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Algarin YA, Jaalouk D, Pulumati A, Nouri K. The Impact of Acculturation on Skin Cancer Risk and Protective Behaviors in Hispanic Populations. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2024; 39:315-324. [PMID: 38393448 DOI: 10.1007/s13187-024-02413-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/12/2024] [Indexed: 02/25/2024]
Abstract
The US Hispanic population faces rising skin cancer risks and poorer clinical outcomes, despite lower incidence rates. Acculturation, adopting elements of the dominant culture, may influence skin cancer attitudes and behaviors among Hispanics. We systematically reviewed PubMed articles from 2000 to 2023. Peer-reviewed English articles that assessed the relationship between acculturation and skin cancer in the Hispanic population were included. Andreeva et al. observed that lower acculturation levels correlated with increased use of shade and protective clothing (P < 0.05). More acculturated Latinos were more likely to use sunscreen, but this association weakened after adjusting for covariates (P > 0.48). Heckman et al. highlighted significant differences in skin cancer concern among Hispanic youth, with less acculturated individuals expressing greater worry (P < 0.05). Coups et al. found that higher acculturation was linked to less sun protective clothing usage and more frequent sunburns. Their subsequent online survey indicated that English-acculturated Hispanics engaged less in protective behaviors. Viola et al. reported that English-acculturated Hispanics perceived greater suntan benefits and had lower perceptions of skin cancer risk, severity, and concerns about photo-aging, along with higher melanoma risk factors, compared to Spanish-acculturated Hispanics. Acculturation influences skin cancer attitudes and behaviors in Hispanics. Tailored interventions based on acculturation levels are essential to reduce skin cancer risk. For example, educating English-acculturated Hispanics about skin cancer risks and prioritizing knowledge dissemination for Spanish-acculturated individuals may be effective approaches. These findings emphasize the need for targeted skin cancer prevention efforts to address disparities among US Hispanics.
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Affiliation(s)
- Yanci A Algarin
- Eastern Virginia Medical School, Norfolk, VA, USA.
- Department of Dermatology and Cutaneous Surgery, University of Miami Leonard M. Miller School of Medicine, Miami, FL, USA.
| | - Dana Jaalouk
- Department of Dermatology and Cutaneous Surgery, University of Miami Leonard M. Miller School of Medicine, Miami, FL, USA
| | - Anika Pulumati
- University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA
- Department of Dermatology and Cutaneous Surgery, University of Miami Leonard M. Miller School of Medicine, Miami, FL, USA
| | - Keyvan Nouri
- Department of Dermatology and Cutaneous Surgery, University of Miami Leonard M. Miller School of Medicine, Miami, FL, USA
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Noriega Esquives BS, St George SM, Moreno PI, Lee TK, Munoz E, Lad T, Pollack A, Hollowell CMP, Ramirez AG, Penedo FJ. A latent class analysis of health behavior changes after cancer diagnosis among Hispanic/Latino cancer survivors. J Cancer Surviv 2024; 18:739-749. [PMID: 36459380 PMCID: PMC10441686 DOI: 10.1007/s11764-022-01300-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 11/10/2022] [Indexed: 12/03/2022]
Abstract
PURPOSE We aimed to identify subgroups of Hispanic/Latino (H/L) cancer survivors with distinct health behavior patterns and their associated sociodemographic, medical, and psychosocial characteristics. METHODS Baseline data were used from a randomized clinical trial evaluating the efficacy of an enhanced patient navigation intervention in H/L cancer survivors. Participants (n = 278) completed the Lifestyle Behavior Scale and validated questionnaires on health-related quality of life (HRQOL), supportive care needs, distress, and satisfaction with cancer care. Latent class analysis was used to determine the latent classes and associated characteristics. RESULTS Three latent classes emerged: class 1 (survivors who increased health behaviors [e.g., exercising and eating healthy] since diagnosis); class 2 (no changes in health behaviors since diagnosis); and class 3 (a "mixed class," with a higher or lower engagement across various health behaviors since diagnosis). Participants in class 1 were significantly more educated and less likely to be foreign born. Participants in class 2 were significantly older and more likely to have prostate cancer. H/L cancer survivors in class 3 had a significantly lower income, were less educated, and reported greater unmet supportive care needs, more distress, and poorer HRQOL. CONCLUSIONS Survivors who report engaging in health behaviors less frequently since diagnosis may be experiencing psychosocial challenges and health disparities. IMPLICATIONS FOR CANCER SURVIVORS Hispanic/Latino cancer survivors may benefit from screening for social determinants of health and mental health needs, prompt referral to supportive care services, community resources, and public services, and participating in culturally informed psychosocial interventions to address their unique needs.
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Affiliation(s)
| | - Sara M St George
- Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, USA
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, USA
| | - Patricia I Moreno
- Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, USA
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, USA
| | - Tae Kyoung Lee
- Department of Child Psychology and Education, Sungkyunkwan University, Seoul, South Korea
| | - Edgar Munoz
- Institute for Health Promotion Research, UT Health San Antonio, San Antonio, USA
| | - Thomas Lad
- Department of Oncology, Cook County Health and Hospital Systems, Chicago, USA
| | - Alan Pollack
- Department of Radiation Oncology, University of Miami Miller School of Medicine, Miami, USA
| | | | - Amelie G Ramirez
- Institute for Health Promotion Research, UT Health San Antonio, San Antonio, USA
| | - Frank J Penedo
- Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, USA.
- Department of Psychology, University of Miami, Coral Gables, USA.
- Department of Medicine, University of Miami Miller School of Medicine, Miami, USA.
- University of Miami Don Soffer Clinical Research Center, 1120 NW 14Th Street, 15th Floor, Miami, FL, 33136, USA.
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Rivera Rivera JN, Lacson JCA, Kim Y, Roetzheim RG, Sutton SK, Soto-Torres B, Vadaparampil ST, Kanetsky PA. Sharing and seeking information about skin cancer risk and prevention among Hispanic people from Florida and Puerto Rico. PEC INNOVATION 2023; 3:100232. [PMID: 38028436 PMCID: PMC10679524 DOI: 10.1016/j.pecinn.2023.100232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Revised: 10/02/2023] [Accepted: 11/11/2023] [Indexed: 12/01/2023]
Abstract
Objective To explore factors associated with communication and information-seeking after receipt of skin cancer prevention information among Hispanic individuals. Methods Multivariable logistic regression was used to analyze existing data on demographics, personal experience, salience, and beliefs variables collected from Hispanic individuals to determine independent associations with sharing and seeking information about skin cancer prevention. Results Of 578 participants, 53% reported any communication about skin cancer prevention behaviors or skin cancer genetic risk; and 31% and 21% sought additional information about preventive behaviors or genetic risk, respectively. Female sex, greater perceived severity, higher comparative chance of getting skin cancer, and lower health literacy were associated with greater communication, while having no idea of one's own skin cancer risk was related to less communication. Greater health numeracy and higher cancer worry were associated with information-seeking about prevention behaviors and genetic risk. Conclusion Up to half of participants reported communication or information-seeking, although factors associated with specific activities differed. Future studies should evaluate how to promote communication behaviors in the Hispanic community and how sharing and seeking information influence an individual's network prevention practices. Innovation Several factors related to communication behaviors among Hispanic people after obtaining skin cancer prevention information were identified.Trial registration: This trial was registered on clinicaltrials.gov (NCT03509467).
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Affiliation(s)
- Jessica N. Rivera Rivera
- Department of Health and Behavioral Outcomes, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, United States of America
- Health Care Delivery Research, MedStar Health Research Institute, Washington, DC, United States of America
| | - John Charles A. Lacson
- Department of Cancer Epidemiology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, United States of America
| | - Youngchul Kim
- Department of Biostatistics and Bioinformatics, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, United States of America
| | - Richard G. Roetzheim
- Department of Family Medicine, Morsani College of Medicine, University of South Florida, Tampa, FL, United States of America
| | - Steven K. Sutton
- Department of Biostatistics and Bioinformatics, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, United States of America
| | - Brenda Soto-Torres
- Public Health Program, Ponce Health Sciences University, Ponce, PR, United States of America
| | - Susan T. Vadaparampil
- Department of Health and Behavioral Outcomes, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, United States of America
| | - Peter A. Kanetsky
- Department of Cancer Epidemiology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, United States of America
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Lacson JCA, Soto-Torres B, Sutton SK, Doyle SH, Kim Y, Roetzheim RG, Vadaparampil ST, Kanetsky PA. Skin cancer prevention behaviors, beliefs, distress, and worry among hispanics in Florida and Puerto Rico. BMC Public Health 2023; 23:2234. [PMID: 37957686 PMCID: PMC10644628 DOI: 10.1186/s12889-023-17039-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 10/21/2023] [Indexed: 11/15/2023] Open
Abstract
BACKGROUND Incidence of skin cancer has been increasing among U.S. Hispanics, who often are diagnosed with larger lesions and at later stage disease. Behaviors to decrease exposure to ultraviolet radiation can reduce risk of skin cancer. We describe skin cancer prevention behaviors and psychosocial variables among Hispanic participants recruited into a skin cancer prevention trial. METHODS Self-reported Hispanic participants from eight primary care clinics in Tampa, Florida and Ponce, Puerto Rico were recruited into a randomized controlled prevention trial. Information on demographics, sun-related behaviors, and psychosocial variables were collected before intervention materials were provided. Multivariable regression models were used to compare baseline sun-related behaviors and psychosocial variables across groups defined by geographic location and language preference. RESULTS Participants reported low levels of intentional outdoor tanning, weekday and weekend sun exposure, and very low levels of indoor tanning. However, only a minority of participants practiced sun-protective behaviors often or always, and about 30% experienced a sunburn in the past year. Participants had low levels of recent worry and concern about skin cancer, modest levels of perceived risk and severity, and high levels of response efficacy and self-efficacy. When comparing across groups defined by geographic location and language preference, English-preferring Tampa residents (hereafter referred to as Tampeños) had the highest proportion who were sunburned (35.9%) and tended toward more risky behavior but also had higher protective behavior than did Spanish-preferring Tampeños or Puerto Ricans. Spanish-preferring Puerto Ricans had higher recent concern about skin cancer, comparative chance of getting skin cancer, and response efficacy compared to either English- or Spanish-preferring Tampeños. Spanish-preferring Tampeños had the highest levels of familism and recent distress about skin cancer. CONCLUSIONS Our results mirror previous observations of low levels of sun-protective behavior among U.S. Hispanics compelling the need for culturally appropriate and translated awareness campaigns targeted to this population. Because Hispanics in Tampa and Puerto Rico reported modest levels of perceived risk and severity, and high levels of response efficacy and self-efficacy, interventions aiming to improve skin cancer prevention activities that are anchored in Protection Motivation Theory may be particularly effective in this population subgroup.
