title: Hat, shade, long sleeves, or sunscreen? Rethinking US sun protection messages based on their relative effectiveness.
abstract: BACKGROUND
  Sun protection messages in the United States emphasize sunscreen use, although its efficacy in skin cancer prevention remains controversial.
  
  
  METHODS
  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.
  
  
  RESULTS
  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).
  
  
  CONCLUSIONS
  Our findings suggest that shade and protective clothing may be more effective than sunscreen, as typically used by Americans.
authors.affiliation: Department of Dermatology, Stanford University School of Medicine, 450 Broadway St, Pavillion C, Redwood City, CA 94063, USA. linos@stanford.edu
authors.forename: Eleni
authors.initials: E
authors.lastname: Linos
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Keiser
authors.forename: Teresa
authors.initials: T
authors.lastname: Fu
authors.forename: Graham
authors.initials: G
authors.lastname: Colditz
authors.forename: Suephy
authors.initials: S
authors.lastname: Chen
authors.forename: Jean Y
authors.initials: JY
authors.lastname: Tang
mesh_terms: D000328:Adult; D002277:Carcinoma / Q000453:epidemiology / Q000517:prevention & control; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D033181:Information Dissemination / Q000379:methods; D008297:Male; D008875:Middle Aged; D009749:Nutrition Surveys; D015397:Program Evaluation; D011481:Protective Clothing / Q000706:statistics & numerical data*; D012878:Skin Neoplasms / Q000453:epidemiology / Q000517:prevention & control; D013471:Sunburn / Q000453:epidemiology / Q000517:prevention & control*; D013472:Sunlight / Q000009:adverse effects*; D013473:Sunscreening Agents / Q000627:therapeutic use*; D014481:United States / Q000453:epidemiology; D044465:White People / Q000706:statistics & numerical data; D055815:Young Adult
chemical_list: D013473:Sunscreening Agents