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PEDIATRICS Vol. 110 No. 1 July 2002, pp. 27-35

Summer Sunburn and Sun Exposure Among US Youths Ages 11 to 18: National Prevalence and Associated Factors

Kourtney J. Davis, PhD, MSPH^*, Vilma E. Cokkinides, PhD, MSPH, Martin A. Weinstock, MD, PhD, Mary C. O’Connell, BA, Phyllis A. Wingo, PhD

^* Worldwide Epidemiology, GlaxoSmithKline, Inc, Research Triangle Park, North Carolina
Departments of Epidemiology and Surveillance Research and Cancer Control, American Cancer Society, Atlanta, Georgia
DermatoEpidemiology Unit, VA Medical Center and Department of Dermatology, Rhode Island Hospital and Brown University, Providence, Rhode Island

Objective. Epidemiologic evidence suggests that ultraviolet radiation (UVR), from sun exposure and sunburns during early life, is associated with increased risk of melanoma and other skin cancers in adulthood. The objective of this study was to gather national, population-based data on sun exposure and protection behaviors among US youths ages 11 to 18 to quantify the magnitude and patterns of sun exposure and establish baselines for continued surveillance.

Methods. A nationwide survey based on random-digit dialing and stratified, 2-stage national probability sampling was conducted of households with telephones in the 48 contiguous states of the United States during July through October of 1998; a population-based sample of 1192 youth ages 11 to 18 was studied to measure weighted prevalence estimates of summer sunburn and sun exposure and adjusted prevalence odds ratios and 95% confidence intervals from logistic regression analyses of sunburn.

Results. Among youths ages 11 to 18, 72% reported having had at least 1 summer sunburn, 30% reported at least 3, and 12% reported at least 5 sunburns. Before receiving their most serious summer sunburn, 39% of youths reported having applied sunscreen. Factors associated with increased odds of sunburn included greater sun sensitivity, white race, age younger than 16 years, more hours spent outdoors, and high desirability of a tan.

Conclusions. Summer sunburn was the norm among US youths ages 11 to 18. The high frequency of sunscreen use during the sunburning episodes suggests the need to educate youth and parents better about proper use of these agents, as well as the importance of practicing other sun protection behaviors, such as wearing hats and protective clothing and avoiding the sun during peak exposure times. These data may serve as a baseline for tracking progress in skin cancer prevention efforts and will inform the crafting of future public health campaigns.

Key Words: youth • skin cancer prevention • sunburn • behaviors • prevalence • national survey

Abbreviations: UVR, ultraviolet radiation • ACS, American Cancer Society • CI, confidence interval • aPOR, adjusted prevalence odds ratio

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Received for publication Aug 28, 2001; Accepted Jan 28, 2002.

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