Developing and testing a mobile health intervention to promote sun protection behaviors and skin examination among Hispanics

摘要 皮肤癌是美国（US）最常见的癌症。黑色素瘤是最致命的皮肤癌。 在过去的二十年里，西班牙裔人的黑色素瘤发病率上升了20%。西班牙裔的死亡率 非西班牙裔白人（NHW）。总的来说，与NHW相比，被诊断为 黑色素瘤更年轻，肿瘤更厚，存活率更低。皮肤癌可以预防， 定期防晒和早期发现可以改善皮肤癌的结果。 西班牙裔人口是美国增长最快的种族群体。令人震惊的是，西班牙裔人不太清楚 皮肤癌的症状和危害，往往对皮肤癌的风险和益处有误解。 癌症预防行为，从事防晒行为比NHW少，只有18%的人报告 做过皮肤自我检查此外，由于拉美裔美国人的文化适应程度提高， 他们的阳光安全行为比非美国西班牙裔人差。职业性紫外线照射 (UVR)是皮肤癌的一个危险因素，西班牙裔人在许多户外活动中占主导地位。 职业。2018年美国西班牙裔劳动力中约有21%受雇于涉及以下领域的行业： 大量的职业性紫外线照射，如建筑。因此，越来越多的努力提高 需要提高防晒和皮肤自我检查行为的意识，以解决现有的差距 在拉美裔人中进行的皮肤癌研究。 本研究项目旨在开发一种基于移动和以用户为中心的干预措施，以促进Sun 保护和皮肤自我检查之间的不同样本的西班牙裔使用迭代的方法来捕捉 相关的背景问题并评估干预的初步效果。在K99阶段，我将： 1)收集，分析和三角分析来自西班牙裔社区和其他利益相关者的数据（例如，保健 供应商和社区领导人）进行皮肤癌数字干预开发;以及2）通过用户- 中心的方法，开发创新的WhatsApp干预措施，以促进皮肤癌相关的健康 西班牙裔美国人的行为，以提高参与者的参与干预。在R 00阶段，我 将：3）在试验前、试验后研究中评价这种移动的干预的可行性和可接受性， 有皮肤癌风险的西班牙裔人;以及4）完善干预措施并进行试点随机对照试验 使用这种移动的服务在西班牙裔皮肤癌的风险，并评估的初步效果， 干预后和6个月随访时的移动的干预。干预措施具有很大的成本潜力- 有效的，广泛的传播，并针对未来癌症发展风险的研究不足的群体。 在K99/R 00项目期间获得的培训经验和指导是 成功的独立癌症研究生涯。

ABSTRACT Skin cancer is the most common cancer in the United States (US). Melanoma is the deadliest form of skin cancer. In the past two decades, melanoma incidence among Hispanics has risen by 20%. The mortality rate of Hispanics is higher compared to Non-Hispanic whites (NHW). In general, compared to NHW, Hispanics diagnosed with melanoma are younger, have thicker tumors, and have worse survival rates. Skin cancer can be prevented with regular sun protection, and early detection can improve skin cancer outcomes. The Hispanic population is the fastest growing ethnic group in the US. Alarmingly, Hispanics are less aware of the symptoms and harms of skin cancers, tend to have misperceptions regarding the risks and benefits of skin cancer prevention behaviors, engage in less sun protection behaviors than NHW, and only 18% of them reported ever having done a skin self-examination. In addition, due to the increase of acculturation of Hispanics in the US, their sun-safety behaviors are poorer than non-US Hispanics. Occupational exposure to ultraviolet radiation (UVR) is a risk factor for skin cancer, and Hispanic individuals are over-represented in a number of outdoor occupations. Approximately 21% of the 2018 US Hispanic workforce were employed in industries that involved significant amounts of occupational UVR exposure such as construction. Therefore, an increasing effort to raise awareness regarding sun protection and skin self-examination behaviors is needed to address the existing gap of skin cancer research among Hispanics. This research project seeks to develop a mobile-based and user-centered intervention to promote sun protection and skin self-examination among a diverse sample of Hispanics using an iterative approach to capture relevant contextual issues and evaluate the preliminary effects of the intervention. During the K99 phase, I will: 1) collect, analyze, and triangulate data from the Hispanic community and other stakeholders (e.g., health care providers and community leaders) for skin cancer digital intervention development; and 2) through a user- centered approach, develop an innovative WhatsApp intervention to promote skin cancer-related health behaviors among Hispanics to improve participants’ engagement in the intervention. During the R00 phase, I will: 3) evaluate the feasibility and acceptability of this mobile intervention in a pre-, post-test study among Hispanics at risk for skin cancer; and 4) refine the intervention and conduct a pilot randomized controlled trial using this mobile service among Hispanics at risk for skin cancers and assess the preliminary effects of the mobile intervention at post-intervention and 6-month follow-up. The intervention has strong potential for cost- effective, widespread dissemination and targets an understudied group at-risk for future cancer development. The training experiences and mentoring obtained during this K99/R00 project are critical foundations for a successful independent cancer research career.