Simran Kaur, MD; Eva M. Shelton, MD; Alexa Figueroa Baiges, BS; Janmesh D. Patel, BS; Yaohui Gloria Xu, MD, PhD
WMJ. 2025;124(2):83-84.
To the Editor:
Skin cancer, including basal cell carcinoma, squamous cell carcinoma, and melanoma, is the most common form of cancer in the United States.1 Fortunately, effective sun protection can reduce the risk–especially for melanoma, the deadliest type.1 In Wisconsin, rural residents make up 26% of the population and are particularly vulnerable to sun damage, especially those in high-risk occupations like farming.1-3 Despite this heightened risk, sunscreen use remains suboptimal in rural communities.2,3
Rural communities often struggle with sunscreen accessibility due to barriers in education, diagnosis, and socioeconomic status.2 Our research aimed to quantify these disparities by evaluating sunscreen availability, affordability, and geographic accessibility in urban and rural Wisconsin counties.
We surveyed sunscreen products online from Banana Boat, Neutrogena, CeraVe, and Cetaphil at Walmart, Target, Walgreens, and CVS in 9 urban and rural counties in Wisconsin.4 (See Figure in full-text pdf). Product availability and price per fluid ounce were compared. Geographic accessibility was assessed by measuring the distance from each retailer to the nearest city center. Data analysis included the Mann-Whitney U test and Shapiro-Wilk normality test.
Results show significant disparities in sunscreen availability between urban and rural locations. (See Table in full-text pdf.) Urban retailers stocked 288 out of 413 surveyed products, while rural retailers offered fewer options (eg, Sauk County: 19 products vs Dane County: 40 products, 47.5% of urban selection). Menominee, Buffalo, and Bayfield counties had no sunscreen products due to the absence of retail stores. Walmart carried the greatest number of overall products, while CVS carried the fewest. This coincides with geographic accessibility as CVS showed the largest disparity (7 urban stores vs 1 rural store). The average cost per fluid ounce of sunscreen was similar in urban ($5.70) and rural ($5.32) areas (P = 0.598). However, rural residents had a lower median household income ($68,699) compared to urban ($80,622), limiting their purchasing power and furthering disparities.5 Rural counties averaged 22.62 miles to a large retailer, compared to 5.44 miles in urban counties, increasing travel burdens.
Limited product availability, diminished income, and greater travel distances impede sun protection efforts among rural populations. Addressing these disparities include policy initiatives to enhance product accessibility, incentivize retailer participation, and raise awareness about the importance and proper application of sunscreen.
Limitations include variations of online versus in-store pricing, exclusion of small retailers, and cross-sectional nature of data collection. Future research includes expanding to other states and monitoring product availability and pricing throughout all seasons.
REFERENCES
- Yu SY, Hirsch A, Zaslavsky O, Cochrane BB. Risk factors and early prevention of skin cancer in rural older outdoor workers: A scoping review. Geriatr Nurs. 2023;54:37-45. doi:10.1016/j.gerinurse.2023.08.017
- Wisconsin Office of Rural Health. Rural Wisconsin Demographics 2022. Published January 2022. Accessed May 11, 2025. https://worh.org/wp-content/uploads/2022/01/Rural-WI-Demographics-2022.pdf
- Wu YP, Parsons B, Jo Y, et al. Outdoor activities and sunburn among urban and rural families in a Western region of the US: Implications for skin cancer prevention. Prev Med Rep. 2022;29:101914. doi:10.1016/j.pmedr.2022.101914
- WISH: Urban and Rural Counties. Wisconsin Department of Health Services. Updated April 25, 2024. Accessed May 11, 2025. https://www.dhs.wisconsin.gov/wish/urban-rural.htm
- HDPulse: An Ecosystem of Minority Health and Health Disparities Resources. National Institute on Minority Health and Health Disparities. Accessed May 11, 2025. https://hdpulse.nimhd.nih.gov