Have We Moved the Needle on Photoprotection Messaging? Insight From Sunburn Trends Using the 2019 Behavioral Risk...

Despite decades of public health messaging promoting sun safety and universal sunscreen utilization, sunburn remains prevalent among U.S. adults, posing a significant public health concern due to its links to skin cancer and photoaging.

This study aims to evaluate self-reported sunburn prevalence and associated risk factors using a nationally representative cross-sectional survey.

We analyzed data from the Centers for Disease Control and Prevention's (CDC's) 2019 Behavioral Risk Factor Surveillance System (BRFSS), a nationally representative cross-sectional survey of the US civilian noninstitutionalized population. Our sample included 15,545 adults aged 18 years and older who had complete data on sunburn and relevant variables. Multivariable logistic regression with adjustment for sampling probabilities was used to examine factors associated with self-reported sunburn in the last 12 months preceding the interview. All statistical analyses were performed using Stata 17.

We found that 31.02% of American adults reported sunburn in the past year, with higher rates observed among younger adults, those with higher income and education, and rural residents. Binge drinking was strongly associated with increased sunburn risk. Despite increased sun-protective behaviors such as sunscreen use, seeking shade, and wearing protective clothing, these practices have not significantly reduced sunburn prevalence, particularly among high-risk groups.

Our findings suggest that public health campaigns may not sufficiently address the unique needs of certain populations, including young adults, rural residents, and binge drinkers. We recommend tailored interventions, multimodal sun protection strategies, and enhanced use of digital platforms for outreach. Further research is essential to refine these strategies and reduce the public health burden of sunburn and its associated risks.