Background: Sun exposure is strongly associated with skin cancer. Sun protection to reduce harmful effects of sun exposure, including skin cancer, is encouraged. However, sun sensitivity, a possible confounder of the association between sun exposure and sun protection, is often overlooked. Objectives: This study examined how sun exposure and sun protection behaviors among indoor workers vary between sun sensitive and less sun sensitive individuals. Methods: Diaries over 45 days (August and September of 2009) from indoor workers in the Midwest were examined. Diaries included daily sun exposure, sun protection, and sun sensitivity. Sun sensitivity was measured by determination of fair and non-fair complexion, categorized based on inability to tan and tendency to sunburn. Sun exposure was compared between fair and non-fair complexion. Total exposure (sunrise to sunset) was examined, along with exposure between 10 am and 4 pm, and long exposure between 10 am and 4 pm (at least 60 minutes). Percentages of time in the sun spent practicing sun protection were reported by study participants with fair and non-fair complexion. Logistic regression was used to determine odds ratios between fair complexion and mean sun exposure and mean sun protection times. Results: Fair complexioned individuals spent less time in the sun than non-fair complexioned individuals. In addition, fair complexioned individuals spent greater percentages of time practicing sun protection behaviors while they were in the sun. They were more likely to practice sun protection behaviors related to sunscreen application and protective clothing, notably, wearing a long-sleeved shirt.Conclusion: Fair complexioned individuals spend less time in the sun and practice more sun protective behaviors than non-fair complexioned individuals. These interrelations between sun sensitivity, sun protection and amount of sun exposure suggest that controlling for potential confounding when examining one of these factors and skin cancer may be challenging.
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