Cancer-related risk factors and preventive measures in US Hispanics/Latinos.

In this article, we provide prevalence data on major cancer-related risk factors, early detection testing, and vaccination among Hispanics using nationally representative surveys. Compared with non-Hispanic whites, Hispanic adults are less likely to be current smokers (13% vs 22%) or frequent alcohol drinkers, but they are more likely to be obese (32% vs 26%) and to have lower levels of mammography use within the past year (46% vs 51%), colorectal screening as per recommended intervals (47% vs 61%), and Papanicolaou (Pap) test use within the past 3 years (74% vs 79%). Within the Hispanic population, the prevalence of these risk factors and early detection methods substantially vary by country of origin. For example, Cuban men (20.7%) and Puerto Rican men (19%) had the highest levels of current smoking than any other Hispanic subgroups, while Mexican women had the lowest levels of mammogram use (44%) and Pap test use (71%). Hispanic migrants have a higher prevalence of hepatitis B virus and Helicobacter pylori, which cause liver and stomach cancer, respectively. Among Hispanic adolescents, tobacco use (eg, 20.8% use of any tobacco products), alcohol use (42.9%), and obesity (23.2%) remain highly prevalent risk factors. Although 56% of Hispanic adolescents initiate human papillomavirus vaccination, only 56% of them completed the 3-dose series. Differences in risk factors and early detection testing among Hispanic groups should be considered in clinical settings and for cancer control planning.

Physician sun protection counseling: prevalence, correlates, and association with sun protection practices among US adolescents and their parents, 2004.

OBJECTIVE: To assess the population prevalence and correlates of ever receiving physician advice to practice sun protection (i.e. sun protection counseling) and whether such counseling is associated with sun protection behaviors in adolescents and their parents. METHOD: Analysis of a nationally representative cross-sectional telephone survey of ultraviolet radiation exposure behaviors among US adolescents ages 11 to 18 and their parents, conducted between August and November 2004. RESULTS: Forty-four percent of US adolescents and their parents reported physician sun protection counseling. Counseling was more frequently reported by adolescents whose parents were also counseled, reported other sun protection information sources (skin cancer prevention media messages and school sun safety messages), had first degree relatives with skin cancer, and were white, non-Hispanic. Counseling was positively associated with regular sunscreen use, appropriate sunscreen application practices, and intermittent hat use, but not with other recommended behaviors. Sunscreen use rates were generally higher among adolescents reporting several sun protection information sources (counseling, media and school messages) than those with combinations of two or fewer of these sources. CONCLUSIONS: The role of physicians, either independently or in concert with other information sources, should be explored in strategies promoting primary skin cancer prevention behaviors among adolescents and parents.

Sunburns, sun protection and indoor tanning behaviors, and attitudes regarding sun protection benefits and tan appeal among parents of U.S. adolescents-1998 compared to 2004.

This study presents nationally representative trends (1998-2004) and patterns in skin cancer risk behaviors, including sunburns, sun protection, and indoor tanning behaviors, and attitudes regarding ultraviolet radiation exposure among parents of U.S. adolescents. Data were from the American Cancer Society Sun Surveys I and II, telephone-based random digit dialed cross-sectional surveys of U.S. adolescents and their parents conducted in the summers of 1998 and 2004. Between 1998 and 2004, use of sunscreen, wide-brimmed hats and composite use of three to five behaviors increased significantly; concurrently, indoor tanning use increased significantly and sunburn prevalence changed a little. In 2004, 47% reported summer sunburns and more than half of those received painful sunburns. Parents continued to report low compliance with recommended behaviors; sunscreen use was most frequently reported, but many followed inappropriate application practices. About 13% practiced indoor tanning in the past year. Parents reported high levels of positive attitudes toward sun protection benefit, but at the same time, significant proportions reported positive tan appeal and outdoor sun exposure attitudes. The low rates and mixed progress in safe ultraviolet radiation exposure behaviors demand more attention for primary skin cancer prevention among parents of adolescents that focuses on changing beliefs about tanning appeal and promotes comprehensive ultraviolet radiation exposure protection.

Mortality from leading causes by education and race in the United States, 2001.

