People with pale skin who are sensitive to the sun should use several sun-protective behaviors to avoid sunburn, according to a new study.
Those who only used sunscreen had a higher likelihood of burning versus those who also wore a hat, wore protective clothing, and sat in the shade.
For skin cancer prevention, it's critical to understand how sun-protective behaviors are related to sunburn, said study leader Kasey Morris of the National Cancer Institute in Bethesda, Maryland.
Skin cancer affects millions of Americans and is estimated to cost more than $8 billion per year for melanoma and non-melanoma skin cancer.
Scientists have shown that redheads and other fair-skinned people need hats and clothing to lower their skin cancer risk from the sun (file image)
About one in five people are diagnosed with some form of skin cancer in their lifetime, and 100,000 Americans will be diagnosed with malignant melanoma, the most dangerous kind, in 2018.
'Most of these cases are caused by excess exposure to ultraviolet radiation and could be avoided through adequate sun-protective behaviors,' Morris told Reuters Health by email.
Morris and colleague Frank Perna analyzed data from more than 28,000 responses to the 2015 National Health Interview Survey.
The survey asks participants what would happen to their skin if they were out in the sun for an hour after several months of not being exposed.
Those who said 'get a severe burn with blisters,' 'have a moderate sunburn with peeling,' or 'burn mildly with some or no tanning' were considered sun-sensitive.
Those who said 'turn darker without sunburn' or 'nothing would happen' were considered non-sun-sensitive.
The survey respondents also indicated how many times they had a sunburn in the past year and how often they used sun protection on a warm, sunny day.
The choices included sunscreen, shade, a cap or visor, a wide-brimmed hat, long sleeves, and long pants.
Most people - 77 percent - used at