Department of Medicine, Solna Isabella Cedercreutz
Study Program in Medicine KI Degree project 30 credits Spring 2016
Tanning beauty ideals among Swedish
adults who exercise regularly
Author: Isabella Cedercreutz
Supervisor: Magnus Bäcklund Co-supervisor: Yvonne Brandberg
Enkätstudie om svenska motionärers solningsrelaterade skönhetsideal
Bakgrund: Majoriteten av Sveriges befolkning tränar regelbundet, och det har påvisats att de upplever
att det är viktigt att ha en attraktiv kropp. Forskning på svenskars solvanor har visat att svenskar vill vara solbrända, men det är okänt om det finns något samband mellan det och svenskarnas motionsvanor. Syfte: Det primära syftet var att undersöka svenska vuxna motionärers hudtonsideal och solningsrelaterade skönhetsideal. Även associationer till kön, ålder, socio-ekonomisk bakgrund samt motionsvanor undersöktes. En jämförelse med gymnasie-elever utfördes för att undersöka möjliga skillnader. Material och Metoder: Friskis&Svettis (F&S) Tyresös medlemmar blev tillfrågade att fylla i en webbaserad enkät som inkluderade frågor om svararens kön, ålder, utbildningsnivå, motionsvanor, solvanor och hudtonsideal. Enkäten skickades ut via e-mail som en länk i F&S’s nyhetsbrev. Resultat: Majoriteten av de 160 motionärer som deltog i studien upplevde att en mörkare solbränna (nivå fyra av fem) är den attraktivaste (46%) och att en medelmörk solbränna (nivå tre av fem) var den hälsosammaste solbrännan (40%). De äldre deltagarna hade ett mörkare hudtonsideal än de unga (p=0,01). Vid jämförelse mellan olika träningsformer framkom att aktiviteten promenader positivt korrelerade med ett mörkt hudtonsideal (p<0,03). Slutsats: Studien visar att svenska vuxna motionärer har ett mörkt hudtonsideal. Mängden promenader de utförde hade en positiv association till idealet. De yngre deltagarna såg blekare hudtoner som attraktivare och hälsosammare jämfört med de äldre deltagarna. Gymnasie-eleverna upplevde att en hälsosam solbränna är ljusare än vad motionärerna upplevde.
Tanning beauty ideals among Swedish adults who exercise regularly
Introduction: The majority of the Swedish population exercise regularly, and it has been reported that
they believe having an attractive body is important. While research has shown that Swedes wish to be tanned, it is unknown whether there are any correlations to their exercise habits. Aims: The primary aim was to determine tanned skin tone ideals and tanning beauty ideals among regularly exercising Swedish adults. Associations to gender, age, social-economical background, exercise form and amount were also studied. A comparison to high school students was made to explore potential differences.
Material and Methods: Members of Friskis&Svettis (F&S) Tyresö were asked to fill out a web-based
questionnaire regarding gender, age, education, exercise habits, sun-related behavior and tanning beauty ideals. The questionnaire was sent out through F&S Tyresö’s newsletter. Results: Out of 160 participants 46% chose tan four out of five as the most attractive, and 40% chose tan three out of five as the healthiest. Age was negatively associated with dark tanned skin tone ideals (p=0.01). A positive correlation between walking and dark tanned skin tone ideals was found (p<0.03). Conclusions: This study showed that regularly exercising Swedish adults have dark tanned skin tone ideals. Walking for exercise purposes was positively associated with these ideals. Younger participants had lighter tanned skin tone ideals than older participants. High school students had lighter tanned skin tone ideals regarding the healthiest tan.
Abbreviations
BCC = basal cell carcinoma F&S = Friskis&Svettis
HIIT = high-intensity interval training
NBHW = The National Board of Health and Welfare RF = The Swedish Sports Confederation
SCB = Statistics Sweden
SPSS = Statistical Package for the Social Sciences UV = ultraviolet
Introduction
In order to prevent skin cancer, the attitudes regarding tanning have to be changed. But to change attitudes, we need to understand them better. Suntan has been associated with a healthy appearance. It is therefore of interest to study the tanning beauty ideals in a sample of Swedish adults who exercise regularly, as improving health is considered to be a major reason for exercising.
Skin cancer
The three most common forms of skin cancer include basal cell carcinoma (BCC), squamous cell carcinoma and malignant melanoma (1). Apart from these three, there are more
uncommon forms of skin cancer including Merkel cell carcinoma, lymphomas, blood or lymph vessel tumors, adnexal tumors and connective tissue tumors. In Sweden BCC is the most common and squamous cell carcinoma is the second most common type of skin cancer. Both forms evolve and grow slower than malignant melanoma (1). BCC very seldom
metastasizes while squamous cell carcinoma might metastasize, but mainly to the regional lymph nodes. Malignant melanoma has a risk of distant metastasis and is therefore a more severe, and potentially lethal, form of skin cancer (1). The primary treatment of BCC, squamous cell carcinoma and malignant melanoma is very similar. In most cases, where it is possible and no metastasizing has occurred, the whole tumor is removed with a large enough margin to ensure that all tumor tissue is removed (1).
According to statistics by The National Board of Health and Welfare (NBHW), skin cancer (excluding malignant melanoma and BCC) is the second most common type of cancer in Sweden in both men and women (2). Malignant melanoma is also relatively common in Sweden. In 2011 more than 5% of all tumors registered were melanomas, and it was the sixth most common form of cancer (3). The incidence of skin cancer is the fastest increasing of all cancer forms, partly because several patients are nowadays diagnosed with more than one case of skin cancer (2). The incidence of malignant melanoma in Sweden has increased by approximately 5% per year during the past decade (3).While the mortality for skin cancers excluding malignant melanoma, has stayed low with 0.7 deaths in 100 000 people in 2014, the mortality rate for malignant melanoma has increased from 4 deaths in 100 000 people in 1999 to 5.2 deaths in 100 000 people in 2011 (2, 3). BCC incidence is not part of the statistics from the NBHW, but constitutes the most common form of cancer of all with >40,000 new cases
The amount of ultraviolet (UV) radiation exposure is the most important and preventable risk factor for not only malignant melanoma, but also for BCC and squamous cell carcinoma (1, 5). Intensive sun bathing during several shorter periods of time is considered more dangerous than less intense sun exposure stretched over a longer time period, for example shorter sun bathing vacations compared to working outside during the whole summer (3). Excessive exposure during childhood is also considered more dangerous than exposure later in life (3). Other risk factors for developing BCC, squamous cell carcinoma or malignant melanoma include the skin’s sensitivity to sunburn after exposure to UV radiation, light skin tone, blonde or red hair color, a large amount of nevi, a large amount of actinic keratosis and other UV radiation related skin conditions. In addition, 5-10% of all malignant melanoma cases have a contributing genetic factor (1, 6).