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Affiliation(s)
- John Charles A Lacson
- Department of Cancer Epidemiology, H. Lee Moffitt Cancer Center & Research Institute, 12902 Magnolia Dr., MRC 213, Tampa, FL, 33612, US
| | | | - Steven K Sutton
- Department of Biostatistics and Bioinformatics, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, US
| | - Scarlet H Doyle
- Department of Cancer Epidemiology, H. Lee Moffitt Cancer Center & Research Institute, 12902 Magnolia Dr., MRC 213, Tampa, FL, 33612, US
| | - Youngchul Kim
- Department of Biostatistics and Bioinformatics, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, US
| | - Richard G Roetzheim
- Department of Family Medicine, Morsani College of Medicine, University of South Florida, Tampa, FL, US
| | - Susan T Vadaparampil
- Department of Health Outcomes and Behavior, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, US
| | - Peter A Kanetsky
- Department of Cancer Epidemiology, H. Lee Moffitt Cancer Center & Research Institute, 12902 Magnolia Dr., MRC 213, Tampa, FL, 33612, US.
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Camacho I, Biro M, Stevenson ML, Deng M. Characteristics of Hispanic patients with nonmelanoma skin cancer undergoing Mohs micrographic surgery: a review of the literature. Int J Dermatol 2023; 62:1317-1323. [PMID: 37737563 DOI: 10.1111/ijd.16855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 08/30/2023] [Accepted: 09/08/2023] [Indexed: 09/23/2023]
Abstract
BACKGROUND Nonmelanoma skin cancer (NMSC) is the most common cancer worldwide and is frequently treated with Mohs micrographic surgery (MMS); however, data regarding characteristics of Hispanic patients undergoing MMS for NMSC are limited. OBJECTIVE To review the characteristics of Hispanic patients undergoing MMS for NMSC in the United States. METHODS A systematic review of PubMed articles from inception through September 2022 providing data for Hispanic patients undergoing MMS for NMSC was completed. RESULTS Overall, six publications met inclusion criteria and provided data for 2,856 Hispanic patients that underwent MMS for 2,955 NMSCs. Results demonstrate 60% of Hispanic patients were male, and the majority of NMSCs were basal cell carcinoma (BCC) (71%), followed by squamous cell carcinoma (SCC) (21%). Additionally, a larger percentage of pigmented BCC was found in the Hispanic population. While there is conflicting data in the literature, Hispanic patients may also have larger MMS defects when controlled for additional variables. Finally, over 64% of NMSCs in Hispanic patients were in high-risk locations. CONCLUSION Literature regarding the characteristics of Hispanic patients undergoing MMS for NMSC demonstrates most patients were male, BCC was the most common tumor subtype, and the majority of NMSCs were in high-risk locations.
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Affiliation(s)
- Isabella Camacho
- Department of Dermatology, MedStar Washington Hospital Center, Washington, DC, USA
- Department of Dermatology, MedStar Georgetown University Hospital, Washington, DC, USA
| | - Mark Biro
- Department of Dermatology, MedStar Washington Hospital Center, Washington, DC, USA
- Department of Dermatology, MedStar Georgetown University Hospital, Washington, DC, USA
| | - Mary L Stevenson
- The Ronald O. Perelman Department of Dermatology, New York University Langone Medical Center, NY, New York, USA
| | - Min Deng
- Department of Dermatology, MedStar Washington Hospital Center, Washington, DC, USA
- Department of Dermatology, MedStar Georgetown University Hospital, Washington, DC, USA
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Gianola M, Llabre MM, Gallo LC, Daviglus ML, Sotres-Alvarez D, Schneiderman N. Language Preference and its Moderating Role in Coping with Stress: The Hispanic Community Health Study/Study of Latinos. MEDICAL RESEARCH ARCHIVES 2023; 11:10.18103/mra.v11i10.4625. [PMID: 38846550 PMCID: PMC11156427 DOI: 10.18103/mra.v11i10.4625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/09/2024]
Abstract
Stress and stressful events are widely accepted risk factors for cardiometabolic diseases, including coronary heart disease and diabetes. As language plays a seminal role in development and regulation of emotions and appraisals of stressful situations, it may contribute to documented differences in the stress-cardiometabolic disease association across ethnic groups. We investigated associations between language preferences (Spanish vs English) and downstream health consequences of stress. Using data from the Sociocultural Ancillary Study of the Hispanic Community Health Study/Study of Latinos, we assessed the relationship between reported stress and risk factors (alcohol use, smoking, body mass index, depressive symptoms) and prevalence of self-reported (coronary heart disease, stroke, chronic obstructive pulmonary disease [COPD]) and clinically assessed chronic conditions (diabetes, hypertension) among 5154 Hispanic/Latino adults living in the US. Factor analysis was used to calculate a composite stress variable from participants' self-reported chronic stress, perceived stress, and adverse childhood experiences. Sampling weights and survey methodology were integrated in all analyses to account for this study's complex survey design. After controlling for sociodemographic factors (Hispanic/Latino background, study site, years in the US, social acculturation, education, income, age, sex), higher composite stress scores were associated with elevated risk factors and greater prevalence of coronary heart disease, diabetes, and COPD. Furthermore, the relationship between stress and COPD was significantly stronger among Hispanic/Latino adults who preferred to be interviewed in Spanish (compared to English). Stronger connections between stress and likelihood of drinking alcohol among English-preferring persons also emerged. These results are interpreted in light of the Hispanic health paradox and the role of cultural processes in the development of health risk factors and chronic conditions. Our findings can be integrated into relevant approaches to address health disparities within and across Hispanic/Latino populations in the US.
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Tsai J, Chien AL. Reinforcing Photoprotection for Skin of Color: A Narrative Review. Dermatol Ther (Heidelb) 2023; 13:1935-1958. [PMID: 37495857 PMCID: PMC10442306 DOI: 10.1007/s13555-023-00982-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 07/11/2023] [Indexed: 07/28/2023] Open
Abstract
Skin of color (SOC) is characterized by increased tendency for tanning and decreased likelihood of sunburns due to the attenuation of sunlight by epidermal melanin. Although this contributes to the decreased incidence of skin cancer among SOC populations, individuals with SOC remain susceptible to various health consequences associated with sun exposure, including non-melanoma skin cancer, photoaging, pigmentary disorders, and photodermatoses - many of which not only present differently, but also disproportionately affect SOC. Prior epidemiological studies have found lower prevalence of sun protection behaviors among individuals with SOC, particularly in sunscreen use, signifying an unmet area for improvement in the prevention of sun-induced dermatologic conditions in these populations. The objective of this narrative review was to summarize the biology and health consequences of sun exposure in SOC, as well as cognitive and behavioral factors that affect the practice of photoprotection behaviors in SOC populations. We also review prior interventions that have been used to enhance photoprotection knowledge and behaviors among individuals with SOC, either in racially and ethnically diverse communities or within specific SOC populations.
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Affiliation(s)
- Jerry Tsai
- Department of Dermatology, Johns Hopkins University School of Medicine, 601 N Caroline Street, Suite 8060C, Baltimore, MD, 21287, USA
| | - Anna L Chien
- Department of Dermatology, Johns Hopkins University School of Medicine, 601 N Caroline Street, Suite 8060C, Baltimore, MD, 21287, USA.
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Validity of a Self-Assessment Skin Tone Palette Compared to a Colorimeter for Characterizing Skin Color for Skin Cancer Research. Curr Oncol 2023; 30:3189-3200. [PMID: 36975454 PMCID: PMC10047066 DOI: 10.3390/curroncol30030241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 12/28/2022] [Accepted: 02/27/2023] [Indexed: 03/11/2023] Open
Abstract
Our goal is to determine whether our objective 9-point Self-Assessment Skin Tone Palette (SASTP) is correlated with a colorimeter’s assessment of a melanin index, so that Hispanic and Black people can be included in skin cancer research where scales were developed for White populations. Subjects were asked to self-identify their skin tones using the SASTP. This study assessed the criterion validity of the SASTP by measuring a range of skin colors compared to a melanin index reported from a colorimeter for the upper-inner arm (non-sun-exposed skin color), and the outer forearm (sun-exposed). Among 188 non-artificial tanners, 50% were White, 30% were Hispanic or White-Hispanic, and 20% were other racial categories. Meanwhile, 70% were female (30% male) and 81% were age 18–29 (19% age 30+). The mean melanin of the upper-inner arm decreased with lighter skin color and stronger tendency to burn. The SASTP in comparison to melanin index values was correlated for both the upper-inner arm (r = 0.81, p < 0.001) and the outer forearm (r = 0.77, p < 0.001). The SASTP provides a 9-point scale that can be considered as an alternative, less expensive method that is comparable to the objective colorimeter melanin index, which may be useful in studies on skin cancer among White, non-White, and Hispanic peoples.
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Niu Z, Heckman CJ. Digital Educational Strategies to Teach Skin Self-examination to Individuals at Risk for Skin Cancer. JOURNAL OF HEALTH COMMUNICATION 2022; 27:790-800. [PMID: 36625227 DOI: 10.1080/10810730.2022.2157910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
Skin cancer is the most common cancer in the United States, and early detection of melanoma may lead to diagnosis of thinner and more treatable cancers, resulting in improved survival rates. This study examined the effects of message interactivity (high vs. low) and imagery (cartoon, real human character, or customized imagery preference) on accuracy of identifying abnormal skin lesions (ASL) and skin self-examination (SSE) intention. This study employed a 3 (cartoon character vs. real person vs. customization) x 2 (high interactivity vs. low interactivity) between-subjects online experimental design. Participants at risk for skin cancer were randomly assigned to one of the six conditions and completed a survey after reviewing the educational materials. Univariate analyses were conducted to detect group differences on the accuracy of identifying ASL and intention to conduct SSE in the next 3 months. Among 321 participants who completed the study, the mean age was 36.61 years, 56.7% were females, 76.1% had a college or higher degree, and over 60% self-identified as non-Hispanic White. Individuals in the high interactivity and customization group (compared to the low interactivity and cartoon group) were more likely to accurately identify ASL. Individuals in the high interactivity and customization or low interactivity and real person imagery groups (compared to the low interactivity and cartoon group) reported higher intention to conduct SSE in the next 3 months. These results suggest that customization and interactivity may be beneficial for educational programs or intervention design to improve both melanoma identification and SSE intention.
