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Hat, shade, long sleeves, or sunscreen? Rethinking US sun protection messages based on their relative effectiveness

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Abstract

Background

Sun protection messages in the United States emphasize sunscreen use, although its efficacy in skin cancer prevention remains controversial.

Methods

We used data from NHANES 2003–2006, restricted to adult whites (n = 3,052) to evaluate how Americans protect themselves from the sun. Participants completed questionnaires on the frequency with which they used sunscreen, wore a hat, long sleeves, or stayed in the shade, in addition to the number of sunburns in the past year.

Results

Although using sunscreen is the most common sun protective behavior (30%), frequent sunscreen use was not associated with fewer sunburns. However, the odds of multiple sunburns were significantly lower in individuals who frequently avoided the sun by seeking shade (OR = 0.70, p < 0.001) or wearing long sleeves (OR = 0.73, p = 0.01).

Conclusions

Our findings suggest that shade and protective clothing may be more effective than sunscreen, as typically used by Americans.

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References

  1. AAD. Be Sun Smart Campaign. http://www.aad.org/public/sun/smart.html

  2. AMA. http://www.ama-assn.org/ama1/pub/upload/mm/39/sunteen.pdf

  3. AMA American Medical Association. (2010) http://www.ama-assn.org/ama/pub/news/news/2010-new-policies.shtml

  4. Green AC, Williams GM (2007) Point: sunscreen use is a safe and effective approach to skin cancer prevention. Cancer Epidemiol Biomarkers Prev 16(10):1921–1922

    Article  PubMed  CAS  Google Scholar 

  5. Berwick M (2007) Counterpoint: sunscreen use is a safe and effective approach to skin cancer prevention. Cancer Epidemiol Biomarkers Prev 16(10):1923–1924

    Article  PubMed  CAS  Google Scholar 

  6. Matsuoka LY, Ide L, Wortsman J, MacLaughlin JA, Holick MF (1987) Sunscreens suppress cutaneous vitamin D3 synthesis. J Clin Endocrinol Metab 64(6):1165–1168

    Article  PubMed  CAS  Google Scholar 

  7. Green A, Williams G, Neale R, Hart V, Leslie D, Parsons P et al (1999) Daily sunscreen application and betacarotene supplementation in prevention of basal-cell and squamous-cell carcinomas of the skin: a randomised controlled trial. Lancet 354(9180):723–729

    Article  PubMed  CAS  Google Scholar 

  8. Thieden E, Philipsen PA, Sandby-Moller J, Wulf HC (2005) Sunscreen use related to UV exposure, age, sex, and occupation based on personal dosimeter readings and sun-exposure behavior diaries. Arch Dermatol 141(8):967–973

    Article  PubMed  Google Scholar 

  9. Autier P, Boniol M, Dore JF (2007) Sunscreen use and increased duration of intentional sun exposure: still a burning issue. Int J Cancer 121(1):1–5

    Article  PubMed  CAS  Google Scholar 

  10. Davis KJ, Cokkinides VE, Weinstock MA, O’Connell MC, Wingo PA (2002) Summer sunburn and sun exposure among US youths ages 11 to 18: national prevalence and associated factors. Pediatrics 110(1 Pt 1):27–35

    Article  PubMed  Google Scholar 

  11. CDC (2009) Centers for disease control and prevention, national center for health statistics. National health and nutrition examination survey data sets and related documentation. Internet: http://www.cdc.gov/nchs/nhanes/nhanes_questionnaires.htm

  12. Brown TT, Quain RD, Troxel AB, Gelfand JM (2006) The epidemiology of sunburn in the US population in 2003. J Am Acad Dermatol 55(4):577–583

    Article  PubMed  Google Scholar 

  13. Santmyire BR, Feldman SR, Fleischer AB Jr (2001) Lifestyle high-risk behaviors and demographics may predict the level of participation in sun-protection behaviors and skin cancer primary prevention in the United States: results of the 1998 National Health Interview Survey. Cancer 92(5):1315–1324

    Article  PubMed  CAS  Google Scholar 

  14. Hall HI, Saraiya M, Thompson T, Hartman A, Glanz K, Rimer B (2003) Correlates of sunburn experiences among US adults: results of the 2000 National Health Interview Survey. Public Health Rep 118(6):540–549

    Article  PubMed  Google Scholar 

  15. Holick MF (2009) Vitamin D status: measurement, interpretation, and clinical application. Ann Epidemiol 19(2):73–78

    Article  PubMed  Google Scholar 

  16. Cicarma E, Porojnicu AC, Lagunova Z, Dahlback A, Juzeniene A, Moan J (2009) Sun and sun beds: inducers of vitamin D and skin cancer. Anticancer Res 29(9):3495–3500

