Perceived Skin Cancer Risk and Sunscreen Use among African American Adults

Abstract

We examined perceived skin cancer risk and its relationship to sunscreen use among a large (N = 1932) random sample of African American adults for the first time. Skin cancer risk perceptions were low (Mean = 16.11 on a 1-100 scale). Sun-sensitive skin type and a prior cancer diagnosis were associated with higher perceived skin cancer risk, but demographic factors were not. Unlike findings for Whites, perceived skin cancer risk was not associated with sunscreen use among African Americans. Directions for future research, and suggestions for increasing sunscreen use among African Americans are provided.

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Journal of Health Psychology
http://hpq.sagepub.com/content/early/2010/06/01/1359105310364177
The online version of this article can be found at:
DOI: 10.1177/1359105310364177
published online 3 June 2010J Health Psychol
Latrice C. Pichon, Irma Corral, Hope Landrine, Joni A. Mayer and Denise Adams-Simms
Perceived skin cancer risk and sunscreen use among African American adults
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1
Perceived Skin
Cancer Risk and
Sunscreen Use
among African
American Adults
LATRICE C. PICHON
School of Public Health, University of Michigan, USA
IRMA CORRAL
Behavioral Research Center, American Cancer Society, Atlanta,
USA
HOPE LANDRINE
Behavioral Research Center, American Cancer Society,
Atlanta, USA
JONI A. MAYER
Graduate School of Public Health, San Diego State
University, USA
DENISE ADAMS-SIMMS
California Black Health Network, San Diego, USA
Abstract
We examined perceived skin cancer
risk and its relationship to sunscreen
use among a large (N= 1932) random
sample of African American adults for
the first time. Skin cancer risk
perceptions were low (Mean =16.11
on a 1–100 scale). Sun-sensitive skin
type and a prior cancer diagnosis were
associated with higher perceived skin
cancer risk, but demographic factors
were not. Unlike findings for Whites,
perceived skin cancer risk was not
associated with sunscreen use among
African Americans. Directions for
future research, and suggestions for
increasing sunscreen use among
African Americans are provided.
Journal of Health Psychology
Copyright © 2010 SAGE Publications
Los Angeles, London, New Delhi,
Singapore and Washington DC
www.sagepublications.com
Vol XX(X) 1–9
DOI: 10.1177/1359105310364177
ACKNOWLEDGEMENTS. We are grateful to Uzoma Mmeje, Jo Eure, Gayle
Watts, Twila Laster, Diane Ake, and Julie Waters of the California Black
Health Network, and to Ivory Veley, Chassie Jualo, Jonathan Martinez,
Danica Aniciete, Yavette Vaden, Isabel Altarejos, Renata Harpster, Maria
Flores, Norval Hickman, Michael Hunt, and Arianna Aldridge of San Diego
State University for participating in data collection and scanning. We also
would like to acknowledge Drs Gregory Norman, James Sallis, John Elder,
Linda Hill, and Lisa Madlensky.
Supported by funds provided by the University of California Tobacco-related
Disease Program Grant No.15 AT-1300.
COMPETING INTERESTS: None declared.
ADDRESS. Correspondence should be directed to:
LATRICE C. PICHON, PhD, MPH, The University of Michigan, School of
Public Health, Health Management and Policy, 1415 Washington Heights
M3242, Ann Arbor, MI 48109-2029, USA. [Tel. + 1 734 936 1189;
Fax +1 734 764 4338; email: lpichon@umich.edu]
Keywords
■African American
■perceived risk
■risk perception
■skin cancer
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Introduction
Many theories in health psychology argue that
people with higher perceived vulnerability to
illness (i.e. higher perceived risk) are more likely
to engage in health protective behavior; this
includes the Health Belief Model, Protection
Motivation Theory, Precaution Adoption Model,
and Self-Regulative Systems Theory (see Klein &
Stefanek [2007] for a comprehensive review). The
concept of perceived risk has been applied to skin
cancer (Klein & Stefanek, 2007), with most studies
based on Whites—that is, the population at highest
risk for skin cancer (American Cancer Society,
2009). Perceived skin cancer risk is low among
Whites, with only 13 to 25 percent reporting per-
ceived high risk for skin cancer, despite Whites’
high incidence of skin cancer, frequent sun expo-
sure, and inconsistent sun protection behaviors
(Branstrom, Kristjansson, & Ullen, 2006; Douglass,
McGee, & Williams, 1997).
