According to a report published in JAMA Dermatology, sexual minority men (SMM) participate more often in indoor and sunless tanning compared with heterosexual men; however, they also are also more likely to take sun-protective measures such as avoiding sun exposure and using sunscreen when outdoors.

Because SMM show increased rates of skin cancer, investigators performed a cross-sectional analysis on data from the 2015 National Health Interview Surveys.

The age-adjusted prevalence rates and multivariable-adjusted odds ratios were calculated in SMM vs heterosexual men for indoor tanning, sunless tanning, sunburn, and sun avoidance.

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In a subcohort of sun-exposed men, mean behavioral scores and multivariable-adjusted regression coefficients were calculated for sun-protection behaviors. In addition, among indoor tanners, frequent indoor tanning (≥10 sessions per year) was examined.

The sample comprised 13,698 adult men, 370 of whom were SMM. In comparison with heterosexual men, SMM were more likely to participate in indoor tanning (weighted mean [standard error (SE)], 22.1% [2.7%] vs 9.1 [0.4%]; multivariable-adjusted prevalence odds ratio [aPOR], 3.14; 95% CI, 2.14-4.60), sunless tanning (7.6% [1.8%] vs 1.0% [0.1%]; aPOR, 7.58; 95% CI, 4.46-12.91), and sun avoidance (9.6% [2.2%] vs 6.7 [0.3%]; aPOR, 3.25; 95% CI, 1.21-8.70).

However, no differences were noted in sunburn rates (36.1% [3.5%] vs 35.1% [0.6%]; aPOR, 0.95; 95% CI, 0.67-1.32). In the subcohort of sun-exposed men, SMM were more likely to apply sunscreen (mean behavioral score [SE], 2.8 [0.1] vs 2.4 [0.02]; coefficient, 0.17; 95% CI, 0.01-0.33) and remain in the shade (3.2 [0.1] vs 3.0 [0.02]; coefficient, 0.18; 95% CI, 0.02-0.33). Frequent indoor tanning did not differ between groups among indoor tanners (mean [SE], 37.0% [5.9%] vs 33.9% [6.6%], respectively; aOR, 0.66; 95% CI, 0.19-2.31).

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The study was limited by the small number of SMM. Gay and bisexual men were combined into 1 group to increase statistical power; however, generalizability of the results may now be compromised when applied across gay and bisexual populations individually.

“Dermatologists should be aware that indoor tanning, sunless tanning, and sun-protection behaviors are different in SMM and should consider routine assessment of sexual orientation in clinical settings to help guide behavioral screening and counseling,” the authors commented. “Future studies should investigate the motivations contributing to these differences and outdoor sun exposure behaviors in SMM. Targeted interventions designed to change behaviors could help reduce the risk of skin cancer among SMM.”


Gao Y, Arron ST, Linos E, et al. Indoor tanning, sunless tanning, and sun-protection behaviors among sexual minority men [published online February 28, 2018]. JAMA Dermatol. doi: 10.1001/jamadermatol.2018.0003