Association of Cigarette Smoking and Alcohol Consumption With Subsequent Mortality Among Black Breast Cancer Survivors in New Jersey.

Importance: There are limited data about how lifestyle factors are associated with breast cancer prognosis among Black or African American women because most of the evidence is based on studies of White breast cancer survivors. Objective: To examine the association of prediagnostic cigarette smoking and alcohol consumption with all-cause mortality and breast cancer-specific mortality in a cohort of Black breast cancer survivors. Design, Setting, and Participants: This population-based cohort study included 1926 Black or African American breast cancer survivors who received a diagnosis from June 6, 2005, to May 21, 2019, identified in 10 counties in New Jersey through rapid case ascertainment by the New Jersey State Cancer Registry. Statistical analysis was conducted from January 1, 2021, to August 1, 2022. Exposures: Information on prediagnostic cigarette smoking, alcohol consumption, and additional covariates was collected during in-person interviews. The covariates examined included smoking status at the time of breast cancer diagnosis (currently smoking at the time of breast cancer diagnosis, formerly smoking, or never smoking), smoking duration (number of years smoking), smoking intensity (cigarettes smoked per day), number of pack-years of smoking, and regular alcohol consumption the year before diagnosis (categorized as nondrinkers, ≤3 drinks per week, or >3 drinks per week). Main Outcomes and Measures: Primary outcomes included breast cancer-specific mortality and all-cause mortality. Results: Among the 1926 women in the study, the mean (SD) age at breast cancer diagnosis was 54.4 (10.8) years. During 13 464 person-years of follow-up (median follow-up, 6.7 years [range, 0.5-16.0 years]), there were 337 deaths, of which 187 (55.5%) were breast cancer related. Compared with never smokers, current smokers at the time of breast cancer diagnosis had a 52% increased risk for all-cause mortality (hazard ratio [HR], 1.52; 95% CI, 1.15-2.02), which was most pronounced for those with 10 or more pack-years of smoking (HR, 1.84; 95% CI, 1.34-2.53). Similar findings were observed for breast cancer-specific mortality (current smokers vs never smokers: HR, 1.27; 95% CI, 0.87-1.85), although they were not statistically significant. There was no statistically significant association between alcohol consumption and all-cause mortality (>3 drinks per week vs nondrinkers: HR, 1.05; 95% CI, 0.73-1.51) or breast cancer-specific mortality (>3 drinks per week vs nondrinkers: HR, 1.06; 95% CI, 0.67-1.67). Conclusions and Relevance: This population-based cohort study of Black breast cancer survivors suggests that current smoking at the time of diagnosis was associated with an increased risk of all-cause mortality, particularly among women with greater pack-years of smoking.

Multilevel Factors for Adiposity Change in a Population-Based Prospective Study of Black Breast Cancer Survivors.

PURPOSE: Unfavorable weight change after breast cancer diagnosis increases the risk of mortality, but individual and neighborhood risk factors affecting postdiagnosis weight and body fat changes are unclear among Black women, who have higher rates of obesity and mortality than any other racial/ethnic group. METHODS: Adiposity changes during the period approximately 10 months-24 months after diagnosis were evaluated among 785 women diagnosed between 2012 and 2018 and enrolled in the Women's Circle of Health Follow-Up Study, a population-based prospective cohort of Black breast cancer survivors in New Jersey. Multilevel factors for weight and fat mass change (with gain or loss defined as a relative difference of 3% or more, and considering whether changes were intentional or unintentional) were estimated using multivariable polytomous logistic regressions and multilevel models. RESULTS: Adiposity gain was prevalent: 28% and 47% gained weight and body fat, respectively, despite a high baseline prevalence of overweight or obesity (86%). Risk factors for fat mass gain included receiving chemotherapy (relative risk ratio: 1.59, 95% CI, 1.08 to 2.33) and residing in neighborhoods with a greater density of fast-food restaurants (relative risk ratio comparing highest with lowest tertile: 2.18, 95% CI, 1.38 to 3.46); findings were similar for weight gain. Only 9% of women had intentional weight loss, and multilevel risk factors differed vastly from unintentional loss. CONCLUSION: Both individual and neighborhood factors were associated with adiposity change among Black breast cancer survivors. Residential environment characteristics may offer clinically meaningful information to identify cancer survivors at higher risk for unfavorable weight change and to address barriers to postdiagnosis weight management.