Predictors of increased perceived skin cancer risk
among White adults include family or personal his-
tory of skin cancer (Rhee et al., 2008; Webb,
Friedman, Bruce, Weinberg, & Cooper, 1996), sun
sensitive (Type I) skin (Cody & Lee, 1990;
Douglass et al., 1997; Mermelstein & Riesenberg,
1992), gender (Brandberg et al., 1996; Branstrom et
al., 2006; Douglass et al., 1997; Rasmussen &
O’Connor, 2005), and sunscreen use (Berwick,
Fine, & Bolognia, 1992; Cody & Lee, 1990;
Douglass et al., 1997; Mermelstein & Riesenberg,
1992). Demographic factors such as age and educa-
tion generally are not associated (or, are associated
minimally) with skin cancer risk perceptions among
White adults (Berwick et al., 1992; Brandberg et al.,
1996; Branstrom et al., 2006). Increasing age, how-
ever, may be associated with increased skin cancer
risk perceptions among adolescents (Mermelstein
& Riesenberg, 1992).
Evidence for a role of perceived skin cancer
risk in sun protection behaviors among Whites
has been inconsistent. Among those with a family
history of melanoma, sun protection behaviors
tend to be positively associated with perceived
risk; first-degree relatives with greater perceived
risk of melanoma are more likely to practice sun
protection behaviors (Azzarello, Dessureault, &
Jacobsen, 2006). Alternatively, among college
students, perceived susceptibility to skin cancer
tends to be negatively associated with sun protec-
tion behavior (Lamanna, 2004).
Only a few studies have examined skin cancer
risk perceptions among African Americans.
Friedman et al. (1994) measured perceived skin
cancer risk among sun-sensitive White and African
American adults at a worksite skin cancer screening
event. Whites (Mean = 2.42) had significantly
higher perceived skin cancer risk than African
Americans (Mean = 1.58) on a scale that ranged
from 1 = very small to 4 = very high risk. Sun pro-
tective behaviors likewise were significantly more
frequent among Whites than African Americans
(Friedman et al., 1994). Unfortunately, possible
relationships between risk perceptions and sun pro-
tection behaviors among African Americans were
not examined. Similarly, Mermelstein and
Riesenberg (1992) assessed the relationship
between perceived skin cancer risk and frequency
of sunscreen use among a multi-ethnic sample (83%
White, 7.6% Asian, 5.0% Hispanic, 1.1% African
American, and 3.3% other) of high school students.
Perceived skin cancer risk was positively associated
with sunscreen use for the sample as a whole, but
analyses by race/ethnicity were not conducted.
Likewise, Kim et al. (2009) assessed perceived skin
cancer risk among 75 African Americans at the
Northwestern Center for Ethnic Skin in Chicago,
Illinois. Kim found that 65 percent perceived them-
selves as having no risk for skin cancer. Moreover,
perceived skin cancer risk was not associated with
sunscreen use for African Americans, a finding
somewhat inconsistent with data on Whites.
Unfortunately, the sample was a clinical rather than
community one and was small, thereby limiting
generalization.
Hence, little is known about skin cancer risk per-
ceptions among African American adults, and the
relationship between such perceptions and sun pro-
tection behaviors among this population similarly
remains unknown. Thus, we examined skin cancer
risk perceptions and their association with sun pro-
tection behaviors among a large, statewide, random
sample of African American adults for the first
time. Because skin cancer risk perceptions are low
for Whites despite their objective risk, and data
indicate limited knowledge of skin cancer among
African Americans (MMWR, 1996), we hypothe-
sized that the majority of African Americans would
report no or extremely low perceived skin cancer
risk. Likewise, we examined the correlates and pre-
dictors of perceived skin cancer risk among African
Americans for the first time, and focused on demo-
graphic factors (e.g. age, gender, education, income),
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previous cancer diagnosis, and skin type (propensity
to tan or burn). Consistent with data on Whites, we
hypothesized that among African Americans, those
with a previous cancer diagnosis, women, and
those with sun sensitive skin (Type I/II) would have
higher perceived risk than their cohorts. Finally, we
explored the relationship between skin cancer risk
perceptions and sunscreen use among African
American adults.
Methods
Participants
The sample consisted of N= 1932 African
American adult (1037 Women, 760 Men, 135 did
not report sex) residents of California (CA).
Participants ranged in age from 18 to 95 years
(Mean = 43.37 years). Additional demographic data
are shown in Table 1.
