Psychosocial and cultural factors in the primary prevention of melanoma targeted to multiethnic children

Malignant melanoma is the most serious form of skin cancer, accounting for more than 75% of all skin cancer deaths. In contrast with decreasing trends for most major cancer sites, incidence rates of melanoma have been rising for the past several decades globally. Because childhood sun exposure and sunburn have been associated with significantly increased risk of melanoma in adulthood, children are particularly important targets for melanoma primary prevention, which includes the reduction of solar overexposure through methods such as limiting sun during peak hours, using sunscreen with adequate sun protection factor, using protective clothing including long sleeves, long pants, and hats, and seeking shade. ❧ This dissertation examines determinants of sun protection behaviors in a multiethnic sample of children participating in a school-based skin cancer prevention intervention. To date, interventions targeting children have been largely unsuccessful in improving UV-related behaviors. In addition, data regarding the sun protective behaviors of non-white children are scarce, and few skin cancer prevention interventions have been conducted amongst ethnically diverse samples despite rising rates of melanoma in non-white populations, particularly among U.S. Hispanics. ❧ Findings from our studies indicate that ethnic minority children experience similar sun protection correlates previously observed among non-Hispanic white (NHW) children. Strong positive associations were found between parental variables and child sun protection across studies. Mediation analysis between the intervention and sunscreen use found short-term effects for psychosocial variables; however, only knowledge of sun protection was found to mediate program effects over longer-term follow-up. Finally, latent class analysis revealed complex patterns of sun protection behaviors for Hispanic children in the sample, with strata of increasingly risky UV behaviors. Children who reported high parental engagement with sun protection were significantly more likely to be classified in high protective categories, as were girls. ❧ The studies presented here suggest considerable overlap between variables associated with greater sun protection for NHW and multiethnic youth, as well as patterns that may be unique to ethnic minority children. The results of this research will inform the design and delivery of future interventions as well as aid in the development of more effective and tailored strategies to improve sun protection practices in racial and ethnic minority groups.