Moderated mediation regarding the sun-safe behaviors of U.S. Latinos: advancing the theory and evidence for acculturation-focused research and interventions

Associations between linguistic acculturation and skin cancer knowledge and beliefs among U.S. Hispanic adults

The incidence of melanoma among U.S. Hispanics is rising and Hispanics have poorer melanoma survival compared to non-Hispanic whites. Acculturation has been linked with skin cancer-related behaviors among Hispanic individuals, such that Hispanic individuals who are more acculturated to U.S. norms and attitudes have been found to use sunscreen more frequently, to seek shade and use sun protective clothing less often, to sunbathe and indoor tan more frequently, and to have more sunburns than less acculturated individuals. However, little is known about factors that may account for the effect of acculturation on such behaviors and outcomes. The goal of this study was to examine the association between linguistic acculturation and skin cancer-related knowledge and beliefs among Hispanic adults. 788 Hispanic adults completed an online survey measuring linguistic acculturation, sun protection knowledge, perceived skin cancer risk, perceived severity, perceived worry, skin color preference, perceived suntan benefits, photo-aging concerns, sun protection norms, tanning norms and skin cancer fatalism. Compared with Spanish-acculturated Hispanics, English-acculturated Hispanics had greater knowledge, lower levels of perceived risk of skin cancer, lower perceived severity of skin cancer, less worry about skin cancer, greater perceived suntan benefits, and lower photo-aging concerns. This study highlights the importance of considering an individual's level of acculturation when designing skin cancer prevention interventions. Additional research is warranted to develop and test culturally relevant, tailored interventions to reduce the risks of skin cancer among U.S. Hispanics.

Preliminary evidence for mediation of the association between acculturation and sun-safe behaviors

OBJECTIVES

To identify and test mediators of the relationship between acculturation and sun-safe behaviors among Latinos in the United States. We hypothesized that the effect of acculturation on use of sunscreen, shade, and sun-protective clothing would be mediated by perceived health status, educational level, access to health care, and contact with social networks regarding health matters.

DESIGN

The 2005 Health Information National Trends Survey, implemented by the National Cancer Institute.

SETTING

Nationwide survey.

PARTICIPANTS

A probability-based sample of the US civilian, noninstitutionalized adult population, comprising 496 Latino respondents.

MAIN OUTCOME MEASURES

Use of sunscreen, shade, and sun-protective clothing when outdoors on sunny days, assessed by self-report on frequency scales.

RESULTS

The positive association between acculturation and sunscreen use and the negative association between acculturation and use of sun-protective clothing were mediated by educational level (P < .05 for both). Perceived health status and contact with social networks regarding health matters were supported as mediators for sunscreen use only (P < .05). Health care access was not supported as a mediator for any of the outcomes.

CONCLUSIONS

Structural equation models revealed distinct direct and indirect paths between acculturation and each sun-safe practice. Our findings emphasize behavior-specific mediated associations and could inform sun safety programming for Latinos with low and high levels of acculturation. The models support educational level, contact with social networks regarding health matters, and perceived health status as mediators primarily for sunscreen use. Future research should test different mediators for use of shade or sun-protective clothing.