Procedure
Participants were randomly sampled, statewide,
door to door, on weekends, from the seven
California (CA) cities in which 90 percent of CA
African American population resides (i.e. Los
Angeles, Oakland, San Bernardino, Riverside, San
Diego, Sacramento, San Francisco). African
Americans were sampled from the cities with prob-
ability proportional to their representation. For
example, 42 percent of all CA African Americans
reside in Los Angeles and 6 percent in San Diego;
hence, 42 percent and 6 percent of the sample came
from Los Angeles and San Diego (respectively)
such that the sample was representative of the CA
African American population. Twenty census tracts
(CTS) across the seven cities were randomly
selected, with the number of CTS in each city con-
tingent upon the proportion of the CA African
American population residing in that city (e.g. more
CTS were sampled in Los Angeles than in San
Diego). Then, block-groups within the CTS were
randomly selected, and all homes therein sampled
until 100–125 participants had been obtained from
each CT, with only one participant permitted per
household.
This study was part of a 2006–2009, community-
based participatory research (CBPR) project on
tobacco use (primarily) and other health behaviors
among a random, statewide sample of CA African
American adults. The project involved a collaboration
between San Diego State University researchers
and the California Black Health Network (CBHN),
a well-known, African American health promotion
organization. CBHN’s goals were to identify
African American neighborhoods (CTS) with high
prevalence rates of health-risk behaviors, and then
return to conduct tailored interventions (programs)
in those specific neighborhoods.
CBHN hired African American surveyors who
were residents of each city to distribute the
California Black Health Network Survey in the seven
cities. Surveyors knocked on each door in the ran-
domly selected block-group and introduced them-
selves as CBHN employees who were conducting a
brief, anonymous health survey in order to improve
CBHN health programs in that community. Surveyors
then handed each potential participant a detailed,
Informed Consent letter and simultaneously stated
the contents of the letter aloud.To increase response
rates, the survey was left with participants to com-
plete in private in their homes, then collected 30
minutes to one hour later. In addition, participants
were given $10 cash for completing the survey.
With surveys distributed to African Americans by
African American adult CBHN residents of each
city, and using the above procedures and explicitly
stated study-purpose, the survey refusal rate ranged
from 0 (San Francisco and Oakland) to 3 percent
(Los Angeles). The study had the approval of the
Institutional Review Board of San Diego State
University.
Materials
Participants completed a brief, anonymous, written,
health survey assessing tobacco use (primarily), diet,
physical activity, any previous cancer diagnosis
(yes/no), skin cancer risk perceptions, skin type, sun-
screen use, and demographics. The survey took
15–30 minutes to complete, and required an
8th grade (middle-school) reading level. The
Fitzpatrick’s Skin Type Classification scale was used
to assess skin type (Fitzpatrick, 1988). Participants
were asked: ‘Which of the following best describes
your skin’s usual reaction to your first exposure to
summer sun, without sunscreen, for one-half hour at
midday?’ The five response categories were: (1)
Always burn, unable to tan (Type I); (2) Usually
burn, then can tan if I work at it (Type II); (3)
Sometimes mild burn, then tan easily (Type III); (4)
Rarely burn, tan easily (Type IV); and (5) None of the
above describes me, added for this study. To assess
perceived skin cancer risk, participants were asked:
‘On a scale of 0 to 100, what do you think your
chances of getting skin cancer are, where 0 is no
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chance of getting skin cancer, and 100 means you
will definitely get it?’ (adapted from McGregor et al.,
2004). Sunscreen use was assessed by asking:
‘During the summer months, when you are out in the
sun for more than 15 minutes, how often do you use
sunscreen with a sun protection factor (SPF) of 15 or
higher?’ This was followed by a Likert-type scale that
ranged from Never to Always (Mayer et al., 2007).
Results
Skin cancer risk perceptions
Perceived skin cancer risk was categorized as no
risk (0), low risk (1–25), medium risk (26–74), and
high risk (75–100) on the 0–100 scale. As shown at
the bottom of Table 1, 46 percent perceived them-
selves as having zero risk, and 76 percent as having
zero or low risk, with a mean perceived risk of
16.11 (SD = 23.87). Chi-square analyses comparing
those who perceived No vs. High Risk are shown in
Table 2. As shown, the No vs. High perceived skin
cancer risk groups differed significantly in personal
history of cancer and in skin type, with the High
perceived risk group significantly more likely to
have a history of cancer (any type) and to have sun-
sensitive skin. The two groups did not differ in sun-
screen use.
