# Attitudes and behaviors regarding sun exposure in Japan compared to Europe and North America

A. Morita, H. Lim, T. Passeron, C. Goh, H. Kang, F. Ly, J.

Ocampo-Candiani, S. Puig, S. Schalka, L. Wei, et al.

► To cite this version:

A. Morita, H. Lim, T. Passeron, C. Goh, H. Kang, et al. Attitudes and behaviors regarding sun exposure in Japan compared to Europe and North America. Journal of Dermatology, 2024, 51 (7), pp.1004-1009. 10.1111/1346-8138.17217. inserm-04573246

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# Attitudes and behaviors regarding sun exposure in Japan compared to Europe and North America

A. Morita<fnref n="1" /> ID | H. W. Lim<fnref n="2" /> | T. Passeron<fnref n="3" />,<fnref n="4" /> | C. L. Goh<fnref n="5" /> | H. Y. Kang<fnref n="6" /> | F. Ly<fnref n="7" /> |
J. Ocampo-Candiani<fnref n="8" /> | S. Puig<fnref n="9" /> | S. Schalka<fnref n="10" /> | L. Wei<fnref n="11" /> | A. L. Demessant<fnref n="12" /> ID |
C. Le Floc'h<fnref n="12" /> | D. Kerob<fnref n="12" /> | B. Dreno<fnref n="13" /> | J. Krutmann<fnref n="14" />,<fnref n="15" />

**Correspondence**

A. Morita, Department of Geriatric and
Environmental Dermatology, Nagoya City
University Graduate School of Medical
Sciences, Nagoya, Japan.

Email: amorita@med.nagoya-cu.ac.jp

**Funding information**

La Roche Posay International

**Abstract**

The objective of our study was to assess the attitudes and behaviors in Japan regarding sun exposure and compare them to those in Europe and North America. The study population was a representative sample of individuals aged >18 years from Ipsos panels in Japan (N=1000), North America (N=1000), and Europe (N=6000) using the quota method. Questionnaires covered habits, practices, and perceptions regarding sun exposure. Results revealed that the majority of people (80.1%) believed that the sun gives them energy, and 61.1% considered that being tanned made them look healthier. However, there was a significant difference between men and women regarding the appeal of tanned skin, with 54.95% of men versus 34.67% (p < 0.001) of women seeing a tan as an aesthetic asset. People aged <40 years were less likely to find a tan attractive (30.3%) compared to those aged ≥40 years (48.9%) (p < 0.001). Of those questioned, 45.70% of used sunscreen with a much higher use among women (70.10%) than men (18.74%) (p < 0.001). Almost 54% of people said they stayed in the shade to protect themselves from the sun with this behavior being more prevalent among women (67.05%) and fair-skinned individuals

This is an open access article under the terms of the [Creative Commons Attribution License](https://creativecommons.org/licenses/by/4.0/), which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

© 2024 The Authors. *The Journal of Dermatology* published by John Wiley & Sons Australia, Ltd on behalf of Japanese Dermatological Association.

<footnote n="1">¹Department of Geriatric and Environmental Dermatology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan</footnote>

<footnote n="2">²Department of Dermatology, Henry Ford Health, Detroit, Michigan, USA</footnote>

<footnote n="3">³Department of Dermatology, Côte d'Azur University, Nice University Hospital Center, Nice, France</footnote>

<footnote n="4">⁴INSERM U1065, C3M, Côte d'Azur University, Nice, France</footnote>

<footnote n="5">⁵National Skin Centre, Singapore, Singapore</footnote>

<footnote n="6">⁶Department of Dermatology, University School of Medicine, Suwon, South Korea</footnote>

<footnote n="7">⁷Department of Dermatology, Cheikh Anta Diop Dakar University, EPS Institute of Social Hygiene, Dakar, Senegal</footnote>

<footnote n="8">⁸Universidad Autonoma de Nuevo León, Facultad de Medicina, University Hospital "Dr. Jose E. González", Monterrey, Mexico</footnote>

<footnote n="9">⁹Dermatology Department, Hospital Clinic de Barcelona, Barcelona University, Barcelona, Spain</footnote>

<footnote n="10">¹⁰Medecin Skin Research Center and Biochemistry Department, Chemistry Institute of Sao Paulo University, Sao Paulo, Brazil</footnote>

