Sunburn and sun-protective behaviors among adults with and without previous nonmelanoma skin cancer (NMSC): A population-based study

Alexander H. Fischer, Timothy S Wang, Gayane Yenokyan, Sewon Kang, Anna Lien-Lun Chien

Research output: Contribution to journalArticle


Background: Individuals with previous nonmelanoma skin cancer (NMSC) are at increased risk for subsequent skin cancer, and should therefore limit ultraviolet exposure. Objective: We sought to determine whether individuals with previous NMSC engage in better sun protection than those with no skin cancer history. Methods: 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. Results: 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. Limitations: Self-reported cross-sectional data and unavailable information quantifying regular sun exposure are limitations. Conclusion: Physicians should emphasize sunburn prevention when counseling patients with previous NMSC, especially younger adults, focusing on shade and sun avoidance over sunscreen.

Original languageEnglish (US)
JournalJournal of the American Academy of Dermatology
StateAccepted/In press - 2016



  • Multimodal sun protection
  • Nonmelanoma skin cancer
  • Photoprotection
  • Skin cancer prevention
  • Sunburn
  • Sunscreen
  • Ultraviolet exposure

ASJC Scopus subject areas

  • Dermatology

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