BACKGROUND: Low educational attainment is a marker of socioeconomic status that correlates strongly with higher death rates from many conditions. No previous studies have analyzed national data to measure the number of deaths associated with lower education among working-aged adults (25-64 years) by race or ethnicity. Furthermore, no previous studies have examined comprehensively the relationship of education to cause-specific and all-cause mortality in the three largest racial or ethnic groups in the United States using national data. METHODS: Age-standardized, race/ethnicity-specific death rates from all causes and the 15 leading causes were measured among men and women aged 25-64 years by level of education based on U.S. national mortality data in 2001. The total number of deaths that potentially could be avoided among people aged 25-64 years was estimated by applying the mortality rates among college graduates (within each 5-year category of age, gender, and race/ethnicity) to each of the less-educated subpopulations. All analyses were performed in 2007. RESULTS: Nearly half (48%) of all deaths among men aged 25-64 years (white, black, and Hispanic), and 38% of all deaths in women would not have occurred in this age range if all segments of the population experienced the death rates of college graduates. Black men and women had the highest death rates from all causes combined and from many specific causes at nearly all levels of education, and the largest average life years lost before age 65 years. However, the total number of deaths associated with low education status was not confined to any single racial group. About 161,280 deaths in whites, 40,840 deaths in blacks, and 13,162 deaths in Hispanics in this age range were associated with educational disparity. CONCLUSIONS: Potentially avoidable factors associated with lower educational status account for almost half of all deaths among working-aged adults in the U.S.; these deaths are not confined to any single racial or ethnic group. These findings highlight the need for greater attention to social determinants of health.

Racial and ethnic disparities in smoking-cessation interventions: analysis of the 2005 National Health Interview Survey.

BACKGROUND: Recent national surveys document racial and ethnic disparities in receipt of smoking-cessation advice. This study updates and expands prior analyses using survey data for 2005, and evaluates the association between smokers' race and ethnicity and three separate measures of healthcare-encounter-based tobacco interventions: screening, smoking-cessation advice, and use of smoking-cessation aids. METHODS: Analyses are based on 4756 smokers (aged 18 and older) reporting a healthcare encounter within the past year who participated in the 2005 National Health Interview Survey (NHIS). Multivariate-adjusted OR and 95% CI for receipt of tobacco interventions in non-Hispanic black and Hispanic smokers were compared to those of non-Hispanic white smokers, adjusted for smokers' characteristics (sociodemographics, health status, and healthcare-utilization factors, and smoking-related characteristics). Analyses were done in 2006. RESULTS: Results show that compared to white smokers, black and Hispanic smokers had significantly lower odds of (1) being asked about tobacco use (AOR=0.70 and AOR=0.69, respectively); (2) being advised to quit (AOR=0.72 and AOR=0.64, respectively); or (3) having used tobacco-cessation aids during the past year in a quit attempt (AOR=0.60 and AOR=0.59, respectively). Compared to 2000 NHIS published data, the prevalence of receipt of advice to quit from a healthcare provider increased from 52.9% in 2000 to 61.2% in 2005, with increases across racial and ethnic groups. CONCLUSIONS: Despite progress in smokers' being advised to quit during healthcare encounters in the past 5 years, black and Hispanic smokers continue to be less likely than whites to receive and use tobacco-cessation interventions, even after control for socioeconomic and healthcare factors. Further actions are needed to understand and eliminate this disparity.

Under-use of smoking-cessation treatments: results from the National Health Interview Survey, 2000.

OBJECTIVE: To describe the use of treatment for tobacco dependence in relation to insurance status and advice from a healthcare provider in a population-based national sample interviewed in 2000. METHODS: Analyses are based on 3996 adult smokers who participated in the National Health Interview Survey in 2000, and who provided information on tobacco-cessation treatments used at their most recent quit attempt occurring in the last year. Age-adjusted and weighted categorical analysis was used to compute prevalence estimates of self-reported treatments (pharmacotherapy and behavioral counseling) for tobacco dependence. Multivariate logistic regression analyses were used to examine factors associated with use of treatments. RESULTS: Overall, 22.4% of smokers who tried to quit in the previous year used one or more types of cessation aid compared to 15% in 1986. Treatment usually involved pharmacotherapy (21.7%) rather than behavioral counseling (1.3%). Smokers attempting to quit were more likely to use cessation aids if covered by private (25.4%) or military (25.0%) insurance than by Medicare (17.8%), Medicaid (15.5%), or no insurance (13.2%). In a multivariate analysis of factors related to use of cessation aids, advice from a healthcare provider to quit smoking and the number of cigarettes smoked per day were significant predictors of treatment use, regardless of insurance status. CONCLUSIONS: Cessation aids are under-used across insurance categories. Advice by a healthcare provider to quit is associated with increased use of effective therapies for tobacco dependence. Systematic efforts are needed to eliminate barriers to appropriate treatment.

