Exposure to UV radiation is a major risk factor for the development of malignant skin neoplasms. Currently, there are no studies available on sun-exposure habits among different countries. We conducted a cross-sectional survey among medical students from the University of Rome, Italy and the University of Granada, Spain to compare their photoprotection knowledge, habits, and attitudes. A total of 215 medical students (114 Spanish, and 101 Italian) were included. Spanish students considered the Sun to be the main cause of skin cancer (83.3% vs 61.4%; p=.003) and they looked at their skin more often than Italian students did (32.5% vs 9.9%; p<.001). The latter received information on photoprotection mainly from their dermatologist (34.7%, 35/101) vs Spaniards who received such information from their university (39.5%, 45/114; p<.001). After studying dermatology, Spaniards used sunscreen more frequently than Italians did (76.8% before vs 88.1% after; p=.007), and recognized the need to implement other measures as well (44.9% vs 67.2%; p=.025).
La exposición a la radiación ultravioleta es un factor de riesgo fundamental en el desarrollo de neoplasias malignas de la piel. Actualmente, no disponemos de estudios que comparen los hábitos de exposición solar entre diferentes países. Se realizó un estudio transversal mediante encuesta en el que se incluyeron a estudiantes de Medicina de la Universidad de Roma y de Granada y se compararon sus hábitos y conocimientos sobre fotoprotección. Se incluyeron 215 estudiantes (114 españoles y 101 italianos). Los estudiantes españoles consideraron que la principal causa de cáncer de piel era el sol (83,3 vs. 61,4%, p=0,003) y, examinaron más veces su piel (32,5 vs. 9,9%, p<0,001). Los italianos recibieron información sobre fotoprotección fundamentalmente a través de su dermatólogo (34,7%, 35/101), los españoles en su universidad (39,5%, 45/114, p<0,001). Los españoles usaron más frecuentemente una crema fotoprotectora después de cursar Dermatología (76,8% antes vs. 88,1% después, p=0,007) y, reconocieron que eran necesarias otras medidas (44,9 vs. 67,2%, p=0,025).
The most common malignant skin neoplasms are categorized into cutaneous melanoma and non-melanoma skin cancer, with exposure to UV radiation being the primary risk factor.1 In recent years, the increase in solar exposure by the population, changes in habits related to a greater tendency for tanning, and population aging have significantly increased the risk of skin cancer1. Since UV radiation is a modifiable etiological factor in the development of skin cancer, it is crucial to promote proper photoprotection as a preventive measure.2,3
Public knowledge about photoprotection has been studied by referencing various population groups, including swimmers,2 adolescents,4 and athletes.5 Although training programs on the use of photoprotection measures have not decreased the incidence of skin cancer, they have actually improved attitudes toward skin cancer prevention.6 Among university populations, it has been observed that these measures are not adequate.7–9 Studies with Italian students reveal that they are aware of the risks of solar exposure, but they consider tanning to produce a pleasant esthetic effect.10,11 In other countries such as Jordan, Romania, or Peru, medical students demonstrated higher knowledge vs the general population, yet solar exposure habits were often inadequate.12–14
The objective of this study was to compare the knowledge and habits of photoprotection between Spanish and Italian students.
Materials and methodsWe conducted an observational, descriptive, cross-sectional study through a self-administered closed-response questionnaire on paper (Supplementary data). We included medical students from the 4th, 5th, or 6th year (University of Rome “La Sapienza”) and 3rd, 4th, and 5th year (Universidad of Granada), corresponding respectively to “before studying Dermatology,” “while studying Dermatology,” and “after studying Dermatology.” Study methods are shown in Supplementary data.
ResultsDescriptive analysisA total of 215 students were included in the study, 114 of whom were Spanish (53%) and 101, Italian (47%). The patients’ mean age was 23.28 (SD, 2.99); a total of 74.4% of participants were women (160/215) and 25.6%, men (55/215).
A total of 32.1% (69/215) of students studied filled out the questionnaire “before studying Dermatology,” 36.7% (79/215) filled out the “while studying Dermatology,” questionnaire and 31.2% (67/215) the “after studying Dermatology” one.
Regarding knowledge, a total of 70.7% (152/215) of participants thought that sun exposure could be both healthy and dangerous, and they considered it the main cause of skin cancer (73.0%, 157/215). Similarly, the vast majority, 81.9% (176/215), knew that the most dangerous time for sun exposure was between 12:00 and 16:00h; 80% (172/215) said that it was of paramount importance to prevent solar exposure at early ages, and 93.5% (201/215) thought that sunscreen should be used in children; a total of 74% (159/215) of students had received information about photoprotection in the last year.
Regarding photoprotection habits, a total of 52.1% (112/215) of the students showed interest in tanning. Most (72.6%, 156/215) “always” or “almost always” used sunscreen with a protection factor≥30; a total of 60.9% (131/215) reported having had some sort of sunburn throughout their lifetime, and 38.6% (83/215) said they never examined their skin for malignant lesions. Only 14.9% (32/215) had a family history of skin cancer, and 10.2% (22/215) a family history of melanoma.
