Think you have sun smarts? Maybe, but it doesn't help if you don't use them.
Americans may be too complacent about using sunscreen -- properly or at all -- according to a survey of 1,000 adults by the Consumer Reports National Research Center.
In the survey, 31 percent of Americans reported not using sunscreen while 69 percent were occasional users.
Skin experts find that the results match patient attitudes toward sun protection that they see in practice.
"It's exactly correct," Dr. Doris Day, a dermatologist at New York University, said of the survey's findings. "It's very frustrating. ... We have the information and we know what to do and people are not improving their behavior."
Brittany Cicala, 25, of Chesapeake Beach, Md., said her parents were religious about putting sunscreen on her pale skin.
"But as soon as I was 13, that kind of went out the window," Cicala said. "I felt like most teenage girls do, that I look better with a tan. At 17, I was able to go to tanning salons, also without sunscreen."
At 19, Cicala developed melanoma and underwent multiple surgeries to battle the skin cancer. Her attitude toward sunscreen and skin protection have changed drastically and she now wears sunscreen with SPF 85.
"Even if you're out in the sun for 10 minutes, you can still get sun exposure and bad sun exposure at that," Cicala said.
Survey respondents said they were aware that sunscreens with higher SPF afforded greater protection, and sunscreens past their expiration dates should not be used.
Day reiterated that sunscreen with an SPF 15 or greater should be applied an ounce at a time before going into the sun and reapplied about hourly in order to gain the most protection from cancer-causing ultraviolet UVA and UVB rays.
"You need to go through sunscreen," Day said. "One bottle should not last a summer."
According to the American Cancer Society, more than 1 million skin cancers are diagnosed each year in the United States. Melanoma is on the rise, especially among young women. And the Skin Cancer Foundation reported that 90 percent of nonmelanoma skin cancer and premature aging have been linked to sun exposure.
Other measures, such as wearing long-sleeved clothing, hats and sunglasses and avoiding the sun during peak hours can also reduce the risk of sun exposure.
Dr. Michele McDonald, a dermatologist and assistant professor of medicine at Vanderbilt University Medical Center in Nashville, Tenn., said that recent concerns that regular sunscreen use can limit vitamin D intake are unfounded.
"If you're out and you're getting sun, you're getting vitamin D," McDonald said. "After 30 to 40 minutes, it's getting through [sunscreen]."
Incidental sun exposure, such as walking to a bus stop, can provide an opportunity to get vitamin D, even when wearing sunscreen, as can dietary supplements and foods such as fish, eggs and fortified milk.
But even among sunscreen users, more than half the respondents reported mild or severe sunburn in the past two years because they misjudged the sun's strength or how long they had been exposed.
McDonald pointed out that sun strength is difficult to judge because it can depend on so many factors, including the season, the time of day and your latitude.
The survey reported that women were more likely to use sunscreen than men and that parents were more conscientious about putting sunscreen on their children than they were about putting it on themselves.
Even so, 27 percent of parents with children under 12 said they seldom apply sunscreen on their children when they are outside for two to four hours. And 14 percent said they don't apply sunscreen on their kids even when they are outside for more than four hours.
"People might feel a little bit of sun is healthy," McDonald said. "They want to get sun and then put on sunscreen. But that is not really the case."