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Affiliation(s)
- Zhaomeng Niu
- Department of Health Informatics, Rutgers School of Health Professions, Piscataway, New Jersey, United States
| | - Carolyn J Heckman
- Section of Behavioral Sciences, Division of Medical Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey, United States
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Shao K, Feng H. Racial and Ethnic Healthcare Disparities in Skin Cancer in the United States: A Review of Existing Inequities, Contributing Factors, and Potential Solutions. THE JOURNAL OF CLINICAL AND AESTHETIC DERMATOLOGY 2022; 15:16-22. [PMID: 35942012 PMCID: PMC9345197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Objective Racial and ethnic health disparities affect the diagnosis and management of melanoma and nonmelanoma skin cancers, leading to deleterious outcomes. Non-Hispanic White patients make up the majority of skin cancers cases, yet racial and ethnic minorities have poorer prognoses and outcomes. The skin cancer literature is fragmented with regards to potential contributors to these healthcare disparities. In this article, we provide a comprehensive review of the skin cancer literature to briefly quantify racial and ethnic inequities, highlight contributing factors, and propose practical changes that can be made. Methods A PubMed search was completed to identify articles related to racial and ethnic health care disparities in the context of melanoma, basal cell carcinoma, squamous cell carcinoma, Merkel cell carcinoma, and dermatofibrosarcoma protuberans. Results Relative to non-Hispanic White patients, patients of racial and ethnic minorities have differing clinical presentations of skin cancers and genetic risk factors. Insurance, access to specialty care, cultural beliefs, and available educational resources further contribute to racial and ethnic disparities. Limitations We are limited to the level of detail provided in the existing literature, and at some times are unable to distinguish race of Hispanic populations. We also acknowledge that there are different nationalities grouped under these broad labels as well as multi-racial populations that may not be accounted for. Conclusion Awareness of and familiarization with innate factors and potentially more modifiable contributors can help inform efforts to close the observed gap in racial and ethnic inequities.
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Affiliation(s)
- Kimberly Shao
- Both authors are with the Department of Dermatology at University of Connecticut, Farmington, Connecticut
| | - Hao Feng
- Both authors are with the Department of Dermatology at University of Connecticut, Farmington, Connecticut
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Abstract
Photoprotection behaviors can mitigate skin damage caused by ultraviolet radiation, and common methods include seeking shade, avoiding sun exposure during peak daylight hours, wearing sun-protective clothing, applying sunscreen, and using sunglasses. While the role of sun protection in preventing sunburns, photoaging, and skin cancer is well established in fair-skinned populations, individuals with skin of color (SOC) are presumed to suffer fewer negative effects from solar radiation. Thus, the importance of photoprotection in this population is understudied and may be underestimated. In SOC populations, sun exposure is known to cause pigmentary disorders, photoaging, and basal cell carcinoma (BCC), highlighting the potential benefits of photoprotection. Although SOC populations tend to practice photoprotection by seeking shade and wearing sun-protective clothing, survey and interview-based studies have consistently found relatively low use of sunscreen among these populations. Common motivators for photoprotection in individuals with SOC include preventing sunburn and pigmentation, with the prevention of skin cancer being a less important reason. As a skin cancer risk behavior, indoor tanning is relatively rare in SOC populations, but its use may increase with acculturation to US norms. While more studies are necessary to clarify whether photoprotection behaviors may decrease skin cancer-related mortality in SOC populations, regular dermatologic care and counseling on photoprotection remain essential in patients with SOC for overall skin health.
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Sunburns and Sun Protection Behaviors among Male Hispanic Outdoor Day Laborers. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19052524. [PMID: 35270218 PMCID: PMC8909209 DOI: 10.3390/ijerph19052524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 02/13/2022] [Accepted: 02/18/2022] [Indexed: 12/10/2022]
Abstract
Individuals who work outside are at increased risk for skin cancer due to excessive exposure to ultraviolet (UV) radiation. Little is known about UV exposures and sun safety practices of outdoor day laborers, who are disproportionately Hispanic. This study identified the correlates of sunburn and sun protection behaviors in a sample of male, Hispanic day laborers (n = 175). More than half of the participants (54.9%) experienced one or more sunburns when working during the past summer, and 62.9% reported having one or more symptoms of heat illness. The frequency of engaging in sun protection behaviors was suboptimal, including sunglasses use (M = 2.68, SD = 1.71), staying in the shade (M = 2.30, SD = 0.94), wearing sunscreen (M = 2.10, SD = 1.39), and wearing a wide-brimmed hat (M = 1.75, SD = 1.32), based on a 5-point scale (1 = never; 5 = always). Lower education level, higher levels of skin sensitivity to the sun, any symptom of heat illness, fewer barriers to wearing a wide-brimmed hat, and not wearing a wide-brimmed hat were associated with a greater number of sunburns. Factors associated with each sun protection behavior varied. Implications and directions for future research are discussed.
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Bowers JM, Hamilton JG, Wu YP, Moyer A, Hay JL. Acculturation, Sun Tanning Behavior, and Tanning Attitudes Among Asian College Students in the Northeastern USA. Int J Behav Med 2022; 29:25-35. [PMID: 33942255 PMCID: PMC9272584 DOI: 10.1007/s12529-021-09993-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/19/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND College students participate in high levels of tanning, a skin cancer risk behavior due to ultraviolet radiation exposure, yet little is known about Asian college students' behavior. This study examined the relationship between tanning attitudes, acculturation to the USA (cultural assimilation), and tanning behavior. METHOD An online survey was used to recruit 211 Asian college students in the northeastern USA (47.4% born outside of the USA) to respond to questions about recent tanning behavior, sun protection strategies, attitudes about tanning, and acculturation to the USA. RESULTS Attitudes about tanning, particularly desire for a darker skin tone and social norms, along with acculturation to the USA, were predictive of intentional tanning. The sample reported high levels of sun protection, which was associated with low acculturation. CONCLUSION The significant role of acculturation in this study indicates that it may be a useful factor to include in future tanning intervention studies of relevant populations.
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Affiliation(s)
- Jennifer M. Bowers
- Department of Psychology, Stony Brook University, 100 Nichols Road, Stony Brook, NY 11794-2500, USA,Department of Psychiatry & Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY 10022, USA
| | - Jada G. Hamilton
- Department of Psychiatry & Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY 10022, USA
| | - Yelena P. Wu
- Department of Dermatology, University of Utah, Salt Lake City, UT 84132, USA
| | - Anne Moyer
- Department of Psychology, Stony Brook University, 100 Nichols Road, Stony Brook, NY 11794-2500, USA
| | - Jennifer L. Hay
- Department of Psychiatry & Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY 10022, USA
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Sacksner JP, Kaundinya T, Daftary K, Jackson KL, Kundu RV. Skin tone preferences and their influence on skin care behaviors. Arch Dermatol Res 2022; 314:961-966. [PMID: 34985574 DOI: 10.1007/s00403-021-02320-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 12/15/2021] [Accepted: 12/22/2021] [Indexed: 11/02/2022]
Abstract
Knowledge regarding skin tone preferences and their influence on skincare behaviors among people of color is limited. The objective of this study was to determine whether there is a difference between ideal and actual skin tone among people of color and whether this difference is associated with tanning and sunscreen use. This was a one-time, voluntary, anonymous, electronic survey designed in REDCap and delivered through ResearchMatch, a national electronic, recruitment tool. Eligible participants were at least 18 years old and self-identified as Black, Asian, Latinx, American Indian/Alaskan Native or Mixed Race. In total, 548 completed survey results were analyzed using SAS. Only the Latinx population was found to have a significant preference for tanner skin (p < 0.05). The Latinx population had significantly more subjects that participated in outdoor tanning than both the Black (p < 0.0001) and Asian population (p < 0.05). Latinx participants who indicated a preference for tanner skin were 2.8 times more likely to never use sunscreen than those without this preference (OR = 2.821, CI = 1.029-7.732, p < 0.05). Our findings have implications for how dermatologists screen, treat, and educate Latinx and skin of color populations.
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Affiliation(s)
- Jamie P Sacksner
- Department of Dermatology, Northwestern University Feinberg School of Medicine, 676 North St. Clair, Suite 1600, Chicago, IL, 60611, USA
| | - Trisha Kaundinya
- Department of Dermatology, Northwestern University Feinberg School of Medicine, 676 North St. Clair, Suite 1600, Chicago, IL, 60611, USA. .,Northwestern University Feinberg School of Medicine, Chicago, IL, 60611, USA.
| | - Karishma Daftary
- Department of Dermatology, Northwestern University Feinberg School of Medicine, 676 North St. Clair, Suite 1600, Chicago, IL, 60611, USA
| | - Kathryn L Jackson
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, 60611, USA
| | - Roopal V Kundu
- Department of Dermatology, Northwestern University Feinberg School of Medicine, 676 North St. Clair, Suite 1600, Chicago, IL, 60611, USA
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15
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Boyas JF, Woodiwiss JL, Nahar VK. Examining intentions to engage in sun protective behaviors among Latino day laborers: An application of the theory of planned behavior. Health Promot Perspect 2021; 11:351-359. [PMID: 34660231 PMCID: PMC8501480 DOI: 10.34172/hpp.2021.45] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 06/11/2021] [Indexed: 11/09/2022] Open
Abstract
Background: The past two decades has revealed an unprecedented increasing incidence of skin cancer within the Latinx population. Although Latino day laborers (LDLs) are at heightened risk for developing skin cancer because of the outdoor work in which they engage, there is limited research examining their intentions to engage in sun protective behaviors (SPBs). Therefore, this study sought to assess the explanatory power of the theory of planned behavior (TPB) to identify attitudinal, subjective norms, and perceived behavioral control factors associated with intentions to engage in SPB among LDLs. Methods: This cross-sectional retrospective study consists of a non-random convenience,community-based, sample of 137 LDLs residing in Mississippi and Illinois. Data were collected using a self-report survey centered on health practices and sun-protective behaviors. Results: Findings revealed that five significant factors shaped intentions to engage in SPBs, including barriers to engaging in SPBs (β =.30, P<0.001), benefits of engaging in SPBs (β =.27,P<0.001), education (β=0.20, P<0.01), and acculturation (β=0.18, P≤0.05). The independent variables tested in the model accounted for 42% of the change in intentions to engage in SPBs. Conclusion: This study demonstrates TPB’s usefulness for predicting future intentions to engage in SPBs among LDLs. Moreover, the strongest factor associated with predicting intentions to engage in SPBs among LDLs was perceived behavioral control. Thus, since SPBs are malleable, emphasis is placed on implementing interventions for this population that promote intentions and address perceived behavioral control.
