The high costs of cheap tanning: pricing and promotional practices of indoor tanning facilities in six cities in the United States.

Few studies have investigated pricing and promotional practices used by the indoor tanning industry, despite their potential to promote indoor UV tanning-a well-established risk factor for melanoma skin cancer. Posing as potential customers, we telephoned 94 indoor tanning businesses in six United States (U.S.) cities and requested pricing information. The price of a single tanning session ranged from $0 to $23, and was lower at facilities that offered indoor tanning as a secondary service (mean $4.82 and free in 35%) than at tanning salons (mean $16.45). Session prices in salons could be as low as $1.50 with daily use of an unlimited monthly plan. Free indoor tanning, monthly packages, and memberships encourage increased use. Policies that limit free indoor tanning or that restrict pricing and advertising for indoor tanning exist in several places in the U.S. and Europe. Future research should evaluate whether those policies are effective in reducing indoor tanning.

Randomized trial of a web-based survivor intervention on melanoma prevention behaviors of first-degree relatives.

OBJECTIVES: Melanoma can be prevented through reducing sun exposure and detected early by increasing examination of skin for lesions. First-degree relatives of melanoma cases have higher risk than the general population and, therefore, could be targets of behavioral interventions through families. We tested the effects of a family-based web delivered intervention to melanoma families on the melanoma risk reduction behaviors of first-degree relatives of melanoma cases. METHODS: A total of 313 families that included one first-degree relative were recruited to join this randomized trial. All intervention families received access to the Suntalk website developed to promote family communication and behavioral risk reduction among families of melanoma survivors. RESULTS: First degree relatives in the intervention arm significantly increased their yearly performance of both skin self examination and thorough provider examination from baseline to 12-month follow-up while the control FDRs decreased their yearly performance of both of those behaviors (p's = 0.006 and 0.005, respectively). Several sun protection behaviors increased significantly in FDRs in the intervention arm but not the control arm, including wearing a covering on the head (p = 0.005), staying in available shade (p = 0.008), and avoiding sun exposure during peak hours (p = 0.010). Some of these changes were mediated by perceptions of risk and other process variables. CONCLUSIONS: A web-based intervention can reduce risk of melanoma through changes in relevant behaviors among first-degree relatives of melanoma survivors. Future research should identify methods for making this type of intervention accessible to more families and for broadening the reach to other types of cancer families. PRACTICE IMPLICATIONS: This program can be provided to melanoma families to improve their sun protection and screening behaviors, at the point of diagnosis.

Indoor tanning promotions on social media in six US cities #UVTanning #tanning.

There is no research investigating indoor tanning advertising on social media. We assessed the use of social media to promote indoor tanning. We subscribed to social media platforms in six US cities and content-analyzed promotional messages received. We captured 662 messages on Twitter and Facebook, through salon emails, and in daily deal coupons. Salon postings were most frequent on Twitter and Facebook, with an average of 2-3 postings per week. National chains posted more frequently than local businesses. Forty percent of messages were devoid of tanning content and included photos, jokes, or popular references. Thirty percent mentioned price reductions, and 28 % referenced an upcoming holiday. Sunless tanning (17 %) was promoted more often than ultraviolet tanning (9 %). Tanning salons actively use social media as a strategy for maintaining relationships with customers and offer pricing deals that promote loyalty and high-frequency tanning.

Using research data to impact consumer protection legislation: lessons learned from CITY100 dissemination efforts.

The Correlates of Indoor Tanning in Youth (CITY100) project evaluated individual, built-environmental, and policy correlates of indoor tanning by adolescents in the 100 most populous US cities. After CITY100's completion, the research team obtained supplemental dissemination funding to strategically share data with stakeholders. The primary CITY100 dissemination message was to encourage state-level banning of indoor tanning among youth. We created a user-friendly website to broadly share the most relevant CITY100 data. Journalists were a primary target audience, as were health organizations that would be well positioned to advocate for legislative change. CITY100 data were used to pass the first US state law to ban indoor tanning among those under 18 (CA, USA), as well as in other legislative advocacy activities. This paper concludes with lessons learned from CITY100 dissemination activities that we hope will encourage more health researchers to proactively address policy implications of their data and to design relevant, effective dissemination strategies.

Dog ownership and physical activity: a review of the evidence.

