Sunscreen Behaviors Among Libyan Society Survey

www.wjpps.com Vol 3, Issue 4, 2014.

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Nagib et al. World Journal of Pharmacy and Pharmaceutical Sciences

SUNSCREEN BEHAVIORS AMONG LIBYAN SOCIETY SURVEY

Nagib A. Elmarzugi1*, Eseldin I. Keleb2, Aref T. Mohamed2, Amel M. Hamza3,

Yosef S. Issa4, Ahmad A. Layla5, Mohamed Salama6

1Institute of Bioproduct Development, Universiti Teknologi Malaysia, 81310, Johor,

Malaysia 2Dept. of Industrial Pharmacy, Faculty of Pharmacy, Tripoli University, Tripoli, Libya

3BioNano Integration Research Group, Biotechnology Research Center, LARST, Libya. 4Dept. of Histology, Faculty of Medicine, Tripoli University, Libya

5Dept. of Pharmaceutics, Faculty of Pharmacy, Alazhar University, Cairo, Egypt. 6Faculty of Pharmacy, Universiti Teknologi Mara, Malaysia

ABSTRACT

Sunscreen products are available in wide scale for consumers, the

topical use products act by either absorbing or scattering the UV

radiation. Excessive UV radiation exposure have been shown to be

associated with a series of dermatologic disorders, which symptoms

may appear instantly, or even developed few years later in life. The

objective of this study is to assess the behaviors, application and use-

base of sunscreen. A questionnaire-based study was conducted in

Tripoli province, Libya. The questionnaire included four broad

categories, developed to explore and highlight the main behaviors

during the use and application of sunscreen. Questionnaire circulated inside dermatology

follow-up clinics and outside hospital. Respondent characteristics pattern reported as a

percentages. Data were analyzed from 385 participants who had complete information

regarding behaviors and use of sunscreen at Libyan society. With at least 70% of participants

using and applying sunscreen, the majority of users were female 87.8%, and their age ranges

from 20 to29 years, with frequent use more than 2 times per week. Whereas 57% of

participants applied sunscreen as personal protection of their skin. In this survey, the

questionnaire-based study provided valuable information about the behaviors and habits of

applying sunscreen products. The majority of participants applied sunscreen to protect their

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Article Received on 02 March 2014, Revised on 21 March 2014, Accepted on 12 April 2014

*Correspondence for Author

Dr. Nagib A. Elmarzugi

Institute of Bioproduct

Development, Universiti

Teknologi Malaysia, 81310


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skin, the market drives the users about the type of sunscreen and most of the participants gave

the medical counsel and recommendation low attention.

Keywords: sunscreen, UV radiation, questionnaire, skin protection, dermatology.

INTRODUCTION

Sunscreens have been proven for a long time as a protective materials against excessive

amounts of sunlight to prevent UV induced skin pathological changes, which is ranging from

mild erythema to skin cancer (Elmarzugi, Keleb et al. 2013). Applying sunscreen and

practicing sun protective behaviors reduces exposure to UV radiation. Many cosmetic

products such as sunscreen, skin lighters, tanners and moisturizers have been used at daily

base among the communities. The habits and frequent use is very important to optimize its

benefits (Anselmi, Centini et al. 2002). Sunscreen substances play a specific function when

penetrating the skin surface; therefore, the proper use must be adequately taken into account

as the number of applicant users increase (Finlay-Jones and Hart 1998). Sunscreen have been

recommended by dermatologists for a long time as a protective measure against excessive

amounts of sunlight to prevent UV induced erythema, and regular use of sunscreens

contribute to the prevention of skin photodamage (Gaspar and Maia Campos 2006). The

active ingredients in sunscreen preparations should remain on the skin for a reasonable period

of time conserving their activity. Sunscreens are expanding worldwide (Kim, Oh et al. 2010),

and complex formulations, often based on water in oil emulsion, containing mixture of

organic/inorganic and lipophilic/hydrophilic compounds (Elmarzugi, Keleb et al. 2013).

Understanding more about the protection habits from sun radiation, is critical to the society

effective delivery of this this important public health message. Between 2004 and 2008 in

USA, 70230 incident cases followed up the Dermatology clinics suffered from sun burn

during the radiation exposure and about 8790 associated with deaths (Valentina A. Andreeva,

Myles G. Cockburn et al. 2011). UV radiation exposures at an early age are particularly

important for the development of cutaneous melanoma in adulthood (Hamilton and Arndt

2013). A recent meta-analysis of 51 studies found that ever reporting a sunburn during

childhood almost doubled the risk for the development of cutaneous melanoma in adulthood

(Kelvin Choi, DeAnn Lazovich et al. 2010). During the past decade, there have been

numerous public health efforts to increase the use of sun protection. Despite these efforts,

reported prevalence of sunburn remains high (Stephen W. Dusza, Allan C. Halpern et al.

