Only a third of the 10,079 youngsters surveyed said they routinely used sunscreen during the previous summer, and nearly 10 percent said they had used a tanning bed. Most reported having at least one sunburn during the previous summer, and half with multiple sunburns said it was worth it to get the tan that followed.
Research has shown that severe sunburns in childhood can significantly increase the risk later in life of developing melanoma, the most serious type of skin cancer; while the use of tanning beds has been linked to other skin cancers.
Studies have suggested that using sunscreen in childhood could reduce the risk of developing skin cancers other than melanoma in adulthood by as much as 78 percent, the researchers said.
More than one million Americans are diagnosed each year with skin cancer, and excess sun exposure is the leading cause. With rates rising nationwide, public health messages from the Centers for Disease Control and Prevention and the American Cancer Society have urged sun-protection measures for all ages, including using sunscreen and avoiding tanning beds.
However, they appear to have had minimal impact among youngsters, according to the study led by Boston University researcher Alan Geller. Results appear in the June issue of Pediatrics.
Geller said a stronger national effort is needed, akin to anti-smoking campaigns that have been credited with helping to reduce teen smoking.
Alexandra Tomlinson, a fair-skinned 14-year-old in suburban Detroit, said the reason she goes to tanning booths and lays out in the sun without sunscreen is simple: "I just think I look better when I'm tan and not white."
She said she has heard the warnings from her mother and in school, where teachers show pictures of prematurely wrinkled, sun-damaged skin, but the consequences are "too far off to worry about."
"Maybe showing us someone who does have skin cancer" would help, Tomlinson said.
In the study, boys and girls ages 12 to 18 filled out questionnaires in 1999 about "tan-seeking" behaviors during that year and the previous summer. The youngsters were children of participants in a national study of female nurses. Though they were mostly white and middle-class and were not randomly selected, Geller said the results likely can be generalized to other teens.
While girls were much more likely than boys to report sunscreen use — 40 percent versus 26 percent - they also were more likely to have been sunburned at least three times. Girls also were far more likely to have used a tanning salon or tanning bed, 14 percent versus 2 percent for boys.
Dr. Martin Weinstock, a Brown University dermatology professor and head of the American Cancer Society's skin cancer advisory group, said changing the cultural norm will require time and novel methods.
"If you just tell people, wag your finger at them and say, 'You ought to wear sunscreen,' it has very little effect, particularly with teen-agers," said Weinstock, who was not involved in the study.
The study was funded by grants from the National Institutes of Health, the CDC and the Association of Teachers of Preventive Medicine.