Disparities in HPV vaccine knowledge and adolescent HPV vaccine uptake by parental nativity among diverse multiethnic parents in New Jersey.

BACKGROUND: Suboptimal human papillomavirus (HPV) vaccination rates persist among adolescents in the United States (U.S.). New Jersey (NJ), among the top, most racially/ethnically diverse states in the U.S., had among the lowest HPV vaccine initiation rates, prior to 2018. This study examined parental HPV vaccine knowledge and adolescent HPV vaccine initiation among multiethnic parents in NJ, where access to language concordant HPV vaccine information and vaccination services may differ, for immigrant parents. METHODS: We surveyed parents of adolescents (ages 11-18) at community events in NJ to examine parental HPV vaccine knowledge and adolescent HPV vaccine uptake. Vaccine knowledge was assessed using an 11-item question stem that covered vaccine efficacy, gender recommendation, vaccine protection, and myths. Multivariable models assessed the association of parent nativity on HPV vaccine knowledge scores and adolescent HPV vaccine initiation, controlling for sociodemographic factors. RESULTS: Of the 77 parents, most parents (84%) were aware of the HPV vaccine. However, knowledge scores were low and differed by parent nativity. Non-U.S. born parents had significantly lower knowledge scores - 1.7 [- 3.1, - 0.4] and lower odds of adolescent children initiating the HPV vaccine 0.3 [0.1, 0.9] compared to U.S.-born parents after adjusting demographic characteristics. CONCLUSIONS: Our findings reveal that parental HPV vaccine knowledge remains low among suburban dwelling, immigrant parents, even though they have higher education and access to health care. Multilevel strategies to reduce missed opportunities for HPV vaccine education among parents and HPV vaccination for adolescents are needed, including for suburban, immigrant communities.

Association of Body Mass Index, Central Obesity, and Body Composition With Mortality Among Black Breast Cancer Survivors.

IMPORTANCE: Obesity disproportionately affects Black women, who also have a higher risk of death after a breast cancer diagnosis compared with women of other racial/ethnic groups. However, few studies have evaluated the association of measures of adiposity with mortality among Black breast cancer survivors. OBJECTIVE: To assess the association of measures of adiposity with survival after a breast cancer diagnosis among Black women. DESIGN, SETTING, AND PARTICIPANTS: This prospective population-based cohort study comprised 1891 women with stage 0 to IV breast cancer who self-identified as African American or Black and were ages 20 to 75 years. The New Jersey State Cancer Registry was used to identify women living in 10 counties in New Jersey who were recruited from March 1, 2006, to February 29, 2020, and followed up until September 2, 2020. EXPOSURES: Measures of adiposity, including body mass index, body fat distribution (waist circumference and waist-to-hip ratio), and body composition (percent body fat and fat mass index), were collected during in-person interviews at approximately 10 months after breast cancer diagnosis. MAIN OUTCOMES AND MEASURES: All-cause and breast cancer-specific mortality. RESULTS: Among 1891 women, the mean (SD) age at breast cancer diagnosis was 54.5 (10.8) years. During a median follow-up of 5.9 years (range, 0.5-14.8 years), 286 deaths were identified; of those, 175 deaths (61.2%) were associated with breast cancer. A total of 1060 women (56.1%) had obesity, and 1291 women (68.3%) had central obesity. Higher adiposity, particularly higher waist-to-hip ratio, was associated with worse survival. Women in the highest quartile of waist-to-hip ratio had a 61% increased risk of dying from any cause (hazard ratio [HR], 1.61; 95% CI, 1.12-2.33) and a 68% increased risk of breast cancer death (HR, 1.68; 95% CI, 1.04-2.71) compared with women in the lowest quartile. The risks of all-cause and breast cancer-specific death were similarly high among women in the highest quartile for waist circumference (HR, 1.74 [95% CI, 1.26-2.41] and 1.64 [95% CI, 1.08-2.48], respectively), percent body fat (HR, 1.53 [95% CI, 1.09-2.15] and 1.81 [95% CI, 1.17-2.80]), and fat mass index (HR, 1.57 [95% CI, 1.11-2.22] and 1.74 [95% CI, 1.10-2.75]); however, the risk was less substantial for body mass index (HR, 1.26 [95% CI, 0.89-1.79] and 1.33 [95% CI, 0.84-2.10]). In analyses stratified by estrogen receptor status, menopausal status, and age, a higher waist-to-hip ratio was associated with a higher risk of all-cause death among women who had estrogen receptor-negative tumors (HR, 2.24; 95% CI, 1.14-4.41), women who were postmenopausal (HR, 2.15; 95% CI, 1.28-3.61), and women who were 60 years or older at diagnosis (HR per 0.10-U increase, 1.76; 95% CI, 1.37-2.26). CONCLUSIONS AND RELEVANCE: In this population-based cohort study, central obesity and higher adiposity were associated with higher all-cause and breast cancer-specific mortality among Black breast cancer survivors. Simple measures of body fat distribution and body composition were found to be useful tools for identifying Black women with a higher risk of death after a breast cancer diagnosis.

