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

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.

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.

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.

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.

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