Elizabeth J. Clapp

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.

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 facilitys 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.

Promoting Sun Safety Among US Postal Service Letter Carriers: Impact of a 2-Year Intervention

OBJECTIVES We examined whether US Postal Service letter carriers who received a sun safety intervention would wear wide-brim hats and sunscreen significantly more often than those who did not receive the intervention. METHODS We used a 2-group randomized design with 2662 evaluation cohort participants from 70 US postal stations. Evaluations were conducted at baseline, 3 months, 1 year, and 2 years. Questionnaire items assessed occupational use of sun-screen and wide-brim hats. The 2-year sun safety intervention included the provision of wide-brim hats, accessible sunscreen, reminders, and 6 educational sessions. RESULTS At the 3-month follow-up evaluations, the odds ratio (OR) for regular sun-screen use was 2.8 times higher among the intervention group than among the control group (95% confidence interval [CI]=2.2, 3.5); at the 2-year follow-up evaluations, the rate was still significantly higher (OR=2.0; 95% CI=1.6, 2.6). Intervention group participants also had significantly higher rates of hat use, with the differences remaining consistent across all follow-ups (OR=2.9; 95% CI=2.3, 3.6). CONCLUSIONS The intervention should be disseminated to postal stations nationwide and possibly to other occupational groups that work outdoors.

Long-term maintenance of a successful occupational sun safety intervention.

Skin cancer prevention specialists should attempt to reduce ultraviolet radiation exposure (UVR) among outdoor workers, as pointed out in a recent review.1 To address this need, Project SUNWISE, a randomized controlled sun safety intervention trial with Southern Californian United States Postal Service letter carriers, was conducted from 2001 through 2004. The intervention consisted of providing free sunscreen, free wide-brim hats, a series of 6 brief onsite educational sessions, and sun safety prompts. The primary outcome measures were validated questionnaire items that asked participants how often they had used specific sun protection strategies over the past 5 workdays while delivering mail.2, 3 They were administered at baseline and 3, 12, 24, and 36 months post-baseline. The 5 response options ranged from “never” to “always”; we considered “always” as “consistent use” in analyses. At the 2-year follow-up evaluation, participants at the intervention postal stations had significantly higher rates of consistent sunscreen use and wide-brim hat use than those at control stations.2 Details about the study procedures and sample characteristics have been published previously.2 Immediately following the 2-year evaluation, control station participants received the free items and 3 of the education sessions (i.e., introduction and protections strategies, sun safety for eyes, and recap/encouragement to maintain sun safety practices). At the intervention stations, we continued to provide free sunscreen during that year. This paper describes the behavioral outcomes at the 3-year follow-up evaluation. Evaluation cohort retention rates (of those completing questionnaires) from the 2- to 3- year follow-ups were 93.2% (927/994) for the intervention group and 94.4% (1130/1196) for the control group. The trends over 3 years in two key outcomes—consistent use of sunscreen and wide-brim hats--were analyzed using generalized linear mixed models treating 3 months, 1 year, 2 years, and 3 years as a set of repeated measures on each postal worker. In addition, we adjusted for postal workers nested within post offices within a multi-level model; the intraclass correlation coefficients for sunscreen and hats were .015 and .067, respectively. All analyses were adjusted for the baseline level of the corresponding outcome variable. For each analysis, we tested 1) the time by condition interaction, to determine if the intervention effect remained constant over time, and 2) the condition main effect. Consistent sunscreen use levels for intervention participants at the 2- and 3- year follow-ups were 39.2% and 38.3%, respectively, and for control participants, they were 26.3% and 34.3%, respectively. Wide-brim hat levels for intervention participants during these periods were 40.0% and 43.8%, respectively, and for control participants, they were 22.3% and 33.0%, respectively. Results of the analyses for each of these outcomes showed significant condition by time interaction effects (ps<0.0001), indicating that the differences between the conditions were changing over time. The table shows these patterns. For both behaviors, the change in the odds ratios from year 2 to year 3 is not due to a drop among intervention participants but rather to an increase among control group participants. We are encouraged that intervention effects were maintained at least one year after the program ended, and that once the control participants received the intervention, their consistent use of sun protection increased substantially. Table Results of generalized linear mixed-model analyses a: Patterns of odds ratios over three years of follow-up

Effects of an Introductory Letter on Response Rates to a Teen/Parent Telephone Health Survey

The authors conducteda pilotstudyin preparationfor a larger investigationthatwill rely ontelephone surveys to assess select health behaviors of teens and their parents, with a focus on indoor tanning. This study used a randomized design to assess the impact of a presurvey letter on response rates to a telephone survey, as well as prevalence estimates of ever having used an indoortanningfacility. The letter didnothavea significanteffect onresponserates or prevalence estimates in the two cities under study. Findings suggest that researchers should not assume that a letter sent in advance of a telephone survey will necessarily increase response rates enough to justify their use.

Retailer Education to Reduce the Availability of Single Cigarettes

Abstract The practice of selling single cigarettes is a reflection of the shifting demographics of smoking as a habit of lower-income Americans. Buying singles is an affordable way to try smoking and keep smoking. The purpose of this study was to: (1) determine store and retailer characteristics associated with the availability of single cigarettes in a variety of store types in low-income, ethnic communities, and (2) to describe the effectiveness of an intervention to reduce such availability. Information on availability was collected at four store types: supermarkets, independent markets, gas station/convenience stores, and liquor stores in seven communities of San Diego County, California. Singles were observed to be available in 24.8 percent of stores during the 1990 baseline survey, mostly in liquor stores (39.7 percent) and independent markets (31.4 percent). As part of a larger intervention to reduce youth access to tobacco products, 313 retailers received information regarding laws prohibiting sal...

Youth Access to Artificial Ultraviolet Radiation Exposure: Practices of 3,647 U.S. 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 facilitys 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.