2012). This work focuses on surveying the applicant of sunscreens behaviors and frequent


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use, bases of and reasons of use. A series of questions were included to assess and explore the

potential application of sunscreen in Libyan society throughout sample of study.

DATA MANAGEMENT

The sample for this study was 385 cases, where 279 cases were surveyed from outside of

hospital and their professionals were varied, students, physicians, housewife and others, the

other 80 cases were surveyed of Central Hospital, and 26 cases of Ber Osta Melaad Hospital,

Tripoli province, Libya. The information was distributed as questionnaire and the extent for

collection of this information is more than 4 months, Dermatology department was set up at

the two hospitals and outside of hospital, which are the source of data. Overall question has

been analyzed by using software SPSS (V10, 11) which helped us to obtain accurate result in

suitable time. For this study, data obtained from the questionnaires were used to explore

society sample behavior about the sunscreen.

DATA PRESENTATION

The questionnaire contained four main categories of questions, the first group contained

general questions, the second group was developed to explore the use range of sunscreen, the

third group by investigators to view the link between sunscreen and skin pathochanges, the

final group was developed to assess the local market of sunscreen and potency observation.

The following data provides descriptive analysis format of 385 questionnaires, which, has

been distributed, and their analysis. Respondent characteristics of sunscreen application and

behaviors pattern are reported as percentages.

Gender

The gender of participants who participated in the current study is presented in the table 1,

males and female. The 87.8% of participants were females while 12.2% male, both of them

agreed of using the sunscreen. Moreover, 72.5% were surveyed outside the hospital, while

27.5% of them were met at the dermatology follow up clinic in the different hospitals, which

involved in the study. Gender differences in sunscreen use among adults displayed a

discrepancy. Individual’s behavior is determined by his or her behavioral intention and is

important of sunscreen outcomes (Lorien Abroms, Cynthia M. Jorgensen et al. 2003).


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Table 1. Gender participants

Gender Number Percentage % Males 47 12.2 Females 338 87.8 Total 385 100.0

Marital Status

The marital status of participants were questioned in the survey, 77.4% single, and 21 %

married, this covered both male and female. Unmarried participants are more likely than

married to use sunscreen. Moreover, female are more likely than male to use sunscreen.

Table 2. Marital status of participants

Social Life

Sex Total Male Female Number % Number % Number %

Single 38 80.9 260 76.9 298 77.4 Married 9 19.1 72 21.3 81 21.0 Other 0 0.0 6 1.8 6 1.6 Total 47 100.0 338 100.0 385 100.0

Age

Table 3 shows the average range of age that represented in study, 31.9% of male participants

were the highest at the age (25-29), while, 34.6% of female participants were the highest at

the average age (20-24). Overall, for both male and female participants, the bulk number

were at the age (20-29) and represented about 58.9%.

Table 3. Average age of participants

Age Sex Total Male Female

Number % Number % Number % 15-19 5 10.6 16 4.7 21 5.5 20-24 11 23.4 117 34.6 128 33.2 25-29 15 31.9 84 24.9 99 25.7 30-34 7 14.9 48 14.2 55 14.3 35-39 2 4.3 30 8.9 32 8.3 40-44 0 0.0 11 3.3 11 2.9 45-49 1 2.1 5 1.5 6 1.6 50-54 2 4.3 3 0.9 5 1.3 +55 2 4.3 1 0.3 3 0.8 Unknown 2 4.3 23 6.8 25 6.5 Total 47 100.0 338 100.0 385 100.0


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Profession

Table 4 shows the classification of survey sample according to their occupation, high

percentage of them male was working is 46.8% of male (employ), 47.6% of female (student)

from the total percentage 46.2% for student.

Table 4 Classification of samples according to occupation

Occupation Sex

Total Percentage% Male Female Number % Number %

Employee 22 46.8 125 37.0 147 38.2 student 17 36.2 161 47.6 178 46.2 Housewife - - 30 8.9 30 7.8 Other 8 170 22 6.5 30 7.8

Total 47 100.0 338 100.0 385 100.0

Frequent use of sunscreen

Table 5 shows the frequent use for sunscreen, it is accounted based on how many times of

application and use per week. The term usually in the current survey refers to more than three

times of application by participants per week. The other refers to less use of sunscreen on

weekly basis. 84.7% of female participants apply sunscreen usually.

Table 5 Frequent use of sunscreen application

Frequent use of sunscreen

Number Percentage%

Usually 326 84.7

Sometimes 59 15.3 Total 385 100.0

Decision of sunscreen use

The participant’s use of sunscreen do decide to apply after visit their clinic. However, others

may decide personally as a kind of routine use to protect their skin. Table 6 shows the users

of sunscreen based on their physician advice and consultation were 42.9% of participants.

