Laura Eckhardt

Promoting skin cancer prevention counseling by pharmacists.

OBJECTIVES This study evaluated the effects of an intervention on rates of skin cancer prevention counseling by pharmacists. METHODS Fifty-four pharmacies were randomly assigned to intervention or control conditions. Intervention consisted of training, feedback, and prompts. Counseling rates before and after the intervention were obtained from study confederates. RESULTS At pretest, the proportions of control and intervention sites providing counseling at least once were 7.4% and 0%, respectively (NS). At posttest, these proportions were 3.7% and 66.7%, respectively (P < .001). CONCLUSIONS The results indicated that the intervention was successful and that pharmacists can play an important role in educating the public about skin cancer prevention strategies.

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.

Relative Effectiveness of Continued, Lapsed, and Delayed Smoking Prevention Intervention in Senior High School Students

The relative effectiveness of continued, lapsed, and delayed smoking prevention intervention was tested with senior high school students. The original intervention was conducted during Grades 7 through 9, with significantly fewer intervention students reporting smoking than control students. The intervention was reintroduced in the 11th grade to one-half of intervention students (continued intervention), was withdrawn from the other half (lapsed intervention), and was initiated with one-half of control students (delayed intervention). The 11th-grade smoking rates of these three groups were compared to those of a fourth group, a continued control group. Results showed that continued intervention students reported significantly less smoking than continued control students and lapsed intervention students. Additionally, the delayed intervention group exhibited smoking rates lower than the lapsed intervention and continued control groups. This finding underscores the importance of continuing smoking prevention activities, as well as initiating these activities, in senior high school years.

Assessing children's ultraviolet radiation exposure : The use of parental recall via telephone interviews

OBJECTIVES This study evaluated the validity of a parental report measure of childrens solar protection behaviors. METHODS Fifty-eight children had skin color assessed twice with a colorimeter. Between measurement sessions, parents were interviewed by telephone to assess childrens indoor-outdoor status and solar protection across 40 hourly intervals. RESULTS Parental report of childs indoor-outdoor status was significantly correlated with the colorimeter values, whereas the use of sunscreen and protective clothing was not. CONCLUSIONS This measure was feasible for assessing ultraviolet exposure in young children. The component that assessed the number of intervals spent outdoors evidenced predictive validity.

Mammography knowledge and intentions among insured women.

UNLABELLED METHOD. A survey was conducted among 1,113 randomly selected insured state university employees to evaluate knowledge of the American Cancer Society mammography guidelines, awareness of insurance coverage for screening mammograms, previous guideline adherence, and future mammography intentions. RESULTS The survey, which included two mailings with follow-up phone cells of nonresponders, had a refusal rate of 6%. Respondents were relatively more likely to know the guideline for older age groups; 77% knew the guidelines for women 50+. Over one-third of the responders were not aware that their insurance policy covered screening mammograms. For women who had never had a mammogram, insurance knowledge was significantly related to intentions to have a mammogram in the future. Previous screening adherence, as well as future intentions, was positively related to the age of the respondent. The results are contrasted with those of previous studies, and the implications for the content of future breast cancer screening campaigns are discussed.

Indoor tanning facility density in eighty U.S. cities.

The purpose of this study was to examine the number of tanning facilities in select U.S. cities. The twenty most populated cities from each of 4 U.S. regions were selected for the sample. For each city, data on the number of tanning facilities, climate, and general demographic profile were collected. Data for state tanning facility legislation also were collected. A tanning facility density variable was created by dividing the citys number of facilities by its population size. The 80 cities had an average of 50 facilities each. Results of linear regression analysis indicated that higher density was significantly associated with colder climate, lower median income, and higher proportion of Whites. These data indicate that indoor tanning facilities are prevalent in the environments of U.S. urban-dwellers. Cities having the higher density profile may be logical targets for interventions promoting less or safer use of these facilities.

Skin Cancer Prevention Education: A National Survey of YMCAs

High skin cancer incidence and mortality rates have created a need for skin cancer prevention education. Children are an important target for this education, as overexposure to sun and sunburns at an early age have been linked to the development of skin cancer.This study identified the prevalence of skin cancer prevention education and the need for this education at YMCA swim classes. This study also assessed the feasibility of implementing Project SUNWISE, an existing skin cancer prevention curriculum, developed for YMCA swim classes. A 51-item survey was mailed to Aquatics Directors at all YMCAs with outdoor pools.Based on a 63% response rate (N = 208), only 28% of YMCAs thought the children in their swim classes were adequately protected from the sun, and only 28% offered skin protection or sun safety education in swim classes. Only 50% of YMCAs trained their swim instructors on skin cancer prevention. While 91% of YMCAs had one or more sun protection items near the pool (e.g., sunscreen, umbrella, covered area), 93% of YMCAs saw the need for additional protection. The majority of YMCAs (95%) were willing to incorporate a skin cancer prevention education curriculum, similar to Project SUNWISE, into their swim classes. This study emphasized the need for more skin cancer prevention education programs targeting children and examined the correlates of skin cancer prevention education at YMCAs. Geographic region, percent of possible sunshine, and ultraviolet radiation were significantly associated with the skin cancer prevention education program status at the YMCAs.

Interval estimation for the intraclass correlation in dirichlet-multinomial data

When the underlying distribution is discrete with a limited number of categories, methods for interval estimation of the intraclass correlation which assume normality are theoretically inadequate for use. On the basis of large sample theory, this paper develops an asymptotic closed-form interval estimate of the intraclass correlation for the case where there is a natural score associated with each category. This paper employs Monte Carlo simulation to demonstrate that when the underlying intraclass correlation is large, the traditional interval estimator which assumes normality can be misleading. We find that when the number of classes is ≥ 20, the interval estimator proposed here can generally perform reasonably well in a variety of situations. This paper further notes that the proposed interval estimator is invariant with respect to a linear transformation. When the data are on a nominal scale, an extension of the proposed method to account for this case, as well as a discussion on the relationship between the intraclass correlation and a kappa-type measure defined here and on the limitation of the corresponding kappa-type estimator are given.

Participation in a Telephone-Based Tobacco Use Prevention Program for Adolescents.

Despite studies documenting the success of schoolbased smoking prevention interventions, these studies are subject to criticisms? One criticism relates to nonparticipation among youth considered high-risk for tobacco use. One promising strategy for delivering health promotion interventions is the use of the telephone. Although some argue that use of the telephone may restrict delivery of an intervention to those more well-off, recent estimates show that 93% of households have telephones, and further, that the telephone offers advantages in contacting hard-to-reach individuals. 2’:~

Confidence intervals for the risk ratio under cluster sampling based on the beta-binomial model.

In cohort studies, the risk ratio (RR) is one of the most commonly used epidemiologic indices to quantify the effect of a suspected risk factor on the probability of developing a disease. When we employ cluster sampling to collect data, an interval estimator that does not account for the intraclass correlation between subjects within clusters is likely inappropriate. In application of the beta-binomial model to account for the intraclass correlation, we develop four asymptotic interval estimators of the RR, which are direct extensions of some recently developed estimators for independent binomial sampling. We then use Monte Carlo simulation to evaluate the finite-sample performance of these four interval estimators in a variety of situations. We find that the estimator using the logarithmic transformation generally performs well and is preferable to the other three estimators in most of the situations considered here. Finally, we include an example from a study of an educational intervention with emphasis on behaviour change to illustrate the use of the estimators developed in this paper.