Differences across multiple countries among medical students are shown in Table 1.
Student responses by country.
| Variable | Total (n=215) | Italy | Spain | p |
|---|---|---|---|---|
| Age (Mean) | Median 23.28 (SD, 2.99) | Median 25.18 | Median 21.60 | <0.001 |
| Gender | 0.793 | |||
| Male | 55 (25.6%) | 76 (75.2%) | 84 (73.7%) | |
| Female | 160 (74.4%) | 25 (24.8%) | 30 (26.3%) | |
| Course | 0.909 | |||
| Before studying Dermatology | 69 (32.1%) | 33 (32.7%) | 36 (31.6%) | |
| While studying Dermatology | 79 (36.7%) | 38 (37.6%) | 41 (36%) | |
| After studying Dermatology | 67 (31.2%) | 30 (29.7%) | 37 (32.5%) | |
| 1. Do you like being tanned? | 0.807 | |||
| Yes | 112 (52.1%) | 52 (51.5%) | 60 (52.6%) | |
| No | 39 (18.1%) | 17 (16.8%) | 22 (19.3%) | |
| Indifferent | 64 (29.8%) | 32 (31.7%) | 32 (28.1%) | |
| 2. The sun that burns the most | <0.001 | |||
| From 10a.m. to 2p.m. | 17 (7.9%) | 16 (15.8%) | 1 (0.9%) | |
| From 12p.m. to 4p.m. | 176 (81.9%) | 81 (80.2%) | 95 (83.3%) | |
| From 2p.m. to 6p.m. | 12 (5.6%) | 1 (1%) | 11 (9.6%) | |
| All times are the same | 8 (3.7%) | 2 (2%) | 6 (5.3%) | |
| I don’t know | 2 (0.9%) | 1 (1%) | 1 (0.9%) | |
| 3. Exposing yourself to the sun is | <0.001 | |||
| Healthy | 2 (0.9%) | 2 (2%) | 0 (0%) | |
| Healthy and dangerous | 152 (70.7%) | 86 (85.1%) | 66 (57.9%) | |
| Dangerous | 33 (15.3%) | 10 (9.9%) | 23 (20.2%) | |
| Very dangerous | 28 (13%) | 3 (3%) | 25 (21.9%) | |
| 4. Main cause of skin cancer | 0.003 | |||
| The sun | 157 (73%) | 62 (61.4%) | 95 (83.3%) | |
| Hereditary | 2 (0.9%) | 2 (2%) | 0 (0%) | |
| I don’t know | 2 (0.9%) | 1 (1%) | 1 (0.9%) | |
| Several of the above | 54 (25.1%) | 36 (35.6%) | 18 (15.8%) | |
| 5.1. I don’t like the texture of sunscreen cream | 0.630 | |||
| Agree | 29 (13.5%) | 37 (36.6%) | 70 (61.4%) | |
| Partially agree | 75 (34.9%) | 38 (37.6%) | 27 (23.7%) | |
| Disagree | 70 (32.6%) | 16 (15.8%) | 12 (10.5%) | |
| Indifferent | 41 (19.1%) | 10 (9.9%) | 5 (4.4%) | |
| 5.2. At the beach, I prefer to be in the shade | 0.004 | |||
| Agree | 107 (49.8%) | 32 (58.2%) | 75 (46.9%) | |
| Partially agree | 65 (30.2%) | 16 (29.1%) | 49 (30.6%) | |
| Disagree | 28 (13%) | 1 (1.8%) | 27 (16.9%) | |
| Indifferent | 15 (7%) | 6 (10.9%) | 9 (5.6%) | |
| 5.3. I do not use sunscreen to tan | 0.151 | |||
| Agree | 10 (4.7%) | 8 (7.9%) | 2 (1.8%) | |
| Partially agree | 22 (10.2%) | 11 (10.9%) | 11 (9.6%) | |
| Disagree | 174 (80.9%) | 79 (78.2%) | 95 (83.3%) | |
| Indifferent | 9 (4.2%) | 3 (3%) | 6 (5.3%) | |
| 5.4. To protect myself from the sun, sunscreen is enough | 0.278 | |||
| Agree | 14 (6.5%) | 9 (8.9%) | 5 (4.4%) | |
| Partially agree | 83 (38.6%) | 49 (48.5%) | 34 (29.8%) | |
| Disagree | 115 (53.3%) | 42 (41.6%) | 73 (64%) | |
| Indifferent | 3 (1.4%) | 1 (1%) | 2 (1.8%) | |
| 5.5. Young children do not need sunscreen | 0.035 | |||
| Agree | 4 (1.9%) | 3 (3%) | 1 (0.9%) | |
| Partially agree | 2 (0.9%) | 2 (2%) | 0 (0%) | |
| Disagree | 201 (93.5%) | 93 (92.1%) | 108 (94.7%) | |
| Indifferent | 8 (3.7%) | 3 (3%) | 5 (4.4%) | |
| 5.6. Sunbathing helps prevent health issues and is, therefore, healthy | 0.048 | |||
