Investigators may have uncovered associations between the reported number of sunburns and sociodemographic characteristics as well as the prevalence of protective skin behaviors adopted by U.S. adults, according to a recent study published by Etzel et al in the American Journal of Lifestyle Medicine.
Background
Skin cancer is the most common cancer type in the United States, resulting in millions of nonmelanoma and tens of thousands of melanoma diagnoses per year. Treating skin cancer costs the United States approximately $8.9 billion annually.
Basal cell carcinoma is the most common and least aggressive skin cancer type, typically appearing as a shiny, pearly bump or pinkish patch on sun-exposed areas. Squamous cell carcinoma usually appears as red scaly patches or open sores and can spread to other parts of the body if not treated early. Melanoma—the most lethal type of skin cancer—develops in pigment-producing melanocytes and can appear as a new mole or changes to an existing one. It is highly aggressive and can spread quickly to other organs if not identified and treated early.
Individuals with lighter skin tones, a history of sun exposure or tanning bed use, and a genetic predisposition are often at higher risk of developing skin cancer. Key barriers to prevention include a lack of awareness, cultural preferences for tanned skin, and limited access to sun protection. According to the American Academy of Dermatology, experiencing five or more blistering sunburns between the ages of 15 and 20 increases an individual’s melanoma risk by 80% and nonmelanoma skin cancer risk by 68%.
Study Methods and Results
In this study, the investigators used a nationally representative sample of 6,252 adults from the U.S. National Cancer Institute’s 2022 Health Information National Trends Survey 6 to examine perceptions of skin cancer. They selected questions focused on the respondents’ confidence in their health, perceived cancer risk, worry about getting diagnosed with cancer, and sunburn experiences over the past year. The investigators assessed sociodemographic factors such as age, gender, occupational status, marital status, educational level, Hispanic origin, race, and income because of their potential link to skin cancer risk.
When asked how confident they felt about their ability to take care of their own health, 44% and 27.3% of the respondents felt either very confident or completely confident, respectively. Most of the respondents had moderate concerns regarding skin cancer risk. A total of 9.1% of them reported being extremely concerned, whereas 26.6% of them were somewhat concerned, and 25.6% of them were slightly concerned.
For sunburn and skin protection, 67.6% of the respondents reported no sunburns, whereas 30.3% experienced one to five sunburns in the past year. Additionally, 6.4% of them reported consuming alcohol while sunburned, a known risk factor for increased sunburn incidence. Activities such as drinking alcohol, working outside, or swimming were common among the respondents who reported sunburns.
Using multinomial regression analysis, the investigators discovered statistically significant associations between the number of sunburns and sociodemographic factors. Adults older than age 40 and women had lower sunburn risks. Individuals who had disabilities, were unemployed, and had multiple occupations reported fewer sunburns. Married or partnered individuals had higher risks of sunburn, whereas divorced or single participants had lower risks. Higher education levels as well as Hispanic, Black, Asian, or mixed race were linked to lower sunburn risks. Additionally, higher income groups had higher risks of sunburns—with the highest income group having greater than four times the risk of reporting a sunburn.
“Social determinants such as race/ethnicity, sex, income, and employment status are closely linked to sunburn and skin cancer risk. While Hispanic and Black [individuals] generally report lower rates of sunburn, Hispanic [individuals] often perceive greater benefits of UV exposure, which increases their risk,” emphasized senior study author Lea Sacca, PhD, MPH, Assistant Professor in the Department of Population Health and Social Medicine at the Charles E. Schmidt College of Medicine at Florida Atlantic University. “Factors such as sex, education, and income also influence sunscreen use, with lower use observed among Black and Hispanic [individuals]. However, within these groups, women with higher education and income are more likely to use sunscreen. Interestingly, higher income is associated with more frequent sunburns,” she added.
Conclusions
According to the American Cancer Society and other health organizations, practicing sun safety and skin awareness is vital to preventing skin cancer. Regularly applying a broad-spectrum sunscreen with an SPF of 30 or higher—particularly when spending time outdoors—and reapplying it every 2 hours is essential as a first step for skin cancer prevention. Avoiding direct sunlight, particularly between 10 AM and 4 PM, when ultraviolet (UV) rays are strongest, and seeking shade whenever possible are also additional preventive strategies to reduce the risk of skin cancer. In addition, protecting skin by wearing long-sleeve clothing, wide-brimmed hats, and sunglasses with 100% ultraviolet A/ultraviolet B protection has also been recommended. Individuals were advised to avoid tanning beds, since they increase the risk of skin cancer. Performing regular self-examinations of the skin for any unusual moles or skin changes along with professional skin screenings by a dermatologist may help to detect skin cancer early. Surfaces such as water, sand, and snow also may reflect ultraviolet rays, so reapplying sunscreen more frequently in these environments may reduce the risk of sun exposure. The investigators stressed the critical need to remain hydrated to support skin health and resilience against ultraviolet damage.
“Understanding perceptions of skin cancer risk and the prevalence of protective behaviors is vital to reducing the likelihood of developing skin cancer, particularly among vulnerable groups,” highlighted lead study author Madison Etzel, BS, a second-year medical student at the Charles E. Schmidt College of Medicine at Florida Atlantic University. “Our study underscores the importance of raising awareness about skin cancer susceptibility, as we found that all sociodemographic factors were significantly linked to the number of reported sunburns in the past year. Future research should explore how additional social determinants of health influence sunburn incidence and prevention behaviors. A deeper understanding of these factors is critical to addressing the widespread harms of skin cancer in U.S. adults,” she concluded.
Disclosure: For full disclosures of the study authors, visit journals.sagepub.com.