Physician skin cancer screening among U.S. military veterans: Results from the National Health Interview Survey.

INTRODUCTION: Although military veterans are at increased risk for skin cancer, little is known about the extent to which they have been screened for skin cancer. The study objective was to examine the prevalence and correlates of physician skin cancer screening among U.S. military veterans. METHODS: Data were drawn from the National Health Interview Survey. The study sample consisted of 2,826 individuals who reported being military veterans. Receipt of a physician skin examination was measured using a single question that asked participants whether they had ever had all of their skin from head to toe checked for cancer by a dermatologist or some other kind of doctor. RESULTS: Less than a third (30.88%) of participants reported ever having a physician skin examination. Factors positively associated with receipt of a physician skin examination in a multivariable logistic regression analysis included: older age, greater educational level, non-Hispanic white race/ethnicity, having TRICARE (military) health insurance, greater skin sensitivity to the sun, and engagement in more sun protection behaviors. CONCLUSIONS: The majority of military veterans have never been screened for skin cancer by a physician. Screening rates were higher among individuals with one or more skin cancer risk factors. Future research is warranted to test targeted skin cancer screening interventions for this at risk and understudied population.

Correction: Association Between State Indoor Tanning Legislation and Google Search Trends Data in the United States From 2006 to 2019: Time-Series Analysis.

[This corrects the article DOI: 10.2196/26707.].

Association Between State Indoor Tanning Legislation and Google Search Trends Data in the United States From 2006 to 2019: Time-Series Analysis.

BACKGROUND: Exposure to ultraviolet radiation from the sun or indoor tanning is the cause of most skin cancers. Although indoor tanning has decreased in recent years, it remains most common among adolescents and young adults, whose skin is particularly vulnerable to long-term damage. US states have adopted several types of legislation to attempt to minimize indoor tanning among minors: a ban on indoor tanning among all minors, a partial minor ban by age (eg, <14 years), or the requirement of parental consent or accompaniment for tanning. Currently, only 6 US states have no indoor tanning legislation for minors. OBJECTIVE: This study investigated whether internet searches (as an indicator of interest) related to indoor tanning varied across US states by the type of indoor tanning legislation, using data from Google Trends from 2006 to 2019. METHODS: We conducted a time-series analysis of Google Trends data on indoor tanning from 2006 to 2019 by US state. Time-series linear regression models were generated to assess the Google Trends data over time by the type of indoor tanning legislation. RESULTS: We found that indoor tanning search rates decreased significantly for all 50 states and the District of Columbia over time (P<.01). The searches peaked in 2012 when indoor tanning received marked attention (eg, indoor tanning was banned for all minors by the first state-California). The reduction in search rates was more marked for states with a complete ban among minors compared to those with less restrictive types of legislation. CONCLUSIONS: Our findings are consistent with those of other studies on the association between indoor tanning regulations and attitudinal and behavioral trends related to indoor tanning. The main limitation of the study is that raw search data were not available for more precise analysis. With changes in interest and norms, indoor tanning and skin cancer risk among young people may change. Future studies should continue to determine the impact of such public health policies in order to inform policy efforts and minimize risks to public health.

Predictors of health-related quality of life among Hispanic and non-Hispanic White breast cancer survivors in New Jersey.