<footnote n="11">¹¹Department of Dermatology, The General Hospital of air Force PLA, Beijing, China</footnote>

<footnote n="12">¹²La Roche-Posay International, Levallois-Perret, France</footnote>

<footnote n="13">¹³Univ Angers, INSERM, Immunology and New Concepts in ImmunoTherapy, INCIT, UMR 1302, Nantes University, Nantes, France</footnote>

<footnote n="14">¹⁴IUF Leibniz Research Institute for Environmental Medicine, Duesseldorf, Germany</footnote>

<footnote n="15">¹⁵Medical Faculty, Heinrich-Heine-University, Duesseldorf, Germany</footnote>
(56.13%). Fear of the risks of sun exposure was more common among women, with 84.8% fearing premature skin aging, compared to 71.8% of men (p < 0.001). In Japan, 44.30% of those questioned said tanned skin was attractive (p < 0.001); for Europeans and North Americans the proportions were 81.1% and 77.6%, respectively. Only a quarter (25.80%) thought it essential to return from vacation with a tan. On the other hand, Europeans showed a strong recognition of the energy the sun brings (83.18%), and widely believed that tanned skin is attractive (82.32%) and healthy (73.15%). In North America, attitudes were similar to those in Europe regarding the attractiveness of tanned skin (77.65%) and the importance of returning tanned from vacation (48.15%). Compared to Europeans and North Americans, the Japanese seemed to be more cautious about sun-induced hazards and considered lighter skin to be more attractive.

### KEYWORDS

Japan, public health, sun exposure

# 1 | INTRODUCTION

Protection of the skin from sun exposure is increasingly being recognized as a major public health issue¹ as knowledge about the risks of ultraviolet (UV) radiation is growing. It is well documented that UV radiation causes skin cancer, sunburn, premature aging, immunosuppression, and activation of latent viruses. While climate factors may influence the level of UV radiation at the earth's surface, it is individual behavior that has the greatest impact on exposure to UV radiation.¹,² Data on attitudes to sun exposure in Japan are lacking. The objective of our study was to assess attitudes and behaviors regarding sun exposure in Japan and compare them to those in Europe and North America.

# 2 | METHODS

The survey was conducted online from 28 September to 18 October 2021. The study population, selected from Ipsos online panels, included men and women aged ≥18 years from Japan (N=1000), North America (USA & Canada, N=1000), and Europe (France, Germany, Italy, Russia, Spain, and the UK N=6000). Eligibility required that all participants had not recently taken part in a similar survey. A preliminary sample population was compiled using the automatic selection process of the Ipsos software (eMethodology). The preliminary sample was adjusted, giving a final sample population that fit the quotas³,⁴ based on sex, age, employment status, and regions of the individual countries. The final sample size made allowances for country-specific variations in response rates.

The questionnaires covered demographics, personal medical history, and sun-exposure habits and practices. Information on phototypes (skin types) was documented using the Fitzpatrick classification, together with a description of the color of the skin and color picture representations. The questionnaires were translated into the

appropriate languages for each country and proofread by a native speaker.

Data were analyzed using descriptive statistics, including frequency tables, means, standard deviations, and 95% confidence intervals. Two-sided chi-squared tests with a 0.05 significance level were used to compare subgroups. The Cosi software (M.L.I., France, 1994) was used for all analyses.

This survey was conducted in accordance with the ICC/ESOMAR code of conduct.

# 3 | RESULTS

Table 1 shows the results of a survey of 1000 individuals in Japan on sun-related perceptions, protection habits and their knowledge of the impact and risks of sun exposure, comparing responses by sex, age, and skin type.

The results revealed that the majority of people (80.1%) believed that the sun gives them energy, and 61.1% considered that being tanned made them look healthier. However, there was a significant difference between men and women regarding the appeal of tanned skin, with 54.9% of men versus 34.7% (p < 0.001) of women seeing it as an aesthetic asset. People <40 years were less likely to find a tan attractive (30.3%) compared to those aged ≥40 years (48.9%) (p < 0.001).

In terms of sun protection habits, 45.7% of people used sunscreen with much higher use among women (70.10%) than men (18.74%) (p < 0.001). It is also interesting to note that 53.9% of people said they stayed in the shade to protect themselves from the sun. This behavior was more prevalent among women (67.1%) and fair-skinned individuals (56.1%).