Amount, type, and timing of recreational physical activity in relation to colon and rectal cancer in older adults: the Cancer Prevention Study II Nutrition Cohort.

Physical activity has consistently been associated with lower risk of colon cancer, but information is limited on the amount, type, and timing of activities. The relationship between physical activity and rectal cancer is unclear. We examined characteristics of recreational physical activity in relation to colon and rectal cancer in the Cancer Prevention Study II Nutrition Cohort of 70,403 men and 80,771 women (median age, 63 years); 940 colon and 390 rectal cancers were identified from enrollment in 1992 to 1993 through August 1999. The multivariate-adjusted rate ratios (95% confidence intervals) associated with any recreational physical activity compared with none were 0.87 (0.71-1.06) for colon cancer and 0.70 (0.53-0.93) for rectal cancer. Colon cancer risk decreased significantly with increasing total hours (P for trend without reference group = 0.007) and metabolic equivalent hours (P for trend = 0.006) per week of activities. No clear decrease in rectal cancer risk was seen with increasing hours per week of physical activity. Rate ratios (95% confidence intervals) were 0.72 (0.52-0.98) for <2 hours, 0.68 (0.47-0.97) for 2 to 3 hours, 0.59 (0.41-0.83) for 4 to 6 hours, and 0.83 (0.59-1.16) for >/=7 hours per week of physical activity compared with none. Past exercise, as reported in 1982, was not associated with risk of either colon or rectal cancer. We conclude that increasing amounts of time spent at recreational physical activity are associated with substantially lower risk of colon cancer and that recreational physical activity is associated with lower risk of rectal cancer in older men and women.

Sun-safe practices in U.S. youth and their parents: role of caregiver on youth sunscreen use.

BACKGROUND: There is a limited understanding of the social influences, such as the role of parents on youth sun-safe practices, that may reduce the risk of developing skin cancer later in life. METHODS: This study examined the degree of correlation in sun-safe practices between youth and their parents and assessed independent parental factors of youth sunscreen use in a 1998 cross-sectional, population-based telephone survey of U.S. youth (11- to 18-year-olds) and their parents/caregivers (N=1192 pairs of youth and parents). RESULTS: Sunscreen-use practices between youth and their parents were significantly correlated, albeit small. Youth were significantly more likely to use sunscreen frequently if their parents applied it frequently on themselves. Multivariate analysis revealed three independent parental factors associated with frequent youth sunscreen use: Their parent reported to insist frequently that the child uses sunscreen (adjusted prevalence odds ratio [aPOR]=2.4, 95% confidence interval [CI], 1.6-3.8); parent reported no difficulty with protecting their child from the sun (aPOR=1.4, 95% CI, 1.1-1.9); and parent's own frequency of sunscreen use (aPOR=1.3, 95% CI, 0.9-1.8). CONCLUSIONS: Sun-safe practices were correlated between parent-child pairs and parental factors exerted a positive role on youth sunscreen-use frequency. These data may guide further sociobehavioral and intervention research for the design of skin cancer prevention programs in schools and communities to improve levels of sun-safe practices.

Trends in melanoma mortality among non-Hispanic whites by educational attainment, 1993-2007.

