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Table 1. 
Demographic Characteristics of and Correct Knowledge Statements Made by UMMSM Medical Students
Demographic Characteristics of and Correct Knowledge Statements Made by UMMSM Medical Students
Table 2. 
Knowledge Score Comparisons by UMMSM Medical Student Category
Knowledge Score Comparisons by UMMSM Medical Student Category
Table 3. 
Summary Scores of Sun-Protection Behaviors of UMMSM Medical Students
Summary Scores of Sun-Protection Behaviors of UMMSM Medical Students
Table 4. 
Sun-Protection Attitudes of UMMSM Medical Students
Sun-Protection Attitudes of UMMSM Medical Students
Table 5. 
Key Correlations of UMMSM Student Knowledge, Attitudes, and Behaviors
Key Correlations of UMMSM Student Knowledge, Attitudes, and Behaviors
1.
Glanz  KYaroch  ALDancel  M  et al.  Measures of sun exposure and sun protection practices for behavioral and epidemiologic research. Arch Dermatol 2008;144 (2) 217- 222
PubMedArticle
2.
Gillani  FRashid  AAnis  A  et al.  The skin we are in: knowledge and practices regarding skin cancer in preclinical medical students. J Pak Med Assoc 2001;51 (10) 373- 378
PubMed
3.
Jemal  ASiegel  RWard  E  et al.  Cancer statistics, 2008. CA Cancer J Clin 2008;58 (2) 71- 96
PubMedArticle
4.
Bedikian  AYJohnson  MMWarneke  CL  et al.  Prognostic factors that determine the long-term survival of patients with unresectable metastatic melanoma. Cancer Invest 2008;26 (6) 624- 633
PubMedArticle
5.
Hymowitz  MBHayes  BBMaury  JJGeller  AC Evaluation of medical students' knowledge, attitudes, and personal practices of sun protection and skin self-examination. Arch Dermatol 2006;142 (4) 523- 524
PubMedArticle
Research Letter
July 2010

Skin Cancer Awareness, Attitude, and Sun Protection Behavior Among Medical Students at the University of Miami Miller School of Medicine

Author Affiliations

Author Affiliations: Department of Dermatology and Cutaneous Surgery (Drs Kirsner and Hu) University of Miami Miller School of Medicine (Ms Patel and Dr Rouhani), Miami, Florida; Department of Dermatology, St Luke’s-Roosevelt Hospital, New York, New York (Dr Nijhawan); Department of Dermatology, Weill Cornell Medical College Methodist Hospital, Houston, Texas (Dr Stechschulte); Department of Industrial Engineering and Management, Ben Gurion University of the Negev, Beer-Sheva, Israel (Dr Parmet).

Arch Dermatol. 2010;146(7):797-800. doi:10.1001/archdermatol.2010.140

Sun protection and skin cancer awareness among young adults is vital in the primary prevention of melanoma and sun-induced skin cancers. As future physicians, medical students will play an important role in the primary prevention of skin cancers. Their knowledge and awareness of skin cancer prevention will likely impact the effectiveness of their promotion of sun-smart behavior. Given the sunny location of Miami, Florida, and the high incidence of melanoma in Florida, we surveyed medical students of University of Miami Miller School of Medicine (UMMSM) on their sun-protection knowledge, attitudes, and behaviors. The questions, along with the survey results, are outlined in Tables 1, 2, 3, and 4.

Methods

With approval from the UMMSM institutional review board, we offered a questionnaire made up of validated questions to first- and second-year medical students in October 2007.1 Nine true or false questions assessed the students' knowledge of sun protection methods. The final knowledge score was determined by the percentage of correct answers, with 100% as the maximum possible score.

Eleven questions assessed sun-protective behaviors: 4 about sunscreen use, 2 about sun avoidance, and 4 about other behaviors including avoidance of tanning beds. The 5 possible responses to each question ranged from very unlikely to very likely, with a score of 1 (low performance) assigned to very unlikely and a score of 5 (high performance) assigned to very likely responses. Mean scores for each student's responses in each of the 3 categories of sun-protective behaviors were calculated, yielding 3 final scores for behavior.

A 2-sample t test was used to compare both the sun-protective knowledge and sun-protective behaviors between male and female students and between students with and without a personal or family history of skin cancer.

