Most Americans are familiar with the popular city rankings of the fattest cities, the fittest cities, the most livable cities and the most expensive cities. Now, in the first-of-its-kind survey, the American Academy of Dermatology has identified the cities that take sun protection seriously and those that fail to make the grade despite repeated health warnings.
The "RAYS: Your Grade" survey polled adults in 32 U.S. metropolitan regions spanning 29 states on their knowledge, attitudes and behaviors toward tanning and sun protection. Cities were then ranked based on the percentage of people who scored A's and B's.
"Based on our initial review of what people are currently doing, know and believe about sun protection, 35 percent of the national public score above average, with grades of A or B," said dermatologist Diane R. Baker, MD, FAAD, president of the Academy. "From here, our goal is to move the needle so that we have 45 percent or even 50 percent starting to score in the A or B range."
Of the 32 cities and states ranked on their percentage of A and B grades, Washington, DC, was ranked No. 1, with 47 percent of its residents receiving A's and B's, followed closely by New York City which earned the No. 2 ranking. Dr. Baker also observed that Miami, Tampa and Los Angeles - each noted for year-round sunny weather - rounded out the top five rankings.
At the other end of the sun-smart spectrum, Chicago was ranked last of the 32 cities polled, earning the designation of the least sun-smart city and demonstrating the need for increased efforts to educate residents on the dangers of sun exposure. In this case, only 21 percent of Chicagoans received A's and B's on their tanning and sun protection knowledge, attitudes and behaviors.
In examining how the respondents in the top- and bottom-ranked cities fared in answering the 17 sun-smart survey questions, notable differences were found within specific cities. For example, in Washington, DC, there were three specific questions where respondents rated significantly higher than average. First, 45 percent of residents disagreed with the statement "People look healthier with a tan" - the highest percent of all respondents who did not agree with this popular belief and 13 percentage points higher than the 32 percent average for all adults.
"District of Columbia (DC) residents also weren't fooled by the statement 'It is smarter to tan indoors using a tanning bed where ultraviolet rays can be controlled,'" stated Dr. Baker. "Specifically, 68 percent of adults in the nation's capital disagreed with this statement versus 58 percent of adults polled across all cities."
When asked whether "Getting a base tan is a healthy way to protect skin from sun damage," DC residents also rated significantly higher than average - 66 percent of respondents correctly disagreed with this statement, the highest of any city, versus 52 percent of adults overall. By comparison, Chicago ranked significantly lower than average when residents' responses to 10 of the survey questions were examined. For example, Chicagoans' laissez-faire attitudes toward sun protection were evident when comparing their answers about how much they worry about sun exposure to adults in other cities.
When asked if they agree or disagree with the statement "I prefer to enjoy sunshine and not worry about what I should do to protect myself from it," 41 percent of Chicago respondents agreed, representing the highest number of respondents across all cities and 10 percentage points higher than the average of 31 percent. Similarly, approximately half of Chicagoans (49 percent) agreed with the statement "Given my skin type, I don't worry too much about sun exposure" - far exceeding the 37 percent of all adults who agreed with this statement.
In addition, a high proportion of Chicagoans (40 percent) felt that the climate in which they live was a reason why they were not that worried about skin cancer - implying that somehow their short period of sun exposure during the summer months could not cause enough damage to their skin to develop skin cancer. "The notion that only people living in year-round sunny climates are prone to developing skin cancer is completely untrue," explained Dr. Baker. "As dermatologists, we treat skin cancer patients living in all areas of the country - from big cities to small towns, in tropical climates and snowbelt states. Studies also show that intense, intermittent sun exposure - which typically involves residents of colder climates vacationing in warm, tropical areas during the winter months - is a significant risk factor for developing future skin cancers."
Dr. Baker also noted 80 percent of the sun's UV rays can pass through light clouds, mist, and fog and that snow can reflect more than 80 percent of the sun's damaging ultraviolet radiation. "The bottom line is that everyone needs to be concerned about protecting themselves from skin cancer, no matter where you live."