Knowledge, Attitudes, and Practices Regarding Skin Cancer and Sun Exposure among Homeless Men at a Shelter in Dallas, TX


This cross-sectional study evaluated the knowledge, attitudes, and practices regarding skin cancer and sun exposure among homeless men (n = 75). A 21-item survey was given to men residing at Calvert Place Men’s Shelter in Dallas, TX. Results indicated that 49% knew that a change in a mole’s appearance and a sore that does not heal were signs of skin cancer. Black homeless men were less likely to know that people with dark skin could get skin cancer and that sunscreen should be applied 15–30 min before sun exposure compared to white and other subgroups (p < .05). People were more likely to agree that sun protection is important (median = 5.0), but less likely to agree that they were at risk for skin cancer (median = 3.0). White men had higher levels of agreement that melanoma was dangerous compared to other racial/ethnic groups (p = 0.0224). Over half (52%) of individuals reported being in the sun often, yet only 21% reported the use of sunscreen. Most (71%) homeless men had never checked themselves for skin cancer and only 13% reported ever being screened by a health professional for skin cancer. Increased skin cancer education and increased screening efforts should be implemented to better protect the homeless population at Calvert Place from skin cancer.

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  1. 1.

    U.S. Department of Health and Human Services (2014) The surgeon General’s call to action to prevent skin Cancer. U.S. Dept of Health and Human Services, Office of the Surgeon General, Washington, DC

    Google Scholar 

  2. 2.

    American Cancer Society (2018) Cancer Facts & Figures 2018. American Cancer Society, Atlanta

    Google Scholar 

  3. 3.

    Buster KJ, You Z, Fouad M, Elmets C (2012) Skin cancer risk perceptions: a comparison across ethnicity, age, education, gender, and income. J Am Acad Dermatol 66(5):771–779.

    Article  PubMed  Google Scholar 

  4. 4.

    Metro Dallas Homeless Alliance (2018) State of the Homeless Address 2018. Metro Dallas Homeless Alliance, Dallas

    Google Scholar 

  5. 5.

    U.S. Environmental Protection Agency (2017) Sun safety monthly average UV index. U.S. Environmental Protection Agency, Stratospheric Protection Division, Washington, DC

    Google Scholar 

  6. 6.

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

    PubMed  Google Scholar 

  7. 7.

    Wilde MJ, Jones B, Lewis BK, Hull CM (2013) Skin cancer screening in the homeless population. Dermatol Online J 15(19(1)):14

    Google Scholar 

  8. 8.

    Truong A, Laggis C, Gardner L, Forbes B, Powell D, Vranes C, Annis T, Gregory T, Hull C, Lewis B (2018) Evaluation of skin cancer diagnoses in dermatology patients seen in a homeless clinic. J Investig Dermatol 138(5):S44–S44

    Article  Google Scholar 

  9. 9.

    Williams LB, McCall A, Looney SW, Joshua T, Tingen MS (2018) Demographic, psychosocial, and behavioral associations with cancer screening among a homeless population. Public Health Nurs 35:281–290.

    Article  PubMed  Google Scholar 

  10. 10.

    Day AK, Wilson C, Roberts RM, Hutchinson AD (2014) The skin cancer and sun knowledge (SCSK) scale: validity, reliability, and relationship to sun-related behaviors among young western adults. Health Educ Behav 41(4):440–448.

    Article  PubMed  Google Scholar 

  11. 11.

    Patel SS, Nijhawan RI, Stechschulte S, Parmet Y, Rouhani P, Kirsner RS, Hu S (2010) Skin cancer awareness, attitude, and sun protection behavior among medical students at the University of Miami Miller School of medicine. Arch Dermatol 146(7):797–800.

    Article  PubMed  Google Scholar 

  12. 12.

    Meh C, Gill J, Kim DH (2010) A comparison of skin cancer knowledge, attitude, and protective behavior in AA students in east and west coasts. Calif J Health Promot 11(3):25–35

    Article  Google Scholar 

  13. 13.

