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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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Hagerman CJ, Stock ML, Jobe MC, Dwyer LA, Houlihan AE, Yeung EW. Ethnic and Gender Differences in Sun-Related Cognitions Among College Students: Implications for Intervention. Int J Behav Med 2024:10.1007/s12529-024-10257-7. [PMID: 38360939 DOI: 10.1007/s12529-024-10257-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/07/2024] [Indexed: 02/17/2024]
Abstract
BACKGROUND Skin cancer incidence and prognosis vary by ethnicity and gender, and previous studies demonstrate ethnic and gender differences in sun-related cognitions and behaviors that contribute to this disease. The current study sought to inform skin cancer interventions tailored to specific demographic groups of college students. The study applied the prototype willingness model (PWM) to examine how unique combinations of ethnic and gender identities influence sun-related cognitions. METHOD Using data from a survey of 262 college students, the study tested whether self-reported sun-related cognitions were different for White women, Hispanic women, White men, and Hispanic men. Path modeling was also used to identify which PWM cognitions (e.g., prototypes, norms) were the strongest predictors of risk and protection intentions and willingness in each demographic group. RESULTS Several differences in sun-related cognitions and PWM pathways emerged across groups, emphasizing the need for tailored skin cancer education and interventions. Results suggest that, for White women, interventions should primarily focus on creating less favorable attitudes toward being tan. CONCLUSION Interventions for Hispanic women may instead benefit from manipulating perceived similarity to sun-related prototypes, encouraging closer personal identification with images of women who protect their skin and encouraging less identification with images of women who tan. For White men, skin cancer interventions may focus on creating more favorable images of men who protect their skin from the sun. Lastly, interventions for Hispanic men should increase perceived vulnerability for skin cancer.
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Affiliation(s)
- Charlotte J Hagerman
- Weight, Eating, and Lifestyle Science (WELL) Center, Drexel University, Philadelphia, Pennsylvania, USA
| | - Michelle L Stock
- Department of Brain and Psychological Sciences, The George Washington University, 2013 H St NW, Washington, DC, USA
| | - Mary C Jobe
- Department of Brain and Psychological Sciences, The George Washington University, 2013 H St NW, Washington, DC, USA.
| | - Laura A Dwyer
- Department of Brain and Psychological Sciences, The George Washington University, 2013 H St NW, Washington, DC, USA
| | | | - Ellen W Yeung
- Department of Brain and Psychological Sciences, The George Washington University, 2013 H St NW, Washington, DC, USA
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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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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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Trepanowski N, Chen R, Kim DY, Fuxench ZCC, Huang L, Mattei J, Ahmad A, Hartman RI. Sun protective behaviors and exposure habits in diverse Hispanic nationalities: Data from the National Health Interview Survey 2005 to 2015. J Am Acad Dermatol 2023; 88:1206-1209. [PMID: 36732107 DOI: 10.1016/j.jaad.2023.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 12/20/2022] [Accepted: 01/03/2023] [Indexed: 02/03/2023]
Affiliation(s)
- Nicole Trepanowski
- Boston University School of Medicine, Boston, Massachusetts; Department of Dermatology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Richard Chen
- Department of Dermatology, Brigham and Women's Hospital, Boston, Massachusetts; Emory School of Medicine, Atlanta, Georgia
| | - Daniel Y Kim
- Department of Dermatology, Brigham and Women's Hospital, Boston, Massachusetts; Harvard-MIT Health Sciences and Technology Program, Harvard Medical School, Boston, Massachusetts
| | - Zelma C Chiesa Fuxench
- Department of Dermatology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Linglin Huang
- Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Josiemer Mattei
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Areebah Ahmad
- Department of Dermatology, Brigham and Women's Hospital, Boston, Massachusetts; University of Texas Health Science Center at Houston, McGovern Medical School, Houston, Texas
| | - Rebecca I Hartman
- Department of Dermatology, Brigham and Women's Hospital, Boston, Massachusetts; Department of Dermatology, VA Integrated Service Network (VISN-1), Jamaica Plain, Massachusetts.
