There is concern that rural residents may be less likely to engage in behaviors to reduce their risk for skin cancer compared with urban residents.

First, we sought to determine whether rural residents are less likely to use sunscreen and engage in other skin cancer preventive measures. Second, we sought to determine whether such actions are sufficiently explained by factors known to affect these behaviors or whether such actions are affected by rurality.

We analyzed the 2005 Health Information National Trends Survey, a survey of the noninstitutionalized, adult population performed by the National Cancer Institute. We used logistic regression analysis to adjust for confounding by age, race, income, education, health insurance, smoking, sex, marital status, and region.

Compared with urban residents, rural residents were 33% less likely (odds ratio = 0.67; 95% confidence interval, 0.57-0.80) to wear sunscreen when exposed to the sun for more than 1 hour. After adjusting for the above confounding variables, however, rural individuals were just as likely as urban individuals to use sunscreen with sun exposure.

Inability to adjust for unmeasured confounding variables, such as occupational sun exposure, is a limitation.

Rural residents were less likely to use sunscreen. This decreased use of sunscreen, however, was explained by differences in age, race, income, education, and other confounding factors that negatively influence the use of sunscreen.