Study Evaluates UV Protective Behaviors in American Indian and Alaskan Native Populations

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Ultraviolet (UV) protection from the sun and avoiding indoor tanning play important roles in reducing a person’s risk for skin cancer, the most common cancer in the United States and one of the most preventable. A recent article published by Yang et al in the Journal of the American Academy of Dermatology revealed that UV-protective behaviors are lacking in many American Indians/Alaskan Natives, highlighting the importance of educating this population about the need to protect themselves from harmful UV rays.

“We conducted this study to learn about the skin cancer risk of the 9 million American Indians/Alaskan Natives living in the United States, so we could identify their sun protection habits and determine how to decrease their risk of skin cancer,” said board-certified dermatologist and coauthor of the study Vinod E. Nambudiri, MD, MBA, FAAD, of Brigham and Women’s Hospital. “We found that American Indians/Alaskan Natives needed to better protect themselves from UV rays to reduce their risk of skin cancer.”

Analysis Details

The analysis involved more than 360,500 participants and compared data from American Indian/Alaskan Natives with other racial and ethnic groups on skin cancer screenings, risk factors, and prevention behaviors from the National Health Interview Survey from 2005, 2008, 2010, 2013, and 2015.

The research found that American Indians/Alaskan Natives less frequently used sun-protective behaviors—including wearing hats on a sunny day and seeking shade when outdoors—compared with other racial and ethnic groups. American Indians/Alaskan Natives also reported less frequent sunscreen use compared with non-Hispanic White and Asian participants but more frequent sunscreen use than Black participants.

In addition to less frequent use of sun protection, American Indians/Alaskan Natives also reported using indoor tanning devices more frequently than other minority groups. Indoor tanning can increase users’ risk of developing squamous cell skin cancer by 58% and basal cell skin cancer by 24%.

In addition to avoiding tanning beds, the American Academy of Dermatology and Dr. Nambudiri recommend that people take the following steps to protect themselves from damaging UV rays when outside:

  • Seek shade: Seek shade when appropriate, remembering that the sun’s rays are the strongest between 10 AM and 2 PM. Also look at your shadow—anytime it appears shorter than you, seek shade.
  • Wear sun-protective clothing: Wear a lightweight and long-sleeved shirt, pants, a wide-brimmed hat, and sunglasses with UV protection when possible. For more effective protection, select clothing with an ultraviolet protection factor number on the label.
  • Apply sunscreen: Apply a broad-spectrum, water-resistant sunscreen with a sun-protection factor of 30 or higher to all skin not covered by clothing. Remember to reapply every 2 hours or after swimming or sweating.

“When you look at the lack of sun protection and use of tanning beds, it’s not surprising to see that American Indians/Alaskan Natives are reporting more severe sun damage to their skin, such as sunburns, when spending over an hour in the sun as compared to non-[Hispanic] White respondents,” said Dr. Nambudiri. “While some people may be most concerned about the freckles, age spots, and wrinkles that develop on their skin from UV exposure, it’s the increasing risk of skin cancer, including melanoma, the deadliest form of skin cancer, which is the most alarming.”

American Indians/Alaskan Natives were also reported to have a significantly higher rate of melanoma compared with other minority groups. When American Indian/Alaskan Native patients develop melanoma, they experience lower-5-year survival rates compared with non-Hispanic White patients. In addition, fewer American Indians/Alaskan Natives reported ever receiving full-body skin exams by a dermatologist than non-Hispanic White patients. Although it is estimated that one in five Americans will be diagnosed with skin cancer in their lifetime, when caught early, skin cancer is highly treatable.

“Our results suggest American Indians/Alaskan Natives need to increase their use of sun protection and avoid using tanning beds to decrease their risk of skin cancer, including melanoma,” said Dr. Nambudiri. “In addition, performing a skin self-exam is a critical part of identifying melanoma early when it [is at its] most treatable.”

Disclosure: For full disclosures of the study authors, visit

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.