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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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Cole SE, Hawkins M, Miller KA, Allen MW, Cockburn M. Correlation Between Objective Measures of Sun Exposure and Self‐reported Sun Protective Behavior and Attitudes in Predominantly Hispanic Youth. Photochem Photobiol 2022; 99:1037-1046. [DOI: 10.1111/php.13687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 07/31/2022] [Indexed: 11/29/2022]
Affiliation(s)
- Sarah E. Cole
- Department of Population and Public Health Sciences Keck School of Medicine of the University of Southern California Los Angeles CA United States
| | - Makenzie Hawkins
- Department of Pediatrics University of Utah Salt Lake City UT United States
| | - Kimberly A. Miller
- Department of Population and Public Health Sciences 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
| | - Martin W. Allen
- MacDiarmid Institute for Advanced Materials and Nanotechnology, Department of Electrical and Computer Engineering University of Canterbury Christchurch New Zealand
| | - Myles Cockburn
- Department of Population and Public Health Sciences 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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Besch-Stokes J, Brumfiel CM, Patel MH, Harvey J, Montoya J, Severson KJ, Cumsky H, Buras M, Fagoaga JEG, Costello CM, Pittelkow MR, Mangold AR. Skin Cancer Knowledge, Attitudes and Sun Protection Practices in the Hispanic Population: A Cross-Sectional Survey. J Racial Ethn Health Disparities 2022; 10:1293-1303. [PMID: 35486349 DOI: 10.1007/s40615-022-01314-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Revised: 04/18/2022] [Accepted: 04/21/2022] [Indexed: 11/29/2022]
Abstract
Hispanics are more likely to be diagnosed with skin cancer at a later stage and experience worse overall survival than Whites. The objective of this cross-sectional study was to assess the skin cancer knowledge, attitudes, perceived risk, and sun protection practices among an underserved population in the Phoenix area. We recruited participants from the greater Phoenix area to undergo skin examination and complete a questionnaire. 208 participants were included. The majority were Hispanic (64.9%). Of this Hispanic group, most were from Mexico (87.9%). The Hispanic cohort had an overall mean skin cancer knowledge score of 3.68/6, the lowest of any other racial/ethnic group, but had the highest desire to learn more about skin cancer (64.6%, "strongly agree"). They were the most concerned about developing skin cancer (50.4%, "very concerned") but had relatively lower rates of sun protection practices (7.9% "always use" sunscreen, 22.0% "always use" sun-protective clothing). Limitations of this study include a small sample size, lack of validation for the skin cancer knowledge score, lack of season as a covariate in the multivariate analysis, lack of follow-up, and lack of robust skin cancer risk assessment. In conclusion, despite poorer skin cancer knowledge and sun protection practices, the Hispanic population had the highest concern for developing skin cancer and desire to learn more about skin cancer. Targeted and culturally relevant skin cancer and sun protection education for this group is needed.
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Affiliation(s)
| | | | - Meera H Patel
- Department of Dermatology, Mayo Clinic, Scottsdale, AZ, USA
| | - Jamison Harvey
- Department of Dermatology, Mayo Clinic, Scottsdale, AZ, USA
| | - Jordan Montoya
- Mayo Clinic Alix School of Medicine, Scottsdale, AZ, USA
| | | | - Helen Cumsky
- Department of Dermatology, Mayo Clinic, Scottsdale, AZ, USA
| | - Matthew Buras
- Division of Biostatistics, Department of Health Science Research, Mayo Clinic, Scottsdale, AZ, USA
| | | | | | | | - Aaron R Mangold
- Department of Dermatology, Mayo Clinic, Scottsdale, AZ, USA.
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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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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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15
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Miller KA, Huh J, Piombo SE, Richardson JL, Harris SC, Peng DH, Cockburn MG. Sun protection changes among diverse elementary schoolchildren participating in a sun safety intervention: A latent transition analysis of a randomized controlled trial. Prev Med 2021; 149:106601. [PMID: 33971211 PMCID: PMC8195865 DOI: 10.1016/j.ypmed.2021.106601] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 05/02/2021] [Accepted: 05/05/2021] [Indexed: 11/25/2022]
Abstract
Children are a priority population for skin cancer prevention as excessive sun exposure in childhood increases the risk of melanoma in adulthood. The complexity of sun protective behaviors has posed measurement challenges for trials testing intervention efficacy. The current study evaluated a sun safety intervention for schoolchildren using latent transition analysis (LTA) to examine patterns of sun protection behaviors over time. A three-armed randomized controlled trial was conducted between 2012 and 2016 with two intervention groups (N = 3368) and an observation-only control group (N = 342) among 4th and 5th graders from 24 public schools in Los Angeles County. Both interventions conditions were grouped and compared to controls. Five self-reported sun protective behaviors were measured at baseline and three-month follow-up: use of sunscreen, long sleeves, long pants, hats, and shade seeking. Participants comprised 3710 schoolchildren, mean age 9 years, 47% female and 69% Latino. At baseline, four patterns of sun protection behaviors were found: children who engaged in 1) all sun protective behaviors; 2) few protective behaviors; 3) protective clothing and shade only; and 4) hats only. Children in the control group were likely to remain in their baseline status or transition to a less protective status at three-month follow-up. By contrast, 30% of children in the intervention group transitioned to a more protective status at follow-up. In this RCT of a sun safety intervention, children in the intervention transitioned to more protective behaviors compared to controls. Using LTA enriches understanding of intervention efficacy by modeling the complexity of sun protection behaviors over time. TRIAL REGISTRATION: School-based Randomized Trial of SunSmart Interventions, ClinicalTrials.gov Identifier: NCT04176237 https://clinicaltrials.gov/ct2/show/NCT04176237?cond=School-based+Randomized+Trial+of+SunSmart+Interventions&draw=2&rank=1.
