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Ramirez F, Riva H, Digbeu B, Samaniego M, Fernandez L, Mansour S, Vasquez R, Lopez DS, Chacon J. Effects of treatment methods on cutaneous melanoma related mortality and all-cause mortality in Texas: TCR-Medicare 2007-2017 database. Cancer Causes Control 2024; 35:265-275. [PMID: 37702966 DOI: 10.1007/s10552-023-01780-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Accepted: 08/18/2023] [Indexed: 09/14/2023]
Abstract
PURPOSE The incidence of cutaneous melanoma is rising, and Melanoma related deaths are highest among people aged 65-74. Herein, we aim to understand the impact of novel and established melanoma treatment methods on CM related mortality and all-cause mortality. We further compared these effects among Hispanic and non-Hispanic Whites (NHW). METHODS The data was extracted from the Texas Cancer Registry from 2007 to 2017. A Cox Proportional Hazard regression analysis was performed to assess treatment effect on melanoma mortality and all-cause mortality, with race-ethnicity as an effect modifier. RESULTS A higher percentage of Hispanic patients presented with CM-related mortality (22.11%) compared to NHW patients (14.39%). In both the Hispanic and NHW, post-diagnosis radiation (HR = 1.610, 95% CI 0.984-2.634, HR = 2.348, 95% CI 2.082-2.648, respectively), post-diagnosis chemotherapy (HR = 1.899, 95% CI 1.085-3.322, HR = 2.035, 95% CI 1.664-2.489, respectively), and post-diagnosis immunotherapy (HR = 2.100, 95% CI 1.338-3.296, HR = 2.402, 95% CI 2.100-2.748) are each associated with an increased risk in CM-related mortality. Similar results were seen with post-diagnosis radiation (Hispanic HR = 1.640, 95% CI 1.121-2.400, NHW HR = 1.800, 95% CI 1.644-1.971), post-diagnostic chemotherapy (Hispanic HR = 1.457, 95% CI 0.898-2.364, NHW HR = 1.592, 95% CI 1.356-1.869), and post-diagnosis immunotherapy (Hispanic HR = 2.140, 95% CI 1.494-3.065, NHW HR = 2.190, 95% CI 1.969-2.435) with respect to all-cause mortality. Post-diagnosis surgery (HR = 0.581, 95% CI 0.395-0.856, HR = 0.622, 95% CI 0.571-0.678) had the opposite effect in CM-related mortality for Hispanics and NHWs respectively. CONCLUSION Our results propose differences in all-cause and CM-only related mortality with separate treatment modalities, particularly with chemotherapy, radiation therapy and immunotherapy. In addition, this retrospective cohort study showed that health disparities exist in the Hispanic Medicare population of Texas with CM.
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Affiliation(s)
- Fabiola Ramirez
- Department of Medical Education, Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center El Paso, 5001 El Paso Dr, El Paso, TX, 79905, USA
| | - Hannah Riva
- Department of Medical Education, Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center El Paso, 5001 El Paso Dr, El Paso, TX, 79905, USA
| | - Biai Digbeu
- School of Public and Population Health, University of Texas Medical Branch, Galveston, TX, USA
| | - Michelle Samaniego
- Department of Medical Education, Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center El Paso, 5001 El Paso Dr, El Paso, TX, 79905, USA
| | - Lorena Fernandez
- Department of Medical Education, Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center El Paso, 5001 El Paso Dr, El Paso, TX, 79905, USA
| | - Sara Mansour
- Department of Medical Education, Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center El Paso, 5001 El Paso Dr, El Paso, TX, 79905, USA
| | - Rebecca Vasquez
- Department of Dermatology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - David S Lopez
- School of Public and Population Health, University of Texas Medical Branch, Galveston, TX, USA.
- Department of Epidemiology, Medical Branch, The University of Texas, 301 University Blvd., Galveston, TX, 77555, USA.
| | - Jessica Chacon
- Department of Medical Education, Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center El Paso, 5001 El Paso Dr, El Paso, TX, 79905, USA.
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Mesia RJ, Espinosa PR, Hutchison H, Safaeinili N, Finster LJ, Muralidharan V, Glenn BA, Haile RW, Rosas LG, Swetter SM. Melanoma awareness and prevention among latinx and non-latinx white adults in urban and rural California: A qualitative exploration. Cancer Med 2022; 12:7438-7449. [PMID: 36433634 PMCID: PMC10067099 DOI: 10.1002/cam4.5457] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 09/26/2022] [Accepted: 11/09/2022] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Melanoma mortality rates in the US are highest among older men, individuals of lower socioeconomic status (SES), and people of color. To better understand these inequities, a qualitative exploratory study was conducted in Northern and Southern California to generate knowledge about barriers and facilitators of awareness, prevention, and early detection of melanoma in lower SES Latinx and non-Latinx White (NLW) individuals living in urban and semi-rural areas. METHODS Nineteen focus groups were conducted (N = 176 adult participants), stratified by race/ethnicity (Latinx, low-income NLW), geography (semi-rural, urban), and language (English and Spanish). Inductive and deductive thematic analysis was conducted, and the findings were organized using the socioecological model framework: individual, interpersonal, community, and health system/policy levels. RESULTS Four socioecological themes describe how key factors affect knowledge, perceived risk, preventive behaviors, and melanoma screening. Individual level findings revealed that many participants were not familiar with melanoma, yet were willing to learn through trusted sources. Having brown or darker skin tone was perceived as being associated with lower risk for skin cancer. Interpersonally, social relationships were important influences for skin cancer prevention practice. However, for several Latinx and semi-rural participants, conversations about melanoma prevention did not occur with family and peers. At the community level, semi-rural participants reported distance or lack of transportation to a clinic as challenges for accessing dermatology care. Healthcare systems barriers included burdens of additional healthcare costs for dermatology visits and obtaining referral. CONCLUSIONS Varying factors influence the awareness levels, beliefs, and behaviors associated with knowledge, prevention, and early detection of melanoma among low-income Latinx and NLW individuals and in semi-rural areas. Results have implications for health education interventions. Navigation strategies that target individuals, families, and health care settings can promote improved prevention and early detection of melanoma in these communities.