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Affiliation(s)
- Javier F Boyas
- School of Social Work, University of Georgia, 279 Williams St., Athens, GA, 30602, USA
| | - Jana L Woodiwiss
- School of Social Work, University of Georgia, 279 Williams St., Athens, GA, 30602, USA
| | - Vinayak K Nahar
- Department of Dermatology, University of Mississippi Medical Center, 2500 N., State St., Jackson, MS 39216, USA
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Cardona S, Calixte R, Rivera A, Islam JY, Vidot DC, Camacho-Rivera M. Perceptions and Patterns of Cigarette and E-Cigarette Use among Hispanics: A Heterogeneity Analysis of the 2017-2019 Health Information National Trends Survey. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:6378. [PMID: 34204687 PMCID: PMC8296202 DOI: 10.3390/ijerph18126378] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 06/07/2021] [Accepted: 06/10/2021] [Indexed: 12/19/2022]
Abstract
There are documented disparities in smoking behaviors among Hispanic adults in the U.S., but little is known about patterns of e-cigarette use. Using data from the HINTS 5 cycle 1-3, we examined cigarette and e-cigarette history and current use, as well as perceptions of the dangers of e-cigarette use relative to cigarette use. Primary predictors were Hispanic ethnic group, gender, age, education, income, and English language proficiency. Binary outcomes were modeled using the logit link, and multinomial outcome variables were modeled using generalized logit model. Fifty-three percent of participants were Mexican, 8% Puerto Rican, 4% were Cuban, and 35% identified as other Hispanics. Of the 1618 respondents, 23% were former cigarette smokers and 10% were current cigarette smokers. Twenty percent reported history of electronic cigarettes and 4% reported current use. In multivariable models, Hispanic women were significantly less likely to report ever being smokers compared to Hispanic men (aOR = 0.61, 95% CI = 0.42, 0.88). Puerto Ricans were 2.4 times as likely to report being current smokers (95% CI = 1.11, 5.11) compared to Mexicans. Among Hispanics, significant differences in e-cigarette and cigarette use behaviors emerged by gender, age, ethnicity, and cancer history, with implications for tailoring smoking prevention and cessation messages.
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Affiliation(s)
- Stephanie Cardona
- Department of Community Health Sciences, SUNY Downstate Health Sciences University, Brooklyn, NY 11203, USA;
| | - Rose Calixte
- Department of Epidemiology and Biostatistics, SUNY Downstate Health Sciences University, Brooklyn, NY 11203, USA;
| | - Argelis Rivera
- Department of Medicine, Mount Sinai Icahn School of Medicine, New York, NY 10009, USA;
| | - Jessica Yasmine Islam
- Cancer Epidemiology Program, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL 33612, USA;
| | - Denise Christina Vidot
- Sylvester Comprehensive Cancer Center, School of Nursing and Health Studies, University of Miami, Miami, FL 33146, USA;
| | - Marlene Camacho-Rivera
- Department of Community Health Sciences, SUNY Downstate Health Sciences University, Brooklyn, NY 11203, USA;
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17
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Niu Z, Tortolero-Luna G, Lozada C, Heckman CJ, Coups EJ. Correlates of Sun Protection Behaviors Among Adults in Puerto Rico. Int J Behav Med 2021; 29:36-45. [PMID: 33928477 DOI: 10.1007/s12529-021-09991-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/13/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND The incidence of skin cancer has been increasing in Puerto Rico in recent years. Sun protection behaviors are suboptimal among Puerto Ricans. However, there are limited data regarding major factors associated with Puerto Rican adults' sun protection behaviors. To examine factors associated with Puerto Rican adults' sun protection behaviors, a survey study was conducted in Puerto Rico. METHOD A population-based sample of 667 Puerto Rican adults completed a telephone survey in 2016. Survey items addressed potential correlates of sun protection behaviors. Hierarchical multiple regression analyses examining correlates of the sun protection behaviors index were conducted. RESULTS Higher levels of sun protection behaviors were found among English language acculturated compared to Spanish language acculturated individuals (p < .05) and among individuals with private versus no health insurance (p < .05). Higher levels of sun protection behaviors were found among individuals with greater skin cancer knowledge (p < .001), fewer sun protection barriers (p < .01), and greater sun protection self-efficacy (p < .001). CONCLUSION By identifying correlates of Puerto Rican adults' sun protection behaviors, this timely study provides insight on factors to target in future skin cancer interventions in this understudied population.
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Affiliation(s)
- Zhaomeng Niu
- Rutgers Cancer Institute of New Jersey, Rutgers, The State University of New Jersey, 195 Little Albany Street, New Brunswick, NJ, 08901, USA.
| | - Guillermo Tortolero-Luna
- Division of Cancer Control and Population Sciences, University of Puerto Rico Comprehensive Cancer Centre, San Juan, PR, USA
| | - Carolina Lozada
- Rutgers Cancer Institute of New Jersey, Rutgers, The State University of New Jersey, 195 Little Albany Street, New Brunswick, NJ, 08901, USA
| | - Carolyn J Heckman
- Rutgers Cancer Institute of New Jersey, Rutgers, The State University of New Jersey, 195 Little Albany Street, New Brunswick, NJ, 08901, USA
- Department of Medicine, Rutgers Robert Johnson Medical School, Rutgers, The State University of New Jersey, New Brunswick, NJ, USA
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18
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Associations between linguistic acculturation and skin cancer knowledge and beliefs among U.S. Hispanic adults. Prev Med Rep 2019; 15:100943. [PMID: 31338284 PMCID: PMC6627961 DOI: 10.1016/j.pmedr.2019.100943] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Revised: 06/10/2019] [Accepted: 06/28/2019] [Indexed: 11/30/2022] Open
Abstract
The incidence of melanoma among U.S. Hispanics is rising and Hispanics have poorer melanoma survival compared to non-Hispanic whites. Acculturation has been linked with skin cancer-related behaviors among Hispanic individuals, such that Hispanic individuals who are more acculturated to U.S. norms and attitudes have been found to use sunscreen more frequently, to seek shade and use sun protective clothing less often, to sunbathe and indoor tan more frequently, and to have more sunburns than less acculturated individuals. However, little is known about factors that may account for the effect of acculturation on such behaviors and outcomes. The goal of this study was to examine the association between linguistic acculturation and skin cancer-related knowledge and beliefs among Hispanic adults. 788 Hispanic adults completed an online survey measuring linguistic acculturation, sun protection knowledge, perceived skin cancer risk, perceived severity, perceived worry, skin color preference, perceived suntan benefits, photo-aging concerns, sun protection norms, tanning norms and skin cancer fatalism. Compared with Spanish-acculturated Hispanics, English-acculturated Hispanics had greater knowledge, lower levels of perceived risk of skin cancer, lower perceived severity of skin cancer, less worry about skin cancer, greater perceived suntan benefits, and lower photo-aging concerns. This study highlights the importance of considering an individual's level of acculturation when designing skin cancer prevention interventions. Additional research is warranted to develop and test culturally relevant, tailored interventions to reduce the risks of skin cancer among U.S. Hispanics.
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19
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Ziehfreund S, Schuster B, Zink A. Primary prevention of keratinocyte carcinoma among outdoor workers, the general population and medical professionals: a systematic review updated for 2019. J Eur Acad Dermatol Venereol 2019; 33:1477-1495. [PMID: 30801774 DOI: 10.1111/jdv.15525] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Accepted: 01/29/2019] [Indexed: 02/07/2023]
Abstract
Worldwide 2-3 million cases of keratinocyte carcinoma (KC) are diagnosed annually. Sun-related knowledge is essential for adequate protection against solar ultraviolet radiation (UVR), the main risk factor for KC. The goal was (i) to provide an updated overview of primary prevention against KC including skin cancer-related knowledge, attitudes and sun protection behaviour (SPB) of outdoor workers, the general population and medical professionals as well as (ii) to evaluate the effectiveness and acceptability of sun protection programmes. We conducted a systematic review of articles indexed for MEDLINE on PubMed using selected MeSH terms and keywords related to the studied topic as well as an extensive hand search of publications between 1 January 2012 and 31 December 2018. We identified 51 relevant cross-sectional studies and 22 interventional studies. Sun-related knowledge and attitude showed substantial differences with some alarming results, including people who had not even heard about skin cancer before. Reported SPB varied enormously between the included studies, with none of the studies providing an overall sufficient SPB in their examined sun protection measures. However, sun protection programmes using new technologies seem to have great potential to increase sun-related knowledge and SPB. In countries worldwide, particularly in those where KC is not yet a public health issue, UVR protection should be promoted by healthcare institutions and authorities, politicians, cancer foundations and dermatologists to increase awareness as well as SPB and to decrease the worldwide burden of KC.
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Affiliation(s)
- S Ziehfreund
- Department of Dermatology and Allergy, Technical University of Munich, Munich, Germany
| | - B Schuster
- Department of Dermatology and Allergy, Technical University of Munich, Munich, Germany
| | - A Zink
- Department of Dermatology and Allergy, Technical University of Munich, Munich, Germany
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20
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Ehrhardt MJ, Hochberg J, Bjornard KL, Brinkman TM. Long-term survivors of childhood, adolescent and young adult non-Hodgkin lymphoma. Br J Haematol 2019; 185:1099-1110. [PMID: 30714126 DOI: 10.1111/bjh.15775] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Progress in overall survival rates for childhood non-Hodgkin lymphoma (NHL) can be largely attributed to effective development and conduct of a number of international treatment studies. Knowledge gained from these studies has shifted the treatment paradigm from a "one-size fits all" strategy to a histologically dependent approach. More specifically, many now adhere to a risk-stratified approach, prescribing cumulative doses and intensities of chemotherapeutic exposures based upon the aggressiveness of disease. Moreover, recognition that high cure rates could be achieved without the use of radiation has eliminated the use of this modality in frontline settings for the majority of newly diagnosed children. These changes have contributed to the emergence of a heterogeneous group of NHL survivors. As the number of NHL survivors continues to increase, providers will encounter a wide spectrum of individuals whose risk for long-term complications are accordingly diverse. The following review summarizes the existing literature surrounding late effects, such as chronic health conditions, functional and neurocognitive performance outcomes, and health-related quality of life, that are unique to NHL survivors, as well as those extrapolated from the broader childhood cancer survivor population.