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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 of America; Department of Dermatology, Keck School of Medicine of the University of Southern California, Los Angeles, CA, United States of America.
| | - Jimi Huh
- Department of Preventive Medicine, Keck School of Medicine of the University of Southern California, Los Angeles, CA, United States of America
| | - Sarah E Piombo
- Department of Preventive Medicine, Keck School of Medicine of the University of Southern California, Los Angeles, CA, United States of America
| | - Jean L Richardson
- Department of Preventive Medicine, Keck School of Medicine of the University of Southern California, Los Angeles, CA, United States of America
| | - Susan C Harris
- Joint Educational Project, Dana and David Dornsife College of Letters, Arts and Sciences, University of Southern California, Los Angeles, CA, United States of America
| | - David H Peng
- Department of Dermatology, Keck School of Medicine of the University of Southern California, Los Angeles, CA, United States of America
| | - Myles G Cockburn
- Department of Preventive Medicine, Keck School of Medicine of the University of Southern California, Los Angeles, CA, United States of America; Department of Dermatology, Keck School of Medicine of the University of Southern California, Los Angeles, CA, United States of America
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16
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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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Truong A, Forbes B, Zhang M, McFadden M, Klein S. A Sun Safety Pilot Program Using a Tanning Myths–Focused Video Contest for Utah Adolescents: Cross-sectional Analysis. JMIR DERMATOLOGY 2021. [DOI: 10.2196/20192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background
Adolescents are susceptible to excessive ultraviolet exposure due to intentional tanning, outdoor lifestyles, and poor sunscreen adherence. As skin cancer incidence continues to rise in the United States, effective and focused interventions are needed to encourage photoprotective behaviors.
Objective
This study seeks to determine poor photoprotective behavior risk factors in adolescents residing in Utah and whether video contest participants have increased sun-protective knowledge and intentions.
Methods
In this cross-sectional study, we surveyed Utah high school students (n=20) who participated in a tanning myths-themed public service announcement video contest. A control cohort of students who did not participate in the video contest were also surveyed (n=89). Demographics, sun exposure history, intentions to tan, and intentions to use sunscreen were documented. Knowledge of tanning myths was assessed with a 7-question sun safety quiz.
Results
The survey response rate was 93.2% (109/117). Two-thirds reported at least one sunburn, and 47.7% (52/109) reported intentional tanning within the past 2 years. Higher tanning intentions were associated with a personal (P<.001), family (P=.001), and peer (P<.001) history of tanning. Video contest participants had higher sun safety quiz scores (P<.001) and higher sunscreen use intentions (P=.01), but did not have decreased tanning intentions (P=.47) compared to non–video contest participants. Hispanic and Black students were less likely to participate in the video contest (P<.001 and P=.04, respectively). In a comparison of White students to students of color, there were no differences in sun exposure history, but students of color had lower sun safety knowledge (P=.01) and lower sunscreen use intention (P=.02).
Conclusions
Sun safety educational disparities exist, and targeted efforts are needed to encourage photoprotective behaviors in high-risk populations. Our findings suggest that video contest participation may encourage sunscreen use and sun protection awareness.
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18
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Sun exposure and sun protective behaviours in Portugal: results from the first National Health Examination Survey (INSEF 2015). J Public Health (Oxf) 2021. [DOI: 10.1007/s10389-019-01133-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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19
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Rivera-Paredez B, Hidalgo-Bravo A, de la Cruz-Montoya A, Martínez-Aguilar MM, Ramírez-Salazar EG, Flores M, Quezada-Sánchez AD, Ramírez-Palacios P, Cid M, Martínez-Hernández A, Orozco L, Denova-Gutiérrez E, Salmerón J, Velázquez-Cruz R. Association between vitamin D deficiency and common variants of Vitamin D binding protein gene among Mexican Mestizo and indigenous postmenopausal women. J Endocrinol Invest 2020; 43:935-946. [PMID: 31907821 DOI: 10.1007/s40618-019-01177-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Accepted: 12/30/2019] [Indexed: 12/13/2022]
Abstract
PURPOSE Vitamin D deficiency (VDD) and polymorphisms in the group-specific component (GC) gene are known to be associated in different populations. However, the effects of such genetic variants may vary across different populations. Thus, the objective of this study was to estimate the association between Vitamin D-Binding Protein (VDBP) haplotypes and VDD in mestizo postmenopausal women and Mexican Amerindian ethnic groups. METHODS This was a cross-sectional study of 726 postmenopausal Mexican women from the Health Workers Cohort Study (HWCS) and 166 postmenopausal women from the Metabolic Analysis in an Indigenous Sample (MAIS) cohort in Mexico. GC polymorphisms (rs7045 and rs4588) were analyzed by TaqMan probes. Serum 25-hydroxyvitamin D [25(OH)D] levels were measured by Chemiluminescent Microparticle Immuno Assay. RESULTS The prevalence of VDD serum 25(OH)D < 20 ng/mL was 43.7% in mestizo women and 44.6% in indigenous women. In HWCS, the single nucleotide polymorphisms (SNPs) rs7041 and rs4588 were associated with VDD. In addition, women from the HWCS, carrying the haplotypes GC2/2 and GC1f/2 had higher odds of VDD (OR = 2.83, 95% CI 1.14, 7.02; and OR = 2.30, 95% CI 1.40, 3.78, respectively) compared to women with haplotype 1f/1 s. These associations were not statistically significant in the MAIS cohort. CONCLUSIONS Our results show genetic association of the analyzed SNPs and related haplotypes, on the GC gene, with VDD in mestizo Mexican postmenopausal women. Moreover, a high prevalence of VDD with high genetic variability within the country was observed. Our results support the need for national policies for preventing VDD.