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Affiliation(s)
- Rachel J Mesia
- Stanford Cancer Institute, Stanford University School of Medicine, Stanford, California, USA
| | | | - Hayden Hutchison
- Cancer Research Center for Health Equity, Cedars Sinai Medical Center, Los Angeles, California, USA
| | - Nadia Safaeinili
- Stanford University School of Medicine, Office of Community Engagement, Stanford, California, USA
| | - Laurel J Finster
- Cancer Research Center for Health Equity, Cedars Sinai Medical Center, Los Angeles, California, USA
| | - Vijaytha Muralidharan
- Department of Dermatology/Cutaneous Oncology, Stanford University Medical Center, Stanford, California, USA.,Veterans Affairs Palo Alto Health Care System, Dermatology Service, Palo Alto, California, USA
| | - Beth A Glenn
- UCLA Fielding School of Public Health, UCLA Kaiser Permanente Center for Health Equity, Los Angeles, California, USA
| | - Robert W Haile
- Cancer Research Center for Health Equity, Cedars Sinai Medical Center, Los Angeles, California, USA
| | - Lisa Goldman Rosas
- Stanford University School of Medicine, Office of Community Engagement, Stanford, California, USA
| | - Susan M Swetter
- Department of Dermatology/Cutaneous Oncology, Stanford University Medical Center, Stanford, California, USA.,Veterans Affairs Palo Alto Health Care System, Dermatology Service, Palo Alto, California, USA
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Ortega P, López-Hinojosa I, Park YS, Girotti JA. Medical Spanish Musculoskeletal and Dermatologic Educational Module. MEDEDPORTAL : THE JOURNAL OF TEACHING AND LEARNING RESOURCES 2021; 17:11071. [PMID: 33473381 PMCID: PMC7809932 DOI: 10.15766/mep_2374-8265.11071] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Accepted: 09/26/2020] [Indexed: 05/28/2023]
Abstract
INTRODUCTION While many medical schools provide opportunities in medical Spanish for medical students, schools often struggle with identifying a structured curriculum. The purpose of this module was to provide a flexible, organ system-based approach to teaching and learning musculoskeletal and dermatologic Spanish terminology, patient-centered communication skills, and sociocultural health contexts. METHODS An 8-hour educational module for medical students was created to teach musculoskeletal and dermatologic medical communication skills in Spanish within the Hispanic/Latinx cultural context. Participants included 47 fourth-year medical students at an urban medical school with a starting minimum Spanish proficiency at the intermediate level. Faculty provided individualized feedback on speaking, listening, and writing performance of medical Spanish skills, and learners completed a written pre- and postassessment testing skills pertaining to communication domains of vocabulary, grammar, and comprehension as well as self-reported confidence levels. RESULTS Students demonstrated improvement in vocabulary, grammar, comprehension, and self-confidence of musculoskeletal and dermatologic medical Spanish topics. While students with overall lower starting proficiency levels (intermediate) scored lower on the premodule assessment compared to higher proficiency students (advanced/native), the postmodule assessment did not show significant differences in skills performance among these groups. DISCUSSION An intermediate Spanish level prerequisite for this musculoskeletal and dermatologic module can result in skills improvement for all learners despite starting proficiency variability. Future study should evaluate learner clinical performance and integration of this module into other educational settings such as graduate medical education (e.g., orthopedic, rehabilitation, and dermatology residency programs) and other health professions (e.g., physical therapy and nursing).