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Affiliation(s)
- Matthew J Ehrhardt
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, TN, USA.,Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Jessica Hochberg
- Department of Pediatrics, New York Medical College, Valhalla, NY, USA
| | - Kari L Bjornard
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Tara M Brinkman
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN, USA.,Department of Psychology, St. Jude Children's Research Hospital, Memphis, TN, USA
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21
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Calderón TA, Bleakley A, Jordan AB, Lazovich D, Glanz K. Correlates of sun protection behaviors in racially and ethnically diverse U.S. adults. Prev Med Rep 2018; 13:346-353. [PMID: 30792951 PMCID: PMC6369227 DOI: 10.1016/j.pmedr.2018.12.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Accepted: 12/16/2018] [Indexed: 02/07/2023] Open
Abstract
Although skin cancer incidence is highest among non-Hispanic Whites, minority populations are often diagnosed with more advanced stage disease and are more likely to experience poor outcomes. Fewer people of color do not practice primary prevention of skin cancer according to recommendations, but public health education and interventions to promote sun protection behaviors have consistently targeted non-Hispanic Whites. This study examines performance of sun protection behaviors in a multiethnic sample and whether demographic, lifestyle and psychosocial predictors of these behaviors differ by race and ethnicity. In this study, a probability-based sample of 1742 adults completed an online survey in 2015. Main outcomes of interest included sunscreen use, wearing a sleeved shirt, and seeking shade. We stratified the sample into racial/ethnic groups (White, Black, Hispanic, Asian) and investigated demographic, lifestyle and psychosocial correlates of these behaviors in each group. Differences in adjusted estimates from each behavior-specific model were tested across strata. Racial/ethnic groups were significantly different in regards to sunscreen use and wearing a sleeved shirt, but similarly engaged in seeking shade. Results from multivariate ordered logistic regression models for each behavior revealed important demographic, lifestyle and psychosocial predictors and the importance of some demographic correlates varied between racial/ethnic groups. This study provides insight into the practice and correlates of skin cancer prevention among a multiethnic sample. Our findings suggest that targeting public health education efforts and interventions to promote sun protection in minority populations may be a beneficial approach to addressing heightened skin cancer morbidity and mortality in these groups.
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Affiliation(s)
- Tirza Areli Calderón
- University of Pennsylvania Perelman School of Medicine, 423 Guardian Drive, Blockley Hall, Philadelphia, PA 19104, United States of America
| | - Amy Bleakley
- University of Pennsylvania Annenberg School for Communication, 3620 Walnut Street, Philadelphia, PA 19104, United States of America
| | - Amy B Jordan
- University of Pennsylvania Annenberg School for Communication, 3620 Walnut Street, Philadelphia, PA 19104, United States of America.,Rutgers University School of Communication and Information, 4 Huntington Street, New Brunswick, NJ 08901, United States of America
| | - DeAnn Lazovich
- University of Minnesota School of Public Health, 1300 South 2nd Street, Minneapolis, MN 55454, United States of America
| | - Karen Glanz
- University of Pennsylvania Perelman School of Medicine, 423 Guardian Drive, Blockley Hall, Philadelphia, PA 19104, United States of America
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22
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Cheng J, Widjajahakim R, Rajanala S, Maymone MBC, Secemsky E, Vashi NA. Effect of stimuli on sun protective habits: A randomized double-blind controlled study. PHOTODERMATOLOGY PHOTOIMMUNOLOGY & PHOTOMEDICINE 2018; 35:17-23. [PMID: 30058182 DOI: 10.1111/phpp.12416] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Revised: 06/17/2018] [Accepted: 07/16/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND Visual imagery has been shown to improve adherence to health messages but has scarcely been investigated in sun protection campaigns. OBJECTIVE To determine the effectiveness of pictorial- and textual-based sun protective messages in a largely Hispanic population. METHODS One hundred and forty-five participants received standard of care (SOC) as defined as sun protective counseling and were then randomized to receive either (a) images of sun damage, (b) a textual pamphlet about sun damage, or (c) no further messages. Analysis-of-variance tests for repeated measures were used to estimate the effects of the different stimuli on participants' knowledge and intention to sun protect. RESULTS All stimulus groups demonstrated an improvement in perceived effectiveness of sun protective habits (p < 0.05). However, pictorial and textual stimuli were both more effective than SOC in improving intentions to sun protect (p < 0.05), but there was no differential effect between the two. CONCLUSIONS Both pictorial and textual stimuli were more effective than SOC in improving intentions to sun protect, but there was no differential effect between the two.
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Affiliation(s)
- Judy Cheng
- Department of Dermatology, Boston University School of Medicine, Boston, Massachusetts
| | - Rafael Widjajahakim
- Department of Dermatology, Boston University School of Medicine, Boston, Massachusetts
| | | | - Mayra B C Maymone
- Department of Dermatology, Boston University School of Medicine, Boston, Massachusetts
| | - Eric Secemsky
- Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts
| | - Neelam A Vashi
- Department of Dermatology, Boston University School of Medicine, Boston, Massachusetts
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23
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Predictors of Sun Protective Behaviors among Latino Day Laborers. J Skin Cancer 2018; 2018:3454309. [PMID: 29623223 PMCID: PMC5829325 DOI: 10.1155/2018/3454309] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Revised: 11/22/2017] [Accepted: 12/17/2017] [Indexed: 12/04/2022] Open
Abstract
Objectives Despite the substantial solar ultraviolet radiation experienced by Latino day laborers, little attention has been given to factors that are associated with sun protective behaviors. The purpose of this study was to examine psychological and nonpsychological predictors of sun protective behaviors among Latino day laborers. Methods This cross-sectional study included a nonrandom sample of 137 Latino day laborers recruited from Mississippi and Illinois. Participants completed a self-report survey instrument, available in English and Spanish, on sun protective behaviors. Results Multivariate regression results showed that sun protective behaviors were significantly greater among Latino day laborers: (a) who had greater perceptions that their supervisor also engaged in sun protective behaviors (β = 0.25, p ≤ 0.01); (b) who reported higher levels of health literacy (β = 0.23, p ≤ 0.001); (c) who have greater knowledge of skin cancer risk factors (β = 0.21, p ≤ 0.01); and (d) who have skin tone that was self-perceived to be more prone to sunburns (β = 0.19, p ≤ 0.01). Conclusions Latino day laborers possess marginal levels of skin cancer knowledge and engage minimally in sun protective behaviors. Skin cancer prevention interventions are warranted for this high-risk group, particularly in the locations in which Latino day laborers work.
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Peng BL, Zou GY, Chen W, Lin YW, Ling L. Association between health service utilisation of internal migrant children and parents' acculturation in Guangdong, China: a cross-sectional study. BMJ Open 2018; 8:e018844. [PMID: 29331968 PMCID: PMC5781153 DOI: 10.1136/bmjopen-2017-018844] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES To assess the health service utilisation of internal migrant children in Guangdong, China, and to explore the association between children's health service utilisation and their parents' acculturation. DESIGN Cross-sectional survey between April and May 2016. SETTING Six society-run schools of Tianhe and Baiyun districts in Guangzhou City of China. PARTICIPANTS We recruited all students at grade 7 or 8 and one of their parents who resided in Guangzhou over 6 months without permanent registered residence (hukou) in Guangzhou (1161 pairs completed this survey). 258 children were ill within the past 2 weeks or during the last year. MAIN OUTCOME MEASURES The main outcome was self-reported health service utilisation. Logistic regression analysis was conducted to explore the association between children's unmet needs for outpatient or inpatient service and their parents' acculturation (categorised into high, middle and low groups). RESULTS In total, 216 children, or 18.6% of the total subjects, were ill within the past 2 weeks and were in need of outpatient service; 94 children, or 8.1% of the total subjects, were in need of inpatient service. Among them, 17.6% and 46.8% of the migrant children had unmet needs for outpatient and inpatient services, respectively. After controlling for enabling resources and predisposing characteristics, migrant children with parents in the middle-acculturation group (adjusted OR=3.17, 95% CIs 1.2 to 8.3, P<0.05) were more likely to have an unmet outpatient need than high-acculturation or low-acculturation groups, although only statistically significant when comparing with the high-acculturation group. Stratified analysis suggested that this association could be moderated by their family economic status. CONCLUSIONS Our study suggested that the association between migrant children's health service utilisation and their parents' acculturation was complex and could be moderated by family economic status. Increasing the service utilisation among migrant children requires improving the acculturation and economic status of the parents of internal migrants.
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Affiliation(s)
- Bo-li Peng
- Center for Migrant Health Policy, Sun Yat-sen University, Guangzhou, China
| | - Guan-yang Zou
- Center for Migrant Health Policy, Sun Yat-sen University, Guangzhou, China
- Institute for International Health and Development, Queen Margaret University, Edinburgh, UK
| | - Wen Chen
- Center for Migrant Health Policy, Sun Yat-sen University, Guangzhou, China
- Faculty of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Yan-wei Lin
- Center for Migrant Health Policy, Sun Yat-sen University, Guangzhou, China
- Faculty of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Li Ling
- Center for Migrant Health Policy, Sun Yat-sen University, Guangzhou, China
- Faculty of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, China
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25
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Association Between Sunscreen Use and Indoor Tanning Use Among American High School Students. Dermatol Surg 2017; 44:897-899. [PMID: 28961636 DOI: 10.1097/dss.0000000000001351] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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26
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Rodríguez VM, Shuk E, Arniella G, González CJ, Gany F, Hamilton JG, Gold GS, Hay JL. A Qualitative Exploration of Latinos' Perceptions About Skin Cancer: the Role of Gender and Linguistic Acculturation. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2017; 32:438-446. [PMID: 26687207 PMCID: PMC4916022 DOI: 10.1007/s13187-015-0963-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
Latinos have the highest rate of skin cancers among U.S. minorities. Despite a rising incidence of melanoma-the deadliest form of skin cancer-and greater disease burden, Latinos tend to have poor awareness of skin cancer risk factors which may inhibit preventive action. We expanded on prior work by qualitatively examining potential moderators (i.e., gender, acculturation) of skin cancer perceptions among Latinos from El Barrio in Harlem, New York City. Four focus groups stratified by language (English/Spanish) and gender were conducted. Discussions were recorded, transcribed, and coded using thematic analysis. Thirty-eight self-identified Latinos (32 % male) participated. Across groups, median age was 35 years; 50 % completed <high school degree, 82 % had annual incomes ≤$29,999, and 55 % were born in Mexico. Mean acculturation level was 8.5 (SD = 3.9, range = 4-20). Major themes included (1) knowledge of common skin cancer risk factors, (2) acknowledgment of personal risk although lighter-skin individuals are at greater risk, and (3) awareness of effective risk reduction methods, despite the presence of fatalistic beliefs. Compared to males, females discussed tanning norms and appearance-based factors, identified children as vulnerable, highlighted the benefits of sun exposure, and wanted more information. Few linguistic acculturation patterns were noted; English speakers questioned the carcinogenic effect of sunscreen and reported more skin cancer-related physician discussions than Spanish speakers. Despite generally low acculturation, Latinos correctly identified skin cancer risk factors and agreed that it is preventable with engagement in risk-reducing behaviors. Future educational interventions must capitalize upon and reinforce such beliefs and address fatalistic perceptions which may hinder prevention efforts.
