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Research Article | DOI: https://doi.org/10.31579/2578-8949/111
Department of internal medicine, Faculty of Medicine, Umm Al-Qura University
*Corresponding Author: Ahmed M. ZahrAllayali, Umm Al-Qura university, College of Medicine, 2 Taif Road, Makkah, 24382, Saudi Arabia.
Citation: Zahr Allayali M Ahmed, Ahmed A Walaa, Badirah B Sara, Alshahrani M Ghada, Alabdullah R Raghd, et all, (2023), Assessing the Knowledge, Attitude, Practice Towards the Sun Exposure and the use of Sunscreen by the General Population in Makkah, Saudi Arabia. Dermatology and Dermatitis, 8(3); DOI:10.31579/2578-8949/111
Copyright: © 2023, Ahmed M. ZahrAllayali. This is an open-access article distributed under the terms of The Creative Commons. Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Received: 10 May 2023 | Accepted: 17 June 2023 | Published: 27 June 2023
Keywords: sun exposure; sunscreen; sun protection; photo protection; ultraviolet radiation; skin cancer
Context: Sunlight exposure is a major cause of melanoma and non-melanoma skin cancer (NMSC). The sunscreen use can reduce the risk of developing melanoma and NMSC.
Purpose: To assess the knowledge, attitude, and practice of the general population of Makkah city, Saudi Arabia related to sun exposure and the use of sun protection.
Methods and Material: The present study is a descriptive cross-sectional study including 577 participants from the general population of Makkah city, Saudi Arabia using an online pretested Arabic questionnaire designed via Google Forms.
Results: More than three-quarters of the respondents (78.4%) stated that sun exposure is harmful; of these, 61.9% stated that tanning, pigmentation, burns, skin cancer, and aging are potential risks that result from sun exposure. Further, 39.5% of the participants sometimes used sunscreen, while 23.9% of them regularly used sunscreen when exposed to the sun; the majority (75.1%) was unaware of the different forms of sunscreens. The factors associated with the regular use of sunscreen were female gender, aged between 18-25 years, and single. The majority of the respondents admitted that sunscreen use is necessary for protection against harmful ultraviolet radiation (88.9%); however, only 34.7% of them used other protective methods such as avoiding exposure to the sun (84.0%) and seeking shade (72.0%).
Conclusions: According to the results, various attitudes toward the usage of sunscreen were found. Most of the respondents believed that exposure to the sun are harmful. However, the rate of sunscreen use by our population was average despite their reasonable awareness of the effects of sun exposure. This implies the need for health education campaigns and programs.
Sunlight exposure, specifically ultraviolet radiation (UVR), has a wide range of benefits. Such benefits are not only limited to vitamin D activation, but also include reducing the risk of cardiovascular diseases, breast cancer, malignant transformation of colorectal tumors, multiple sclerosis, type 2 diabetes, and obesity (Hoel et al., 2016). Nevertheless, sunlight exposure is the root of many skin problems such as tanning, burning, pigmentary changes (e.g., melasma, lentigines), and skin aging. It is also a major cause of melanoma and non-melanoma skin cancer (NMSC), including basal and squamous cell carcinoma (AlGhamdi et al., 2016; Reichrath et al., 2014). In addition, it can cause extracutaneous manifestations such as cataract formation, immune suppression, and the activation of latent viruses (Al-Mutairi et al., 2012).
According to the WHO, the mortality rate due to UVR overexposure is up to 60,000 fatalities annually worldwide. Of these deaths, malignant melanomas are responsible for 48,000 fatalities, while the remaining 12,000 are due to skin carcinomas. UVR acts by directly damaging the DNA, causing mutations to the genes involved in DNA repair, oxidative stress, and inflammation (Narayanan et al., 2010). The sunscreen use can reduce the risk of developing melanoma and NMSC (Green et al., 1999; Green et al., 2011).
A previous study at King Saud University measured the knowledge, attitude, and practice of the general population of Saudi Arabia related to sun exposure and sun protection (AlGhamdi et al., 2016). It was found that 55% were aware of the correlation between sun exposure and skin cancer and 67.7% were aware that sun exposure can cause sunburn. Females, middle class, and higher educated people had higher awareness than other participants. Regarding sunscreen use, only 23.7% were using it regularly, with more prevalence among women and employed respondents. While, 90% of the population used clothes as a protective measure (AlGhamdi et al., 2016).
Another study from the College of Medicine, Qassim University, Saudi Arabia assessed the knowledge of the general population of Qassim province on the association of sun exposure with skin cancer, revealing the low use of sunscreen despite a good level of knowledge. Overall, 56% of the respondents were aware of the correlation between sun exposure and developing skin cancer, but the sunscreen use was only reported by 8.3% of the population. Sunscreen use was related to the following sociodemographic factors of being female, having higher level of education, and social class (Al Robaee, 2010).