Hierarchical logistic regression was used to
examine the predictors of perceived High (vs. No)
skin cancer risk; these results are shown in Table 3.
Demographic factors were entered in Step 1, history
of cancer in Step 2, and skin type in the last step. As
shown, demographic variables did not contribute to
perceived High skin cancer risk. However, those
with a history of any type of cancer were five times
more likely (than those without this) to perceive
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Table 1. Descriptive characteristics of study participants
(N= 1932)
N%
Gender
Women 1037 57.7
Men 760 42.3
Education
< High school (HS) 120 6.4
HS graduate 529 28.4
Some college 822 44.1
College graduate 262 14.1
Masters degree 98 5.3
Doctorate and similar degree 33 1.8
Income
< $5,000 228 13.2
$5000–10,999 152 8.8
$11,000–16,999 144 8.4
$17,000–25,999 178 10.3
$26,000–49,999 390 22.6
$50,000–75,999 311 18.1
$76,000–99,999 156 9.1
≥ $100,000 163 9.5
Skin type
Type I/II 81 4.4
Type III/IV 679 37.0
None of the above 1076 58.6
History of cancer
Yes 105 5.8
No 1711 94.2
Perceived cancer risk
No risk 889 46.0
Low risk 573 29.7
Medium risk 401 20.8
High risk 69 3.6
Table 2. Bivariate relationships between potential
correlates and perceived skin cancer risk
No risk High risk Overall
Correlates %% χ2 or F
Mean age 44.07 43.43 5.696 ns
Gender
Men 42.7 45.5 0.184 ns
Women 57.3 54.5
Education
≤ High school 39.7 43.8 0.403 ns
graduate
> High school 60.3 56.3
graduate
Income
$0–25,999 41.8 54.0 3.542 ns
> $26,000 58.2 46.0
History of cancer
No 94.5 81.8 16.451*
Yes 5.5 18.2
Skin type
Type I/II 3.6 15.2 19.299*
Others 96.4 84.8
Sunscreen
Always 6.3 9.2 0.850 ns
Other (the 93.7 90.8
remaining options)
Sunscreen (middle
excluded)
Always 8.5 14.0 1.487 ns
Never 91.5 86.0
*=p< 0.05; ns = not significant
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their skin cancer risk as High (OR = 4.93); likewise,
those with less sensitive skin types were 81 percent
less likely (than those with sun sensitive skin—
types I/II) to perceive their skin cancer risk as High.
Moreover, there was a significant correlation
between actual risk and perceived risk insofar as
African Americans with low sun sensitivity (Skin
Type IV) reported the lowest perceived skin cancer
risk scale (r=−0.089, p= 0.014).
These chi-square and logistic regression analyses
were then repeated with the No and Low perceived
risk participants combined and compared to the
High perceived risk group. Identical results (not
shown here) were obtained: chi-squares revealed
that the No + Low perceived risk group differed
from the High perceived risk group only on history
of cancer and skin type. In the logistic regression,
only history of cancer (OR = 5.120) and skin type
(OR = 0.173) contributed.
Sunscreen use
Hierarchical logistic regression was used to exam-
ine the predictors of sunscreen use (Always Use vs.
All other responses combined); these results are
shown in Table 4. Demographic factors were
entered in Step 1, history of cancer in Step 2, skin
type in Step 3, and perceived risk in the last step. As
shown, age, gender and education contributed sig-
nificantly to sunscreen use. That is, those that were
older in age, were women, and had more education
were more likely to report sunscreen use. Income,
history of cancer, skin type, and perceived skin can-
cer risk (None vs. High) were not significant pre-
dictors of sunscreen use.
Discussion
This novel study examined the nature, prevalence,
and correlates of perceived skin cancer risk among
a large, random, representative sample of African
American adults for the first time, and has three
important findings. First, as hypothesized, perceived
skin cancer risk among African Americans was low,
with 46 percent reporting zero skin cancer risk and
76 percent perceiving zero or low risk. These find-
ings are consistent with those of smaller, conve-
nience- and clinical-sample studies (e.g. Friedman
et al., 1994; Kim et al., 2009), and hence strongly
suggest that African Americans as a whole probably
do not perceive themselves to be at risk for skin
cancer.
The second important finding was on the predictors
and correlates of skin cancer risk perceptions. Age,
income, and education were not associated with risk
perceptions for African American adults, and this is
consistent with studies of White adults (e.g.
Brandberg et al., 1996; Branstrom et al., 2006).