Intentional tanning
Despite the increased awareness of the risks associated with UV radiation exposure and the known precautions for sun protection, people still seek the sun and expose themselves intentionally to UV radiation (7). An international survey showed that people tend to value the more immediate consequences of sun bathing more than the long-term consequences, hence the wish to be tanned is larger than the fright of developing melanoma (8). One
exception to this is patients with a history of skin cancer. A Swedish study showed that people who have been previously diagnosed with skin cancer consistently reported avoiding sun exposure more than their healthy peers (7). In accordance with this, a negative attitude towards sun bathing and being tanned, and good knowledge of the risks associated with tanning, is associated with less sun exposure and better strategies to protect oneself from UV radiation (5). By contrast a more positive attitude is strongly associated with intentional tanning, traveling to sunny resorts for vacations and a large amount of time spent in the sun (5). Other factors associated with sun protective behavior include awareness of the skin’s sun-sensitivity, blonde or red hair color and a perception of being at risk for developing skin cancer (9). Factors associated with more sun exposure, apart from a positive attitude, include dark hair color, downplaying the risk of sunbathing, thinking it is worth getting a sunburn to get tanned and perceiving sunscreen application as inconvenient, time consuming and that it reduces the likelihood of a desired tan (9).
Swedes’ tanning habits
On a global scale, Europeans, including the Swedish population, seem to sunbathe more than non-Europeans (8). Swedes sunbathe more with the intention of getting tanned, use less sun protection, get sunburned more often and have a darker tanned skin tone ideal compared to other nationalities (8). Swedes also increasingly travel to sunny places close to the equator (3, 7). A tan is highly valued since it is perceived as attractive and healthy. A Swedish study showed that low self-esteem in girls might be related to higher levels of tanning, while high self-esteem in boys might be related to higher levels of tanning (10). For age and gender subpopulations, adolescents spend the most time in the sun and girls intentionally tan more than boys (10). Earlier degree projects at Karolinska Institutet, focusing on Swedish high school students’ tanning habits, have shown that the tanned skin tone ideal does indeed exist among adolescents. Out of the 165 high school students who responded to a questionnaire as part of an earlier degree project in 2013, more than 90% indicated that it is attractive to be tanned. The majority, 81% of the girls and 68% of the boys, answered that they sunbathe with the intention to get tanned (11). A similar degree project in 2015 showed similar results: 92% of the 286 high school students indicated that it is attractive to be tanned and 80% of the students answered that they sunbathed with the intention to get tanned. The tanned skin tone that most of the students found the most attractive was clearly darker than the skin tone that they found the healthiest. This shows that the tanned skin tone ideal results in higher UV radiation exposure than considered healthy (12). Some health promoting behaviors, for example brushing teeth, also increase attractiveness. Decreasing exposure to UV radiation and thereby staying light skinned, however, does not have this positive side effect (10).
Swedes’ exercising habits and the health benefits of exercising
Swedes are an exercising population. According to a survey from 2011 more than 75% of the Swedish population exercise at least once a week and almost 50% exercise more than twice a week (13). The population that does not exercise has been reduced from 13% in 2001 to 10% in 2011, while the population that exercises more than twice a week has increased from 41% to 45% in the same time. Children aged 7-14 exercise the most while the age group of 30-39 year olds has the lowest level of exercising (13). The most common reasons for exercising include staying in shape, having fun, feeling bad if not exercising, losing weight, meeting other people and competing. The most common reason for both genders is staying in shape,
but losing weight is a more important motivator for women while meeting other people is a more important motivator for men (13).
Regularly exercising people seem to have a complex relationship to healthy habits. While they in many ways are healthier than their less exercising peers, they do not always think about the health risks associated with UV radiation (14, 15). Exercise is associated with physical health benefits as well as positive emotions, feelings and an enhanced perception of wellbeing with a higher quality-of-life. Physical activity is also associated with less
depressive symptoms, age-related cognitive declines, coronary heart disease, myocardial infarction, obesity, diabetes and cancer (15). While the majority of the US and world
population lives a sedentary lifestyle associated with multiple risk factors for negative health outcomes, regularly exercising people seem to have the best premises for physical and mental health (15). Sportsmen and athletes who practice and compete outdoors receive high doses of UV radiation. Sweating because of heat or physical exercise also increases the skin’s
photosensitivity, probably because the hydration of the horny layer causes a shift in the UV absorption by decreasing reflection and dispersion, thereby contributing to the risk of sunburns (14). In accordance, sportsmen practicing endurance outdoor sports have more melanocytic nevi and solar lentigines, which may result in an increased risk for malignant melanoma (14). In addition, protective behavior such as choosing protective clothing,
applying water-resistant sunscreen frequently and avoiding training in sun exposure is rare in the community of outdoor sportsmen (14). In some sports the teams have required uniforms that expose large parts of the athlete’s body including the face, arms, legs and some portions of the back. Certain pieces of clothing, including hats and sunglasses, are prohibited in some sports and long sleeves may restrict the range of motion (16). An American study showed that collegiate athletes lack knowledge about skin cancer and sun protection, which adds to the total amount of UV radiation they expose themselves to (16). In addition to the UV exposure of outdoor sports, suppression of cell-meditated immunity caused by repetitive tissue trauma during excessive exercise may increase the risk for skin cancer in athletes (14).
Exercise and tanning
The majority of the Swedish population exercise regularly, and it has been reported that regularly exercising people believe it is important to achieve and maintain an attractive body (13, 17). Of the exercising population 26% think it is important to have an attractive body and 27% consider it important to try to maintain an attractive body.Men are more prone to say
that they have an attractive body than women are, but it seems being fit and attractive is important to both women and men who exercise regularly (17).