    Glanz K, Yaroch A, Dancel M, Saraiya M, Crane LA, Buller DB, Manne S, O'Riordan DL, Heckman CJ, Hay J, Robinson JK (2008) Measures of sun exposure and sun protection practices for behavioral and epidemiologic research. Arch Dermatol 144(2):217–222

    Article  Google Scholar 

  14. 14.

    Ho BK, Robinson JK (2015) Color bar tool for skin type self-identification: a cross sectional study. J Am Acad Dermatol 73(2):312–313.e1.

    Article  PubMed  PubMed Central  Google Scholar 

  15. 15.

    DeHaven M, Gimpel N, Dallo F, Billmeier T (2011) Reaching the underserved through community-based participatory research (CBPR) and service learning: description and evaluation of a unique medical student training program. J Public Health Manag Pract 17(4):363–368

    Article  Google Scholar 

  16. 16.

    Chau S, Chin M, Chang J, Luecha A, Cheng E, Schlesinger J et al (2002) Cancer risk behaviors and screening rates among homeless adults in Los Angeles County. Cancer Epidemiol Biomark Prev 11:431–438

    Google Scholar 

  17. 17.

    Lakhani NA, Saraiya M, Thompson TD, King SC, Guy GP (2014) Total body skin examination for skin cancer screening among U.S. adults from 2000 to 2010. Prev Med 61:75–80.

    Article  PubMed  PubMed Central  Google Scholar 

  18. 18.

    National Cancer Institute (2017) Do you ever check your skin for signs of skin cancer? Health Information National Trends Survey 5. Cycle 1 [Data file]. Retrieved from Accessed 8 March 2019

  19. 19.

    USPSTF, Bibbins-Domingo K, Grossman DC et al (2016) Screening for skin cancer: US preventive services task force recommendation statement. JAMA 316(4):429–435.

    Article  Google Scholar 

  20. 20.

    American Cancer Society (2018) Skin exams. American Cancer Society, Atlanta. Available at Accessed 8 March 2019

    Google Scholar 

  21. 21.

    Pichon LC, Corral I, Landrine H, Mayer JA, Adams-Simms D (2010) Perceived skin cancer risk and sunscreen use among African American adults. J Health Psychol 15(8):1181–1189.

    Article  PubMed  Google Scholar 

  22. 22.

    Cheng CE, Irwin B, Mauriello D, Hemminger L, Pappert A, Kimball AB (2010) Health disparities among different ethnic and racial middle and high school students in sun exposure beliefs and knowledge. J Adolesc Health 47(1):106–109.

    Article  PubMed  Google Scholar 

  23. 23.

    Temoshok L, DiClemente RJ, Sweet DM, Blois MS, Sagebiel RW (1984) Prognostic and psychosocial factors related to delay behavior in patients with cutaneous malignant melanoma. Prog Clin Biol Res 156:169–179

    CAS  PubMed  Google Scholar 

  24. 24.

    Tsai S, Frank SH, Bordeaux JS (2018) Improving sun-protective behaviors and self-skin examinations among African Americans: a randomized controlled trial. Dermatol Surg 44(4):512–518.

    CAS  Article  PubMed  Google Scholar 

  25. 25.

    Chung GY, Brown G, Gibson D (2015) Increasing melanoma screening among Hispanic/Latino Americans. Health Educ Behav 42(5):627–632.

    Article  PubMed  Google Scholar 

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Correspondence to Nora Gimpel.

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Joseph, A., Kindratt, T., Pagels, P. et al. Knowledge, Attitudes, and Practices Regarding Skin Cancer and Sun Exposure among Homeless Men at a Shelter in Dallas, TX. J Canc Educ 35, 682–688 (2020).

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  • Homeless
  • Skin neoplasms
  • Sun exposure
  • Underserved