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J Cosmet Dermatol. 2018 Jul 16. doi: 10.1111/jocd.12712. [Epub ahead of print]

Wrinkles, brown spots, and cancer: Relationship between appearance- and health-based knowledge and sunscreen use.

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UT Southwestern Medical Center, Dallas, Texas.



There is increasing understanding that sunscreen use is associated with reduced photoaging and that appearance-based messages are more effective than health-based messages in promoting daily sunscreen use. We hypothesized that persons with greater awareness of the effects of photoaging use sunscreen more consistently.


Cross-sectional survey of adults in Dallas, TX, assessing sunscreen-related knowledge, behavior, and information source.


Each respondent averaged 2.5 ± 1.7 hours of self-reported sun exposure daily with the least reported time being 0.15 hours. Eighty-eight percent reported that sun exposure caused skin cancer "a lot." Eighty-nine percent "agreed" or "strongly agreed" that "sun exposure causes most signs of skin aging." Over 70% "agreed" or "strongly agreed" to an appearance-based reason for their sunscreen use. Sixty-six percent reported they would consider using sunscreen if anticipating sun exposure lasting 2 hours or less. Only 30% reported using sunscreen daily. Greater photoaging knowledge was positively associated with sunscreen adherence (at least P < 0.05 with each knowledge item). Those with darker complexions or skin less likely to burn reported less knowledge of photoaging (ρ = -0.219, P ≤ 0.001) and had lower sunscreen use (ρ = 0.301, P < 0.001).


Despite most respondents reporting knowledge of health and appearance risks of sun exposure and a motivation to prevent them with sunscreen, most do not use sunscreen adequately. This discrepancy could be due to people perceiving risks of sun exposure based on duration of continuous exposure. There may be misconceptions that short-interval sun exposure that does not result in sunburn is less harmful than extended exposure.


health behavior; health promotion; photoaging; public health; sunscreens


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