Yet 57.1% were not rely on doctor’s advice did use by themselves and self-opinion. Another

research finds that physicians rarely advice their visitors, for protecting from UV radiation,

even the children, who experience the most sun exposure (Carrera, Puig-Butillè et al. 2013).


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Table 6 Decision and use of sunscreen

Decision of use Number Percentage % Physician advice 165 42.9 Personal decision 220 57.1

Reasons of sunscreen use

The reasons of use of sunscreen by participants were categorized into main reasons. The

protection of skin and body was one reason and treatment of pathological reasons and

infections was another reason. Table 7 shows 70.1% of participants did apply sunscreen for

protection reason. While, 40.3% took the sunscreen as monotherapy or part of combination

therapy to cure certain disease. Dermatologists were the most likely to make sunscreen

recommendations of use (Kimberly A. Mallett, Rob Turrisi et al. 2011).

Table 7 Reasons of use of sunscreen

Reasons of use Yes No Total Protection number 270 115 385

% 70.1 29.9 100.0 Therapy number 155 230 385

% 40.3 59.7 100.0 Diseases lead to use of sunscreen as a treatment

The participants have mentioned many dermatological diseases, and accordingly physicians

after their diagnosis give their advice to use sunscreen as a part of the treatment. These

diseases may be non-infectious, inflammatory diseases, acquired conditions, and delayed

pigmentation of the skin (Kim DS, Kim SY et al. 2003, Sabrina E. Vinzón, Ilona

Braspenning-Wesch et al. 2014). Table 8 summarizes the participants who use the sunscreen

as therapy based onto following up at dermatology clinic in different hospitals.

Table 8 Diseases that lead to use of sunscreen as a treatment

Disease Number of Participants

%

Tanning 45 29.0 Vitiligo 54 34.8 Melasma 34 21.9 Laser therapy 9 5.8 Acne 4 2.6 Eczema 4 2.6 Psoriasis 3 1.9 Other 2 1.8 Total 155 100.0


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Advice based use of sunscreen

Table 9 represents the way of decision which commercial sunscreen are applied. Many of

participants decided to choose one type based on physician advice, other users were affected

by many advices when applying certain type of commercial sunscreen. Likewise, media,

retail shop active marketing and other different ways. Photoderm® was the highest percentage

commercial sunscreen with about 53.9 %. It is well known, that sunscreens act as largely by

reflecting UV light chemically such as Photoderm or physically such as zinc oxide (Petersen

and Wulf 2014).

Table 9 the participant’s advice use of sunscreen

sunscreen trade name

Physician advice based use Other advice based use

number % number %

Ambersoler® 5 3.0 20 9.1 Photoderm® 89 53.9 76 34.5 Even® 12 7.3 27 12.3 Anthelios® 26 15.8 17 7.7 Zinc oxide® 10 6.1 4 1.8 Other 23 13.9 76 34.5 Total 165 100.0 220 100.0

Sunscreen side effects

Clinically side effect as a result of using medication are well known features. In the current

survey, many participants contacted their clinic, and the complaining symptoms were result

risky side effects symptoms. Table 10 shows the side effects that resulted, clinically riskless

because it is localized effect on the skin and can be overcome by stop using of sunscreen and

refer to dermatologist. Several studies referred to the non-toxic effects of sunscreen found.

Beside UV radiation, sew types of sunscreen has antifungal effect (Patra, Mitra et al. 2012,

Joshi, Mundhe et al. 2013).

Table 10 Side effects which observed by physician by use of different commercial types

of sunscreen

Side effects symptoms Incidence no. % Redness 20 5.2 Spots on the face 10 2.6 Heads 16 4.2 Tanning 12 3.1 Other 16 4.2 Participants with side effects 74 19.2


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Participants without side effects 311 80.8 Total 385 100.0

Commercial sunscreen in the market

Many sunscreen trade names are available in the Libyan market. The different commercial

types of sunscreens were enumerated by the participated persons. Table 11 shows, the

consumer’s choices of different trade names. The reason of choosing one type rather than

other is dominated by many factors, cost, manufacturing propaganda, retailer’s advice and

media could be part of the reasons. The culture and public health information may encourage

the use of sunscreen (Hernandez, Calero et al. 2012).

Table 11 Commercial sunscreen in the Libyan market

Sunscreen trade name Number % Ambersoler® 25 6.5 photoderm® 165 42.9 Even® 39 10.1 Anthioles® 43 11.2 Zinc oxide® 14 3.6 Other 99 25.7 Total 385 100

Sun Protection Factor (SPF)

The current survey is trying to explore the whether the participants aware about the SPF, and

do they consider it when it comes to choose the sunscreen. The sunscreens UV protection is

according to the labeled SPF. However, sunscreen with SPF 30 or 50 may not produce

sufficient protection at actual consumer usage level (Ou-Yang, Stanfield et al. 2012). SPF is

a measure used to identify protection factor against erythema and sunburn against UV rays.