While research on Swedes’ tanning habits show that Swedes intentionally tan a lot and that they wish to be tanned (5, 10, 11), it is unknown whether there is any association between tanning beauty ideals and exercise. If exercise is positively associated with darker tanned skin tone ideals, this should be considered when designing skin prevention programs. Prevention strategies tailored to the exercising population should be developed, focusing on weakening the association between the tanned skin tone ideals and health.
Aims
The primary aim was to determine the tanned skin tone ideals and tanning beauty ideals among a sample of regularly exercising Swedish adults. In addition, associations between the tanned skin tone ideals/tanning beauty ideals and gender, age, social-economical background, form and amount of exercise were studied. The third aim was to compare the regularly
exercising Swedish adults to high school students to explore potential differences.
Materials and Methods
Study design
The study was a quantitative cohort study that was implemented as a self-report survey. The study group consisted of a sample of members of Friskis&Svettis (F&S) Tyresö. F&S is a non-profit Swedish sports association and the biggest fitness center chain in Sweden with its members making up 5.2% of the Swedish population (18).F&S Tyresö was chosen because of their large member count, 5,000 people, with various socio-economical backgrounds and because the fitness center offers a large range of exercise forms.
The inclusion criteria were: at least eighteen years old and having an active membership at F&S Tyresö. The decision to only include members who were at least eighteen years old was made to avoid having to get consent of under-aged participants’ guardians. The only
exclusion criterion was lack of understanding of the Swedish language, as the questionnaire was in Swedish.
The questionnaire
The self-report questionnaire was based on a questionnaire that has been adjusted several times for previous research projects with its original used in an international survey regarding tanning (8). For this project it was specifically adjusted for adults who exercise regularly by adding three questions about exercising: an open answer question about how many hours the participant exercises during a normal week, a multiple-choice question about the reason for exercising and a multiple-choice question about which exercise forms the participant regularly practices and how often. These questions were found in a questionnaire designed by the Swedish Sports Confederation (RF) and sent out by Statistics Sweden (SCB). These items were used with the permission of RF. The background questions included age, gender and highest started or finished education (multiple choice with the following answer options: grade school, high school, vocational school or university). The questions regarding tanning beauty ideals included a series of five pictures illustrating a young couple on the beach. In the first picture their skin was very pale, and in the last picture their skin was darkly tanned, while the pictures in between showed different levels of tanned skin. The participants were asked to choose in which picture the couple looked the most attractive and in which picture the couple looked the healthiest. The other questions regarding tanned skin tone ideals were multiple-choice questions and included for example the following statements: it is attractive to be tanned, it is healthy to be tanned, I feel healthier when I am tanned and I am more attractive when I am tanned. The final questionnaire included 21 questions concerning gender, age, education, amounts of exercise, reasons for exercising, forms of exercise, sun-related behaviors, tanning beauty ideals and attitudes regarding tanning (see attachment 1). The survey was transformed into a web-based questionnaire developed through KI Survey and an information letter was included. The information letter included information about the time estimated for completing the questionnaire (5-10 min), that participating was voluntary and that all answers would be collected and handled anonymously. The information letter also stated that the information retrieved from the survey would be used in two student degree projects at the Study Program in Medicine at Karolinska Institutet as well as some scientific articles and lectures.
Comparison group
High school students were asked about their sun-related behavior and their tanned skin tone ideals in 2015 (12). The study included 143 students at St:Petri School in Malmö and 143 students at Kungsholmen’s School in Stockholm (12). The questions asked were based on the same questionnaire as in the present study. This comparison group was chosen because they had been asked the same questions regarding tanning beauty ideals. It was of particular interest to compare with a well-defined age group (18-year-olds vs. the mean age of 52 years in our age mixed sample).
Data collection
The questionnaire was delivered through e-mail to the members of F&S Tyresö as a part of the fitness center’s own newsletter on 2016-02-22. There was in the newsletter itself a short text written by F&S to explain the reasons for sending out the survey to their members. The survey was closed on 2016-03-18. A total of 163 people (3%) responded. The data was then exported from KI Survey into a Microsoft Office Excel® file. Two minors and one person of unknown age were excluded before any analyses were made.
Figure 1. The participants of the survey shown in a flow chart.
5000 active members were on the emailing list
163 answers were collected
2 people were excluded because of age < 18 years
1 person was excluded because of unknown age
Statistics
The results were presented on a group level, including descriptive statistics, such as mean values for the results from multiple-choice questions. The data were adapted into nominal or ordinal types for appropriate analyzing. Data were further analyzed for potential associations between the tanning beauty ideals and the exercise factors, gender, age and social-economy using Students t-test and Chi2-test. Missing data due to lack of response to single questions were labeled as “missing” and were not used in the analyses.
Regrouping of data was done when relevant, in order to get enough amounts of responders for the different response alternatives. In the questionnaire, exercise amount was asked as an open question, but during analysis it was regrouped into two categories: 1-4 hours per week and >4 hours per week, or little and frequent exercise, respectively. The number of times the
participants practiced each exercise form was divided into six response options in the
questionnaire, but during analysis the data were regrouped into two categories: less than once per week and at least once per week. The decision not to make a separate group for zero times was made in order to make the group sizes more even. The picture series of the couple with different levels of tanned skin was regrouped from five response alternatives into three groups: light tan (pictures number one and two), medium tan (picture number three) and dark tan (pictures number four and five), with the same motivation as for the data from the two previous questions. In the questionnaire the participants also wrote down their exact age, but this variable was categorized for the analyses into the following age groups: 18-33 years, 34-49 years, 50-65 years and >65 years. These groups were chosen in order to make the age span in the groups similar (16 years).
In the analyses the answers from the picture series represented the tanned skin tone ideals regarding attractiveness and healthiness, respectively. The answers on amount of exercise and background factors were used exactly as they appeared in the questionnaire. Out of the eleven different exercise forms used in the questionnaire the three most popular exercise forms were analyzed independently in order to find the exercise forms’ and their amounts’ associations to the tanned skin tone ideals.
Statistical significance was defined as p<0.05. All data analyses were performed using IBM Statistical Package for the Social Sciences (SPSS) version 23.
