Sun Protective Behaviors Amongst Non-White US Adults from 2003-2023

Sun-protective behaviors play a significant role in preventing UV-related skin damage, photoaging, increased pigmentation in pigmentary disorders, and skin cancer. Understanding changes in sun protection practices over time can further elucidate the long-term impact of ongoing efforts to educate populations about the role of UV exposure in these pathologies. We assessed 20-year trends in sun-protective behaviors (sunscreen use, shade-seeking, and long-sleeve clothing) among U.S. adults according to race and ethnicity using nationally representative data from the National Health and Nutrition Examination Survey (NHANES) between 2003 and 2023. We analyzed responses from 28,765 U.S. adults using logistic regression models, adjusted for age, sex, education, income-to-poverty ratio, and occupation to assess behavioral trends across racial groups: Black, White, and Other (Hispanic, Asian, Multiracial). Our analysis indicated all racial groups had statistically significant increases in sunscreen use over time (White p = 0.0267, Black p = 0.0013, Other p < 0.0001). White participants consistently used sunscreen more than any group (from 28.7% in 2003-04, rising to 36.4% in 2021–23). Black participants reported the lowest usage compared to White and Other racial groups but demonstrated a steady increase over the course of this 20-year period, starting from 4.4% in 2003–04, peaking at 11.4% in 2021–23. Sunscreen use amongst Other races, showed steady increases from 17.2% to 29.1% over the course of this 20-year period. Compared to Black adults, the odds of sunscreen use were significantly higher among White (OR 8.01, 95% CI 5.15–12.47) and Other race participants (OR 5.91, 95% CI 3.86–9.04). In contrast, Black participants reported the highest rates of shade-seeking behavior, and Other races reported the highest use of long-sleeve protective clothing. Our findings highlight persistent disparities in sun-protective behaviors, particularly low sunscreen use among Black Americans despite improvement over time. Cultural norms, cosmetic acceptability (specifically white cast), and lack of inclusive public health messaging may play a role in these trends. Future education efforts, more tailored resources and inclusive messaging may help bridge this gap and advance skin health equity.