Regarding the impact and risks of sun exposure, a large proportion of those questioned (78.5%) said they knew that the sun accelerates skin aging, and 70.1% recognized that the sun can cause skin health problems (p < 0.001). Fear of such risks was more common
<table><caption>TABLE 1 Attitudes and behaviors of the Japanese regarding sun exposure according to sex, age, and phenotype.</caption><thead><tr><th rowspan="2"></th><th colspan="2">Global Japan population n=1000</th><th colspan="2">Men n=475</th><th colspan="2">Women n=525</th><th colspan="2">Under 40 years old n=332</th><th colspan="2">40 years and over n=668</th><th colspan="2">Fair skin n=702</th><th colspan="2">Dark skin n=298</th></tr><tr><th>N</th><th>%</th><th>N</th><th>%</th><th>N</th><th>%</th><th>N</th><th>%</th><th>N</th><th>%</th><th>p-Value</th><th>N</th><th>%</th><th>N</th><th>%</th></tr></thead><tbody><tr><td colspan="15"><strong>Preconceptions</strong></td></tr><tr><td colspan="15">Individual thinks/believes that...</td></tr><tr><td>The sun gives us energy</td><td>801</td><td>80.1</td><td>383</td><td>80.6</td><td>418</td><td>79.6</td><td>0.748</td><td>213</td><td>55.8</td><td>588</td><td>88.0</td><td>&lt;0.001</td><td>558</td><td>79.5</td><td>243</td><td>81.5</td><td>&lt;0.001</td></tr><tr><td>Tanned skin is attractive</td><td>443</td><td>44.3</td><td>261</td><td>54.9</td><td>182</td><td>34.7</td><td>&lt;0.001</td><td>116</td><td>30.4</td><td>327</td><td>49.0</td><td>&lt;0.001</td><td>294</td><td>41.9</td><td>149</td><td>50.0</td><td>0.472</td></tr><tr><td>Being tanned makes us look healthier</td><td>611</td><td>61.1</td><td>323</td><td>68.0</td><td>288</td><td>54.9</td><td>&lt;0.001</td><td>154</td><td>40.3</td><td>457</td><td>68.4</td><td>&lt;0.001</td><td>420</td><td>59.8</td><td>191</td><td>64.1</td><td>0.004</td></tr><tr><td>It's essential to come back from holiday with a tan</td><td>258</td><td>25.8</td><td>157</td><td>33.1</td><td>101</td><td>19.2</td><td>&lt;0.001</td><td>64</td><td>16.8</td><td>194</td><td>29.0</td><td>&lt;0.001</td><td>162</td><td>23.1</td><td>96</td><td>32.2</td><td>0.437</td></tr><tr><td colspan="15"><strong>Sun protection habits</strong></td></tr><tr><td colspan="15">Individual is in the habit of...</td></tr><tr><td>Using sunscreen</td><td>457</td><td>45.7</td><td>89</td><td>18.7</td><td>368</td><td>70.1</td><td>&lt;0.001</td><td>162</td><td>48.8</td><td>295</td><td>44.2</td><td>0.188</td><td>344</td><td>49.0</td><td>113</td><td>37.9</td><td>&lt;0.001</td></tr><tr><td>Wearing a cap or hat</td><td>490</td><td>49.0</td><td>225</td><td>47.4</td><td>265</td><td>50.5</td><td>0.358</td><td>107</td><td>32.2</td><td>383</td><td>57.3</td><td>&lt;0.001</td><td>330</td><td>47.0</td><td>160</td><td>53.7</td><td>0.159</td></tr><tr><td>Wearing protective clothes</td><td>355</td><td>35.5</td><td>108</td><td>22.7</td><td>247</td><td>47.0</td><td>&lt;0.001</td><td>105</td><td>31.6</td><td>250</td><td>37.4</td><td>0.083</td><td>258</td><td>36.8</td><td>97</td><td>32.6</td><td>&lt;0.001</td></tr><tr><td>Wearing sunglasses</td><td>190</td><td>19.0</td><td>93</td><td>19.6</td><td>97</td><td>18.5</td><td>0.716</td><td>45</td><td>13.6</td><td>145</td><td>21.7</td><td>0.003</td><td>134</td><td>19.1</td><td>56</td><td>18.8</td><td>0.094</td></tr><tr><td>Staying in the shade</td><td>539</td><td>53.9</td><td>187</td><td>39.4</td><td>352</td><td>67.0</td><td>&lt;0.001</td><td>158</td><td>47.6</td><td>381</td><td>57.0</td><td>0.006</td><td>394</td><td>56.1</td><td>145</td><td>48.7</td><td>&lt;0.001</td></tr><tr><td colspan="15"><strong>Preparing to tan</strong></td></tr><tr><td colspan="15">Individual reports using</td></tr><tr><td>Sunbeds</td><td>51</td><td>5.1</td><td>34</td><td>7.2</td><td>17</td><td>3.2</td><td>0.008</td><td>24</td><td>7.2</td><td>27</td><td>4.0</td><td>0.045</td><td>35</td><td>5.0</td><td>16</td><td>5.4</td><td>0.685</td></tr><tr><td>Gradual self-tanners, cosmetics</td><td>65</td><td>6.5</td><td>26</td><td>5.5</td><td>39</td><td>7.4</td><td>0.261</td><td>29</td><td>8.7</td><td>36</td><td>5.4</td><td>0.059</td><td>49</td><td>7.0</td><td>16</td><td>5.4</td><td>0.094</td></tr><tr><td>Vitamin D supplements</td><td>150</td><td>15.0</td><td>69</td><td>14.5</td><td>81</td><td>15.4</td><td>0.756</td><td>55</td><td>16.6</td><td>95</td><td>14.2</td><td>0.377</td><td>113</td><td>16.1</td><td>37</td><td>12.4</td><td>0.006</td></tr><tr><td>Oral supplements (beta-carotene, lycopene, lutein...)