Hispanic and Latino Ethnicity and Acculturation: Influences on Skin Cancer Prevention Attitudes and Behaviors

J Clin Aesthet Dermatol. 2026;19(4):16–17.

by Luis F. Andrade, MD, MPH; Maria J. Lalama, BSc; Parsa Abdi, BEng; Yasmine Nousari, BA; Gizelle Godinez, BS; Lea Tordjman, BS; Denisse Montana, BS; Carmen Nicole Beliz, BS; and Shasa Hu, MD

Dr. Andrade, Ms. Lalama, Ms. Nousari, Ms. Godinez, Ms. Tordjman, Ms. Montana, Ms. Beliz, and Dr. Hu are with the Department of Dermatology and Cutaneous Surgery at the University of Miami Miller School of Medicine, Miami, Florida. Mr. Abdi is with Memorial University Faculty of Medicine, St. Johns, Canada.

FUNDING: Internal funding was provided by University of Miami Sylvester Comprehensive Cancer Center.

DISCLOSURES: The authors declare no conflicts of interest relevant to the content of this article.

ABSTRACT: Hispanic and Latino (H/L) populations are among the fastest-growing minority groups in the United States (US), projected to collectively reach 27.5% of the population by 2060. Despite a lower melanoma incidence compared to non-Hispanic White (NHW) individuals, H/L individuals face disproportionately higher disease burdens, including later-stage diagnoses and worse prognoses. While differences in sun-protective behaviors and UV exposure have been noted between H/L and NHW populations, the role of acculturation—a process by which individuals adopt the cultural norms of a dominant society—remains underexplored in dermatologic health. A cross-sectional survey study was conducted from August 2023 to August 2024 of adult patients capable of providing informed consent and fluent in English or Spanish. The survey included 32 questions covering sociodemographic data, the validated Short Acculturation Scale for Hispanics, and items adapted from prior sun protection behavior studies. A total of 257 responses were collected; 160 respondents (62%) self-identified as H/L, and 141 (55%) were born outside the United States. H/L participants were more likely than non-H/L respondents to avoid peak sun exposure hours (P=0.003) and to wear hats (P=0.03). Among H/L respondents, higher acculturation scores were significantly associated with increased use of sunglasses (P<0.001) and daily water intake (P=0.002). However, overall acculturation did not influence 83.3% of surveyed health behaviors. Socioeconomic status was a stronger predictor of sun-protective practices; H/L participants from lower socioeconomic backgrounds were less likely to perform or be aware of self-skin examinations (P=0.01) and less likely to wear sunglasses (P=0.08). H/L individuals were approximately 20% less likely than non-H/L participants to perform regular self-skin exams (relative risk: 0.81; 95% confidence interval: 0.62–1.05). Contrary to prior assumptions, acculturation to US culture showed limited influence on most sun-protective behaviors among H/L adults in this study. Instead, socioeconomic disparities and occupational exposure—particularly in high UV-risk industries such as agriculture and construction—may contribute more directly to increased melanoma burden in this population. These findings underscore the need for dermatologic public health strategies that consider socioeconomic and occupational risk factors alongside cultural dynamics. Future multicenter studies are recommended to further explore these relationships and to improve skin cancer prevention efforts in H/L communities. Keywords: Antiaging, photoaging, photodamage, skin of color, sunscreen

Introduction

The Hispanic and Latino (H/L) populations are the fastest-growing minority groups in the United States (US), currently comprising 19% of the population, with projections reaching 27.5% by 2060.¹ Although melanoma rates are lower than those of non-Hispanic White (NHW) individuals, H/L individuals continue to experience disproportionately higher disease burdens, including worse overall prognoses, thicker tumors at presentation, and a 20% higher incidence rate over the past 2 decades.² Prior studies have shown differences between H/L and NHW individuals regarding sun-protective behaviors and UV exposure risk,³ suggesting a need for educational strategies tailored to this population. However, the H/L population is highly diverse in terms of race, Fitzpatrick skin types, and levels of acculturation. Acculturation is defined as “assimilation to a different culture, typically the dominant one,” but mounting evidence has shown that H/L immigrants, who initially appeared healthier than the general population upon arrival to the US, have significantly worse health over time and generations across various metrics including obesity, diabetes, depression, and all-cause mortality (eg, the Immigrant Paradox).⁴ In dermatologic health outcomes, factors such as language proficiency, socioeconomic status, health literacy, education, and time within the US vary within this minority group, potentially influencing sun-protective behaviors and skin cancer risk. Given the diversity of H/L people within Miami-Dade County in Florida and the growing population nationally, we sought to assess sun-protective behaviors in the H/L population by examining how acculturation to the US influences skin cancer risk perception and protective behaviors.

A cross-sectional survey was conducted from August 2023 to August 2024 with institutional review board approval. The survey was offered to all adult patients capable of providing informed consent who met the inclusion criteria, including the ability to read or speak English and/or Spanish. The 32-question survey included questions regarding sociodemographic data, the Short Acculturation Scale for Hispanics (SASH; a validated instrument to determine acculturation to mainstream US culture), and a risk factor and sun-protective behavior survey adapted from a prior cross-sectional study.⁵ Patients were offered a $20 gift card for participation upon study completion. We estimated a sample size of approximately 256 participants to achieve 80% power and a 95% confidence interval (CI).

The study collected a total of 257 participant responses, with 160 identifying as H/L (62%) and 141 respondents (55%) born outside the US.

Among participants, H/L adults were significantly more likely than non-Hispanic adults to avoid sun exposure between 10 AM and 4 PM (P=0.003) and to wear hats (P=0.03). H/L patients with higher acculturation scores were more likely to wear sunglasses (P<0.001) and drink a minimum of 8 to 10 glasses of water daily (P=0.002). Compared to patients from higher socioeconomic cohorts, H/L patients from lower socioeconomic backgrounds were less likely to be knowledgeable about self-skin check examinations (P=0.01) and to regularly wear sunglasses (P=0.08). H/L adults were about 20% less likely to be knowledgeable about self-skin check examinations (relative risk [RR]: 0.79; 95% CI: 0.57–1.09) and to examine their skin regularly (RR: 0.81; 95% CI: 0.62–1.05) compared to non-H/L adults.

While ocular UV protection and hydration are important educational messages⁶ for patients, overall acculturation had no statistical impact on 83.3% of the health habits assessed. Our findings indicate that cultural norms and US acculturation may have less impact on sun-protective behaviors and skin cancer prevention knowledge in the H/L population than previously thought. If health knowledge and sun-protective behaviors remain overall consistent across cohorts, one potential explanation for the increased melanoma disease burden in the H/L population could be the disproportionate representation in areas of higher UV occupational exposure, such as in the agricultural sector. According to the 2023 US Bureau of Labor Statistics, although H/L individuals currently constitute only 18.8% of the workforce above the age of 16 years, they represent nearly 34.5% of the construction and natural resources labor and 44.6% of the agricultural and forestry workforce, work environments with a high risk of UV exposure for extended lengths and during peak exposure hours.⁷ Our results showed H/L patients with lower socioeconomic backgrounds were less likely to perform skin checks, data that echo prior findings in Hispanic adults,⁸ which may also contribute to delayed melanoma diagnosis.

The single-center design may limit the generalizability of the findings across the US. A larger sample size may provide a more accurate assessment on the complexity among acculturation, ethnicity, and sun-protective behaviors. Lastly, self-reported survey data introduce the potential for recall bias. Future research should consider a larger, multicenter study design to examine occupational hazards and additional influences on melanoma risk.

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