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Coups EJ, Stapleton JL, Hudson SV, Medina-Forrester A, Goydos JS, Natale-Pereira A. Skin Cancer Screening Among Hispanic Adults in the United States: Results From the 2010 National Health Interview Survey. Arch Dermatol. 2012;148(7):861–863. doi:10.1001/archdermatol.2012.615
Compared with non-Hispanic whites, Hispanics are more likely to be diagnosed as having melanoma at an earlier age, with thicker, more advanced lesions, and they are more likely to die from their disease.1 Physician skin examination (PSE) may reduce the incidence of thick melanomas that have a poor prognosis.2 Few studies have examined the rate of PSE among US Hispanic adults. In the present study, we examine the prevalence and correlates of PSE among US Hispanic adults in a nationally representative sample.
The data were drawn from the 2010 National Health Interview Survey (NHIS), which is an annual, probability-based survey of US adults.3 Institutional review board approval was obtained for the study. The sample consisted of 4766 individuals who self-reported Hispanic ethnicity, reported no personal history of skin cancer, and provided data regarding their PSE history.
Participants indicated whether they were born in the United States and the language they generally use when speaking, which are 2 commonly used proxy measures of acculturation. They also reported their Hispanic origin, sex, age, level of education, region of residence, source of routine preventive care, health care coverage, skin sensitivity to the sun, the number of sunburns they had in the past year, and whether they had ever had a PSE (defined as having all of the skin from head to toe checked for cancer by a dermatologist or other physician).
Using Sudaan 10.0 software and a statistical significance cutoff of P < .05, we conducted a series of univariate logistic regression analyses, using “ever having a PSE” as the dichotomous outcome variable and each of the other variables as independent variables.
As listed in the Table, 7.2% of participants reported ever having a PSE. Lower rates of PSE were found among those born outside of the United States as well as those who did not report speaking mostly or only in English. The rate of PSE differed significantly according to individuals' Hispanic origin, with lower rates found among those from Mexico and the Dominican Republic and higher rates among those from Cuba and Puerto Rico.
With regard to demographic factors, the rate of PSE was lower among men, younger individuals, and those with a lower education level, but the rate did not differ across region of residence. The rate of PSE was lower among individuals who had no source of preventive care or who received preventive care somewhere other than a physician's office or health maintenance organization. Individuals lacking health care coverage also had lower rates of PSE. Participants reporting less sun-sensitive skin had lower rates of PSE than those with the most sensitive skin. The rate of PSE did not differ according to the number of reported sunburns in the past year.
Only 1 in 14 US Hispanic adults in the present study reported ever having a PSE, which is lower than the 1 in 4 rate (25.4%) among non-Hispanic white adults in the 2010 NHIS. Based on their reported nativity and language use, more-acculturated Hispanics had a higher rate of PSE. Prior research has found mixed evidence regarding the association between acculturation among US Hispanics and skin cancer–related behaviors, with more acculturated individuals having higher rates of sunscreen use but lower rates of staying in the shade and wearing sun-protective clothing.4 Differences in the rate of PSE across individuals' levels of acculturation and Hispanic origin in the current study highlight the need for future research to explore concomitant differences in skin cancer prevention knowledge, attitudes, and beliefs.
The lower rate of PSE among younger individuals and those with lower levels of education is consistent with previous findings in the general US population, but the lower PSE rate among men stands in contrast to prior research5 and warrants further exploration. The rate of PSE was particularly low among individuals lacking health care access or coverage, suggesting that these factors serve as barriers to the receipt of PSE. It is encouraging that the PSE rate was higher among individuals with the most sun-sensitive skin, although 90% of them remained unscreened, and the PSE rate was not higher among individuals reporting more vs fewer sunburns.
Overall, the rate of PSE among US Hispanics is low. Future research and public health efforts are needed to develop and test interventions to promote PSE among Hispanics at risk for melanoma.
Correspondence: Dr Coups, The Cancer Institute of New Jersey, 195 Little Albany St, Room 5567, New Brunswick, NJ 08901 (firstname.lastname@example.org).
Accepted for Publication: February 6, 2012.
Published Online: May 21, 2012. doi:10.1001/archdermatol.2012.615
Author Contributions: Dr Coups had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. Study concept and design: Coups, Stapleton, Hudson, Medina-Forrester, Goydos, and Natale-Pereira. Acquisition of data: Coups. Analysis and interpretation of data: Coups, Stapleton, Hudson, Medina-Forrester, Goydos, and Natale-Pereira. Drafting of the manuscript: Coups. Critical revision of the manuscript for important intellectual content: Coups, Stapleton, Hudson, Medina-Forrester, Goydos, and Natale-Pereira. Statistical analysis: Coups. Obtained funding: Coups.
Financial Disclosure: None reported.
Funding/Support: This research was supported by a Cancer Prevention and Control Pilot Award from The Cancer Institute of New Jersey (Dr Coups) and by National Cancer Institute grants K07CA133100 (Dr Coups) and K01CA131500 (Dr Hudson).
Role of the Sponsors: The sponsors had no role in the design and conduct of the study, the collection, management, analysis, or interpretation of the data, and the preparation, review, or approval of the manuscript.
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