10.5826/dpc.1301a14
Introduction: Adolescents, an age group that can reduce sun exposure early, may benefit from school-based skin cancer education programs. Literature regarding the demographics of melanoma knowledge is sparse.
Objectives: This study sought to evaluate melanoma knowledge among students in Texas viewing John Wayne Cancer Foundation Block the Blaze (JWCFBTB) presentations and identify group differences with regard to sociodemographic factors.
Methods: Before JWCFBTB presentations delivered in Houston and Dallas by health professions students, a pre-presentation melanoma knowledge quiz was distributed. This survey was adapted from a 2000 study evaluating melanoma knowledge in middle and high schoolers in Houston and Dallas. Respondents were also asked to provide their gender, age, grade, race, parent education level, and whether they are first-generation American. ANOVA and Tukey tests were used to evaluate demographic group differences in scores. Logistic regression models determined predictors of answering selected true/false questions correctly.
Results: One-way ANOVA tests showed statistically significant group differences in pre-test scores for all demographic factors evaluated. Females, Whites/Caucasians, students whose parents hold graduate degrees, and older students had higher scores. Black students and non-first-generation Americans were more likely to answer selected commonly missed questions correctly.
Conclusions: Results from 2000 and 2020-2021 indicate older students from higher grade levels know more about melanoma, suggesting adolescents may benefit from earlier skin cancer education. Racial minorities and individuals of low socioeconomic status, who suffer from disparities in melanoma treatment and mortality, showed poorer melanoma knowledge. Targeting skin cancer education to disadvantaged schools may help remedy such gaps.
text/xml
2160-9381
2383
en
Ida  Orengo
https://creativecommons.org/licenses/by-nc/4.0
Dermatology Practical & Conceptual
demographics
Demographics of Skin Cancer Knowledge Among Middle and High Schoolers in Texas
Text.Serial.Journal
https://dpcj.org/index.php/dpc
Original Article
2023-01-31
2022-02-12
2023-01-31
2023-02-27
e2023014
Dermatol Pract Concept
Introduction: Adolescents, an age group that can reduce sun exposure early, may benefit from school-based skin cancer education programs. Literature regarding the demographics of melanoma knowledge is sparse.
Objectives: This study sought to evaluate melanoma knowledge among students in Texas viewing John Wayne Cancer Foundation Block the Blaze (JWCFBTB) presentations and identify group differences with regard to sociodemographic factors.
Methods: Before JWCFBTB presentations delivered in Houston and Dallas by health professions students, a pre-presentation melanoma knowledge quiz was distributed. This survey was adapted from a 2000 study evaluating melanoma knowledge in middle and high schoolers in Houston and Dallas. Respondents were also asked to provide their gender, age, grade, race, parent education level, and whether they are first-generation American. ANOVA and Tukey tests were used to evaluate demographic group differences in scores. Logistic regression models determined predictors of answering selected true/false questions correctly.
Results: One-way ANOVA tests showed statistically significant group differences in pre-test scores for all demographic factors evaluated. Females, Whites/Caucasians, students whose parents hold graduate degrees, and older students had higher scores. Black students and non-first-generation Americans were more likely to answer selected commonly missed questions correctly.
Conclusions: Results from 2000 and 2020-2021 indicate older students from higher grade levels know more about melanoma, suggesting adolescents may benefit from earlier skin cancer education. Racial minorities and individuals of low socioeconomic status, who suffer from disparities in melanoma treatment and mortality, showed poorer melanoma knowledge. Targeting skin cancer education to disadvantaged schools may help remedy such gaps.
Ida  Orengo
2023/01/31
10.5826/dpc.1301a14
e2023014
Baylor College of Medicine, Department of Dermatology, Houston, TX, US
2160-9381
demographics
en
e2023014
Sample A, He Y-Y. Mechanisms and prevention of UV-induced melanoma. Photodermatol Photoimmunol Photomed. 2018;34(1):13–24. PMID: 28703311.
Demographics of Skin Cancer Knowledge Among Middle and High Schoolers in Texas
https://dpcj.org/index.php/dpc/article/download/2383/1943
    Demographics of Skin Cancer Knowledge Among
         Middle and High Schoolers in Texas
            Dina H. Zamil1, Shangyi Fu1, Zahra Majd2, Emily Powell3, Jenna H. Zamil4,
                                Zeena Y. Nawas5, Ida F. Orengo5


