Rates of primary and secondary skin preventive behaviors remain suboptimal, and the prevalence of multiple sunburns continues to rise, according to study research published in the Journal of the American Academy of Dermatology.

To elucidate potential areas of improvement in skin cancer prevention, the study investigated temporal trends of skin cancer-related primary (concerned with disease prevention) and secondary (concerned with early disease detection) preventive behaviors.

During a 10-year period, from 2005 to 2015, The National Health Information Survey was examined and included a total of 67,471 individuals. Outcomes of interest included a lifetime history of full-body skin examination (FBSE) by a physician, use of sun protective measures (including sun avoidance, protective clothing, and sunscreen use), and histories in the past year of indoor tanning and 2 or more sunburns. To assess the association of time period and weighted prevalence of sun protective behaviors, adjusting for race, sex, region, health insurance, income, education, smoking status, alcohol use, personal and family histories of skin cancer, and skin reaction to the sun, multivariable logistic regression analyses were conducted.

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The results demonstrated that the prevalence of the majority of skin cancer preventive behaviors rose, including sunscreen use, sun avoidance, and FBSE, with the exception of wearing protective clothing. Although the adjusted prevalence of indoor tanning decreased, that of sunburn increased. In addition, indoor tanning was significantly decreased. However, the rates of primary and secondary skin preventive behaviors remained suboptimal, and the prevalence of multiple sunburns continues to rise, despite increases in most sun protective behaviors.

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The researchers believe that future studies should examine why prevalence of multiple sunburns is rising and evaluate the effect of increased adoption of sun protective behaviors on skin cancer incidence in the US population. Also, they wrote, the successful effort against indoor tanning can provide public health advocates guidance on more effective strategies aimed at skin cancer prevention.


Bolick NL, Huang L, Mostaghimi A, Hartman RI. Temporal trends in primary and secondary skin cancer prevention in the US [published online February 16, 2020]. J Am Acad Dermatol. doi:10.1016/j.jaad.2020.02.027