title: Sunburn and sun-protective behaviors among adults with and without previous nonmelanoma skin cancer (NMSC): A population-based study.
abstract: BACKGROUND
  Individuals with previous nonmelanoma skin cancer (NMSC) are at increased risk for subsequent skin cancer, and should therefore limit ultraviolet exposure.
  
  
  OBJECTIVE
  We sought to determine whether individuals with previous NMSC engage in better sun protection than those with no skin cancer history.
  
  
  METHODS
  We pooled self-reported data (2005 and 2010 National Health Interview Surveys) from US non-Hispanic white adults (758 with and 34,161 without previous NMSC). We calculated adjusted prevalence odds ratios (aPOR) and 95% confidence intervals (CI), taking into account the complex survey design.
  
  
  RESULTS
  Individuals with previous NMSC versus no history of NMSC had higher rates of frequent use of shade (44.3% vs 27.0%; aPOR 1.41; 95% CI 1.16-1.71), long sleeves (20.5% vs 7.7%; aPOR 1.55; 95% CI 1.21-1.98), a wide-brimmed hat (26.1% vs 10.5%; aPOR 1.52; 95% CI 1.24-1.87), and sunscreen (53.7% vs 33.1%; aPOR 2.11; 95% CI 1.73-2.59), but did not have significantly lower odds of recent sunburn (29.7% vs 40.7%; aPOR 0.95; 95% CI 0.77-1.17). Among those with previous NMSC, recent sunburn was inversely associated with age, sun avoidance, and shade but not sunscreen.
  
  
  CONCLUSIONS
  Self-reported cross-sectional data and unavailable information quantifying regular sun exposure are limitations.
  
  
  CONCLUSIONS
  Physicians should emphasize sunburn prevention when counseling patients with previous NMSC, especially younger adults, focusing on shade and sun avoidance over sunscreen.
authors.affiliation: Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, Maryland; Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland. Electronic address: afisch11@jhmi.edu.
authors.forename: Alexander H
authors.initials: AH
authors.lastname: Fischer
authors.affiliation: Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors.forename: Timothy S
authors.initials: TS
authors.lastname: Wang
authors.affiliation: Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
authors.forename: Gayane
authors.initials: G
authors.lastname: Yenokyan
authors.affiliation: Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors.forename: Sewon
authors.initials: S
authors.lastname: Kang
authors.affiliation: Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors.forename: Anna L
authors.initials: AL
authors.lastname: Chien
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003430:Cross-Sectional Studies; D005260:Female; D015438:Health Behavior; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000517:prevention & control; D012878:Skin Neoplasms / Q000517:prevention & control; D013471:Sunburn / Q000517:prevention & control*; D013473:Sunscreening Agents / Q000627:therapeutic use*; D055815:Young Adult
chemical_list: D013473:Sunscreening Agents
keywords: multimodal sun protection; nonmelanoma skin cancer; photoprotection; skin cancer prevention; sunburn; sunscreen; ultraviolet exposure