Hat, shade, long sleeves, or sunscreen? Rethinking US sun protection messages based on their relative effectiveness

Sun protection messages in the United States emphasize sunscreen use, although its efficacy in skin cancer prevention remains controversial.

We used data from NHANES 2003-2006, restricted to adult whites (n = 3,052) to evaluate how Americans protect themselves from the sun. Participants completed questionnaires on the frequency with which they used sunscreen, wore a hat, long sleeves, or stayed in the shade, in addition to the number of sunburns in the past year.

Although using sunscreen is the most common sun protective behavior (30%), frequent sunscreen use was not associated with fewer sunburns. However, the odds of multiple sunburns were significantly lower in individuals who frequently avoided the sun by seeking shade (OR = 0.70, p < 0.001) or wearing long sleeves (OR = 0.73, p = 0.01).

Our findings suggest that shade and protective clothing may be more effective than sunscreen, as typically used by Americans.