title: Social Differentiation of Sun-Protection Behaviors: The Mediating Role of Cognitive Factors.
abstract: BACKGROUND
  Adherence to sun-protection guidelines in developed countries is low, especially among people of low SES. Mechanisms underlying this social differentiation are poorly understood. This study aimed to examine the social differentiation of sun-protection behaviors and of two cognitive factors (knowledge about both sun health and behavioral risk factors for cancer) and to determine if these cognitive factors mediate the association between SES and sun-protection behaviors.
  
  
  METHODS
  Data came from the 2010 Baromètre Cancer survey (analyzed in 2014), a random cross-sectional telephone survey conducted among the French general population (n=3,359 individuals aged 15-75 years). First, bivariate associations between a composite individual SES indicator (based on education level, occupation, and income) and both sun-protection behaviors and cognitive factors were tested with chi-square tests and ANOVA. Then, confirmatory factor analysis and structural equation modeling were used to test the mediating role of cognitive factors with a multiple mediation model including four latent variables.
  
  
  RESULTS
  In bivariate analyses, the individual SES indicator was positively associated with sun-protection behaviors and both cognitive factors. Multiple mediation analyses showed that both cognitive factors partially mediated the effect of individual SES on sun-protection behaviors. The overall proportion of mediated effects was 48%. The direct effect of SES remained significant.
  
  
  CONCLUSIONS
  These results suggest that interventions aimed at modifying the knowledge and perceptions of people of low SES might help to reduce social differentiation of sun-protection behaviors. Further qualitative research is needed to better understand these cognitive factors and develop suitable prevention messages.
authors.affiliation: INSERM, UMR912 "Economics and Social Sciences Applied to Health & Analysis of Medical Information" (SESSTIM), Marseille, France; Aix Marseille University UMR_S912, IRD, Marseille, France; ORS PACA, Southeastern Health Regional Observatory, Marseille, France. Electronic address: aurelie.bocquier@inserm.fr.
authors.forename: Aurélie
authors.initials: A
authors.lastname: Bocquier
authors.affiliation: INSERM, UMR912 "Economics and Social Sciences Applied to Health & Analysis of Medical Information" (SESSTIM), Marseille, France; Aix Marseille University UMR_S912, IRD, Marseille, France; ORS PACA, Southeastern Health Regional Observatory, Marseille, France.
authors.forename: Lisa
authors.initials: L
authors.lastname: Fressard
authors.affiliation: Institut national d'études démographiques (INED), Paris, France; INSERM, U1178 Univ Paris-Sud and Univ Paris Descartes, UMR-S0669, Paris, France.
authors.forename: Stéphane
authors.initials: S
authors.lastname: Legleye
authors.affiliation: INSERM, UMR912 "Economics and Social Sciences Applied to Health & Analysis of Medical Information" (SESSTIM), Marseille, France; Aix Marseille University UMR_S912, IRD, Marseille, France; ORS PACA, Southeastern Health Regional Observatory, Marseille, France.
authors.forename: Pierre
authors.initials: P
authors.lastname: Verger
authors.affiliation: INSERM, UMR912 "Economics and Social Sciences Applied to Health & Analysis of Medical Information" (SESSTIM), Marseille, France; Aix Marseille University UMR_S912, IRD, Marseille, France; ORS PACA, Southeastern Health Regional Observatory, Marseille, France.
authors.forename: Patrick
authors.initials: P
authors.lastname: Peretti-Watel
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D003430:Cross-Sectional Studies; D004781:Environmental Exposure / Q000009:adverse effects; D005260:Female; D005602:France; D015438:Health Behavior; D007722:Health Knowledge, Attitudes, Practice; D006306:Health Surveys; D006801:Humans; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011481:Protective Clothing / Q000706:statistics & numerical data*; D012878:Skin Neoplasms / Q000517:prevention & control*; D012923:Social Class; D013471:Sunburn / Q000517:prevention & control*; D013472:Sunlight / Q000009:adverse effects; D013473:Sunscreening Agents / Q000627:therapeutic use*; D055815:Young Adult
chemical_list: D013473:Sunscreening Agents