摘要：Objectives. We examined the relationship between acculturation and sun safety among US Latinos. Methods. We used linear regression models to analyze data from 496 Latino respondents to the 2005 Health Information National Trends Survey. Using sunscreen, seeking shade, and wearing protective clothing were the primary outcomes and were assessed by frequency scales. Acculturation was assessed with a composite index. Results. In bivariate models, acculturation was negatively associated with use of shade and protective clothing and positively associated with sunscreen use (all, P < .004). In adjusted models, acculturation was negatively associated with seeking shade and wearing protective clothing across gender and region of residence (all, P < .05). Conclusions. Our results demonstrated both adverse and beneficial effects of acculturation on Latinos’ risk behaviors relating to skin cancer. Education about sun safety is needed for all Latinos and should be tailored to different levels of acculturation. Initiatives for Latinos who are not yet acculturated could focus on reinforcing existing sun-safe behaviors and presenting new ones, such as use of sunscreen; initiatives for highly acculturated Latinos might require more resources because the objective is behavior modification. Latinos represent the most rapidly growing segment of the US population and live primarily in areas with high levels of ultraviolet (UV) radiation, such as California and Texas. 1 UV radiation exposure, however, might predispose individuals toward melanoma and is clearly implicated in nonmelanoma skin cancer development. 2 – 4 Although skin pigmentation is protective, 5 , 6 research has linked UV radiation exposure with DNA damage and skin cancer across skin types. 5 , 7 , 8 The annual age-adjusted melanoma incidence among US Latinos was 3.7 per 100 000 from 1992 to 1996, and from 2001 to 2005 it reached 4.9 per 100 000 (32.4% change). 9 , 10 Melanoma incidence increased 1.8% annually among Latino men in California from 1988 to 2001. 11 Latinos experience more advanced tumors with a poorer prognosis than do non-Latino Whites, 11 – 13 possibly because they have less awareness about risk factors or symptoms, 6 , 14 are more likely to lack health insurance, 15 are not targeted in melanoma-screening efforts, 11 and may delay seeking treatment. 16 , 17 Recent research documented that Latinos were at greater risk of sunburn (regarded as a UV radiation overexposure estimate 11 ) than were non-Latino Whites. 18 Adult sunburn prevalence (i.e., reporting ≥ 1 sunburn episode during the preceding year) was 35.6% among non-Latino Whites and 45.6% among Latinos. The 2 groups were almost equally likely to report 4 or more sunburn episodes. 18 These findings about Latinos might be partially explained by low perceived skin cancer risk that leads to high UV radiation exposure. 14 , 19 Sun safety is important for the primary prevention of skin cancer and can be achieved by preventing UV radiation overexposure through applying sunscreen, avoiding midday sun exposure, and wearing protective clothing. 2 The few studies conducted to date on sun-safe behaviors and attitudes among adults in Latin America revealed less perception of suntans as healthful than in the United States 20 , 21 and suggested that sun-safe behaviors were not optimal but might be more prevalent than in the United States. 20 – 23 Recent data showed that US Latinos aged 18 to 39 years were about half as likely as non-Latino Whites to report multiple skin cancer risk behaviors. 24 However, no racial/ethnic group appeared to meet existing sun safety recommendations. The growing melanoma incidence among US Latinos could be partially attributable to declines in sun-safe behaviors with increasing acculturation, which has been established as an independent risk factor for several other health practices. 25 – 28 Acculturation describes the process of interchange by which immigrants accommodate the language, behaviors, and norms predominant in the host country. 29 Among Latinos, greater acculturation has been associated with increased substance use and cancer incidence and deteriorating dietary practices (e.g. decreased fruit and vegetable consumption). 30 – 32 Evidence suggests that women experience more unfavorable acculturation effects than do men, 25 , 33 , 34 because of baseline differences in certain behaviors (e.g., smoking) and gender-based social norms. 35 , 36 Research also indicates that vulnerability to the adverse effects of acculturation decreases with age because distress factors related to mainstream integration might act less powerfully on older adults. 28 We investigated the influence of acculturation on Latinos’ sun-safe behaviors, which could affect their skin cancer risk. Because the US cultural norm favors sunscreen use more than the cultural norm among Latinos, 22 , 37 we expected that sunscreen use would increase among Latinos as acculturation increased. Also, because the US cultural norm is more accepting of suntans 21 than is the Latin America cultural norm, 20 we expected that acculturation would be negatively associated with use of shade or protective clothing. Consistent with the literature, 25 , 38 , 39 we hypothesized that the observed effects would be stronger among women than men and among younger than older Latinos. We also hypothesized that the observed effects would be more pronounced in areas with higher versus lower UV radiation levels. Finally, drawing on findings among non-Latino Whites, 40 we hypothesized that the role of acculturation in sun safety would be greater among those of higher socioeconomic status (SES). We used Bandura's social cognitive theory, 41 which has been applied in previous sun safety research 42 – 44 and which accommodates the influence of the sociocultural environment on health behaviors.
