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

摘要 皮肤癌是美国最常见的癌症。黑色素瘤是最致命的皮肤癌。 在过去的20年里，拉美裔美国人的黑色素瘤发病率上升了20%。拉美裔美国人的死亡率 与非西班牙裔白人(Nhw)相比更高。总体而言，与NHW相比，被诊断为 黑色素瘤更年轻，肿瘤更厚，存活率更低。皮肤癌可以通过以下方法预防 经常防晒，及早发现可以改善皮肤癌的预后。 拉美裔人口是美国增长最快的种族群体。令人担忧的是，拉美裔美国人意识到的 皮肤癌的症状和危害，往往对皮肤癌的风险和好处有误解 癌症预防行为，从事的防晒行为比nhw少，只有18%的人报告说 曾经做过皮肤自检。此外，由于美国拉美裔美国人的文化适应程度增加， 他们的防晒行为比非美国拉美裔更差。职业性紫外线照射 紫外线(UVR)是皮肤癌的风险因素，西班牙裔个人在许多户外活动中比例过高 职业。2018年美国拉美裔劳动力中约有21%受雇于涉及 大量职业性紫外线照射，如建筑业。因此，越来越多的努力筹集 需要对防晒和皮肤自我检查行为的认识来解决现有的差距 在西班牙裔美国人中进行皮肤癌研究。 该研究项目旨在开发一种以移动为基础、以用户为中心的干预方式来推广SUN 使用迭代捕获方法在西班牙裔不同样本中进行保护和皮肤自我检查 相关背景问题，并评估干预的初步效果。在K99阶段，我将： 1)收集、分析和三角测量来自西班牙裔社区和其他利益攸关方(例如，医疗保健)的数据 提供者和社区领袖)用于皮肤癌数字干预开发；以及2)通过用户- 以此为中心，开发创新的WhatsApp干预措施，以促进皮肤癌相关健康 西班牙裔美国人的行为，以提高参与者在干预中的参与度。在R00阶段，我 将：3)在测试前、测试后的研究中评估这种移动干预的可行性和可接受性 有患皮肤癌风险的拉美裔美国人；以及4)完善干预措施并进行试点随机对照试验 在有皮肤癌风险的拉美裔美国人中使用这项移动服务，并评估 干预后的活动干预和6个月的随访。这种干预具有很大的成本潜力- 有效、广泛的传播，并针对研究不足的群体，面临未来癌症发展的风险。 在K99/R00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.