OBJECTIVE: To evaluate overall trends in melanoma mortality rates among non-Hispanic whites by educational level. DESIGN: Descriptive study. SETTING: Death certificate records from 26 states, representing approximately 45% of the US population as reported by the National Center for Health Statistics, with recorded educational level information and population data from the US Bureau of Census Current Population Survey. PATIENTS: Recorded deaths from malignant melanoma in non-Hispanic whites reported from 1993 through 2007. MAIN OUTCOME MEASURES: Age-standardized mortality rates for melanoma were evaluated by educational attainment (a marker of socioeconomic status) among non- Hispanic whites (aged 25-64 years) from 1993 through 2007. Rate ratios assessed the time trend in age-adjusted death rates by sex and educational level. Mortality differentials in educational level were measured using the regression-based Relative Index of Inequality. All statistical tests were 2-sided. RESULTS: Melanoma mortality declined significantly between 1993-1997 and 2003-2007 in men (RR [rate ratio], 0.916; 95% CI, 0.878-0.954; P.001) and women (RR, 0.907; 95% CI, 0.857-0.957; P.001). However, these declines occurred only among the most educated persons (≥13 years of education irrespective of sex), and nonsignificant increases were found among the least-educated individuals, specifically men (P=.17). As a result, the Relative Index of Inequality by education in melanoma mortality in 2003-2007 relative to 1993-1997 (baseline) widened by 51.7% in men and by 35.7% in women. CONCLUSIONS: Recent declines in melanoma mortality rates among non-Hispanic whites in the United States mainly reflect declines among the most-educated individuals. The widening disparities in melanoma mortality rates by education calls for early detection strategies to effectively target high-risk, less-educated, non-Hispanic white individuals.

The receipt and utilization of effective clinical smoking cessation services in subgroups of the insured and uninsured populations in the USA.

Subgroups among the uninsured and even the insured may be at increased risk for not receiving and utilizing effective clinical smoking cessation services. Data for this study came from 18 to 64 year old smokers in the 2005 National Health Interview Survey. Long-term uninsured (greater than or equal to one year) smokers were less likely to receive physician advice to quit than those continuously-insured in the past year. Being long-term and short-term uninsured (less than one year) was negatively associated with dependence treatments' use in quit attempts compared to the continuously-insured, even though the prevalence of quit attempts were similar between these groups. Intermittent-uninsurance (spell of uninsurance in past year) did not influence cessation services delivery or use. Even though Medicaid-insured smokers were more likely to be advised to quit than those privately-insured, they were less likely to use dependence treatments, especially if they had a spell of uninsurance in the past year. Provisions in the Affordable Care Act of 2009 that ensure coverage of effective cessation services for previously-uninsured individuals and Medicaid-insured smokers may increase access and potentially improve population cessation rates.

Impact of health care reform legislation on uninsured and medicaid-insured cancer patients.

The Patient Protection and Affordable Care Act of 2010 is the most important US health legislation since the creation of Medicare and Medicaid in 1965. Repeated attempts at a complete overhaul of the health care system under various administrations and 4 decades of incrementalism in our approach to health policy making paved the way for this historic legislation. Major components of the recently enacted legislation include a substantial expansion of the Medicaid program to include 17.1 million currently uninsured adults with incomes below 133% of the federal poverty line, a mandated minimum health benefits package, a renewed focus on prevention, the establishment of state health exchanges with special provisions to permit affordability by those with incomes below 400% of the federal poverty line, and the establishment of high-risk health insurance pools for patients who were previously denied coverage because of preexisting conditions. The time for change was long overdue. Although many challenges exist, particularly for the states, in the implementation phase of the Affordable Care Act, the benefit to low-income cancer patients is increased access to guideline-recommended levels of screening, diagnostic, treatment, and follow-up services.

Use of sunless tanning products among US adolescents aged 11 to 18 years.

OBJECTIVE: To describe the prevalence and correlates of the use of sunless tanning products among US adolescents and their association with UV radiation exposure behaviors, including indoor tanning, sunburn experiences, and use of sunscreen while outdoors. DESIGN: Telephone-based, random-digit-dialed, cross-sectional survey conducted from July 1 through October 30, 2004. SETTING: Telephone-accessible households with resident adolescents living with parents or caregivers in the mainland United States. PARTICIPANTS: Nationally representative, population-based sample of 1600 adolescents aged 11 to 18 years and their caregivers. MAIN OUTCOME MEASURE: Prevalence of recent (past-year) use of sunless tanning products and UV radiation exposure behaviors. RESULTS: The prevalence of self-reported use of sunless tanning products in the past year among US adolescents was 10.8%. Adolescent users of these products were more likely to be older and female, to perceive a tanned appearance as desirable, to have a parent or caregiver who used sunless tanning products, and to hold positive beliefs or attitudes about these products. Use of sunless tanning products was independently associated with indoor tanning and higher frequency of sunburn but not with use of sunscreen. CONCLUSIONS: Among US adolescents, 10.8% used sunless tanning products in the past year; this practice was associated with risky UV radiation exposure-related behaviors. Adolescents, therefore, must be educated about these products and the importance of avoiding indoor tanning and practicing sun-protective behaviors.

