title: The risks and benefits of sun exposure: should skin colour or ethnicity be the main variable for communicating health promotion messages in New Zealand?
abstract: OBJECTIVE
  Using New Zealand as a case study, to determine whether ethnicity is appropriate for communicating sun exposure health promotion messages.
  
  
  METHODS
  This study reviews recent literature on minimising skin cancer risk and achieving sufficient serum vitamin D levels. It draws on a variety of scientific literature, reports and media statements to determine appropriate sun exposure messages for minimising skin cancer risk and achieving sufficient vitamin D status among the New Zealand population, which is diverse with regards to both ethnicity and skin colour.
  
  
  RESULTS
  Due to a unique combination of factors, New Zealand and Australia lead the world in melanoma incidence. Devising ways of minimising skin cancer risk and achieving optimal vitamin D blood levels among the New Zealand population provide major challenges for researchers and health promoters. These challenges include the many unknowns and uncertainties about vitamin D, such as determining what constitutes an optimal level as well as its association with specific diseases. There is strong evidence that skin cancer, including melanoma, is caused by excess harmful sun exposure with skin colour having long been established as a risk factor. More recently, there has been significant focus in New Zealand on the potential beneficial aspects of sun exposure, mainly in assisting vitamin D synthesis, especially for Maori and Pacific people. But research also shows that Maori and Pacific people are increasingly at risk of developing melanoma. In New Zealand, where there is a high rate of ethnic intermarriage and ethnicity is culturally constructed, there is likely to have been a weakening of the relationship between ethnicity and skin colour. Skin colour information is required to understand both the risks and benefits of sun exposure. In the immediate future, ethnicity appears likely to remain an important reference point for assessing the risks and benefits of sun exposure in New Zealand. However, we contend that while ethnic-based channels may be useful for communicating appropriate sun exposure messages, there are dangers in such advice based on membership of particular ethnic group(s). Rather skin colour, along with other key variables, such as season and time of day, should be the core considerations for assessing and discussing risk. In the longer term, direct measures of skin type are needed when assessing the risks and benefits of sun exposure, including the potential protective effects against various illnesses.
  
  
  CONCLUSIONS
  While ethnic-based dissemination channels may be useful for communicating about the risks and benefits of sun exposure in New Zealand, discussion of risk factors should focus on skin colour.
authors.affiliation: Institute of Policy Studies, Victoria University, Wellington, New Zealand. paul.callister@vuw.ac.nz
authors.forename: Paul
authors.initials: P
authors.lastname: Callister
authors.forename: Judith
authors.initials: J
authors.lastname: Galtry
authors.forename: Robert
authors.initials: R
authors.lastname: Didham
mesh_terms: D054242:Emigrants and Immigrants; D004781:Environmental Exposure / Q000009:adverse effects / Q000517:prevention & control; D006293:Health Promotion; D006801:Humans; D008545:Melanoma / Q000208:ethnology / Q000517:prevention & control; D009520:New Zealand; D010565:Persuasive Communication; D018570:Risk Assessment; D012878:Skin Neoplasms / Q000208:ethnology / Q000209:etiology / Q000517:prevention & control; D012880:Skin Pigmentation; D013472:Sunlight / Q000009:adverse effects*; D014466:Ultraviolet Rays / Q000009:adverse effects*; D014807:Vitamin D / Q000097:blood
chemical_list: D014807:Vitamin D