Table 12 shows the SPF of different commercial sunscreen which used by participants, the

most used sunscreen with SPF 50 by 31.9% of participants.

Table 12 Values of SPF of commercial sunscreen used

SPF Number % 15 17 4.4 30 32 8.3 50 123 31.9 60 84 21.8 100 60 15.6

Unknown 69 17.9 Total 385 100.0


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Sunscreen combined use with face powder (Female only)

Cosmetics are an important part of the dermatologic management of many skin disorders.

They can camouflage contour and pigment abnormalities, provide moisturization, enhance oil

control, add sun protection, deliver barriers-enhancing agents, and create a sense of personal

well-being (Draelos ZD 2000). Table 13 shows the combined use of sunscreen with face

powder for female participants.

Table 13 the combination use of sunscreen with face powder cosmetics

Using face powder Number % Yes 164 48.5 No 137 39.9 Sometimes 39 11.5 Total 338 100

DISCUSSION

The purpose of this survey was to assess the behaviors of the use of sunscreen throughout the

Libyan society. Examining people’s behavior and beliefs about the way of use, decision of

use and choose one of different commercial sunscreens, which are available at the local

market, is integrated with general health, skin care and life style (Gałajda K, Kamińska-

Winciorek G et al. 2013). The measures of people’s perception consideration in use and

select their type of sunscreen may consist of a large number measures, however a survey

could provide a define picture about the selected sample of survey. The author’s analysis are

aware of the need to rewrite the data as presented in the previous section. However, the

intention is to focus on principles and skeleton results of the study. A number of issues raised

up by participants, during their high response rate, which was about 100%. This may be

considered an excellent response rate for voluntary questionnaire by a group of respondents

who, as research culture premature of different jobs personnel, are considered to be elusive

groups of subjects. Currently, the majority of participants were students; therefore, it is

essential to consider the analysis would base upon those at all stages of analysis, and it will

reflect mainly the student's opinion and their age. There were many reasons for this high

percentage participation, among them; the current research is conducted by a team of young

researchers. Moreover, it is quite common these days that female students use a sunscreen

and cosmetics preparations in the university life day, however, the family and the society did

not accept such common frequent use few years ago (Lodén, Beitner et al. 2011). The


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participant’s cases from outside of hospital 72.5%, which in agree and expected with the

response to the reason of use of sunscreen as a protection tool, 70.1% rather than therapy

tool. Moreover, the age from 20-29 years, reflected the most users of sunscreen for both male

and female, at this age media, education level and skin care are enough influencers to leave

its impact on this age range. The frequent use of different sunscreen products 84.7%, ensure

its efficacy, moreover, the physician advice were clearly reflected. Although the American

Academy of Dermatology and many other professional organizations advice physicians to

counsel patients about sun protective behaviors, the researchers mentioned that only small

percentage of physicians are implanting such advice to use sunscreen (Massone, Wolf et al.

2013).

Based on physician diagnosis and recommendation, sunscreen used as a therapy for many

diseases, however, the most disease treatment was Vitiligo (34.8%) and tanning (29%). The

common commercial type of sunscreen was used in Libyan market Photoderm then

Anthelous-xl, which more prescribed by dermatologist, and higher SPF value of used

commercial sunscreen was +55. During the use of sunscreen by participants, the main

observed side effects was redness symptoms 2-5%. The combined use of sunscreen and face

powder has no side effects observed.

There were limitations of this study, obtaining accurate and objective assessment of

sunscreen use and application about Libyan society throughout such study sample is difficult.

The sample of study covered one geographical region of the country.

CONCLUSION

Applying and use of sunscreen among the Libyan society has been studied by a

questionnaire-based study. It provided very useful assessment about the community of study.

The female participants aged between 20-29 years were the most likely users, with about

87% for multiple use per week. It seems that the use of sunscreen linked strongly with the use

of sunscreen as personal cosmetics. However, no enough symptoms for the side effects

occurred as a result of sunscreen applications, although the market drive the selection of the

type of sunscreen nor physician advice neither SPF. Most applicant of sunscreen behaviors

aimed to protect their skin from sun radiation and not affected by health and medical

situation, physician advice does not affect the users decision of use and choose of sunscreen,

which found in agreement with few other studies (Mahler 2014).


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ACKNOWLEDGEMENTS

Authors would like to thank H. Ehfeda, L. Alarnaouti, S. Azzoz and S. Baraka for their

valuable contribution in this study.

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Sunscreen Behaviors Among Libyan Society Survey

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