The epidemiology of sunburn in the US population in 2003

doi:10.1016/j.jaad.2006.05.029

Journal of the American Academy of Dermatology

Volume 55, Issue 4, October 2006, Pages 577-583

https://doi.org/10.1016/j.jaad.2006.05.029 Get rights and content

Background

Sunburn is a major preventable risk factor for skin cancer.

Objective

We investigated risk factors for sunburn in the United States based on the 2003 Behavioral Risk Factor Surveillance System.

Design and methods

A random sample of 207,776 respondents provided data for the population-based survey. The main outcome measure was any report of sunburn within the previous 12 months.

Results

Overall, 39% of respondents had at least one sunburn. The strongest factors associated with sunburn were age and socioeconomic factors. Sunburn prevalence was greatest in respondents 18 to 24 years old (61%). This group was more likely to have a sunburn than respondents 45 to 54 years of age (odds ratio [OR] = 2.76). Higher income and higher levels of education were positively associated with sunburn (OR 1.67 and 1.63, respectively). Individuals reporting recent binge drinking had a higher prevalence of sunburn (OR = 1.33).

Limitations

The Behavioral Risk Factor Surveillance System does not include data on skin type or sun protection behavior; therefore the impact of these factors was not assessed.

Conclusion

Sunburn occurs at a very high rate in the United States.

Section snippets

Questionnaire content

The CDC's BRFSS questionnaire includes questions about sociodemographic characteristics, general health status, physician encounters in the past year, smoking, alcohol use, diabetes, hypertension, and other leading diseases. In 2003, all states, the District of Columbia, and 3 territories included questions about behaviors associated with skin cancer in their survey. Questions addressed whether a respondent had experienced a sunburn (defined as any time when even a small part of the skin was

Characteristics of study population

In 2003, 248,042 respondents from the continental United States provided sunburn data for the BRFSS. Of these individuals, 84.4% self-identified as white and these individuals were included in the analysis. The characteristics of the whites in the BRFSS population are shown in Table I. The sample consisted of 40% men and 60% women, with a mean age of 50 years (range, 18-99 years). Each respondent's data are weighted according to age, sex, race, region, and sampling strata. After weighting the

Discussion

The results of this study demonstrate that sunburn is very common in the United States. These results are compelling as they are derived from interviews with almost 210,000 people who are broadly representative of the US population. On the basis of our finding of 39% sunburn prevalence, we estimate that more than 73 million Americans experienced at least one sunburn in 2003.²¹ Sunburn prevalence was highest among individuals between 18 and 24 years old, men, students, alcohol users, and

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Cited by (34)