| Agree | 30 (14%) | 16 (15.8%) | 14 (12.3%) | |
| Partially agree | 140 (65.1%) | 72 (71.3%) | 68 (59.6%) | |
| Disagree | 43 (20%) | 12 (11.9%) | 31 (27.2%) | |
| Indifferent | 2 (0.9%) | 1 (1%) | 1 (0.9%) | |
| 5.7. If I am tan, I don’t need sunscreen | 0.210 | |||
| Agree | 0 (0%) | 0 (0%) | 0 (0%) | |
| Partially agree | 13 (6%) | 9 (8.9%) | 4 (3.5%) | |
| Disagree | 196 (91.2%) | 90 (89.1%) | 106 (93%) | |
| Indifferent | 6 (2.8%) | 2 (2%) | 4 (3.5%) | |
| 5.8. Avoiding the sun in central hours is the best way to protect myself | 0.132 | |||
| Agree | 62 (28.8%) | 23 (22.8%) | 39 (34.2%) | |
| Partially agree | 116 (54%) | 63 (62.4%) | 53 (46.5%) | |
| Disagree | 34 (15.8%) | 14 (13.9%) | 20 (17.5%) | |
| Indifferent | 3 (1.4%) | 1 (1%) | 2 (1.8%) | |
| 5.9. Avoiding the sun at a young age reduces the risk of skin cancer | <0.001 | |||
| Agree | 119 (55.3%) | 38 (37.6%) | 81 (71.1%) | |
| Partially agree | 53 (24.7%) | 32 (31.7%) | 21 (18.4%) | |
| Disagree | 24 (11.2%) | 20 (19.8%) | 4 (3.5%) | |
| Indifferent | 19 (8.8%) | 11 (10.9%) | 8 (7%) | |
| 6. Information received | <0.001 | |||
| No information received | 56 (26%) | 34 (33.7%) | 22 (19.3%) | |
| From my dermatologist and university | 10 (4.7%) | 0 (0%) | 10 (8.8%) | |
| From my dermatologist | 41 (19.1%) | 35 (34.7%) | 6 (5.3%) | |
| From university | 45 (20.9%) | 0 (0%) | 45 (39.5%) | |
| Other sources (TV, radio, press, etc.) | 63 (29.3%) | 32 (31.7%) | 31 (27.2%) | |
| 7.1. Used sunscreen with SPF≥30 | 0.747 | |||
| Always | 67 (31.2%) | 34 (33.7%) | 33 (28.9%) | |
| Almost always | 89 (41.4%) | 39 (38.6%) | 50 (43.9%) | |
| Sometimes | 40 (18.6%) | 20 (19.8%) | 20 (17.5%) | |
| Almost never | 14 (6.5%) | 5 (5%) | 9 (7.9%) | |
| Never | 5 (2.3%) | 3 (3%) | 2 (1.8%) | |
| 7.2. Wore a t-shirt | 0.808 | |||
| Always | 23 (10.7%) | 9 (8.9%) | 14 (12.3%) | |
| Almost always | 55 (25.6%) | 28 (27.7%) | 27 (23.7%) | |
| Sometimes | 64 (29.8%) | 30 (29.7%) | 34 (29.8%) | |
| Almost never | 37 (17.2%) | 19 (18.8%) | 18 (15.8%) | |
| Never | 36 (16.7%) | 15 (14.9%) | 21 (18.4%) | |
| 7.3. Wore a cap or hat | 0.503 | |||
| Always | 17 (7.9%) | 8 (7.9%) | 9 (7.9%) | |
| Almost always | 38 (17.7%) | 20 (19.8%) | 18 (15.8%) | |
| Sometimes | 61 (28.4%) | 28 (27.7%) | 33 (28.9%) | |
| Almost never | 53 (24.7%) | 20 (19.8%) | 33 (28.9%) | |
| Never | 46 (21.4%) | 25 (24.8%) | 21 (18.4%) | |
| 7.4. Wore sunglasses | 0.058 | |||
| Always | 65 (30.2%) | 39 (38.6%) | 26 (22.8%) | |
| Almost always | 53 (24.7%) | 26 (25.7%) | 27 (23.7%) | |
| Sometimes | 43 (20%) | 14 (13.9%) | 29 (25.4%) | |
| Almost never | 30 (14%) | 13 (12.9%) | 17 (14.9%) | |
| Never | 24 (11.2%) | 9 (8.9%) | 15 (13.2%) | |
| 7.5. Stayed in the shade | 0.164 | |||
| Always | 37 (17.2%) | 18 (17.8%) | 19 (16.7%) | |
| Almost always | 100 (46.5%) | 54 (53.5%) | 46 (40.4%) | |
| Sometimes | 65 (30.2%) | 26 (25.7%) | 39 (34.2%) | |
| Almost never | 12 (5.6%) | 3 (3%) | 9 (7.9%) | |
| Never | 1 (0.5%) | 0 (0%) | 1 (0.9%) | |
| 7.6.1. How many hours were you exposed to the sun between 12 and 16h? | 0.693 | |||
| 0h | 13 (6%) | 7 (6.9%) | 6 (5.3%) | |