PURPOSE: To examine predictors of health-related quality of life (HRQoL) in Hispanic and non-Hispanic White (NHW) breast cancer (BC) survivors. DESIGN: Cross-sectional study using survey data. PARTICIPANTS: Women diagnosed with BC at ages 21-79 years, between 2012-2014, recruited from the New Jersey State Cancer Registry. METHODS: HRQoL was assessed using the Functional Assessment Cancer Therapy (FACT-G) instrument. Descriptive statistics compared Hispanics and NHWs, and multivariate regression analyses identified predictors of HRQoL. RESULTS: HRQoL was significantly higher scores among NHW (85.7 ± 18.5) than Hispanics (79.4 ± 20.1) (p < 0.05). In multivariate analyses, comorbidities (ß: -13.3, 95%CI: -20.6, -5.92), late-stage diagnosis (ß: -5.67, 95%CI: -10.7, -0.62), lower income (ß: -13.9, 95%CI: -19.8, -7.97) and younger age at diagnosis were associated with lower HRQoL. CONCLUSION: Socio-demographic and clinic characteristics were significant predictors of HRQoL among diverse BC survivors. IMPLICATIONS FOR PSYCHOSOCIAL ONCOLOGY: Supportive psychosocial care interventions tailored to the needs of young, low-income BC survivors with comorbidities are needed.

Prevalence and Location of Indoor Tanning Among High School Students in New Jersey 5 Years After the Enactment of Youth Access Restrictions.

Importance: Several state governments have enacted bans on the use of indoor tanning beds at tanning salons among minors, but studies of the association of such restrictions with tanning behavior have produced mixed results. Little is known about the prevalence of tanning in nonsalon locations that are typically not covered by restrictions. Evidence that age bans are associated with a reduction in tanning bed use is needed to support policy makers' efforts to expand tanning regulations. Objective: To determine the prevalence and location of indoor tanning among New Jersey youths after a 2013 statewide indoor tanning ban for minors younger than 17 years. Design, Setting, and Participants: This survey study comprised 4 biennial (2012-2018) and representative cross-sectional surveys conducted among 12 659 high school students (grades 9-12) in New Jersey. Main Outcomes and Measures: The main outcome was the frequency of indoor tanning in the past year. Location of tanning bed use (ie, tanning salons or nonsalon locations, such as private residences or gyms) was also assessed. Results: Survey responses from a total of 12 659 high school students (6499 female [51%]; mean [SD] age, 15.8 [1.3] years) were analyzed across the 4 survey waves. Tanning prevalence among students younger than 17 years (ie, younger than the legal tanning age) was 48% lower in 2018 compared with 2012 (adjusted odds ratio, 0.52; 95% CI, 0.33-0.81; P = .002). Tanning prevalence was 72% lower among female students 17 years or older (adjusted odds ratio, 0.28; 95% CI, 0.18-0.44; P < .001). Prevalence rates were not significantly different for male students 17 years or older and for racial/ethnic minority students. The prevalence of tanning in salons and private residences was similar among students younger than 17 years. Conclusions and Relevance: This study suggests that the prevalence of tanning in New Jersey has begun to decrease among all youths younger than the legal tanning age and among female students of legal age in the 5 years after a statewide tanning ban. These findings provide valuable evidence to policy makers to support ongoing state-level efforts to enact age-specific bans on indoor tanning. The unique assessment of tanning location demonstrates the need for both greater enforcement of existing tanning salon regulations to ensure compliance and broadening restrictions to cover nonsalon tanning locations.

Feasibility of FitSurvivor: A technology-enhanced group-based fitness intervention for adolescent and young adult survivors of childhood cancer.

BACKGROUND: This study evaluated the feasibility of a technology-enhanced group-based fitness intervention for adolescent and young adult (AYA) survivors of childhood cancer. PROCEDURE: AYA survivors ages 13-25 years were randomized to the intervention (eight in-person group sessions with mobile app and FitBit followed by 4 weeks of app and FitBit only) or waitlist control. Assessments were at 0, 2, 3, 6, and 9 months. Feasibility was evaluated by enrollment, retention, attendance, app engagement, and satisfaction. Secondary outcomes included physical activity, muscular strength/endurance, cardiorespiratory fitness, health-related quality of life, and fatigue. RESULTS: A total of 354 survivors were mailed participation letters; 68 (19%) were screened, of which 56 were eligible and 49 enrolled (88% of those screened eligible, 14% of total potentially eligible). Forty-nine survivors (Mage  = 18.5 years, 49% female) completed baseline assessments and were randomized (25 intervention, 24 waitlist). Thirty-seven (76%) completed the postintervention assessment and 32 (65%) completed the final assessment. On average, participants attended 5.7 of eight sessions (range 1-8). Overall intervention satisfaction was high (M = 4.3, SD = 0.58 on 1-5 scale). Satisfaction with the companion app was moderately high (M = 3.4, SD = 0.97). The intervention group demonstrated significantly greater improvement in lower body muscle strength compared to the waitlist postintervention, and small but not statistically significant changes in other secondary measures. CONCLUSIONS: A group-based intervention with a mobile app and fitness tracker was acceptable but has limited reach due to geographical barriers and competing demands experienced by AYA survivors.

