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Table 1.  
Skin Cancer History, Skin Type, and Sun Protection Practices as a Function of Ethnicitya
Skin Cancer History, Skin Type, and Sun Protection Practices as a Function of Ethnicitya
Table 2.  
Percentage of Participants Who Endorsed Each Reason for Using or Failing to Use Sunscreen as a Function of Ethnicity
Percentage of Participants Who Endorsed Each Reason for Using or Failing to Use Sunscreen as a Function of Ethnicity
1.
Mahler  HIM, Kulik  JA, Gerrard  M, Gibbons  FX.  Long-term effects of appearance-based interventions on sun protection behaviors. Health Psychol. 2007;26(3):350-360.
PubMedArticle
2.
Mahler  HIM, Kulik  JA, Butler  HA, Gerrard  M, Gibbons  FX.  Social norms information enhances the efficacy of an appearance-based sun protection intervention. Soc Sci Med. 2008;67(2):321-329.
PubMedArticle
3.
Lunney  GH.  Using analysis of variance with a dichotomous dependent variable: an empirical study. J Educ Meas. 1970;7:263-269.Article
4.
US Department of Health and Human Services. Healthy People 2020: topics and objectives. http://www.healthypeople.gov/2020/topicsobjectives2020/objectiveslist.aspx?topicId=5. Accessed December 20, 2012.
5.
Cress  RD, Holly  EA.  Incidence of cutaneous melanoma among non-Hispanic whites, Hispanics, Asians, and blacks: an analysis of California cancer registry data, 1988-93. Cancer Causes Control. 1997;8(2):246-252.
PubMedArticle
6.
Cormier  JN, Xing  Y, Ding  M,  et al.  Ethnic differences among patients with cutaneous melanoma. Arch Intern Med. 2006;166(17):1907-1914.
PubMedArticle
Research Letter
January 2014

Reasons for Using and Failing to Use SunscreenComparison Among Whites, Hispanics, and Asian/Pacific Islanders in Southern California

Author Affiliations
  • 1Department of Psychology, University of California, San Diego
  • 2Department of Psychology, California State University, San Marcos
JAMA Dermatol. 2014;150(1):90-91. doi:10.1001/jamadermatol.2013.4992

More detailed information about the perceived benefits of or barriers to adopting particular risk reduction behaviors would inform skin cancer prevention interventions. The primary purpose of this study was to compare the reasons for using and failing to use sunscreen among Asian/Pacific Islanders, Hispanics, and non-Hispanic whites.

Methods

All procedures were reviewed and approved by the University of California, San Diego (UCSD), institutional review board. All participants provided written informed consent. The data were drawn from baseline questionnaires completed during 9 different experiments examining the efficacy of various sun protection interventions conducted at UCSD or at area beaches between 2000 and 2009. Although results of the interventions have been published previously (eg, Mahler and colleagues1,2), participants’ reasons for sunscreen use have not. Demographic information, UV exposure, sun protection behaviors, and reasons for using and failing to use sunscreen (Table 1) were assessed. To assess the latter, participants who indicated ever using sunscreen checked any of 5 reasons, and those who indicated ever failing to use sunscreen checked any of 9 reasons (Table 2; reasons derived through piloting). Analyses of variance were used to compare baseline behaviors and demographics. χ2 Tests were used to examine the distributions of each of the reasons for using and failing to use sunscreen, with follow-up paired t tests to enable comparison across ethnic groups.3

Results

Results of any participants who reported their ethnicity as white (n = 795), Asian/Pacific Islander (n = 323), or Hispanic (n = 65) were included in the analyses. See Table 1 for demographics and sun protection behaviors across groups.