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Affiliation(s)
- Pilar Ortega
- Clinical Assistant Professor, Departments of Emergency Medicine and Medical Education, University of Illinois College of Medicine
| | | | - Yoon Soo Park
- Director of Health Professions Education Research, Massachusetts General Hospital, Harvard Medical School
| | - Jorge A. Girotti
- Assistant Professor, Department of Medical Education, and Former Director, Hispanic Center of Excellence, University of Illinois College of Medicine
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Garcia D, Jefferson IS, Ramirez P, Palomino A, Adams W, Vera J, De La Torre R, Lee K, Elsensohn A, Kazbour H, Tung R. Video Education to Promote Skin Cancer Awareness and Identification in Spanish-speaking Patients. THE JOURNAL OF CLINICAL AND AESTHETIC DERMATOLOGY 2020; 13:41-43. [PMID: 32082472 PMCID: PMC7028375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Objective: We sought to evaluate the efficacy of a Spanish-language educational video in teaching primary Spanish speaking patients to recognize benign and malignant lesions and to increase their awareness about skin cancer. Materials and Methods: Thirty-seven subjects were enrolled in study. An instructional video was developed to increase knowledge of benign and malignant lesions, skin cancer awareness, and prevention among Spanish-speaking patients. Two examples each of six common skin lesions (e.g., malignant melanoma, cherry angioma, seborrheic keratosis, benign melanocytic nevus, basal cell carcinoma, and squamous cell carcinoma) were presented as high-quality images to the participants before and after watching the two-minute educational video. A pre- and postvideo survey was used to assess competency. Results: The prevideo baseline median score was six points (interquartile range [IQR]: 5-6 points); postviewing median score improved to 11 points (IQR: 11-12 points), which was statistically significant (Median=5 points, IQR: 4-6 points; p<.001). The ability of the participants to identify nonmelanoma skin cancers improved from 74 percent to 98 percent and from 35 percent to 99 percent for squamous cell carcinoma and basal cell carcinoma. Initially, only 30 percent of participants could identify melanoma prior to viewing the video. Afterwards, 97 percent of participants could identify this malignancy. However, the video format preferences were not statistically significant: 67.6 percent of the participants preferred the video format. Conclusion: These results suggest that this educational video is an effective and valuable method to enhance knowledge about skin health and improve identification of skin cancer among Spanish-speaking patients.
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Affiliation(s)
- Dante Garcia
- Dr. Garcia is with the Department of Internal Medicine at Loma Linda University in Loma Linda, California
- Mr. Ramirez is with San Juan Bautista School of Medicine in Caguas, Puerto Rico
- Dr. Adams is with Biostatistics Core at Stritch School of Medicine of Loyola University Chicago
- Ms. Vera is with the Department of Dermatology at Northwestern University in Chicago, Illinois
- Dr. Lee and Mses. Jefferson, Palomino, and De La Torre are with the Division of Dermatology at Stritch School of Medicine of Loyola University Chicago in Chicago, Illinois
- Dr. Elsensohn is with the Department of Dermatology at the University of California Irvine in Irvine, California
- Dr. Kazbour is with the Department of Internal Medicine at Loyola University Chicago Stritch School of Medicine
- Dr. Tung is with Florida Dermatology and Skin Cancer Centers in Winter Haven, Florida
| | - Itisha S Jefferson
- Dr. Garcia is with the Department of Internal Medicine at Loma Linda University in Loma Linda, California
- Mr. Ramirez is with San Juan Bautista School of Medicine in Caguas, Puerto Rico
- Dr. Adams is with Biostatistics Core at Stritch School of Medicine of Loyola University Chicago
- Ms. Vera is with the Department of Dermatology at Northwestern University in Chicago, Illinois
- Dr. Lee and Mses. Jefferson, Palomino, and De La Torre are with the Division of Dermatology at Stritch School of Medicine of Loyola University Chicago in Chicago, Illinois
- Dr. Elsensohn is with the Department of Dermatology at the University of California Irvine in Irvine, California
- Dr. Kazbour is with the Department of Internal Medicine at Loyola University Chicago Stritch School of Medicine
- Dr. Tung is with Florida Dermatology and Skin Cancer Centers in Winter Haven, Florida
| | - Pablo Ramirez
- Dr. Garcia is with the Department of Internal Medicine at Loma Linda University in Loma Linda, California
- Mr. Ramirez is with San Juan Bautista School of Medicine in Caguas, Puerto Rico
- Dr. Adams is with Biostatistics Core at Stritch School of Medicine of Loyola University Chicago
- Ms. Vera is with the Department of Dermatology at Northwestern University in Chicago, Illinois
- Dr. Lee and Mses. Jefferson, Palomino, and De La Torre are with the Division of Dermatology at Stritch School of Medicine of Loyola University Chicago in Chicago, Illinois
- Dr. Elsensohn is with the Department of Dermatology at the University of California Irvine in Irvine, California
- Dr. Kazbour is with the Department of Internal Medicine at Loyola University Chicago Stritch School of Medicine
- Dr. Tung is with Florida Dermatology and Skin Cancer Centers in Winter Haven, Florida
| | - Angelina Palomino
- Dr. Garcia is with the Department of Internal Medicine at Loma Linda University in Loma Linda, California
- Mr. Ramirez is with San Juan Bautista School of Medicine in Caguas, Puerto Rico
- Dr. Adams is with Biostatistics Core at Stritch School of Medicine of Loyola University Chicago