1 Baylor College of Medicine, School of Medicine, Houston, TX, US
2 University of Houston College of Pharmacy, Department of Pharmaceutical Health Outcomes and Policy, Houston, TX, US
3 Integrated Dermatology of Ponchatoula, Los Angeles, CA, US
4 University of Houston, Department of Biology and Biochemistry, Houston, TX, US
5 Baylor College of Medicine, Department of Dermatology, Houston, TX, US



Key words: melanoma, education, adolescents, knowledge, demographics
Citation: Zamil DH, Fu S, Majd Z, et al. Demographics of Skin Cancer Knowledge Among Middle and High Schoolers in Texas.
Dermatol Pract Concept. 2023;13(1):e2023014. DOI: https://doi.org/10.5826/dpc.1301a14
Accepted: July 4, 2022; Published: January 2023
Copyright: ©2023 Zamil et al. This is an open-access article distributed under the terms of the Creative Commons Attribution-
NonCommercial License (BY-NC-4.0), https://creativecommons.org/licenses/by-nc/4.0/, which permits unrestricted noncommercial use,
distribution, and reproduction in any medium, provided the original authors and source are credited.
Funding: A grant was provided for this study by the Texas Medical Association Alliance.
Competing Interests: None.
Authorship: All authors have contributed significantly to this publication
Corresponding Author: Dina H. Zamil, Baylor College of Medicine, 1 Baylor Plaza Houston, TX 77030. Phone: 713-798-4951
E-mail: dina.zamil@bcm.edu




  ABSTRACT             Introduction: Adolescents, an age group that can reduce sun exposure early, may benefit from
                       school-based skin cancer education programs. Literature regarding the demographics of melanoma
                       knowledge is sparse.
                       Objectives: This study sought to evaluate melanoma knowledge among students in Texas viewing
                       John Wayne Cancer Foundation Block the Blaze (JWCFBTB) presentations and identify group differ-
                       ences with regard to sociodemographic factors.
                       Methods: Before JWCFBTB presentations delivered in Houston and Dallas by health professions
                       students, a pre-presentation melanoma knowledge quiz was distributed. This survey was adapted from
                       a 2000 study evaluating melanoma knowledge in middle and high schoolers in Houston and Dallas.
                       Respondents were also asked to provide their gender, age, grade, race, parent education level, and
                       whether they are first-generation American. ANOVA and Tukey tests were used to evaluate demo-
                       graphic group differences in scores. Logistic regression models determined predictors of answering
                       selected true/false questions correctly.
                       Results: One-way ANOVA tests showed statistically significant group differences in pre-test scores for
                       all demographic factors evaluated. Females, Whites/Caucasians, students whose parents hold graduate
                       degrees, and older students had higher scores. Black students and non-first-generation Americans were
                       more likely to answer selected commonly missed questions correctly.




Original Article | Dermatol Pract Concept. 2023;13(1):e2023014                                                                      1
                     Conclusions: Results from 2000 and 2020-2021 indicate older students from higher grade levels
                     know more about melanoma, suggesting adolescents may benefit from earlier skin cancer education.
                     Racial minorities and individuals of low socioeconomic status, who suffer from disparities in melano-
                     ma treatment and mortality, showed poorer melanoma knowledge. Targeting skin cancer education to
                     disadvantaged schools may help remedy such gaps.