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Affiliation(s)
- B Rivera-Paredez
- Centro de Investigación en Políticas, Población Y Salud de La Facultad de Medicina de La Universidad Nacional Autónoma de México, Ciudad de México, México
| | - A Hidalgo-Bravo
- Departamento de Genética, Instituto Nacional de Rehabilitación, Ciudad de México, México
| | - A de la Cruz-Montoya
- Laboratorio de Genómica del Metabolismo Óseo, Instituto Nacional de Medicina Genómica (INMEGEN), Ciudad de México, México
| | - M M Martínez-Aguilar
- Laboratorio de Genómica del Metabolismo Óseo, Instituto Nacional de Medicina Genómica (INMEGEN), Ciudad de México, México
| | - E G Ramírez-Salazar
- CONACYT-Laboratorio de Genómica del Metabolismo Óseo, (INMEGEN), Ciudad de México, México
| | - M Flores
- Centro de Investigación en Nutrición y Salud, Instituto Nacional de Salud Pública, Cuernavaca, Morelos, México
| | - A D Quezada-Sánchez
- Centro de Información Para Decisiones en Salud Pública, Instituto Nacional de Salud Pública, Cuernavaca, Morelos, México
| | - P Ramírez-Palacios
- Unidad de Investigación Epidemiológica Y en Servicios de Salud, Instituto Mexicano del Seguro Social (IMSS), Delegación Morelos, Cuernavaca, México
| | - M Cid
- Laboratorio de Inmunogenómica Y Enfermedades Metabólicas Instituto Nacional de Medicina Genómica (INMEGEN), Ciudad de México, México
| | - A Martínez-Hernández
- Laboratorio de Inmunogenómica Y Enfermedades Metabólicas Instituto Nacional de Medicina Genómica (INMEGEN), Ciudad de México, México
| | - L Orozco
- Laboratorio de Inmunogenómica Y Enfermedades Metabólicas Instituto Nacional de Medicina Genómica (INMEGEN), Ciudad de México, México
| | - E Denova-Gutiérrez
- Centro de Investigación en Nutrición y Salud, Instituto Nacional de Salud Pública, Cuernavaca, Morelos, México
| | - J Salmerón
- Centro de Investigación en Políticas, Población Y Salud de La Facultad de Medicina de La Universidad Nacional Autónoma de México, Ciudad de México, México
| | - R Velázquez-Cruz
- Laboratorio de Genómica del Metabolismo Óseo, Instituto Nacional de Medicina Genómica (INMEGEN), Ciudad de México, México.
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20
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Non-use of sunscreen among adults and the elderly in southern Brazil. An Bras Dermatol 2019; 94:567-573. [PMID: 31777358 PMCID: PMC6857572 DOI: 10.1016/j.abd.2018.10.002] [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: 07/27/2018] [Accepted: 10/25/2018] [Indexed: 11/22/2022] Open
Abstract
Background One of the main prevention methods against skin cancer is the use of sunscreen; however, incidence of this disease has not declined despite prevention campaigns. Objective Investigate the prevalence of non-use of sunscreen and its associated factors. Method A population-based cross-sectional study with individuals aged 18 years or over living in the urban area. Conducted between April and July of 2016. Participants were interviewed about socioeconomic, demographic, and behavioral questions. Non-use of sunscreen was considered as the outcome. For multivariate analysis, Poisson regression with robust adjustment for variance was used. Results Among the 1300 participants, prevalence of non-use of sunscreen was 38.2% (95% CI: 34.6–41.8). The variables independently associated with the outcome were male sex, older age, brown or black skin color, lower income, fewer years of education, no physical activity in leisure time, no medical consultations in the last year, and self-perception of health as regular or poor. Study limitations The prevalence may be underestimated by reports of more use of sunscreen than actually used, which could increase the figure in the outcome. Conclusion It was estimated that about four out of ten adults and elderly do not use sunscreen in this sample. Prevention strategies are needed to advance health policy and ensure that sun protection options are easily accessible.
