Letters RESEARCH LETTER
Table 1. Descriptive Statistics for the Sun Protection Behaviorsa
Sun Protection Behaviors Among Puerto Rican Adults
Behavior
The incidence of skin cancer has been increasing among US Hispanics for several decades. Hispanic individuals residing in the continental United States do not sufficiently engage in routine sun protection behaviors.1-3 Hispanics are an important population to target for skin cancer prevention research and public health initiatives. However, there is a dearth of such efforts focusing on Hispanic populations outside the continental United States. From 1974 to 2005, the skin cancer incidence in Puerto Rico increased 4-fold, from 41.5 per 100 000 individuals to 167.9 per 100 000. 4 The Puerto Rican population is 99% Hispanic, and most individuals report their race as white (75.8%) or black/African American (12.4%). Using data from the population-based 2009 Health Information National Trends Survey Puerto Rico (HINTS-PR),5 we examined the prevalence and demographic correlates of sun protection behaviors among Puerto Rican adults. Methods | Institutional review board approval was waived. Detailed information regarding the HINTS-PR project is available elsewhere.5 In summary, 639 adults (a 76% response rate) in Puerto Rico were recruited via random-digit dialing to complete a telephone survey in Spanish or English on a variety of health-related topics. Individuals were excluded from the current analyses if they indicated that they never go out in the sun (n = 42) or were missing data for the 4 sun protection behavior questions (n = 25), leaving an analytic sample size of 572 participants. Participants reported their age, sex, and education level. Using a 5-point response scale (1, never; 2, rarely; 3, sometimes; 4 often; 5, always), standard single-item questions asked individuals to report the frequency with which they use sunscreen, wear a shirt that covers the shoulders, wear a hat, and stay in the shade (or under an umbrella) when outside on a hot sunny day. We analyzed the data using SUDAAN statistical software (version 10.0; Research Triangle Institute) in order to handle the complex sample survey design, which included jackknife replicate weights and weighting of the data based on estimates of population demographics.5 For each sun protection behavior variable, we conducted a multiple regression analysis with the behavior as the dependent variable and age, sex, and education level as independent variables. We used a cutoff of P < .05 to determine statistical significance. Results | Descriptive statistics for the sun protection behaviors are shown in Table 1. The rates of using sunscreen (21.1%, often or always) and staying in the shade (38.5%, often or always) were lower than those reported in recent studies of His-
Weighted Sample, % (95% CI)
Sunscreen use Never
47.8 (41.4-54.3)
Rarely
16.8 (12.8-21.7)
Sometimes
14.3 (9.8-20.3)
Often
8.4 (6.2-11.5)
Always
12.7 (9.5-16.9)
Wear shirt covering the shoulders Never
7.4 (4.3-12.6)
Rarely
5.6 (3.2-9.8)
Sometimes
14.0 (10.0-19.3)
Often
12.9 (9.6-17.3)
Always
60.1 (53.5-66.3)
Wear a hat Never
51.5 (45.4-57.6)
Rarely
7.6 (4.7-12.1)
Sometimes
15.3 (10.5-21.8)
Often
9.5 (5.8-15.1)
Always
16.1 (11.9-21.5)
Stay in the shade
a
Never
25.3 (19.3-32.5)
Rarely
13.2 (9.3-18.4)
Sometimes
23.0 (18.0-28.9)
Often
15.6 (12.7-19.1)
Always
22.9 (18.3-28.2)
In 572 adults drawn from the 2009 Health Information National Trends Survey Puerto Rico.5
panic adults residing in the continental United States.1,2 Approximately half of the participants reported never using sunscreen and never wearing a hat when outside on a hot sunny day. As shown in Table 2, less frequent use of sunscreen was reported by men and individuals with a lower education level, which is consistent with prior research.1,2 Women reported wearing a hat less often than men. Individuals aged 50 to 64 years reported staying in the shade more often than those aged 18 to 34 years and 65 years or older. Discussion | This study provides much-needed, timely data regarding the population-based prevalence of sun protection behaviors in Puerto Rico. Overall, the results reveal considerable room for improvement in sun protection behaviors among Puerto Rican adults. In addition, identifying demographic differences in Puerto Rican adults’ engagement in sun protection behaviors highlights subpopulations to target in interventions to promote sun safety behaviors. Such interventions should also be informed by future research examining
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Letters
Table 2. Demographic Correlates of Sun Protection Behaviorsa: Results of Multiple Regression Analyses b (95% CI)
Adj Meanb
18-34
Reference
2.15
35-49
0.20 (−0.31 to 0.71)
2.35
50-64
0.22 (−0.25 to 0.69)
2.37
−0.20 (−0.61 to 0.22)
1.95
Characteristic Use Sunscreen
P Value
Age, y
≥65
.31
Sex Male Female
Reference
1.93
0.56 (0.26 to 0.85)
2.49
Reference
1.86
Table 1. Descriptive Statistics for the Sun Protection Behaviorsa