Introduction                                                     school-based interventions addressing knowledge gaps in
                                                                 the US. Moreover, literature regarding adolescents of vary-
Accounting for 4% of cancers in adolescents, melanoma            ing socioeconomic backgrounds or adolescents of racial mi-
of the skin is a common preventable cancer in the United         norities is sparse [16]. Such knowledge would help identify
States [1]. Adolescents can reduce sun exposure early, and       sociodemographic subgroups that may specifically benefit
thus particularly benefit from sun-protective practices [2].     from more education. This will be essential to targeting skin
This age group also tends to engage in intentional tanning       cancer education programs to the grade levels, age groups,
and may not actively avoid UV exposure [3]. Countries            and geographic areas in which they will be most effective.
such as Australia have implemented state government and             The John Wayne Cancer Foundation Block the Blaze
non-governmental organization skin cancer awareness pro-         (JWCFBTB) program, based in California, delivers skin can-
grams, which emphasize childhood prevention, since the           cer education presentations to youth in 16 states [17]. The
1980s [4]. A ­20-year study found that one of these pro-         Texas branch of the program includes presentations offered
grams, SunSmart, likely contributed to a reduced incidence       at middle and high schools by Baylor College of Medicine
of melanoma among younger Australians [5]. Additionally,         medical and physician assistant students. Texas has a high
a 2015 review found skin cancer prevention initiatives to be     UV index for most of the year [18] and ranks fourth in the
cost-­effective and even cost-saving [6]. As such, skin cancer   nation for estimated new cases of melanoma of the skin
and melanoma awareness initiatives for adolescents in the        in 2020 [1]. Texas is also the second most populous state
United States warrant further investigation.                     in the US [19], where people enjoy spending time outside.
    Previous studies have evaluated adolescent knowledge         Thus, early melanoma education in Texas is essential for
and attitudes towards skin cancer and the efficacy of vari-      prevention.
ous school-based interventions. As early as 1992, a Chicago
study found that high schoolers spend significant amounts of
                                                                 Objectives
time in the sun and that a 45-minute intervention increased
students’ knowledge of skin cancer [7]. Another study from       As part of JWCFBTB presentations, anonymous surveys are
2001 found that Texas teenagers under 16 indicated they          distributed. These include true/false pre-presentation mel-
would limit sun exposure following a melanoma educa-             anoma knowledge quizzes and post-presentation surveys
tional quiz exercise [8]. Later research investigated differ-    evaluating program efficacy. The objective of this study
ent populations and methods of intervention. Disparities in      was to assess the current knowledge of high school students
skin cancer awareness and sun-safe behaviors were found          regarding melanoma and skin cancer and examine group
among White Hispanic and White non-Hispanic students in          sociodemographic group differences in knowledge using
Florida [9]. Among Utah high school students, skin cancer        pre-presentation survey responses.
presentations, sunscreen efficacy demonstrations, and dis-
tribution of personalized UV damage photos at schools sig-
                                                                 Methods
nificantly increased sun-protective behaviors in a 1-month
follow-up [3]. Finally, medical students have been described     This was a cross-sectional survey study. The pre-presentation
as an asset to skin cancer awareness programs for teens; they    true/false melanoma knowledge quizzes and post-presentation
can offer cost-effective, enthusiastic, and informative mel-     surveys utilized in this study were adapted from a previ-
anoma education that can help identify and prevent mela-         ously published study of melanoma knowledge among
noma [10].                                                       Texas teenagers [8]. Surveys also collected information on
    While the literature has extensively investigated atti-      race, parent education level, age, grade, gender, and whether
tudes towards and knowledge of skin cancer and melanoma          the student is a first-generation American. Middle and high
in adults [11–14], few studies have specifically focused on      schools in the greater Houston area and Dallas were con-
adolescents [15], and even fewer studies have examined           tacted via email, and 46 virtual JWCFBTB presentations