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21
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Hay JL, Zielaskowski K, Meyer White K, Kaphingst K, Robers E, Guest D, Sussman A, Talamantes Y, Schwartz M, Rodríguez VM, Li Y, Schofield E, Bigney J, Hunley K, Buller D, Berwick M. Interest and Uptake of MC1R Testing for Melanoma Risk in a Diverse Primary Care Population: A Randomized Clinical Trial. JAMA Dermatol 2019; 154:684-693. [PMID: 29801061 DOI: 10.1001/jamadermatol.2018.0592] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Importance Germline variants in the MC1R gene are common and confer moderate melanoma risk in those with varied skin types. Approaches to precision skin cancer prevention that include genetic information may promote risk awareness and risk reduction in the general population, including Hispanics. Objective To examine prevalence of interest in and uptake of MC1R testing in the general population and examine patterns across demographic and skin cancer risk factors. Design, Setting, and Participants A randomized clinical trial examined interest in and uptake of MC1R testing among patients at University of New Mexico General Internal Medicine clinics. Study participants were randomized to either a usual-care condition (National Cancer Institute skin cancer pamphlet for diverse skin types) or an MC1R test offer. Participants were registered clinic patients (≥6 months) and English or Spanish fluent. Of the 600 participants recruited to the overall trial, the present study included those 499 participants randomized to the MC1R test offer. Interventions Participants were presented with the option to log onto the study website to read 3 educational modules presenting the rationale, benefits, and drawbacks of MC1R testing. Main Outcomes and Measures Main outcomes include website log on (yes vs no), saliva test kit request (yes vs no), and saliva test kit return for MC1R testing (yes vs no). Demographic and skin cancer risk factors were examined as potential predictors of test interest and uptake. Results Of the 499 participants (220 [44%] non-Hispanic white, 242 [48%] Hispanic, 396 [79%] female; mean [SD] age, 54 [14.3] years), 232 (46%) elected to learn about MC1R testing by logging onto the website; 204 (88%) of those who logged on decided to request testing; and 167 (82%) of those who requested testing returned the kit. The strongest predictors of website log on were race/ethnicity and education (non-Hispanic whites were more likely to log on [odds ratio for Hispanics vs non-Hispanic whites, 0.5; 95% CI, 0.3-0.7], as were more highly educated individuals [odds ratio for more than high school vs high school or less, 2.7; 95% CI, 1.7-4.3]). The strongest predictor of ordering the test was sunburn history (odds ratio, 5.4; 95% CI, 2.3-12.9 vs no sunburn history). Conclusions and Relevance There were moderately high levels of MC1R test interest and uptake in this diverse sample. Addressing potential barriers to testing may be warranted as genomic information becomes integrated into general population approaches to the precision prevention of skin cancer. Trial Registration ClinicalTrials.gov identifier: NCT03130569.
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Affiliation(s)
- Jennifer L Hay
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Kate Zielaskowski
- Clinical Research Finance, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Kirsten Meyer White
- Division of Epidemiology, Department of Internal Medicine, University of New Mexico, Albuquerque
| | - Kimberly Kaphingst
- Department of Communication, University of Utah, Salt Lake City.,Huntsman Cancer Institute, University of Utah, Salt Lake City
| | - Erika Robers
- New Mexico Translation and Transcription, Albuquerque
| | - Dolores Guest
- CRTC Population Sciences Academic Unit, University of New Mexico, Albuquerque
| | - Andrew Sussman
- Department of Family and Community Medicine, University of New Mexico, Albuquerque
| | - Yvonne Talamantes
- CRTC Population Sciences Academic Unit, University of New Mexico, Albuquerque
| | - Matthew Schwartz
- CRTC Population Sciences Academic Unit, University of New Mexico, Albuquerque
| | | | - Yuelin Li
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Elizabeth Schofield
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Jessica Bigney
- Department of General Internal Medicine, University of New Mexico, Albuquerque
| | - Keith Hunley
- Department of Anthropology, University of New Mexico, Albuquerque
| | | | - Marianne Berwick
- Department of Internal Medicine, University of New Mexico, Albuquerque.,Department of Dermatology, University of New Mexico, Albuquerque
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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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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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Kanetsky PA, Hay JL. Marshaling the Translational Potential of MC1R for Precision Risk Assessment of Melanoma. Cancer Prev Res (Phila) 2018; 11:121-124. [PMID: 29246956 PMCID: PMC5839988 DOI: 10.1158/1940-6207.capr-17-0255] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2017] [Revised: 10/30/2017] [Accepted: 12/07/2017] [Indexed: 01/27/2023]
Abstract
Melanoma rates have been increasing in the United States, and neither primary (sun protection and avoidance) nor secondary (skin examination) prevention is practiced consistently, even by those with melanoma risk factors. Inherited variation at MC1R is a robust marker for increased risk of melanoma, even among individuals with "sun-resistant" phenotypes. Although MC1R conveys important information about inherited melanoma risk for a broad spectrum of individuals, concerns that MC1R feedback could have negative consequences, including increased distress about melanoma, inappropriate use of health services, and development of a false sense of security, are valid and require empirical examination. The time is right for high-quality research focusing on the translation of MC1R genotype into clinical and public health practice. If studies show MC1R genetic risk screening is effective at motivating behavior change, more melanomas may be detected at earliest stages for which surgical excision is highly curative or a large number of melanomas may be prevented altogether. While other genetic markers for melanoma susceptibility may emerge in the coming years, the burgeoning research agenda on the public health translational potential of MC1R genetic risk screening will inform and usefully advance current and future precision risk assessment of melanoma. Cancer Prev Res; 11(3); 121-4. ©2017 AACR.
