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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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Nagib et al. World Journal of Pharmacy and Pharmaceutical Sciences
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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