A cross-sectional study was performed at the outpatient dermatology clinics of four hospitals in Lima, Peru to evaluate the patients’ knowledge, attitude, and practice related to sun exposure and sun protection. It showed an acceptable level of awareness of risks of sun exposure; however, a large percentage of the population failed to integrate the regular sunscreen use as a practice in their daily life. Moreover, 93.4% of the patients were cautious about the risks of sun exposure, with a greater level of awareness among university students. In total, 78.9% were aware of sunscreen and 52.3% of the patients used it regularly; however, only 38.4% used sunscreen daily and 61.6% used it occasionally (Thomas-Gavelan et al., 2011).
Another study conducted by the College of Medicine at the University of Baghdad, Iraq evaluated the awareness of medical students on the negative impacts of sun exposure. It showed that most students were knowledgeable about the negative impacts and risks of unprotected sun exposure, but only one-third of the students used sunscreen regularly. Further, while 93% of females used sunscreen, only 25% of males did. Knowledge on the types of sunscreen, its reapplication, and the proper way of using it was low among the population (Al Battat et al., 2021).
Skin cancer is the most typical form of cancer worldwide and the ninth most common malignancy in Saudi Arabia (Almuqati et al., 2019). Therefore, this study aimed to assess the knowledge, attitude, and practice of the general population of Makkah, Saudi Arabia related to sun exposure and sunscreen use.
A cross-sectional descriptive study was conducted from April, 2022 to December, 2022 via Google Forms in Makkah, Saudi Arabia. A biomedical ethics committee of Umm Al-Qura University in Makkah, Saudi Arabia approved the distribution of the survey using snowball sampling. Our study included the general population aged above 18 years from Makkah; exclusion criteria included participants who did not belong to Makkah. A modified questionnaire from previous published studies was used, face validity was assessed by four dermatology experts and then a pilot study was conducted to establish reliability and consistency before distribution (Al Robaee, 2010; Thomas-Gavelan et al., 2011; Al Battat et al., 2021).
The sample size was calculated using Open Epi version 3.0 with a 95% confidence interval (OpenEpi Menu, 2022), with 385 participants; but the questionnaire was distributed among 630 participants.
The questionnaire was pretested on 20 individuals with slight modifications according to their feedback before distributing. An online link from Google Forms website was sent to the participants via social media applications. The link included an informed consent form and explained the anonymous and voluntary nature of the survey.
The questionnaire consisted of four parts. The first part included the sociodemographic data on the participants, while the second and third parts assessed the participants’ knowledge and attitude towards sun exposure and sunscreen use. The fourth part evaluated those factors affecting knowledge, attitude, and practice.
Statistical Analysis
R Studio (R version 4.1.1) was applied to perform the statistical analysis. We described the categorical variables using frequencies and percentages. The factors associated with the regular sunscreen use were evaluated applying Pearson’s Chi-squared test or Fisher's exact test, whenever required. A multivariate logistic regression model was designed to explore the independent predictors using the significantly associated factors from the univariate analysis as the independent variables. The results were expressed as odds ratios (ORs) with 95% CI. Statistical significance was considered at p < 0>
Sociodemographic and skin-related characteristics:
A total of 577 participants responded to the online questionnaire. The majority of the participants were females (n = 416, 72.1%) and all of them resided in Makkah, Saudi Arabia. The most common age categories were 18–25 years (n = 255, 44.2%) and > 40 years (n = 229, 39.7%). Almost half of the participants were married (n = 287, 49.7%) and the majority (n
= 415, 71.9%) had obtained a University degree. The most common Fitzpatrick skin type was type III (n = 263, 45.6%), whereas the combined skin type (oily and dry skin) was reported among 219 participants (38.0%). Only 9 participants (1.6%) indicated a positive family history of skin cancer (Table 1).
*Fitzpatrick skin types included type I (always burns, never tans), type II (burns, then tans), type III (sometimes burns, moderately tans), and type VI (never burns, intensely tans).
Sun exposure and sun protection behavior: Over three-quarters of the respondents (78.2%) stated that sun exposure is harmful; of these, 61.9% statedthat tanning, pigmentation, burns, skin cancer,and aging are potential risks that result from exposureto the sun (Figure 1A). Importantly, 39.5% of the participants sometimes used sunscreen, while 23.9% of them regularly used sunscreen when exposed to the sun. Based on the submitted responses, the most dangerous periods for sun exposure were 10 am to 2 pm (44.4%) and 10 am to 4 pm (39.2%).The majority of the respondents admitted that sunscreen use is necessary for protection against harmful UVR (88.9%); however, only 34.7% of them used other methods for protection. Of the latter group, the most commonapproaches other than the sunscreen use included avoiding exposure to the sun (84.0%)and seeking shade (72.0%, Figure 1B).The application of sunscreen was the most important way of protection from UVR, as indicated by 44.2% of the sample, followed by the avoidance of sun exposure (38.0%, Table 2).
Figure 1: A) Participants’ responses to the items related to harm from sun exposure (panel A, n = 494), B) methods used for sun protection other than sunscreen (panel B, n = 217).
