title: Methodologic artifacts in adult sun-protection trends.
abstract: BACKGROUND
  Skin cancer is the most common of all cancers and a public health concern of increasing magnitude in the U.S.
  
  
  OBJECTIVE
  A mid-year review of Healthy People 2010 found that the percentage of adults engaging in sun-safe practices increased from 59% in 2000 to 71% in 2005. This paper examines whether this increase in sun-safe practices in adults is an artifact caused by the change from 2000 to 2005 in the operational definition of "sun-safe practices" in the National Health Interview Survey (NHIS).
  
  
  METHODS
  This study analyzed the 2000 and 2005 NHIS data sets in 2009 to examine changes in sun-safe practice prevalence estimates and to estimate the relative odds of practicing sun-safe behaviors associated with gender, age, race/ethnicity, education, and geographic region.
  
  
  RESULTS
  Contrary to the Healthy People 2010 mid-year review, it was found that engaging in sun-safe practices by adults decreased from 59% (2000) to 55% (2005). A question order effect and use of images for use of sun-safe hats likely caused an artificial change in "cover-up" behavior estimates from 31% (2000) to 18% (2005) and wide-brim hat usage from 27% (2000) to 12% (2005). When eliminating data from these two questions added in 2005, the relative odds of practicing sun-safe behaviors was significantly lower for men in both 2000 and 2005 but were not different for other demographic characteristics.
  
  
  CONCLUSIONS
  The current analyses suggest that the increase in sun-safe behaviors in adults and a notable decrease in "hat use" may be due to methodologic artifacts. When operational definitions change, caution should be used in interpreting estimates over time.
authors.affiliation: Hunterdon County Department of Health, Flemington, New Jersey, USA.
authors.forename: Marc A
authors.initials: MA
authors.lastname: Katz
authors.forename: Cristine D
authors.initials: CD
authors.lastname: Delnevo
authors.forename: Daniel A
authors.initials: DA
authors.lastname: Gundersen
authors.forename: David Q
authors.initials: DQ
authors.lastname: Rich
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D003430:Cross-Sectional Studies; D005260:Female; D015438:Health Behavior; D006306:Health Surveys; D006801:Humans; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011481:Protective Clothing; D012737:Sex Factors; D012878:Skin Neoplasms / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D013472:Sunlight / Q000009:adverse effects; D013473:Sunscreening Agents / Q000008:administration & dosage*; D009626:Terminology as Topic; D014466:Ultraviolet Rays / Q000009:adverse effects; D014481:United States / Q000453:epidemiology; D055815:Young Adult
chemical_list: D013473:Sunscreening Agents