Parental communication not to smoke and adolescent cigarette smokers' readiness to quit: differences by age.

There is limited information on the relationship between parental practices that specifically discourage current cigarette smoking and adolescent cessation, and how this relationship varies by age. Among 1629 adolescent smokers, self-reported receipt of parental communication not to smoke was significantly and positively associated with readiness to quit. The strength and significance of this association decreased from early to middle adolescence and was not significant in late adolescence.

Cancer mortality in the United States by education level and race.

BACKGROUND: Although both race and socioeconomic status are well known to influence mortality patterns in the United States, few studies have examined the simultaneous influence of these factors on cancer incidence and mortality. We examined relationships among race, education level, and mortality from cancers of the lung, breast, prostate, colon and rectum, and all sites combined in contemporary US vital statistics. METHODS: Age-adjusted cancer death rates (with 95% confidence intervals [CIs]) were calculated for 137,708 deaths among 119,376,196 individuals aged 25-64 years, using race and education information from death certificates and population denominator data from the US Bureau of the Census, for 47 states and Washington, DC, in 2001. Relative risk (RR) estimates were used to compare cancer death rates in persons with 12 or fewer years of education with those in persons with more than 12 years of education. RESULTS: Educational attainment was strongly and inversely associated with mortality from all cancers combined in black and white men and in white women. The all-cancer death rates were nearly identical for black men and white men with 0-8 years of education (224.2 and 223.6 per 100,000, respectively). The estimated relative risk for all-cancer mortality comparing the three lowest (< or = 12 years) with the three highest (> 12 years) education categories was 2.38 (95% CI = 2.33 to 2.43) for black men, 2.24 (95% CI = 2.23 to 2.26) for white men, 1.43 (95% CI = 1.41 to 1.46) for black women, and 1.76 (95% CI = 1.75 to 1.78) for white women. For both men and women, the magnitude of the relative risks comparing the three lowest educational levels with the three highest within each race for all cancers combined and for lung and colorectal cancers was higher than the magnitude of the relative risks associated with race within each level of education, whereas for breast and prostate cancer the magnitude of the relative risks associated with race was higher than the magnitude of the relative risks associated with level of education within each racial group. Among the most important and novel findings were that black men who completed 12 or fewer years of education had a prostate cancer death rate that was more than double that of black men with more schooling (10.5 versus 4.8 per 100,000 men; RR = 2.17, 95% CI = 1.82 to 2.58) and that, in contrast with studies of mortality rates in earlier time periods, breast cancer mortality rates were higher among women with less education than among women with more education (37.0 and 31.1 per 100,000, respectively, for black women and 25.2 versus 18.6 per 100,000, respectively, for white women). CONCLUSION: Cancer death rates vary considerably by level of education. Identifying groups at high risk of death from cancer by level of education as well as by race may be useful in targeting interventions and tracking cancer disparities.

Sedentary behavior, recreational physical activity, and 7-year weight gain among postmenopausal U.S. women.