Table 2 provides the percentage of participants in each race/ethnicity category who endorsed each of the reasons for using or failing to use sunscreen. Avoiding sunburn was endorsed most frequently, and the avoidance of skin cancer was the second most frequently endorsed reason for using sunscreen, by all 3 groups. Half of the white participants indicated that avoidance of wrinkles is one reason they wear sunscreen, whereas significantly fewer Asian/Pacific Islanders (36%) endorsed this reason. “I often forget” was the most frequently endorsed reason for failing to use sunscreen, and there was no significant difference across groups in the percentage endorsing this reason. The second most frequently endorsed reason for failing to use sunscreen was that “it is too greasy.” However, there was disparity in the numbers of individuals across the groups who endorsed this reason, with only approximately one-third of whites and Hispanics, but well over half of Asian/Pacific Islanders, selecting this reason. Approximately one-third of whites and more than 43% of Asian/Pacific Islanders, but only 16% of Hispanics, indicated that sunscreen use is “too much trouble.” More than a quarter of whites indicated that they did not use sunscreen because it prevents a tan. A similar number of Asians indicated that sunscreen is too messy, and 29% of Hispanics checked that they do not use sunscreen because they have dark skin.

Discussion

Reducing skin cancer risk among all Americans is one of the objectives of “Healthy People 2020.”4 Skin cancers, including melanoma, are less prevalent but more costly to treat and more often deadly in nonwhites than in whites.5,6 This study found some racial/ethnic differences in reasons for engaging in one important type of risk reduction behavior—sunscreen use. Future prevention efforts may be improved by (1) encouraging the incorporation of sunscreen into daily routines to decrease forgetting and perceived inconvenience; (2) increasing awareness, particularly among race/ethnicities other than white, of the potential appearance benefits of sun protection; and (3) emphasizing the availability of nonoily/nongreasy types of sunscreen products. Future work should focus on increasing generalizability by recruiting larger Hispanic, African American, male, and community samples and examining disparities in other prevention behaviors.

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Article Information

Corresponding Author: Heike I. M. Mahler, PhD, Department of Psychology 0109, University of California, San Diego, La Jolla, CA 92093 (hmahler@ucsd.edu).

Published Online: November 13, 2013. doi:10.1001/jamadermatol.2013.4992.

Author Contributions: Dr Mahler had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Conflict of Interest Disclosures: None reported.

Funding/Support: This study was supported in part by a grant from the National Cancer Institute.

Role of the Sponsors: The funding agency had no role in the design and conduct of the study; in the collection, analysis, and interpretation of the data; or in the preparation, review, or approval of the manuscript.

Additional Contributions: The author thanks James Kulik, Meg Gerrard, Rick Gibbons, Daniel Barron, Shiloh Beckerly, Heather Butler, Alma Correa, Anthony Daggett, Angela Gorezman, Emily Gray, Jody Harrell, Kathryn Herbst-Damm, Karen Lee, Jaimi Martsolf, Anna Pang, Gali Weissberger, Lauren Whelan-Miille, Crystal Winters, and Gardie Lueders for their help in carrying out this project.

References
1.
Mahler  HIM, Kulik  JA, Gerrard  M, Gibbons  FX.  Long-term effects of appearance-based interventions on sun protection behaviors. Health Psychol. 2007;26(3):350-360.
PubMedArticle
2.
Mahler  HIM, Kulik  JA, Butler  HA, Gerrard  M, Gibbons  FX.  Social norms information enhances the efficacy of an appearance-based sun protection intervention. Soc Sci Med. 2008;67(2):321-329.
PubMedArticle
3.
Lunney  GH.  Using analysis of variance with a dichotomous dependent variable: an empirical study. J Educ Meas. 1970;7:263-269.Article
4.
US Department of Health and Human Services. Healthy People 2020: topics and objectives. http://www.healthypeople.gov/2020/topicsobjectives2020/objectiveslist.aspx?topicId=5. Accessed December 20, 2012.
5.
Cress  RD, Holly  EA.  Incidence of cutaneous melanoma among non-Hispanic whites, Hispanics, Asians, and blacks: an analysis of California cancer registry data, 1988-93. Cancer Causes Control. 1997;8(2):246-252.
PubMedArticle
6.
Cormier  JN, Xing  Y, Ding  M,  et al.  Ethnic differences among patients with cutaneous melanoma. Arch Intern Med. 2006;166(17):1907-1914.
PubMedArticle
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