Environmental cues to UV radiation and personal sun protection in outdoor winter recreation

Objective: To predict the prevalence of UV radiation (hereinafter, UV) at North American ski resorts using temporal, seasonal, altitudinal, and meteorological factors and associate UV with a set of adult sun protection behaviors. Design: Ultraviolet radiation observations and cross-sectional survey of adults on sun protection were collected. Setting: Data were collected at 32 high-altitude ski areas located in western North America from 2001 through 2003. Participants: The sample consisted of 3937 adult skiers or snowboarders. Main Outcome Measures: Measurements of direct, reflected, and diffuse UV were performed at 487 measurement points using handheld meters and combined with self-reported and observed sun protection assessed for adults interviewed on chairlifts. Results: The strongest predictors of UV were temporal proximity to noon, deviation from winter solstice, and clear skies. By contrast, altitude and latitude had more modest associations with UV and temperature had a small positive relationship with UV. Guest sun safety was inconsistently associated with UV: UV was positively related to adults wearing more sunscreen, reapplying it after 2 hours, and wearing protective eyewear, but fewer adults exhibited many of the other sun protection behaviors, such as wearing hats and protective clothing or using lip balm, on days when UV was elevated. Guests took more sun safety precautions on clear-sky days but took steps to maintain body warmth on inclement days. Conclusions: In future sun safety promotions, adults should be encouraged to wear sunscreen on cloudy days because UV is still high and conditions can change rapidly. They need reminders to rely more on season and time of day when judging UV and the need for sun safety.