Gender however also was not associated with risk
PICHON ET AL.: PERCEIVED SKIN CANCER RISK
5
Table 3. Logistic regression predicting perceived skin cancer risk from demographic and objective risk factors
Step and correlate selected β SE β/SE p OR 95% C.I.
(1) Demographic factors
Mean age 0.000 0.010 0.000 0.963 1.000 0.982, 1.020
Gender
Women −0.265 0.303 0.875 0.382 0.767 0.424, 1.390
Men (ref) —— —
Education
≤ High school 0.161 0.322 0.500 0.616 1.175 0.625, 2.207
> High school (ref) —— —
Income
$25,999 0.333 0.318 1.047 0.295 1.395 0.748, 2.603
$26,000+ (ref) —— —
(2) History of cancer
Yes 1.595 0.412 3.871 p< 0.001 4.927 2.197, 11.051
No (ref) —— —
(3) Skin type
Type I/II 1.648 0.456 3.614 p< 0.001 5.196 2.127, 12.695
Other (ref) ———
ref = reference group
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perceptions for these African American adults, and
this does not match findings for Whites in which
women tend to perceive themselves to be at higher
risk than men (e.g. Branstrom et al., 2006; Rasmussen
& O’Connor, 2005). While demographic factors did
not play a role, sun-sensitive skin and a personal his-
tory of cancer both contributed to high skin cancer
risk perceptions among African Americans in a man-
ner consistent with hypotheses and with studies of
Whites as well (e.g. Mermelstein & Riesenberg,
1992; Rhee et al., 2008).
The third important finding was the lack of a rela-
tionship between perceived skin cancer risk and sun-
screen use. Sunscreen use did not vary with High vs.
Low skin cancer risk perceptions (or even with skin
type) but instead varied with demographic factors
(age, gender, education). These findings are consis-
tent with those of Kim et al. (2009) who similarly
found no relationship between skin cancer risk
perceptions and sunscreen use among African
Americans. The lack of a relationship between risk
perceptions and risk-reducing behaviors in both stud-
ies may reflect African Americans’ low knowledge
about the value of sunscreen use (Kim et al., 2009;
MMWR, 1996). Alternatively, it may reflect envi-
ronmental barriers to sunscreen use—for example,
low access to sunscreen as a result of the paucity of
drug-stores and grocery stores (selling sunscreen) in
African American neighborhoods, irrespective of
neighborhood income (Landrine & Corral, 2009).
Thus, these findings also may highlight a limitation
of risk-perception theories, namely, their tendency to
downplay the role of objective barriers to risk-reduc-
ing behaviors among those (minorities and low-
income populations in particular) who perceive
themselves to be at high risk (Brewer, Weinstein,
Cuite, & Herrington, 2004; Klein & Stefanek, 2007;
Landrine & Corral, 2009).
Such findings and interpretations, however, must
be considered in the context of the limitations of
this study. Foremost among these is that partici-
pants were asked to recall their use of sunscreen
during the summer months, and their recall might
be inaccurate. Likewise, there may be seasonal
biases in recall, with those sampled during the sum-
mer months providing more accurate reports than
those sampled in the winter. Similarly, although we
assessed the role of a personal history of cancer
(any type) in skin cancer risk perceptions, we did
not examine (as other studies have) the role of fam-
ily history of cancer; this may limit the comparabil-
ity of these findings to those in the literature. In
JOURNAL OF HEALTH PSYCHOLOGY XX(X)
6
Table 4. Logistic regression predicting sunscreen use from demographic and objective risk factors
Step and correlate selected β SE β/SE p OR 95% C.I.
(1) Demographic factors
Mean age 0.028 0.011 2.545 0.009 1.028 1.007, 1.050
Gender
Women 1.491 0.421 3.542 p< 0.001 4.440 1.947, 10.126
Men (ref) —— —
Education
≤ High school −0.980 0.427 2.295 0.022 0.375 0.163, 0.867
> High school (ref) —— —
Income
$0–25,999 −0.683 0.386 1.769 0.077 0.505 0.237, 1.077
$26,000+ (ref) —— —
(2) History of cancer
Yes −0.358 0.760 0.471 0.638 0.699 0.158, 3.103
No (ref) —— —
(3) Skin type
I/II 1.406 0.738 1.905 0.057 4.078 0.959, 17.338
Other (ref) —— —
(4) Perceived risk
No risk −0.983 0.576 1.706 0.088 0.374 0.121, 1.157
High risk (ref) —— —
ref = reference group
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addition, although the sample was large, random,
and statewide, it was restricted to Californians.
