Discussion
sunburned, sunburn, sunburns, indoor intentional tanning, skin cancer, low skin cancer worry
STRUCK, SKIN CANCER
We found low to modest baseline levels of weekday and weekend sun exposure and outdoor and indoor intentional tanning among our Hispanic participants. However, about 30% of our participants reported having a sunburn in the past 12 months, with an average of almost two sunburns among those ever sunburned; and most participants in our study did not practice sun protection behaviors often or always, with an average of only two out of five sun protection behaviors being practiced often or always.Overall, our results reflect previous literature demonstrating high rates of experiencing sunburns among Hispanics, and low prevalence of routine sun protection behaviors. Compared to a report on sunburns among Hispanics who completed the 2015 National Health Interview Survey, our study population had a similar proportion of individuals who had a sunburn in the past year [English-preferring Tampeños had the lowest weekday sun exposure, and the highest frequencies of wearing sunglasses, sunscreen, and sleeved shirts. However, they also had the highest weekend sun exposure, highest frequency of outdoor intentional tanning, and the highest proportion who were ever sunburned in the past year. It is unlikely that daytime outdoor work accounts for the observed difference in lower weekday sun exposure since similar proportions of English-preferring Tampeños (35.1%), Spanish-preferring Tampeños (38%), and Puerto Ricans (38%) reported such work. These percentages are similar to the percentage of the US Hispanic workforce (35.0%) that are employed in building and grounds cleaning and maintenance, farming, construction, installation, and maintenance occupations [Hispanic participants in our study reported low skin cancer worry, recent worry, recent concern, and recent distress about skin cancer, high levels of response efficacy and self-efficacy, and a plurality reported being unlikely to get skin cancer or having below or well below average comparative risk. Yet, participants also reported modest levels of perceived severity. Two previous studies examined these psychosocial variables among U.S. Hispanics [Compared to both English- and Spanish-preferring Tampeños, Spanish-preferring Puerto Ricans had the highest recent concern about skin cancer, comparative chance of getting skin cancer, and response efficacy, and, non-significantly, the highest recent worry about skin cancer. These results are similar to previous study among U.S. Hispanics, comprised of mostly Mexicans from California and Texas, that found Spanish-acculturated Hispanics had higher perceived risk and worry compared to English-acculturated Hispanics [Because Hispanic men and individuals with low education, health literacy and health numeracy were underrepresented in our study, our findings may have limited generalizability to these groups. Similarly, our findings are likely to be most relevant to Hispanics reporting a Puerto Rican identity. It also is important to appreciate temporal trends that may have influenced reported measures obtained from participants living in Ponce, Juana Díaz, and Salinas, where Hurricane Irma and Maria struck in September 2017, which likely affected typical sun-related activities and prevention behaviors reported over the 1-year ‘think back’ timeframe anchoring our baseline questions.