| <1h | 97 (45.1%) | 49 (48.5%) | 48 (42.1%) | |
| 1–2h | 79 (36.7%) | 34 (33.7%) | 45 (39.5%) | |
| 2–4h | 26 (12.1%) | 11 (10.9%) | 15 (13.2%) | |
| 7.6.2. How often were you exposed during this time? | 0.403 | |||
| Every day | 8 (3.7%) | 2 (2%) | 6 (5.3%) | |
| Most days (≥5/week) | 29 (13.5%) | 12 (11.9%) | 17 (14.9%) | |
| 3–4 days a week | 47 (21.9%) | 26 (25.7%) | 21 (18.4%) | |
| <2 days/week or occasionally | 121 (56.3%) | 55 (54.5%) | 66 (57.9%) | |
| None | 10 (4.7%) | 6 (5.9%) | 4 (3.5%) | |
| 8. Sunburns in the past year | 0.312 | |||
| No sunburns | 74 (34.4%) | 39 (38.6%) | 35 (30.7%) | |
| 1–3 sunburns | 131 (60.9%) | 59 (58.4%) | 72 (63.5%) | |
| 4–6 sunburns | 10 (4.7%) | 3 (3%) | 7 (6.1%) | |
| 9. How many with blisters involved? | 0.130 | |||
| None | 207 (96.3%) | 94 (93.1%) | 113 (99.1%) | |
| 1–3 | 6 (2.8%) | 5 (5%) | 1 (0.9%) | |
| 4–6 | 1 (0.5%) | 1 (1%) | 0 (0%) | |
| >7 | 1 (0.5%) | 1 (1%) | 0 (0%) | |
| 10. Phototype | 0.915 | |||
| Phototype I | 46 (21.4%) | 23 (22.8%) | 23 (20.2%) | |
| Phototype II | 79 (36.7%) | 36 (35.6%) | 43 (37.7%) | |
| Phototype III | 58 (27%) | 29 (28.7%) | 29 (25.4%) | |
| Phototype IV | 22 (10.2%) | 9 (8.9%) | 13 (11.4%) | |
| Phototype V | 10 (4.7%) | 4 (4%) | 6 (5.3%) | |
| Phototype VI | 0 (0%) | 0 (0%) | 0 (0%) | |
| 11. Outdoor physical exercise | <0.001 | |||
| Never | 73 (34%) | 31 (30.7%) | 42 (36.8%) | |
| 1 or 2 days a week | 74 (34.4%) | 22 (21.8%) | 52 (45.6%) | |
| 3 or 4 days a week | 32 (14.9%) | 15 (14.9%) | 17 (14.9%) | |
| 1 or 2 times a month | 36 (16.7%) | 33 (32.7%) | 3 (2.6%) | |
| 12. If you exercise, how often do you protect yourself from the sun? | 0.002 | |||
| Always | 43 (23.4%) | 17 (16.8%) | 26 (31.3%) | |
| Almost always | 37 (20.1%) | 18 (17.8%) | 19 (22.9%) | |
| Sometimes | 35 (19%) | 23 (22.8%) | 12 (14.5%) | |
| Almost never | 34 (18.5%) | 15 (14.9%) | 19 (22.9%) | |
| Never | 35 (19%) | 28 (27.7%) | 7 (8.4%) | |
| 13. Family history of skin cancer | 0.814 | |||
| Yes | 32 (14.9%) | 16 (15.8%) | 16 (14%) | |
| No | 168 (78.1%) | 79 (78.2%) | 89 (78.1%) | |
| Don’t know | 15 (7%) | 6 (5.9%) | 9 (7.9%) | |
| 14. Family history of melanoma | 0.659 | |||
| Yes | 22 (10.2%) | 12 (11.9%) | 10 (8.8%) | |
| No | 171 (79.5%) | 80 (79.2%) | 91 (79.8%) | |
| Don’t know | 22 (10.2%) | 9 (8.9%) | 13 (11.4%) | |
| 15. Skin self-examination last year | <0.001 | |||
| Never | 83 (38.6%) | 44 (43.6%) | 39 (34.2%) | |
| Once | 53 (24.7%) | 34 (33.7%) | 19 (16.7%) | |
| 2–3 times | 32 (14.9%) | 13 (12.9%) | 19 (16.7%) | |
| More than 3 times | 47 (21.9%) | 10 (9.9%) | 37 (32.5%) | |
| 16. UVA tanning booths | 0.555 | |||
| Yes | 5 (2.3%) | 3 (3%) | 2 (1.8%) | |
| No | 210 (97.7%) | 98 (97%) | 112 (98.2%) | |
| 17. If answered yes, frequency of UVA sessions | 0.329 | |||
| Once every 4–5 months | 1 (20%) | 0 (0%) | 1 (50%) | |
| Once a year or less | 1 (20%) | 1 (33.3%) | 0 (0%) | |
| Only went once | 3 (60%) | 2 (66.7%) | 1 (50%) | |
Differences in knowledge and habits about photoprotection were observed between Spanish and Italian students. Italian students were older than the Spanish ones (25.18 vs 21.60 years, p<0.001).
