevalent among women (67.1%) and fair-skinned individuals (56.1%).
Regarding the impact and risks of sun exposure, a large proportion of those questioned (78.5%) said they knew that the sun accelerates skin aging, and 70.1% recognized that the sun can cause skin health problems (p < 0.001).Fear of such risks was more common (56.13%).Fear of the risks of sun exposure was more common among women, with 84.8% fearing premature skin aging, compared to 71.8% of men (p < 0.001).In Japan, 44.30% of those questioned said tanned skin was attractive (p < 0.001); for Europeans and North Americans the proportions were 81.1% and 77.6%, respectively.Only a quarter (25.80%) thought it essential to return from vacation with a tan.On the other hand, Europeans showed a strong recognition of the energy the sun brings (83.18%), and widely believed that tanned skin is attractive (82.32%) and healthy (73.15%).In North America, attitudes were similar to those in Europe regarding the attractiveness of tanned skin (77.65%) and the importance of returning tanned from vacation (48.15%).Compared to Europeans and North Americans, the Japanese seemed to be more cautious about sun-induced hazards and considered lighter skin to be more attractive.

K E Y W O R D S
Japan, public health, sun exposure TA B L E 1 Attitudes and behaviors of the Japanese regarding sun exposure according to sex, age, and phototype.

| CON CLUS ION
In conclusion, sun protection habits and perception of skin hazards present in the Japanese population differ according to age, sex, and phototype.Compared to Europeans and North Americans, the Japanese seem to be more cautious regarding sun-induced hazards and consider lighter skin to be more attractive.Given that sun exposure is a modifiable factor for skin cancer and photo-ageing, promoting new cultural beliefs like those in Japan, and changing the of physical attractiveness might be a strategy to encourage sun-smart behavior in campaigns against sun exposure.Culture and perception of tanned skin among the Japanese population seems to be a protective factor from sun exposure.With the increased use of social media, the promotion of the perception of light-skin beauty on different online platforms could be considered to build a new trend in beauty alongside other beauty trends.

FU N D I N G I N FO R M ATI O N
As part of the HELIOS project, this work was funded by La Roche Posay International.

DATA AVA I L A B I L I T Y S TAT E M E N T
The data that support the findings of this study are available from the corresponding author upon reasonable request.

E TH I C S S TATEM ENT
This survey was conducted according to the ICC/ESOMAR code of conduct.

F I G U R E 1
Comparison of perceptions of sun exposure in Japan, Europe, and North America.Percentages represent the proportion of individuals in the studied population of each region.The sun accelerates skin ageing.
The risk of premature skin ageing The risk of developing cancer Cantabria labs, Pierre Fabre, NAOS, Uriage, and Pfizer.Pr.Chee Leok Goh reports other support from La Roche Posay during the conduct of the study.Pr.Kang reports personal fees from L'Oréal during the conduct of the study.Pr.Fatimata Ly has nothing to disclose.Pr.Morita reports personal fees from L'Oréal during the conduct of the study.Dr. Jorge Ocampo-Candiani reports personal fees from La Roche Posay during the conduct of the study.