Predictors of tanning dependence in white non-Hispanic females and males.

BACKGROUND: Growing evidence suggests that some individuals may exhibit symptoms of dependence on ultraviolet (UV) light, a known carcinogen, in the context of tanning; however, few studies have investigated predictors of tanning dependence (TD). OBJECTIVE: To identify predictors of TD. METHODS: Non-Hispanics of European ancestry who had previously participated in a case-control study of early-onset basal cell carcinoma completed an online survey to ascertain TD and other behaviours (alcohol dependence, nicotine dependence, seasonal affective disorder (SAD), exercise 'addiction' and depression). Information on host factors, such as skin and eye colour and history of sunbathing and indoor tanning, was obtained from a study in which the participants were previously enrolled. Lifetime TD was assessed using the modified Cut down, Annoyed, Guilty, Eye-opener (mCAGE) and the modified Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (mDSM-IV-TR) questionnaires. Participants were classified as 'TD' if positive on both questionnaires and not TD if negative on both questionnaires. RESULTS: In total, 499 individuals completed the online survey (81.9% participation rate), and 24.4% were classified as 'TD'. In the multivariate model, women were more likely to be TD [odds ratio (OR) 6.93; 95% confidence intervals (95% CI) (3.36-14.27)] than men. Alcohol dependence (OR 6.55: 95% CI 3.19-13.42), SAD (OR 2.77; 95% CI 1.26-6.09) and exercise 'addiction' (OR 5.47; 95% CI 1.15-26.06) were all significant predictors for TD. CONCLUSION: Increased knowledge of those at risk for TD will allow appropriate interventions to be designed.

The rural market: a unique communication medium.

PIP: In January 1990, the Health Secretary asked the Technologies for Primary Health Care (PRITECH) project to facilitate access to the many small villages with 500 people in Mexico since PRITECH had assisted the diarrhea disease control program. 1st PRITECH had Ministry of Health staff train trainers which would eventually spread the information to the rural areas. This strategy was effective only for those people who did not live in remote areas. The same reasons for remote people being at high risk of disease also limited this strategy: isolation, lack of education, limited diets, lack of access to services, and limited fluency in Spanish. PRITECH hired a local consulting organization, CICLOPE, to develop a new strategy. CICLOPE limited its activities to the states of Hidalgo and Vera Cruz for 8 months. 1st CICLOPE staff provided proper diarrhea management training including emphasis on oral rehydration therapy (ORT) to rural health auxiliaries. They used a gourd painted to look like an infant with holes and other modifications to depict the workings and results of diarrheal dehydration. The staff then sent the auxiliaries to their own communities to use the gourd dolls to teach mothers about ORT and correct diarrhea management. The staff conducted follow-up activities to monitor the auxiliaries' progress. This training approach allowed the auxiliaries to realize the abilities of the mothers and their active role in learning. The auxiliaries conducted the training at markets where women living in remote areas came weekly. The local radio announced market day events in which the auxiliaries participated and aired dramas about diarrhea management. CICLOPE staff and the auxiliaries sat up a booth at these markets to promote proper diarrhea management. They used a flip chart, comic books, a lottery game, and entertainment to impart education messages.^ieng

Evaluation: past and present.

PIP: Traditionally, program evaluation has been an after-the-fact exercise with the following characteristics: it has been performed by an outside consultant or team, there has been an adversarial relationship between project people and evaluators, the emphasis is on negative aspects, and there is frequently confusion with policy analysis. A new role for evaluation is evolving, however, that allows evaluation to play a more positive role in project implementation. In this new model, evaluation is integrated into the project as an essential function, not as a luxury in situations where funding is available. This function is performed by members of the project staff, not by outsiders, and seeks to provide constructive guidelines. The evaluation process is used to determine whether progress is being made toward the goals of the project. Evaluators can provide the data to policy makers, but should not be placed in the position of making policy decisions. Evaluators can help project personnel to articulate the results they want and help them determine the corresponding measurable indicators. No longer a threat to project staff, evaluation is gaining recognition as a constructive tool that can help to achieve desired results.^ieng