Figure 2: Reported subjective side effectsfrom using sunscreens
| Variable | Category | N (%) |
| Gender | Male | 161 (27.9%) |
| Female | 416 (72.1%) | |
| Age | 18-25 years | 255 (44.2%) |
| 26-30 years | 64 (11.1%) | |
| 31-40 years | 29 (5.0%) | |
| Over 40 years | 229 (39.7%) | |
| Marital status | Single | 272 (47.1%) |
| Married | 287 (49.7%) | |
| Divorced | 18 (3.1%) | |
| Level of education | Below secondary school | 11 (1.9%) |
| Secondaryschool | 109 (18.9%) | |
| University | 415 (71.9%) |
Table 1: Sociodemographicand skin-related characteristics (n = 577).
| Variable | Category | N (%) |
| Do you think thatexposure to the sun is harmful? | Yes | 451 (78.2%) |
| No | 126 (21.8%) | |
| Use a sunscreen when exposed to the sun | No | 211 (36.6%) |
| Sometimes | 228 (39.5%) | |
| Yes | 138 (23.9%) | |
| The mostdangerous period for exposure to thesun is … | 8–10 am | 15 (2.6%) |
| 10 am–2 pm | 256 (44.4%) | |
| 10 am–4 pm | 226 (39.2%) | |
| 2–4 pm | 80 (13.9%) | |
| Sunscreen is necessary for protection from harmful Ultra Violet (UV) light from the sun | Yes | 513 (88.9%) |
| No | 64 (11.1%) | |
| Do you use other methods to protectyourself from the UV light of the sun | Yes | 200 (34.7%) |
| No | 377 (65.3%) | |
| The most important way ofprotection from UVRis … | Using sunscreen | 255 (44.2%) |
| Avoiding exposure | 219 (38.0%) | |
| Wearing protective clothing or seekingshade | 93 (16.1%) | |
| Other | 10 (1.7%) |
Table 2: Sun exposure and sun protection behavior (n = 630).
Factors associated with and predictors of the regularuse of sunscreen:
The results of the univariate analysis (Chi-squared test or Fisher’s exacttest) showed that the regular sunscreen use was associated with being female(94.2% vs. 5.8% among males,p < 0.0001), aged between18 and
25 years (58.7% among participants aged 18–25 years vs. 26.8%, 10.1%, and 4.3% among those aged > 40 years, 26–30 years, and 31–40 years, p
< 0.0001), and single (62.3% amongsingle participants vs. 34.8% amongmarried participants and 2.9% among divorced participants, p < 0>
Fitzpatrick skin type (p = 0.010) and type of the skin (p = 0.008, Table 3).
Based on the multivariate binary logistic analysis, and considering the male gender as the reference group, the female gender was the sole independent predictor of an increased rate of the regular sunscreen use (OR = 9.54, 95% CI, 4.45 to 23.1, p < 0 dry skin were less likelyto regularly use sunscreen (OR = 0.41,95% CI, 0.16 to p = 0.046>, Table 4).
| Variable | Category | Regular useof sunscreen | ||
| No, N = 439 | Yes, N = 138 | Sig. | ||
| Gender | Male | 153 (34.9%) | 8 (5.8%) | <0> |
| Female | 286 (65.1%) | 130 (94.2%) | ||
| Age | 18–25 years | 174 (39.6%) | 81 (58.7%) | <0> |
| 26–30 years | 50 (11.4%) | 14 (10.1%) | ||
| 31–40 years | 23 (5.2%) | 6 (4.3%) | ||
| Over 40 years | 192 (43.7%) | 37 (26.8%) | ||
| Marital status | Single | 186 (42.4%) | 86 (62.3%) | <0> |
| Married | 239 (54.4%) | 48 (34.8%) | ||
| Divorced | 14 (3.2%) | 4 (2.9%) | ||
| Level of education | Below secondary school | 9 (2.1%) | 2 (1.4%) | 0.054 |
| Secondary school | 93 (21.2%) | 16 (11.6%) | ||
| Graduate | 304 (69.2%) | 111 (80.4%) | ||
| Postgraduate | 33 (7.5%) | 9 (6.5%) | ||
| Fitzpatrickskin type | Type I | 11 (2.5%) | 5 (3.6%) | 0.010 |
| Type II | 86 (19.6%) | 43 (31.2%) | ||
| Type III | 202 (46.0%) | 61 (44.2%) | ||
| Type IV | 140 (31.9%) | 29 (21.0%) | ||
| Type of skin | Normal | 106 (24.1%) | 24 (17.4%) | 0.008 |
| Oily | 127 (28.9%) | 37 (26.8%) | ||
| Dry | 55 (12.5%) | 9 (6.5%) | ||
| Combined | 151 (34.4%) | 68 (49.3%) | ||
| Family history of skin cancer | No | 434 (98.9%) | 134 (97.1%) | 0.228 |
| Yes | 5 (1.1%) | 4 (2.9%) | ||
| Variable | Category | OR | 95% CI | Sig. |
| Gender | Male | Ref. | Ref. | |
| Female | 9.54 | 4.45, 23.1 | <0> | |
| Age | 18–25 years | Ref. | Ref. | |
| 26–30 years | 0.77 | 0.34, 1.67 | 0.514 | |
| 31–40 years | 1.17 | 0.35, 3.64 | 0.788 | |
| Over 40 years | 0.97 | 0.48, 1.95 | 0.930 | |
| Marital status | Single | Ref. | Ref. | |
| Married | 0.72 | 0.38, 1.34 | 0.302 | |
| Divorced | 0.48 | 0.11, 1.71 | 0.188 | |
| Skin type | Type 1 | Ref. | Ref. | |
| Type 2 | 1.39 | 0.43, 4.98 | 0.596 | |
| Type 3 | 0.61 | 0.19, 2.14 | 0.414 | |
| Type 4 | 0.42 | 0.13, 1.50 | 0.157 | |
| Type of skin | Normal | Ref. | Ref. | |
| Oily | 1.39 | 0.73, 2.68 | 0.321 | |
| Dry | 0.41 | 0.16, 0.96 | 0.046 | |
| Combined | 1.15 | 0.65, 2.07 | 0.642 |
OR = Odds ratio, CI = Confidence interval; Ref indicates the reference group.