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Affiliation(s)
- Peter A Kanetsky
- Department of Cancer Epidemiology, Moffitt Cancer Center and Research Institute, Tampa, Florida.
| | - Jennifer L Hay
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, New York
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25
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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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Hay JL, Berwick M, Zielaskowski K, White KA, Rodríguez VM, Robers E, Guest DD, Sussman A, Talamantes Y, Schwartz MR, Greb J, Bigney J, Kaphingst KA, Hunley K, Buller DB. Implementing an Internet-Delivered Skin Cancer Genetic Testing Intervention to Improve Sun Protection Behavior in a Diverse Population: Protocol for a Randomized Controlled Trial. JMIR Res Protoc 2017; 6:e52. [PMID: 28442450 PMCID: PMC5424125 DOI: 10.2196/resprot.7158] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2016] [Revised: 02/08/2017] [Accepted: 02/08/2017] [Indexed: 11/13/2022] Open
Abstract
Background Limited translational genomic research currently exists to guide the availability, comprehension, and appropriate use of personalized genomics in diverse general population subgroups. Melanoma skin cancers are preventable, curable, common in the general population, and disproportionately increasing in Hispanics. Objective Variants in the melanocortin-1 receptor (MC1R) gene are present in approximately 50% of the population, are major factors in determining sun sensitivity, and confer a 2-to-3-fold increase in melanoma risk in the general population, even in populations with darker skin. Therefore, feedback regarding MC1R risk status may raise risk awareness and protective behavior in the general population. Methods We are conducting a randomized controlled trial examining Internet presentation of the risks and benefits of personalized genomic testing for MC1R gene variants that are associated with increased melanoma risk. We will enroll a total of 885 participants (462 participants are currently enrolled), who will be randomized 6:1 to personalized genomic testing for melanoma risk versus waiting list control. Control participants will be offered testing after outcome assessments. Participants will be balanced across self-reported Hispanic versus non-Hispanic ethnicity (n=750 in personalized genomic testing for melanoma risk arm; n=135 in control arm), and will be recruited from a general population cohort in Albuquerque, New Mexico, which is subject to year-round sun exposure. Baseline surveys will be completed in-person with study staff and follow-up measures will be completed via telephone. Results Aim 1 of the trial will examine the personal utility of personalized genomic testing for melanoma risk in terms of short-term (3-month) sun protection and skin screening behaviors, family and physician communication, and melanoma threat and control beliefs (ie, putative mediators of behavior change). We will also examine potential unintended consequences of testing among those who receive average-risk personalized genomic testing for melanoma risk findings, and examine predictors of sun protection at 3 months as the outcome. These findings will be used to develop messages for groups that receive average-risk feedback. Aim 2 will compare rates of test consideration in Hispanics versus non-Hispanics, including consideration of testing pros and cons and registration of a decision to either accept or decline testing. Aim 3 will examine personalized genomic testing for melanoma risk feedback comprehension, recall, satisfaction, and cancer-related distress in those who undergo testing, and whether these outcomes differ by ethnicity (Hispanic vs non-Hispanic), or sociocultural or demographic factors. Final outcome data collection is anticipated to be complete by October 2017, at which point data analysis will commence. Conclusions This study has important implications for personalized genomics in the context of melanoma risk, and may be broadly applicable as a model for delivery of personalized genomic feedback for other health conditions.
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Affiliation(s)
- Jennifer L Hay
- Memorial Sloan Kettering Cancer Center, Department of Psychiatry & Behavioral Sciences, New York, NY, United States
| | | | - Kate Zielaskowski
- Memorial Sloan Kettering Cancer Center, Department of Psychiatry & Behavioral Sciences, New York, NY, United States
| | | | | | - Erika Robers
- University of New Mexico, Albuquerque, NM, United States
| | | | - Andrew Sussman
- University of New Mexico, Albuquerque, NM, United States
| | | | | | - Jennie Greb
- University of New Mexico, Albuquerque, NM, United States
| | - Jessica Bigney
- University of New Mexico, Albuquerque, NM, United States
| | | | - Keith Hunley
- University of New Mexico, Albuquerque, NM, United States
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Cestari T, Buster K. Photoprotection in specific populations: Children and people of color. J Am Acad Dermatol 2016; 76:S110-S121. [PMID: 28038884 DOI: 10.1016/j.jaad.2016.09.039] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2016] [Revised: 09/19/2016] [Accepted: 09/24/2016] [Indexed: 10/20/2022]
Abstract
Improved education on appropriate photoprotection in children is vital. Photoprotection for these individuals should include seeking shade, the use of physical agents (clothing, hat, sunglasses), and application of sunscreens on exposed areas. Avoidance of the use of tanning beds is an important component of education for teenagers. Ultraviolet radiation exposure induces DNA damage and photoaging in all skin types, including people of color. The extent of such damage is inversely related to constitutive skin pigmentation. Therefore, personalized photoprotection recommendations concerning skin cancer risk factors, desired treatment outcomes, health needs (eg, vitamin D), and photoaging based on the needs and preferences of the patient are essential. It is clear that additional research is needed on optimal levels of protection against ultraviolet radiation for people of color.