Ethical considerations
The individuals participated voluntarily and anonymously. The results were presented on a group level, and no individual participant can be identified. The questionnaire was not expected to affect the participants significantly, neither in a positive nor a negative way. A possible positive effect is that some individuals may reconsider and question their tanning habits and tanned skin tone ideals in the future because of this survey. That has been seen in a study including a self-report survey regarding intentional tanning (19). A negative effect is that some individuals may have felt the questionnaire to be intruding, since it appeared in their e-mail inbox as a part of the fitness center’s newsletter. Sending out a questionnaire by e-mail is, however, the easiest and fastest way to reach out to a large population. Our
assessment was that the potential benefit of understanding the tanning beauty ideals of the exercising Swedish adults outweighed the small risk of intrusion.
No ethical permit was required, since the participants were healthy volunteers and the questionnaire was not a medical intervention.
Results
A total of 160 questionnaires were used in the analyses, 135 (84%) women and 25 (16%) men. The youngest participant was 18 years old and the oldest participant was 81 years old. The mean age was 51.9 years. The majority (58.8%) of the participants had finished or started a university education, while high school was the highest started or finished education for 25% of the participants.
Exercise
The mean value of time used for exercising per week was 4.6 hours (range 1-16 hours). There was no statistically significant gender difference, mean time 5.2 hours per week for males compared to 4.5 for females. The top reasons for exercising included staying healthy (98.1%) feeling good mentally (71.9%) and exercise being fun (65.6%). Staying in shape/getting fit was a reason forexercising for 40.0% of the participants. This was a more important reason for women (45.2%) than men (12.0%) (p=0.002).
Exercise forms
The participants were also asked which exercise forms they regularly practice and how often. The most popular forms of exercise were weight training, weight training in class, circuit training, walking and gymnastics (Table 1). Women practiced more gymnastics: 78.1% of the women vs. 46.7% of the men practiced it at least once a month (p=0.019). The less popular exercise forms were the following: spinning/biking, running/jogging, yoga/flexibility, dance/aerobics, high-intensity interval training (HIIT) and martial arts. Less than half of the participants practiced these exercise forms on a monthly basis.
Table 1. The most popular exercise forms and the participants’ amounts of exercise. Shown here
in three categories in order to illustrate the distribution of participation in the different exercise forms. Which forms of exercise do you practice and how many times per month?
Weight training
Weight training
in class Circuit training Walking Gymnastics Coun
t % Count % Count % Count % Count %
0 times 33 29.7 % 48 49.0 % 42 42.0 % 22 17.3 % 33 25.6 % 1-8 times 57 51.4 % 47 48.0 % 52 52.0 % 67 52.8 % 79 61.2 % > 8 times 21 18.9 % 3 3.1% 6 6.0% 38 29.9 % 17 13.2 %
Tanning beauty ideals
Out of a series of five pictures the participants were asked to choose the picture where the couple looked the most attractive and the healthiest, respectively (question 14 and 15, see attachment 1). The results are presented in Table 2. The majority indicated that the couple looked the most attractive and the healthiest in pictures number three (medium tan) and four (slightly darker tan). There was no statistically significant difference between the
attractiveness and the healthiness ideals with regard to tan. Table 2. Attractiveness and healthiness in the pictures.
In which picture does the couple
look the most
Coun t
% Valid %
In which picture does the couple
look the
attractive? healthiest?
1 (light tan) 0 0% 0% 1 (light tan) 8 5.0% 5.1%
2 9 5.6% 8.6% 2 26 16.3% 16.7%
3 (medium tan) 44 27.5% 41.9% 3 (medium tan) 63 39.4% 40.4%
4 48 30.0% 45.7% 4 56 35.0% 35.9%
5 (dark tan) 4 2.5% 3.8% 5 (dark tan) 3 1.9% 1.9% Total (excluding missing) 105 65.6% 100.0% Total (excluding missing) 156 97.5% 100.0% Missing 55 34.4% Missing 4 2.5% Total 160 100.0% Total 160 100.0%
Exercise amounts and tanning beauty ideals
Table 3 shows the associations between perceived attractiveness/healthiness and amount of exercise per week. There was no statistically significant difference between the group that exercised 1-4 hours per week and the group that exercised more than four hours per week. Table 3. Correlations between amount of exercise and perception of what level of tanned skin is the most attractive/healthiest. No results of statistical significance.
Amount of exercise per week 1-4 h >4 h Count % Coun
t %
In which picture does the couple look the most
attractive?
1 / 2 (light tan) 4 6.3% 4 10.3% 3 (medium tan) 29 46.0
% 15 38.5% 4 / 5 (dark tan) 30 47.6% 20 51.3%
In which picture does the couple look the healthiest?
1 / 2 (light tan) 19 20.4
% 15 25.0% 3 (medium tan) 39 41.9% 23 38.3%
The three most popular exercise forms and tanning beauty ideals
The three most popular forms of exercise were weight training, walking and gymnastics. Table 4 shows the associations between perceived attractiveness/healthiness and amount of weight training practiced. There was no statistically significant difference between the group that practiced weight training less than once a week and the group that practiced weight training at least once a week.
Table 4. Correlations between amount of weight training practiced and perception of what level of tanned skin is the most attractive/healthiest. No results of statistical significance.
Weight training
Less than once / week At least once / week
Count % Count %
In which picture does the couple look the
most attractive?
1 / 2 (light tan) 6 13.3% 2 14.3% 3 (medium tan) 19 42.2% 5 35.7% 4 / 5 (dark tan) 20 44.4% 7 50.0% In which picture does
the couple look the healthiest?
1 / 2 (light tan) 17 22.7% 10 31.3% 3 (medium tan) 28 37.3% 11 34.4% 4 / 5 (dark tan) 30 40.0% 11 34.4%
Table 5 shows the associations between perceived attractiveness/healthiness and amount of walking practiced. The majority of those that practiced walking less than once per week indicated that the medium tan was the most attractive. In the group that walked at least once per week the darker tans were indicated as the most attractive ones. The more the participants walked, the more likely they were to choose the dark tans as the most attractive ones
(p=0.029). Regarding healthiness the association was not as clear, but the group that walked more was less likely to choose a light tan as the healthiest (p=0.016).
