Sun exposure and protection behaviors in urban and rural long-term melanoma survivors


Given the increased risk for another occurrence of melanoma among melanoma survivors, safe sun behaviors are important. Little data exist about differences in sun behaviors among melanoma survivors residing in urban versus rural communities. We wanted to describe differences in sun exposure and protection behaviors by urban/rural status among melanoma survivors. We conducted a secondary data analysis of 724 melanoma survivors who participated in a cross-sectional survey. Unadjusted and adjusted logistic regression models assessed urban versus rural differences in sun exposure and protection behaviors. Unadjusted analyses showed evidence that urban melanoma survivors spent less time in the sun on weekdays and were more likely to use sunscreen, however, these differences disappeared when adjusting for confounding factors. Our study provides little evidence that rurality is an independent risk factor for worse sun protection behaviors in melanoma survivors after accounting for sociodemographic differences, but rurality as a broader term may be partially defined by urban versus rural sociodemographic differences. Skin health messaging to rural melanoma survivors should emphasize on ways to protect oneself from UV radiation even when spending time outside.

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This study was funded by a grant from the Masonic Cancer Center of the University of Minnesota's Internal Grants Program to D. Lazovich, National Cancer Institute NIH grant P30 CA77598 (Principal InvestigatOR D. Yee) utilizing the Biostatistics Core shared resource of the Masonic Cancer Center, and University of Minnesota and Award Number UL1TR000114 (Principal InvestigatOR B. Blazar) from the National Center for Advancing Translational Sciences (NCATS) of the NIH. R.I. Vogel is supported by a Young Investigator Award from the Melanoma Research Alliance. The funders had no role in design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; or decision to submit the manuscript for publication.

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PJ: Data analysis and interpretation; manuscript draft and review; approval of final manuscript. DL: Conception/design; data acquisition and interpretation; manuscript draft and review; approval of final manuscript. HW: Literature review; data analysis and interpretation; manuscript review; approval of final manuscript. CB: Data interpretation; manuscript draft and review; approval of final manuscript. RV: Conception/design; data acquisition, analysis and interpretation; manuscript draft and review; approval of final manuscript. All authors agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Corresponding author

Correspondence to Rachel I. Vogel.

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Human and animal rights statement

All procedures performed in this study involving human participants were in accordance with the ethical standards of the University of Minnesota Institutional Review Board and the Minnesota Cancer Surveillance System (1312S46684) and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

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Jewett, P.I., Lazovich, D., Wehelie, H. et al. Sun exposure and protection behaviors in urban and rural long-term melanoma survivors. Arch Dermatol Res 312, 413–420 (2020).

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  • Melanoma
  • Rural–urban differences
  • Cancer survivorship
  • Sun behaviors
  • Sun exposure