</td><td>95</td><td>9.5</td><td>42</td><td>8.8</td><td>53</td><td>10.1</td><td>0.571</td><td>30</td><td>9.0</td><td>65</td><td>9.7</td><td>0.812</td><td>61</td><td>8.7</td><td>34</td><td>11.4</td><td>0.955</td></tr><tr><td>Phototherapy under dermatological supervision</td><td>31</td><td>3.1</td><td>10</td><td>2.1</td><td>21</td><td>4.0</td><td>0.123</td><td>16</td><td>4.8</td><td>15</td><td>2.2</td><td>0.044</td><td>23</td><td>3.3</td><td>8</td><td>2.7</td><td>0.369</td></tr><tr><td>Hydroxychloroquine</td><td>37</td><td>3.7</td><td>20</td><td>4.2</td><td>17</td><td>3.2</td><td>0.518</td><td>14</td><td>4.2</td><td>23</td><td>3.4</td><td>0.665</td><td>30</td><td>4.3</td><td>7</td><td>2.3</td><td>0.056</td></tr><tr><td colspan="15"><strong>Following recommendations</strong></td></tr><tr><td colspan="15">Individual reports</td></tr><tr><td>Avoiding the sun at the hottest part of the day (12 noon-4pm)</td><td>374</td><td>37.4</td><td>134</td><td>28.2</td><td>240</td><td>45.7</td><td>&lt;0.001</td><td>119</td><td>35.8</td><td>255</td><td>38.2</td><td>0.517</td><td>280</td><td>39.9</td><td>94</td><td>31.5</td><td>&lt;0.001</td></tr></tbody></table>
<table><caption>TABLE 1 (Continued)</caption><thead><tr><th rowspan="2"></th><th colspan="2">Global Japan population n=1000</th><th colspan="2">Men n=475</th><th colspan="2">Women n=525</th><th colspan="2">Under 40 years old n=332</th><th colspan="2">40 years and over n=668</th><th colspan="2">Fair skin n=702</th><th colspan="2">Dark skin n=298</th></tr><tr><th>N</th><th>%</th><th>N</th><th>%</th><th>N</th><th>%</th><th>N</th><th>%</th><th>N</th><th>%</th><th>N</th><th>%</th><th>N</th><th>%</th></tr></thead><tbody><tr><td>Applying sunscreen (at least) every 2h</td><td>49</td><td>4.9</td><td>20</td><td>4.2</td><td>29</td><td>5.5</td><td>0.416</td><td>18</td><td>5.4</td><td>31</td><td>4.6</td><td>0.702</td><td>41</td><td>5.8</td></tr><tr><td>Keep applying sunscreen even when tanned</td><td>149</td><td>14.9</td><td>89</td><td>18.7</td><td>60</td><td>11.4</td><td>0.002</td><td>40</td><td>12.0</td><td>109</td><td>16.3</td><td>0.091</td><td>100</td><td>14.2</td></tr><tr><td>Individual knows that..</td><td></td><td></td><td></td><td></td><td></td><td></td><td></td><td></td><td></td><td></td><td></td><td></td><td></td><td></td></tr><tr><td>The sun accelerates skin aging.</td><td>785</td><td>78.5</td><td>354</td><td>74.5</td><td>431</td><td>82.1</td><td>0.005</td><td>193</td><td>58.1</td><td>592</td><td>88.6</td><td>&lt;0.001</td><td>551</td><td>78.5</td></tr><tr><td>The sun can cause skin health problems</td><td>701</td><td>70.1</td><td>323</td><td>68.0</td><td>378</td><td>72.0</td><td>0.190</td><td>177</td><td>53.3</td><td>524</td><td>78.4</td><td>&lt;0.001</td><td>496</td><td>70.7</td></tr><tr><td>Individual fears</td><td></td><td></td><td></td><td></td><td></td><td></td><td></td><td></td><td></td><td></td><td></td><td></td><td></td><td></td></tr><tr><td>The risk of premature skin aging</td><td>786</td><td>78.6</td><td>341</td><td>71.8</td><td>445</td><td>84.8</td><td>&lt;0.001</td><td>202</td><td>52.9</td><td>584</td><td>87.4</td><td>&lt;0.001</td><td>545</td><td>77.6</td></tr><tr><td>The risk of developing cancer</td><td>789</td><td>78.9</td><td>342</td><td>72.0</td><td>447</td><td>85.1</td><td>0.725</td><td>198</td><td>51.8</td><td>591</td><td>88.5</td><td>&lt;0.001</td><td>550</td><td>78.3</td></tr></tbody></table>