Table 4: Predictors of the regular use of sunscreen.
Focusing on sunscreen users (n = 366), the majority of the respondents did not know about the type of sunscreen (whether chemical or physical)
and 38.0% did not know about the type of SPF used. However, SPF was the most common factor that influenced the choice of sunscreen (57.1%), followed by personal experience (54.9%) and prescriptions (48.1%). Almost half of the respondents (52.2%) used sunscreen once a day and 31.7% of them do not care about the amount of time that it is left on the skin. Additionally, the most common amounts of sunscreen applied ranged between one-quarter of a teaspoon up to one teaspoonful (72.4%). Sunscreen was applied more frequently on the exposed parts of the body (47.8%) and users applied these products in both summer and winter (50.8%). More details about the patterns of using sunscreen are provided in Table 5. Adverse events were reported by 35.1% and 22.6% of individuals as oiliness and acne were observed, respectively but fewer than half of the participants (44.0%) reported no adverse events (Figure 2).
Regarding the perceptions of the sample, approximately one-third of the participants indicated that sunscreen protects from heat (34.5%) and may lose its effects after sweating or swimming (39.3%). Moreover, about two-thirds of the sample declared that sun protection in Saudi Arabia is necessary (67.4%) and that medicalknowledge increases one’s awareness of sun protection (67.8%). The majority of the respondents (85.4%) did not know about the components of sunscreen. Only 36.9% of the participants were ready to advise peopleabout sun protection (Table 6).
| Variable | Category | N (%) |
| Type of sunscreen preferred | Chemical | 62 (16.9%) |
| Physical | 29 (7.9%) | |
| Do not know | 275 (75.1%) | |
| Type of SPF preferred | Do not know | 139 (38.0%) |
| SPF 15 | 2 (0.5%) | |
| SPF 30 | 24 (6.6%) | |
| SPF 50 | 127 (34.7%) | |
| Over SPF 50 | 74 (20.2%) | |
| Do you think thatSPF 50 is different fromSPF 30 sunscreen? | No | 35 (9.6%) |
| Yes | 134 (36.6%) | |
| Do not know | 197 (53.8%) | |
| Factors affecting the choice of sunscreen* | SPF | 209 (57.1%) |
| Personal experience | 201 (54.9%) | |
| Origin | 41 (11.2%) | |
| Friends’ advice | 142 (38.8%) | |
| Prescription | 176 (48.1%) | |
| Internet | 82 (22.4%) | |
| I do not buy any | 25 (6.8%) | |
| Amount of sunscreen applied to theface | Do not know | 70 (19.1%) |
| One-quarter of a teaspoon | 100 (27.3%) | |
| Half a teaspoon | 74 (20.2%) | |
| 1 teaspoonful | 91 (24.9%) | |
| 2 teaspoonfuls | 28 (7.7%) | |
| Over 2 teaspoonfuls | 3 (0.8%) | |
| How often do you use sunscreen in a day? | Do not use | 51 (13.9%) |
| Once | 191 (52.2%) | |
| Twice | 52 (14.2%) | |
| Over twice | 22 (6.0%) | |
| Not sure | 50 (13.7%) | |
| Time you apply sunscreen before exposedto the sun | Do not care about the time | 116 (31.7%) |
| 5 min | 69 (18.9%) | |
| 10 min | 57 (15.6%) | |
| 15 min | 69 (18.9%) | |
| 20 min | 28 (7.7%) | |
| 25 min | 5 (1.4%) | |
| 30 min | 12 (3.3%) | |
| Over 30 min | 10 (2.7%) | |
| Season in whichsunscreen is used | None | 24 (6.6%) |
| Summer | 152 (41.5%) | |
| Winter | 4 (1.1%) | |
| Both | 186 (50.8%) |
| For how longparticipants have been using sunscreen | Do not use | 58 (15.8%) |
| Weeks | 23 (6.3%) | |
| Months | 81 (22.1%) | |
| Years | 204 (55.7%) | |
| Where do participants apply sunscreen on their body | Do not use | 33 (9.0%) |
| Face | 95 (26.0%) | |
| Face and neck | 63 (17.2%) | |
| All exposed parts of the body | 175 (47.8%) |
*A multiple-response variable
Table 5: Patterns of the use of sunscreen (n =366).
