Research shows English-speaking U.S. Hispanics less likely to engage in skin cancer prevention practices

The Cancer Institute of New JerseyApr 19 2013

Research from The Cancer Institute of New Jersey shows that U.S. Hispanics who speak English are less likely to engage in skin cancer prevention practices and more likely to put themselves at risk for skin cancer as compared to Spanish-speaking Hispanics who live in this country. Investigators say their findings show a need to consider linguistic acculturation - the way one adapts to the multiple languages to which he or she is exposed - in developing interventions for this population. The Cancer Institute of New Jersey is a Center of Excellence of the University of Medicine and Dentistry of New Jersey-Robert Wood Johnson Medical School (RWJMS).

U.S. Census figures show that Hispanics are the fastest growing racial/ethnic group in the country. Even though Hispanics have a lower incidence of melanoma skin cancer than non-Hispanic Caucasian individuals, they are more likely to be diagnosed with melanoma at an earlier age and at an advanced stage, according to the National Cancer Institute. Researchers say for those reasons it is important to target Hispanics for skin cancer prevention interventions.

The current study, Linguistic Acculturation and Skin Cancer-Related Behaviors among Hispanics in the Southern and Western United States, appears in the latest print edition of JAMA Dermatology (doi:10.1001/jamadermatol.2013.745). The study focuses on the association between Hispanic individuals' language use and preference and their engagement in skin cancer-related behaviors. It also examined whether Hispanic individuals' skin cancer-related behaviors varied according to their demographic characteristics.

The study participants were 788 Hispanic adults residing in Arizona, California, Florida, New Mexico or Texas who were drawn from a nationally representative panel of individuals known as KnowledgePanelLatinoSM, which is administered by the research company GfK Custom Research, LLC (GfK). The participants completed an online survey in English or Spanish that included questions about how often and how well they speak English and Spanish. They also completed survey items related to skin cancer prevention (sunscreen use, shade seeking, use of sun-protective clothing) and risk behaviors (sunbathing, indoor tanning). Demographic information such as gender, age, education level, latitude of residence and Hispanic heritage also was collected. Of the total participants, 35.6 percent were denoted as Spanish-speaking, 19.5 percent English-speaking and 44.9 percent acculturated to both languages.

Overall, as compared to Spanish-speaking Hispanics, English-acculturated Hispanics reported being more likely to engage in behaviors that put them at a higher risk for developing skin cancer (sunbathing, indoor tanning) and less likely to protect themselves by seeking shade and wearing protective clothing. The results showed that language had no bearing on sunscreen use.

Hispanics with a strong command of both languages were found to engage in skin cancer prevention behaviors at a lower level than Spanish-speaking Hispanics, but at a higher rate than English-acculturated Hispanics. But with regard to risk behaviors, bicultural participants were found to engage in these practices at levels similar to English-speaking Hispanics.

As far as specific risk behaviors, 39 percent of participants reported sunbathing, which was more commonly reported by younger individuals and those of Puerto Rican, Cuban, South American or "other" Hispanic heritage compared to those of Mexican descent. A little more than five percent of participants had ever tanned indoors, and this activity was more prevalent among women and those of Cuban or "other" Hispanic descent compared to those of Mexican origin.

In terms of protective behaviors, 53 percent of participants reported that they stay in the shade most of the time or always when outside on a sunny day. Thirty-one percent reported using sunscreen at least most of the time when they are outside, while 24 percent reported wearing sun protective clothing most of the time or always. Hispanic men reported using sunscreen and seeking shade less often than women, but were more likely to wear sun protective clothing. It was also found that older Hispanics were more likely to seek shade and wear sun protective clothing. Just over 43 percent of participants reported that they never or rarely use sunscreen, and nearly a quarter of those who did were not aware of the sun protection factor (SPF) of their sunscreen.

Elliot J. Coups, PhD, behavioral scientist at The Cancer Institute of New Jersey and associate professor of medicine at UMDNJ-Robert Wood Johnson Medical School, is the lead author of the study. "The association we identified between language use and preference and skin-cancer related behaviors emphasizes the need to develop and test interventions to reduce skin cancer risk among Hispanic individuals of varying levels of acculturation," noted Dr. Coups. "The study results also highlight the need to include issues related to culture, race and ethnicity in dermatology training programs."

To further address the needs for this population, Coups and colleagues are embarking on a project to develop and test a program to promote sun-safe behaviors among Hispanic outdoor laborers - a project made possible with the commitment of Johnson & Johnson to help address health priorities impacting community residents.