Research article
Multiple Skin Cancer Risk Behaviors in the U.S. Population

https://doi.org/10.1016/j.amepre.2007.09.032Get rights and content

Background

The incidence of all types of skin cancer has increased over the past 3 decades in the United States. Increased skin cancer risk is associated with exposure to ultraviolet radiation. This study examined the age-stratified prevalence and correlates of multiple skin cancer risk behaviors (infrequent use of sun-protective clothing, staying in the sun when outside on a sunny day, infrequent use of sunscreen, indoor tanning, and receiving a sunburn) among U.S. adults.

Methods

28,235 adults participating in the 2005 National Health Interview Survey (NHIS) answered questions regarding sun-protection behaviors, indoor tanning in the past year, and sunburns in the past year. Examined correlates included geographic location, demographics, healthcare access, BMI, physical activity, smoking, alcohol use, melanoma family history, perceived cancer risk, skin sensitivity to the sun, and receipt of a total skin exam.

Results

The most commonly reported skin cancer risk behaviors were infrequent use of sun-protective clothing and infrequent use of sunscreen. The majority of individuals reported multiple skin cancer risk behaviors. Although significant correlates varied according to age, individuals reporting more risk behaviors were more likely younger, residing in the Midwest, male, non-Hispanic white, less-educated, smokers, risky drinkers, and had skin that was less sun-sensitive.

Conclusions

The majority of the U.S. population engage in multiple skin cancer risk behaviors. A comprehensive approach to skin cancer prevention requires attention to multiple skin cancer risk behaviors that are common in the U.S. population.

Section snippets

Procedure

The data for this study were drawn from the 2005 NHIS, which is an annual representative U.S. health survey conducted using a multistage, clustered, cross-sectional design, with state-level stratification and oversampling of black and Hispanic populations. The response rate for the data used in this study was 69.0%.16 Additional details regarding the 2005 NHIS are available elsewhere.16 The data were collected in 2005 and analyzed in 2007.

Participants

Participants were drawn from the 31,428 individuals

Missing Data Analyses and Sample Demographic Characteristics

Individuals missing data for the multiple skin cancer risk behavior variable were less likely to be non-Hispanic white individuals (65.8%) than those who were not missing data for that variable (71.1%) (χ2=19.39; p=0.0003). There were no differences in missing data for the multiple skin cancer risk behavior variable according to gender, age, education, or marital status (χ2≤13.54; p≥0.004). The demographic characteristics of the sample are shown in Table 1.

Age-Stratified Prevalence of Single and Multiple Skin Cancer Risk Behaviors

The age-stratified prevalence of each

Discussion

This study represents the most comprehensive examination to date of the prevalence and correlates of multiple skin cancer risk behaviors among U.S. adults. The majority of individuals reported multiple skin cancer risk behaviors. This was particularly the case among young adults aged 18–29 years, more than 80% of whom reported at least two risk behaviors. The finding of more risk behaviors among young adults is consistent with previous research on single skin cancer risk behaviors.9, 11, 12, 13

Implications and Conclusion

The majority of the U.S. population reported engaging in more than one skin cancer risk behavior, with infrequent use of sun-protective clothing and infrequent use of sunscreen being the most common risk behaviors. Groups at highest risk for having more skin cancer risk behaviors include individuals under the age of 40, those residing in the Midwest, men, non-Hispanic whites, those with a lower education level, smokers, risky drinkers, and individuals with less skin sensitivity to the sun.

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      Melanoma is the most common type of cancer among Danish females aged 15–34 years and the third most common type of cancer among men in that age range (Engholm et al., 2015). Sunburn is common and associated with characteristics such as young age (Buller et al., 2011; Green et al., 2013; Hall et al., 2003; Holman et al., 2014), male sex (Buller et al., 2011; Coups et al., 2008; Green et al., 2013; Hall et al., 2003; Holman et al., 2014), white race (Buller et al., 2011; Coups et al., 2008; Green et al., 2013; Hall et al., 2003) and light skin type (Hall et al., 2003; Holman et al., 2014). In addition, sunburn has been associated with health behaviour such as smoking, alcohol consumption and physical activity, although the associations were inconsistent (Buller et al., 2011; Coups et al., 2008; Green et al., 2013; Hall et al., 2003; Holman et al., 2014).

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    The full text of this article is available via AJPM Online at www.ajpm-online.net; 1 unit of Category-1 CME credit is also available, with details on the website.

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