| Variable | Category | N (%) |
| Sunscreen protects from heat | No | 212 (36.7%) |
| Yes | 199 (34.5%) | |
| Do not know | 166 (28.8%) | |
| Medical knowledge increases awareness of sun protection | No | 26 (4.5%) |
| Maybe | 160 (27.7%) | |
| Yes | 391 (67.8%) | |
| Sun protection in SaudiArabia is … | Not necessary | 28 (4.9%) |
| Necessarysometimes in the year | 160 (27.7%) | |
| Necessary | 389 (67.4%) | |
| Important content looked for in sunscreen | Do not knowabout components | 493 (85.4%) |
| Physical sunscreens such as titanium oxide and zinc oxide | 46 (8.0%) | |
| Chemical components suchas avobenzone | 38 (6.6%) | |
| Sunscreen may lose its effect aftersweating or swimming | No | 69 (12.0%) |
| Maybe | 281 (48.7%) | |
| Yes | 227 (39.3%) | |
| Ready to advise people about sun protection | No | 115 (19.9%) |
| Sometimes | 249 (43.2%) | |
| Yes | 213 (36.9%) |
Table 6: Perceptions of skin protection and sunscreen.
In our study, the number of female participants was double the number of male participants, which might be due to the healthier lifestyles led by women, showing interest in skin care, and fear of aging. Hence, they show greater concern about their appearance (Al Robaee, 2010; Thomas-Gavelan et al., 2011; Al Battat et al., 2021).
A total of 44.2% of the respondents were between 18 to 25 years. This observation demonstrates young Saudis increasingly using the internet, and media campaigns have made them aware of the need to use sunscreen. A community-based study conducted in Shanghai, China, showed similar findings to our study. It was observed that women, higher socioeconomic status, and younger age were the factors which concerned about the sun protection and hence, were inclined to use sunscreen (OpenEpi Menu, 2022). Childhood is an optimal age to inculcate preventive measures as lifestyle habits and attitudes are still in the developing stage (CDC, 2002).
The majority of the respondents (71.9%) had a higher education degree and most samples had Fitzpatrick skin type III. The type III skin is medium-colored skin characterized by their ability to gradually tan and sometimes mildly burn. Similarly, in a Danish study, 41% of respondents claimed to have skin type III or IV, indicating only sometimes or rarely getting sunburned (Ravnbak, 2010). Further, 28.4% had oily skin, 38% had combined skin and 1.6% had a family history of skin cancer.
The present study observed participants agreeing on sunlight being harmful, with 61.9% mentioning that several risk factors for sun exposure such as aging, burns, pigmentation, skin cancer. Our findings on skin cancer were consistent with a previous study from Qassim province (Al Robaee, 2010). About 78.2% of the participants agreed that sunlight is harmful with 23.9% using sunscreen regularly and 36.6% not using at all. Similarly, AlGhamdi et al. (2016) observed 23.7% using sunscreen, while 41% never using it and Alshaalan et al. (2022) found 36% participants had never used sunscreen.
The majority of the participants (44.2%) considered sunscreen as the most important protective method, but only 23.9% used it regularly. A Saudi Arabian study reported that only 38.8% agreed on sunscreen being protective, while 54.8% applied it as a protective method (Alshayeb et al., 2022). Our results were also similar to a past study in the United States where seeking shade and wearing a hat were practices for avoiding sun exposure (Shuk et al., 2012). Only 7.9% of the respondents favoured physical sunscreen and 16.9% preferred chemical sunscreen; 75.1% were unaware of the different forms of sunscreens. Around 36.6% of the participants believed SPF 50 sunscreen to be significantly different from SPF 30 sunscreen, but majority did not know the difference. More than 50% of the participants preferred SPF 50 or higher, but 6.6% preferred SPF 30 and 38% were unaware of the SPF number or its protection effectiveness.
In a study conducted by the University of Miami’s Department of Dermatology and Cutaneous Surgery, most dermatologists agreed on using sunscreens with FDA approval for preventing skin cancer and photo aging. Patients are advised on using broad-spectrum sunscreen with SPF 30 or above, but they also recommend their patients to use sunscreens with SPF 50 or above, for greater protection (Farberg et al., 2017).
Sunscreen should be reapplied every two hours when outdoors, specifically during swimming, excessive sweating, and towelling off (Al Battat et al., 2021). Only 6% of our participants used sunscreen over twice a day, but the rest did not apply much as recommended, and 13.9% did not apply at all. Many sources recommend applying sunscreen 15–20 minutes before sun exposure for effective and even application (Mancuso et al., American Academy of Dermatology Association, 2022).
The time duration of applying sunscreen before sun exposure is as follows: 18.9% applied sunscreen 5 or 15 minutes before exposure, while 15.6% applied it 10 minutes. The damaging effects of UVR on the skin diminish with regular sunscreen use at recommended dosages. Our study observations showed 55.7% of the participants applying sunscreen for years, and 22.1% for months.