Table 5. Correlations between amount of walking practiced and perception of what level of tanned skin is the most attractive/healthiest. The association regarding attractiveness p=0.029. The
association regarding healthiness p=0.016.
Walking
Less than once / week At least once / week
Count % Count %
In which picture does the couple look the
most attractive?
1 / 2 (light tan) 7 18.9% 1 2.5% 3 (medium tan) 16 43.2% 15 37.5%
4 / 5 (dark tan) 14 37.8% 24 60.0% In which picture does
the couple look the healthiest?
1 / 2 (light tan) 21 32.8% 7 11.7% 3 (medium tan) 20 31.3% 28 46.7% 4 / 5 (dark tan) 23 35.9% 25 41.7%
Table 6 shows the associations between perceived attractiveness/healthiness and amount of gymnastics practiced. There was no statistically significant difference between the group that practiced gymnastics less than once a week and the group that practiced gymnastics at least once a week.
Table 6. Correlations between amount of gymnastics practiced and perception of what level of tanned skin is the most attractive/healthiest. No results of statistical significance.
Gymnastics
Less than once / week At least once / week
Count % Count %
In which picture does the couple look the
most attractive?
1 / 2 (light tan) 6 11.8% 3 10.7% 3 (medium tan) 25 49.0% 8 28.6% 4 / 5 (dark tan) 20 39.2% 17 60.7% In which picture does
the couple look the healthiest?
1 / 2 (light tan) 23 25.8% 9 24.3% 3 (medium tan) 33 37.1% 14 37.8% 4 / 5 (dark tan) 33 37.1% 14 37.8%
Table 7 shows the associations between perceived attractiveness/healthiness and gender. There was no statistically significant gender difference.
Table 7. Correlations between gender and perception of what level of tanned skin is the most attractive/healthiest. No results of statistical significance.
Gender
Male Female
Count % Count %
In which picture does the couple look the
most attractive?
1 / 2 (light tan) 0 0.0% 9 10.3% 3 (medium tan) 7 38.9% 37 42.5% 4 / 5 (dark tan) 11 61.1% 41 47.1% In which picture does
the couple look the healthiest?
1 / 2 (light tan) 2 8.3% 32 24.2% 3 (medium tan) 10 41.7% 53 40.2% 4 / 5 (dark tan) 12 50.0% 47 35.6%
Table 8 shows the associations between perceived attractiveness/healthiness and age. In the two youngest age groups the majority (57.1% and 58.6%) found the medium tan to be the most attractive one. In contrast, the majority (66.7% and 54.2%) of the older age groups, 50-65 year-olds and > 50-65 year-olds, found the darker tans to be the most attractive ones. Thus, younger participants thought that the most attractive tans were lighter than what the older participants thought (p=0.008). A similar tendency could be seen regarding the healthiest tan. The younger participants indicated that the lighter tans were healthier than the darker tans while the older participants thought the darker tans were healthier than the lighter tans (p=0.01).
Table 8. Correlations between age and perception of what level of tanned skin is the most attractive/healthiest. The association regarding attractiveness p=0.008. The association regarding
healthiness p=0.01.
Age (years)
18-33 34-49 50-65 >65
N % N % N % N %
In which picture does the couple look the
1 / 2 (light tan) 2 28.6 %
4 13.8 %
most attractive? 3 (medium tan) 4 57.1 % 1 7 58.6 % 1 4 31.1 % 9 37.5 % 4 / 5 (dark tan) 1 14.3% 8 27.6% 30 66.7% 13 54.2%
In which picture does the couple look the
healthiest? 1 / 2 (light tan) 8 53.3 % 1 5 28.3 % 7 12.0 % 4 13.8 % 3 (medium tan) 3 20.0 % 2 2 41.5 % 2 8 47.5 % 1 0 34.5 % 4 / 5 (dark tan) 4 26.7% 16 30.2% 24 40.7% 15 51.7%
Table 9 shows the associations between perceived attractiveness/healthiness and highest started/finished education. When comparing the groups with different educational
backgrounds (highest education) the differences were small and statically non-significant. The majority of all groups chose either the medium or dark tans, but differences were minor. Table 9. Correlations between highest started/finished education and perception of what level of tanned skin is the most attractive/healthiest. No results of statistical significance.
Highest started/finished education Grade school High school Vocational school University N % N % N % N % In which picture does the
couple look the most attractive? 1 / 2 (light tan) 0 0.0% 0 0.0% 2 20.0% 7 11.3% 3 (medium tan) 2 50.0% 11 39.5% 3 30.0% 28 45.2% 4 / 5 (dark tan) 2 50.0% 17 60.7% 5 50.0% 2 7 43.5 % In which picture does the
couple look the healthiest? 1 / 2 (light tan) 1 14.3% 7 18.4% 5 29.4% 2 1 22.6 % 3 (medium tan) 3 42.9% 15 39.5% 6 35.3% 3 9 41.9 % 4 / 5 (dark tan) 3 42.9% 16 42.1% 6 35.3% 33 35.5%
The high school students were all 18 years old and were not asked about exercise habits (12). Table 10 shows the comparison between the regularly exercising adults and the high school students. The opinions of the high school students regarding the most attractive tan were similar to the opinions in the group of exercising adults, but regarding the healthiest tan the high school students tended to choose a lighter tan than the adults (p<0.001).
Table 10. Comparison between the exercising adults at F&S Tyresö and the high school students. No results of statistical significance regarding attractiveness. The association regarding
healthiness p<0.001.
F&S High school students Count % Coun
t %
In which picture does the couple look
the most attractive?
1 / 2 (light tan) 9 8.6% 32 11.2% 3 (medium tan) 44 41.9% 126 44.1% 4 / 5 (dark tan) 52 49.5% 128 44.8% In which picture
does the couple look the healthiest?
1 / 2 (light tan) 34 21.8% 49 17.1% 3 (medium tan) 63 40.4% 194 67.8% 4 / 5 (dark tan) 59 37.8% 43 15.0%
Discussion
The purpose of this study was to examine the tanning beauty ideals in a sample of Swedish regularly exercising adults. Improving the knowledge about different subpopulations’ tanned skin tone ideals could support development of tailored methods to prevent UV radiation exposure in the different subpopulations. Since exercising people are assumed to be conscious about health-related life style factors it would be paradoxical if their skin-related beauty ideals were unhealthy. In the present study, regularly exercising people showed a tendency to think that medium to slightly darker tans are both the healthiest and the most attractive ones. An association between age and tanned skin tone ideals was also found, as well as a positive association between walking and a darker tanned skin tone ideal.