Regarding knowledge, 83.3% (95/114) of Spanish students considered the sun was the main cause of skin cancer vs 61.4% (62/101) of Italian students (p=0.003). On the other hand, Spanish students mainly received information through college (39.5%, 45/114), while Italians received it mostly from their dermatologist (34.7%, 35/101, p<0.001).
Regarding habits and behaviors, Spanish students examined their skin more frequently through self-examination (32.5% vs 9.9%, p<0.001). Additionally, a higher percentage of Italians never used sun protection (8.4% vs 27.7%, p=0.002).
Sex differences across medical students are shown in Table S1. Supplementary data.
Men had a lower phototype than women did (31.9% women vs 50.9% men with phototype II, p=0.034).
Regarding knowledge, a higher number of women indicated that despite being tanned, topical sunscreens were required (96.3% vs 76.4%, p<0.001) and that using only sunscreen was not enough to protect from the sun (58.1% vs 40%, p=0.041).
On photoprotection habits, women were more concerned about tanning (58.8% vs 32.7%, p=0.003), used sunscreen “always” or “almost always” with a factor of 30 or higher (76.9% vs 60%, p=0.008), but also spent more hours in the sun than men did (55.6% vs 29.1% exposure to the sun>1h, p=0.003). Men sought shade more often than women did (46.9% vs 58.2%, p=0.020).
Course differences among medical students are shown in Table 2.
Responses of students based on the academic year they were in during their medical degree.
| Before studying Dematology | While studying Dematology | After studying Dematology | p | |
|---|---|---|---|---|
| Age | Mean22.03 | Mean22.87 | Mean25.04 | 0.135 |
| Gender | 0.059 | |||
| Man | 13 (18.8%) | 18 (22.8%) | 24 (35.8%) | |
| Woman | 56 (81.2%) | 61 (77.2%) | 43 (64.2%) | |
| Country | 0.909 | |||
| Spain | 36 (52.2%) | 41 (51.9%) | 37 (55.2%) | |
| Italy | 33 (47.8%) | 38 (48.1%) | 30 (44.8%) | |
| 1. Do you like being tanned? | 0.283 | |||
| Yes | 42 (60.9%) | 39 (49.4%) | 31 (46.3%) | |
| No | 12 (17.4%) | 12 (15.2%) | 15 (22.4%) | |
| Indifferent | 15 (21.7%) | 28 (35.4%) | 21 (31.3%) | |
| 2. The sun that burns the most | 0.793 | |||
| From 10a.m. to 2p.m. | 5 (7.2%) | 7 (8.9%) | 5 (7.5%) | |
| From 12p.m. to 4p.m. | 59 (85.5%) | 63 (79.7%) | 54 (80.6%) | |
| From 2p.m. to 6p.m. | 4 (5.8%) | 3 (3.8%) | 5 (7.5%) | |
| All times are the same | 1 (1.4%) | 5 (6.3%) | 2 (3%) | |
| I don’t know | 0 (0%) | 1 (1.3%) | 1 (1.5%) | |
| 3. Exposing yourself to the sun is | 0.110 | |||
| Healthy | 0 (0%) | 0 (0%) | 2 (3%) | |
| Healthy and dangerous | 54 (78.3%) | 58 (73.4%) | 40 (59.7%) | |
| Dangerous | 10 (14.5%) | 10 (12.7%) | 13 (19.4%) | |
| Very dangerous | 5 (7.2%) | 11 (13.9%) | 12 (17.9%) | |
| 4. Main cause of skin cancer | 0.337 | |||
| The sun | 46 (66.7%) | 59 (74.7%) | 52 (77.6%) | |
| Hereditary | 1 (1.4%) | 1 (1.3%) | 0 (0%) | |
| I don’t know | 0 (0%) | 2 (2.5%) | 0 (0%) | |
| Several of the above | 22 (31.9%) | 17 (21.5%) | 15 (22.4%) | |
| 5.1. I don’t like the texture of sunscreen cream | 0.047 | |||
| Agree | 6 (8.7%%) | 7 (8.9%) | 16 (23.9%) | |
| Partially agree | 23 (33.3%) | 29 (36.7%) | 23 (34.3%) | |
| Disagree | 28 (40.6%) | 23 (29.1%) | 19 (28.4%) | |
| Indifferent | 12 (17.4%) | 20 (25.3%) | 9 (13.4%) | |
| 5.2. At the beach, I prefer to be in the shade | 0.196 | |||
| Agree | 32 (46.4%) | 35 (44.3%) | 40 (59.7%) | |
| Partially agree | 19 (27.5%) | 25 (31.6%) | 21 (31.3%) | |
| Disagree | 12 (17.4%) | 13 (16.5%) | 3 (4.5%) | |
| Indifferent | 6 (8.7%) | 6 (7.6%) | 3 (4.5%) | |