Based on past research, 78% of adults only applied sunscreen on their faces (Agarwal et al., 2018). According to our sample; sunscreen was applied to all exposed body parts, followed by the face only (26%), and face and neck (26%). However, researchers found that sunscreen did not affect the mean skin temperature or core-to-skin thermal gradient, which are indicators of heat dissipation (Connolly & Wilcox, 2000).
Daily usage and regular reapplication of sunscreen with zinc oxide and titanium dioxide are specifically suggested for UVR-B protection (Gonzaga, 2009). Our study reported complaints on oiliness (35.1%) as majority had combined skin. Other complaints like acne (22.6%) and allergies (17%) were related to active or extra components with burning sensation in few cases (Al Battat et al., 2021). A study also reported acne as the most observed side effect of sunscreen application, followed by allergies (Agarwal et al., 2018).
We found that 67.8% of the participants stated that medical knowledge increases one’s awareness of sun protection.
Strengths: It is the first population-based study in Makkah to evaluate the prevalence of sunscreen use and study the factors associated with sunscreen use among adults. We surveyed a relatively large sample size of community members with fair questions about sun protection behaviors.
Limitations: First, young participants were prevalent and majority had a medium socioeconomic level. Also, the questionnaire was limited based on participants’ knowledge on sunscreen, especially as the most used protective approach.
The study conducted was a first-of-a-kind cross sectional study in Makka, Saudi Arabia that evaluated various attitudes toward the use of sunscreen. Females were the major participants as they are more concerned about their skin care. Lifestyle habits and positive attitude were also essential for at the initial stages of life for incorporating preventive measures since childhood. Most of the respondents believed that exposure to the sun are harmful. The most common approach reported in our study to protect against UVR was avoiding sun exposure after sunscreen use, followed by seeking shade. However, the rate of sunscreen use by our population was average despite their reasonable awareness of the effects of sun exposure. This implies the need for health education campaigns and programs, to obligate schools, hospitals, and organizations to spread awareness and educate society about the need for sunscreen and hazards of sun exposure. A majority of respondents said having medical knowledge increases sun protection awareness.
Sources of support: None
Any disclaimers: None
Conflict of interest declaration: The authors declare that they have no conflict of interest.
Acknowledgements: None
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Dr. Bernard Terkimbi Utoo, I am happy to publish my scientific work in Journal of Women Health Care and Issues (JWHCI). The manuscript submission was seamless and peer review process was top notch. I was amazed that 4 reviewers worked on the manuscript which made it a highly technical, standard and excellent quality paper. I appreciate the format and consideration for the APC as well as the speed of publication. It is my pleasure to continue with this scientific relationship with the esteem JWHCI.
This is an acknowledgment for peer reviewers, editorial board of Journal of Clinical Research and Reports. They show a lot of consideration for us as publishers for our research article “Evaluation of the different factors associated with side effects of COVID-19 vaccination on medical students, Mutah university, Al-Karak, Jordan”, in a very professional and easy way. This journal is one of outstanding medical journal.
Dear Hao Jiang, to Journal of Nutrition and Food Processing We greatly appreciate the efficient, professional and rapid processing of our paper by your team. If there is anything else we should do, please do not hesitate to let us know. On behalf of my co-authors, we would like to express our great appreciation to editor and reviewers.
As an author who has recently published in the journal "Brain and Neurological Disorders". I am delighted to provide a testimonial on the peer review process, editorial office support, and the overall quality of the journal. The peer review process at Brain and Neurological Disorders is rigorous and meticulous, ensuring that only high-quality, evidence-based research is published. The reviewers are experts in their fields, and their comments and suggestions were constructive and helped improve the quality of my manuscript. The review process was timely and efficient, with clear communication from the editorial office at each stage. The support from the editorial office was exceptional throughout the entire process. The editorial staff was responsive, professional, and always willing to help. They provided valuable guidance on formatting, structure, and ethical considerations, making the submission process seamless. Moreover, they kept me informed about the status of my manuscript and provided timely updates, which made the process less stressful. The journal Brain and Neurological Disorders is of the highest quality, with a strong focus on publishing cutting-edge research in the field of neurology. The articles published in this journal are well-researched, rigorously peer-reviewed, and written by experts in the field. The journal maintains high standards, ensuring that readers are provided with the most up-to-date and reliable information on brain and neurological disorders. In conclusion, I had a wonderful experience publishing in Brain and Neurological Disorders. The peer review process was thorough, the editorial office provided exceptional support, and the journal's quality is second to none. I would highly recommend this journal to any researcher working in the field of neurology and brain disorders.
Dear Agrippa Hilda, Journal of Neuroscience and Neurological Surgery, Editorial Coordinator, I trust this message finds you well. I want to extend my appreciation for considering my article for publication in your esteemed journal. I am pleased to provide a testimonial regarding the peer review process and the support received from your editorial office. The peer review process for my paper was carried out in a highly professional and thorough manner. The feedback and comments provided by the authors were constructive and very useful in improving the quality of the manuscript. This rigorous assessment process undoubtedly contributes to the high standards maintained by your journal.
