artists affiliated with a tattoo studio had a website; of those six tattoo studio websites, only three provided short-term ultraviolet (UV) protection advice (stay out of sun for two weeks and no tanning). None provided long-term UV protection advice. All tattoo artists were willing to distribute sun protective information on their personal and tattoo studio social media accounts.
Other
Ninety percent of Hispanic tattoo artists felt emotionally invested in their clients. Although no tattoo artist recommended sun protection involving the client’s whole body, all tattoo artists concur that tattoo artists could influence skin cancer safety in young adults by providing full-body sun protection in their aftercare instruction. Furthermore, all tattoo artists agreed that providing aftercare instructions in Spanish is a great idea.
Other
Ninety percent of Hispanic tattoo artists felt emotionally invested in their clients. Although no tattoo artist recommended sun protection involving the client’s whole body, all tattoo artists concur that tattoo artists could influence skin cancer safety in young adults by providing full-body sun protection in their aftercare instruction. Furthermore, all tattoo artists agreed that providing aftercare instructions in Spanish is a great idea.
DISCUSSION
Although Hispanics do not constitute the majority of melanoma and NMSC cases in the U.S., Hispanics are more likely to be diagnosed with advanced malignant melanoma and NMSC.12,13 Furthermore, Hispanics diagnosed with melanoma have a lower 5-year survival rate than Whites.14-16 Factors that influence an increased risk of melanoma in Hispanics include a high prevalence of outdoor occupation, low socioeconomic status, and inadequate awareness.17,18 Nonmedical professionals could improve melanoma and NMSC awareness in Hispanics by learning more about skin cancer prevention and implementing culturally sensitive sun protective behaviors in their aftercare instructions and social media.
All Hispanic tattoo artists in this study had inadequate skin cancer knowledge to recognize a suspicious lesion; however, all tattoo artists were willing to learn more about skin cancer prevention. Early suspicion and detection of a lesion could influence overall survival. In a study comparing survival between Hispanics and non-Hispanics, 70% of Hispanic subjects diagnosed with localized melanoma had greater overall survival than non-Hispanics diagnosed with melanoma (P<0.01).19 Furthermore, ultraviolet radiation plays a role in the development of melanoma and nonmelanoma skin cancer in Hispanics.20,21 Although other studies report White patients diagnosed with melanoma have decreased overall survival than Hispanic patients, Hispanic tattoo artists who undergo primary and secondary skin cancer prevention training and educate their clients about the harmful effects of ultraviolet radiation could influence melanoma and NMSC clinical outcome in Hispanics.22-24 Many of the Hispanic tattoo artists in our study believed that primary and secondary skin cancer prevention should be included in apprenticeships or pre-requisite to obtaining a license to tattoo. Additionally, although it may seem that Hispanic tattoo artists only interact with a small group of Hispanic clients, 38% of all Hispanics have a tattoo; therefore, Hispanic tattoo artists may influence sun protective behaviors at a larger scale.25 Hispanic tattoo artists did not provide effective sun protective behaviors in their aftercare instructions. Additionally, the majority of Hispanic tattoo artists practiced suboptimal sun safety which may have influenced their sun safety advice to their clients. Sun protective behaviors including avoidance of excessive sun exposure, applying sunscreen and sun protective clothing, and performing regular skin exams are essential for early melanoma and NMSC detection.26 Such sun protective behaviors may be simple measures for tattoo artists to apply in their aftercare instructions. It should be emphasized that full-body, comprehensive skin cancer prevention recommendations (applying sunscreen prior to UV exposure, reapplying it when outdoors for over 2 hours, using protective clothing that physically blocks UV, wearing wide-brimmed hats that shade the head, or seeking shade when available) should be compatible with current recommendations to protect new tattoos. Furthermore, failing to implement a cultural approach to Hispanic clientele could jeopardize effective communication between the tattoo artist and the client. Multiple studies conclude that a culturally sensitive approach in Latinos could improve melanoma and NMSC education.27-29 Additionally, 90% of Latinos aged 18 to 49 seek health information through the internet and social media.30,31 However, most minorities feel that health information on the web is not tailored towards various ethnic/cultural groups.32 Providing Hispanic tattoo artists with guideline recommendations on sun protective behaviors in a culturally sensitive approach may convey information to Hispanic clients more effectively.