Ethanol consumption synergistically increases ultraviolet radiation induced skin damage and immune dysfunction
2021, Journal of Dermatological Science
Excessive UV radiation disrupts skin homeostasis by multiple mechanisms that extend beyond the simple erythema associated with sunburns including reduction of antioxidants, increased DNA damage, and impairment of skin immune responses. Recreational UV exposure frequently occurs concurrently with excessive ethanol (EtOH). Epidemiological studies suggest a harmful, dose-dependent impact of EtOH in the setting of high UV exposure, leading to increased severity of sunburns relative to those generated in the absence of EtOH. Furthermore, EtOH consumption and UV radiation have multiple overlapping effects on the skin that could account for the epidemiological association.
To elucidate the relationship between excessive EtOH ingestion and UV exposures on early skin damage and downstream immune dysfunction.
We examined the impact of UVB on local skin damage, including inflammation, sunburned cells, apoptotic cells, melanin and antioxidant levels, DNA damage and immune dysfunction in the presence or absence of EtOH ingestion by combining standard mouse models of EtOH consumption and UVB exposure models. To confirm that the observed changes in mouse skin were relevant to human skin, we investigated the effects of EtOH on UV-induced skin damage with human skin explants.
We demonstrated that EtOH consumption and UV exposure act synergistically to increase the severity of local skin damage resulting in impaired melanin responses, reduced antioxidants, greater DNA damage, and immune dysfunction as measured by reduced contact hypersensitivity.
The results support incorporation of the risks of combined UV exposure and excessive alcohol consumption into public health campaigns.
A systematic review of socioeconomic status measurement in 13 years of U.S. injury research
2018, Journal of Safety Research
The purpose of this review was to assess the impact of socioeconomic status (SES) on injury and to evaluate how U.S. injury researchers have measured SES over the past 13 years in observational research studies.
This systematic review included 119 US injury studies indexed in PubMed between January 1, 2002 and August 31, 2015 that used one or more individual and/or area-level measures of SES as independent variables. Study findings were compared to the results of a previous review published in 2002.
Findings indicate SES remains an important predictor of injury. SES was inversely related to injury in 78 (66%) of the studies; inverse relationships were more consistently found in studies of fatal injury (77.4%) than in studies of non-fatal injury (58%). Approximately two-thirds of the studies (n = 73, 61%) measured SES along a gradient and 59% used more than one measure of SES (n = 70). Studies that used a gradient measure of SES and/or more than one measure of SES identified significant relationships more often. These findings were essentially equivalent to those of a similar 2002 review (Cubbin & Smith, 2002).
There remains a need to improve measurement of SES in injury research. Public health training programs should include best practices for measurement of SES, which include: measuring SES along a gradient, selecting SES indicators based on the injury mechanism, using the smallest geographic region possible for area-level measures, using multiple indicators when possible, and using both individual and area-level measures as both contribute independently to injury risk. Area-level indicators of SES are not accurate estimates of individual-level SES.
Injury researchers should measure SES along a gradient and incorporate individual and area-level SES measures that are appropriate to the injury outcome under study.
Sunburn and sun-protective behaviors among adults with and without previous nonmelanoma skin cancer (NMSC): A population-based study
2016, Journal of the American Academy of Dermatology
Citation Excerpt :
We performed multivariable logistic regression to estimate prevalence odds ratios (POR) for the outcome variables using previous NMSC (compared with no history of skin cancer) as the main exposure variable. We selected covariates for adjustment a priori based on their known association with the primary outcomes and/or UV exposure behaviors, including age, sex, region, family history of skin cancer, sun sensitivity, education, BMI, and physical activity.22-26 Refused, not ascertained, and unknown responses were coded collectively as missing for the above analysis.
Individuals with previous nonmelanoma skin cancer (NMSC) are at increased risk for subsequent skin cancer, and should therefore limit ultraviolet exposure.
We sought to determine whether individuals with previous NMSC engage in better sun protection than those with no skin cancer history.
We pooled self-reported data (2005 and 2010 National Health Interview Surveys) from US non-Hispanic white adults (758 with and 34,161 without previous NMSC). We calculated adjusted prevalence odds ratios (aPOR) and 95% confidence intervals (CI), taking into account the complex survey design.
Individuals with previous NMSC versus no history of NMSC had higher rates of frequent use of shade (44.3% vs 27.0%; aPOR 1.41; 95% CI 1.16-1.71), long sleeves (20.5% vs 7.7%; aPOR 1.55; 95% CI 1.21-1.98), a wide-brimmed hat (26.1% vs 10.5%; aPOR 1.52; 95% CI 1.24-1.87), and sunscreen (53.7% vs 33.1%; aPOR 2.11; 95% CI 1.73-2.59), but did not have significantly lower odds of recent sunburn (29.7% vs 40.7%; aPOR 0.95; 95% CI 0.77-1.17). Among those with previous NMSC, recent sunburn was inversely associated with age, sun avoidance, and shade but not sunscreen.
Self-reported cross-sectional data and unavailable information quantifying regular sun exposure are limitations.
Physicians should emphasize sunburn prevention when counseling patients with previous NMSC, especially younger adults, focusing on shade and sun avoidance over sunscreen.
Prevalence of sunburn, sun protection, and indoor tanning behaviors among Americans: Review from national surveys and case studies of 3 states
2011, Journal of the American Academy of Dermatology
Citation Excerpt :
The BRFSS prevalence represented an increase from 1999 in 20 states,7 but the NHIS prevalence was slightly lower than in 2000.10 BRFSS sunburn prevalence was highest in Midwestern states in 2003.6 One fifth (20.7%) of white adults reported 4 or more sunburns over the past 12 months in the BRFSS.7
Exposure to ultraviolet radiation (from solar and nonsolar sources) is a risk factor for skin cancer.
We sought to summarize recent estimates on sunburns, sun-protection behaviors, and indoor tanning available from national and selected statewide behavioral surveys.
Estimates of the prevalence of sunburn, sun-protection behaviors, and indoor tanning by US adults, adolescents, and children collected in national surveys in 1992, 2004 to 2005, and 2007 to 2009 were identified and extracted from searches of computerized databases (ie, MEDLINE and PsychINFO), reference lists, and survey World Wide Web sites. Sunburn estimates from 3 state Behavioral Risk Factors Surveillance Systems were also analyzed.