among women, with 84.8% fearing premature skin aging, compared to 71.8% of men (p < 0.001).

Figure 1 compares the perception and knowledge of the sun hazards among populations in Europe, Japan, and North America. Of those in Japan, 44.3% said they found tanned skin attractive, significantly lower (p < 0.001) than Europeans (81.1%) and North Americans (77.6%). Only a quarter of Japanese respondents (25.8%) thought it essential to return from vacation with a tan. On the other hand, Europeans showed a strong recognition of the energy the sun brings (83.2%), and widely believed that tanned skin is attractive (82.3%) and healthy (73.1%). It is also worthy of note that over half the Europeans (52.2%) thought it essential to return from vacation with a tan. In North America, attitudes were similar to those in Europe regarding the appeal of tanned skin (77.6%) and the importance of returning tanned from vacation (48.1%). They also showed a strong awareness of sun-related risks, with 89.2% recognizing that the sun accelerates skin aging and 92% understanding that the sun causes skin health hazards.

## 4 | DISCUSSION

This is the first study to assess the sun exposure habits and attitudes among the Japanese and compare them with such habits in Europe and North America. Overall, the results highlight significant differences in attitudes and behavior towards sun exposure, depending on sex, age, and skin type within the Japanese population. Compared to women, men considered that tanned skin is attractive, makes them look healthier, and is essential after a vacation. Women have a higher tendency to use sunscreen and stay in the shade. While women tend to avoid the sun at the peak hours of the day, men tend to apply sunscreen even after they are tanned. Individuals >40 years have more positive perceptions about the effect of the sun in their lives. However, they tend to wear a cap and sunglasses and stay in the shade more than those aged <40 years. Women and individuals aged >40 years expressed more fear of the risk of skin aging, but there was no difference between fair and dark-skinned people. Those aged >40 years had more fear of the risk of skin cancer with no difference in regard to sex or skin type. While Europeans and North Americans share similar views on the appeal of tanning and the risks of the sun exposure, the Japanese show a more cautious attitude towards tanning. In fact, pale skin has historically been a standard of beauty in Asia, and until today, white skin represents beauty or wealth.⁵,⁶ There exists a cultural preference for lighter and evenly toned skin in Asia, which may make Asians practice sun protection.⁷,⁸ Previous studies have found that women raised in East Asian countries living in the USA express a desire for pale skin and, therefore, prefer to engage in activities out of the sun.⁹ On the other hand, white men and women tend to admire tanned skin, which can motivate skin cancer risk behaviors.¹⁰ One of the limitations in the study is the use of the Fitzpatrick classification. The classification, used for Japanese people, utilizes the Japan phototypes I, II and III. While it might sometimes be difficult to classify the phenotype of Japanese people using only the Fitzpatrick classification, but the same classification had to be used on all individuals of the study.
<figure><img src="image_2.png" /></figure>