- Ms. Vera is with the Department of Dermatology at Northwestern University in Chicago, Illinois
- Dr. Lee and Mses. Jefferson, Palomino, and De La Torre are with the Division of Dermatology at Stritch School of Medicine of Loyola University Chicago in Chicago, Illinois
- Dr. Elsensohn is with the Department of Dermatology at the University of California Irvine in Irvine, California
- Dr. Kazbour is with the Department of Internal Medicine at Loyola University Chicago Stritch School of Medicine
- Dr. Tung is with Florida Dermatology and Skin Cancer Centers in Winter Haven, Florida
| | - William Adams
- Dr. Garcia is with the Department of Internal Medicine at Loma Linda University in Loma Linda, California
- Mr. Ramirez is with San Juan Bautista School of Medicine in Caguas, Puerto Rico
- Dr. Adams is with Biostatistics Core at Stritch School of Medicine of Loyola University Chicago
- Ms. Vera is with the Department of Dermatology at Northwestern University in Chicago, Illinois
- Dr. Lee and Mses. Jefferson, Palomino, and De La Torre are with the Division of Dermatology at Stritch School of Medicine of Loyola University Chicago in Chicago, Illinois
- Dr. Elsensohn is with the Department of Dermatology at the University of California Irvine in Irvine, California
- Dr. Kazbour is with the Department of Internal Medicine at Loyola University Chicago Stritch School of Medicine
- Dr. Tung is with Florida Dermatology and Skin Cancer Centers in Winter Haven, Florida
| | - Jessica Vera
- Dr. Garcia is with the Department of Internal Medicine at Loma Linda University in Loma Linda, California
- Mr. Ramirez is with San Juan Bautista School of Medicine in Caguas, Puerto Rico
- Dr. Adams is with Biostatistics Core at Stritch School of Medicine of Loyola University Chicago
- Ms. Vera is with the Department of Dermatology at Northwestern University in Chicago, Illinois
- Dr. Lee and Mses. Jefferson, Palomino, and De La Torre are with the Division of Dermatology at Stritch School of Medicine of Loyola University Chicago in Chicago, Illinois
- Dr. Elsensohn is with the Department of Dermatology at the University of California Irvine in Irvine, California
- Dr. Kazbour is with the Department of Internal Medicine at Loyola University Chicago Stritch School of Medicine
- Dr. Tung is with Florida Dermatology and Skin Cancer Centers in Winter Haven, Florida
| | - Ruby De La Torre
- Dr. Garcia is with the Department of Internal Medicine at Loma Linda University in Loma Linda, California
- Mr. Ramirez is with San Juan Bautista School of Medicine in Caguas, Puerto Rico
- Dr. Adams is with Biostatistics Core at Stritch School of Medicine of Loyola University Chicago
- Ms. Vera is with the Department of Dermatology at Northwestern University in Chicago, Illinois
- Dr. Lee and Mses. Jefferson, Palomino, and De La Torre are with the Division of Dermatology at Stritch School of Medicine of Loyola University Chicago in Chicago, Illinois
- Dr. Elsensohn is with the Department of Dermatology at the University of California Irvine in Irvine, California
- Dr. Kazbour is with the Department of Internal Medicine at Loyola University Chicago Stritch School of Medicine
- Dr. Tung is with Florida Dermatology and Skin Cancer Centers in Winter Haven, Florida
| | - Kristin Lee
- Dr. Garcia is with the Department of Internal Medicine at Loma Linda University in Loma Linda, California
- Mr. Ramirez is with San Juan Bautista School of Medicine in Caguas, Puerto Rico
- Dr. Adams is with Biostatistics Core at Stritch School of Medicine of Loyola University Chicago
- Ms. Vera is with the Department of Dermatology at Northwestern University in Chicago, Illinois
- Dr. Lee and Mses. Jefferson, Palomino, and De La Torre are with the Division of Dermatology at Stritch School of Medicine of Loyola University Chicago in Chicago, Illinois
- Dr. Elsensohn is with the Department of Dermatology at the University of California Irvine in Irvine, California
- Dr. Kazbour is with the Department of Internal Medicine at Loyola University Chicago Stritch School of Medicine
- Dr. Tung is with Florida Dermatology and Skin Cancer Centers in Winter Haven, Florida
| | - Ashley Elsensohn
- Dr. Garcia is with the Department of Internal Medicine at Loma Linda University in Loma Linda, California
- Mr. Ramirez is with San Juan Bautista School of Medicine in Caguas, Puerto Rico
- Dr. Adams is with Biostatistics Core at Stritch School of Medicine of Loyola University Chicago
- Ms. Vera is with the Department of Dermatology at Northwestern University in Chicago, Illinois
- Dr. Lee and Mses. Jefferson, Palomino, and De La Torre are with the Division of Dermatology at Stritch School of Medicine of Loyola University Chicago in Chicago, Illinois
- Dr. Elsensohn is with the Department of Dermatology at the University of California Irvine in Irvine, California
- Dr. Kazbour is with the Department of Internal Medicine at Loyola University Chicago Stritch School of Medicine
- Dr. Tung is with Florida Dermatology and Skin Cancer Centers in Winter Haven, Florida
| | - Hana Kazbour
- Dr. Garcia is with the Department of Internal Medicine at Loma Linda University in Loma Linda, California
- Mr. Ramirez is with San Juan Bautista School of Medicine in Caguas, Puerto Rico
- Dr. Adams is with Biostatistics Core at Stritch School of Medicine of Loyola University Chicago
- Ms. Vera is with the Department of Dermatology at Northwestern University in Chicago, Illinois
- Dr. Lee and Mses. Jefferson, Palomino, and De La Torre are with the Division of Dermatology at Stritch School of Medicine of Loyola University Chicago in Chicago, Illinois
- Dr. Elsensohn is with the Department of Dermatology at the University of California Irvine in Irvine, California
