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Original Investigation
December 2016

Defining the Need for Skin Cancer Prevention Education in Uninsured, Minority, and Immigrant Communities

Author Affiliations
  • 1Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida
  • 2The Caridad Center, Boynton Beach, Florida
  • 3Dermatology Medical Missions Inc, Delray Beach, Florida
JAMA Dermatol. 2016;152(12):1342-1347. doi:10.1001/jamadermatol.2016.3156
Key Points

Question  What are appropriate strategies and education topics for skin cancer prevention interventions in uninsured, minority, and immigrant communities?

Findings  In a survey of 206 participants, 25.4% had never heard of skin cancer or melanoma, 20.7% believed that people with dark skin cannot get skin cancer, and 58.2% never or rarely conducted self–skin checks. Video (37.3%) and text messaging (30.8%) were the most popular outreach methods.

Meaning  Intervention efforts in uninsured, minority, and immigrant communities need to focus on increasing knowledge capacity and promoting self–skin checks. Video and text messaging may be appropriate intervention methods.


Importance  As the minority population increases in the United States, the incidence of skin cancer has important public health consequences, including poor skin cancer outcomes, in part because of late-stage diagnosis. Therefore, it is important to identify obstacles in skin cancer prevention in these communities.

Objective  To characterize skin cancer prevention and education needs in uninsured, minority, and immigrant communities in South Florida.

Design, Setting, and Participants  At a large free medical clinic in Florida, a convenience sample of people completed a 23-question survey in English, Spanish, or Haitian Creole assessing their skin cancer risk perception, knowledge, sun protective behaviors and barriers, and desirable outreach methods. All participants were uninsured and living at least 200% below the federal poverty level. Participants were adults recruited from the general waiting room who understood 1 of the 3 languages and were not present for a scheduled dermatology visit.

Main Outcomes and Measures  The survey used Likert-type scales, true or false, and yes or no questions. Data were analyzed with SPSS IBM statistical software (version 22) using 1-way analysis of variance, χ2 tests, and Pearson correlations.

Results  Among the 219 people invited, 206 participants (mean [SD] age, 43 [13.2] years) completed the survey; 75% of respondents were women who usually worked indoors. Almost a quarter (49 [24.5%) had never heard of skin cancer or melanoma. Nearly half (89 [44.3%]) had never conducted a self–skin examination. One in 5 (41 [20.7%]) believed that people with dark skin cannot get skin cancer. Three quarters (156 [75.7%]) of respondents fell into the “low/inconsistent” sun protective behavior category. Barriers to sun-protective behaviors were “using sun protection is too hot” (75 participants [39.3%]) and “I forget.” (72 [37.7%]). More than 85% (175 [87.9%]) wanted to learn more about how to prevent skin cancer. Watching a video (37.3%) and text messaging (30.8%) were identified as the most popular outreach methods.

Conclusions and Relevance  Important barriers to skin cancer prevention were lack of knowledge, the belief that dark skin was protective, and using sun protection made them feel too hot. Skin cancer education and intervention efforts in uninsured, minority, immigrant populations may be provided by videos and text messaging.