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Objectives: We evaluated psychosocial, built-environmental, and policy-related correlates of adolescents' indoor tanning use., Methods: We developed 5 discrete data sets in the 100 most populous US cities, based on interviews of 6125 adolescents (aged 14-17 years) and their parents, analysis of state indoor tanning laws, interviews with enforcement experts, computed density of tanning facilities, and evaluations of these 3399 facilities' practices regarding access by youths. After univariate analyses, we constructed multilevel models with generalized linear mixed models (GLMMs)., Results: In the past year, 17.1% of girls and 3.2% of boys had used indoor tanning. The GLMMs indicated that several psychosocial or demographic variables significantly predicted use, including being female, older, and White; having a larger allowance and a parent who used indoor tanning and allowed their adolescent to use it; and holding certain beliefs about indoor tanning's consequences. Living within 2 miles of a tanning facility also was a significant predictor. Residing in a state with youth-access legislation was not significantly associated with use., Conclusions: Current laws appear ineffective in reducing indoor tanning; bans likely are needed. Parents have an important role in prevention efforts.

Objective: To assess indoor tanning facility practices in a sample of facilities in 116 cities representing all 50 states., Design: Cross-sectional study., Setting: United States., Participants: Employees of 3647 indoor tanning facilities were contacted by telephone. Data collectors (ie, confederates) posed as prospective, fair-skinned, 15-year-old female customers who had never tanned before., Main Outcome Measures: Confederates asked respondents about their facility's practices related to parental consent, parental accompaniment, and allowable tanning session frequency., Results: Approximately 87% of the facilities required parental consent, 14% required parental accompaniment, 5% said they would not allow the confederate to tan owing to her age, and 71% would allow tanning every day the first week of indoor tanning. In Wisconsin, which bans indoor tanning among those younger than 16 years, 70% of facilities would not allow the confederate to tan. Multivariate analyses indicated that facilities in states with a youth access law were significantly more likely to require parental consent (P <.001) and parental accompaniment (P <.001) than those in states without a youth access law. Law was not significantly related to allowable tanning frequency (P = .81). Conclusion We recommend that additional states pass youth access legislation, preferably in the form of bans.

Background: U.S. adolescents and young adults are using indoor tanning at high rates, even though it has been linked to both melanoma and squamous cell cancer. Because the availability of commercial indoor tanning facilities may influence use, data are needed on the number and density of such facilities., Methods: In March 2006, commercial indoor tanning facilities in 116 large U.S. cities were identified, and the number and density (per 100,000 population) were computed for each city. Bivariate and multivariate analyses conducted in 2008 tested the association between tanning-facility density and selected geographic, climatologic, demographic, and legislative variables., Results: Mean facility number and density across cities were 41.8 (SD=30.8) and 11.8 (SD=6.0), respectively. In multivariate analysis, cities with higher percentages of whites and lower ultraviolet (UV)index scores had significantly higher facility densities than those with lower percentages of whites and higher UV index scores., Conclusions: These data indicate that commercial indoor tanning is widely available in the urban U.S., and this availability may help explain the high usage of indoor tanning.

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.

A surprising finding from the present study was the occasional retailer practice of giving singles away upon confederates' requests to purchase singles. This practice was not expected, and additional data related to its occurrence (i.e., under what circumstances it occurred) were not collected. Although the prevalence of giving away singles was not high (approximately 6% of stores at pretest and 3% at posttest), the practice raises concern in that it may greatly facilitate experimental smoking and undermine cessation attempts. Availability (i.e., sales and giving) of single cigarettes dropped significantly during the four-month period of this study (34% to 10%), suggesting that a brief educational intervention followed by a "booster" mailing of materials effectively reduced single cigarette availability. The overall reduction in availability of singles was also seen for the two store types individually. It is noteworthy, however, that at both assessments, liquor stores were more likely than independent markets to have singles available. The finding that location of singles changed from on top of and behind the counter to exclusively behind the counter indicated that retailers may have become aware that providing singles is illegal, and made attempts to be less obvious about their availability. Although the ultimate goal was to completely eliminate the availability of single cigarettes, the change in location may be positive in that impulse buying could be diminished when singles are hidden.

Mammography facilities frequently use inreach strategies, such as reminders, to encourage annual returns by asymptomatic women 50 years of age and older. We describe three pilot studies that systematically compared various strategies. In each study, patients seen for a screening mammogram during a specified period were randomly assigned to a novel reminder condition or a comparison condition one year later, and return rates were monitored. In study 1, return rates for subjects receiving a standard mailed reminder (36%) and subjects receiving a mailed reminder plus incentive (32%) were similar. In study 2, return rates for subjects receiving a mailed reminder (44%) and subjects receiving a phoned reminder (48%) also were similar. However, study 3 focused on a mailed reminder on the referring physician's letterhead sent by the mammography facility versus no reminder, and a significant increase in return rates resulted (47% versus 19%). We present the implications of this pattern of findings and discuss the need for a larger trial of the physician-endorsed reminder.

Data were collected at multiple mammography facilities to determine the use of inreach strategies for asymptomatic women age 50 and older and the annual return rates for screening by this age group. Interviews with 26 facility managers indicated that the majority use a reminder strategy. Using chart audits in a subset (n = 10) of the facilities of 475 randomly-selected patients, the return rate in 1991 (of patients seen in 1990) averaged 41% within 18 months after the 1990 appointment. Those data suggest that mammography providers, as well as the women they serve, could benefit from interventions to encourage annual mammograms.