International Journal of Clinical Case Reports and Reviews. I strongly recommend to consider submitting your work to this high-quality journal. The support and availability of the Editorial staff is outstanding and the review process was both efficient and rigorous.
Thank you very much for publishing my Research Article titled “Comparing Treatment Outcome Of Allergic Rhinitis Patients After Using Fluticasone Nasal Spray And Nasal Douching" in the Journal of Clinical Otorhinolaryngology. As Medical Professionals we are immensely benefited from study of various informative Articles and Papers published in this high quality Journal. I look forward to enriching my knowledge by regular study of the Journal and contribute my future work in the field of ENT through the Journal for use by the medical fraternity. The support from the Editorial office was excellent and very prompt. I also welcome the comments received from the readers of my Research Article.
Dear Erica Kelsey, Editorial Coordinator of Cancer Research and Cellular Therapeutics Our team is very satisfied with the processing of our paper by your journal. That was fast, efficient, rigorous, but without unnecessary complications. We appreciated the very short time between the submission of the paper and its publication on line on your site.
I am very glad to say that the peer review process is very successful and fast and support from the Editorial Office. Therefore, I would like to continue our scientific relationship for a long time. And I especially thank you for your kindly attention towards my article. Have a good day!
"We recently published an article entitled “Influence of beta-Cyclodextrins upon the Degradation of Carbofuran Derivatives under Alkaline Conditions" in the Journal of “Pesticides and Biofertilizers” to show that the cyclodextrins protect the carbamates increasing their half-life time in the presence of basic conditions This will be very helpful to understand carbofuran behaviour in the analytical, agro-environmental and food areas. We greatly appreciated the interaction with the editor and the editorial team; we were particularly well accompanied during the course of the revision process, since all various steps towards publication were short and without delay".
I would like to express my gratitude towards you process of article review and submission. I found this to be very fair and expedient. Your follow up has been excellent. I have many publications in national and international journal and your process has been one of the best so far. Keep up the great work.
We are grateful for this opportunity to provide a glowing recommendation to the Journal of Psychiatry and Psychotherapy. We found that the editorial team were very supportive, helpful, kept us abreast of timelines and over all very professional in nature. The peer review process was rigorous, efficient and constructive that really enhanced our article submission. The experience with this journal remains one of our best ever and we look forward to providing future submissions in the near future.
I am very pleased to serve as EBM of the journal, I hope many years of my experience in stem cells can help the journal from one way or another. As we know, stem cells hold great potential for regenerative medicine, which are mostly used to promote the repair response of diseased, dysfunctional or injured tissue using stem cells or their derivatives. I think Stem Cell Research and Therapeutics International is a great platform to publish and share the understanding towards the biology and translational or clinical application of stem cells.
I would like to give my testimony in the support I have got by the peer review process and to support the editorial office where they were of asset to support young author like me to be encouraged to publish their work in your respected journal and globalize and share knowledge across the globe. I really give my great gratitude to your journal and the peer review including the editorial office.
I am delighted to publish our manuscript entitled "A Perspective on Cocaine Induced Stroke - Its Mechanisms and Management" in the Journal of Neuroscience and Neurological Surgery. The peer review process, support from the editorial office, and quality of the journal are excellent. The manuscripts published are of high quality and of excellent scientific value. I recommend this journal very much to colleagues.
Dr.Tania Muñoz, My experience as researcher and author of a review article in The Journal Clinical Cardiology and Interventions has been very enriching and stimulating. The editorial team is excellent, performs its work with absolute responsibility and delivery. They are proactive, dynamic and receptive to all proposals. Supporting at all times the vast universe of authors who choose them as an option for publication. The team of review specialists, members of the editorial board, are brilliant professionals, with remarkable performance in medical research and scientific methodology. Together they form a frontline team that consolidates the JCCI as a magnificent option for the publication and review of high-level medical articles and broad collective interest. I am honored to be able to share my review article and open to receive all your comments.
“The peer review process of JPMHC is quick and effective. Authors are benefited by good and professional reviewers with huge experience in the field of psychology and mental health. The support from the editorial office is very professional. People to contact to are friendly and happy to help and assist any query authors might have. Quality of the Journal is scientific and publishes ground-breaking research on mental health that is useful for other professionals in the field”.
Dear editorial department: On behalf of our team, I hereby certify the reliability and superiority of the International Journal of Clinical Case Reports and Reviews in the peer review process, editorial support, and journal quality. Firstly, the peer review process of the International Journal of Clinical Case Reports and Reviews is rigorous, fair, transparent, fast, and of high quality. The editorial department invites experts from relevant fields as anonymous reviewers to review all submitted manuscripts. These experts have rich academic backgrounds and experience, and can accurately evaluate the academic quality, originality, and suitability of manuscripts. The editorial department is committed to ensuring the rigor of the peer review process, while also making every effort to ensure a fast review cycle to meet the needs of authors and the academic community. Secondly, the editorial team of the International Journal of Clinical Case Reports and Reviews is composed of a group of senior scholars and professionals with rich experience and professional knowledge in related fields. The editorial department is committed to assisting authors in improving their manuscripts, ensuring their academic accuracy, clarity, and completeness. Editors actively collaborate with authors, providing useful suggestions and feedback to promote the improvement and development of the manuscript. We believe that the support of the editorial department is one of the key factors in ensuring the quality of the journal. Finally, the International Journal of Clinical Case Reports and Reviews is renowned for its high- quality articles and strict academic standards. The editorial department is committed to publishing innovative and academically valuable research results to promote the development and progress of related fields. The International Journal of Clinical Case Reports and Reviews is reasonably priced and ensures excellent service and quality ratio, allowing authors to obtain high-level academic publishing opportunities in an affordable manner. I hereby solemnly declare that the International Journal of Clinical Case Reports and Reviews has a high level of credibility and superiority in terms of peer review process, editorial support, reasonable fees, and journal quality. Sincerely, Rui Tao.
