Barriers to skin cancer prevention in uninsured, minority, immigrant populations

A survey of uninsured patients at a large free medical clinic in South Florida identified barriers to skin cancer prevention in minority and immigrant populations, including a lack of knowledge, the belief that dark skin was protective, and that using sun protection made the wearers feel too hot, according to an article published online by JAMA Dermatology.

The incidence of skin cancer in minority populations is rising. Minority populations in the United States are expected to reach over 50 percent by 2044 so research to determine appropriate skin cancer prevention interventions is needed.

John Strasswimmer, M.D., Ph.D., of the University of Miami Miller School of Medicine, Florida, and coauthors used a 23-question survey in English, Spanish or Haitian Creole to assess skin cancer risk, perception, knowledge of sun-protective behaviors and barriers. All participants were uninsured and living at least 200 percent below the federal poverty line.

A total of 206 participants completed the survey and most of them were women who usually worked indoors. The largest proportion of participants was immigrants from Central America, Mexico, South America and the Caribbean, according to the report.

The authors report:

• Nearly 25 percent of the participants (n=49) had never heard of skin cancer or melanoma.
• Nearly 40 percent (n=80) believed they were "very unlikely" or "unlikely" to get skin cancer in their lifetime.
• About 21 percent (n=41) believed people with dark skin cannot get skin cancer.
• More than half of the participants (58.2 percent) had never or rarely checked their skin for suspicious spots.
• Nearly 90 percent (n=175) wanted to learn more about preventing skin cancer; watching a video and text messages were the most popular outreach methods.
• Wearing a hat was the most consistent sun-protective behavior (35.9 percent); barriers to sun-protective behaviors ranged from it was too hot to wear to it was inconvenient or too expensive.

A limitation of the study was using a clinic population and a small sample of Caribbean participants.

"Intervention efforts in uninsured, minority and immigrant communities need to focus on increasing knowledge capacity and promoting self-skin checks," the authors conclude.