Attitudes and Sun Protection Behaviors Among Kidney Transplant Recipients

Introduction: As kidney transplant recipients (KTRs) return to active living after their transplantation, it is expected that they engage in 150 minutes of physical activity each week. Many will chose to walk outdoors, which exposes KTRs to carcinogenic sunlight. The requisite lifelong immunosuppressive therapy taken by KTRs is associated with developing skin cancer, especially squamous cell carcinoma (SCC). By 20 years post-transplant, SCC afflicts 61% of KTRs (Carroll et al, 2003). Among the estimated 100,000 living KTRs in the United States (US Organ Procurement 2009), regular use of broad spectrum sunscreen can prevent the development of SCC (Ulrich, et al, 2009). While KTRs with fair skin have the greatest risk of developing SCC, it also occurs in patients with darker skin complexions despite lay expectations that an increased level of pigment is protective (Buoy, et al, 2010). This study investigated attitudes toward sun exposure and sun protection behaviors with the purpose of understanding possible discrepancies amongst KTRs from three racial/ethnic groups: non-Hispanic Whites (NHWs), Hispanic/Latinos (H/Ls) and Non-Hispanic Blacks (NHBs).

Methods: Accrual was stratified to assure representation of all three racial/ethnic groups. Inclusion criteria required kidney transplantation in the past 2-24 months and the ability to read English. Demographic information such as gender, marital status, age, education and race/ethnicity were obtained, and attitudinal items about the importance of sun protection and sun protection behaviors used on a warm, sunny day were collected by self-reported responses to a Likert scale (1-5).

Results: Of 108 participants, 50 were NHW, 33 were NHB, and 25 were H/L. Results were analyzed using a linear regression model that was fit for race while adjusting for marital status, sex and education. There was a significant correlation between measures of behaviors (F-test p=<0.007) and attitudes (p=<0.001) among NHWs, H/Ls and NHBs. There was a disassociation between measures of importance (I scale 7-35) (p=0.465) and behaviors (scale 5-25) (p=0.007). Among NHWs, behavior was not associated with the level of importance for sun protection (I low 16.6, high 17.8). However, among NHBs (I low 14.4, high 17.3) and H/Ls (I low 13.5, high 18.2), behavior correlated directly with their level of importance.

Conclusion: While Latinos and Non-Hispanic Blacks may display considerable diversity in sun sensitivity, individuals who perceived sun protection as less important used less sun protection. Future research is needed to address the misperception of protective pigment among post-transplant KTRs at risk for developing skin cancer.