BACKGROUND: Dog walking is a strategy for increasing population levels of physical activity (PA). Numerous cross-sectional studies of the relationship between dog ownership and PA have been conducted. The purpose was to review studies comparing PA of dog owners (DO) to nondog owners (NDO), summarize the prevalence of dog walking, and provide recommendations for research. METHODS: A review of published studies (1990-2010) examining DO and NDO PA and the prevalence of dog walking was conducted (N = 29). Studies estimating the relationship between dog ownership and PA were grouped to create a point- estimate using meta-analysis. RESULTS: Most studies were conducted in the last 5 years, were cross-sectional, and sampled adults from Australia or the United States. Approximately 60% of DO walked their dog, with a median duration and frequency of 160 minutes/week and 4 walks/week, respectively. Meta-analysis showed DO engage in more walking and PA than NDO and the effect sizes are small to moderate (d = 0.26 and d = 0.16, respectively). Three studies provided evidence of a directional relationship between dog ownership and walking. CONCLUSIONS: Longitudinal and interventional studies would provide stronger causal evidence for the relationship between dog ownership and PA. Improved knowledge of factors associated with dog walking will guide intervention research.

Use of conventional care and complementary/alternative medicine among US adults with arthritis.

OBJECTIVE: Managing arthritis and co-morbid conditions is of public health importance. It is therefore critical to have a comprehensive understanding of healthcare utilization among US adults with arthritis. Thus, the present study identified characteristics associated with using both complementary and alternative medicine (CAM) and conventional healthcare. METHOD: Using 2007 National Health Interview Survey data, multinomial logistic regression was performed to compare four categories of past year healthcare use (both CAM and conventional care vs. conventional care only, CAM only, and no healthcare use) on their potential correlates. RESULTS: The sample (n=3850) was 62.8% female and 80.4% non-Hispanic White. Nearly half were at least 65 years old, and had used both CAM and conventional services in the previous year. The following characteristics were associated with having used neither CAM nor conventional care in the previous year (vs. having used both CAM and conventional care): being from an ethnic and racial minority group (ORs=2.44, 3.26, and 3.91) and being uninsured (OR=4.06), identifying individuals potentially at risk for unmet need. CONCLUSION: To ensure access to comprehensive care, potentially underserved populations should be targeted with outreach (e.g., providing low-cost, accessible care, and education about benefits of various treatments for arthritis and co-morbid conditions).

Adolescents' use of indoor tanning: a large-scale evaluation of psychosocial, environmental, and policy-level correlates.

OBJECTIVES: We evaluated psychosocial, built-environmental, and policy-related correlates of adolescents' indoor tanning use. METHODS: We developed 5 discrete data sets in the 100 most populous US cities, based on interviews of 6125 adolescents (aged 14-17 years) and their parents, analysis of state indoor tanning laws, interviews with enforcement experts, computed density of tanning facilities, and evaluations of these 3399 facilities' practices regarding access by youths. After univariate analyses, we constructed multilevel models with generalized linear mixed models (GLMMs). RESULTS: In the past year, 17.1% of girls and 3.2% of boys had used indoor tanning. The GLMMs indicated that several psychosocial or demographic variables significantly predicted use, including being female, older, and White; having a larger allowance and a parent who used indoor tanning and allowed their adolescent to use it; and holding certain beliefs about indoor tanning's consequences. Living within 2 miles of a tanning facility also was a significant predictor. Residing in a state with youth-access legislation was not significantly associated with use. CONCLUSIONS: Current laws appear ineffective in reducing indoor tanning; bans likely are needed. Parents have an important role in prevention efforts.

Impact of individual-, environmental-, and policy-level factors on health care utilization among US farmworkers.

OBJECTIVES: We examined individual-, environmental-, and policy-level correlates of US farmworker health care utilization, guided by the behavioral model for vulnerable populations and the ecological model. METHODS: The 2006 and 2007 administrations of the National Agricultural Workers Survey (n = 2884) provided the primary data. Geographic information systems, the 2005 Uniform Data System, and rurality and border proximity indices provided environmental variables. To identify factors associated with health care use, we performed logistic regression using weighted hierarchical linear modeling. RESULTS: Approximately half (55.3%) of farmworkers utilized US health care in the previous 2 years. Several factors were independently associated with use at the individual level (gender, immigration and migrant status, English proficiency, transportation access, health status, and non-US health care utilization), the environmental level (proximity to US-Mexico border), and the policy level (insurance status and workplace payment structure). County Federally Qualified Health Center resources were not independently associated. CONCLUSIONS: We identified farmworkers at greatest risk for poor access. We made recommendations for change to farmworker health care access at all 3 levels of influence, emphasizing Federally Qualified Health Center service delivery.

