SKIN CANCER PREVENTION BEHAVIORS AMONG HISPANICS IN THE PENNSYLVANIA STATE CANCER INSTITUTE CATCHMENT AREA: A MIXED-METHODS STUDY

Introduction Given that skin cancer is highly preventable, the increasing trend of skin cancer among Hispanic populations is concerning. U.S. Hispanics represent a target population for heightened skin cancer prevention efforts; however, to date, almost all skin cancer studies, public health programs, and educational interventions related to UV radiation exposure and protective behaviors have targeted populations with a majority white or all white population. Increased public health education efforts and interventions that consider barriers and facilitators to adoption of sun protective behaviors are necessary. This study will provide a robust approach towards promotion of sun protective behaviors among Hispanics in the PSCI catchment area, via the following aims: Aim 1: Describe recent skin cancer prevention practices and correlates of skin cancer prevention behaviors among U.S. Hispanics overall; Aim 2: Discern cultural insights that elucidate barriers and facilitate adherence to healthy behaviors among Hispanics in the PSCI catchment area; Aim 3: Integrate and summarize findings to provide recommendations for policymakers and health professionals to increase sun protective behaviors among the Hispanic population in the PSCI catchment area. Scientific Foundation The Cultural Health Belief model was used to guide this study. U.S. Hispanics perceive skin cancer risk to be low, thus leading to low adoption of behaviors. Cultural and socioecological factors were considered as having a large influence on health behaviors in order to provide culturally-specific recommendations. Methods An explanatory sequential mixed-methods design was employed for this study. First, sociodemographic, psychosocial, lifestyle factors, acculturation level, and adherence to each sun protective behavior (e.g. sunscreen use, seeking shade, wear protective clothing) were quantitatively analyzed among U.S. Hispanics using nationally representative data. Results informed the development of a semi-structured interview guide to be used in the data collection procedures of a subsequent qualitative study. Semi-structured 1-1 interviews were then conducted on a convenience sample of ten key informants in the PSCI catchment area that demonstrate understanding of the importance of reducing cancer burden among Hispanics. Interview questions qualitatively explored cultural insights that influence adoption of sun protective behaviors. Thematic content analysis was performed and summarized to explain significant quantitative findings. Lastly, integration and interpretation of the results were summarized in a joint display. Results Quantitative data analysis on 322 Hispanic adults from HINTS 2013 found that being female (0.66), or those who reported a > $75,000 income (0.87), high English proficiency (0.93), or > 11 years of U.S. residence (0.60) were positively associated with sunscreen use. Males were more likely to wear protective clothing, particularly among those aged 65-74 years old (1.18). Qualitative findings included the effectiveness of community-based approaches that leveraged stakeholders, using trusted sources, and access to easy-to-understand, bilingual materials and services for the delivery of health information and influencing sun protective behaviors. Qualitative findings explained that gender, English fluency, and duration of U.S. residence were influenced by knowledge gaps and misconceptions of skin cancer risk and influenced by cultural norms.
Conclusions Language, literacy, and knowledge gaps and misconceptions of skin cancer risk need to be prioritized for successful health promotion efforts to increase sun protective behaviors among the Hispanic community, especially among the older adult and migrant population, in the PSCI catchment area. Future research among Hispanic community members using in-person and bilingual methods may prove beneficial for future studies.