- Dr. Kazbour is with the Department of Internal Medicine at Loyola University Chicago Stritch School of Medicine
- Dr. Tung is with Florida Dermatology and Skin Cancer Centers in Winter Haven, Florida
| | - Rebecca Tung
- Dr. Garcia is with the Department of Internal Medicine at Loma Linda University in Loma Linda, California
- Mr. Ramirez is with San Juan Bautista School of Medicine in Caguas, Puerto Rico
- Dr. Adams is with Biostatistics Core at Stritch School of Medicine of Loyola University Chicago
- Ms. Vera is with the Department of Dermatology at Northwestern University in Chicago, Illinois
- Dr. Lee and Mses. Jefferson, Palomino, and De La Torre are with the Division of Dermatology at Stritch School of Medicine of Loyola University Chicago in Chicago, Illinois
- Dr. Elsensohn is with the Department of Dermatology at the University of California Irvine in Irvine, California
- Dr. Kazbour is with the Department of Internal Medicine at Loyola University Chicago Stritch School of Medicine
- Dr. Tung is with Florida Dermatology and Skin Cancer Centers in Winter Haven, Florida
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Wojcik KY, Escobedo LA, Wysong A, Heck JE, Ritz B, Hamilton AS, Milam J, Cockburn MG. High Birth Weight, Early UV Exposure, and Melanoma Risk in Children, Adolescents, and Young Adults. Epidemiology 2019; 30:278-284. [PMID: 30499783 PMCID: PMC6435257 DOI: 10.1097/ede.0000000000000963] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
BACKGROUND Melanoma, the deadliest form of skin cancer, is the second most common cancer diagnosed before age 30. Little is known about potentially modifiable or intervenable risk factors specific to developing melanoma at a young age. The objective was to determine if high birth weight or higher early-life ultraviolet (UV) radiation exposure would be associated with increased risk of melanoma in young patients. METHODS Population-based, case-control study of 1,396 cases of melanoma diagnosed before age 30 in 1988-2013 and 27,920 controls, obtained by linking cancer registry data to birth records in California. RESULTS High birth weight (>4,000 g) was associated with 19% higher risk of melanoma (OR = 1.19; 95% CI = 1.02, 1.39), while low birth weight (<2,500 g) was associated with 41% lower risk (OR = 0.59; 95% CI = 0.43, 0.82), compared with normal birth weight (2,500-4,000 g); dose-response per 1,000 g increase was also evident (OR = 1.24; 95% CI = 1.13, 1.36). All quartiles of birthplace UV greater than the lowest quartile were associated with increased melanoma risk. The strongest relation between birthplace UV and melanoma was for 15-19 years of age at diagnosis. CONCLUSIONS High birth weight and high early-life UV exposure may be important independent risk factors for melanoma diagnosis before age 30. The implication is that adopting skin-protective behaviors as early as infancy could be important for primary prevention of melanoma in younger people. However, research that accounts for early-life behavioral patterns of skin protection during infancy is needed to advance our understanding of how birth weight and early-life UV may influence the development of early-onset melanoma.
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Affiliation(s)
- Katherine Y Wojcik
- From the Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Loraine A Escobedo
- Division of Vital Statistics, National Center for Health Statistics, Centers for Disease Control and Prevention, Hyattsville, MD
| | - Ashley Wysong
- Department of Dermatology, University of Nebraska Medical Center, Omaha, NE
| | - Julia E Heck
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, CA
| | - Beate Ritz
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, CA
| | - Ann S Hamilton
- From the Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Joel Milam
- From the Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Myles G Cockburn
- From the Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA
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Predictors of Sun Protective Behaviors among Latino Day Laborers. J Skin Cancer 2018; 2018:3454309. [PMID: 29623223 PMCID: PMC5829325 DOI: 10.1155/2018/3454309] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Revised: 11/22/2017] [Accepted: 12/17/2017] [Indexed: 12/04/2022] Open
Abstract
Objectives Despite the substantial solar ultraviolet radiation experienced by Latino day laborers, little attention has been given to factors that are associated with sun protective behaviors. The purpose of this study was to examine psychological and nonpsychological predictors of sun protective behaviors among Latino day laborers. Methods This cross-sectional study included a nonrandom sample of 137 Latino day laborers recruited from Mississippi and Illinois. Participants completed a self-report survey instrument, available in English and Spanish, on sun protective behaviors. Results Multivariate regression results showed that sun protective behaviors were significantly greater among Latino day laborers: (a) who had greater perceptions that their supervisor also engaged in sun protective behaviors (β = 0.25, p ≤ 0.01); (b) who reported higher levels of health literacy (β = 0.23, p ≤ 0.001); (c) who have greater knowledge of skin cancer risk factors (β = 0.21, p ≤ 0.01); and (d) who have skin tone that was self-perceived to be more prone to sunburns (β = 0.19, p ≤ 0.01). Conclusions Latino day laborers possess marginal levels of skin cancer knowledge and engage minimally in sun protective behaviors. Skin cancer prevention interventions are warranted for this high-risk group, particularly in the locations in which Latino day laborers work.
