Skin Cancer Awareness, Beliefs, Behaviors, and Access to Care Among the Homeless and Underinsured Patients Using a Free Clinic in Nebraska

Overview

Journal Cureus

Specialty Biomedical Engineering

Date 2024 Dec 27

PMID 39726487

Authors

Michelle S Swedek

Mariah Fleischman

Alexander Hall

Bruce Houghton

Affiliations

Soon will be listed here.

Abstract

Introduction: To understand the attitudes, beliefs, knowledge, and access to care surrounding sun safety for a primarily homeless or underinsured patient population at a student-run health clinic.

Methods: All adult attendees at the health clinic were invited to complete an anonymous 16-item questionnaire that assessed their sun safety history, practices, knowledge, and beliefs.

Results: Fifty participants completed our questionnaire, with 35 individuals (70%) reporting that they were without permanent residence, and 21 individuals indicating that they were uninsured or using Medicaid (42%). The typical reported daily sun exposure was high (median=4 hours), while sunscreen use was uncommon (mean=1.83, falling between a "Never" or "Rarely" rating). Only 10 participants (20%) reported having ever seen a dermatologist though commonly assumed barriers such as transportation, cost, or wait time were not endorsed at high rates. Conclusion: Our findings highlight areas for targeted education surrounding sun safety and identify sun protection methods accessible for this patient population.

References

Ho B, Robinson J . Color bar tool for skin type self-identification: A cross-sectional study. J Am Acad Dermatol. 2015; 73(2):312-3.e1. PMC: 4506490. DOI: 10.1016/j.jaad.2015.05.024. View

Resneck Jr J, Isenstein A, Kimball A . Few Medicaid and uninsured patients are accessing dermatologists. J Am Acad Dermatol. 2006; 55(6):1084-8. DOI: 10.1016/j.jaad.2006.07.012. View

Aggarwal P, Knabel P, Fleischer Jr A . United States burden of melanoma and non-melanoma skin cancer from 1990 to 2019. J Am Acad Dermatol. 2021; 85(2):388-395. DOI: 10.1016/j.jaad.2021.03.109. View

Sanchez-Perez J, Vicente-Agullo D, Barbera M, Castro-Rodriguez E, Canovas M . Relationship between ultraviolet index (UVI) and first-, second- and third-degree sunburn using the Probit methodology. Sci Rep. 2019; 9(1):733. PMC: 6345802. DOI: 10.1038/s41598-018-36850-x. View

Linos E, Keiser E, Fu T, Colditz G, Chen S, Tang J . Hat, shade, long sleeves, or sunscreen? Rethinking US sun protection messages based on their relative effectiveness. Cancer Causes Control. 2011; 22(7):1067-71. PMC: 3873510. DOI: 10.1007/s10552-011-9780-1. View

Narayanan D, Saladi R, Fox J . Ultraviolet radiation and skin cancer. Int J Dermatol. 2010; 49(9):978-86. DOI: 10.1111/j.1365-4632.2010.04474.x. View

Creadore A, Desai S, Li S, Lee K, Bui A, Villa-Ruiz C . Insurance Acceptance, Appointment Wait Time, and Dermatologist Access Across Practice Types in the US. JAMA Dermatol. 2021; 157(2):181-188. PMC: 7807384. DOI: 10.1001/jamadermatol.2020.5173. View

Glanz K, Yaroch A, Dancel M, Saraiya M, Crane L, Buller D . Measures of sun exposure and sun protection practices for behavioral and epidemiologic research. Arch Dermatol. 2008; 144(2):217-22. DOI: 10.1001/archdermatol.2007.46. View

Kamimura A, Nourian M, Ashby J, Trinh H, Tabler J, Assasnik N . Sun Protection Behaviors Associated with Self-Efficacy, Susceptibility, and Awareness among Uninsured Primary Care Patients Utilizing a Free Clinic. Dermatol Res Pract. 2015; 2015:753681. PMC: 4575745. DOI: 10.1155/2015/753681. View

10.

Joseph A, Kindratt T, Pagels P, Gimpel N . Knowledge, Attitudes, and Practices Regarding Skin Cancer and Sun Exposure among Homeless Men at a Shelter in Dallas, TX. J Cancer Educ. 2019; 35(4):682-688. DOI: 10.1007/s13187-019-01511-8. View

11.

Patel S, Nijhawan R, Stechschulte S, Parmet Y, Rouhani P, Kirsner R . Skin cancer awareness, attitude, and sun protection behavior among medical students at the University of Miami Miller School of Medicine. Arch Dermatol. 2010; 146(7):797-800. DOI: 10.1001/archdermatol.2010.140. View

12.

Grossberg A, Carranza D, Lamp K, Chiu M, Lee C, Craft N . Dermatologic care in the homeless and underserved populations: observations from the Venice Family Clinic. Cutis. 2012; 89(1):25-32. View

13.

Wu S, Cho E, Li W, Weinstock M, Han J, Qureshi A . History of Severe Sunburn and Risk of Skin Cancer Among Women and Men in 2 Prospective Cohort Studies. Am J Epidemiol. 2016; 183(9):824-33. PMC: 4851991. DOI: 10.1093/aje/kwv282. View

14.

Agbai O, Buster K, Sanchez M, Hernandez C, Kundu R, Chiu M . Skin cancer and photoprotection in people of color: a review and recommendations for physicians and the public. J Am Acad Dermatol. 2014; 70(4):748-762. DOI: 10.1016/j.jaad.2013.11.038. View

15.

Coups E, Geller A, Weinstock M, Heckman C, Manne S . Prevalence and correlates of skin cancer screening among middle-aged and older white adults in the United States. Am J Med. 2010; 123(5):439-45. PMC: 2858071. DOI: 10.1016/j.amjmed.2009.10.014. View

16.

Darnell J . Free clinics in the United States: a nationwide survey. Arch Intern Med. 2010; 170(11):946-53. DOI: 10.1001/archinternmed.2010.107. View

17.

Nakamura A, Kataoka K, Takatsuka S, Takenouchi T . Aging trends in skin cancer: A long-term observational study in Japan. JAAD Int. 2023; 13:32-34. PMC: 10450971. DOI: 10.1016/j.jdin.2023.07.003. View

18.

Cortez J, Fadadu R, Konda S, Grimes B, Wei M . Disparities in access for melanoma screening by region, specialty, and insurance: A cross-sectional audit study. JAAD Int. 2022; 7:78-85. PMC: 8968658. DOI: 10.1016/j.jdin.2022.02.008. View