For Latinos, how long they've lived in the U.S. and how well they speak English were tied to the practice of skin cancer prevention, researchers said.
Educational level, self-perceived health status, and health-related discussions within a social network mediated the positive association between acculturation and sunscreen use, Valentina Andreeva, PhD, of the University of Southern California, and colleagues, reported in the July issue of the Archives of Dermatology.
The authors defined acculturation as the greater use of the English language and longer duration of residence in the U.S. Both of these factors may increase exposure to sun safety information via healthcare access, education, and expanded social networks.
However, other sun-protective behaviors, such as the use of shade and sun-shielding clothing, were not largely mediated by these factors, they reported in a structural equation modeling study that looked at direct and indirect paths between acculturation and sun-safe practice.
The findings "emphasize behavior-specific mediated associations and could inform sun safety programming for Latinos with low and high levels of acculturation," Andreeva and colleagues wrote.
Generally, Latinos have higher rates of melanoma than do whites. So to assess potential mediators between sun-safe behaviors and acculturation, the researchers looked at data from 496 Latino respondents in the 2005 Health Information National Trends Survey.
In the survey, the use of sunscreen, shade, and sun-protective clothing when outdoors on sunny days were assessed by self-report on frequency scales.
The authors of the modeling study found that overall, acculturation was associated with sun-protective behaviors, albeit in different ways.
Talking with members of a social network about health matters; having a greater educational level; perceiving better health were associated with greater use of sunscreen (P<0.05).
Social networks displayed the largest effect size, the researchers said, which is "consistent with evidence that sunscreen use, skin self-examinations and those conducted by a physician or a nurse, and knowledge regarding skin cancer prevention cluster within peer groups."
But there were no links between any of these factors and the use of shade, the researchers reported.
As well, fewer of these factors mediated the relationship between acculturation and the use of sun-protective clothing, except for educational level, which had a negative association (P=0.049).
Healthcare access was the only mediator that had no associations with any sun-protective behaviors at all, the researchers said.
"Although consistent evidence exists that acculturation leads to increased healthcare access, its effects on engagement in health-promoting behaviors are somewhat divergent and outcome-specific," they wrote.
They concluded that future research should test the effects of different mediators -- perceptions of body image and social norms -- on the use of shade or sun-protective clothing.
The study was limited by its cross-sectional nature, and by a lack of ability to distinguish among Latino subgroups or skin types. These issues may confound acculturation by affecting motivation or the ability to acculturate due to perceived discrimination, the researchers said.
The study was supported by the CDC and the National Cancer Institute.
The researchers reported no conflicts of interest.
- Reviewed by Robert Jasmer, MD Associate Clinical Professor of Medicine, University of California, San Francisco and Dorothy Caputo, MA, RN, BC-ADM, CDE, Nurse Planner