Sun Sensitivity in 5 U.S. Ethnoracial Groups

By Gabriel R. Galindo, MPH; Joni A. Mayer, PhD; Donald Slymen, PhD; Delshad D. Almaguer, MPH; Elizabeth Clapp, MPH; Latrice C. Pichon, MPH; Katherine Hoerster, MPH, & John P. Elder, PhD
Published in Cutis 2007, 80;7:25–30

Objective

Many sun safety studies only include non-Hispanic white individuals. The objective of this study was to investigate distributions of Fitzpatrick skin type within 5 ethnoracial groups and substantiate each group’s self report with objective measure.

Methods

This was a 2-group, randomized, controlled sun safety intervention trial among US Postal Service letter carriers from 70 postal stations in California. The overall purpose was to increase sun safety practices (i.e. wearing a hat and using sunscreen). Baseline data was taken from June to August 2001, data collection took place at 3-, 12-, 24-, and 36-month follow-ups.

Participants completed a 43-item survey, measuring self reported sun safety practices, skin cancer risk information, and demographic characteristics, including skin type and ethnoracial identity. Skin color was then also assessed by trained data collectors with colorimeters.

Results

The survey included 2413 participants from five ethnoracial groups: non-Hispanic white, Hispanic, Asian, Black and Pacific Islander. The mean age for the group was 43 years, participants had worked an average of 12 years as a letter carrier and spent and average of 4 hours per workday outdoors. The majority of the participants were men. Fitzpatrick color testing showed that some participants from ethnoracial groups typically thought to have a relatively low sensitivity reported Fitzpatrick skin types I or II. Thus, based on skin type alone, individuals in each of these groups were identified as having a relatively high risk for melanoma, squamous cell carcinoma and possibly other forms of skin cancer.

Comment

Individuals who self-identify with groups other than non-Hispanic white individuals may erroneously have perceived that their risk for skin cancer was negligible, reducing preventative measures, such as sunscreen use and skin self-examination. Also, the use of the 4-category Fitzpatrick system for skin type was found by the study authors to be too limiting for individuals of color, as not all should be categorized as type IV.

Conclusion

Determination of skin cancer risk should be based on factors other than ethnoracial identity, including UV radiation exposure and sun sensitivity. This study brought to light the need to tailor skin cancer prevention and screen processes for the Hispanic and black individuals.

Reprint requests to: Joni A. Mayer, PhD, Graduate School of Public Health, San Diego University, 5500 Campanile Drive, Hardy Tower #119, San Diego, CA 92182-4162.