OBJECTIVE: To assess the relationship among recreational physical activity (PA), non-occupational sedentary behavior, and 7-year weight gain among postmenopausal U.S. women 40 to 69 years old. RESEARCH METHODS AND PROCEDURES: In 1992 and 1999, 18,583 healthy female participants from the Cancer Prevention Study II Nutrition Cohort completed questionnaires on anthropometric characteristics and lifestyle factors. The associations between recreational PA [in metabolic equivalent (MET) hours per week] and non-occupational sedentary behavior (in hours per day) at baseline and risk for 7-year weight gain (5 to 9 or >or =10 vs. +/-4 pounds) were assessed using multivariate logistic regression analysis. RESULTS: Neither PA nor sedentary behavior was associated with a 5- to 9-pound weight gain. Among women who were not overweight at baseline (BMI <25.0), the odds of > or =10-pound weight gain were 12% lower (odds ratio, 0.88; 95% confidence interval, 0.77 to 0.99) for those in the highest category of recreational PA (> or =18 MET h/wk) compared with >0 to <4 MET h/wk; odds were 47% higher (odds ratio, 1.47; 95% confidence interval, 1.21 to 1.79) for non-overweight women who reported > or =6 h/d of non-occupational sedentary behavior compared with <3 h/d. Neither PA nor sedentary behavior were associated with risk of > or =10-pound weight gain weight among women who were overweight at baseline (BMI > or =25.0). DISCUSSION: Both recreational PA and non-occupational sedentary behavior independently predicted risk of > or =10-pound weight gain among postmenopausal women who were not overweight at baseline. Public health messages to prevent weight gain among normal-weight postmenopausal women may need to focus on decreasing time spent in sedentary behaviors and increasing the amount of time spent on PA.

Sun protective behaviors and sunburn experiences in parents of youth ages 11 to 18.

BACKGROUND: Recent studies suggest that parental sun protective behaviors and communication influence their adolescents. However, there is limited information on sun protection for parents of adolescents. METHODS: A telephone-based, nationally representative prevalence study of sun exposure among youth, aged 11-18, and their parents living in households was conducted in 1998. Separate, independent responses were collected. Weighted prevalence estimates and 95% confidence intervals were estimated and presented for parents only (n = 1187). RESULTS: Approximately one-third of parents planned activities to avoid the sun and used sunscreen. Among parents who used sunscreen, 70% applied it while at the beach or pool, but not as often during other outdoor activities. Almost one-third of parents were participating in water or non-water recreational activities during their most serious sunburn. Differences in sun protection and sunburn experiences were observed by age, gender, sun sensitivity, race and ethnicity, and educational attainment. CONCLUSIONS: Parents have adopted sun protection habits, but have not surpassed national sun-protection goals. Combined use of sun protection behaviors may reduce sunburn prevalence and number of incident skin cancers. These data may be useful for developing or enhancing current sun protection programs for effective sun protection that include parents and their adolescents.

Correlates of underutilization of colorectal cancer screening among U.S. adults, age 50 years and older.

BACKGROUND: Although effective screening for colorectal cancer (CRC) exists, only 37% of incident CRC are diagnosed at a localized stage at which treatment is effective. We identified demographic and other characteristics of adults (> or = 50 years old) who reported no CRC screening. METHODS: We calculated the prevalence of never having had a fecal occult blood test and/or a sigmoidoscopy or colonoscopy by age, sex, and other factors using the 1999 Behavioral Risk Factor Surveillance System data. RESULTS: CRC screening tests were underutilized across all segments of the population. Underutilization was highest in persons aged 50-64 years and those with lower education and a lack of health insurance and preventive services. CONCLUSIONS: The data indicate that large proportions of average-risk adults across various sociodemographics and behavioral factors are not utilizing recommended CRC screening tests. There is a need to increase the awareness of the importance of utilizing effective CRC screening tests for the early detection of colorectal cancers.

Use of indoor tanning sunlamps by US youth, ages 11-18 years, and by their parent or guardian caregivers: prevalence and correlates.