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Affiliation(s)
- Tania Cestari
- Department of Dermatology, Federal University of Rio Grande do Sul, School of Medicine, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil.
| | - Kesha Buster
- Buster Dermatology, Tulsa, Oklahoma; University of Alabama at Birmingham, Birmingham, Alabama
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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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Amber KT, Bloom R, Abyaneh MAY, Falto-Aizpurua LA, Viera M, Zaiac MN, Nouri K, Hu S. Patient Factors and Their Association with Nonmelanoma Skin Cancer Morbidity and the Performance of Self-skin Exams: A Cross-Sectional Study. THE JOURNAL OF CLINICAL AND AESTHETIC DERMATOLOGY 2016; 9:16-22. [PMID: 27878058 PMCID: PMC5110325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Objective: Mohs micrographic surgery is widely utilized for the treatment of nonmelanoma skin cancers with the advantage of tissue sparing and higher cure rate. The preoperative tumor size and post-Mohs micrographic surgery defect size are useful surrogate measures of nonmelanoma skin cancer morbidity. The authors sought to evaluate whether gender, Hispanic ethnicity, socioeconomic status, sun-safe practices and self-skin exams affected tumor size and Mohs micrographic surgery defect size. They also investigated factors associated with self-skin exams. Design: A cross-sectional survey-based study. Setting: Two dermatologic surgery clinics-one academic-associated and the other private. Participants: Patients receiving Mohs surgery for nonmelanoma skin cancers. Measurements: Tumor size and Mohs defect size and their relationship to patient factors ascertained from a survey, as well as the number of patients performing self-skin exams. The authors used t-tests and analysis of variance to compare tumor and defect sizes for each patient factor. Chi-squared tests were used to determine the factors associated with self-skin exams performance. Results: Lower education was associated with greater head and face tumor area (95mm2 vs. 41mm2, P=0.019), but not Mohs micrographic surgery defect size. Other studied patient factors were not associated with an increased morbidity. Hispanics performed self-skin exams at a lower rate than non-Hispanics (27% vs. 46%, p=0.03). Conclusion: This study innovatively uses tumor and Mohs micrographic surgery defect area as a measure of morbidity, allowing for identification of populations at need for improved education and prevention. (J Clin Aesthet Dermatol. 2016;9(9):16-22.).
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Affiliation(s)
- Kyle T. Amber
- Department of Dermatology, University of California Irvine Medical Center, Irvine, California
| | - Romi Bloom
- Department of Dermatology & Cutaneous Surgery, University of Miami, Miller School of Medicine, Miami, Florida
| | | | - Leyre A. Falto-Aizpurua
- Department of Dermatology & Cutaneous Surgery, University of Miami, Miller School of Medicine, Miami, Florida
| | - Martha Viera
- Department of Dermatology & Cutaneous Surgery, University of Miami, Miller School of Medicine, Miami, Florida
| | - Martin N. Zaiac
- Department of Dermatology, Herbert Wertheim College of Medicine, Florida International University, Miami, Florida
| | - Keyvan Nouri
- Department of Dermatology & Cutaneous Surgery, University of Miami, Miller School of Medicine, Miami, Florida
| | - Shasa Hu
- Department of Dermatology & Cutaneous Surgery, University of Miami, Miller School of Medicine, Miami, Florida
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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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Kamath S, Miller KA, Cockburn MG. Current Data on Risk Factor Estimates Does Not Explain the Difference in Rates of Melanoma between Hispanics and Non-Hispanic Whites. J Skin Cancer 2016; 2016:2105250. [PMID: 27092276 PMCID: PMC4820624 DOI: 10.1155/2016/2105250] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2015] [Revised: 02/23/2016] [Accepted: 02/23/2016] [Indexed: 01/07/2023] Open
Abstract
United States Hispanics have seven times lower melanoma incidence rates than non-Hispanic whites (NHW). It is unclear whether this difference can be explained solely by phenotypic risk factors, like darker skin, or whether modifiable risk factors, like sun exposure, also play a role. The purpose of this paper is to summarize what is currently known about melanoma risk factors among Hispanics and NHWs, and whether or not those differences could explain the difference in melanoma incidence. Through literature review, relative risks and prevalence of melanoma risk factors in Hispanics and NHWs were identified and used to calculate the expected rate in Hispanics and rate ratio compared to NHWs. We found that melanoma risk factors either have similar frequency in Hispanics and NHWs (e.g., many large nevi) or are less frequent in Hispanics but do not explain a high proportion of disease variation (e.g., red hair). Considering current knowledge of risk factor prevalence, we found that melanoma incidence rates in the two groups should actually be similar. Sun exposure behavior among Hispanics may contribute to the explanation for the 7-fold difference in melanoma rates. Currently, limited data exist on sun exposure behavior among Hispanics, but possibilities for improving primary prevention by further studying these practices are substantial.