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Miller KA, In GK, Jiang SY, Ahadiat O, Higgins S, Wysong A, Cockburn MG. Skin Cancer Prevention Among Hispanics: a Review of the Literature. CURRENT DERMATOLOGY REPORTS 2017. [DOI: 10.1007/s13671-017-0191-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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The Role of Neighborhood Characteristics in Late Stage Melanoma Diagnosis among Hispanic Men in California, Texas, and Florida, 1996-2012. J Cancer Epidemiol 2017; 2017:8418904. [PMID: 28702054 PMCID: PMC5494113 DOI: 10.1155/2017/8418904] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2016] [Revised: 04/05/2017] [Accepted: 04/30/2017] [Indexed: 11/17/2022] Open
Abstract
Background Hispanics diagnosed with cutaneous melanoma are more likely to present at advanced stages but the reasons for this are unknown. We identify census tracts at high risk for late stage melanoma diagnosis (LSMD) and examine the contextual predictors of LSMD in California, Texas, and Florida. Methods We conducted a cross-sectional study using geocoded state cancer registry data. Using hierarchical multilevel logistic regression models we estimated ORs and 95% confidence intervals for the impact of socioeconomic, Hispanic ethnic concentration, index of dissimilarity, and health resource availability measures on LSMD. Results We identified 12,493 cases. In California, late stage cases were significantly more likely to reside within census tracts composed mostly of Hispanics and immigrants. In Texas, LSMD was associated with residence in areas of socioeconomic deprivation and a higher proportion of immigrants. In Florida, living in areas of low education attainment, high levels of poverty, and a high percentage of Hispanic residents was significantly associated with LSMD. Residential segregation did not independently affect LSMD. Conclusion The influence of contextual predictors on LSMD varied in magnitude and strength by state, highlighting both the cosegregation of social adversity and poverty and the complexity of their interactions.
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Hay JL, Berwick M, Zielaskowski K, White KA, Rodríguez VM, Robers E, Guest DD, Sussman A, Talamantes Y, Schwartz MR, Greb J, Bigney J, Kaphingst KA, Hunley K, Buller DB. Implementing an Internet-Delivered Skin Cancer Genetic Testing Intervention to Improve Sun Protection Behavior in a Diverse Population: Protocol for a Randomized Controlled Trial. JMIR Res Protoc 2017; 6:e52. [PMID: 28442450 PMCID: PMC5424125 DOI: 10.2196/resprot.7158] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2016] [Revised: 02/08/2017] [Accepted: 02/08/2017] [Indexed: 11/13/2022] Open
Abstract
Background Limited translational genomic research currently exists to guide the availability, comprehension, and appropriate use of personalized genomics in diverse general population subgroups. Melanoma skin cancers are preventable, curable, common in the general population, and disproportionately increasing in Hispanics. Objective Variants in the melanocortin-1 receptor (MC1R) gene are present in approximately 50% of the population, are major factors in determining sun sensitivity, and confer a 2-to-3-fold increase in melanoma risk in the general population, even in populations with darker skin. Therefore, feedback regarding MC1R risk status may raise risk awareness and protective behavior in the general population. Methods We are conducting a randomized controlled trial examining Internet presentation of the risks and benefits of personalized genomic testing for MC1R gene variants that are associated with increased melanoma risk. We will enroll a total of 885 participants (462 participants are currently enrolled), who will be randomized 6:1 to personalized genomic testing for melanoma risk versus waiting list control. Control participants will be offered testing after outcome assessments. Participants will be balanced across self-reported Hispanic versus non-Hispanic ethnicity (n=750 in personalized genomic testing for melanoma risk arm; n=135 in control arm), and will be recruited from a general population cohort in Albuquerque, New Mexico, which is subject to year-round sun exposure. Baseline surveys will be completed in-person with study staff and follow-up measures will be completed via telephone. Results Aim 1 of the trial will examine the personal utility of personalized genomic testing for melanoma risk in terms of short-term (3-month) sun protection and skin screening behaviors, family and physician communication, and melanoma threat and control beliefs (ie, putative mediators of behavior change). We will also examine potential unintended consequences of testing among those who receive average-risk personalized genomic testing for melanoma risk findings, and examine predictors of sun protection at 3 months as the outcome. These findings will be used to develop messages for groups that receive average-risk feedback. Aim 2 will compare rates of test consideration in Hispanics versus non-Hispanics, including consideration of testing pros and cons and registration of a decision to either accept or decline testing. Aim 3 will examine personalized genomic testing for melanoma risk feedback comprehension, recall, satisfaction, and cancer-related distress in those who undergo testing, and whether these outcomes differ by ethnicity (Hispanic vs non-Hispanic), or sociocultural or demographic factors. Final outcome data collection is anticipated to be complete by October 2017, at which point data analysis will commence. Conclusions This study has important implications for personalized genomics in the context of melanoma risk, and may be broadly applicable as a model for delivery of personalized genomic feedback for other health conditions.
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Affiliation(s)
- Jennifer L Hay
- Memorial Sloan Kettering Cancer Center, Department of Psychiatry & Behavioral Sciences, New York, NY, United States
| | | | - Kate Zielaskowski
- Memorial Sloan Kettering Cancer Center, Department of Psychiatry & Behavioral Sciences, New York, NY, United States
| | | | | | - Erika Robers
- University of New Mexico, Albuquerque, NM, United States
| | | | - Andrew Sussman
- University of New Mexico, Albuquerque, NM, United States
| | | | | | - Jennie Greb
- University of New Mexico, Albuquerque, NM, United States
| | - Jessica Bigney
- University of New Mexico, Albuquerque, NM, United States
| | | | - Keith Hunley
- University of New Mexico, Albuquerque, NM, United States
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A Trial Online Educational Melanoma Program Aimed at the Hispanic Population Improves Knowledge and Behaviors. Dermatol Surg 2017; 42:672-6. [PMID: 27054446 DOI: 10.1097/dss.0000000000000689] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Hispanic individuals who suffer from melanoma are diagnosed later and have a worse prognosis. Because the Hispanic population is one of the fastest growing in the United States, it is important to spread awareness of melanoma. OBJECTIVE The study aimed to evaluate whether an online educational video about skin cancer could improve knowledge about melanoma and encourage self-skin examinations (SSE). METHODS The authors directed Hispanic patients to an online survey, which assessed for knowledge about melanoma risk factors and prevention. This was followed by a 5-minute online video about melanoma. A second survey was sent immediately after the video, and a third survey was sent 1 month later. All project materials were in Spanish and available online. RESULTS Eighty-six participants completed the full experiment. After watching the online video, a significantly higher proportion of participants provided correct answers for melanoma risk factors and prevention techniques. A similar increase was seen in the number of individuals who reported performing SSEs. CONCLUSION This study provides evidence that an online educational video targeted at the Hispanic population has potential to improve melanoma awareness. This type of intervention may lead to earlier diagnosis and better prognosis for Hispanic individuals.
