Melanoma awareness and prevention among latinx and non-latinx white adults in urban and rural California: A qualitative exploration

Analyzing County-level Social Vulnerabilities of Head and Neck Melanomas in the United States

OBJECTIVES

Studies addressing social determinants of health (SDH) in head-neck melanomas (HNM) have only assessed incidence with increasing socioeconomic status. None have investigated a wider scope of SDH or their summed influence on affecting HNM prognosis and follow-up care.

METHODS

This retrospective cohort study analyzed 374,138 HNM in adults from 1975 to 2017 from the NCI-Surveillance, Epidemiology, and End Results Program (NCI-SEER) database. Utilizing the NCI-SEER database, Social Vulnerability Index (SVI) scores were matched to county of residence upon diagnosis. Univariate linear regressions were performed on length of care (months of follow-up/surveyed) and prognosis (months survival) across various SDH/SVI scores of socioeconomic status, minority and language status, household composition, housing and transportation, and their total composite.

RESULTS

With increasing overall SVI score, which indicates increasing social vulnerability, months of follow-up showed significant decreases ranging from 0.04% to 27.63% compared with the lowest vulnerability groups, with the highest differences in nodular melanomas and the lowest with malignant melanomas in giant pigmented nevi. Similarly, months survival significant decreases ranged from 0.19% to 39.84% compared with the lowest SVI scores, with the highest difference in epithelioid cell melanomas and the lowest in amelanotic melanoma. Comprising this overall score trend, decreases with socioeconomic status, minority-language status, household composition, and housing-transportation contributed differentially per histology subtype.

CONCLUSIONS

Our data highlight significant negative trends in HNM prognosis and care with higher total social vulnerability while showing which SDH-themes quantifiably contribute more to these differences.

LEVEL OF EVIDENCE

3 Laryngoscope, 134:185-190, 2024.

Sharing and seeking information about skin cancer risk and prevention among Hispanic people from Florida and Puerto Rico

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).

Patient Perspectives on Social Risk Screening and Documentation in a Dermatology Clinic

Importance

Providing person-centered dermatologic care includes consideration of social risk factors, such as housing instability and unreliable transportation, that may affect clinical management. Patients' perspectives on social risk screening and documentation in dermatology clinics have not yet been evaluated.

Objective

To understand patients' perspectives on social risk screening and documentation in a dermatology clinic.

Design, Setting, and Participants

This mixed-methods study used a survey and semistructured interviews and was conducted in a general dermatology clinic at a large urban public hospital. Patients at the clinic were eligible to complete the survey if they were 18 years or older; able to speak and read English, Spanish, or Cantonese; and comfortable using a computer tablet. Survey participants who preferred to use English were eligible for interviews. The survey included social risk screening questions, measures of acceptability, and questions on social risk factors associated with patient acceptability. Semistructured interviews were conducted to explore attitudes and beliefs about social risk screening and documentation. Survey and interview findings were integrated during data analysis through development of themes and joint display. Data were analyzed from December 2021 to April 2023.

Main Outcomes and Measures

There were 2 outcome measures of acceptability: appropriateness of screening in a dermatology clinic and comfort with documentation of social risk in the electronic health record (EHR).

Results

A total of 135 participants (including 73 males [54.1%]) answered both measures of acceptability in the survey. Of these participants, 116 (85.9%) reported that social risk screening in their dermatology clinic was very or somewhat appropriate and 85 (63.0%) reported being completely or somewhat comfortable with having their social risks documented in the EHR. Themes that were developed from surveys and interviews were the (1) role of interpersonal factors in willingness to disclose social risks, (2) implications of institutional trust for willingness to disclose and comfort with documentation, and (3) relevance of screening in a dermatology clinic.

Conclusions and Relevance

Results of this study showed that most participants found social risk screening to be appropriate in a dermatology clinic, although a smaller proportion of participants were comfortable with EHR documentation of their social risks. Optimizing patients' trust in their physicians and the medical system, while addressing privacy and discrimination concerns, may help facilitate disclosure of social risks.