The Women's Circle of Health Follow-Up Study: a population-based longitudinal study of Black breast cancer survivors in New Jersey.

PURPOSE: The Women's Circle of Health Follow-Up Study is an ongoing longitudinal study of African American/Black breast cancer survivors in New Jersey, specifically designed to evaluate the impact of obesity and related comorbidities on breast cancer survival and health-related quality-of-life in this understudied population. Here, we describe our recruitment and data collection methods and compare characteristics of the overall cohort and the subcohort with follow-up data. METHODS: Newly diagnosed breast cancer cases have been recruited into the study since 2006. Pre-diagnosis data on relevant factors and a saliva sample are collected during an in-person interview within 12 months from diagnosis. In 2013, we began active follow up by recontacting participants annually, including two home visits at approximately 2 and 3 years post-diagnosis, during which blood samples are collected. Mortality outcomes (all-cause and breast cancer-specific mortality) are ascertained through linkage with New Jersey State Cancer Registry files. We expect to assemble a cohort of over 2000 Black breast cancer survivors with at least 800 of them having detailed post-diagnosis data. RESULTS: Distribution of sociodemographic characteristics, body mass index, comorbidities, clinicopathologic characteristics, and treatment modalities were very similar between those in the full cohort and the subset with follow-up data and blood samples. Obesity (> 50%), hypertension (> 58%), and diabetes (22%) were common in this population. CONCLUSIONS AND IMPLICATIONS FOR CANCER SURVIVORS: This ongoing longitudinal study represents a unique resource to better understand breast cancer outcomes, patient-reported symptoms, and health-related quality of life among Black breast cancer survivors.

Perspective on the Development of a Large-Scale Clinical Data Repository for Pediatric Hearing Research.

The use of "big data" for pediatric hearing research requires new approaches to both data collection and research methods. The widespread deployment of electronic health record systems creates new opportunities and corresponding challenges in the secondary use of large volumes of audiological and medical data. Opportunities include cost-effective hypothesis generation, rapid cohort expansion for rare conditions, and observational studies based on sample sizes in the thousands to tens of thousands. Challenges include finding and forming appropriately skilled teams, access to data, data quality assessment, and engagement with a research community new to big data. The authors share their experience and perspective on the work required to build and validate a pediatric hearing research database that integrates clinical data for over 185,000 patients from the electronic health record systems of three major academic medical centers.

Intake of vitamin D and calcium, sun exposure, and risk of breast cancer subtypes among black women.

BACKGROUND: The randomized placebo-controlled Vitamin D and Omega-3 Trial suggested a possible benefit of vitamin D on cancer incidence among black individuals. However, data are limited regarding the impact of vitamin D on breast cancer subtypes among African-American/black women, who tend to develop more aggressive forms of breast cancer. OBJECTIVES: We hypothesize that more vitamin D exposure (through diet, supplements, and sunlight) and higher intake of calcium are associated with decreased risk of estrogen receptor (ER)+ and ER- breast cancer, and of triple-negative breast cancer (TNBC) among black women. METHODS: This study was conducted among 1724 black cases and 1233 controls in the Women's Circle of Health Study (WCHS) and WCHS2. Polytomous logistic regressions were used to estimate ORs and 95% CIs of ER+ and ER- breast cancer; logistic regressions were used for TNBC. The ORs from each study were pooled using an inverse-variance-weighted random-effects model. RESULTS: Dietary vitamin D and calcium intake were not associated with risk of breast cancer subtypes in the pooled analysis. For supplemental vitamin D, we observed possible inverse associations between intake of ≤800 IU/d (compared with nonuse) and risk of several subtypes, with effects that appeared strongest for TNBC (OR: 0.58; 95% CI: 0.35, 0.94); no association was found for >800 IU/d. More daylight hours spent outdoors in a year was associated with lower risk of ER+, ER-, and TNBC (e.g., highest compared with lowest quartile: TNBC OR: 0.53; 95% CI: 0.31, 0.91; P-trend = 0.02). CONCLUSIONS: Moderate supplemental vitamin D intake was associated with decreased risk of TNBC, and increased sun exposure was associated with reduced risk of ER+, ER-, and TNBC among black women.