Twelve questions assessed attitudes toward sun protection, with responses ranging from strongly agree to strongly disagree. To compare the differences in attitudes between male and female students, the number of affirmative responses (strongly agree or agree) were grouped and reported along with P values computed from χ2 analysis. The Spearman test was used to examine the correlation of sun-protective behaviors and knowledge with sun-protection attitudes.

Results

Of the 296 students offered the survey, 270 completed the survey (91% response rate). Tables 1, 2, 3, and 4 summarize the results. The mean score on sun-protection and skin-cancer knowledge was 90.0%, but significant sex differences were found: women scored higher (93.1%) than men (87.7%) (P = .001). When stratified by personal and/or family history of skin cancer, medical students without any family or personal history of skin cancer scored higher (90.1%) than those with family and/or personal history (74.1%) (P = .04).

Regarding sun-protection behaviors, female students reported more frequent sunscreen use and sun-avoidance behavior and more frequently engaged in other sun-protective behaviors than their male peers. More women than men valued the importance of sun protection and acknowledged that sun exposure is the most important risk factor for skin cancer. More women also agreed that darker-skinned individuals also need to use sun protection. However, most students admitted to forgetting to use sun-protection methods. Alarmingly, more than two-thirds of students preferred the image of being tan.

We also examined the relationships between knowledge, behaviors, and attitudes (Table 5). Greater sun-protection knowledge was associated significantly with better sun-protective attitudes and behaviors. Students with good sun-protective attitudes were more likely to engage in sun-protective behaviors. Furthermore, those who used sunscreen tended to also practice other sun-smart behaviors.

Comment

Medical students at UMMSM overall had satisfactory knowledge on skin-cancer prevention, similar to what was reported by Gillani et al2 in a survey of second-year medical students. However, significant differences existed between the sexes. In our study, men had a lower knowledge level, less appreciation for the importance of sun protection, and were less likely to use active sun-protective measures. It is known that men are at higher risk for melanoma than women: 1 in 41 men compared with 1 in 61 women will develop melanoma in their lifetime.3 Men also have a worse prognosis once diagnosed as having melanoma.4 Perhaps sex differences in knowledge and behavior contribute to the higher melanoma incidence and mortality among men. Similar to a recent study by Hymowitz et al,5 our study found pro tanning attitudes in both male and female medical students, which represents an area in need of change through better education.

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Article Information

Correspondence: Dr Hu, Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, 1600 NW 10th Ave, RMSB 2023A, Locator Code R-250 Miami, FL 33136 (shu@med.miami.edu).

Author Contributions: All authors had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. Study concept and design: Patel, Nijhawan, Stechschulte, and Hu. Acquisition of data: Patel, Nijhawan, and Stechschulte. Analysis and interpretation of data: Patel, Stechschulte, Parmet, Rouhani, Kirsner, and Hu. Drafting of the manuscript: Patel, Stechschulte, Parmet, and Rouhani. Critical revision of the manuscript for important intellectual content: Patel, Nijhawan, Stechschulte, Rouhani, Kirsner, and Hu. Statistical analysis: Parmet and Rouhani. Administrative, technical, and material support: Patel and Nijhawan. Study supervision: Stechschulte, Kirsner, and Hu.

Financial Disclosure: None reported

References
1.
Glanz  KYaroch  ALDancel  M  et al.  Measures of sun exposure and sun protection practices for behavioral and epidemiologic research. Arch Dermatol 2008;144 (2) 217- 222
PubMedArticle
2.
Gillani  FRashid  AAnis  A  et al.  The skin we are in: knowledge and practices regarding skin cancer in preclinical medical students. J Pak Med Assoc 2001;51 (10) 373- 378
PubMed
3.
Jemal  ASiegel  RWard  E  et al.  Cancer statistics, 2008. CA Cancer J Clin 2008;58 (2) 71- 96
PubMedArticle
4.
Bedikian  AYJohnson  MMWarneke  CL  et al.  Prognostic factors that determine the long-term survival of patients with unresectable metastatic melanoma. Cancer Invest 2008;26 (6) 624- 633
PubMedArticle
5.
Hymowitz  MBHayes  BBMaury  JJGeller  AC Evaluation of medical students' knowledge, attitudes, and personal practices of sun protection and skin self-examination. Arch Dermatol 2006;142 (4) 523- 524
PubMedArticle
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