Dog walking: its association with physical activity guideline adherence and its correlates.

OBJECTIVE: We examined the prevalence and correlates of dog walking among dog owners, and whether dog walking is associated with meeting the American College of Sports Medicine/American Heart Association physical activity guidelines. METHODS: In March 2008, we mailed a survey to dog-owning clients from two San Diego County veterinary clinics. Useable data were obtained from 984 respondents, and 75 of these completed retest surveys. We assessed associations between potential correlates and dog walking (i.e., yes/no dog walking for at least 10 min in past week). RESULTS: Test-retest reliability of measures was generally high. Approximately one-third of the sample (31.5%) were not dog walkers. Proportions of dog walkers versus non-dog walkers meeting United States guidelines were 64.3% and 55.0%, respectively. Dog walking was independently associated with meeting guidelines in a multivariate model (odds ratio=1.59, p=0.004). Three variables were independently associated with dog walking in a multivariate model: dog encouragement of dog walking, dog-walking obligation, and dog-walking self-efficacy. CONCLUSION: Dog walking was associated with meeting physical activity guidelines, making it a viable method for promoting physical activity. Dog-walking obligation and self-efficacy may be important mediators of dog walking and may need to be targeted if interventions are to be successful.

Perceived skin cancer risk and sunscreen use among African American adults.

We examined perceived skin cancer risk and its relationship to sunscreen use among a large (N = 1932) random sample of African American adults for the first time. Skin cancer risk perceptions were low (Mean = 16.11 on a 1-100 scale). Sun-sensitive skin type and a prior cancer diagnosis were associated with higher perceived skin cancer risk, but demographic factors were not. Unlike findings for Whites, perceived skin cancer risk was not associated with sunscreen use among African Americans. Directions for future research, and suggestions for increasing sunscreen use among African Americans are provided.

Measuring skin cancer risk in African Americans: is the Fitzpatrick Skin Type Classification Scale culturally sensitive?

OBJECTIVE: Fitzpatrick's Skin Type Classification Scale often is used to assess sun sensitivity and skin cancer risk. Because the scale was developed with Whites, its utility and validity with Blacks may be limited by its reliance on the European-cultural terms suntan and sunburn. We tested the hypothesis that most Blacks would be unable to classify their skin into the four Fitzpatrick skin types. DESIGN, SETTING, PARTICIPANTS: A random, statewide sample of 2085 California Black adults were administered a survey to categorize their skin into the Fitzpatrick types of always burn/never tan (I), usually burn/rarely tan (II), rarely burn/usually tan (III), and never burn/always tan (IV). We also added a response option not available in the scale, "none of the above describes me." Questions on sunscreen use and demographics were included. MAIN OUTCOME MEASURE: Self-reported skin type. RESULTS: 1231 (59%) selected none of the above, and only 559 (26.8%) categorized themselves as type IV. When the none option is removed and the 59% who chose it were excluded as non-responders, the 559 who selected type IV constitute 65.5% of the remaining sample. Those who selected none were significantly less likely than all others to use sunscreen, and income and residential segregation were the strongest predictors of type I/II skin. CONCLUSION: Standard administration of the Fitzpatrick Scale excludes the majority of Blacks, yields data that overestimate Black population prevalence of type IV skin, and excludes the Blacks who are least likely to use sunscreen. Suggestions are provided for improving the cultural sensitivity of the skin-type assessment.

Sun-protection behaviors among African Americans.

BACKGROUND: Data suggest that the prevalence of sun-protection behaviors is low (44%) among African Americans; the samples in such studies, however, tended to be small or nonrepresentative. PURPOSE: This article aims to examine the prevalence and correlates of sun-protection behaviors among a large, random, statewide sample of African-American adults living in California to ascertain behavioral patterns and highlight directions for targeted interventions. METHODS: From September 2006 through May 2008, an anonymous health survey collected data on sunscreen, sunglasses, and wide-brim hat use among a random sample of 2187 African-American adults, and assessed demographic, regional, skin type, and other potential correlates of these behaviors. The analysis was conducted in 2009. RESULTS: Only 31% engaged in at least one sun-protection behavior; of the three behaviors, sunscreen use was the least prevalent, with 63% never using sunscreen. Multivariate logistic regressions revealed that gender, SES, and skin type were significant predictors of sun-protection behaviors. CONCLUSIONS: Tailored interventions to increase sun-protection behaviors among African Americans (men in particular) are needed.