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Affiliation(s)
- Vivian M Rodríguez
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, 641 Lexington Avenue, 7th Floor, New York, NY, 10022, USA.
| | - Elyse Shuk
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, 641 Lexington Avenue, 7th Floor, New York, NY, 10022, USA
| | - Guedy Arniella
- Harlem Residency in Family Medicine, The Institute for Family Health, New York, NY, USA
| | - C Javier González
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, 641 Lexington Avenue, 7th Floor, New York, NY, 10022, USA
| | - Francesca Gany
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, 641 Lexington Avenue, 7th Floor, New York, NY, 10022, USA
| | - Jada G Hamilton
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, 641 Lexington Avenue, 7th Floor, New York, NY, 10022, USA
| | - Geoffrey S Gold
- Department of Psychology, Hofstra University, Hempstead, NY, USA
| | - Jennifer L Hay
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, 641 Lexington Avenue, 7th Floor, New York, NY, 10022, USA
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Miller KA, In GK, Jiang SY, Ahadiat O, Higgins S, Wysong A, Cockburn MG. Skin Cancer Prevention Among Hispanics: a Review of the Literature. CURRENT DERMATOLOGY REPORTS 2017. [DOI: 10.1007/s13671-017-0191-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Day AK, Stapleton JL, Natale-Pereira AM, Goydos JS, Coups EJ. Parent and Child Characteristics Associated with Child Sunburn and Sun Protection Among U.S. Hispanics. Pediatr Dermatol 2017; 34:315-321. [PMID: 28523887 DOI: 10.1111/pde.13136] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND/OBJECTIVES Skin cancer incidence has been increasing in U.S. Hispanics over several decades and the postdiagnosis outcomes are worse for Hispanics than for non-Hispanic whites. Parents are influential in children's health preventive behaviors, but little is known about parental factors associated with children's skin cancer-related behaviors in the U.S. Hispanic population. The present study examined parental and child correlates of skin cancer-related behaviors (sunburns, sunbathing, sun-protective clothing use, and sunscreen use) of children of Hispanic parents. METHODS This survey study included a population-based sample of 360 U.S. Hispanic parents (44.8% male) who had a child 14 years of age or younger. Measures included parental reports of parent and child demographic characteristics, parent skin cancer knowledge and linguistic acculturation, and parent and child skin cancer-related behaviors. RESULTS Approximately 28% of children and 31.9% of parents experienced at least one sunburn in the past year and approximately 29% of children and 36.7% of parents were reported to sunbathe. Moderate use of sun-protective clothing and sunscreen was reported for parents and their children. Child sun-protective clothing use and sunscreen use, sunburns, and sunbathing were associated with the corresponding behaviors of their parents. CONCLUSIONS Future research should consider the role of acculturation and perceived risk in the sun protection behaviors of U.S. Hispanic children, particularly in those who report a fair skin type. Hispanic parents should be included in interventions targeting their children's skin cancer-related behaviors, and it is suggested that such interventions could also encourage parents to improve their own behaviors.
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Affiliation(s)
- Ashley K Day
- Rutgers Cancer Institute of New Jersey, Rutgers, The State University of New Jersey, New Brunswick, New Jersey.,School of Psychology, University of Adelaide, Adelaide, South Australia, Australia
| | - Jerod L Stapleton
- Rutgers Cancer Institute of New Jersey, Rutgers, The State University of New Jersey, New Brunswick, New Jersey.,Department of Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey.,Department of Health Education and Behavioral Science, Rutgers School of Public Health, Piscataway, New Jersey
| | | | - James S Goydos
- Rutgers Cancer Institute of New Jersey, Rutgers, The State University of New Jersey, New Brunswick, New Jersey.,Department of Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - Elliot J Coups
- Rutgers Cancer Institute of New Jersey, Rutgers, The State University of New Jersey, New Brunswick, New Jersey.,Department of Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey.,Department of Health Education and Behavioral Science, Rutgers School of Public Health, Piscataway, New Jersey
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Prevalence and Clinical Characteristics of Nonmelanoma Skin Cancers Among Hispanic and Asian Patients Compared With White Patients in the United States: A 5-Year, Single-Institution Retrospective Review. Dermatol Surg 2017; 42:639-45. [PMID: 27100961 DOI: 10.1097/dss.0000000000000694] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Nonmelanoma skin cancers (NMSCs) are the most common malignancy in the United States. Although historically most cases occurred in whites, in recent years, NMSC incidence in Hispanics and Asians has increased. As Hispanics and Asians are the 2 fastest growing groups in the United States, the NMSC rise in these populations is concerning. Currently, data on clinical characteristics of NMSCs in these minorities are limited, and a thorough analysis of risk differences among Hispanic, Asian, and white patients is lacking. OBJECTIVE To assess differences in NMSC prevalence, risk factors, and clinical presentation among Hispanic, Asian, and white populations at University of California San Diego Dermatologic and Mohs Micrographic Surgery Center. METHODS Five-year retrospective chart review. RESULTS Of 4,029 NMSC cases, 3,881 (96.3%) were in whites, 115 (2.9%) were in Hispanics, and 33 (0.8%) were in Asians. Most cases in whites occurred in men, whereas this gender ratio was reversed for Hispanics and Asians. Hispanics had significantly more cases occurring in the "central face." CONCLUSION The rise of NMSCs in Hispanic and Asians, especially among women, is concerning given that they are the fastest growing ethnic populations in the United States. It is important that proper counseling for photoprotection be stressed to these populations.
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Miller KA, Huh J, Unger JB, Richardson JL, Allen MW, Peng DH, Cockburn MG. Correlates of sun protection behaviors among Hispanic children residing in a high UVR environment. PHOTODERMATOLOGY, PHOTOIMMUNOLOGY & PHOTOMEDICINE 2016; 33:75-83. [PMID: 27995652 DOI: 10.1111/phpp.12287] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/14/2016] [Indexed: 12/23/2022]
Abstract
BACKGROUND/PURPOSE Rates of melanoma are rising in Hispanics in the United States. Excessive sun exposure in childhood increases the risk of melanoma in adulthood, and little is known about the factors motivating sun protection behaviors among Hispanic youth. METHODS Correlates of sun protection were examined among Hispanic children residing in Los Angeles, California (N = 1891). Associations between multiple constructs (psychosocial, familial, and cultural) and sun protection outcomes (use of sunscreen, protective clothing, and shade seeking/sun avoidance) were examined. RESULTS Family variables were associated with more frequent sun protection among Hispanic children across outcomes, as were perceived peer norms, perceived self-efficacy, and fewer sun protection barriers. Skin cancer risk factors such as lighter skin and sunburn experience, and level of acculturation were not associated with greater sun protection. CONCLUSION Family sun protection habits are instrumental to Hispanic children's sun safe behaviors, and interventions that engage the family may be most effective. Increasing risk communication to high-risk subgroups of Hispanic children (those with lighter, more sun reactive skin) is important when developing intervention strategies. However, there is overlap between Hispanic children's sun protection correlates and those observed among non-Hispanic white children, suggesting that interventions to improve sun protection may generalize across cultural contexts.
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Affiliation(s)
- Kimberly A Miller
- Department of Preventive Medicine, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
| | - Jimi Huh
- Department of Preventive Medicine, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
| | - Jennifer B Unger
- Department of Preventive Medicine, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
| | - Jean L Richardson
- Department of Preventive Medicine, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
| | - Martin W Allen
- Department of Electrical and Computer Engineering, MacDiarmid Institute for Advanced Materials and Nanotechnology, University of Canterbury, Christchurch, New Zealand
| | - David H Peng
- Department of Dermatology, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
| | - Myles G Cockburn
- Department of Preventive Medicine, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA.,Department of Dermatology, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
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Acculturation, Skin Tone Preferences, and Tanning Behaviours Among Young Adult Asian Australians. J Prim Prev 2016; 37:421-32. [PMID: 27578424 DOI: 10.1007/s10935-016-0442-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Australia has a significant proportion of residents of Asian heritage. Although the incidence of skin cancer is lower in those of Asian heritage than Caucasians, their prognosis is often worse. Sociocultural variables are central to the tanning behaviours of individuals from Western cultures. We examined the role of sociocultural variables in the tanning behaviours (outdoor tanning, indoor/solarium and fake tan use) among Asian Australians. A sample of 399 young adults identifying either as a person of Asian heritage or as Asian Australian participated in an online survey. Our results suggest that Asian Australians are at risk of skin cancer; over 35 % of the sample reported engaging in outdoor tanning and over 10 % in solarium tanning. After controlling for demographic factors and skin cancer knowledge, preferring a darker skin tone and being acculturated to Australia were significantly associated with tanning behaviour. Participants' low levels of skin cancer knowledge are of concern, and possibilities for improving knowledge levels in this group are considered. Further, we recommended that future research studies investigate sociocultural and appearance-related beliefs associated with tanning behaviours in this population, in order to determine best avenues for intervention.
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Melanoma Disparities among US Hispanics: Use of the Social Ecological Model to Contextualize Reasons for Inequitable Outcomes and Frame a Research Agenda. J Skin Cancer 2016; 2016:4635740. [PMID: 27651954 PMCID: PMC5019891 DOI: 10.1155/2016/4635740] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2016] [Accepted: 08/03/2016] [Indexed: 11/29/2022] Open
Abstract
Cutaneous melanoma is a significant public health concern, accounting for thousands of deaths annually in the US. Early detection and diagnosis are critical given the poor prognosis and limited treatment options of advanced-stage disease. While non-Hispanic whites have higher incidence rates of melanoma, Hispanics are typically diagnosed at later disease stages and suffer higher morbidity and mortality. Currently, there is a paucity of literature investigating the root causes underlying these trends among Hispanics. Given that Hispanics are the most rapidly expanding demographic segment in the US, it is essential for cancer control efforts to elucidate the major determinants of their poor melanoma outcomes. Herein, we use the social ecological model as a framework to explore the multitude of influences on melanoma disparities among Hispanics and provide recommendations for planning future studies and interventions.
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Garnett E, Townsend J, Steele B, Watson M. Characteristics, rates, and trends of melanoma incidence among Hispanics in the USA. Cancer Causes Control 2016; 27:647-59. [PMID: 27021339 PMCID: PMC4910394 DOI: 10.1007/s10552-016-0738-1] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2015] [Accepted: 03/10/2016] [Indexed: 10/22/2022]
Abstract
PURPOSE The purpose of this study is to describe the epidemiology of melanoma among Hispanics using data that cover nearly 100 % of the US population. METHODS The study used population-based cancer incidence data from the National Program of Cancer Registries and the Surveillance, Epidemiology and End Results Program to examine melanoma incidence rates and trends among Hispanics by sex, age, race, histology, anatomic location, stage, and tumor thickness. RESULTS From 2008 to 2012, 6,623 cases of melanoma were diagnosed among Hispanics. Rates were higher among males (4.6) than among females (4.0), but females younger than age 55 had higher rates than males. The most common histologic subtype was superficial spreading melanoma (23 %). Melanomas with poorer outcomes, such as nodular (NM) and acral lentiginous melanoma (ALM), were more common among males. Hispanic females had the highest proportion of melanoma on the lower limb and hip (33.7 %), while Hispanic males had the highest proportion on the trunk (29.9 %). Incidence rates for later-stage diagnosis and thicker tumors were significantly higher among Hispanic men than among women. Incidence rates decreased significantly during 2003-2012 (AAPC = -1.4). CONCLUSIONS Clinicians and public health practitioners will need to reach the growing Hispanic population in the USA with strategies for primary prevention and early diagnosis of melanoma. Results suggest Hispanics and providers need education to increase awareness about the characteristics of melanoma among Hispanics, including types that occur on non-sun-exposed areas (ALM and NM). Skin cancer prevention and awareness interventions targeting Hispanics should be culturally relevant.