The majority of the participants indicated that the most attractive couple was the one seen in picture number four. This is in accordance with previous reports on Swedish adolescents (11, 12). Also earlier surveys in adults, both internationally and in Sweden, have shown a dark tanned skin tone ideal (5, 8). Thus, the health-related motivation for exercising does not appear to apply to their considerations related to tanning and skin cancer prevention. In addition, the motivation to be fit and have an attractive body that is seen among exercising adults might push their tanned skin tone ideals towards the darker.
The participants indicated that the healthiest tan was a medium to a slightly darker tan. There was no statistically significant difference between the levels of tans indicated as attractive vs. healthy. Several studies, both in Sweden and abroad, have shown that a tan makes people feel healthier (10, 20). This is not new. Intentional tanning in Europe started as a way to cure diseases such as tuberculosis in the early 1900s, which led to tanned skin being perceived as healthy and pale skin being seen as unhealthy (21).
Differences between exercise amounts and forms
The general exercise amounts did not show any statistically significant association to the tanned skin tone ideals. The majority indicated that the couple looked the most attractive in pictures number four and five (with the slightly darker or dark tan). This strengthens the hypothesis that people who exercise also want to be darkly tanned. The hypothesis is based on an American study that showed an association between high amounts of exercise and high levels of sun exposure (21). The opinions of the exercising adults in this study did not differ from the results regarding Swedish adults in general (5).
Walking showed an association with considering dark tans as both attractive and healthy. The more the participants walked, the more they chose the darker tans. No previous research has been made on associations between walking (or other forms of specified exercise) and tanned skin tone ideals. However, it has been reported that fitness activities, such as walking, are associated with high levels of body-related motivation including weight loss, improving ones appearance and wanting to be attractive to others (22). It could be assumed that the people who walk in order to improve their appearances or to be attractive also want to have a dark tan because of the same reasons, since a dark tan is perceived as attractive (10).
pictures number four and five (with the slightly darker or dark tan), but no statistically significant gender differences were found. This is surprising since earlier surveys have found that women both internationally and in Sweden intentionally tan more than men do (8, 10, 12).
The majority of the participants under 50 years stated that the couple in the pictures looked the most attractive in picture number three (medium tan) while the majority of the participants who were at least 50 years old stated that pictures number four and five (the darker tans) were where the couple looked the most attractive. This differs from an earlier international study where people older than 25 years had darker tanned skin tone ideals than those who were less than 25 years old (8). In our study, the younger participants also indicated that the lighter tans were healthier compared to the darker tans, while the older participants thought the opposite. This is promising, but it does not agree with the results of an earlier international study, which showed that positive attitudes regarding dark tanned skin were inversely related to age (9). In our study, age was the only background factor associated with tanned skin tone ideals.
Differences between the exercising adults and the high school students
The high school students had a similar tanned skin tone ideal as the exercising adults in Tyresö, but they indicated that the healthiest tans were a little lighter than did the adults. This is consistent with the finding that among the exercising adults, the younger participants had lighter tanned skin tone ideals regarding the healthiness of the tan. This once again differs from earlier studies showing that younger participants usually have darker tanned skin tone ideals (8).Strengths and limitations
An advantage of this study design was the cooperation with F&S Tyresö, and that the survey was included as a link in their newsletter in order to reach out to as many members as
possible. This also produced a reliable, controlled way for contact, compared to a physical mail that may never be opened. The negative aspects were that no reminder was sent out, and that the heading of the newsletter did not include information about the survey. These facts might have decreased the participant rate. Furthermore, the mean age of F&S Tyresö members is 44 years, while the mean age of our sample group was 52 years. This can be explained to some extent by our exclusion of people younger than 18 years old, but even when members under 18 years old are excluded the mean age is still four years younger than
in our sample. The gender distribution in the study sample differed from the member
population. At F&S Tyresö 34% are men, while our sample consisted of 16% men only. This hazards the generalizability of the results and should be considered when interpreting data. The questions in the questionnaire have been used several times before, making it possible to compare this study to earlier studies. The questionnaire was designed to collect data needed for the survey, but too many questions may have been included. Not all responses were of use in the analyses. In addition, the large number of questions might have had an impact on the willingness to respond. Responding to all questions in the questionnaire was not mandatory as we wished to avoid random responses.
We chose to maintain the response alternatives from earlier studies in order to make comparisons between the results of our study and the earlier ones. During the analyses, however, several of the answer options were grouped together to enrich the data, make the tables smaller and allow for statistical comparisons. This was by default arbitrarily done and the regrouping might add or cancel out some of to the associations in the analyses.
There are some potential biases and limitations due to the use of a self-report survey. There might have been response bias, such as social desirability (23). People want to present themselves in a favorable light and therefore tend to over-estimate their good behaviors and under-estimate their bad behaviors (23). This might lead to participants reporting more exercising in order to seem more active, or lighter tanned skin tone ideals to seem healthier. Participants in a self-report survey also have a tendency to try maintaining a consistency in their responses, in order to seem rational and consistent, which might lead to participants choosing two pictures close to each other as most attractive and healthiest (23). In addition, we do not know whether it was the intended person who responded (or a relative or friend).
Applications
Skin cancer is common in Sweden and Swedes have dark tanned skin tone ideals (2, 8). Therefore, prevention of extensive UV radiation exposure and affecting the population’s attitudes regarding sunbathing and tanned skin tone ideals is of great importance. The
Swedish Radiation Safety Authority is responsible for prevention of UV radiation exposure in Sweden, but the opinions and attitudes of the Swedish population have to change in order to minimize the UV radiation exposure (3). Regularly exercising Swedish adults have dark
Sweden, could be a subpopulation of interest to target with specific information about skin cancer and UV radiation exposure prevention. Tailored leaflets and information packages about how to limit UV radiation exposure and prevent skin cancer while exercising could be distributed to and by fitness centers, gyms, sports clubs and suchlike organizations in order to educate and remind the exercising population about the risks of UV radiation exposure.