Youth access to artificial UV radiation exposure: practices of 3647 US indoor tanning facilities.

OBJECTIVE: To assess indoor tanning facility practices in a sample of facilities in 116 cities representing all 50 states. DESIGN: Cross-sectional study. SETTING: United States. PARTICIPANTS: Employees of 3647 indoor tanning facilities were contacted by telephone. Data collectors (ie, confederates) posed as prospective, fair-skinned, 15-year-old female customers who had never tanned before. MAIN OUTCOME MEASURES: Confederates asked respondents about their facility's practices related to parental consent, parental accompaniment, and allowable tanning session frequency. RESULTS: Approximately 87% of the facilities required parental consent, 14% required parental accompaniment, 5% said they would not allow the confederate to tan owing to her age, and 71% would allow tanning every day the first week of indoor tanning. In Wisconsin, which bans indoor tanning among those younger than 16 years, 70% of facilities would not allow the confederate to tan. Multivariate analyses indicated that facilities in states with a youth access law were significantly more likely to require parental consent (P <.001) and parental accompaniment (P <.001) than those in states without a youth access law. Law was not significantly related to allowable tanning frequency (P = .81). Conclusion We recommend that additional states pass youth access legislation, preferably in the form of bans.

Healthy Steps: a systematic review of a preventive practice-based model of pediatric care.

The preventive role of anticipatory guidance in pediatric practice has gained increasing importance over the last two decades, resulting in the development of competing models of practice-based care. Our goal was to systematically evaluate and summarize the literature pertaining to the Healthy Steps Program for Young Children, a widely cited and utilized preventive model of care and anticipatory guidance, Medline and the bibliographies of review articles for relevant studies were searched using the keywords: Healthy Steps, preventive care, pediatric practice and others. Other sources included references of retrieved publications, review articles, and books; government documents; and Internet sources. Relevant sources were selected on the basis of their empirical evaluation of some component of care (e.g., child outcomes, parent outcomes, quality of care). From 21 identified articles, 13 met the inclusion criteria of empirical evaluation. These evaluations were summarized and compared. Results indicated that the Healthy Steps program has been rigorously evaluated and shown to be effective in preventing negative child and parent outcomes and enhancing positive outcomes. Despite limited information concerning cost effectiveness, the Healthy Steps Program provides clear benefit through early screening, family-centered care, and evidence-based anticipatory guidance. It is recommended that the Healthy Steps program be more widely disseminated to relevant stakeholders, and further enhanced by improved linguistic and cultural sensitivity and long term evaluation of cost effectiveness.

Density of indoor tanning facilities in 116 large U.S. cities.

BACKGROUND: U.S. adolescents and young adults are using indoor tanning at high rates, even though it has been linked to both melanoma and squamous cell cancer. Because the availability of commercial indoor tanning facilities may influence use, data are needed on the number and density of such facilities. METHODS: In March 2006, commercial indoor tanning facilities in 116 large U.S. cities were identified, and the number and density (per 100,000 population) were computed for each city. Bivariate and multivariate analyses conducted in 2008 tested the association between tanning-facility density and selected geographic, climatologic, demographic, and legislative variables. RESULTS: Mean facility number and density across cities were 41.8 (SD=30.8) and 11.8 (SD=6.0), respectively. In multivariate analysis, cities with higher percentages of whites and lower ultraviolet (UV)index scores had significantly higher facility densities than those with lower percentages of whites and higher UV index scores. CONCLUSIONS: These data indicate that commercial indoor tanning is widely available in the urban U.S., and this availability may help explain the high usage of indoor tanning.

Use of sunglasses in public outdoor recreation settings in Honolulu, Hawaii.

