implement skin cancer prevention in their daily routines. We describe themes and sub-themes generated by semi-structured interviews from Hispanic tattoo artists including skin cancer knowledge, aftercare instructions, social media, and other themes influencing skin cancer prevention.
METHODS
Recruitment and Participant Selection
Licensed tattoo studios in Salt Lake County were identified through Yelp and Google. Studios were contacted by telephone, social media, email, or in person and queried about any working Hispanic/Latino tattoo artists. Participants were eligible if they were 18 years or older, tattoo artist from a licensed studio, and identified as Hispanic or Latino. Ten Hispanic tattoo artists from Salt Lake County agreed to participate in an in-depth interview. At this time, we reached data collection saturation, meaning that additional interviews did not provide any more sub-themes. Six tattoo artists were recruited through social media and four tattoo artists were recruited in person.
Interviews were conducted between November 2018 to February 2019. Written informed consent was obtained from all tattoo artists before the interview. All tattoo artists were interviewed in person and audio recorded. The consent form also contained demographic questions (See Supplemental Figure 1). Each artist was awarded a $50 Amazon e-gift card for participation. The Western Institutional Review Board (IRB) declared the study as IRB exempt.
Data Collection
The investigator conducted in-depth semi-structured interviews with a set of predetermined questions; to help standardize data collection during the interview (See Supplemental Figure 2). However, open ended questions were used to allow the tattoo artist to independently introduce and discuss new topics/issues. The interviewer and tattoo artist either spoke English, Spanish, or both. Interviews lasted between 30 to 60 minutes and were conducted by CG (first author). The interviewer queried on six pre-specified categories— demographics, tattoo training and experience, skin cancer knowledge, aftercare instructions, social media use, and willingness to learn about primary and secondary skin cancer prevention. Sub-themes were identified using a grounded, data led approach (see below in data analysis).
Data Analysis
Unblinded subject responses were transcribed into an excel sheet and manually coded by the first author. Blinded/anonymized subject responses were independently transcribed and coded separately by a third-party. A third-party associate was used to code the data as a mean to avoid bias and verify data accuracy and completeness. Coding discrepancies were resolved by discussion and re-listened audio recordings. A thematic analysis identified recurrent sub-themes from the transcript. Sub-themes derived from the analysis included— lack of sun protection knowledge among tattoo artists, need for a culturally sensitive approach to aftercare instructions, need for a stronger connection between the medical and tattoo community, and stronger tattoo practicing regulations.
Licensed tattoo studios in Salt Lake County were identified through Yelp and Google. Studios were contacted by telephone, social media, email, or in person and queried about any working Hispanic/Latino tattoo artists. Participants were eligible if they were 18 years or older, tattoo artist from a licensed studio, and identified as Hispanic or Latino. Ten Hispanic tattoo artists from Salt Lake County agreed to participate in an in-depth interview. At this time, we reached data collection saturation, meaning that additional interviews did not provide any more sub-themes. Six tattoo artists were recruited through social media and four tattoo artists were recruited in person.
Interviews were conducted between November 2018 to February 2019. Written informed consent was obtained from all tattoo artists before the interview. All tattoo artists were interviewed in person and audio recorded. The consent form also contained demographic questions (See Supplemental Figure 1). Each artist was awarded a $50 Amazon e-gift card for participation. The Western Institutional Review Board (IRB) declared the study as IRB exempt.
Data Collection
The investigator conducted in-depth semi-structured interviews with a set of predetermined questions; to help standardize data collection during the interview (See Supplemental Figure 2). However, open ended questions were used to allow the tattoo artist to independently introduce and discuss new topics/issues. The interviewer and tattoo artist either spoke English, Spanish, or both. Interviews lasted between 30 to 60 minutes and were conducted by CG (first author). The interviewer queried on six pre-specified categories— demographics, tattoo training and experience, skin cancer knowledge, aftercare instructions, social media use, and willingness to learn about primary and secondary skin cancer prevention. Sub-themes were identified using a grounded, data led approach (see below in data analysis).
