Compared to non-Hispanic whites, Hispanics are more likely to be diagnosed with melanoma at an earlier age, with thicker and more advanced lesions, and are more likely to die from their disease.1 Physician skin examinations (PSE) may reduce the incidence of thick melanomas that have a poor prognosis.2 Few studies have examined the rate of PSE among US Hispanics. In the current study, we examined the prevalence and correlates of PSE among US Hispanics in a nationally representative sample.
Methods
Procedures
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 current study.
Participants
The sample for the current study consisted of the 4766 individuals who self-reported Hispanic ethnicity, reported no personal history of skin cancer, and provided data regarding their PSE history.
Measures
Participants indicated whether they were born in the US and the language they generally use when speaking, which are two 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 doctor).
Statistical Analysis
Using SUDAAN 10.0 software and a statistical significance cutoff of P<.05, we conducted a series of univariate logistic regression analyses with ever having a PSE as the dichotomous outcome variable and each of the variables listed in the Measures section as independent variables.
Results
As shown in Table 1, 7.2% of participants reported ever having a PSE. Lower rates of PSE were found among those born outside of the US 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 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 did not differ across region of residence. The rate of PSE was lower among individuals with no source of preventive care or who receive preventive care somewhere other than a doctor’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 compared to those with the most sensitive skin. The rate of PSE did not differ according to the number of reported sunburns in the past year.
Table 1.
Correlates of Ever Having Had a Physician Skin Examination among US Hispanic Adultsa
| Sample %b | Ever Had a Physician Skin Examination
|
|||
|---|---|---|---|---|
| Participants, %b (SE) | OR (95% CI) | P Valuec | ||
| Full sample | NA | 7.2 (0.5) | NA | NA |
| Nativity | ||||
| Born in the US | 39.9 | 8.8 (0.8) | 1 [Reference] | .01 |
| Born outside of the US | 60.1 | 6.2 (0.6) | 0.69 (0.51–0.93) | |
| Language used when speaking | ||||
| Mostly/only Spanish | 39.3 | 4.4 (0.6) | 1 [Reference] | <.001 |
| Spanish/English equally | 25.0 | 5.3 (0.7) | 1.22 (0.82–1.83) | |
| Mostly/only English | 35.7 | 11.5 (1.1) | 2.86 (2.05–4.00) | |
| Hispanic origin | ||||
| Mexico | 61.8 | 6.0 (0.6) | 1 [Reference] | .01 |
| Central/South America | 16.9 | 8.0 (1.4) | 1.36 (0.90–2.07) | |
| Puerto Rico | 10.2 | 9.7 (1.7) | 1.68 (1.08–2.62) | |
| Cuba | 4.0 | 13.1 (2.6) | 2.37 (1.46–3.87) | |
| Dominican Republic | 3.2 | 6.4 (2.8) | 1.08 (0.41–2.79) | |
| Other | 3.9 | 11.3 (3.0) | 2.01 (1.07–3.78) | |
| Sex | ||||
| Male | 51.9 | 6.1 (0.7) | 1 [Reference] | .02 |
| Female | 48.1 | 8.4 (0.7) | 1.40 (1.07–1.84) | |
| Age (years) | ||||
| 18–29 | 30.6 | 4.3 (0.9) | 1 [Reference] | <.001 |
| 30–39 | 23.7 | 4.8 (0.8) | 1.12 (0.65–1.92) | |
| 40–49 | 20.2 | 7.7 (0.9) | 1.85 (1.15–2.98) | |
| 50–64 | 17.0 | 10.9 (1.4) | 2.70 (1.64–4.46) | |
| ≥ 65 | 8.6 | 15.5 (2.0) | 4.04 (2.49–6.56) | |
| Education level | ||||
| Some high school or less | 36.9 | 4.3 (0.6) | 1 [Reference] | <.001 |
| High school graduate | 26.0 | 6.3 (0.8) | 1.50 (0.99–2.26) | |
| Some college | 24.1 | 8.4 (1.2) | 2.06 (1.35–3.12) | |
| College graduate | 13.0 | 15.3 (1.9) | 4.07 (2.73–6.06) | |
| Region of Residence | ||||
| Northeast | 13.3 | 10.3 (2.0) | 1 [Reference] | .08 |
| Midwest | 8.7 | 5.4 (1.5) | 0.49 (0.24–1.01) | |
| South | 35.2 | 7.5 (0.7) | 0.71 (0.44–1.13) | |
| West | 42.9 | 6.4 (0.7) | 0.59 (0.37–0.96) | |
| Source of routine preventive care | ||||
| Nowhere | 22.3 | 2.3 (0.7) | 1 [Reference] | <.001 |
| Doctor’s office or HMO | 43.4 | 11.6 (0.9) | 5.61 (2.94–10.72) | |
| Somewhere else | 34.4 | 4.9 (0.6) | 2.23 (1.12–4.42) | |
| Health care coverage | ||||
| Private | 40.4 | 10.2 (0.9) | 1 [Reference] | <.001 |
| Public | 21.3 | 9.7 (1.1) | 0.95 (0.71–1.29) | |
| None | 38.4 | 2.7 (0.5) | 0.25 (0.16–0.37) | |
| Skin reaction after 1 hour in the sun | ||||
| Moderate/severe burn | 17.4 | 10.0 (1.5) | 1 [Reference] | .02 |
| Mild sunburn | 17.2 | 6.1 (0.9) | 0.59 (0.37–0.93) | |
| No sunburn | 58.4 | 6.4 (0.7) | 0.61 (0.42–0.91) | |
| Do not go out in the sun | 7.0 | 8.9 (1.6) | 0.88 (0.54–1.45) | |
| Number of sunburns in the past year | ||||
| 0 | 73.0 | 7.0 (0.5) | 1 [Reference] | .74 |
| 1 | 13.4 | 8.0 (1.6) | 1.16 (0.75–1.80) | |
| ≥ 2 | 13.7 | 7.6 (1.3) | 1.09 (0.73–1.63) | |
Abbreviations: SE, standard error; OR, odds ratio; CI, confidence interval; HMO = health maintenance organization.
The data are from the 2010 US National Health Interview Survey (NHIS) conducted by the National Center for Health Statistics3; sample sizes vary from n = 4714 to n = 4766.
All percentages are weighted.
Satterthwaite-adjusted F test of the association between the variable and ever having a physician skin examination.
Comment
Only one in fourteen US Hispanic adults reported ever having a PSE, which is lower than the one in four 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’ level 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 remain unscreened and the PSE rate was not higher among individuals reporting more versus 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.
Acknowledgments
Funding/Support: This research was supported by a Cancer Prevention and Control Pilot Award from The Cancer Institute of New Jersey (Coups) and by National Cancer Institute grants K07CA133100 (Coups) and K01CA131500 (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.
Footnotes
Disclosures: None of the authors have any conflicts of interest or financial interest related to this research.
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.
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