PURPOSE: Approximately, 20.5 million Americans (17.2%) older than 40 years have a cataract in at least one eye, and rates are expected to rise to over 30 million by 2020. Wearing sunglasses, especially early in life, may reduce the risk of cataracts. Meanwhile, little is known about the prevalence of wearing sunglasses in the United States, especially in areas with high ultraviolet radiation. The objective of this study was to assess the prevalence and predictors of wearing sunglasses in public outdoor recreation settings. METHODS: Systematic observations were made at beaches, parks and outdoor public swimming pools in Honolulu, Hawaii on sunny days between November 2005 and June 2007. Observations were conducted independently by two trained observers between 10:00 am and 4:00 pm. During each observation period, each individual in the area was coded for gender, age category, clothing coverage, shade use, and use of sunglasses. RESULTS: A total of 5171 people were observed by two independent observers, and the inter-rater reliability use of sunglasses was excellent (Cohen kappa = 0.83). Overall, 33.0% of people wore sunglasses. chi analysis revealed that significantly more people (p < 0.001) wore sunglasses at swimming pools (35.1%) and parks (34.8%) compared to beaches (30.4%). Adults (41.6%) were more likely to wear sunglasses than children (12.3%; p < 0.001). Gender was not significantly associated (p = 0.3) with the use of sunglasses (males = 32.7%; females = 33.3%). Those wearing hats were significantly more likely (p < 0.001) to wear sunglasses (46.6%) than those with bare heads (28.4%). CONCLUSIONS: Direct observation in public outdoor recreation settings revealed that only one third of the population wore sunglasses. Further research should examine the use of sunglasses in other locations and investigate the effectiveness of interventions that promote the wearing of sunglasses in settings with risk for ultraviolet radiation exposure.

Season of interview and self-report of summer sun protection behaviors.

Self-report of past behavior may be affected by recall biases that result in over- or under-reporting. This study explored whether the season an interview was conducted affected individuals' self-reported frequency of past summer sun protection behaviors, including the use of sunscreen, hats, long sleeves, and shade. We examined two existing datasets--National Health Interview Survey (NHIS) and the Behavioral Risk Factor Surveillance System (BRFSS) with sample sizes of 31,428 and 21,122, respectively. Weighted logistic regression models adjusting for survey design estimated the influence of interview season on the odds of consistent summer sun protection behaviors, while controlling for age, sex, sun sensitivity, and geographic region. For NHIS, significant seasonal differences were found for all protection behaviors that were measured. For the BRFSS items, significant seasonal differences were found only for staying in the shade. Based on these findings, when interviewing adults about summer sun safety behavior, we recommend conducting the interviews during the summer season or shortly thereafter to reduce potential recall biases.

Enforcement of state indoor tanning laws in the United States.

INTRODUCTION: Twenty-eight US states have passed legislation for indoor tanning facilities. To our knowledge, whether these state laws are actually enforced has not been evaluated previously in all 28 states. Therefore, we interviewed key informants in these states to assess enforcement practices. METHODS: Two trained interviewers used a structured survey instrument to interview 28 key informants who were knowledgeable about enforcement practices for laws regarding indoor tanning. Respondents provided information specific to the most populous city in their states. RESULTS: Licensure for indoor tanning businesses was required in 22 of the 28 cities. Slightly less than half of the cities gave citations to tanning facilities that violated state law. Approximately 32% of the cities did not inspect indoor tanning facilities for compliance with state law, and another 32% conducted inspections less than annually. Of those cities that inspected at all, most conducted unannounced inspections. CONCLUSION: The relatively low rates of annual inspections and citations are of concern. We recommend that future studies assess whether legislation, enforcement practices, or a combination of the 2 affects the practices of indoor tanning facilities or of consumers.

Correlates of physical activity guideline compliance for adolescents in 100 U.S. Cities.

PURPOSE: This study assessed the rates and correlates of adolescents' compliance with national guidelines for physical activity. METHODS: A cross-sectional phone survey of adolescents and their parents was conducted in the 100 largest cities in the United States in 2005. Adolescents ages 14-17 years (n = 6125) were asked how many days during the previous week and during a typical week they were physically active for at least 60 minutes. Compliance was defined as 5+ days per week. Parents provided data on teen's age and race/ethnicity, parental education level, annual household income, and region of residence. Associations among these variables and compliance with physical activity guidelines were examined. RESULTS: Approximately 40% of the females and 57% of the males complied with the national physical activity guidelines. Logistic regression indicated that for both genders, compliance was significantly associated with having higher household income and that, for females only, compliance declined significantly with age. Region of residence did not predict compliance for either gender. CONCLUSION: A majority of the girls and a large portion of the boys failed to meet the current guidelines, thereby increasing their risks of multiple health problems. Targeting intervention resources for low income teens and older adolescent teen girls is recommended.