Future studies
Future studies with the same aim but with a larger and more representative sample are needed to obtain more reliable and detailed information about the correlations between exercise amounts and the tanned skin tone ideals. The sample group would ideally consist of people exercising at several different fitness centers in Sweden and be more equally divided between genders and age groups than our sample. Additionally, in order to reduce the bias associated with a self-report survey, the exercise amounts and forms could be monitored either by the research team or the exercise facility. This would require extensive resources, but would make the results more reliable.
In order to understand the psychology behind the tanned skin tone ideals of the Swedish exercising population one could study the correlation between tanned skin tone ideals and fitness beauty ideals. A similar picture series as the one used in this study could be designed, but instead of the couple having different levels of tanned skin, they would have different levels of muscular size and distribution. The question would be in which picture the participant finds the couple most attractive. Then by analyzing the answers of the two questions it would be possible to find out if there is a correlation between tanned skin tone ideals and fitness beauty ideals. The study could be implemented as a self-report survey. Another idea would be to do a qualitative study and interview the participants to examine the reasons behind their responses and ask them in-depth questions about what they find
attractive in each picture and why one of them is more attractive than the others.
Examining other Swedish subpopulations’ tanned skin tone ideals could be done by studying for example university students or immigrants. Students could be studied at different
universities and in different fields to examine if geography or field of study has a correlation to the tanned skin tone ideals. The study could be implemented as a self-report survey either by e-mail or in paper form.
Conclusions
This study showed that regularly exercising Swedish adults have dark tanned skin tone ideals. The amount of walking for exercise purposes was positively associated with these ideals. There were no gender or educational differences, but participants younger than 50 years old had lighter tanned skin tone ideals than the older participants. High school students preferred a slightly lighter tanned skin tone than the study sample regarding the healthiest tan.
Student collaboration
The questionnaire development and the adaption of the questionnaire to be KI Survey web-based were made in collaboration with fellow student Dennis Forslund, supervisor Magnus Bäcklund and co-supervisor Yvonne Brandberg. Therefore some of the data (the participants’ age, gender, highest started/finished education, exercise amount and exercise forms) used in this study is the same as the data in Dennis Forslund’s degree project. The statistical analyses and the writing were made individually without collaboration with other students.
Acknowledgements
I would like to thank my supervisor Magnus Bäcklund for the guidance and support during this writing process, and also my co-supervisor Yvonne Brandberg for her help. I also want to thank Friskis&Svettis Tyresö for collaborating with us and making this study possible by being our contact to the sample group. I am grateful for the collaboration with Dennis Forslund while working together on the questionnaire and for him being my go-to-guy for problems with SPSS while doing the statistical analyses. Thank you to the other students in my coordinator group who gave me feedback on my text during the seminars and thank you to my friends for the lovely lunches where we talked about the hardships of writing a thesis. Lastly I want to thank my family: my parents, siblings and in-laws for believing in me when I did not always do it myself, and mostly my fiancé for his never-ending support and patience during the whole writing process.
References
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2014. http://www.socialstyrelsen.se/Lists/Artikelkatalog/Attachments/20008/2015-12-26.pdf2015.
3. Nationellt vårdprogram malignt melanom. 2014 [cited 2016-01-26]. Available from:
http://www.cancercentrum.se/globalassets/cancerdiagnoser/hud/vardprogram/natvp_m alignt_melanom_rev.2015-01-19lang.pdf. 4. Cancerfonden. Cancerfondsrapporten 2015. https://res.cloudinary.com/cancerfonden/image/upload/v1429886338/documents/cance rfondsrapporten-2015.pdf [2016-09-14 ].
5. Branstrom R, Ullen H, Brandberg Y. Attitudes, subjective norms and perception of behavioural control as predictors of sun-related behaviour in Swedish adults. Prev Med. 2004;39(5):992-9.
6. Armstrong BK, Kricker A. The epidemiology of UV induced skin cancer. J Photochem Photobiol B. 2001;63(1-3):8-18.
7. Falk M, Faresjo A, Faresjo T. Sun exposure habits and health risk-related behaviours among individuals with previous history of skin cancer. Anticancer Res.
2013;33(2):631-8.
8. Branstrom R, Chang YM, Kasparian N, Affleck P, Tibben A, Aspinwall LG, et al. Melanoma risk factors, perceived threat and intentional tanning: an international online survey. Eur J Cancer Prev. 2010;19(3):216-26.
9. Branstrom R, Kasparian NA, Chang YM, Affleck P, Tibben A, Aspinwall LG, et al. Predictors of sun protection behaviors and severe sunburn in an international online study. Cancer Epidemiol Biomarkers Prev. 2010;19(9):2199-210.
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gymnasieungdomar 2015.
13. Riksidrottsförbundet. Svenskarnas idrottsvanor. 2011 [2016-02-23].
http://www.rf.se/imagevaultfiles/id_29067/cf_394/svenskarnasidrottsvanor.pdf%5D. 14. Moehrle M. Outdoor sports and skin cancer. Clinics in Dermatology. 2008;26(1):12-5. 15. Penedo FJ, Dahn JR. Exercise and well-being: a review of mental and physical health
benefits associated with physical activity. Curr Opin Psychiatry. 2005;18(2):189-93. 16. Hobbs C, Nahar VK, Ford MA, Bass MA, Brodell RT. Skin Cancer Knowledge,
Attitudes, and Behaviors in Collegiate Athletes. J Skin Cancer. 2014;2014.
17. Riksidrottsförbundet R. Svenska folkets träning med motionsgympa, aerobics och styrketräning.
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Information om en undersökning om solvanor och hudtonsideal
Just nu pågår en undersökning på Karolinska Institutet där svenska motionärers solvanor och hudtonsideal kartläggs. Frågorna handlar om dina motionsvanor, solvanor och solningsideal. Det kommer finnas färdiga svarsalternativ där du kan kryssa i vad som stämmer bäst för dig. Deltagandet tar ca 5-10 minuter.
Deltagandet är frivilligt. Du har rätt att avstå från att svara på frågeformuläret och behöver inte ge någon förklaring till varför.
