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

Cancer Causes Control. 2011 Jul;22(7):1067-71. doi: 10.1007/s10552-011-9780-1. Epub 2011 Jun 3.


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.

MeSH terms

  • Adult
  • Carcinoma / epidemiology
  • Carcinoma / prevention & control
  • European Continental Ancestry Group / statistics & numerical data
  • Female
  • Health Knowledge, Attitudes, Practice
  • Humans
  • Information Dissemination* / methods
  • Male
  • Middle Aged
  • Nutrition Surveys
  • Program Evaluation
  • Protective Clothing / statistics & numerical data*
  • Skin Neoplasms / epidemiology
  • Skin Neoplasms / prevention & control
  • Sunburn / epidemiology
  • Sunburn / prevention & control*
  • Sunlight / adverse effects*
  • Sunscreening Agents / therapeutic use*
  • United States / epidemiology
  • Young Adult


  • Sunscreening Agents