July 18, 2011 Among Latinos living in the United States, acculturation is associated with sunscreen use, but not with use of sun-protective clothing, according to a report in the July issue of Archives of Dermatology, one of the JAMA/Archives journals.
According to background information in the article, DNA damage and skin cancer are an important health issue for U.S. Latinos. Their annual age-adjusted incidence of melanoma is 4.5 per 100,000, which represents an increase of 28.6 percent since 1992. Further, when melanoma is diagnosed, it tends to be thicker among Latinos than among non-Latino white individuals. Acculturation, defined as use of the English language and length of residence in the United States, may affect this population's efforts to avoid sun-related health problems, note the authors: "Acculturated Latinos might have increased exposure to sun safety information via health care access, education, and expanded social networks but display decreased engagement in some sun-safe behaviors."
Valentina A. Andreeva, Ph.D., from the University of Paris XIII in Bobigny, France, who conducted research at the University of Southern California, and colleagues examined cross-sectional data from the National Cancer Institute's 2005 Health Information National Trends Survey. Four-hundred ninety-six Latino respondents answered questions about sun-safe behaviors: wearing sunscreen, long-sleeved shirts and long pants and staying in shade when outside for at least one hour on warm, sunny days. Acculturation was determined by preferred language for the interview, perceived comfort with the English language and, for foreign-born respondents, age at U.S. arrival and duration of U.S. residence. Researchers also asked about health care access, educational level and social support from community organizations, family or friends, neighbors and religious institutions. The study focused on mediated associations.
There was a positive association between acculturation and sunscreen use and a negative association between acculturation and use of sun-protective clothing, with these associations mediated by educational level. Once the mediators were entered in the model, the direct association between acculturation and sunscreen use was no longer significant. The indirect effects of acculturation, education level, perceived health status and social networks appeared to significantly affect this behavior. The researchers found that the direct negative association between acculturation and use of shade was significant, and that education level combined with acculturation to mediate the use of sun-protective clothing.
The authors noted that social networks appeared to have the most overall influence on sun-safe behaviors and that research should focus on sun-safe behaviors other than sunscreen use, for which most of the hypothesized mediators were supported. "In conclusion, sun safety practice is critical for the prevention of skin cancer regardless of skin type, but no ethnoracial group appears to meet current primary prevention recommendations," the researchers state. "Our results, denoting variability in the mediation mechanisms for different sun-safe behaviors, could guide primary prevention program development for Latinos and future public health research."
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- V. A. Andreeva, M. G. Cockburn, A. L. Yaroch, J. B. Unger, R. Rueda, K. D. Reynolds. Preliminary Evidence for Mediation of the Association Between Acculturation and Sun-Safe Behaviors. Archives of Dermatology, 2011; 147 (7): 814 DOI: 10.1001/archdermatol.2011.145
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