Sun Protection Behaviors Among Puerto Rican Adults
Behavior
The incidence of skin cancer has been increasing among US Hispanics for several decades. Hispanic individuals residing in the continental United States do not sufficiently engage in routine sun protection behaviors.1-3 Hispanics are an important population to target for skin cancer prevention research and public health initiatives. However, there is a dearth of such efforts focusing on Hispanic populations outside the continental United States. From 1974 to 2005, the skin cancer incidence in Puerto Rico increased 4-fold, from 41.5 per 100 000 individuals to 167.9 per 100 000. 4 The Puerto Rican population is 99% Hispanic, and most individuals report their race as white (75.8%) or black/African American (12.4%). Using data from the population-based 2009 Health Information National Trends Survey Puerto Rico (HINTS-PR),5 we examined the prevalence and demographic correlates of sun protection behaviors among Puerto Rican adults. Methods | Institutional review board approval was waived. Detailed information regarding the HINTS-PR project is available elsewhere.5 In summary, 639 adults (a 76% response rate) in Puerto Rico were recruited via random-digit dialing to complete a telephone survey in Spanish or English on a variety of health-related topics. Individuals were excluded from the current analyses if they indicated that they never go out in the sun (n = 42) or were missing data for the 4 sun protection behavior questions (n = 25), leaving an analytic sample size of 572 participants. Participants reported their age, sex, and education level. Using a 5-point response scale (1, never; 2, rarely; 3, sometimes; 4 often; 5, always), standard single-item questions asked individuals to report the frequency with which they use sunscreen, wear a shirt that covers the shoulders, wear a hat, and stay in the shade (or under an umbrella) when outside on a hot sunny day. We analyzed the data using SUDAAN statistical software (version 10.0; Research Triangle Institute) in order to handle the complex sample survey design, which included jackknife replicate weights and weighting of the data based on estimates of population demographics.5 For each sun protection behavior variable, we conducted a multiple regression analysis with the behavior as the dependent variable and age, sex, and education level as independent variables. We used a cutoff of P < .05 to determine statistical significance. Results | Descriptive statistics for the sun protection behaviors are shown in Table 1. The rates of using sunscreen (21.1%, often or always) and staying in the shade (38.5%, often or always) were lower than those reported in recent studies of His-
Weighted Sample, % (95% CI)
Sunscreen use Never
47.8 (41.4-54.3)
Rarely
16.8 (12.8-21.7)
Sometimes
14.3 (9.8-20.3)
Often
8.4 (6.2-11.5)
Always
12.7 (9.5-16.9)
Wear shirt covering the shoulders Never
7.4 (4.3-12.6)
Rarely
5.6 (3.2-9.8)
Sometimes
14.0 (10.0-19.3)
Often
12.9 (9.6-17.3)
Always
60.1 (53.5-66.3)
Wear a hat Never
51.5 (45.4-57.6)
Rarely
7.6 (4.7-12.1)
Sometimes
15.3 (10.5-21.8)
Often
9.5 (5.8-15.1)
Always
16.1 (11.9-21.5)
Stay in the shade
a
Never
25.3 (19.3-32.5)
Rarely
13.2 (9.3-18.4)
Sometimes
23.0 (18.0-28.9)
Often
15.6 (12.7-19.1)
Always
22.9 (18.3-28.2)
In 572 adults drawn from the 2009 Health Information National Trends Survey Puerto Rico.5
panic adults residing in the continental United States.1,2 Approximately half of the participants reported never using sunscreen and never wearing a hat when outside on a hot sunny day. As shown in Table 2, less frequent use of sunscreen was reported by men and individuals with a lower education level, which is consistent with prior research.1,2 Women reported wearing a hat less often than men. Individuals aged 50 to 64 years reported staying in the shade more often than those aged 18 to 34 years and 65 years or older. Discussion | This study provides much-needed, timely data regarding the population-based prevalence of sun protection behaviors in Puerto Rico. Overall, the results reveal considerable room for improvement in sun protection behaviors among Puerto Rican adults. In addition, identifying demographic differences in Puerto Rican adults’ engagement in sun protection behaviors highlights subpopulations to target in interventions to promote sun safety behaviors. Such interventions should also be informed by future research examining
jamadermatology.com
JAMA Dermatology August 2014 Volume 150, Number 8
Copyright 2014 American Medical Association. All rights reserved.
Downloaded From: http://archderm.jamanetwork.com/ by a New York University User on 06/02/2015
899
Letters
Table 2. Demographic Correlates of Sun Protection Behaviorsa: Results of Multiple Regression Analyses b (95% CI)
Adj Meanb
18-34
Reference
2.15
35-49
0.20 (−0.31 to 0.71)
2.35
50-64
0.22 (−0.25 to 0.69)
2.37
−0.20 (−0.61 to 0.22)
1.95
Characteristic Use Sunscreen
P Value
Age, y
≥65
.31
Sex Male Female
Reference
1.93
0.56 (0.26 to 0.85)
2.49
Reference
1.86