Dina svar behandlas konfidentiellt, vilket betyder att ingen obehörig kommer att ha tillgång till uppgifterna. Dessutom svarar du anonymt, så inga av dina uppgifter kan spåras till dig.
Undersökningen ger nya kunskaper om svenska motionärers solvanor och varför de solar. Ökade kunskaper inom området kan bidra till att bättre förebygga hudcancer i framtiden.
Kunskaperna kommer att spridas via två studentuppsatser på Läkarprogrammet, samt genom vetenskapliga artiklar och föredrag.
Isabella Cedercreutz Dennis Forslund
Läkarprogrammet, Karolinska Institutet
Om du har frågor om projektet, kontakta handledaren: Dr Magnus Bäcklund, magnus.backlund@ki.se
1. Kön Man Kvinna
2.Din ålder
3.Din högsta avslutade / påbörjade utbildningsnivå Grundskoleutbildning
Gymnasieutbildning Yrkesutbildning
4.Under en normal VECKA, hur många timmar lägger du sammanlagt på motion/idrott?
5.Vad är anledningen till att du motionerar/idrottar? Du kan välja fler än ett alternativ. För att det är roligt
För att förbättra min prestationsförmåga För att få en vältränad/finare kropp För att hålla mig i god fysisk form (hälsa) För att må mentalt/psykiskt bra
För att träffa andra människor För att tävla
6. Vilken sorts motion/idrott utövar du regelbundet? Hur många gånger i MÅNADEN utövar du dem?
0 ggr / mån 1-4 ggr / mån 5-8 ggr/ mån 9-12 ggr /mån 13-16 ggr /mån 17 ggr / måneller fler Styrketräning Styrketräning i klass Spinning / Cykling Löpning / Joggning Cirkelträning Yoga / rörlighet Dans / aerobics HIT
Indoor walking / promenader Kampsport
Jympa Annat
7. Under de senaste 12 månaderna, ungefär hur många dagar har du solat i Sverige? 0 dagar
1-3 dagar 4-10 dagar 11-30 dagar 31-60 dagar 61 dagar eller fler
8. Under de senaste 12 månaderna, ungefär hur många dagar har du solat utomlands? 0 dagar
1-3 dagar 4-10 dagar 11-30 dagar 31-60 dagar 61 dagar eller fler
9. Under de senaste 12 månaderna, ungefär hur många gånger har du solat i ett solarium? Aldrig 1-3 gånger 4-10 gånger 11-30 gånger 31-60 gånger 61 gånger eller mer
10. Hur många gånger under de senaste 12 månaderna har du bränt dig i solen och / eller solarium så att huden både är röd och svider?
Aldrig 1 gång 2-3 gånger 4-5 gånger 6-10 gånger 11 gångereller fler Utomhus
I solarium
11. Under de senaste 12 månaderna, ungefär hur många veckor har du varit på semester på en plats där det varit vackert sommarväder större delen av tiden?
Inte alls 1 vecka 2 veckor 3 veckor 4 veckor 5 veckor Mer än 5 veckor
12. Vad gör du helst en solig sommardag? Är vid sjön
Solar och badar
Jobbar i trädgård / tomt eller liknande Sitter och läser i skuggan
Sitter och läser i solen Håller mig inomhus
13. Markera för varje fråga det svarsalternativ som stämmer bäst för dig.
Stämmer inte Varken stämmer Stämmer helt
Stämmer inte eller inte Stämmer
alls stämmer och hållet
Jag solar för att jag vill bli brun
Jag solar för att jag tycker att det är skönt att få sol på mig Jag solar för att det är avkopplande
Jag solar för att andra i min bekantskapskrets solar
14. Markera på vilken av bilderna du tycker att ungdomarna ser mest ATTRAKTIVA ut på. Klicka på siffran i bilden.
16. Markera för varje fråga det svarsalternativ som stämmer bäst för dig. I vilken utsträckning: Inte alls Påverkar utseendeideal dina solvanor idag? Har utseendeideal påverkat dina solningsvanor tidigare i livet? Tror du att utseendeideal påverkar andra människors solningsvanor? Tror du att du skulle sola om det inte ansågs attraktivt att vara brun?
Tror du att andra människor skulle sola om det inte ansågs attraktivt att vara brun?
Har ditt eget skönhetsideal förändrats under ditt liv?
Har dina solvanor förändrats under ditt liv?
I liten I viss I ganska stor I mycket stor utsträckning utsträckning utsträckning utsträckning
17. Hur har du förändrat dina solvanor under ditt liv? Jag solar mindre nu än tidigare
Jag solar lika mycket/lite nu som tidigare Jag solar mer nu än tidigare
18. Har du ändrat din uppfattning om hur fint det är att vara solbrun under ditt liv? Jag har inte ändrat uppfattning
Jag tycker att det är finare nu än jag tyckte tidigare Jag tycker att det är mindre fint nu än jag tyckte tidigare
19. Markera i vilken utsträckning som du håller med om följande påståenden.
Stämmer inte Varken stämmer Stämmer helt
Stämmer inte eller inte Stämmer
alls stämmer och hållet
Det är snyggt att vara solbrun D e t ä r h ä l s o s a m t a t t v a r a s o l b r u n Ja g kä nn er
mi g me r häl so sa m när jag är sol bru n A tt v ar a s ol br u n s k y d d ar m ot br ä n n s k a d or o c h a n dr a pr o bl e m m e d h u d e n D e t ä r v ä rt
r ä n n a si g lit e f ö r a tt f å e n b r a s ol b r u n f ä r g J a g ä r s n y g g a r e n ä r j a g ä r s o l b r u n
Ja g kä nn er mi g bä ttr e nä r ja g är so lbr un D e t ä r s k ö n t a tt k ä n n a s o l e n m o t h u d e n Ja g be hö ve r va ra so lbr un fö r mi tt ar be te, mi n
sa kti vit et ell er ho bb y
20. I vilken utsträckning anser du att det kan vara skadligt att vara i solen? Inte alls
I liten utsträckning I viss utsträckning I ganska stor utsträckning I mycket stor utsträckning
21. I vilken utsträckning anser du att det kan vara nyttigt att vara i solen? Inte alls
I liten utsträckning I viss utsträckning I ganska stor utsträckning I mycket stor utsträckning
