Americans spend an average of $325 a year trying to improve their skin, according to a study commissioned by Water Filter Guru, a residential water-treatment information resource. In its accompanying survey of 1,000 U.S. adults, 77% said they feel less confident when their skin is not at its best, and 73% reported that skin concerns had negatively affected at least one area of their lives during the past year.

Water Filter Guru also created a national Skin Stress Index comparing 100 U.S. cities. The index gives 40% of its weight to environmental conditions, using EPA air-quality data and National Cancer Institute solar-exposure data as a proxy for UV exposure. The remaining 60% reflects Google search activity related to breakouts, irritation, water and skin treatments.

The study’s leading findings include:

• Orlando ranked worst, with a Skin Stress Score of 77.83, followed by Miami at 75.52 and Atlanta at 74.79.
• Lincoln, Nebraska, ranked best, recording a score of 16.31. Toledo, Ohio, and Fort Wayne, Indiana, followed.
• Florida placed three cities in the worst 10: Orlando, Miami and Tampa. California accounted for seven of the worst 25.
• Minneapolis ranked fifth worst, showing that the highest scores were not limited to sunny destinations.
• Orlando led three search categories, recording the highest rates for irritation-, water- and treatment-related searches.
• Atlanta had the highest breakout-search rate, at 1,948 searches per 100,000 residents, approximately 6.2 times Mesa, Arizona’s rate.

Stress was the factor respondents blamed most often when their skin worsened, cited by 54%, followed by diet at 37% and hormones at 35%. Only 5% blamed tap water.

Water Filter Guru notes that its index measures environmental conditions and online search interest not diagnosed skin problems. The results also do not establish that tap water causes skin concerns or that water filtration can prevent them.