NORDIC DERMATOLOGY ASSOCIATION

DERMATOLOGY

<figure><img src="image_3.png" /><figcaption>**FIGURE 1** Comparison of perceptions of sun exposure in Japan, Europe, and North America. Percentages represent the proportion of individuals in the studied population of each region.</figcaption></figure>

## 5 | CONCLUSION

In conclusion, sun protection habits and perception of skin hazards present in the Japanese population differ according to age, sex, and prototype. Compared to Europeans and North Americans, the Japanese seem to be more cautious regarding sun-induced hazards and consider lighter skin to be more attractive. Given that sun exposure is a modifiable factor for skin cancer and photo-ageing, promoting new cultural beliefs like those in Japan, and changing the definition of physical attractiveness might be a strategy to encourage sun-smart behavior in campaigns against sun exposure. Culture and perception of tanned skin among the Japanese population seems to be a protective factor from sun exposure. With the increased use of social media, the promotion of the perception of light-skin beauty on different online platforms could be considered to build a new trend in beauty alongside other beauty trends.

## CONFLICT OF INTEREST STATEMENT

Pr Thierry Passeron reports personal fees from La Roche Posay during the conduct of the study and personal fees from L'Oréal, ACM, Beiersdorf, Hyphen, ISDIN, ISIS Pharma, NAOS, SVR, SUN Pharma, Symrise. Pr. Henri W Lim is an investigator for Incyte, La Roche-Posay, Pfizer and PCORI, has served as a consultant for ISDIN, Beiersdorf, Ferndale, L'Oreal, Eli Lily, and has been a speaker on general educational session for La Roche-Posay, Cantabria labs, Pierre Fabre, NAOS, Uriage, and Pfizer. Pr. Chee Leok Goh reports other support from La Roche Posay during the conduct of the study. Pr. Kang reports personal fees from L'Oréal during the conduct of the study. Pr. Fatimata Ly has nothing to

disclose. Pr. Morita reports personal fees from L'Oréal during the conduct of the study. Dr. Jorge Ocampo-Candiani reports personal fees from La Roche Posay during the conduct of the study. Pr. Susana Puig reports personal fees from La Roche Posay, during the conduct of the study and personal fees and non-financial support from La Roche Posay. Dr. Sergio Schalka has served as a consultant for La Roche Posay and has participated as a speaker in an educational session for La Roche-Posay. Pr. Liu Wei reports personal fees from La Roche Posay during the conduct of the study. Anne-Laure. Demessant-Flavigny, Caroline Le Floc'h, Dr Delphine. Kerob are employees of La Roche Posay. Pr. Brigitte Dreno was investigator for BMS, Fabre, Novartis, Almirall, Regeneron, La Roche Posay, Bioderma. Pr. Jean Krutmann reports personal fees and grants from La Roche Posay during the conduct of the study and grants and personal fees from Amway, bitop, Blue Lagoon, Evonik, ISDIN, L'Oreal, Meitu, Mistine, Mibelle, RepliCell, Shin, Skinceuticals, Stada, Symrise, and Vichy.

## FUNDING INFORMATION

As part of the HELIOS project, this work was funded by La Roche Posay International.

## DATA AVAILABILITY STATEMENT

The data that support the findings of this study are available from the corresponding author upon reasonable request.

## ETHICS STATEMENT

This survey was conducted according to the ICC/ESOMAR code of conduct.
<figure><img src="image_4.png" /></figure>

ORCID

A. Morita https://orcid.org/0000-0001-8372-3754

A. L. Demessant https://orcid.org/0009-0005-0177-7510

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How to cite this article: Morita A, Lim HW, Passeron T, Goh CL, Kang HY, Ly F, et al. Attitudes and behaviors regarding sun exposure in Japan compared to Europe and North America. J Dermatol. 2024;51:1004-1009. https://doi.org/10.1111/1346-8138.17217