California AfricanAmericans may differ from those
residing in other US geographic regions (e.g. the
southern states, the northeastern states) in their
health behaviors; African Americans’ skin cancer
risk perceptions, sunscreen use, and the relationship
between these may be higher (or lower) in other
parts of the United States.
Moreover, to keep the survey brief, potential cul-
tural correlates of risk perceptions and sunscreen
use were not examined. To date, there are no data on
the role of acculturation (Landrine & Klonoff,
1996), or of cultural values and practices such as
religiosity/spirituality and collectivism (Lukwago,
Kreuter, Bucholtz, Holt, & Clark 2001) in sun-pro-
tection behaviors among African Americans.
Because these cultural factors have been demon-
strated to contribute significantly to a variety of
cancer-related behaviors among African Americans,
including breast self-examination (e.g. Guevarral
et al., 2005), smoking (Guevarral et al., 2005; Klonoff
& Landrine, 1996), and diet/nutrition (Ard et al.,
2005), they might contribute to sun-protection
behaviors as well. Assessing these variables, as well
as possible structural-environmental factors, could
highlight barriers to sun-protection behaviors and
inform interventions.
Despite these limitations, the study has many
strengths, including the size and randomness of
the sample, and hence the findings have important
implications for African American health. In the
context of other health issues among African
Americans, sun-protection and skin cancer pre-
vention trail behind. Some researchers debate the
relevance of skin cancer prevention among
African Americans given the low incidence rate of
melanoma among this population (American
Cancer Society, 2009). However, the low survival
rates and high mortality rates (American Cancer
Society, 2009) among African Americans who
develop skin cancers (relative to Whites) high-
light the need for efforts to prevent these cancers
in African Americans. To do so, culturally-tai-
lored skin cancer prevention programs may need
to be created; such programs are likely to be suc-
cessful if they follow well-known guidelines for
tailoring cancer prevention for African Americans
and are modeled on prior successful efforts (e.g.
Kennedy et al., 2007). Linking sunscreen use with
other types of prevention messages also may be
an effective strategy for this population; this is
because skin cancer risk behaviors are strongly
related to other risky behaviors such as smoking
and alcohol use among African Americans
(Coups, Manne, & Heckman, 2008). Addressing
these multiple behaviors in a comprehensive,
health-behavior change intervention may be the
most viable strategy for increasing risk percep-
tions, sunscreen use, and other sun-protection
behaviors among African Americans (Simmons,
Vidrine, & Brandon, 2008). We recommend
research along each of these lines.
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LATRICE C. PICHON, PhD, MPH is completing the
Kellogg Health Scholars Program Postdoctoral
Fellowship at the University of Michigan, School
of Public Health training site. She was the lead
Research Assistant for the SDSU-CBHN Project
utilized in this study. Her research interests include
examining the social and physical environmental
factors that contribute to health disparities among
ethnic/racial minority populations using multi-
level frameworks and a community-based
participatory research approach.
HOPE LANDRINE, PhD, is the Director of
Multicultural Health Behavior Research at the
American Cancer Society, National Home Office
in Atlanta, Georgia. She was the Principal
Investigator of the SDSU-CBHN Project utilized
in this study. Her research focuses on disparities in
cancer and other chronic health conditions.
IRMA CORRAL, PhD, MPH, is the Project Director
of the Georgia Community Health Study of the
Multicultural Health Behavior Research Group at
the American Cancer Society in Atlanta, Georgia.
She was the Project Director for the SDSU-CBHN
Project utilized in this study. Her research focuses
on disparities in health behavior and chronic
conditions.
JONI A. MAYER, PhD is Professor of Health
Promotion and Behavioral Sciences in the
Graduate School of Public Health at San Diego
State University. Her research interests have
focused on adherence to the prevention and early
detection of cancer. She is particularly interested in
interventions that are tailored to the environments
where risky or healthy behaviors occur. Recent
projects on skin cancer prevention have targeted
children’s outdoor recreation sites (e.g. aquatics
classes and zoos), drugstores, US postal carriers,
and indoor tanning facilities.
DENISE ADAMS-SIMMS, MPH, is the former
executive director of the California Black Health
Network (CBHN). She was the Co-Investigator of
the SDSU-CBHN Project utilized in this study.
Her work focuses on improving the health of
African Americans.
Author biographies
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