Latest published estimates (2005) showed that 34.4% of US adults were sunburned in the past year. Incidence of sunburns was highest among men, non-Hispanic whites, young adults, and high-income groups in national surveys. About 3 in 10 adults routinely practiced sun-protection behaviors, and women and older adults took the most precautions. Among adolescents, 69% were sunburned in the previous summer and less than 40% practiced sun protection. Approximately 60% of parents applied sunscreen and a quarter used shade to protect children. Indoor tanning was prevalent among younger adults and females.
Limitations include potential recall errors and social desirability in self-report measures, and lack of current data on children.
Many Americans experienced sunburns and a minority engaged in protective behaviors. Females and older adults were most vigilant about sun protection. Substantial proportions of young women and adolescents recently used indoor tanning. Future efforts should promote protective hats, clothing, and shade; motivate males and younger populations to take precautions; and convince women and adolescents to reduce indoor tanning.
Reducing barriers to sun protection - Application of a holistic model for social marketing
2011, Australasian Marketing Journal
Reducing high rates of sunburn occurrence, linked to the development of skin cancers, has been the focus of sustained social marketing campaigns in Australasia. Despite substantial investment in public health warnings, barriers to preventing sunburn and associated skin cancers remain. The purpose of this article is to illustrate through a holistic model of sunburn how social marketing interventions can be made at both the macro- and micro-environmental levels to minimise the remaining barriers to sun protection. This is achieved though a review of population studies that identify the barriers to preventable sunburn. Integration of the barriers suggests that a holistic approach is needed to understand sun protection behaviour among the general population. This approach supplements existing public health promotion approaches which tend to target an individual’s knowledge and attitude toward sun protection and tanning. From this holistic model of sunburn, the implications for social marketers and directions for future research are presented.
Prevalence and correlates of skin cancer risk behaviors in Madrid (Spain)
2011, Gaceta Sanitaria
Citation Excerpt :
However, no clear association was found between sunburn and educational level, a relationship that has contradictory information in the literature. Although some studies have found no relationship,25,27,28 others have found a greater probability of sunburn for people with the highest educational level,32,36 or for those with a low educational level.33 Finally, there did not appear to be a higher risk of sunburn for employed people, which could suggest that its occurrence is linked to leisure-time sun exposure, looking for a tan.28
To estimate the prevalence and correlates of skin cancer-related behaviors in a representative sample of the population of the region of Madrid (Spain).
We performed a cross-sectional study based on a telephone survey. A total of 2,007 participants aged 18-64 years completed a questionnaire that included items on knowledge about the risk of skin cancer, sun exposure, the use of ultraviolet (UV) lamps and sunburn during the previous year. Logistic regression models were constructed, adjusted for gender, age, educational level and employment status.
Sun exposure as a risk factor for skin cancer was identified by 92.3% of participants and artificial tanning by 73.6%. Knowledge of risk factors was greater among university graduates and women (P<.001). A total of 14.6% were usually exposed to the sun in the summer during the hours of maximum UV radiation, while 4.3% had used UV lamps during the previous year; the use of these lamps was more frequent among women (P<.001) and young people (P<.05). The prevalence of sunburn was 13.2% and was lower among women: odds ratio (OR) 0.68 (95% CI: 0.51-0.90); this prevalence declined with greater age (p linear trend <0.001) and was higher among students: OR 1.60 (95% CI: 1.07-2.40).
Numerous sociodemographic factors are related to UV radiation exposure and sunburn, with young people at highest risk. UV exposure is more frequent among women, whereas sunburn is more common among men.
Estimar la prevalencia y los factores asociados a las conductas relacionadas con el cáncer de piel en una muestra representativa de la Comunidad de Madrid (España).
Estudio transversal basado en encuesta telefónica. Un total de 2.007 personas de 18-64 años completaron un cuestionario sobre conocimiento de riesgos del cáncer de piel, la exposición al sol, el uso de aparatos de bronceado artificial y quemaduras solares durante el último año. Se elaboraron modelos de regresión logística, ajustando por sexo, edad, nivel educativo y situación laboral.
Un 92,3% identificaron la exposición al sol como un factor de riesgo para el cáncer de piel, disminuyendo al 73,6% para el bronceado artificial. Este conocimiento es mayor entre las personas con educación superior y en las mujeres (p<0,001). El 14,6% estuvieron expuestos al sol en verano durante las horas de máxima radiación ultravioleta (UV), y el 4,3% utilizaron lámparas UV en el último año, siendo más frecuente en las mujeres (p <0,001) y jóvenes (p <0,05). La prevalencia de quemaduras solares fue del 13,2%, siendo menor en las mujeres (odds ratio [OR] de 0,68; IC95%: 0,51-0,90), disminuyendo a medida que aumenta la edad (p de tendencia lineal <0,001) y más alta entre los estudiantes (OR de 1,60; IC95%: 1,07-2,40).
Se detectan numerosos factores sociodemográficos asociados a la exposición a la radiación UV y las quemaduras solares, siendo la población más joven la de mayor riesgo. La exposición a radiación UV es más frecuente entre las mujeres, mientras que las quemaduras solares son más comunes en los hombres.

View all citing articles on Scopus

Supported in part by a grant from the National Institute of Arthritis, Musculoskeletal and Skin Diseases (No. K23 AR051125-01).

Conflicts of interest: None identified.

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ReportThe epidemiology of sunburn in the US population in 2003

Background

Objective

Design and methods

Results

Limitations

Conclusion

Section snippets

Questionnaire content

Characteristics of study population

Discussion

J Am Acad Dermatol

J Am Acad Dermatol

J Am Acad Dermatol

Eur J Cancer

Eur J Cancer

J Invest Dermatol

J Photochem Photobiol B

Am J Prev Med

J Am Acad Dermatol

Dermatol Clin

Prev Med

Awareness, knowledge and attitudes to non-melanoma skin cancer and actinic keratosis among the general public

Int J Dermatol

Cutaneous melanoma in relation to intermittent and constant sun exposure—the Western Canada Melanoma Study

Int J Cancer

The relative importance of risk factors in nonmelanoma carcinoma

Arch Dermatol

Report
The epidemiology of sunburn in the US population in 2003