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Original Investigation
March 14, 2018

Prevalence of Sun Protection Use and Sunburn and Association of Demographic and Behaviorial Characteristics With Sunburn Among US Adults

Author Affiliations
  • 1Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia
  • 2DB Consulting Group Inc, Atlanta, Georgia
  • 3Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, Maryland
JAMA Dermatol. Published online March 14, 2018. doi:10.1001/jamadermatol.2018.0028
Key Points

Questions  Among US adults, what is the prevalence of sun protection and sunburn, and what factors are associated with sunburn?

Findings  In this cross-sectional study of 31 162 US adults, the prevalence of sunburn was highest among younger adults, non-Hispanic white individuals, and those with sun-sensitive skin but was also high among groups considered to have low skin cancer risk (eg, black and Hispanic individuals). Sun avoidance behaviors were associated with a lower likelihood and sunscreen use, sunless tanning, aerobic activity, binge drinking, and overweight/obesity with a greater likelihood of sunburn.

Meaning  Although sunburn is more common among certain groups (eg, younger, sun-sensitive, and physically active adults), targeted prevention efforts are needed across all demographic groups.

Abstract

Importance  Monitoring sun protection and sunburn over time at the population level can provide valuable information about progress toward skin cancer prevention goals and inform future intervention efforts.

Objective  To examine the prevalence of sun protection use (shade, sunscreen, and clothing) and sunburn and the association between sunburn and individual characteristics and health behaviors in the US population.

Design, Setting, and Participants  In this cross-sectional study using a nationally representative sample of 31 162 US adults from the 2015 National Health Interview Survey–Cancer Control Supplement, household interviews of civilian, noninstitutionalized US adults were conducted throughout 2015 in person and completed on the telephone when necessary. Data analysis was performed from August 16, 2016, to September 6, 2017.

Main Outcomes and Measures  The prevalence of sunburn and use of sun protection and their association with demographic characteristics, sun sensitivity, and health-related behaviors and conditions using multivariable logistic regression modeling.

Results  A total of 31 162 respondents (mean [SD] age, 47.0 [0.36] years; 13 932 male [44.7%] and 17 230 female [55.3%]) were included in the analyses, with 34.2% experiencing sunburn in 2015. Sunburn prevalence was higher among younger age groups (51.2% in adults 18-29 years old; 95% CI, 48.8%-53.7%), non-Hispanic white individuals (42.5%; 95% CI, 41.2%-43.9%), and those with sun-sensitive skin (50.2%). However, sunburn was also prevalent among black (13.2%; 95% CI, 11.6%-15.1%) and Hispanic (29.7%; 95% CI, 27.6%-31.9%) individuals, demographic groups that are often considered to be at low risk of skin cancer. The most frequent sun protection behaviors were staying in the shade (37.1%; 95% CI, 36.3%-38.0%) and using sunscreen (31.5%; 95% CI, 30.7%-32.3%) followed by wearing long clothing to the ankles (28.4%; 95% CI, 27.6-29.1). Sun avoidance behaviors (seeking shade and not going in the sun) were significantly (39.5% vs 35.1%; P < .001) associated with a lower prevalence of sunburn. Those who used self-applied sunless tanning products (45.0% of users vs 36.1% of nonusers; P < .001), those who engaged in aerobic activity (37.9% of aerobic exercisers vs 32.8% of non–aerobic exercisers; P < .001), binge drinkers (45.1% of binge drinkers vs 35.0% of non–binge drinkers; P < .001), and overweight or obese individuals (37.9% of overweight or obese individuals vs 34.4% of non–overweight or obese individuals; P < .001) were more likely to experience sunburn compared with the respective comparison groups.

Conclusions and Relevance  Sun sensitivity was significantly associated with a higher sunburn prevalence, independent of race/ethnicity, suggesting a need to consider sun sensitivity when identifying target demographic groups for sun safety interventions. Efforts to improve vigilance and consistency with use of sun protection are needed. In addition, those who engage in physical activity, use sunless tanners, or use sunscreen for tanning purposes may require additional intervention strategies to address the unique barriers they face in staying adequately protected.

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