Factors Associated with Initial Mode of Breast Cancer Detection among Black Women in the Women's Circle of Health Study.

Mammogram-detected breast cancers have a better prognosis than those identified through clinical breast exam (CBE) or through self-detection, primarily because tumors detected by mammography are more likely to be smaller and do not involve regional nodes. In a sample of 1,322 Black women, aged 40-75 years, diagnosed with breast cancer between 2002 and 2016, we evaluated factors associated with CBE and self-detection versus screening mammogram as the initial mode of breast cancer detection, using multivariable logistic regression models. Compared with screening mammogram, history of routine screening mammogram (OR 0.20, 95% CI: 0.07, 0.54) and performance of breast self-examination (BSE) (OR 0.31, 95% CI: 0.13, 0.74) before diagnosis were associated with lower odds of CBE as the initial mode of detection, while performance of CBEs before diagnosis (OR 11.04, 95% CI: 2.24, 54.55) was positively associated. Lower body mass index (<25.0 kg/m2 vs. ≥35.0 kg/m2: OR 2.46, 95% CI: 1.52, 3.98), performance of BSEs before diagnosis (less than once per month: OR 4.08, 95% CI: 2.45, 6.78; at least monthly: OR 4.99, 95% CI: 3.13, 7.97), and larger tumor size (1.0-2.0 cm vs. <1.0 cm: OR 2.92, 95% CI: 1.84, 4.64; >2.0 cm vs. <1.0 cm: OR 6.41, 95% CI: 3.30, 12.46) were associated with increased odds of self-detection relative to screening mammogram. The odds of CBE and self-detection as initial modes of breast cancer detection among Black women are independently associated with breast care and breast cancer screening services before diagnosis and with larger tumors at diagnosis.

Shared Care During Breast and Colorectal Cancer Treatment: Is It Associated With Patient-Reported Care Quality?

There is growing evidence that shared care, where the oncologist, primary care physician, and/or other specialty physicians jointly participate in care, can improve the quality of patients' cancer care. This cross-sectional study of breast and colorectal cancer patients (N = 534) recruited from the New Jersey State Cancer Registry examined patient and health system factors associated with receipt of shared care during cancer treatment into the early survivorship phase. We also assessed whether shared care was associated with quality indicators of cancer care: receipt of comprehensive care, follow-up care instructions, and written treatment summaries. Less than two-thirds of participants reported shared care during their cancer treatment. The odds of reporting shared care were 2.5 (95% CI: 1.46-4.17) times higher for colorectal than breast cancer patients and 52% (95% CI: 0.24-0.95) lower for uninsured compared with privately insured, after adjusting for other sociodemographic, clinical/tumor, and health system factors. No significant relationships were observed between shared care and quality indicators of cancer care. Given a substantial proportion of patients did not receive shared care, there may be missed opportunities for integrating primary care and nononcology specialists in cancer care, who can play critical roles in care coordination and managing comorbidities during cancer treatment.

Prevalence and correlates of intentional outdoor and indoor tanning among adolescents in the United States: Findings from the FLASHE survey.

A body of research has focused on adolescents' indoor tanning behaviors but relatively little is known about the prevalence of adolescents' intentional outdoor tanning (time spent outdoors to get a tan). The present study used data from the National Cancer Institute's 2014 Family Life, Activity, Sun, Health and Eating (FLASHE) cross-sectional survey to examine the prevalence and correlates of intentional outdoor and indoor tanning among adolescents in the United States. Both unadjusted (bivariate) and adjusted (multi-variate) logistic regressions were performed to test the associations between demographic variables, time spent on media (e.g., using computers), emotional status and outdoor or indoor tanning. The overall prevalence of frequent outdoor tanning among adolescents in the U.S. was 15.6% (95% CI 13.8-17.4%) and the rate of indoor tanning in the past 12 months was 3% (95% CI 2.2-3.9). The adjusted odds of intentional outdoor tanning were significantly higher among girls (AOR 2.39, 95% CI 1.75-3.27), Non-Hispanic Whites (AOR 2.85, 95% CI 1.99-4.07), and those who spent more time on cell phones (AOR 1.40, 95% CI 1.25-1.57). The adjusted odds of indoor tanning were significantly higher among those who spent more time on computers (AOR 1.38, 95% CI 1.09-1.74) and cell phones (AOR 1.49, 95% CI 1.19-1.87). This study provides evidence for the relationship between media use and tanning behaviors among adolescents.