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11
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Melanoma Disparities among US Hispanics: Use of the Social Ecological Model to Contextualize Reasons for Inequitable Outcomes and Frame a Research Agenda. J Skin Cancer 2016; 2016:4635740. [PMID: 27651954 PMCID: PMC5019891 DOI: 10.1155/2016/4635740] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2016] [Accepted: 08/03/2016] [Indexed: 11/29/2022] Open
Abstract
Cutaneous melanoma is a significant public health concern, accounting for thousands of deaths annually in the US. Early detection and diagnosis are critical given the poor prognosis and limited treatment options of advanced-stage disease. While non-Hispanic whites have higher incidence rates of melanoma, Hispanics are typically diagnosed at later disease stages and suffer higher morbidity and mortality. Currently, there is a paucity of literature investigating the root causes underlying these trends among Hispanics. Given that Hispanics are the most rapidly expanding demographic segment in the US, it is essential for cancer control efforts to elucidate the major determinants of their poor melanoma outcomes. Herein, we use the social ecological model as a framework to explore the multitude of influences on melanoma disparities among Hispanics and provide recommendations for planning future studies and interventions.
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12
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Skin Protection Behaviors among Young Male Latino Day Laborers: An Exploratory Study Using a Social Cognitive Approach. Dermatol Res Pract 2016; 2016:1479637. [PMID: 27019656 PMCID: PMC4785254 DOI: 10.1155/2016/1479637] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2015] [Revised: 11/26/2015] [Accepted: 12/06/2015] [Indexed: 11/17/2022] Open
Abstract
Latino Day Laborers (LDLs) are employed in occupations where multiple work hazards exist. One such hazard is the overexposure to solar ultraviolet radiation for continuous periods of time. Regular sun exposure can put individuals at increased risk of developing skin cancers, especially without adequate protection. The purpose of this cross-sectional exploratory study was to use a social cognitive framework to assess skin protective behaviors among LDLs. A community-based nonrandom and purposive sample of LDLs was recruited in two states: Mississippi and Illinois. The study sample consisted of 137 male participants, of which the majority were of Mexican ancestry (72%). The average age was 35.40 (SD = 9.89) years. Results demonstrated that a substantial number of LDLs do not adequately practice sun protection behaviors on a regular basis. The skin cancer knowledge scores were very modest. The most frequently indicated barriers towards sun protection were “inconvenient,” “forget to use,” and “not being able to reapply sunscreen.” Overall, LDLs had moderate confidence in their abilities to adopt successful sun protection strategies. This study underscores the need for intervention programs aimed at LDLs to reduce extended time in the sun and increase use of sun protective measures when working outdoors.
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13
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Goldenberg A, Vujic I, Sanlorenzo M, Ortiz-Urda S. Melanoma risk perception and prevention behavior among African-Americans: the minority melanoma paradox. Clin Cosmet Investig Dermatol 2015; 8:423-9. [PMID: 26346576 PMCID: PMC4531028 DOI: 10.2147/ccid.s87645] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Introduction Melanoma is the most deadly type of skin cancer with 75% of all skin cancer deaths within the US attributed to it. Risk factors for melanoma include ultraviolet exposure, genetic predisposition, and phenotypic characteristics (eg, fair skin and blond hair). Whites have a 27-fold higher incidence of melanoma than African-Americans (AA), but the 5-year survival is 17.8% lower for AA than Whites. It is reported continuously that AA have more advanced melanomas at diagnosis, and overall lower survival rates. This minority melanoma paradox is not well understood or studied. Objective To explore further, the possible explanations for the difference in melanoma severity and survival in AA within the US. Methods Qualitative review of the literature. Results Lack of minority-targeted public education campaigns, low self-risk perception, low self-skin examinations, intrinsic virulence, vitamin D differences, and physician mistrust may play a role in the melanoma survival disparity among AA. Conclusion Increases in public awareness of melanoma risk among AA through physician and media-guided education, higher index of suspicion among individuals and physicians, and policy changes can help to improve early detection and close the melanoma disparity gap in the future.