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Affiliation(s)
- Erin Garnett
- Advanced Technology Logistics, Inc, Newnan, GA, USA
| | - Julie Townsend
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, 4770 Buford Hwy NE MS-F76, Atlanta, GA, 30341, USA.
| | - Brooke Steele
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, 4770 Buford Hwy NE MS-F76, Atlanta, GA, 30341, USA
| | - Meg Watson
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, 4770 Buford Hwy NE MS-F76, Atlanta, GA, 30341, USA
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Skin Protection Behaviors among Young Male Latino Day Laborers: An Exploratory Study Using a Social Cognitive Approach. Dermatol Res Pract 2016; 2016:1479637. [PMID: 27019656 PMCID: PMC4785254 DOI: 10.1155/2016/1479637] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2015] [Revised: 11/26/2015] [Accepted: 12/06/2015] [Indexed: 11/17/2022] Open
Abstract
Latino Day Laborers (LDLs) are employed in occupations where multiple work hazards exist. One such hazard is the overexposure to solar ultraviolet radiation for continuous periods of time. Regular sun exposure can put individuals at increased risk of developing skin cancers, especially without adequate protection. The purpose of this cross-sectional exploratory study was to use a social cognitive framework to assess skin protective behaviors among LDLs. A community-based nonrandom and purposive sample of LDLs was recruited in two states: Mississippi and Illinois. The study sample consisted of 137 male participants, of which the majority were of Mexican ancestry (72%). The average age was 35.40 (SD = 9.89) years. Results demonstrated that a substantial number of LDLs do not adequately practice sun protection behaviors on a regular basis. The skin cancer knowledge scores were very modest. The most frequently indicated barriers towards sun protection were “inconvenient,” “forget to use,” and “not being able to reapply sunscreen.” Overall, LDLs had moderate confidence in their abilities to adopt successful sun protection strategies. This study underscores the need for intervention programs aimed at LDLs to reduce extended time in the sun and increase use of sun protective measures when working outdoors.
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Miller KA, Huh J, Unger JB, Richardson JL, Allen MW, Peng DH, Cockburn MG. Patterns of sun protective behaviors among Hispanic children in a skin cancer prevention intervention. Prev Med 2015; 81:303-8. [PMID: 26436682 PMCID: PMC4679689 DOI: 10.1016/j.ypmed.2015.09.027] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2015] [Revised: 08/26/2015] [Accepted: 09/27/2015] [Indexed: 11/25/2022]
Abstract
BACKGROUND Invasive melanoma is becoming more common in U.S. Hispanics, yet little is known about the sun protection behaviors in this population, particularly children and adolescents who incur high ultraviolet (UV) exposures. METHODS We used latent class analysis to examine patterns of sun protective behaviors in a cross-sectional survey of Hispanic elementary students participating in a sun safety intervention in Los Angeles from 2013- to 2014 (N=972). Five behavior indicators in two environments (school and home) representing multiple methods of sun protection were selected for the model. RESULTS Results suggested a four-class model best fit the data. Classes were labeled in order of increasing risk as multiple protective behaviors (28%), clothing and shade (32%), pants only (15%), and low/inconsistent protective behaviors (25%). Children who reported high parental engagement with sun protection were significantly more likely to be classified in high overall protective categories (odds ratio (OR)=4.77). Girls were more likely than boys to be classified in the highest protecting class (OR=3.46), but were also more likely to be in the "pants only" class (OR=2.65). Sensitivity to sunburn was associated with less likelihood of being in the "clothing and shade" class (OR=0.53). CONCLUSION The differences among these classes and their predictors reveal the heterogeneity and complexity of Hispanic children's sun protective behaviors. These findings have implications for the design and delivery of future sun protection interventions targeting Hispanic children, as strategies tailored to specific subgroups may be more effective in achieving meaningful behavioral changes.
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Affiliation(s)
- Kimberly A Miller
- Department of Preventive Medicine, Keck School of Medicine of the University of Southern California, Los Angeles, CA, United States.
| | - Jimi Huh
- Department of Preventive Medicine, Keck School of Medicine of the University of Southern California, Los Angeles, CA, United States
| | - Jennifer B Unger
- Department of Preventive Medicine, Keck School of Medicine of the University of Southern California, Los Angeles, CA, United States
| | - Jean L Richardson
- Department of Preventive Medicine, Keck School of Medicine of the University of Southern California, Los Angeles, CA, United States
| | - Martin W Allen
- MacDiarmid Institute for Advanced Materials and Nanotechnology, Department of Electrical and Computer Engineering, University of Canterbury, Christchurch, New Zealand
| | - David H Peng
- Department of Dermatology, Keck School of Medicine of the University of Southern California, Los Angeles, CA, United States
| | - Myles G Cockburn
- Department of Preventive Medicine, Keck School of Medicine of the University of Southern California, Los Angeles, CA, United States; Department of Dermatology, Keck School of Medicine of the University of Southern California, Los Angeles, CA, United States
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36
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Day AK, Stapleton JL, Natale-Pereira AM, Goydos JS, Coups EJ. Occupational sunscreen use among US Hispanic outdoor workers. BMC Res Notes 2015; 8:578. [PMID: 26477041 PMCID: PMC4609133 DOI: 10.1186/s13104-015-1558-1] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2015] [Accepted: 10/05/2015] [Indexed: 12/02/2022] Open
Abstract
Background Occupational ultraviolet radiation (UVR) exposure is a risk factor for skin cancer, and Hispanic individuals are over-represented in a number of outdoor occupations (e.g., farming, landscaping). This study examined predictors of occupational sunscreen use in a group of US Hispanic adults who work outdoors. Results A population-based sample of outdoor workers (n = 149, 85 % male) completed survey measures regarding their demographics, melanoma risk, perceived skin cancer risk, skin cancer knowledge, and their occupational sunscreen use. Sixty-nine percent of the sample reported never or rarely wearing sunscreen while working outdoors. Being female (p = .02), having a higher level of education (p = .03), and residing at a higher latitude (p = .04) were associated with more frequent sunscreen use. Conclusions This study highlights the importance of interventions to promote sun protection behaviors among US Hispanic outdoor workers, and identifies potential intervention targets.
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Affiliation(s)
- Ashley K Day
- Rutgers Cancer Institute of New Jersey, Rutgers, The State University of New Jersey, 195 Little Albany Street, New Brunswick, NJ, 08901, USA. .,School of Psychology, University of Adelaide, North Tce Campus, Adelaide, SA, 5005, Australia.
| | - Jerod L Stapleton
- Rutgers Cancer Institute of New Jersey, Rutgers, The State University of New Jersey, 195 Little Albany Street, New Brunswick, NJ, 08901, USA. .,Department of Medicine, Rutgers Robert Wood Johnson Medical School, 125 Paterson Street, New Brunswick, NJ, 08901, USA. .,Department of Health Education and Behavioral Science, Rutgers School of Public Health, 683 Hoes Lane West, Piscataway, NJ, 08854, USA.
| | - Ana M Natale-Pereira
- Department of Medicine, Rutgers New Jersey Medical School, 185 South Orange Avenue, Newark, NJ, 07103, USA.
| | - James S Goydos
- Rutgers Cancer Institute of New Jersey, Rutgers, The State University of New Jersey, 195 Little Albany Street, New Brunswick, NJ, 08901, USA. .,Department of Surgery, Rutgers Robert Wood Johnson Medical School, 125 Paterson Street, New Brunswick, NJ, 08901, USA.
| | - Elliot J Coups
- Rutgers Cancer Institute of New Jersey, Rutgers, The State University of New Jersey, 195 Little Albany Street, New Brunswick, NJ, 08901, USA. .,Department of Medicine, Rutgers Robert Wood Johnson Medical School, 125 Paterson Street, New Brunswick, NJ, 08901, USA. .,Department of Health Education and Behavioral Science, Rutgers School of Public Health, 683 Hoes Lane West, Piscataway, NJ, 08854, USA.
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Harvey VM, Patel H, Sandhu S, Wallington SF, Hinds G. Social determinants of racial and ethnic disparities in cutaneous melanoma outcomes. Cancer Control 2015; 21:343-9. [PMID: 25310216 DOI: 10.1177/107327481402100411] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND This article sought to elucidate how aspects of poverty and culture may contribute to race- and ethnicity-based disparities in cutaneous melanoma outcomes. METHODS We identified published studies addressing the social determinants of melanoma. Selected review articles included US-based studies comprised of patients representing adults, children, and adolescents. RESULTS African Americans and Hispanics diagnosed with cutaneous melanoma are more likely to present with more advanced stages of disease at diagnosis and have higher rates of mortality than their nonminority counterparts. These disparities may be a consequence of economic, social, and cultural barriers such as low income, public forms of health insurance, lower levels of education, lower levels of melanoma awareness and knowledge, and lower rates of participation in melanoma screening. No studies in the literature examined the potential impact of social injustice, English proficiency, immigrant status, and health literacy. CONCLUSIONS Substantial gaps exist in our knowledge of the pathways linking social determinants and race- and ethnicity-based disparities in melanoma. More studies are warranted to inform the development of effective interventions aimed at narrowing inequities and improving cutaneous melanoma outcomes among minority populations.
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Affiliation(s)
- Valerie M Harvey
- Department of Dermatology, Eastern Virginia Medical School, Norfolk, VA 23507, USA.
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Miller KA, Langholz BM, Ly T, Harris SC, Richardson JL, Peng DH, Cockburn MG. SunSmart: evaluation of a pilot school-based sun protection intervention in Hispanic early adolescents. HEALTH EDUCATION RESEARCH 2015; 30:371-379. [PMID: 25801103 PMCID: PMC4434952 DOI: 10.1093/her/cyv011] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/29/2014] [Accepted: 02/12/2015] [Indexed: 06/04/2023]
Abstract
The incidence of melanoma is rising among Hispanic populations in the United States. The purpose of this study is to evaluate the impact of a pilot sun safety educational intervention conducted from 2006 to 2012 on Hispanic early adolescents in a high ultraviolet environment. Nineteen schools with high Hispanic enrollment were recruited from urban neighborhoods in Los Angeles. The analytic sample was restricted to students identifying as Hispanic or Latino (n = 777). A mixed effects linear model was used to test mean changes from pre- to posttest on students' sun protection knowledge, attitudes and behaviors. Significant improvements were observed across several cognitive outcomes related to sun protection, including knowledge of and attitudes toward sun protection and self-efficacy to wear sunscreen. However, changes in sun protective behaviors were not achieved. Although some improvements were observed, future studies should identify the factors that motivate sun protection in this population and develop tailored prevention strategies, as improving the sun safe behaviors of Hispanic youths may aid in reducing the risk of melanoma in adulthood in this population.
