Incidence and public health burden of sunburn among beachgoers in the United States

Abstract

The beach environment creates many barriers to effective sun protection, putting beachgoers at risk for sunburn, a well-established risk factor for skin cancer. Our objective was to estimate incidence of sunburn among beachgoers and evaluate the relationship between sunburn incidence and sun-protective behaviors. A secondary analysis, of prospective cohorts at 12 locations within the U.S. from 2003 to 2009 (n = 75,614), were pooled to evaluate sunburn incidence 10-12 days after the beach visit. Behavioral and environmental conditions were cross-tabulated with sunburn incidence. Multivariable logistic regression was used to estimate the association between new sunburn and sun-protective behaviors. Overall, 13.1% of beachgoers reported sunburn. Those aged 13-18 years (16.5%), whites (16.0%), and those at beach locations along the Eastern Seaboard (16.1%), had the highest incidence of sunburn. For those spending ≥5 h in the sun, the use of multiple types of sun protection reduced odds of sunburn by 55% relative to those who used no sun protection (Odds Ratio = 0.45 (95% Confidence Interval:0.27-0.77)) after adjusting for skin type, age, and race. Acute health effects of sunburn tend to be mild and self-limiting, but potential long-term health consequences are more serious and costly. Efforts to encourage and support proper sun-protective behaviors, and increase access to shade, protective clothing, and sunscreen, can help prevent sunburn and reduce skin cancer risk among beachgoers. Sunburn is a biologic indicator of skin damage from ultraviolet radiation (UVR) exposure and is influenced by the intensity of a person's UVR exposure and their sensitivity to such exposure (Wu et al., 2016; International Agency for Research on Cancer, 2012). Each year, approximately one-third of U.S. adults (Holman et al., 2018) and over half of U.S. high school students (Kann et al., 2018) get at least one sunburn. In 2013, almost 34,000 people in the U.S. had sunburn severe enough to seek treatment in an emergency department (ED), resulting in an estimated cost of $11.2 million (Guy et al., 2017). Beach visitation is a prominent mechanism for incurring sunburn, with one study estimating that 15% of beachgoers report sunburn in a single beach visit (Marion et al., 2018). Approximately 43% of

Understanding the Perceived Relationship between Sun Exposure and Melanoma in Atlantic Canada: A Consensual Qualitative Study Highlighting a “Sunscreen Paradox”

“…In addition, a more prominent sun tanning and beach culture seemed to be present in NS/PEI, and participants from this group, along with those from NB, described more experiences with sunburns. This is consistent with the findings of a large US-based prospective cohort study (n = 75,614), in which 13.1% of beachgoers reported sunburn, with the highest sunburn rates occurring at beaches along the Eastern Seaboard [37], an area that is geographically proximate to Atlantic Canada.…”

Sunburns among beachgoers in the northern coast of Peru: frequency and factors associated

“…However, another study conducted in a sample of beach handball players from Spain found a higher sunburn frequency (76.9% had at least one sunburn in the last year) ( De Castro-Maqueda et al, 2019 ). These sunburn events could be related to prolonged sun exposure among the populations mentioned, in addition to insufficient sun protection measures ( DeFlorio-Barker et al, 2020 ).…”

Is sunscreen alone effective at preventing sunburn on a high‐solar beach vacation: A modeling study?

“…1 Although beach destinations generally offer pleasurable climatic conditions, they are normally associated with a high-solar ultraviolet radiation (UV) environment, 2 especially at latitudes below 40°. A consequence of a high-solar environment is a heightened risk of overexposure, which manifests itself not only in an elevated risk of sunburn [3][4][5] but also to DNA damage in the skin. 6 Furthermore, the acute high-UV exposure often received on a beach holiday contributes significantly to our annual cumulative UV exposure, making recreational exposure in a high-solar environment an important contributor to lifetime risk of skin cancer.…”

“…Although beach destinations generally offer pleasurable climatic conditions, they are normally associated with a high‐solar ultraviolet radiation (UV) environment, 2 especially at latitudes below 40°. A consequence of a high‐solar environment is a heightened risk of overexposure, which manifests itself not only in an elevated risk of sunburn 3–5 but also to DNA damage in the skin 6 …”