    PubMed  CAS  Google Scholar 

  17. Moan J, Porojnicu AC, Dahlback A, Setlow RB (2008) Addressing the health benefits and risks, involving vitamin D or skin cancer, of increased sun exposure. Proc Natl Acad Sci USA 105(2):668–673

    Article  PubMed  CAS  Google Scholar 

  18. Webb AR, Kift R, Durkin MT, O’Brien SJ, Vail A, Berry JL et al (2010) The role of sunlight exposure in determining the vitamin D status of the UK white adult population. Br J Dermatol 163(5):1050–1055

    Article  PubMed  CAS  Google Scholar 

  19. Samanek AJ, Croager EJ, Gies P, Milne E, Prince R, McMichael AJ et al (2006) Estimates of beneficial and harmful sun exposure times during the year for major Australian population centres. Med J Aust 184(7):338–341

    PubMed  Google Scholar 

  20. Sliney DH, Wengraitis S (2006) Is a differentiated advice by season and region necessary? Prog Biophys Mol Biol 92(1):150–160

    Article  PubMed  Google Scholar 

  21. Turnbull DJ, Parisi AV (2008) Optimizing solar UV-radiation exposures for vitamin D3: comparing global and diffuse spectral UV radiation. Radiat Res 169(3):344–349

    Article  PubMed  CAS  Google Scholar 

  22. Turnbull DJ, Parisi AV (2010) Latitudinal variations over Australia of the solar UV-radiation exposures for vitamin D3 in shade compared to full sun. Radiat Res 173(3):373–379

    Article  PubMed  CAS  Google Scholar 

  23. Green AC, Williams GM, Logan V, Strutton GM (2011) Reduced melanoma after regular sunscreen use: randomized trial follow-up. J Clin Oncol 29(3):257–263

    Article  PubMed  CAS  Google Scholar 

  24. Chang YM, Barrett JH, Bishop DT, Armstrong BK, Bataille V, Bergman W et al (2009) Sun exposure and melanoma risk at different latitudes: a pooled analysis of 5700 cases and 7216 controls. Int J Epidemiol 38(3):814–830

    Article  PubMed  Google Scholar 

  25. Gorham ED, Mohr SB, Garland CF, Chaplin G, Garland FC (2007) Do sunscreens increase risk of melanoma in populations residing at higher latitudes? Ann Epidemiol 17(12):956–963

    Article  PubMed  Google Scholar 

  26. Linos E, Swetter SM, Cockburn MG, Colditz GA, Clarke CA (2009) Increasing burden of melanoma in the United States. J Invest Dermatol 129(7):1666–1674

    Article  PubMed  CAS  Google Scholar 

  27. Ries (2008) Cancer Statistics Review 1975–2004. National Cancer Institute

  28. Rogers HW, Weinstock MA, Harris AR, Hinckley MR, Feldman SR, Fleischer AB et al (2010) Incidence estimate of nonmelanoma skin cancer in the United States, 2006. Arch Dermatol 146(3):283–287

    Article  PubMed  Google Scholar 

  29. Branstrom R, Kasparian NA, Chang YM, Affleck P, Tibben A, Aspinwall LG et al (2010) Predictors of sun protection behaviors and severe sunburn in an international online study. Cancer Epidemiol Biomarkers Prev 19(9):2199–2210

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Dermatology, Stanford University School of Medicine, 450 Broadway St, Pavillion C, Redwood City, CA, 94063, USA

    Eleni Linos, Elizabeth Keiser, Teresa Fu & Jean Y. Tang

  2. Siteman Cancer Center, Washington University School of Medicine, St Louis, MO, USA

    Graham Colditz

  3. Department of Dermatology, Emory University, Atlanta, GA, USA

    Suephy Chen

  4. Division of Dermatology, Department of Medicine, Atlanta VA Medical Center, Decatur, GA, USA

    Suephy Chen

Authors
  1. Eleni Linos
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  2. Elizabeth Keiser
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  3. Teresa Fu
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  4. Graham Colditz
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  5. Suephy Chen
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  6. Jean Y. Tang
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Corresponding author

Correspondence to Eleni Linos.

Additional information

Impact

These findings highlight the need for comprehensive prevention strategies given the persistent rising rates of skin cancer in the United States.

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Linos, E., Keiser, E., Fu, T. et al. Hat, shade, long sleeves, or sunscreen? Rethinking US sun protection messages based on their relative effectiveness. Cancer Causes Control 22, 1067–1071 (2011). https://doi.org/10.1007/s10552-011-9780-1

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  • DOI: https://doi.org/10.1007/s10552-011-9780-1

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