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Affiliation(s)
- K A Miller
- Department of Preventive Medicine, Keck School of Medicine of the University of Southern California, Joint Educational Project, Dana and David Dornsife College of Letters, Arts and Sciences, University of Southern California and Department of Dermatology, Keck School of Medicine of the University of Southern California, Los Angeles, CA 90032, USA
| | - B M Langholz
- Department of Preventive Medicine, Keck School of Medicine of the University of Southern California, Joint Educational Project, Dana and David Dornsife College of Letters, Arts and Sciences, University of Southern California and Department of Dermatology, Keck School of Medicine of the University of Southern California, Los Angeles, CA 90032, USA
| | - T Ly
- Department of Preventive Medicine, Keck School of Medicine of the University of Southern California, Joint Educational Project, Dana and David Dornsife College of Letters, Arts and Sciences, University of Southern California and Department of Dermatology, Keck School of Medicine of the University of Southern California, Los Angeles, CA 90032, USA
| | - S C Harris
- Department of Preventive Medicine, Keck School of Medicine of the University of Southern California, Joint Educational Project, Dana and David Dornsife College of Letters, Arts and Sciences, University of Southern California and Department of Dermatology, Keck School of Medicine of the University of Southern California, Los Angeles, CA 90032, USA
| | - J L Richardson
- Department of Preventive Medicine, Keck School of Medicine of the University of Southern California, Joint Educational Project, Dana and David Dornsife College of Letters, Arts and Sciences, University of Southern California and Department of Dermatology, Keck School of Medicine of the University of Southern California, Los Angeles, CA 90032, USA
| | - D H Peng
- Department of Preventive Medicine, Keck School of Medicine of the University of Southern California, Joint Educational Project, Dana and David Dornsife College of Letters, Arts and Sciences, University of Southern California and Department of Dermatology, Keck School of Medicine of the University of Southern California, Los Angeles, CA 90032, USA
| | - M G Cockburn
- Department of Preventive Medicine, Keck School of Medicine of the University of Southern California, Joint Educational Project, Dana and David Dornsife College of Letters, Arts and Sciences, University of Southern California and Department of Dermatology, Keck School of Medicine of the University of Southern California, Los Angeles, CA 90032, USA Department of Preventive Medicine, Keck School of Medicine of the University of Southern California, Joint Educational Project, Dana and David Dornsife College of Letters, Arts and Sciences, University of Southern California and Department of Dermatology, Keck School of Medicine of the University of Southern California, Los Angeles, CA 90032, USA
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Day A, Wilson C, Hutchinson A, Roberts R. Sun-related behaviours among young Australians with Asian ethnic background: differences according to sociocultural norms and skin tone perceptions. Eur J Cancer Care (Engl) 2014; 24:514-21. [DOI: 10.1111/ecc.12275] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/05/2014] [Indexed: 11/29/2022]
Affiliation(s)
- A.K. Day
- School of Psychology; University of Adelaide; Adelaide South Australia Australia
| | - C.J. Wilson
- Cancer Prevention; Flinders Centre for Innovation in Cancer; Flinders University; Adelaide South Australia Australia
- Cancer Council South Australia; Adelaide South Australia Australia
| | - A.D. Hutchinson
- School of Psychology, Social Work & Social Policy; University of South Australia; Adelaide South Australia Australia
| | - R.M. Roberts
- School of Psychology; University of Adelaide; Adelaide South Australia Australia
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40
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Sun Protection Beliefs among Hispanics in the US. J Skin Cancer 2014; 2014:161960. [PMID: 25431673 PMCID: PMC4241737 DOI: 10.1155/2014/161960] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2014] [Revised: 10/01/2014] [Accepted: 10/16/2014] [Indexed: 11/24/2022] Open
Abstract
Purpose. We reviewed the literature on sun protection beliefs in Hispanics living in the United States to explore what challenges are faced by area of research. Method. A review of PubMED, PsycINFO, and CINAHL databases was performed. Studies were published in peer-reviewed journals (in all years available) and written in English. The search terms used were [“skin cancer” OR “sun protection”] AND [“Latino” OR “Hispanic”] AND “beliefs.” Eligible papers were included in the final analysis after meeting the following inclusion criteria: (1) the records had to quantitatively examine and report sun protection beliefs in Hispanics, (2) the number of Hispanic participants in the sample had to be clearly specified, and (3) studies reporting differences in sun protection beliefs between Hispanics and other racial and ethnic groups were included in the review. Results. Of the 92 articles identified, 11 met inclusion criteria and addressed sun protection beliefs regarding skin cancer seriousness and susceptibility, and benefits and barriers of sun protection and skin cancer risk behaviors. Characteristics of studies and results were examined. Conclusion. There is insufficient evidence to determine a pattern of sun protection beliefs among Hispanics in the United States. More quality studies are needed which focus on sun protection beliefs in Hispanics.
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Coups EJ, Stapleton JL, Manne SL, Hudson SV, Medina-Forrester A, Rosenberg SA, Gordon M, Tatum KS, Robinson JK, Natale-Pereira A, Goydos JS. Psychosocial correlates of sun protection behaviors among U.S. Hispanic adults. J Behav Med 2014; 37:1082-90. [PMID: 24532153 DOI: 10.1007/s10865-014-9558-5] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2013] [Accepted: 02/04/2014] [Indexed: 11/30/2022]
Abstract
The incidence of skin cancer among U.S. Hispanics increased 1.3% annually from 1992 to 2008. However, little research has focused on skin cancer prevention among the rapidly growing Hispanic population. In this study, we examined theory-driven, psychosocial correlates of sun protection behaviors in a population-based sample of 787 Hispanic adults (49.6% female, mean age = 41.0 years) residing in five southern or western U.S. states. Participants completed an English- or Spanish-language online survey in September 2011. The outcomes of focus were sunscreen use, shade seeking, and use of sun protective clothing. The correlates included suntan benefits, sun protection benefits and barriers, skin color preference, perceived natural skin protection, photo-aging concerns, perceived skin cancer risk, skin cancer worry, skin cancer fatalism, and sun protection descriptive norms. Results of multiple linear regression analyses revealed the following: sun protection barriers were negatively associated with each outcome; descriptive norms were positively associated with each outcome; perceived natural skin protection was inversely associated with sunscreen use; skin cancer worry was positively associated with shade seeking and use of sun protective clothing; skin cancer fatalism was negatively associated with shade seeking; and skin color preference was negatively associated with use of sun protective clothing. A number of additional statistically significant associations were identified in bivariate correlation analyses. This study informs the potential content of interventions to promote engagement in sun protection behaviors among U.S. Hispanics.
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Affiliation(s)
- Elliot J Coups
- Rutgers Cancer Institute of New Jersey, Rutgers, The State University of New Jersey, 195 Little Albany Street, New Brunswick, NJ, 08903, USA,
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Coups EJ, Stapleton JL, Hudson SV, Medina-Forrester A, Rosenberg SA, Gordon M, Natale-Pereira A, Goydos JS. Skin cancer surveillance behaviors among US Hispanic adults. J Am Acad Dermatol 2012. [PMID: 23182066 DOI: 10.1016/j.jaad.2012.09.032] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Little skin cancer prevention research has focused on the US Hispanic population. OBJECTIVE This study examined the prevalence and correlates of skin cancer surveillance behaviors among Hispanic adults. METHODS A population-based sample of 788 Hispanic adults residing in 5 southern and western states completed an online survey in English or Spanish in September 2011. The outcomes were ever having conducted a skin self-examination (SSE) and having received a total cutaneous examination (TCE) from a health professional. The correlates included sociodemographic, skin cancer-related, and psychosocial factors. RESULTS The rates of ever conducting a SSE or having a TCE were 17.6% and 9.2%, respectively. Based on the results of multivariable logistic regressions, factors associated with ever conducting a SSE included older age, English linguistic acculturation, a greater number of melanoma risk factors, more frequent sunscreen use, sunbathing, job-related sun exposure, higher perceived skin cancer risk, physician recommendation, more SSE benefits, and fewer SSE barriers. Factors associated with ever having a TCE were older age, English linguistic acculturation, a greater number of melanoma risk factors, ever having tanned indoors, greater skin cancer knowledge, higher perceived skin cancer severity, lower skin cancer worry, physician recommendation, more TCE benefits, and fewer SSE barriers. LIMITATIONS The cross-sectional design limits conclusions regarding the causal nature of observed associations. CONCLUSIONS Few Hispanic adults engage in skin cancer surveillance behaviors. The study highlights Hispanic subpopulations that are least likely to engage in skin cancer surveillance behaviors and informs the development of culturally appropriate interventions to promote these behaviors.
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Affiliation(s)
- Elliot J Coups
- The Cancer Institute of New Jersey, New Brunswick, New Jersey; Department of Medicine, University of Medicine and Dentistry of New Jersey-Robert Wood Johnson Medical School, New Brunswick, New Jersey; Department of Health Education and Behavioral Science, University of Medicine and Dentistry of New Jersey-School of Public Health, Piscataway, New Jersey.
| | - Jerod L Stapleton
- The Cancer Institute of New Jersey, New Brunswick, New Jersey; Department of Medicine, University of Medicine and Dentistry of New Jersey-Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - Shawna V Hudson
- The Cancer Institute of New Jersey, New Brunswick, New Jersey; Department of Family Medicine and Community Health, University of Medicine and Dentistry of New Jersey-Robert Wood Johnson Medical School, New Brunswick, New Jersey; Department of Health Education and Behavioral Science, University of Medicine and Dentistry of New Jersey-School of Public Health, Piscataway, New Jersey
| | | | | | - Marsha Gordon
- The Cancer Institute of New Jersey, New Brunswick, New Jersey
| | - Ana Natale-Pereira
- Department of Medicine, University of Medicine and Dentistry of New Jersey-New Jersey Medical School, Newark, New Jersey
| | - James S Goydos
- The Cancer Institute of New Jersey, New Brunswick, New Jersey; Department of Surgery, University of Medicine and Dentistry of New Jersey-Robert Wood Johnson Medical School, New Brunswick, New Jersey
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