2                                                                    Original Article | Dermatol Pract Concept. 2023;13(1):e2023014
were offered at the 12 schools that responded and scheduled        Results
presentations. Survey data was collected between October
14, 2020, and May 25, 2021. Due to the COVID-19 pan-               The JWCFBTB presentations were offered to 1279 students
demic, JWCFBTB presentations took place virtually, and a           in Texas, of which 1154 completed the pre-presentation
link to the survey was sent to all middle and high school          survey, providing a response rate of approximately 90.3%.
students in Texas (­Houston and Dallas) watching the pre-          The overall average score on the pre-presentation melanoma
sentations. Anonymous responses were collected in a secure         knowledge test was 64.6%, with a standard deviation of
spreadsheet. ­Students were given the option to enter a gift       0.121, a median of 65.6%, and a range of 24.13% to 96.6%.
card raffle upon completion of both pre-presentation and           One-way ANOVA tests showed statistically significant group
post-presentation surveys. To maintain the anonymity of            differences in melanoma knowledge pre-test scores for all
survey responses, s­ tudents were redirected to a separate link    demographic factors evaluated, including gender (F2,1151
to enter the raffle following survey completion.                   = 21.74; P<.001), race (F5,1148 = 6.10; P<.001), parent ed-
    The G-power 3.1 statistical software was used for sample       ucational level (F5,1148 = 3.92; P= .002), age (F4,1149 = 7.70;
size estimation [20]. It was estimated that a total sample of      P<.001), and grade level (F3,1150 = 10.82; P<.001).
352 subjects will be needed to provide 80% power to de-               For gender (male, female, or other), the Tukey post-hoc
tect significance with a 0.3 effect size for a two-tail analysis   test showed higher test scores among females compared to
t-test at 0.05 α-level. A total of 305 subjects will be needed     males (η2=0.050; 95% CI, 0.032-0.068; Tukey Honestly
to provide 80% power to detect significance with a 0.2 effect      Significant Difference (HSD), P<0.05). Individuals of mul-
size for an ANOVA analysis at a 0.05 α-level. A total of 308       tiracial or biracial background scored higher than individ-
students will be needed for a two-tail analysis using logistic     uals of Black/African American race (η2=0.059; 95% CI,
regression at a 0.05 α-level, 0.10 β-level (80% power), and        0.007-0.112; Tukey HSD, P<0.05) and other (Native
for a 1.5 odds ratio. We planned to recruit a minimum of           ­American/Alaskan Native, ethnicity not listed, prefer not to
500 subjects which provides sufficient power for the pro-          answer) race (η2=0.064; 95% CI, 0.002-0.126; Tukey HSD,
posed analysis.                                                    P<0.05). Whites/Caucasians also had higher pre-test scores
    Scores on the melanoma knowledge pre-test were sum-            than Hispanics/Latinos (η2=0.031; 95% CI, 0.003-0.059;
marized as means and standard deviation overall and strat-         Tukey HSD, P<0.05), Blacks/African Americans (η2=0.052;
ified by race, parent education level, age, grade, gender, and     95% CI, 0.017-0.087; Tukey HSD, P<0.05), and individu-
whether the student is a first-generation American. ANOVA          als of other race (η2=0.057; 95% CI, 0.009-0.104; Tukey
and Tukey tests were used to evaluate group differences in         HSD, P<0.05). With regards to parent education level, sig-
scores. Logistic regression models were carried out to deter-      nificant differences were only found between two categories:
mine predictors of answering the following true/false ques-        ­students who answered graduate degree (Master’s, MD, PhD,
tions correctly, selected from the most missed questions on        etc.) had higher scores than those selecting prefer not to an-
the survey:                                                        swer (η2=0.055; 95% CI, 0.008-0.102; Tukey HSD, P<0.05).
                                                                   Students aged 12-13 scored lower than students aged 14-15
1. Without sun exposure, my body will not produce                  (η2=0.043; 95% CI, 0.015-0.071; Tukey HSD, P<0.05)
    vitamin D.                                                     and 16-17 (η2=0.060; 95% CI, 0.028-0.091; Tukey HSD,
2. Melanoma is usually flat, not raised like a mosquito bite       P<0.05). Students in grades 9-10 tended to outperform stu-
    or a pimple.                                                   dents in grades 5-6 (η2=0.052; 95% CI, 0.018-0.087; Tukey
                                                                   HSD, P<0.05) and 7-8 (η2=0.039; 95% CI, 0.014-0.065;
    The outcome variable in the logistic regression models         Tukey HSD, P<0.05). Students in grades 11-12 also
was correct versus incorrect response to each of the ques-         scored higher than students in grades 5-6 (η2=0.060; 95%
tions. Independent variables in these models included all so-      CI, 0.023-0.098; Tukey HSD, P<0.05) and 7-8 (η2=0.047;
ciodemographic variables collected in the study (race, parent      95% CI, 0.017-0.077; Tukey HSD, P<0.05).
education level, age categories, grade categories, gender, and        Table 1 summarizes the logistic regression results for se-
whether the student is a first-generation American). Age cate-     lecting the correct versus incorrect answer for the True/False
gories were organized as pairs between adjacent ages (12-13,       statement “Without sun exposure, my body will not produce
14-15, 16-17, 18+). Grade-level categories were also created       vitamin D.” Black/African American students were at a greater
in this way (5-6, 7-8, 9-10, 11-12). All statistical analyses      odd of answering this question correctly than White/Cauca-
were carried out using SAS software version 9.4 (SAS Insti-        sian students (aOR=1.56; 95% CI, 1.03-2.37; P-value=0.007).
tute, Cary, NC) at an a priori significance level of 0.05 for      Additionally, eleventh and twelve graders were at significantly
two-sided tests. The study was approved by the Institutional       greater odds of answering this question correctly than fifth or
Review Board of Baylor College of Medicine.                        sixth graders (aOR=3.41; 95% CI, 1.24-9.37; P-value= 0.04).