Clinical Cardiology and Cardiovascular Interventions I testity the covering of the peer review process, support from the editorial office, and quality of the journal.
Clinical Cardiology and Cardiovascular Interventions, we deeply appreciate the interest shown in our work and its publication. It has been a true pleasure to collaborate with you. The peer review process, as well as the support provided by the editorial office, have been exceptional, and the quality of the journal is very high, which was a determining factor in our decision to publish with you.
The peer reviewers process is quick and effective, the supports from editorial office is excellent, the quality of journal is high. I would like to collabroate with Internatioanl journal of Clinical Case Reports and Reviews journal clinically in the future time.
Clinical Cardiology and Cardiovascular Interventions, I would like to express my sincerest gratitude for the trust placed in our team for the publication in your journal. It has been a true pleasure to collaborate with you on this project. I am pleased to inform you that both the peer review process and the attention from the editorial coordination have been excellent. Your team has worked with dedication and professionalism to ensure that your publication meets the highest standards of quality. We are confident that this collaboration will result in mutual success, and we are eager to see the fruits of this shared effort.
Dear Dr. Jessica Magne, Editorial Coordinator 0f Clinical Cardiology and Cardiovascular Interventions, I hope this message finds you well. I want to express my utmost gratitude for your excellent work and for the dedication and speed in the publication process of my article titled "Navigating Innovation: Qualitative Insights on Using Technology for Health Education in Acute Coronary Syndrome Patients." I am very satisfied with the peer review process, the support from the editorial office, and the quality of the journal. I hope we can maintain our scientific relationship in the long term.
Dear Monica Gissare, - Editorial Coordinator of Nutrition and Food Processing. ¨My testimony with you is truly professional, with a positive response regarding the follow-up of the article and its review, you took into account my qualities and the importance of the topic¨.
Dear Dr. Jessica Magne, Editorial Coordinator 0f Clinical Cardiology and Cardiovascular Interventions, The review process for the article “The Handling of Anti-aggregants and Anticoagulants in the Oncologic Heart Patient Submitted to Surgery” was extremely rigorous and detailed. From the initial submission to the final acceptance, the editorial team at the “Journal of Clinical Cardiology and Cardiovascular Interventions” demonstrated a high level of professionalism and dedication. The reviewers provided constructive and detailed feedback, which was essential for improving the quality of our work. Communication was always clear and efficient, ensuring that all our questions were promptly addressed. The quality of the “Journal of Clinical Cardiology and Cardiovascular Interventions” is undeniable. It is a peer-reviewed, open-access publication dedicated exclusively to disseminating high-quality research in the field of clinical cardiology and cardiovascular interventions. The journal's impact factor is currently under evaluation, and it is indexed in reputable databases, which further reinforces its credibility and relevance in the scientific field. I highly recommend this journal to researchers looking for a reputable platform to publish their studies.
Dear Editorial Coordinator of the Journal of Nutrition and Food Processing! "I would like to thank the Journal of Nutrition and Food Processing for including and publishing my article. The peer review process was very quick, movement and precise. The Editorial Board has done an extremely conscientious job with much help, valuable comments and advices. I find the journal very valuable from a professional point of view, thank you very much for allowing me to be part of it and I would like to participate in the future!”
Dealing with The Journal of Neurology and Neurological Surgery was very smooth and comprehensive. The office staff took time to address my needs and the response from editors and the office was prompt and fair. I certainly hope to publish with this journal again.Their professionalism is apparent and more than satisfactory. Susan Weiner
My Testimonial Covering as fellowing: Lin-Show Chin. The peer reviewers process is quick and effective, the supports from editorial office is excellent, the quality of journal is high. I would like to collabroate with Internatioanl journal of Clinical Case Reports and Reviews.
My experience publishing in Psychology and Mental Health Care was exceptional. The peer review process was rigorous and constructive, with reviewers providing valuable insights that helped enhance the quality of our work. The editorial team was highly supportive and responsive, making the submission process smooth and efficient. The journal's commitment to high standards and academic rigor makes it a respected platform for quality research. I am grateful for the opportunity to publish in such a reputable journal.
My experience publishing in International Journal of Clinical Case Reports and Reviews was exceptional. I Come forth to Provide a Testimonial Covering the Peer Review Process and the editorial office for the Professional and Impartial Evaluation of the Manuscript.