Data Analysis
Unblinded subject responses were transcribed into an excel sheet and manually coded by the first author. Blinded/anonymized subject responses were independently transcribed and coded separately by a third-party. A third-party associate was used to code the data as a mean to avoid bias and verify data accuracy and completeness. Coding discrepancies were resolved by discussion and re-listened audio recordings. A thematic analysis identified recurrent sub-themes from the transcript. Sub-themes derived from the analysis included— lack of sun protection knowledge among tattoo artists, need for a culturally sensitive approach to aftercare instructions, need for a stronger connection between the medical and tattoo community, and stronger tattoo practicing regulations.
RESULTS
Ten Hispanic tattoo artists were interviewed (Table 1). Majority of tattoo artists were male (90%) with a mean age of 30 (standard deviation, 5). Of the ten tattoo artists, six tattoo artists were born in the U.S. Furthermore, of the ten tattoo artists, seven tattoo artists have a Mexican heritage. Six tattoo artists were fully bilingual in English and Spanish. Many of them reported a high percentage of Hispanic clientele (mean, 51%; range, 25-93%) and repeat customers (mean, 73%; range, 50-90%).
Skin Cancer Knowledge
None of the Hispanic tattoo artist knew the difference between melanoma and non-melanoma skin cancer. All tattoo artists felt they would not be able to detect an abnormal mole or skin cancer. When tattoo artists were queried about their level of skin cancer knowledge, seven subjects reported no skin cancer knowledge whereas three subjects were able to describe up to two abnormal mole features. The majority (80%) of the tattoo artists finished an apprenticeship whereas two (20%) were trained by mentors. No tattoo artist received a formal education on skin cancer prevention; however, all tattoo artists were willing to undergo skin cancer prevention training. Most tattoo artists were willing to learn more about primary (90%) and secondary skin cancer prevention (100%).
Lack of Sun Protection Knowledge
Among Hispanic Tattoo Artists Although no Hispanic tattoo artist reported any formal education about skin cancer prevention, all artists further acknowledged no form of sun safety training during their tattoo apprenticeship. When queried about basic sun protection, the majority could not describe a specific Sun Protection Factor (SPF) recommendation, how to properly apply sunscreen, when to reapply sunscreen, and the importance of protective clothing. Furthermore, only one tattoo artist practiced safe sun protection consistently whereas five tattoo artists rarely applied sunscreen, two tattoo artists never used sunscreen, and two did not mention their sun protective habits. One artist reported the use of a wide-brimmed hat during the summer to protect his face, ears, and neck from the sun. Only one artist mentioned seeking shade and use of protective clothing during the summer time to protect his skin from the sun.
Need for a Stronger Connection Between the Medical and Tattoo Artist Community
Five Hispanic tattoo artists expressed curiosity throughout the interview by asking general questions about tattoo aftercare
Skin Cancer Knowledge
None of the Hispanic tattoo artist knew the difference between melanoma and non-melanoma skin cancer. All tattoo artists felt they would not be able to detect an abnormal mole or skin cancer. When tattoo artists were queried about their level of skin cancer knowledge, seven subjects reported no skin cancer knowledge whereas three subjects were able to describe up to two abnormal mole features. The majority (80%) of the tattoo artists finished an apprenticeship whereas two (20%) were trained by mentors. No tattoo artist received a formal education on skin cancer prevention; however, all tattoo artists were willing to undergo skin cancer prevention training. Most tattoo artists were willing to learn more about primary (90%) and secondary skin cancer prevention (100%).
Lack of Sun Protection Knowledge
Among Hispanic Tattoo Artists Although no Hispanic tattoo artist reported any formal education about skin cancer prevention, all artists further acknowledged no form of sun safety training during their tattoo apprenticeship. When queried about basic sun protection, the majority could not describe a specific Sun Protection Factor (SPF) recommendation, how to properly apply sunscreen, when to reapply sunscreen, and the importance of protective clothing. Furthermore, only one tattoo artist practiced safe sun protection consistently whereas five tattoo artists rarely applied sunscreen, two tattoo artists never used sunscreen, and two did not mention their sun protective habits. One artist reported the use of a wide-brimmed hat during the summer to protect his face, ears, and neck from the sun. Only one artist mentioned seeking shade and use of protective clothing during the summer time to protect his skin from the sun.
Need for a Stronger Connection Between the Medical and Tattoo Artist Community
Five Hispanic tattoo artists expressed curiosity throughout the interview by asking general questions about tattoo aftercare
