Understanding the Perceived Relationship between Sun Exposure and Melanoma in Atlantic Canada: A Consensual Qualitative Study Highlighting a "Sunscreen Paradox"

Simple Summary Melanoma is a form of skin cancer that can be prevented by limiting exposure to the sun. Among the Atlantic provinces of Canada, varying incidence rates of melanoma have been reported. The province of New Brunswick has melanoma incidence rates comparable to the national average, while in Nova Scotia and Prince Edward Island, the rates are above the national average, and in Newfoundland and Labrador, the rates are below. We conducted focus groups with participants in Atlantic Canada to understand the factors contributing to this difference. We found that Canadians living in Nova Scotia and Prince Edward Island-provinces with high melanoma incidence rates-were more likely to report using sun protection, more aware of the health risks of sun exposure, and more apt to follow the UV index. Despite this, they also received more sun exposure due to warmer temperatures and a tendency to engage in outdoor occupations and recreational activities. These findings suggest a sunscreen paradox, whereby individuals with higher levels of sun exposure also tend to use more but not an adequate quantity of sunscreen or other sun-protection measures, providing a false sense of security. Tailored sun protection campaigns must consider this sunscreen paradox and the unique norms of communities in Atlantic Canada and elsewhere in the world to design effective messaging.Abstract Globally, cutaneous melanoma (CM) incidence is increasing, with sun exposure identified as a key modifiable risk factor. The Atlantic provinces of Canada display varied CM incidence rates: New Brunswick aligns with the national average, while Nova Scotia and Prince Edward Island exceed it, and Newfoundland and Labrador fall below this benchmark. We investigated the relationship between sun exposure and CM in these provinces. Twenty-two focus groups encompassing 95 Atlantic Canada residents were conducted and transcribed. A thematic analysis was conducted in MAXQDA using the social-ecological model as a framework. Residents of high-CM incidence provinces demonstrated greater sun exposure awareness, consulting UV indices, and using sunscreen and sun-protective clothing. However, they received greater UV exposure due to warmer climates and outdoor work and cultural activities. Conversely, those in low-incidence provinces used sunscreen and sun-protective clothing less often, engaged in occupations and hobbies affording less sun exposure, and lived in cooler climates. Our data supports a possible "sunscreen paradox", whereby increased sunscreen use is correlated with augmented sun exposure, leading to a deceptive sense of security. Public health initiatives in Atlantic Canada promoting sun safety must address this paradox while integrating community-specific behaviors and norms in order to develop tailored campaigns.