Asian-Americans Less Likely to Use Sunscreen Than Non-Hispanic Whites

By Lisa Rapaport

March 29, 2021

(Reuters Health) - Asian-American adults are significantly less likely to consistently use sunscreen than non-Hispanic whites, a new U.S. study suggests.

Researchers examined data on 7,173 participants from the 2011 to 2018 National Health and Nutrition Examination Survey (NHANES) who answered a dermatology questionnaire, including 2,200 people who identified as Asian-American (9%) and 4,973 people who identified as non-Hispanic white (91%). Overall, just 35% of non-Hispanic whites and 29% of Asian-Americans said they consistently used sunscreen when they were outside for more than an hour on a sunny day.

After adjusting for age, sex, income, marital status, education level, skin reaction to the sun, and body mass index, Asian-Americans were significantly less likely to consistently use sunscreen than non-Hispanic whites (adjust odds ratio 0.70).

"In my experience, Asian-Americans are much more likely to use an umbrella or seek shade rather than using sunscreens," said senior study author Dr. Jashin Wu, founder and chief executive officer of the Dermatology Research and Education Foundation in Irvine, California.

"If they are resistant to sunscreen use, then I encourage other sun-protective measures such as wearing long-sleeve clothes, using hats and umbrellas, and seeking shade especially during the peak hours of sunlight which are 10am-4pm," Dr. Wu said by email.

In adjusted analysis, several other factors in addition to ethnicity also appeared to influence the odds of consistent sunscreen use, the authors report in the Journal of the American Academy of Dermatology.

Females were significantly more likely to consistently use sunscreen than males (aOR 2.78), the study found.

People with annual household income below $20,000 were significantly less likely to consistently use sunscreen than more affluent individuals (aOR 0.61).

Individuals without a high school degree were significantly less likely to consistently use sunscreen than those with who completed high school (aOR 0.61), while individuals with education beyond high school were significantly more likely to consistently use sunscreen than those with only a high school education (aOR 2.11).

Compared to people with mild or no reactions to the sun, those with severe sunburns and blistering were significantly more likely to use sunscreen consistently (aOR 2.03).

Separated, widowed and divorced people were significantly less likely to consistently use sunscreen than people who were married or living with a partner (aOR 0.68).

Limitations of the study include its use of self-reported data and the lack of objective assessment of sunscreen application, the researchers note. Another drawback is that they lacked data on other forms of sun protection.

"Melanin, the pigment that gives skin, hair and eyes their color, does provide some natural protection again the risk of skin cancers and sunburns from sun exposure," said Dr. Sherry Yu, an instructor of dermatology at Yale University School of Medicine in New Haven, Connecticut.

"However, natural pigmentation does not provide complete protection or immunity, and anyone can get enough sun and develop skin cancers," Dr. Yu, who wasn't involved in the study, said by email.

While skin cancers are less common in Asian Americans, when they do occur, they tend to be diagnosed at a later stage and can often have worse outcomes, Dr. Yu said.

There is no medical reason for Asian-Americans to be less worried about sun exposure, Dr. Yu added. Clinicians need to convey this message along with the importance of skin cancer screening, Dr. Yu said.

"Skin cancer is the most common form of cancer in the U.S. and sun exposure needs to be continuously addressed," said Dr. Aaron Farberg, an assistant professor of dermatology at Baylor University Medical Center in Dallas.

"Evidence shows that sun protection and sunscreen for people of all ages and skin types can help lessen the overall risk of skin cancer," Dr. Farberg, who wasn't involved in the study, said by email.

SOURCE: https://bit.ly/3d4QoQ8 Journal of the American Academy of Dermatology, online March 11, 2021.

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