Original Article | Dermatol Pract Concept. 2023;13(1):e2023014                                                                  3
      Table 1. Multivariable logistic regression for selecting the correct versus incorrect answer for the
            True/False statement “Without sun exposure, my body will not produce vitamin D.”
                                Variable                                         aORa (95% CIb)                     P-Value
    Age
    12-13 vs Under 12                                                            0.89 (0.35-2.28)                   0.82
    14-15 vs Under 12                                                            0.72 (0.24-2.16)                   0.43
    16-17 vs Under 12                                                            0.68 (0.20-2.28)                   0.35
    18+ vs Under 12                                                              0.98 (0.23-4.14)                   0.70
    Gender
    Male vs Female                                                               0.92 (0.70-1.20)                   0.45
    Other vs Female                                                              0.49 (0.13-1.87)                   0.33
    Race
    Asian or Pacific Islander vs White or Caucasian                              1.20 (0.85-1.72)                   0.15
    Black or African American vs White or Caucasian                              1.56 (1.03-2.37)                   0.007*
    Hispanic or Latino vs White or Caucasian                                     1.00 (0.70-1.44)                   1.00
    Multiracial or Biracial vs White or Caucasian                                0.86 (0.48-1.54)                   0.53
    Other vs White or Caucasian                                                  0.62 (0.33-1.16)                   0.06
    First-generation American
    Yes vs No                                                                    0.83 (0.64-1.07)                   0.15
    Grade
    11-12 vs 5-6                                                                 3.41 (1.24-9.37)                   0.04*
    7-8 vs 5-6                                                                   2.09 (1.03-4.27)                   0.76
    9-10 vs 5-6                                                                  2.19 (0.93-5.14)                   0.58
    Highest parent education level
    Bachelor’s degree vs Low education                                           0.91 (0.56-1.48)                   0.56
    Graduate degree (Master’s, MD, PhD, etc.) vs Low educationc                  0.93 (0.59-1.48)                   0.66
                                           c
    Prefer not to answer vs Low education                                        0.89 (0.46-1.73)                   0.68
                      e               c
    High education vs Low education                                              1.04 (0.62-1.73)                   0.72
                  d                            c
    Intermediate education vs Low education                                      1.14 (0.70-1.87)                   0.31
a
  aOR = adjusted odds ratio
b
  CI = confidence interval
c
 Low education includes the following categories: No schooling, some elementary school, completed elementary school, some middle school,
some high school, some trade/vocational school, completed trade/vocational school
d
  Intermediate education includes the following categories: Completed high school, associate degree
e
 High education includes the following categories: Some college, some graduate school
*Indicates statistical significance (significance level P < 0.05)


      Table 2 summarizes the logistic regression results for se-      and increase early diagnosis [21]. While this highlighted the
lecting the correct versus incorrect answer for the True/False        importance of melanoma education, a PubMed search of
statement “Melanoma is usually flat, not raised like a mos-           “melanoma education” showed that there are only 23 re-
quito bite or a pimple.” Students who were first-generation           sults since 1983, as of August 2021, underscoring the lack of
Americans were less likely to select the correct answer, as           melanoma awareness education programs and research ana-
compared to students who were not first-generation Ameri-             lyzing its efficacy. In this study, we implemented a melanoma
cans (aOR=0.71; 95% CI, 0.55-0.92; P-value= 0.009).                   education program designed by the John Wayne Cancer
                                                                      Foundation in middle and high schools, with presentations

Discussion                                                            delivered by health professions student volunteers.
                                                                          This study uses surveys adapted from a school-based mel-
A web-based education resource in Switzerland gathered                anoma education study that took place in Houston and Dallas
data on melanoma knowledge in association with disease                in 2000, which found that students aged 16 and older scored 11
development over 10 years, and found that education pro-              percentage points higher, on average, than those between 12-15
grams can statistically prevent melanoma, reduce mortality,           years on the melanoma pre-test [8]. The present study found



