Sunscreen Use Declining Among US High School Students

Ricki Lewis, PhD

February 14, 2012

February 14, 2012 — A survey of high school students in the United States reveals decreasing use of sunscreen, which may ultimately increase incidence of skin cancers, according to a study published in the March issue of the Journal of Adolescent Health.

Overall, the percentage of white and Hispanic students who never or rarely wore sunscreen increased, whereas the percentage who most of the time or always and sometimes wore sunscreen decreased. In 2009, 73.5% of high school students never or rarely wore sunscreens with a protective factor of 15 or above when outside for more than an hour in the sun compared with 65.2% in 1999, despite education about the dangers of excessive sun exposure.

Sunburn early in life and long-term exposure to ultraviolet radiation are risk factors for all types of skin cancer. Regular use of sunscreen can lower this risk, but compliance, especially among the young, may be suboptimal. Sherry Everett Jones, PhD, MPH, from the Division of Adolescent and School Health, Centers for Disease Control and Prevention, Atlanta, Georgia, and colleagues analyzed sunscreen use from 1999 to 2009 in a large sample of US high school students.

The researchers used data from the Youth Risk Behavior Survey (YRBS), which has been conducted biennially since 1991 to sample students in public and private high schools. The students volunteered to complete computer-scannable questionnaires during regular class periods. Sample sizes exceeded 11,000 students per year.

In 1999 the YRBS began asking how often students used sunscreen with a sun protection factor of 15 or more when they were outside for more than 1 hour on a sunny day. The study design grouped the answers into 3 categories (most of the time or always, sometimes, and never or rarely) and categorized students as non-Hispanic black, non-Hispanic white, and Hispanic of any race. The researchers weighted the responses to account for students who did not respond and for oversampling of Hispanic and black students.

Sunscreen use among blacks of both sexes remained relatively constant. The survey revealed the most change among in white girls, whose sunscreen use fell from 22.7% in 1999 to 14.14% in 2009. The percentage of white girls who never or rarely used sunscreen increased from 48.4% in 1999 to 63.0% in 2009.

The researchers suggest 3 possible explanations for the declining use of sunscreen in this population group: media attention on the health benefits of adequate vitamin D and its connection to light, the sun's effects on clearing up acne, and the desire to appear tanned.

The investigators acknowledge that their study has several limitations. The survey was administered in February, March, and April, when people living in colder climates are generally outdoors less often. The survey did not address other methods of sun protection, such as wearing protective clothing, seeking shade, or using a less powerful sunscreen product. In addition, the survey did not include adolescents who are not in school.

The combined observations of increasing incidence of melanoma and decreasing use of sunscreen in adolescents "suggest a need for renewed public health efforts among clinical-, school-, and community-health professionals to increase sunscreen use as part of a comprehensive approach to preventing skin cancer," the researchers conclude.

The authors have disclosed no relevant financial relationships.

J Adolesc Health. 2012;50:304-307. Abstract


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