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Affiliation(s)
- Alina Goldenberg
- Department of Internal Medicine/Dermatology, University of California, San Diego, CA, USA
| | - Igor Vujic
- Mt Zion Cancer Research Center, University of California San Francisco, San Francisco, CA, USA ; Department of Dermatology, The Rudolfstiftung Hospital, Academic Teaching Hospital, Medical University Vienna, Vienna, Austria
| | - Martina Sanlorenzo
- Mt Zion Cancer Research Center, University of California San Francisco, San Francisco, CA, USA ; Section of Dermatology, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Susana Ortiz-Urda
- Mt Zion Cancer Research Center, University of California San Francisco, San Francisco, CA, USA
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Harvey VM, Patel H, Sandhu S, Wallington SF, Hinds G. Social determinants of racial and ethnic disparities in cutaneous melanoma outcomes. Cancer Control 2015; 21:343-9. [PMID: 25310216 DOI: 10.1177/107327481402100411] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND This article sought to elucidate how aspects of poverty and culture may contribute to race- and ethnicity-based disparities in cutaneous melanoma outcomes. METHODS We identified published studies addressing the social determinants of melanoma. Selected review articles included US-based studies comprised of patients representing adults, children, and adolescents. RESULTS African Americans and Hispanics diagnosed with cutaneous melanoma are more likely to present with more advanced stages of disease at diagnosis and have higher rates of mortality than their nonminority counterparts. These disparities may be a consequence of economic, social, and cultural barriers such as low income, public forms of health insurance, lower levels of education, lower levels of melanoma awareness and knowledge, and lower rates of participation in melanoma screening. No studies in the literature examined the potential impact of social injustice, English proficiency, immigrant status, and health literacy. CONCLUSIONS Substantial gaps exist in our knowledge of the pathways linking social determinants and race- and ethnicity-based disparities in melanoma. More studies are warranted to inform the development of effective interventions aimed at narrowing inequities and improving cutaneous melanoma outcomes among minority populations.
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Affiliation(s)
- Valerie M Harvey
- Department of Dermatology, Eastern Virginia Medical School, Norfolk, VA 23507, USA.
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15
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Korta DZ, Saggar V, Wu TP, Sanchez M. Racial differences in skin cancer awareness and surveillance practices at a public hospital dermatology clinic. J Am Acad Dermatol 2014; 70:312-7. [DOI: 10.1016/j.jaad.2013.10.030] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2013] [Revised: 09/30/2013] [Accepted: 10/15/2013] [Indexed: 10/25/2022]
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Coups EJ, Stapleton JL, Hudson SV, Medina-Forrester A, Rosenberg SA, Gordon M, Natale-Pereira A, Goydos JS. Skin cancer surveillance behaviors among US Hispanic adults. J Am Acad Dermatol 2012. [PMID: 23182066 DOI: 10.1016/j.jaad.2012.09.032] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Little skin cancer prevention research has focused on the US Hispanic population. OBJECTIVE This study examined the prevalence and correlates of skin cancer surveillance behaviors among Hispanic adults. METHODS A population-based sample of 788 Hispanic adults residing in 5 southern and western states completed an online survey in English or Spanish in September 2011. The outcomes were ever having conducted a skin self-examination (SSE) and having received a total cutaneous examination (TCE) from a health professional. The correlates included sociodemographic, skin cancer-related, and psychosocial factors. RESULTS The rates of ever conducting a SSE or having a TCE were 17.6% and 9.2%, respectively. Based on the results of multivariable logistic regressions, factors associated with ever conducting a SSE included older age, English linguistic acculturation, a greater number of melanoma risk factors, more frequent sunscreen use, sunbathing, job-related sun exposure, higher perceived skin cancer risk, physician recommendation, more SSE benefits, and fewer SSE barriers. Factors associated with ever having a TCE were older age, English linguistic acculturation, a greater number of melanoma risk factors, ever having tanned indoors, greater skin cancer knowledge, higher perceived skin cancer severity, lower skin cancer worry, physician recommendation, more TCE benefits, and fewer SSE barriers. LIMITATIONS The cross-sectional design limits conclusions regarding the causal nature of observed associations. CONCLUSIONS Few Hispanic adults engage in skin cancer surveillance behaviors. The study highlights Hispanic subpopulations that are least likely to engage in skin cancer surveillance behaviors and informs the development of culturally appropriate interventions to promote these behaviors.
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Affiliation(s)
- Elliot J Coups
- The Cancer Institute of New Jersey, New Brunswick, New Jersey; Department of Medicine, University of Medicine and Dentistry of New Jersey-Robert Wood Johnson Medical School, New Brunswick, New Jersey; Department of Health Education and Behavioral Science, University of Medicine and Dentistry of New Jersey-School of Public Health, Piscataway, New Jersey.
| | - Jerod L Stapleton
- The Cancer Institute of New Jersey, New Brunswick, New Jersey; Department of Medicine, University of Medicine and Dentistry of New Jersey-Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - Shawna V Hudson
- The Cancer Institute of New Jersey, New Brunswick, New Jersey; Department of Family Medicine and Community Health, University of Medicine and Dentistry of New Jersey-Robert Wood Johnson Medical School, New Brunswick, New Jersey; Department of Health Education and Behavioral Science, University of Medicine and Dentistry of New Jersey-School of Public Health, Piscataway, New Jersey
| | | | | | - Marsha Gordon
- The Cancer Institute of New Jersey, New Brunswick, New Jersey
| | - Ana Natale-Pereira
- Department of Medicine, University of Medicine and Dentistry of New Jersey-New Jersey Medical School, Newark, New Jersey
| | - James S Goydos
- The Cancer Institute of New Jersey, New Brunswick, New Jersey; Department of Surgery, University of Medicine and Dentistry of New Jersey-Robert Wood Johnson Medical School, New Brunswick, New Jersey
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