4                                                                         Original Article | Dermatol Pract Concept. 2023;13(1):e2023014
      Table 2. Multivariable logistic regression for selecting the correct versus incorrect answer for the
        True/False statement “Melanoma is usually flat, not raised like a mosquito bite or a pimple.”
                                 Variable                                        aORa (95% CIb)                     P-Value
    Age
    12-13 vs Under 12                                                            2.10 (0.90-4.92)                    0.12
    14-15 vs Under 12                                                            1.46 (0.53-4.05)                    0.99
    16-17 vs Under 12                                                            1.26 (0.41-3.89)                    0.50
    18+ vs Under 12                                                              1.72 (0.43-6.80)                    0.67
    Gender
    Male vs Female                                                               1.07 (0.82-1.39)                    0.62
    Other vs Female                                                              1.56 (0.49-5.00)                    0.49
    Race
    Asian or Pacific Islander vs White or Caucasian                              0.97 (0.69-1.37)                    0.89
    Black or African American vs White or Caucasian                              0.90 (0.59-1.37)                    0.58
    Hispanic or Latino vs White or Caucasian                                     1.08 (0.75-1.54)                    0.54
    Multiracial or Biracial vs White or Caucasian                                1.04 (0.59-1.81)                    0.83
    Other vs White or Caucasian                                                  0.95 (0.54-1.67)                    0.86
    First-generation American
    Yes vs No                                                                    0.71 (0.55-0.92)                    0.009*
    Grade
    11-12 vs 5-6                                                                 1.06 (0.41-2.80)                    0.57
    7-8 vs 5-6                                                                   0.80 (0.42-1.56)                    0.41
    9-10 vs 5-6                                                                  0.84 (0.38-1.88)                    0.58
    Highest parent education level
    Bachelor’s degree vs Low educationc                                          0.62 (0.38-0.99)                    0.17
    Graduate degree (Master’s, MD, PhD, etc.) vs Low educationc                  0.82 (0.52-1.28)                    0.38
                                            c
    Prefer not to answer vs Low education                                        0.54 (0.28-1.03)                    0.16
                   e                   c
    High education vs Low education                                              0.80 (0.48-1.31)                    0.61
                          d                     c
    Intermediate education vs Low education                                      0.75 (0.46-1.22)                    0.91
a
  aOR = adjusted odds ratio
b
  CI = confidence interval
c
 Low education includes the following categories: No schooling, some elementary school, completed elementary school, some middle school,
some high school, some trade/vocational school, completed trade/vocational school
d
  Intermediate education includes the following categories: Completed high school, associate degree
e
 High education includes the following categories: Some college, some graduate school
*Indicates statistical significance (significance level P < 0.05)


a similar trend: students aged 12 to 13 tended to score lower             Although melanoma of the skin is more prevalent among
than students who were between 14 and 17 years old. Grade             non-Hispanic Whites, survival has been poorer among eth-
level followed the same pattern as high school students (9th-12th     nic minorities since the 1990s, and gaps are worsening over
grade) scored better than middle school students (5th-8th grade).     time. Across all minorities, the disparity is growing in pa-
On one of the most missed true/false questions, “Without sun          tients with localized disease. In patients with distant or re-
exposure, my body will not produce vitamin D,” eleventh and           gional disease, the disparity is increasing among Hispanic
twelfth graders were nearly three and a half times more likely        patients [23]. Our study showed White/Caucasian students
than fifth and sixth graders to answer this question correctly.       tended to score higher than minorities such as Hispanics/
This trend of increasing performance with age, found in Hous-         Latinos and Blacks/African Americans on the melanoma
ton and Dallas both in 2000 and 2020-2021, suggests mela-             knowledge pre-test. Similar findings were reported from
noma education programs should target younger students [8].           a survey of Boston adults, in which White race positively
As sun exposure is cumulative [22], it is essential to expose stu-    correlated with melanoma knowledge. Additionally, immi-
dents to information regarding skin cancer early and to bridge        grants and Hispanics could less often define melanoma [24].
the knowledge gap between younger and older students.                 These results are corroborated by the present study, in which



Original Article | Dermatol Pract Concept. 2023;13(1):e2023014                                                                        5
first-generation Americans were less likely to answer the          Milbrey Parke, Louisa Liu, Tiffaney Tran, Hanqing Shang,
true/false statement “Melanoma is usually flat, not raised         Joanne Jacob, Rohit Gupta, Tejas Joshi, and Xiaoman Yu
like a mosquito bite or a pimple” correctly. One unique find-      for their role in data collection. Funding for the inaugural
ing in the present study was that Black/African American           chapter of John Wayne Cancer Foundation’s Block the Blaze
students were more likely to answer the true/false statement       program at Baylor College of Medicine was provided by the
“Without sun exposure, my body will not produce vitamin            Texas Medical Association Alliance.
D” correctly, as compared to White students.
    Research has shown greater melanoma mortality rates
among individuals of low socioeconomic status due to a
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Original Article | Dermatol Pract Concept. 2023;13(1):e2023014                                                                               7
