Geography, facilities, and promotional strategies used to encourage indoor tanning in New York City.

There is emerging evidence for the relationship between indoor tanning and melanoma. Eighty-five indoor tanning facilities in New York City were observed to determine number of tanning machines, pricing, promotions, products, and hours. Census data by zip code was used to determine population density, gender, race, age, percent living in poverty, percent unemployed, and percent college educated of areas in which tanning facilities were located. Pricing varied by the type of machine, number of sessions purchased, and single versus bundled sessions. Facilities were located in areas that had greater population density and slightly greater median age. Compared with the zip code areas with no facilities, those with tanning facilities had a higher proportion of white residents; a lower proportion of residents living in poverty and unemployed; and a higher proportion of residents with a college education. Our data suggest that the strategic location of facilities and promotions used in NYC seek to maximize patronage by those with comparatively high levels of income and education and who may be more influenced by the social desirability of artificial tanning. Long-term interventions aimed at changing social norms regarding tan skin are needed.

Warning signs observed in tanning salons in New York City: implications for skin cancer prevention.

Use of artificial tanning may be contributing to the increased incidence of skin cancer. Federal law requires warning signs to inform consumers about health risks. All of the tanning facilities in New York City were assessed for compliance with this law during April and May 2010. More than one-third of the 224 tanning machines observed in 47 of the 85 facilities visited did not have any warning signs posted, and signs were difficult to see in many others.

Telephone outreach to increase colorectal cancer screening in an urban minority population.

OBJECTIVES: We compared the effectiveness of a telephone outreach approach versus a direct mail approach in improving rates of colorectal cancer (CRC) screening in a predominantly Black population. METHODS: A randomized trial was conducted between 2000 and 2003 that followed 456 participants in the New York metropolitan area who had not had recent CRC screening. The intervention group received tailored telephone outreach, and the control group received mailed printed materials. The primary outcome was medically documented CRC screening 6 months or less after randomization. RESULTS: CRC screening was documented in 61 of 226 (27.0%) intervention participants and in 14 of 230 (6.1%) controls (prevalence rate difference=20.9%; 95% CI = 14.34, 27.46). Compared with the control group, the intervention group was 4.4 times more likely to receive CRC screening within 6 months of randomization. CONCLUSIONS: Tailored telephone outreach can increase CRC screening in an urban minority population.

Association between prescription co-payment amount and compliance with adjuvant hormonal therapy in women with early-stage breast cancer.

PURPOSE: Noncompliance with adjuvant hormonal therapy among women with breast cancer is common. Little is known about the impact of financial factors, such as co-payments, on noncompliance. PATIENTS AND METHODS: We conducted a retrospective cohort study by using the pharmacy and medical claims database at Medco Health Solutions. Women older than age 50 years who were taking aromatase inhibitors (AIs) for resected breast cancer with two or more mail-order prescriptions, from January 1, 2007, to December 31, 2008, were identified. Patients who were eligible for Medicare were analyzed separately. Nonpersistence was defined as a prescription supply gap of more than 45 days without subsequent refill. Nonadherence was defined as a medication possession ratio less than 80% of eligible days. RESULTS: Of 8110 women younger than age 65 years, 1721 (21.1%) were nonpersistent and 863 (10.6%) were nonadherent. Among 14,050 women age 65 years or older, 3476 (24.7%) were nonpersistent and 1248 (8.9%) were nonadherent. In a multivariate analysis, nonpersistence (ever/never) in both age groups was associated with older age, having a non-oncologist write the prescription, and having a higher number of other prescriptions. Compared with a co-payment of less than $30, a co-payment of $30 to $89.99 for a 90-day prescription was associated with less persistence in women age 65 years or older (odds ratio [OR], 0.69; 95% CI, 0.62 to 0.75) but not among women younger than age 65, although a co-payment of more than $90 was associated with less persistence both in women younger than age 65 (OR, 0.82; 95% CI, 0.72 to 0.94) and those age 65 years or older (OR, 0.72; 95% CI, 0.65 to 0.80). Similar results were seen with nonadherence. CONCLUSION: We found that higher prescription co-payments were associated with both nonpersistence and nonadherence to AIs. This relationship was stronger in older women. Because noncompliance is associated with worse outcomes, future policy efforts should be directed toward interventions that would help patients with financial difficulties obtain life-saving medications.

Facilitating factors for colorectal cancer screening.

BACKGROUND: In this retrospective study, we examined factors that facilitated receipt of colorectal cancer (CRC) screening in a sample of low-income, predominantly African Americans participating in a tailored telephone education intervention. METHODS: A total of 61 individuals who received CRC screening were matched on age and sex with 61 individuals who had not received screening. Using records collected as part of the intervention, we identified facilitating factors and compared them between groups. RESULTS: We identified 8 facilitating factors, of which there were significant bivariate relationships with 6 factors. These 6 factors were stated familiarity with CRC test, seemed to only need reminder calls, seemed ready to screen, primary care physician (PCP) encouraged CRC screening, had an upcoming PCP appointment, and being prevention oriented. CONCLUSIONS: Identifying facilitating factors in those who receive screening may lead to insights about what factors need to be cultivated in those who do not receive screening.

Patient preferences and adherence to colorectal cancer screening in an urban population.

We measured patient preferences for colorectal cancer (CRC) screening strategies and actual receipt of alternative CRC screening tests among an urban minority sample participating in an intervention study. The fecal occult blood test was the most preferred test, reportedly owing to its convenience and the noninvasive nature. For individuals who obtained a test that was other than their stated preference (41.1%), reasons for this discordance may be due to physician preferences that override patient preferences.

Barriers to colorectal cancer screening: an educational diagnosis.

BACKGROUND: Colorectal cancer (CRC) is a largely preventable disease through early detection and treatment, yet screening rates remain low and mortality rates remain high, particularly among low-income, minority populations. This study was conducted to identify barriers to CRC screening. METHODS: Repeated telephone contacts were conducted with 226 individuals from 52 to 80 years of age, who had not recently received CRC screening. The contacts were intended to educate and encourage participants to obtain CRC screening. Within this context, CRC screening barriers were identified and categorized using an educational diagnosis as specified in the Precede-Proceed Framework. RESULTS: Findings showed that the most frequently observed barrier was lack of familiarity with CRC screening guidelines and tests. Availability and accessibility to screening tests was a barrier that was difficult to overcome for many participants. The majority of participants faced two or more barriers. CONCLUSIONS: This study suggests a need for public health education about CRC screening guidelines and tests and greater accessibility to CRC screening.