| 5.3. I do not use sunscreen to tan | 0.007 | |||
| Agree | 4 (5.8%) | 5 (6.3%) | 1 (1.5%) | |
| Partially agree | 12 (17.4%) | 9 (11.4%) | 1 (1.5%) | |
| Disagree | 53 (76.8%) | 62 (78.5%) | 59 (88.1%) | |
| Indifferent | 0 (0%) | 3 (3.8%) | 6 (9%) | |
| 5.4. To protect myself from the sun, sunscreen is enough | 0.025 | |||
| Agree | 6 (8.7%) | 8 (10.1%) | 0 (0%) | |
| Partially agree | 31 (44.9%) | 32 (40.5%) | 20 (29.9%) | |
| Disagree | 31 (44.9%) | 39 (49.4%) | 45 (67.2%) | |
| Indifferent | 1 (1.4%) | 0 (0%) | 2 (3%) | |
| 5.5. Young children do not need sunscreen | 0.178 | |||
| Agree | 0 (0%) | 1 (1.3%) | 3 (4.5%) | |
| Partially agree | 1 (1.4%) | 1 (1.3%) | 0 (0%) | |
| Disagree | 67 (97.1%) | 75 (94.9%) | 59 (88.1%) | |
| Indifferent | 1 (1.4%) | 2 (2.5%) | 5 (7.5%) | |
| 5.6. Sunbathing helps prevent health issues and is, therefore, healthy | 0.523 | |||
| Agree | 12 (17.4%) | 13 (16.5%) | 5 (7.4%) | |
| Partially agree | 46 (66.7%) | 48 (60.8%) | 46 (68.7%) | |
| Disagree | 11 (15.9%) | 17 (21.5%) | 15 (22.4%) | |
| Indifferent | 0 (0%) | 1 (1.3%) | 1 (1.5%) | |
| 5.7. If I am tan, I don’t need sunscreen | 0.312 | |||
| Agree | 0 (0%) | 0 (0%) | 0 (0%) | |
| Partially agree | 5 (7.2%) | 4 (5.1%) | 4 (6%) | |
| Disagree | 64 (92.8%) | 73 (92.4%) | 59 (88.1%) | |
| Indifferent | 0 (0%) | 2 (2.5%) | 4 (6%) | |
| 5.8. Avoiding the sun in central hours is the best way to protect myself | 0.753 | |||
| Agree | 18 (26.1%) | 21 (26.6%) | 23 (34.3%) | |
| Partially agree | 42 (60.9%) | 42 (53.2%) | 32 (47.8%) | |
| Disagree | 8 (11.6%) | 15 (19%) | 11 (16.4) | |
| Indifferent | 1 (1.4%) | 1 (1.3%) | 1 (1.5%) | |
| 5.9. Avoiding the sun at a young age reduces the risk of skin cancer | 0.243 | |||
| Agree | 31 (44.9%) | 43 (54.4%) | 45 (67.2%) | |
| Partially agree | 19 (27.5%) | 20 (25.3%) | 14 (20.9%) | |
| Disagree | 11 (15.9%) | 9 (11.4%) | 4 (6%) | |
| Indifferent | 8 (11.6%) | 7 (8.9%) | 4 (6%) | |
| 6. Information received | <0.001 | |||
| No information received | 20 (29%) | 26 (32.9%) | 10 (14.9%) | |
| From my dermatologist and university | 1 (1.4%) | 2 (2.5%) | 7 (10.4) | |
| From my dermatologist | 18 (26.1%) | 12 (15.2%) | 11 (16.4%) | |
| From university | 7 (10.1%) | 12 (15.2%) | 26 (38.8%) | |
| Other sources (TV, radio, press, etc.) | 23 (33.3%) | 27 (34.2%) | 13 (19.4) | |
| 7.1. Used sunscreen with SPF≥30 | 0.373 | |||
| Always | 17 (24.6%) | 25 (31.6%) | 25 (37.3%) | |
| Almost always | 26 (37.3%) | 34 (43%) | 29 (43.3%) | |
| Sometimes | 19 (27.5%) | 14 (17.7%) | 7 (10.4%) | |
| Almost never | 6 (8.7%) | 4 (5.1%) | 4 (6%) | |
| Never | 1 (1.4%) | 2 (2.5%) | 2 (3%) | |
| 7.2. Wore a t-shirt | 0.065 | |||
| Always | 5 (7.2%) | 8 (10.1%) | 10 (14.9%) | |
| Almost always | 20 (29%) | 18 (22.8%) | 17 (25.4%) | |
| Sometimes | 18 (26.1%) | 21 (26.6%) | 25 (37.3%) | |
| Almost never | 9 (13%) | 21 (26.6%) | 7 (10.4%) | |
| Never | 17 (24.6%) | 11 (13.9%) | 8 (11.9%) | |
| 7.3. Wore a cap or hat | 0.304 | |||
| Always | 5 (7.2%) | 9 (11.4%) | 3 (4.5%) | |
| Almost always | 13 (18.8%) | 8 (10.1%) | 17 (25.4%) | |
| Sometimes | 17 (24.6%) | 24 (30.4%) | 20 (29.9%) | |
| Almost never | 19 (27.5%) | 22 (27.8%) | 12 (17.9%) | |
| Never | 15 (21.7%) | 16 (20.3%) | 15 (22.4%) | |
| 7.4. Wore sunglasses | 0.260 | |||
| Always | 23 (33.3%) | 19 (24.1%) | 23 (34.3%) | |
| Almost always | 19 (27.5%) | 25 (31.6%) | 9 (13.4%) | |
| Sometimes | 12 (17.4%) | 16 (20.3%) | 15 (22.4%) | |
| Almost never | 6 (8.7%) | 12 (15.2%) | 12 (17.9%) | |
| Never | 9 (13%) | 7 (8.9%) | 8 (11.9%) | |
| 7.5. Stayed in the shade | 0.054 | |||
