Preliminary Evidence for Mediation of the Association Between Acculturation and Sun-Safe Behaviors

Objectives: To identify and test mediators of the relationship between acculturation and sun-safe behaviors among Latinos in the United States. We hypothesized that the effect of acculturation on use of sunscreen, shade, and sun-protective clothing would be mediated by perceived health status, educational level, access to health care, and contact with social networks regarding health matters. Design: The 2005 Health Information National Trends Survey, implemented by the National Cancer Institute. Setting: Nationwide survey. Participants: A probability-based sample of the US civilian, noninstitutionalized adult population, comprising 496 Latino respondents. Main Outcome Measures: Use of sunscreen, shade, and sun-protective clothing when outdoors on sunny days, assessed by self-report on frequency scales. Results: The positive association between acculturation and sunscreen use and the negative association between acculturation and use of sun-protective clothing were mediated by educational level (P <.05 for both). Perceived health status and contact with social networks regarding health matters were supported as mediators for sunscreen use only (P <.05). Health care access was not supported as a mediator for any of the outcomes. Conclusions: Structural equation models revealed distinct direct and indirect paths between acculturation and each sun-safe practice. Our findings emphasize behavior-specific mediated associations and could inform sun safety programming for Latinos with low and high levels of acculturation. The models support educational level, contact with social networks regarding health matters, and perceived health status as mediators primarily for sunscreen use. Future research should test different mediators for use of shade or sun-protective clothing.