BACKGROUND: Tanning parlors have become common in the United States. Artificial ultraviolet radiation exposure from this source may be harmful and may increase the risk of melanoma, particularly when done for recreational purposes during childhood and early adult years. Population-based data on the prevalence and correlates of this activity is important in the evaluation of potential public health interventions for skin cancer prevention. STUDY DESIGN: In 1998, we conducted a population-based telephone survey of youth and their primary caregiver. The sample (N = 1192) was weighted to represent the population of US youth living in households with a primary caregiver. Interviewers used a standardized questionnaire to document the characteristics of the participant and their practices, attitudes, and experiences regarding ultraviolet exposures. METHOD OF ANALYSIS: Weighted prevalence and adjusted prevalence odds ratios (aPOR) and 95% confidence interval (95% CI) were estimated. Independent factors were evaluated with multivariate logistic regression. RESULTS: Ten percent of youth and 8% of their primary caregivers used indoor tanning sunlamps in the previous year. Thirty percent of the youth whose caregivers used indoor tanning sunlamps did so themselves as well. Independent predictors associated with indoor tanning sunlamp use were as follows: age 17 to 18 years (aPOR = 11.1; 95% CI: 5.0, 25.0); female (aPOR = 8.3; 95% CI: 3.6, 19.2); having a parent who used indoor tanning sunlamps in the previous year (aPOR = 8.7; 95% CI: 4.0, 18.9); nonuser of Sun Protection Factor 15 sunscreen at the beach or pool (aPOR = 1.9; 95% CI: 1.0, 3.4); and low sun sensitivity (aPOR = 2.3; 95% CI: 1.0, 5.3). CONCLUSION: A substantial minority of American youth engages in indoor tanning. However, it is particularly prevalent among older youth, girls, and youth whose parents themselves use indoor tanning sunlamps. The knowledge of these trends may help focus public health initiatives.

Lung cancer trends in young adults: an early indicator of progress in tobacco control (United States).

OBJECTIVE: Tobacco smoking is known to increase lung cancer occurrence beginning in young adulthood, although age-specific rates have not been used to monitor the early consequences of tobacco control efforts in the United States. We evaluated state trends in lung cancer death rates among young adults in relation to an index of state tobacco control activities and conventional indices of current smoking and cessation. METHODS: We calculated lung cancer death rates in young adults (age 30-39 years) over two time intervals from 1990-1994 through 1995-1999 in states with at least 25 deaths per interval. We measured the correlation of an index of state tobacco control in 1992-1993 with absolute rates and with total percent change during the two time intervals. RESULTS: Both lung cancer death rates during the recent time interval (1995-1999) and the change in these rates from 1990-1994 correlated strongly and inversely with the index of state tobacco control efforts measured in 1992-1993. Lung cancer death rates decreased in states with high tobacco control efforts, but increased in states with low tobacco control efforts. Tobacco control indices were strongly and positively correlated with cessation of smoking by age 30-39 years. CONCLUSIONS: Lung cancer death rates among young adults are strongly and inversely correlated with recent indices of tobacco control. Future monitoring of the effectiveness of statewide comprehensive tobacco control programs should assess trends in lung cancer rates in young adults as well as youth and adult smoking prevalence.

Summer sunburn and sun exposure among US youths ages 11 to 18: national prevalence and associated factors.

OBJECTIVE: Epidemiologic evidence suggests that ultraviolet radiation (UVR), from sun exposure and sunburns during early life, is associated with increased risk of melanoma and other skin cancers in adulthood. The objective of this study was to gather national, population-based data on sun exposure and protection behaviors among US youths ages 11 to 18 to quantify the magnitude and patterns of sun exposure and establish baselines for continued surveillance. METHODS: A nationwide survey based on random-digit dialing and stratified, 2-stage national probability sampling was conducted of households with telephones in the 48 contiguous states of the United States during July through October of 1998; a population-based sample of 1192 youth ages 11 to 18 was studied to measure weighted prevalence estimates of summer sunburn and sun exposure and adjusted prevalence odds ratios and 95% confidence intervals from logistic regression analyses of sunburn. RESULTS: Among youths ages 11 to 18, 72% reported having had at least 1 summer sunburn, 30% reported at least 3, and 12% reported at least 5 sunburns. Before receiving their most serious summer sunburn, 39% of youths reported having applied sunscreen. Factors associated with increased odds of sunburn included greater sun sensitivity, white race, age younger than 16 years, more hours spent outdoors, and high desirability of a tan. CONCLUSIONS: Summer sunburn was the norm among US youths ages 11 to 18. The high frequency of sunscreen use during the sunburning episodes suggests the need to educate youth and parents better about proper use of these agents, as well as the importance of practicing other sun protection behaviors, such as wearing hats and protective clothing and avoiding the sun during peak exposure times. These data may serve as a baseline for tracking progress in skin cancer prevention efforts and will inform the crafting of future public health campaigns.