| Always | 9 (13%) | 9 (11.4%) | 19 (28.4%) | |
| Almost always | 36 (52.2%) | 34 (43%) | 30 (44.8%) | |
| Sometimes | 18 (26.1%) | 30 (38%) | 17 (25.4%) | |
| Almost never | 6 (8.7%) | 5 (6.3%) | 1 (1.5%) | |
| Never | 0 (0%) | 1 (1.3%) | 0 (0%) | |
| 7.6.1. How many hours were you exposed to the sun between 12–16h? | 0.236 | |||
| 0h | 4 (5.8%) | 5 (6.3%) | 4 (6%) | |
| <1h | 29 (42%) | 33 (41.8%) | 35 (52.2%) | |
| 1–2h | 25 (36.2%) | 36 (45.6%) | 18 (26.9%) | |
| 2–4h | 11 (15.9%) | 5 (6.3%) | 10 (14.9%) | |
| 7.6.2. How often were you exposed during this time? | 0.846 | |||
| Every day | 2 (2.9%) | 2 (2.5%) | 4 (6%) | |
| Most days (≥5/week) | 8 (11.6%) | 12 (15.2%) | 9 (13.4%) | |
| 3–4 days a week | 14 (20.3%) | 20 (25.3%) | 13 (19.4%) | |
| <2 days/week or occasionally | 40 (58%) | 42 (53.2%) | 39 (58.2%) | |
| None | 5 (7.2%) | 3 (3.8%) | 2 (3%) | |
| 8. Sunburns in the past year | 0.524 | |||
| No sunburns | 22 (31.9%) | 25 (31.6%) | 27 (40.3%) | |
| 1–3 sunburns | 43 (62.3%) | 49 (62%) | 39 (58.2%) | |
| 4–6 sunburns | 4 (5.8%) | 5 (6.3%) | 1 (1.5%) | |
| 9. How many with blisters involved? | 0.305 | |||
| None | 64 (92.8%) | 76 (96.2%) | 67 (100%) | |
| 1–3 | 3 (4.3%) | 3 (3.8%) | 0 (0%) | |
| 4–6 | 1 (1.4%) | 0 (0%) | 0 (0%) | |
| >7 | 1 (1.4%) | 0 (0%) | 0 (0%) | |
| 10. Phototype | 0.144 | |||
| Phototype I | 10 (14.5%) | 18 (22.8%) | 18 (26.9%) | |
| Phototype II | 29 (42%) | 30 (38%) | 20 (29.9%) | |
| Phototype III | 22 (31.9%) | 23 (29.1%) | 13 (19.4%) | |
| Phototype IV | 6 (8.7%) | 6 (7.6%) | 10 (14.9%) | |
| Phototype V | 2 (2.9%) | 2 (2.5%) | 6 (9%) | |
| Phototype VI | 0 (0%) | 0 (0%) | 0 (0%) | |
| 11. Outdoor physical exercise | 0.690 | |||
| Never | 25 (36%) | 30 (38%) | 18 (26.9%) | |
| 1 or 2 days a week | 21 (30.4%) | 26 (32.9%) | 27 (40.3%) | |
| 3 or 4 days a week | 9 (13%) | 11 (13.9%) | 12 (17.9%) | |
| 1 or 2 times a month | 14 (20.3%) | 12 (15.2%) | 10 (14.9%) | |
| 12. If you exercise, how often do you protect yourself from the sun? | 0.659 | |||
| Always | 13 (23.2%) | 13 (19.1%) | 17 (28.3%) | |
| Almost always | 9 (16.1%) | 16 (23.5%) | 12 (20%) | |
| Sometimes | 14 (25%) | 9 (13.2%) | 12 (20%) | |
| Almost never | 9 (16.1%) | 15 (22.1%) | 10 (16.7%) | |
| Never | 11 (19.6%) | 15 (22.1%) | 9 (15%) | |
| 13. Family history of skin cancer | 0.816 | |||
| Yes | 9 (13%) | 11 (13.9%) | 12 (17.9%) | |
| No | 54 (78.3%) | 62 (78.5%) | 52 (77.6%) | |
| Don’t know | 6 (8.7%) | 6 (7.6%) | 3 (4.5%) | |
| 14. Family history of melanoma | 0.583 | |||
| Yes | 10 (14.5%) | 5 (6.3%) | 7 (10.4%) | |
| No | 52 (75.4%) | 65 (82.3%) | 54 (80.6%) | |
| Don’t know | 7 (10.1%) | 9 (11.4%) | 6 (9%) | |
| 15. Skin self-examination last year | 0.320 | |||
| Never | 25 (36.2%) | 36 (45.6%) | 22 (32.8%) | |
| Once | 21 (30.4%) | 16 (20.3%) | 16 (23.9%) | |
| 2–3 times | 9 (13%) | 14 (17.7%) | 9 (13.4%) | |
| More than 3 times | 14 (20.3%) | 13 (16.5%) | 20 (29.9%) | |
| 16. UVA tanning booths | 0.828 | |||
| Yes | 1 (1.4%) | 2 (2.5%) | 2 (3%) | |
| No | 68 (98.6%) | 77 (97.5%) | 65 (97%) | |
| 17. If answered yes, frequency of UVA sessions | 0.287 | |||
| Once every 4–5 months | 0 (0%) | 1 (50%) | 0 (0%) | |
| Once a year or less | 0 (0%) | 1 (50%) | 0 (0%) | |
| Only went once | 1 (100%) | 0 (0%) | 2 (100%) | |
Regarding knowledge, students before and during the Dermatology course received information about photoprotection mostly through social media or television (34.2% vs 19.4%, p<0.001), while those who had already taken the subject mostly received information through the university (38.8% vs 15.2%, p<0.001).
