Sun protection and sun exposure habits among tattooed individuals

Background: Little is known about sun-exposure and sun-protection behaviors among tattooed individuals. Objectives: This study sought to investigate the sun-exposure and sun-protective habits among tattooed individuals. Methods: Population-based study using a representative sample of the general population aged >= 18 years from four countries (Brazil, China, Russia and United-States). All participants were asked to fill in a digital structured questionnaire. We inquired about socio-demographics, self-evaluation of their skin phototype (from I to VI), tattoo(s) and sun-exposure and sun-protection habits. Results: A total of 9031 adult participants responded to the questionnaire of whom 1682 (18.6%) had >= 1 tattoo(s). The prevalence of tattoos was significantly higher among individuals with lighter skin tone (phototype I to III, 20.2%) compared to those with darker one (phototype IV to VI, 13.9%, p<0.001). Almost 20% percent of the tattooed individuals acknowledged heavy lifestyle sun-exposure compared to 11% of those without tattoos (p<0.001). Multinomial analyses showed that Brazilians and those having >= 1 tattoo were more likely to have intermediate and intense lifestyle sun-exposure. Tattooed individuals were more likely to report that they used regular or occasional sun-protection methods than non-tattooed individuals (p < 0.001 and 0.016 respectively). Multinomial analyses for regular sun-protection methods showed significant association with respondents from Brazil and those having one tattoo, but not more than one tattoo. Limitations include mainly that this is a questionnaire-based study and and we lack of questions about sunburns and skin cancers. Conclusions: This large population-based study shows that tattooed individuals do have a heavily sun-exposed lifestyle but, at the same time, display sun-protection habits.