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Affiliation(s)
- Sonia Kamath
- Department of Dermatology, Keck School of Medicine of the University of Southern California (USC), 1200 N State Street, Room 3250, Los Angeles, CA 90033, USA
| | - Kimberly A. Miller
- Department of Preventive Medicine, Keck School of Medicine of USC, 2001 N. Soto Street, Suite 318-A, Los Angeles, CA 90032, USA
| | - Myles G. Cockburn
- Department of Dermatology, Keck School of Medicine of the University of Southern California (USC), 1200 N State Street, Room 3250, Los Angeles, CA 90033, USA
- Department of Preventive Medicine, Keck School of Medicine of USC, 2001 N. Soto Street, Suite 318-A, Los Angeles, CA 90032, USA
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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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Sun Protection Behaviors Associated with Self-Efficacy, Susceptibility, and Awareness among Uninsured Primary Care Patients Utilizing a Free Clinic. Dermatol Res Pract 2015; 2015:753681. [PMID: 26425119 PMCID: PMC4575745 DOI: 10.1155/2015/753681] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2015] [Accepted: 08/25/2015] [Indexed: 12/19/2022] Open
Abstract
Background. Skin cancer is the most commonly diagnosed form of cancer in the United States (US). However, knowledge, behaviors, and attitudes regarding sun protection vary among the general population. The purpose of this study is to examine sun protection behaviors of low-income primary care patients and assess the association between these health behaviors and the self-efficacy, susceptibility, and skin cancer awareness. Methods. Uninsured primary care patients utilizing a free clinic (N = 551) completed a self-administered survey in May and June 2015. Results. Using sunscreen was the least common tactic among the participants of this study. Skin cancer awareness and self-efficacy are important to improve sun protection behaviors. Spanish speakers may have lower levels of skin care awareness compared to US born and non-US born English speakers. Male and female participants use different sun protection methods. Conclusion. It is important to increase skin cancer awareness with self-efficacy interventions as well as education on low-cost sun protection methods. Spanish speaking patients would be a target population for promoting awareness. Male and female patients would need separate gender-specific sun protection education. Future studies should implement educational programs and assess the effectiveness of the programs to further promote skin cancer prevention among underserved populations.
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Transtheoretical Model Constructs' Longitudinal Prediction of Sun Protection Over 24 Months. Int J Behav Med 2015; 23:71-83. [PMID: 26163352 DOI: 10.1007/s12529-015-9498-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
PURPOSE This research examined dynamic transtheoretical model (TTM) constructs for adopting sun protection practices. This secondary data analysis pooled four large population-based TTM-tailored intervention studies and examined use of constructs across three groups, organized by longitudinal progress: maintainers, relapsers, and stable non-changers. METHODS A total of 3463 adults, in the USA, who met criteria for unsafe sun exposure at baseline received a TTM-tailored computerized intervention at baseline, 6 months, and 12 months. The final analytic sample consisted of 1894 participants; the majority were female, White, married, and middle-aged. The three groups were assessed with reliable and valid scales assessing use of TTM constructs at baseline, 6 months, 12 months, and 24 months. Analyses included a MANOVA followed by a series of ANOVAs, with Tukey follow-up tests assessing differences in use of TTM constructs across the three groups at each timepoint. RESULTS Findings demonstrated that relapsers and maintainers were similar in their use of most TTM processes of change at baseline, with the exception of Consciousness Raising, Stimulus Control, Reinforcement Management, and Self-Liberation. CONCLUSIONS These findings suggest that although relapsers reverted to unsafe sun practices, their overall greater use of processes of change indicates that their change efforts remain better than that of stable non-changers.
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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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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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Sprague J, Obioha J, Chiu MW. Availability of sunscreen in predominantly Hispanic neighborhoods vs. adjacent predominantly non-Hispanic neighborhoods in Los Angeles. PHOTODERMATOLOGY PHOTOIMMUNOLOGY & PHOTOMEDICINE 2014; 29:279-82. [PMID: 24001387 DOI: 10.1111/phpp.12062] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/13/2013] [Indexed: 11/29/2022]
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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 MA, Natale-Pereira A, Goydos JS. Linguistic acculturation and skin cancer-related behaviors among Hispanics in the southern and western United States. JAMA Dermatol 2013; 149:679-86. [PMID: 23752366 DOI: 10.1001/jamadermatol.2013.745] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
OBJECTIVE To examine the association between linguistic acculturation (assessed using the Language Use and Linguistic Preference subscales from the Bidimensional Acculturation Scale for Hispanics) and skin cancer-related behaviors among US Hispanic adults to determine whether, compared with Hispanics denoted as Spanish-acculturated, English-acculturated Hispanics would report less frequent shade seeking and use of sun protective clothing and higher rates of sunscreen use, sunbathing, and indoor tanning. DESIGN Online survey study conducted in September 2011. SETTING Five southern and western US states. PARTICIPANTS A population-based sample of 788 Hispanic adults drawn from a nationally representative web panel. MAIN OUTCOME MEASURES Self-reported sunscreen use, shade seeking, use of sun protective clothing, sunbathing, and indoor tanning. RESULTS Multivariate regression analyses were conducted to examine predictors of the skin cancer-related behaviors. As hypothesized, English-acculturated Hispanics had lower rates of shade seeking and use of sun protective clothing and reported higher rates of sunbathing and indoor tanning than Spanish-acculturated Hispanics. English-acculturated Hispanics and bicultural Hispanics (ie, those with high Spanish and high English acculturation) reported comparably high rates of sunbathing and indoor tanning. Results suggested that bicultural Hispanics seek shade and wear sun protective clothing less often than Spanish-acculturated Hispanics but more often than English-acculturated Hispanics. Acculturation was not associated with sunscreen use. CONCLUSIONS Hispanic adults do not routinely engage in behaviors that reduce their risk of skin cancer. Bicultural and English-acculturated Hispanics are particularly in need of skin cancer prevention interventions.
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Affiliation(s)
- Elliot J Coups
- The Cancer Institute of New Jersey, 195 Little Albany St, Room 5567, New Brunswick, NJ 08901, 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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