Since all Hispanic tattoo artists in our study possess a social media account, they have the opportunity to convey their sun protective behaviors more effectively. Social media may influence sun protective behaviors by improving user attention and accountability.33,34 A randomized control trial stratifying 604 Hispanic and non-Hispanic adult subjects into either a mobile app group that provided sun protective information or control group reported an improvement in shade use ([mean days] 41.0% vs 33.7%; P=0.03), mean total sunburns (0.60 vs 0.62; P=0.87), sun exposure (60.4% vs 49.3%; P=0.04), and all sun protective behaviors (39.4% vs 33.8%; P=0.04) in the mobile app group compared to control; however, less sunscreen was used in the mobile app group than the control group, respectively (28.6% vs 34.5%; P=0.48).35 Further studies are needed to distinguish the benefit of tattoo artists providing sun protective behaviors through social media.
Small sample size, a young age group, and local recruitment (Salt Lake County) may jeopardize our data’s external validity. Since all interviewed subjects were young, our data underrepresented older Hispanic tattoo artists. Furthermore, our young tattoo artists may influence our high rate of social media use by tattoo artists. In a study exploring Hispanic opinions of melanoma education, many subjects believed melanoma education may be conveyed more effectively in the Hispanic community
All Hispanic tattoo artists in this study had inadequate skin cancer knowledge to recognize a suspicious lesion; however, all tattoo artists were willing to learn more about skin cancer prevention. Early suspicion and detection of a lesion could influence overall survival. In a study comparing survival between Hispanics and non-Hispanics, 70% of Hispanic subjects diagnosed with localized melanoma had greater overall survival than non-Hispanics diagnosed with melanoma (P<0.01).19 Furthermore, ultraviolet radiation plays a role in the development of melanoma and nonmelanoma skin cancer in Hispanics.20,21 Although other studies report White patients diagnosed with melanoma have decreased overall survival than Hispanic patients, Hispanic tattoo artists who undergo primary and secondary skin cancer prevention training and educate their clients about the harmful effects of ultraviolet radiation could influence melanoma and NMSC clinical outcome in Hispanics.22-24 Many of the Hispanic tattoo artists in our study believed that primary and secondary skin cancer prevention should be included in apprenticeships or pre-requisite to obtaining a license to tattoo. Additionally, although it may seem that Hispanic tattoo artists only interact with a small group of Hispanic clients, 38% of all Hispanics have a tattoo; therefore, Hispanic tattoo artists may influence sun protective behaviors at a larger scale.25 Hispanic tattoo artists did not provide effective sun protective behaviors in their aftercare instructions. Additionally, the majority of Hispanic tattoo artists practiced suboptimal sun safety which may have influenced their sun safety advice to their clients. Sun protective behaviors including avoidance of excessive sun exposure, applying sunscreen and sun protective clothing, and performing regular skin exams are essential for early melanoma and NMSC detection.26 Such sun protective behaviors may be simple measures for tattoo artists to apply in their aftercare instructions. It should be emphasized that full-body, comprehensive skin cancer prevention recommendations (applying sunscreen prior to UV exposure, reapplying it when outdoors for over 2 hours, using protective clothing that physically blocks UV, wearing wide-brimmed hats that shade the head, or seeking shade when available) should be compatible with current recommendations to protect new tattoos. Furthermore, failing to implement a cultural approach to Hispanic clientele could jeopardize effective communication between the tattoo artist and the client. Multiple studies conclude that a culturally sensitive approach in Latinos could improve melanoma and NMSC education.27-29 Additionally, 90% of Latinos aged 18 to 49 seek health information through the internet and social media.30,31 However, most minorities feel that health information on the web is not tailored towards various ethnic/cultural groups.32 Providing Hispanic tattoo artists with guideline recommendations on sun protective behaviors in a culturally sensitive approach may convey information to Hispanic clients more effectively.
Since all Hispanic tattoo artists in our study possess a social media account, they have the opportunity to convey their sun protective behaviors more effectively. Social media may influence sun protective behaviors by improving user attention and accountability.33,34 A randomized control trial stratifying 604 Hispanic and non-Hispanic adult subjects into either a mobile app group that provided sun protective information or control group reported an improvement in shade use ([mean days] 41.0% vs 33.7%; P=0.03), mean total sunburns (0.60 vs 0.62; P=0.87), sun exposure (60.4% vs 49.3%; P=0.04), and all sun protective behaviors (39.4% vs 33.8%; P=0.04) in the mobile app group compared to control; however, less sunscreen was used in the mobile app group than the control group, respectively (28.6% vs 34.5%; P=0.48).35 Further studies are needed to distinguish the benefit of tattoo artists providing sun protective behaviors through social media.
Small sample size, a young age group, and local recruitment (Salt Lake County) may jeopardize our data’s external validity. Since all interviewed subjects were young, our data underrepresented older Hispanic tattoo artists. Furthermore, our young tattoo artists may influence our high rate of social media use by tattoo artists. In a study exploring Hispanic opinions of melanoma education, many subjects believed melanoma education may be conveyed more effectively in the Hispanic community