In terms of photoprotection habits, more students used sunscreen after studying Dermatology (88.1% vs 76.8%, p=0.007). Additionally, a higher percentage of students thought that additional measures (beyond using sunscreen) were necessary to protect from the sun after taking Dermatology (67.2% vs 49.4%, p=0.025).
Country differences among medical students are shown in Table S2. Supplementary data.
In terms of knowledge, in Spain, the importance of avoiding the sun in childhood was greater after taking the course (52.8% before vs 89.2% after, p=0.045), unlike Italy, where it was similar (36.4% vs 40.0%, p=0.879). Information about photoprotection primarily came from the media in Spanish students before studying Dermatology (41.7% vs 8.1%, p=0.001), while university information was more prevalent in Spanish students after studying Dermatology (19.4% vs 70.3%, p=0.001).
Regarding photoprotection habits, in Spain, a higher number of students showed an interest in tanning before taking Dermatology vs those who had already studied the subject (61.1% before vs 43.2% after, p=0.009), with similar percentages in Italy. Spanish students used caps almost always after studying the subject (8.3% before vs 35.1% after, p=0.002).
DiscussionThis study shows that there are differences among medical students regarding knowledge and photoprotection habits across different countries and sexes. Furthermore, taking Dermatology increases knowledge and improves habits regarding photoprotection.
Spanish students had more knowledge about sun exposure due to their university training, while Italians acquired it from their dermatologist. Additionally, Spanish students examined their skin more frequently and used topical photoprotectors to protect vs the risk of skin cancer in childhood. Former studies conducted among Spanish university students in Gran Canaria (Canary Islands)15 similarly found that students had a high level of knowledge about photoprotection, yet almost three-quarters of them had suffered sunburns. However, this study does not demonstrate a corresponding improvement in knowledge or photoprotection habits as students advance through their medical degree. This lack of change may partly be due to the fact that Gran Canaria students acquire knowledge about photoprotection before starting their college degree or because during the Dermatology course, less emphasis is placed on sun-related problems and photoprotection measures. On the other hand, a study conducted at Universidad de Zaragoza (Zaragoza, Spain) evaluated the impact of the educational program SolSano16, an educational project on photoprotection aimed at children aged 6–12 years in Primary Education. This study found that there were few differences in photoprotection knowledge between college students who had studied in SolSano program-affiliated schools and those who had not, stressing the need to continue emphasizing photosafe habits in later stages of education, such as university level.
Women demonstrated adequate knowledge of photoprotection and used sunscreen with SPF≥30 more frequently. However, they also showed more interest in tanning and spent more hours in the sun. Similar results were found by the study conducted by Fagundo et al.,17 in which women demonstrated higher sun exposure and a greater risk of melanoma.
Both Spanish and Italian college students showed that the Dermatology course improved their knowledge about photoprotection and changed their habits to achieve better sun protection, which may be due to campaigns on healthy habits and skin cancer prevention, directed by Fundación Piel Sana endorse by the Spanish Academy of Dermatology and Venereology (specifically the Euromelanoma campaign). In former studies, we found that college students improve their perception of Dermatology and the role of the dermatologist after taking the Dermatology course, recognizing the importance of dermatological diseases.18 Moreover, it has been demonstrated that the most effective way to prevent skin cancer is through primary prevention educational programs.19
ConclusionsThere are differences in knowledge and photoprotection habits between students of both countries. Spanish students have better knowledge and photoprotection habits, as a higher percentage considers solar radiation to be the main risk factor for the development of skin cancer and uses topical photoprotectors more frequently. Taking Dermatology can help improve photoprotection habits (greater use of sunscreen and implementation of additional measures to protect from solar radiation) in both Spain and Italy.
FundingNone declared.
Conflicts of interestNone declared.
Uncited reference16.
The followings are the supplementary data to this article:
