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Introduction Sunburn increases skin cancer risk and is common among U.S. adults. However, little is known about the contexts in which sunburns often occur. The purpose of this study is to examine the contextual factors surrounding sunburns among U.S. adults. Methods Cross-sectional data from a 2018 online panel survey were analyzed. A total of 4,088 panel members were recruited by mail using probability-based, random sampling by address. Respondents were asked about their most recent sunburn, and analyses were limited to those who remembered their most recent sunburn (N=3,106). Data were weighted to match the U.S. Current Population Survey proportions; analyses were conducted in 2018 and 2019. Results Participants’ age ranged from 18 to 93 years. About half (50.8%) were women, and most (82.3%) were non-Hispanic White adults. Swimming or spending time in water (32.5%), working outside at home (26.2%), traveling/vacationing (20.7%), and engaging in nonswimming physical activity (14.2%) were the most frequently reported activities. Using sunscreen on the face, neck, and chest (38.8%) and on the body (19.9%) and wearing sunglasses (34.2%) were the most frequently reported sun safety behaviors. Wearing clothes to the ankles (6.6%) and a long-sleeved shirt (4.5%) were least frequently reported. Conclusions This study provides new information about the contexts in which adult sunburns often occur, especially about contexts unrelated to intentional tanning, which was relatively infrequent. The results suggest the need to promote multiple forms of sun protection tailored to specific outdoor activities and develop innovative solutions for outdoor physical and aquatic activities, which present unique sun safety challenges.

Lancet Oncology, The - Sous presse. Epreuves corrigees par l'auteur. Disponible en ligne depuis le mercredi 11 aout 2021

Stereotactic ablative body radiation therapy (SBRT) has evolved as the standard treatment for patients with inoperable stage I non-small-cell lung cancer (NSCLC). We report the results of a retrospective analysis conducted on a large, well-controlled cohort of patients with stage I to II NSCLC who underwent lobectomy (LOB) or SBRT.One hundred eighty-seven patients with clinical-stage T1a-T2bNoMO NSCLC were treated in 2 academic hospitals between August 2008 and May 2015. Patients underwent LOB or SBRT; those undergoing SBRT were sub-classified as surgical candidates and nonsurgical candidates, according to the presence of surgical contraindications or comorbidities.In univariate analysis, no significant difference was found in local control between patients who underwent SBRT and LOB, with a trend in favor of surgery (hazard ratio [HR], 0.27; 95% confidence interval [CI], 0.07-1.01; P .053). Univariate analysis showed that overall survival (OS) was significantly better in patients who underwent LOB (HR, 0.44; 95% CI, 0.23-0.85) with a 3-year OS of 73.4% versus 65.2% for surgery and radiation therapy patients, respectively (P .01). However, no difference in OS was observed between operable patients undergoing SBRT and patients who underwent LOB (HR, 1.68; 95% CI, 0.72-3.90). Progression-free survival was comparable between patients who underwent LOB and SBRT (HR, 0.61; P = .09).SBRT is a valid therapeutic approach in early-stage NSCLC. Furthermore, SBRT seems to be very well-tolerated and might lead to the same optimal locoregional control provided by surgery for patients with either operable or inoperable early-stage NSCLC.

Importance In February 2019, the US Food and Drug Administration issued a proposed rule (84 FR 6204), an amendment to the Sunscreen Innovation Act of 2014, that would require listing active ingredients on the principal display panel of sunscreens to allow consumers to “more readily compare products and either select or avoid a given product accordingly.” Objective To understand consumers’ perceived importance of active ingredients in sunscreen and their ability to recall these ingredients when comparing, avoiding, or selecting sunscreen products. Design, Setting, and Participants In this qualitative study, participants were recruited from Fors Marsh Group and User Works, Inc consumer panels and interviewed in person in November and December 2019. Eligible participants were 18 years or older, reported sunscreen use in the past 12 months, and were residents of the Washington, DC, area. After viewing 2 mock sunscreen labels (1 that meets current US Food and Drug Administration requirements and 1 designed to meet proposed requirements), participants were asked questions to assess their perceived importance of active ingredients in sunscreen products, whether they could recall any of the active ingredients on the labels, and whether they typically looked for active ingredients on a sunscreen label. Main Outcomes and Measures The main outcomes were the sunscreen label information used by participants to select a sunscreen and their ability to recall the active ingredients after viewing 2 mock sunscreen labels. Results The mean (SD) age of the 47 participants was 42.8 (13.6) years, 32 (68%) were women, and 40 (85%) had a bachelor’s or graduate degree. Of the total, 13 (28%) participants stated that sunscreen ingredients influenced their sunscreen selection, but only 5 (11%) said it was the most important information. Instead, 34 (72%) participants stated that the sun protection factor rating was the most important information. After viewing the mock sunscreen labels, only 5 (11%) participants recalled any of the active ingredients, although 10 (21%) reported typically looking at active ingredients when choosing a sunscreen. Conclusions and Relevance This qualitative study investigated the US Food and Drug Administration’s proposed new rule requiring that active ingredients be listed on the front of sunscreen labels to facilitate product comparison for consumers. However, active ingredients were not reported to be a primary reason for consumers’ sunscreen selection. Recall of active ingredients was low, and few consumers reported typically looking at the active ingredients, which were more commonly used to avoid ingredients rather than to select a sunscreen. Therefore, listing active ingredients on the front label alone may not have the intended usefulness for consumers.

Introduction In this observational, retrospective, multicenter study, we aimed to assess the safety of the combination of local metastasis-directed radiotherapy (RT) and immunotherapy (IT) in a cohort of advanced non–small-cell lung cancer (aNSCLC) patients. Material and Methods We collected clinical data of aNSCLC patients who received concomitant RT and anti-PD-1/PD-L1 inhibitors in seven Italian centers from September 2015 to June 2019. Concomitant RT was defined as delivered ≤4 weeks before or after the first or last administration of immunotherapy, or within two consecutive cycles of ICI. All adverse events apparently related to RT and/or IT were graded according to the Common Terminology Criteria for Adverse Events, version 4.0, and reported in terms of incidence and severity as immune related or RT related, or combined. Results We analyzed the clinical charts of 187 patients. Median follow-up time was 23 months, and median overall survival was 16.5 months (range, 3-162). Thirteen patients developed pure RT-related side effects, and 43 patients (23.9%) developed immune-related side effects. No additive toxic effects were observed. A case of grade 5 pulmonary toxicity was recorded as a possible consequence of a combined effect. Conclusion This analysis suggests that the combination of concomitant RT and anti-PD-1/PD-L1 agents is safe, and the two toxicity profiles are independent.

Afatinib, a second-generation epidermal growth factor receptor (EGFR) tyrosine kinase inhibitor, is effective as first-line treatment in patients with EGFR-mutated non-small cell lung cancer (NSCLC). We report 2 cases of EGFR-mutated locally advanced NSCLC treated in neoadjuvant setting with EGFR tyrosine kinase inhibitor at University of Florence/Careggi Hospital. In both cases, afatinib was used for up to 3 months, until 1 week before surgery. Both patients achieved significant reduction (downstaging) of the pulmonary mass and lymphadenopathies and after surgery, it was decided for both cases to restore afatinib treatment up to a further 4 months. Both patients experienced local and distant disease relapses after 9 and 10 months, respectively, and then we restored the afatinib treatment.

Introduction: This retrospective study analyzes the safety and feasibility of concurrent chemoradiotherapy (CRT) in adjuvant treatment of soft tissue sarcoma (STS). Methods: A total of 158 patients with STS were retrospectively analyzed. Anthracycline-based computed tomography was performed in high-risk patients. Acute radiotherapy toxicity and chemotherapy-related toxicity were assessed according to the Common Terminology Criteria for Adverse Events 4.0; late radiotherapy toxicity was recorded according to Radiation Therapy Oncology Group/European Organization for Research and Treatment of Cancer criteria. Results: Fifty-four (34.2%) patients received CRT. Mean follow up was 5.4 years (range .2–21.1 years). Local DFS–recurrence-free survival, distant DFS–relapse-free survival, and overall survival were 79.1%, 76.4%, and 64.6%, respectively, at last follow-up. Leukopenia occurred in 11.4% of patients. Skin acute toxicity developed in 60.1% of patients and determined interruption of radiotherapy treatment in 19 (12%) patients. Nineteen patients (12%) experienced moderate fibrosis (grade 2). Mild and moderate joint stiffness was recorded in 16 (10.1%) patients. Size ≥5 cm was the only predictor of local recurrence at multivariate analysis (hazard ratio [HR] 9.65, 95% confidence interval [CI] 1.28–72.83, p = .028). Age and stage resulted as independent distant relapse predictors (HR 4.77, 95% CI 1.81–12.58, p = .002 and HR 4.83, CI 1.41–16.57, p = .012, respectively). At Cox regression univariate analysis, Karnofsky Performance Status, size, and stage were significant survival predictors (HR 2.23, 95% CI 1.02–4.87, p = .045; HR 2.88, 95% CI 1.10–7.52, p = .031; HR 2.59, 95% CI 1.11–6.04, p = .028). Conclusions: Concurrent CRT is a well-tolerated treatment option with no additional toxicity compared to exclusive radiotherapy or sequential CRT.

Introduction This study describes the calibration and validity of the Youth Activity Profile (YAP) for use in the National Cancer Institute’s Family Life, Activity, Sun, Health, and Eating (FLASHE) study. The calibrated YAP was designed to estimate minutes of moderate to vigorous physical activity (MVPA) and sedentary behavior (SB). Methods The YAP was calibrated/validated in adolescents (aged 12–17 years) using cross-sectional data from the FLASHE study. Participants wore a GT3X+ ActiGraph on the dominant wrist for 7 days and then completed the YAP. Calibration was conducted for school (n=118); out of school (n=119); weekend (n=61); and SB (n=116) subsections of the YAP and by regressing percentage time in MVPA/SB (%MVPA/%SB) on each respective YAP subsection score, age, and the interaction between these two. The final algorithms were applied to independent samples (n=39–51) to examine validity (median absolute percentage error, equivalence testing). Results The final algorithms explained 15% (school); 16% (out of school); and 12% (weekend) of the variability in GT3X+ %MVPA and 7% of the variability in GT3X+ %SB. The calibrated algorithms were applied to independent samples and predicted GT3X+ minutes of MVPA/SB, with median absolute percentage error values ranging from 12.5% (SB section) to 32.5% (weekend section). Predicted values obtained from the YAP were within 10%–20% of those produced by the GT3X+. Conclusions The YAP-predicted minutes of MVPA/SB resulted in similar group estimates obtained from an objective measure. The YAP offers good utility for large-scale research projects to characterize PA/SB levels among groups of youth.

Introduction Accurate tracking of physical activity (PA) and sedentary behavior (SB) is important to advance public health, but little is known about how to interpret wrist-worn accelerometer data. This study compares youth estimates of SB and moderate to vigorous PA (MVPA) obtained using raw and count-based processing methods. Methods Data were collected between April and October 2014 for the National Cancer Institute’s Family Life, Activity, Sun, Health, and Eating Study: a cross-sectional Internet-based study of youth/family cancer prevention behaviors. A subsample of 628 adolescents (aged 12–17 years) wore the ActiGraph GT3X+ on the wrist for 7 days. In 2015–2016, SB and MVPA time were calculated from raw data using R-package GGIR and from activity counts data using published cutpoints (Crouter and Chandler). Estimates were compared across age, sex, and weight status to examine the impact of processing methods on behavioral outcomes. Results ActiGraph data were available for 408 participants. Large differences in SB and MVPA time were observed between processing methods, but age and gender patterns were similar. Younger children (aged 12–14 years) had lower sedentary time and greater MVPA time (p-values

Choroidal localization from non-small cell lung cancer is rare and when it occurs may cause visual alterations. Targeted therapy against actionable gene mutations represents the standard of care in advanced non-small cell lung cancer. We report the case of a 53-year-old woman affected by metastatic anaplastic lymphoma kinase (ALK)-rearranged non-small cell lung cancer who received ALK tyrosine kinase inhibitors, from January 2017. The patient had a complete response of choroidal metastasis after therapy with ALK tyrosine kinase inhibitors. She recovered a complete visus and actually she still continue therapy with alectinib. The patient had a complete recovery of visus in addiction to a long response on treatment.

Background The positive association between physical activity and sunburn is a health behavior trade-off between the health benefits of physical activity and increased risk of skin cancer. Purpose We assessed walking, which is a common source of physical activity, and the prevalence of sunburn. Methods This research used the 2015 National Health Interview Survey of adults (N = 26,632), age ≥ 18 years. We defined four exclusive categories of walking: (a) those who reported not walking; (b) only transportation (to get some place, such as work, a store, or public transit stop); (c) only leisure (such as for fun, relaxation, or exercise); and (d) both categories. We estimated the adjusted prevalence of sunburn by walking category and separately for walking duration; we stratified by gender and sun sensitivity. Results The adjusted sunburn prevalence was not different between walking categories for women, but it was for men. Specifically, prevalence was lower for men who reported not walking, 34.1% (95% confidence interval [CI]: 32.2%–36.1%) compared to 38.8% (95% CI: 36.5%–41.2%) who walked for both purposes (p = .003). Walking duration was not associated with sunburn prevalence. Conclusion We could not determine whether sunburn occurred during walking trips because the questions were not asked as such. However, the results suggest that walking, unlike leisure-time physical activity (such as exercise, sports, or physically active hobbies), may not generally be associated with sunburn, except for the higher sunburn prevalence for men who walked for both leisure and transportation purposes.

Introduction This study examined the association between state physical education time requirements and physical activity and physical education outcomes among high school students. Methods State physical education time requirement laws for 2004–2016 from the Classification of Laws Associated with School Students database were linked with 2005–2017 national Youth Risk Behavior Survey data using state and year identifiers. Analyses were conducted between 2018 and 2019 to assess associations between physical education time requirement laws and physical activity or physical education outcomes using multinomial logistic regressions, while controlling for sociodemographic characteristics, year-fixed effects, and state confounders. Results State laws requiring ≥90 minutes of physical education per week were associated with 3.1 percentage points lower probability of no days of physical activity ≥60 minutes (95% CI= −5.0, −1.1), 3.7 percentage points lower probability of no days of moderate exercise ≥30 minutes (95% CI= −6.2, −1.3), 4.2 percentage points lower probability of no days of vigorous exercise ≥20 minutes (95% CI= −5.2, −3.3), and 19.3 percentage points lower probability of not attending physical education class (95% CI= −34.4, −4.2). The laws were associated with a 2.4 percentage point higher probability of daily moderate exercise ≥30 minutes in male students (95% CI=0.6, 4.2) and a 3.4 percentage point higher probability in female students (95% CI=1.9, 4.9), with larger associations for female students (p Conclusions Findings from this study help support the role that physical education state requirements can play in enhancing adolescents’ ability to meet recommended amounts of daily physical activity and the related public health benefits.

Objective Emotion suppression (ES) is associated with unhealthy coping strategies, such as emotional eating. Physical activity (PA) is a healthy coping strategy that may attenuate the association between emotion suppression and emotional eating (EE). This study evaluated whether: 1) ES is associated with body mass index (BMI) through EE and/or dietary patterns, 2) PA moderates these relationships, and 3) these patterns differ by race/ethnicity and gender. Methods Adult participants (N = 1674) of the Family Life, Activity, Sun, Health, and Eating study completed modified versions of the Emotion Regulation, Eating in the Absence of Hunger, and International Physical Activity Questionnaires; a validated dietary assessment; and items on demographics, height, and weight. Results Analyses revealed a serial mediation pathway in the full sample where greater ES was associated with higher BMI through greater EE and lower fruit and vegetable (F&V) intake (B = 0.0017, CI 95% [0.0001, 0.0042]) after controlling for age, gender, and education. Hedonic snack food (HSF) intake was not a significant mediator of the ES-BMI association. Greater PA attenuated associations of ES and EE with dietary intake and BMI. The serial pathway remained significant for non-Hispanic White women only in subgroup analyses. EE was a significant mediator among women, and PA effects were largely found among Hispanics and men. Conclusions ES was associated with higher BMI through greater EE and lower F&V, but not HSF intake. PA attenuated these associations. Differences in patterns of coping strategies may help to explain disparities in obesity-related health behavior.

Perna, FM, Coa, K, Troiano, RP, Lawman, HG, Wang, C-Y, Li, Y, Moser, RP, Ciccolo, JT, Comstock, BA, and Kraemer, WJ. Muscular grip strength estimates of the U.S. population from the National Health and Nutrition Examination Survey 2011–12. J Strength Cond Res 30(3): 867–874, 2016—The purposes of this study were to use the National Health and Nutrition Examination Study (2011–12) data to determine nationally representative combined handgrip strength ranges and percentile information by sex and age group, examine trends in strength across age by sex, and to determine the relative proportion of children and adults falling into established health benefit zones (HBZ). Results indicate that mean strength was greater among men than women and increased linearly for children and in a quadratic fashion among adults for both sexes. Grip strength peaked in the 30- to 39-year age group for both men (216.4 lbs) and women (136.5 lbs) with subsequent age groups showing gradual decline, p < 0.0001. Relative and absolute increases in grip strength were greater for men than for women, but relative decrease from peak strength was less among women than men. Although absolute strength was greater among men than women, HBZ data indicated that a higher percentage of men than women overall and at each age group fell into the needs improvement zone, with differences particularly pronounced during adolescence and older adulthood. These data provide the first nationally representative population estimates of combined handgrip strength and percentile information from childhood through senescence and suggest consideration of HBZ information in conjunction with grip strength to improve surveillance data interpretation and intervention planning.

To investigate the role of radiotherapy (RT) in the management of EGFR- or ALK-mutated metastatic non-small cell lung cancer (NSCLC) treated with TKI.Clinical data of 106 patients (pts) from five Institutions treated with RT concomitant to TKI were retrospectively revised. Overall survival (OS) and toxicities were analyzed as endpoints of the study.Median age of pts was 65 years. TKIs were given for EGFR (81%)- or ALK (19%)-mutated metastatic NSCLC. Stereotactic RT (SRT) was delivered to 49 pts (46%). Patients with four or less metastasis were defined as oligometastatic/oligoprogressive (OM/OP); sites of RT were brain, bone, lung or others in 46%, 27%, 14% and 13%, respectively. Median OS was 23 months. At univariate analysis SRT, ECOG PS 0-1, OM/OP disease, lung sites and a TKI duration longer than median favorably affected OS (all p 0.001). Multivariate analysis confirmed SRT (HR 0.355, CI 95% 0.212-0.595; p 0.001) and median duration of TKI 14 months (HR 0.17, 95% CI 0.10-0.30; p 0.001) as independent factors related to better OS. Toxicities were rare.SRT seems to positively affect OS with limited toxicity in selected patients.

IMPORTANCE: Monitoring sun protection and sunburn over time at the population level can provide valuable information about progress toward skin cancer prevention goals and inform future intervention efforts. OBJECTIVE: To examine the prevalence of sun protection use (shade, sunscreen, and clothing) and sunburn and the association between sunburn and individual characteristics and health behaviors in the US population. DESIGN, SETTING, AND PARTICIPANTS: In this cross-sectional study using a nationally representative sample of 31 162 US adults from the 2015 National Health Interview Survey–Cancer Control Supplement, household interviews of civilian, noninstitutionalized US adults were conducted throughout 2015 in person and completed on the telephone when necessary. Data analysis was performed from August 16, 2016, to September 6, 2017. MAIN OUTCOMES AND MEASURES: The prevalence of sunburn and use of sun protection and their association with demographic characteristics, sun sensitivity, and health-related behaviors and conditions using multivariable logistic regression modeling. RESULTS: A total of 31 162 respondents (mean [SD] age, 47.0 [0.36] years; 13 932 male [44.7%] and 17 230 female [55.3%]) were included in the analyses, with 34.2% experiencing sunburn in 2015. Sunburn prevalence was higher among younger age groups (51.2% in adults 18-29 years old; 95% CI, 48.8%-53.7%), non-Hispanic white individuals (42.5%; 95% CI, 41.2%-43.9%), and those with sun-sensitive skin (50.2%). However, sunburn was also prevalent among black (13.2%; 95% CI, 11.6%-15.1%) and Hispanic (29.7%; 95% CI, 27.6%-31.9%) individuals, demographic groups that are often considered to be at low risk of skin cancer. The most frequent sun protection behaviors were staying in the shade (37.1%; 95% CI, 36.3%-38.0%) and using sunscreen (31.5%; 95% CI, 30.7%-32.3%) followed by wearing long clothing to the ankles (28.4%; 95% CI, 27.6-29.1). Sun avoidance behaviors (seeking shade and not going in the sun) were significantly (39.5% vs 35.1%; P < .001) associated with a lower prevalence of sunburn. Those who used self-applied sunless tanning products (45.0% of users vs 36.1% of nonusers; P < .001), those who engaged in aerobic activity (37.9% of aerobic exercisers vs 32.8% of non–aerobic exercisers; P < .001), binge drinkers (45.1% of binge drinkers vs 35.0% of non–binge drinkers; P < .001), and overweight or obese individuals (37.9% of overweight or obese individuals vs 34.4% of non–overweight or obese individuals; P < .001) were more likely to experience sunburn compared with the respective comparison groups. CONCLUSIONS AND RELEVANCE: Sun sensitivity was significantly associated with a higher sunburn prevalence, independent of race/ethnicity, suggesting a need to consider sun sensitivity when identifying target demographic groups for sun safety interventions. Efforts to improve vigilance and consistency with use of sun protection are needed. In addition, those who engage in physical activity, use sunless tanners, or use sunscreen for tanning purposes may require additional intervention strategies to address the unique barriers they face in staying adequately protected.

Background:Evidence is building that strength training may reduce complications associated with cancer such as fatigue, muscle wasting, and lymphedema, particularly among breast and prostate cancer survivors. Population estimates are available for rates of aerobic physical activity; however, data on strength training in this population are limited. The objective of this study was to identify rates of meeting public health recommendations for strength training and aerobic activity among cancer survivors and individuals with no cancer history.Methods:Data from the Health Information National Trends Survey (HINTS), Iteration 4 Cycle 1 and Cycle 2 were combined to conduct the analyses. Missing data were imputed, and weighted statistical analyses were conducted in SAS.Results:The proportion of individuals meeting both strength training and aerobic guidelines were low for both cancer survivors and those without a history of cancer. The odds of meeting strength training guidelines were significantly lower for women with a history of any cancer except breast, compared with women with no history of cancer (OR: 0.70, 95% CI: 0.51−0.96).Conclusions:More work needs to be done to understand why women with cancers other than breast, may be less inclined to engage in aerobic physical activity and strength training.

Background:This paper tested whether a physical activity index (PAI) that integrates PA-related behaviors (ie, moderate-to-vigorous physical activity [MVPA] and TV viewing) and performance measures (ie, cardiorespiratory fitness and muscle strength) improves prediction of health status.Methods:Participants were a nationally representative sample of US adults from 2011 to 2012 NHANES. Dependent variables (self-reported health status, multimorbidity, functional limitations, and metabolic syndrome) were dichotomized. Wald-F tests tested whether the model with all PAI components had statistically significantly higher area under the curve (AUC) values than the models with behavior or performance scores alone, adjusting for covariates and complex survey design.Results:The AUC (95% CI) for PAI in relation to health status was 0.72 (0.68, 0.76), and PAI-AUC for multimorbidity was 0.72 (0.69, 0.75), which were significantly higher than the behavior or performance scores alone. For functional limitations, the PAI AUC was 0.71 (0.67, 0.74), significantly higher than performance, but not behavior scores, while the PAI AUC for metabolic syndrome was 0.69 (0.66, 0.73), higher than behavior but not performance scores.Conclusions:These results provide empirical support that an integrated PAI may improve prediction of health and disease. Future research should examine the clinical utility of a PAI and verify these findings in prospective studies.

Both endocrine and chemotherapy can be utilized for breast cancer patients' management, in multiple setting (i.e., primary systemic therapy, adjuvant, metastatic treatment). Health-related quality of life in breast cancer survivors can be significantly influenced by cognitive impairment, which has been related in several previously reported experiences to systemic therapies administration. However, although the growing body of literature, the impact of both chemo- and endocrine therapy on cognitive function is currently unclear, due to many confounding factors (i.e., multiple therapies, duration of therapy, comorbidity, age). The aim of the present review is to present an overview of the current literature concerning the possible influence of endocrine and systemic therapy on breast cancer patients' cognitive impairment.

To examine the association between demographic and behavioral characteristics and sunburn among U.S. adults.We used 2010 National Health Interview Survey data (N=24,970) to conduct multivariable logistic regressions examining associations with having 1 or more sunburns in the past year and having 4 or more sunburns in the past year.Overall, 37.1% of adults experienced sunburn in the past year. The adjusted prevalence of sunburn was particularly common among adults aged 18-29years (52.0%), those who repeatedly burn or freckle after 2weeks in the sun (45.9%), whites (44.3%), indoor tanners (44.1%), those with a family history of melanoma (43.9%), and those who are US-born (39.5%). Physical activity, alcohol consumption, and overweight/obesity were positively associated with sunburn (all P0.001); sun protection behaviors were not significantly associated with sunburn (P=0.35). Among those who were sunburned in the past year, 12.1% experienced 4 or more sunburns.Sunburn is common, particularly among younger adults, those with a more sun-sensitive skin type, whites, those with a family history of melanoma, the highly physically active, and indoor tanners. Efforts are needed to facilitate sun-safety during outdoor recreation, improve the consistency of sun protection practices, and prevent sunburn, particularly among these subgroups.

Sun protective behaviors and physical activity have the potential to reduce cancer risk. Walking is the most common type of physical activity in the United States, but it is unclear whether sun protective behaviors differ by categories of walking, such as leisure versus transportation walking. We examined whether sun protective behaviors varied by category or duration of walking in the 2015 National Health Interview Survey (N = 26,632), age ≥ 18 years. We used logistic regression to estimate sunscreen use, sun avoidance, and sun protective clothing use by four categories of walking (no reported walking, transportation only, leisure only, or walking for both) and separately for walking duration for the general population and sun-sensitive individuals. Prevalence of sunscreen use varied across walking categories and the odds of use were higher with longer walking duration for transportation and leisure compared to those who reported no walking. Sun avoidance varied across walking categories and the odds of avoidance were lower with longer duration leisure but not transportation walking. Sun protective clothing varied across walking categories and the odds of use were higher for longer duration transportation, but not leisure walking. Data on the concurrence of walking and sun protection is needed to further understand the relationship between these health behaviors. By examining leisure and transportation walking, we found variations in sun protective behaviors that may provide important insight into strategies to increase sun protection while promoting physical activity.

Objective To determine if state physical education (PE) laws are associated with student physical education attendance and physical activity (PA), and whether physical education and competitive food laws, in conjunction, are associated with lower BMI change. Method State laws regarding physical education time requirements and competitive foods in 2003 and 2006 were classified as strong, weak, or none, based on codified law ratings obtained from the Classification of Laws Associated with School Students. Laws were linked to student data on PE attendance and physical activity (8th grade, Spring 2007) and BMI change (5th–8th grade, 2004–2007), obtained from the Early Childhood Longitudinal Study (n = 5510 students in 40 states). Results Girls reported 0.31 more days of activity (95% CI: 0.02, 0.61) and were more likely to attend physical education ≥ 3 days/week (74.1% versus 52.1%, difference = 22.0, 95% CI: 2.1, 42.0) if they resided in states with strong physical education laws compared to no physical education laws. Weak physical education laws had modest associations with PE and activity, and there was no evidence that weak laws reduce BMI gain regardless of competitive food laws. Conclusion Strong physical education laws with specific time requirements may increase physical education attendance and activity in girls. There is insufficient evidence that physical education laws reduce student weight gain.

The National Cancer Institute developed the Family Life, Activity, Sun, Health, and Eating (FLASHE) Study to examine multiple cancer preventive behaviors within parent–adolescent dyads. The purpose of creating FLASHE was to enable the examination of physical activity, diet, and other cancer preventive behaviors and potential correlates among parent–adolescent dyads. FLASHE surveys were developed from a process involving: literature reviews, scientific input from experts in the field, cognitive testing, and usability testing. This cross-sectional, web-based study of parents and their adolescent children (aged 12–17 years) was administered between April and October 2014. The nationwide sample consisted of 1,573 parent–adolescent dyads (1,699 parents and 1,581 adolescents) who returned all FLASHE surveys. FLASHE assessed parent and adolescent reports of several intrapersonal and interpersonal domains (including psychosocial variables, parenting, and the community and home environments). On a subset of example FLASHE items across these domains, responses of parents and adolescents within the same dyads were positively and significantly correlated (r =0.32–0.63). Analyses were run in 2015–2016. FLASHE data present multiple opportunities for studying research questions among individuals or dyads, including the ability to examine similarity between parents and adolescents on many constructs relevant to cancer preventive behaviors. FLASHE data are publicly available for researchers and practitioners to help advance research on cancer preventive health behaviors.

OBJECTIVES: To determine if state laws regulating nutrition content of foods and beverages sold outside of federal school meal programs (“competitive foods”) are associated with lower adolescent weight gain. METHODS: The Westlaw legal database identified state competitive food laws that were scored by using the Classification of Laws Associated with School Students criteria. States were classified as having strong, weak, or no competitive food laws in 2003 and 2006 based on law strength and comprehensiveness. Objective height and weight data were obtained from 6300 students in 40 states in fifth and eighth grade (2004 and 2007, respectively) within the Early Childhood Longitudinal Study–Kindergarten Class. General linear models estimated the association between baseline state laws (2003) and within-student changes in BMI, overweight status, and obesity status. Fixed-effect models estimated the association between law changes during follow-up (2003–2006) and within-student changes in BMI and weight status. RESULTS: Students exposed to strong laws at baseline gained, on average, 0.25 fewer BMI units (95% confidence interval: −0.54, 0.03) and were less likely to remain overweight or obese over time than students in states with no laws. Students also gained fewer BMI units if exposed to consistently strong laws throughout follow-up (β = −0.44, 95% confidence interval: −0.71, −0.18). Conversely, students exposed to weaker laws in 2006 than 2003 had similar BMI gain as those not exposed in either year. CONCLUSIONS: Laws that regulate competitive food nutrition content may reduce adolescent BMI change if they are comprehensive, contain strong language, and are enacted across grade levels.

Background: Although pulmonary involvement is common in systemic lupus erythematosus (SLE), its effects on healthy lifestyle physical activity and its association with fatigue have not been well characterized. The goals of this study were to describe pulmonary function measured by office-based spirometry in patients with SLE and to compare spirometry with physical activity and systemic fatigue. Methods: During an office visit, 49 patients with SLE completed spirometry assessing: a) forced expiratory volume in 1 s (FEV1, a measure of airway patency and responsiveness); b) forced vital capacity (FVC, a measure of lung volume); and c) maximum voluntary ventilation (MVV, a measure of volume of air moved during rapid breathing) which has been hypothesized to be decreased in SLE due to muscle fatigue. Patients also performed a 2-min corridor walking test and completed self-reported questionnaires measuring weekly physical activity and systemic fatigue. Results: Mean age was 45 years, 45 (92%) were women, mean SLEDAI and SLICC scores were 2.8 and 1.0, respectively. Some 24 patients had a smoking history, and 15 had a history of SLE-related pleuritis, which was not active at enrollment. FEV1 and FVC were 96% of predicted, but MVV was only 55% of predicted. The distance walked during the corridor test was similar to that of patients with other chronic diseases; however, self-reported physical activity was less than recommended by national guidelines. There were no associations between spirometry values and history of pleuritis, other pulmonary diagnoses, or smoking ( p > .10 for all comparisons), however, better FEV1 ( p = .04) and better FVC ( p = .04) were associated with more self-reported activity and better FEV1 ( p = .03) was associated with longer distance walked during the corridor test. Most patients reported marked systemic fatigue; however, there were no associations between spirometry values and fatigue scores ( p > .10 for all comparisons). Conclusions: MVV was markedly diminished, which supports the hypothesis that SLE may be associated with respiratory muscle fatigue during rapid breathing. MVV was not associated with mild-to-moderate patient-directed physical activity; however, lower FEV1 and FVC were associated with less self-reported and performance-based physical activity.

Purpose: The purpose of this study was to examine the independent associations of self-reported and objectively measured (using accelerometers) moderate to vigorous physical activity (MVPA) with physiological and anthropometric biomarkers in a nationally representative sample of U.S. adults. Methods: Data from the cross-sectional National Health and Nutrition Examination Survey 2003-2006 data were analyzed. Adults 20 yr and older (N = 5797) with self-reported PA and 4 d or more of accelerometer data were included in the analyses. Pregnant or lactating women were excluded. Outcomes were blood pressure, body mass index, waist circumference, triceps and subscapular skinfolds, cholesterol, triglyceride, C-reactive protein, homocysteine, and insulin resistance and hyperinsulinemia indices. Results: Objectively measured MVPA displayed stronger independent associations with the biomarkers than did self-reported MVPA, even after adjusting for sociodemographic and health factors (adjusted Wald F values = 3.9-85.6, P < 0.05-0.0001). Self-reported and objectively measured MVPA were independently associated with skinfold measures, HDL, and C-reactive protein when both were included in the model. Conclusions: Objectively measured MVPA displayed stronger associations with physiological and anthropometric biomarkers than self-reported MVPA. However, self-reported and objectively measured MVPA appear to capture distinct aspects of PA that are independently associated with certain biomarkers. Further understanding of the distinct contributions of self-reported and objectively measured PA to health outcomes could help to better identify optimal activity level and pattern

Hispanics have lower cancer mortality rates than non-Hispanic Whites and Blacks, despite demographic profiles previously associated with higher cancer mortality. Differences in adherence to multiple cancer-preventive behaviors by acculturation may offer one explanation for this ''Hispanic paradox,'' but the relationship is not well understood. We examined this relationship using the 2000 National Health Interview Survey, which provides cross- sectional data on a nationally representative sample of US Hispanics. Multinomial logistic regression models esti- mated relationships between language use (a measure of acculturation) and patterns of adherence, by gender, to multiple cancer-preventive health behaviors using adher- ence scores. Hispanics had greater odds of adherence to multiple behaviors compared to Non-Hispanics (OR = 2.76 (2.27, 3.36)). Hispanics with greater English language use had lower odds of adherence (OR = 0.45 (0.29, 0.69)). Women were more adherent than men (P \ 0.01) and their language use was associated with patterns of behavioral adherence more so than among men. Differences by gender and language use were identified in patterns of adherence to behavioral recommendations among the Hispanic pop- ulation. Greater English language use was negatively associated with tobacco, alcohol, fruit and vegetable rec- ommendation adherence but not with exercise. Study find- ings support evidence behaviors occur in combination and contributes to understanding of the role of language use in patterns of behavioral adherence.

Importance Understanding patterns of sun-protective behaviors and their association with sunburn can provide important insight into measurement approaches and intervention targets. Objective To assess whether decision-based modeling can be used to identify patterns of sun-protective behaviors associated with the likelihood of sunburn and to compare the predictive value of this method with traditional (ie, composite score) measurement approaches. Design, Setting, and Participants This cross-sectional study used a nationally representative sample of 31 162 US adults from the 2015 National Health Interview Survey, consisting of household interviews conducted in person and completed by telephone when necessary. Participants included civilian noninstitutionalized US adults. Data were collected from January 1 through December 31, 2015. Main Outcomes and Measures The associations among sun sensitivity, multiple sun-protective behaviors (ie, using sunscreen, seeking shade, wearing a hat, and wearing protective clothing), and sunburn were examined using a χ2automatic interaction detection method for decision tree analysis. Results were compared with a composite score approach. Results In our study population of 28 558 respondents with complete data (54.1% women; mean [SD] age, 49.0 [18.0] years), 20 patterns of sun protection were identified. Among 15 992 sun-sensitive individuals, those who used only sunscreen had the highest likelihood of sunburn (62.4%). The group with the lowest likelihood of sunburn did not report using sunscreen but engaged in the other 3 protective behaviors (24.3% likelihood of sunburn). Among 12 566 non–sun-sensitive individuals, those who engaged in all 4 protective behaviors had the lowest likelihood of sunburn (6.6%). The highest likelihood of sunburn was among those who only reported sunscreen use (26.2%). The decision tree model and the composite score approach correctly classified a similar number of cases; however, the decision tree model was superior in classifying cases with sunburn (44.3% correctly classified in the decision tree vs 25.9% with the composite score). Conclusions and Relevance This innovative application of a decision tree analytic approach demonstrates the interactive and sometimes counterintuitive effects of multiple sun-protective behaviors on likelihood of sunburn. These data show where traditional measurement approaches of behavior may fall short and highlight the importance of linking behavior to a clinically relevant outcome. Given the scope of those affected and enormous associated health care costs, improving efforts in skin cancer prevention has the potential for a significant effect on public health.

Overexposure to the sun is associated with an increased risk of melanoma and nonmelanoma skin cancer, but indications of improvements in sun protection behavior are poor. Attempts to identify emerging themes in skin cancer control have largely been driven by groups of experts from a single field. In December 2016, 19 experts from various disciplines convened for Interdisciplinary Perspectives on Skin Cancer, a 2-day meeting hosted by the National Academy of Sciences. The group discussed knowledge gaps, perspectives on sun exposure, implications for skin cancer risk and other health outcomes, and new directions. Five themes emerged from the discussion: (1) The definition of risk must be expanded, and categories for skin physiology must be refined to incorporate population diversities. (2) Risky sun exposure often co-occurs with other health-related behaviors. (3) Messages must be nuanced to target at-risk populations. (4) Persons at risk for tanning disorder must be recognized and treated. (5) Sun safety interventions must be scalable. Efficient use of technologies will be required to sharpen messages to specific populations and to integrate them within multilevel interventions. Further interdisciplinary research should address these emerging themes to build effective and sustainable approaches to large-scale behavior change.

Objective To assess the relative frequency of and barriers to exercise among women with breast cancer while controlling for cancer-relevant and demographic factors. Design The present study employed concurrent samples, correlational research design. Main outcome measures Exercise frequency and its association with negative affect and barriers to exercise, independent of cancer treatment, among women (N=176) with Stage I or II breast cancer who were 3, 6, and 12 months postsurgery. Results After accounting for cancer-relevant and control variables, degree of negative affect and frequency of perceived barriers were significantly inversely associated with exercise. Conclusion These findings suggest that attention to both emotional factors and psychosocial barriers to exercise may be warranted to further understand exercise among women with early stage breast cancer.

There is considerable evidence that a healthy lifestyle consisting of physical activity, healthy diet, and weight control is associated with reduced risk of morbidity and mortality after cancer. However, these behavioral interventions are not widely adopted in practice or community settings. Integrating heath behavior change interventions into standard survivorship care for the growing number of cancer survivors requires an understanding of the current state of the science and a coordinated scientific agenda for the future with focused attention in several priority areas. To facilitate this goal, this paper presents trends over the past decade of the National Cancer Institute (NCI) research portfolio, fiscal year 2004 to 2014, by funding mechanism, research focus, research design and methodology, primary study exposures and outcomes, and study team expertise and composition. These data inform a prioritized research agenda for the next decade focused on demonstrating value and feasibility and creating desire for health behavior change interventions at multiple levels including the survivor, clinician, and healthcare payer to facilitate the development and implementation of appropriately targeted, adaptive, effective, and sustainable programs for all survivors.

INTRODUCTION: Although decline in muscle mass and quality and resulting declines in muscle strength are associated with aging, more research is needed in general populations to assess the utility of handgrip strength as an indicator of muscle strength and cardiovascular disease risk. METHODS: Data from 4,221 participants aged ≥20 years in the 2011–2012 cycle of National Health and Nutrition Examination Survey were analyzed during 2014–2015. Standing isometric relative handgrip strength (calculated as maximal absolute handgrip strength from both hands divided by BMI) was used to predict cardiovascular biomarkers, including blood pressure (measured systolic and diastolic blood pressure); serum lipids (total cholesterol, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, and triglycerides); and plasma insulin and glucose. RESULTS: Results from regression analyses showed that higher relative grip strength was significantly associated with lower systolic blood pressure, triglycerides, and plasma insulin and glucose, and higher high-density lipoprotein cholesterol in male and female participants (p

Importance The Surgeon General’s Call to Action to Prevent Skin Cancer broadly identified research gaps, but specific objectives are needed to further behavioral intervention research. Objective To review National Institute of Health (NIH) grants targeting skin cancer–related behaviors and relevant outcomes. Design, Setting, and Participants A portfolio analysis of the title, abstract, specific aims, and research plans of identified grant applications from 2000 to 2014 targeting skin cancer–related behaviors or testing behavioral intervention effects on cancer-relevant outcomes along the cancer continuum. Main Outcomes and Measures Funding trends were compared along the cancer control continuum, with respect to investigator demographics and use of theory, technology, policy, and changes to environmental surroundings (built environment). Results A total of 112 submitted applications met inclusion criteria; of these, 40 (35.7%) were funded, and 31 of the 40 were interventions. Comparing the 40 funded grants with the 72 unfunded grants, the overall success rates did not differ significantly between male (33.3%) and female (37.3%) investigators, nor did the frequency of R01 awards (36.7% and 28.1%, respectively). Among intervention awards, most (24 of 31) addressed prevention. Fewer awards targeted detection alone or in conjunction with prevention (3) or cancer survivorship (4), and no grant addressed emotional sequelae or adherence behavior related to diagnosis or treatment. Fewer than half of funded grants aimed for clinically related targets (eg, sunburn reduction). Use of theory and technology occurred in more than 75% of grants. However, the full capability of proposed technology was infrequently used, and rarely did constructs of the proposed behavior change theory clearly and comprehensively drive the intervention approach. Policy or environmental manipulation was present in all dissemination grants but was rarely used elsewhere, and 19.4% included policy implementation and 25.8% proposed changes in built environment. Conclusions and Relevance Grant success rate in skin cancer–related behavioral science compares favorably to the overall NIH grant success rate (approximately 18%), and the success rate of male and female investigators was not statistically different. However, gaps exist in behavioral research addressing all points of the skin cancer control continuum, measuring interventions that hit clinically related targets, and leveraging technology, theory, and environmental manipulation to optimize intervention approach.

Purpose:This study examines the relationship between state laws for physical education and neighborhood amenities for physical activity on weight status in adolescents of low socioeconomic status.Methods:Data from 2 national data sources: Classification of Laws Associated with School Students (CLASS) and the National Survey of Children’s Health (NSCH) were combined and analyzed.Results:Multinomial regression models found that adolescents in states with strong PE law were associated with a lower odds of being obese [OR = 0.63 (0.41, 0.97)]; however, when PE law and neighborhood amenities were included, only neighborhood amenities were associated with lower odds of obesity, but also greater odds of overweight status.Conclusion:This study emphasizes the potential significance of state laws on low SES groups to combat obesity; as well as the potential differential effects of local level factors, and alignment with policy goals for healthy weight.

ObjectiveThe current study characterizes associations between physical and social contexts of self-reported primary episodes of eating/drinking and sociodemographic and obesity-related variables in US adults.DesignMultinomial logistic regression was used to analyse a nationally representative sample of adults from the 2006–2008 American Time Use Survey. Models identifying physical (where) and social (whom) contexts of primary eating/drinking episodes at the population level, controlling for demographic characteristics, weight status and time of eating, were conducted.SettingUSA.SubjectsA nationally representative sample of US adults (n21 315).ResultsEating/drinking with immediate family was positively associated with age (OR = 1·15 (95 % CI 1·04, 1·27) to 1·23 (95 % CI 1·09, 1·39)), education level (OR = 1·16 (95 % CI 1·03, 1·30) to 1·36 (95 % CI 1·21, 1·54)), obesity (OR = 1·13 (95 % CI 1·04, 1·22)), children in the household (OR = 3·39 (95 % CI 3·14, 3·66)) and time of day (OR = 1·70 (95 % CI 1·39, 2·07) to 5·73 (95 % CI 4·70, 6·99)). Eating in the workplace was negatively associated with female gender (OR = 0·65 (95 % CI 0·60, 0·70)) and children in the household (OR = 0·90 (95 % CI 0·83, 0·98)), while positively associated with non-white status (OR = 1·14 (95 % CI 1·01, 1·29) to 1·47 (95 % CI 1·32, 1·65)) and time of day (OR = 0·25 (95 % CI 0·28, 0·30) to 5·65 (95 % CI 4·66, 6·85)). Women (OR = 0·80 (95 % CI 0·74, 0·86)), those aged >34 years (OR = 0·48 (95 % CI 0·43, 0·54) to 0·83 (95 % CI 0·74, 0·93)) and respondents with children (OR = 0·69 (95 % CI 0·63, 0·75)) were less likely to eat in a restaurant/bar/retail than at home. Overweight and obese respondents had a greater odds of reporting an episode of eating in social situationsv. alone (e.g. immediate family and extended family; OR = 1·13 (95 % CI 1·04, 1·22)) and episodes occurring in restaurant/bar/retail locations (OR = 1·12 (95 % CI 1·03, 1·23) to 1·14 (95 % CI 1·05, 1·24)).ConclusionsFindings underscore the multidimensional nature of describing eating/drinking episodes. Social and physical contexts for eating/drinking and their demographic correlates suggest opportunities for tailoring interventions related to diet and may inform intervention targeting and scope.

The purposes of the present study were to assess the effects of a 12-wk laboratory based aerobic exercise program on cardiopulmonary function, CD4 cell count, and physician-assessed health status among symptomatic pre-AIDS HIV-infected individuals (N = 28) and to assess the degree to which ill health was associated with exercise relapse.Responses to graded exercise test, physician-assessed health status, and CD4 cell counts were determined at baseline and 12-wk follow-up for participants randomly assigned to exercise or control conditions, and reasons for exercise noncompliance were recorded.Approximately 61% of exercise-assigned participants complied (50% attendance) with the exercise program, and analyses of exercise relapse data indicated that obesity and smoking status, but not exercise-associated illness, differentiated compliant from noncompliant exercisers. Compliant exercisers significantly improved peak oxygen consumption (VO2peak; 12%), oxygen pulse (O2pulse; 13%), tidal volume (TV; 8%), ventilation (VE; 17%), and leg power (25%) to a greater degree than control participants and noncompliant exercisers (all P0.05). Although no group differences in health status were found, a significant interaction effect indicated that noncompliant exercisers' CD4 cells declined (18%) significantly, whereas compliant exercisers' cell counts significantly increased (13%; P0.05).We conclude that although aerobic exercise can improve cardiopulmonary functioning in symptomatic HIV-infected individuals with minimal health risks, attention to factors associated with exercise adherence is warranted.

21-Aminosteroids (Lazaroids), acting as free radical scavengers and as membrane stabilizers, proved to have beneficial effects in various pathological conditions. In the present study we explored the effectiveness of one of these compounds, U 74389 G, in protecting pigs myocardium against the ischemia-reperfusion damage induced by transient coronary occlusion achieved by clampling the left anterior descending coronary artery. Animals were divided into three groups: control, untreated and treated. Control animals were operated but not subjected to ischemia-reperfusion; the untreated group underwent to ischemia-reperfusion without pharmacological treatment; while the treated group received the aminosteroid (4 mg/kg) before coronary occlusion and at the time of reperfusion. Specimens of myocardial tissue and blood samples were taken for morphological and biochemical studies. In the ischemic-reperfused myocardium of the untreated animals, the dominant morphological features were neutrophil infiltration, intercellular edema and severe swelling of mitochondria. All these alterations, notably neutrophil infiltration, were attenuated by aminosteroid treatment. As for the biochemical findings, the changes in adenine nucleotides and nucleosides levels, thus the reduction of energy charge, were reversed in the treated, but not in the untreated group. Myocardial concentration of malondialdehyde, which was undetectable in the control group, was raised in all the animals after reperfusion, but this effect was significantly less marked with aminosteroid treatment. In addition, the higher myocardial content of ascorbic acid and the reduced serum potential peroxidation exhibited by the treated animals compared with untreated group indicate an enhanced antioxidant protection induced by aminosteroid administration. On the other hand, the serum levels of myoglobin, cardiac troponin I and creatine kinase MB isoenzyme suggest the ability of the aminosteroid to attenuate the modifications of membrane permeability induced by ischemia-reperfusion injury. All these results lead to the conclusion that aminosteroid treatment, at least in the conditions of the present study, is effective in reducing the morphological and biochemical alterations occurring in ischemic-reperfused myocardium.

Recent estimates report that over one-third of children between the ages of 6- to 19-years old are now overweight or obese.1 This trend is alarming given the short- and long-term health impact of obesity. Obese youth are more likely to experience metabolic risk factors, asthma, and dental health issues as well as internalizing and externalizing disorders, attention-deficit hyperactivity disorder, and sleep problems.2 Studies have also shown that the impact of childhood obesity is witnessed throughout the lifespan and increases the risk of all-cause mortality in adulthood.3 This makes preventing obesity among youth a national public health priority. Recent attention has been placed on the role of state law governing school competitive foods as a means of addressing the childhood obesity epidemic.4–6 Competitive foods, defined as all foods and beverages sold or served outside of the reimbursable federal school meal program (FSMP),7,8 have been shown to contribute excess fat and calories to children’s diets.9–11 Emerging evidence suggests a link between strong competitive food policies, children’s diets, and healthy weight status12,13 however, not all studies have had consistent findings.14,15 More research is needed to understand whether competitive food policies influence youth behavior and health outcomes. This evidence could, in turn, help guide state policymakers, school administrators, and public health advocates on what aspects of school health policy require the most attention. The majority of this literature has focused predominantly on within-state analyses or used self-reported policy data.16–20 Riis et al21 examined the relationship between children’s weight status and state policies governing school nutrition and physical education. They found no relationship between laws governing middle or high school competitive foods and beverages and children’s weight status, and limited evidence for elementary school. However, these findings should take into account several methodological decisions. First, the Riis et al21 study categorizes states as having a strong policy for all states that require standards for competitive foods regardless of whether such standards are undefined or specified. However, prior work has empirically demonstrated that it may be more appropriate to categorize states as having a strong policy in cases where the policy is both required and standards are defined.12,13, 22 Second, the methods allowed for inclusion of school students from private schools. In the United States, nearly all public schools participate in the FSMP and are therefore required to follow federal and state policy governing this program.23 In contrast, fewer private schools participate in the FSMP. Schools that do not participate would be exempt from such standards. For this reason, other investigations have excluded students attending private schools.12 Lastly, the analysis examined competitive food and beverage laws for each location (ala carte, vending, or other venue) separately rather than as a composite score. A composite score provides a more comprehensive evaluation of the competitive food and beverage environment that children are exposed to within the school setting. Current knowledge remains limited in evaluating enacted state laws for competitive foods in a state- and nationally-representative sample. This study refines and extends the work of Riis et al21 by focusing on public middle schools only, using a comprehensive measure of competitive food and beverage laws, and adopting a more rigorous definition of policy strength. The purpose of this analysis is to determine if public middle school students living in states with strong competitive food and beverage laws had a significantly lower weight status as compared to students living in states with no or weak school competitive food and beverage laws using a nationally and state-representative sample. The focus on laws governing middle schools only is based on the prevalence of competitive foods and beverages in public middle schools, the declining strength of laws governing these competitive foods as children progress from elementary to middle to high school, and the high rates of obesity among this age (11–14 years) group.1, 24

We used data from the American Time Use Survey (years 2003–06) to analyze whether the intensity and duration of high school students' (ages 15–18 years) sports and exercise bouts differed across physical and social environments. Boys' sports and exercise bouts were more likely to reach a vigorous intensity when taking place at school and with friends/acquaintances/other people; whereas girls' sports and exercise bouts were more likely to reach a vigorous intensity when outdoors and alone. For boys and girls, bout durations were greater at school and with friends/acquaintances/other people than in other environments. Overall, environmental influences on the intensity but not duration of sports and exercise bouts appear to differ between boys and girls.

This paper describes the epidemiology of hospitalised cases with influenza-like illness (ILI) and laboratory-confirmed influenza A cases in Sicily (Italy) during the 2009 influenza pandemic. The first ILI case diagnosed as infected with pandemic influenza A(H1N1)2009 in Sicily was reported in June 2009 and it rapidly became the dominant circulating strain. In the period from 30 April 2009 through 31 December 2010, a total of 2,636 people in Sicily were hospitalised for ILI and 1,193 were laboratory-confirmed for influenza A. Basic demographic and clinical information for all hospitalised patients was collected and population mortality rates (PMRs) and case fatality ratios (CFRs) were calculated. The median age of hospitalised patients infected with pandemic influenza A(H1N1)2009 was significantly lower than that of hospitalised ILI cases in general (18.0 vs. 32.1 years; p0.0001). Among adults, women were more susceptible than men. The majority of clinical presentations were mild, but 6.6% of hospitalised patients required admission to an intensive care unit, of whom 26.3% had confirmed influenza A. Twenty-four fatal cases were documented. The age group of 45–54 year-olds showed the highest PMRs once hospitalised, while CFRs were higher in elderly patients of 65 years and older. All fatal cases were confirmed as influenza A(H1N1)2009 and most of them had established risk factors for influenza complications.

This national study examines differences between racial/ethnic groups on awareness of physical activity and reduced cancer risk and explores correlates of awareness including trust, demographic, and health characteristics within racial/ethnic groups. The 2007 Health Information and National Trends Survey (HINTS) provided data for this study. After exclusions, 6,809 adults were included in analyses. Awareness of physical activity in reduced cancer risk was the main outcome. Logistic regression models tested relationships. Non-Hispanic Blacks had a 0.71 (0.54,0.93) lower odds of being aware of physical activity in reduced cancer risk than non-Hispanic Whites. Current attempts to lose weight were associated with greater odds for awareness among non-Hispanic Blacks and Hispanics (p < .01). Among non-Hispanic Blacks, trust in traditional and Internet media was associated with greater odds of awareness (p < .01). This study is the first national study to examine racial/ethnic disparities in awareness of physical activity and cancer risk. Comparisons between racial/ethnic groups found Black-White disparities in awareness. Variables associated with awareness within racial/ethnic groups identify potential subgroups to whom communication efforts to promote awareness may be targeted.

Background Studies examining environmental influences on adolescent physical activity largely measure the presence and availability of social resources and built environment facilities. Unfortunately, this research approach provides limited information about adolescents' social company during exercise or the extent to which adolescents actually use physical settings for physical activity. Purpose The current study used data from the nationally representative American Time Use Survey (2003–2006) to describe demographic and temporal patterns in the social and physical contexts of physical activity among adolescents. Methods The sample consisted of high school students (aged 15–18 years) reporting at least one bout of sports or exercise (N=867). During the interview, participants reported where (e.g., outdoors, home, work) and with whom (e.g., alone, family, friends) each bout occurred. Sample-weighted multinomial logistic regression analyses compared the proportion of bouts occurring in each environment by age, gender, family income, season, weekend/weekday, and time of day, controlling for race/ethnicity. Data were analyzed in 2009. Results Girls were more likely to exercise with family (22% vs 16%), and less likely to exercise with friends/acquaintances/others (47% vs 52%) and outdoors (18% vs 24%) than boys. Compared with those aged 15 years, a larger proportion of exercise bouts among those aged 18 years occurred alone (23% vs 18%); and a smaller proportion occurred at home (14% vs 20%), at someone else's house (5% vs 12%), and at school (14% vs 27%) ( p 's Conclusions Information about the social and physical contexts of adolescents' sports and exercise can help guide the selection of future environmental targets for investigation and intervention.

Depression is common among athletes following sport injury, yet few studies have explored the severity of postinjury depression. Among those studies, only one examined gender differences although women in the general population are more likely than men to experience depression. No research to date has used interviews to assess depression despite their standard use among mental health professionals. In a quasi-experimental design, we used a self-report checklist and a clinical interview to compare depression among male and female athletes at 1 week, 1 month, and 3 months postinjury. Results revealed significant effects of group (injured vs. control) and time (since injury), and these effects were different for the two depression measures. We also explored the sensitivity and specificity of the user-rated checklist in identifying severely depressed athletes compared with the interview. Findings underscore the importance of multimodal approaches and clinical judgment when evaluating athletes' postinjury depression symptoms.

Background:Exercise effectively reduces symptoms of depression. However, correlates of regular exercise in depressed women are unknown. This study assessed psychosocial determinants of exercise in a sample of women with depressive symptoms.Methods:Sixty-one women completed demographic, depression, and exercise-related questionnaires.Results:The average Primary Health Ques-tionnaire-9 (PHQ-9) depression score was 12.1 (SD = 5.0), indicating moderate depressive symptoms. In the previous week, the women reported 12.8 metabolic equivalents (METs) of exercise. Low levels of self-efficacy and social support for exercise were also reported. Depressive symptoms were positively associated with barriers to exercise (r = .35, P < .01), and barriers were inversely related to exercise METs (r = –.37, P < .05). Barriers to activity and education level were significant determinants of exercise.Conclusions:Women with depressive symptoms report minimal exercise involvement, numerous barriers to exercise, and low exercise self-efficacy and social support for exercise.

Clinical depression affects millions of women annually. Exercise has been studied as a potential antidepressant, with most studies supporting its efficacy. Exercise also has the potential to reduce the risk for physical comorbidities that occur with depression. However, less is known about the types of exercise programs to which women with depressive symptoms will adhere. Our objectives were to (1) compare two exercise programs, varying in their degree of structure, on improvements in physical activity and (2) compare the two exercise interventions on depressive symptoms, body composition, and fitness.Women with depressive symptoms (physician diagnosed and confirmed with the Beck Depression Inventory) residing in the greater Boston area were recruited for this 3-month intervention study. Continuous enrollment took place between November 2005 and November 2006. Women were randomly assigned to either a clinic-based or home-based exercise intervention, with assessments at baseline and 3-months.Participants (n=32) were predominantly minority (81.4%) and, at baseline, had moderate symptoms of depression (Beck Depression Inventory [BDI], mean=25.6, SD=9.3), and were sedentary (mean=35.8 min/week of moderate and vigorous activity, SD=31.4). Gain scores for depressive symptoms (clinic-based mean=-11.7, home-based mean=-9.7) and physical activity (clinic-based mean=65.4, home-based mean=39.0) indicate strong improvements across time. Intent-to-treat analyses on 3-month data show that both interventions were associated with improvements in time spent in physical activity and depressive symptoms. Neither intervention impacted body composition or fitness.Both exercise programs were associated with reductions in depressive symptoms and increased physical activity participation, suggesting that even a home-based program can benefit women with depressive symptoms.

The purpose of this study was to demonstrate the diagnostic efficacy of contrast–enhanced power Doppler (CEPD) after ultrasound (US) with colour power Doppler (CPD) in defining disease activity in patients with ileal Crohn’s disease in the acute phase and during treatment follow–up. The study included 15 patients with ileal Crohn’s disease, 12 of whom were examined in the acute phase of their illness and then 30–60 days after treatment. Three patients were studied during clinical quiescence. All patients were examined prior to treatment with US–CPD study and then with contrast–enhanced power Doppler (CEPD) examination (CEPD) with the use of US contrast agent (SonoVue, Bracco), together with clinical assessment and laboratory tests. Disease activity was defined by the Crohn’s Disease Activity Index (CDAI) and some of the most sensitive biohumoural markers. After initial US, CPD and CEPD were performed to assess enhancement of the thickened bowel wall with the use of a reference box and a semiquantitative scoring system. The CEPD study is more reliable then US–CPD in the diagnosis of Crohn’s disease and statistically agrees significantly with clinical and laboratory indices for disease activity. This study demonstrates the importance of US–CPD in the follow–up of patients with Crohn’s disease and suggests systematic use of the US contrast agent, which can improve diagnostic performance of abdominal US study. It also provides more information about patients both in the acute phase and during follow–up, thus improving treatment planning and better monitoring of treatment efficacy.

First described by Klemperer and Rabin in 1931, solitary fibrous tumour of the pleura (SFTP) is a mesenchymal tumour that tends to involve the pleura, although it has also been described in other thoracic areas (mediastinum, pericardium and pulmonary parenchyma) and in extrathoracic sites (meninges, epiglottis, salivary glands, thyroid, kidneys and breast). SFTP usually presents as a peripheral mass abutting the pleural surface, to which it is attached by a broad base or, more frequently, by a pedicle that allows it to be mobile within the pleural cavity. A precise preoperative diagnosis can be arrived at with a cutting-needle biopsy, although most cases are diagnosed with postoperative histology and immunohistochemical analysis of the dissected sample. SFTP, owing to its large size or unusual locations (paraspinal, para-mediastinal, intra-fissural and intraparenchymal), can pose interpretation problems or, indeed, point towards a diagnosis of diseases of a totally different nature. We present some unusual radiographic and computed tomography (CT) images of large SFTP or SFTP located in atypical thoracic locations in patients who underwent surgical resection.

Prevalence of HBV infection in Palermo was investigated in 1989, in comparison with similar data observed in 1982. Between September 1988 and April 1989, 1001 serum samples taken from healthy individuals or from patients with pathology unrelated to liver diseases, in the age groups 0 to 59 years, were collected. Prevalence of HBsAg and anti-HBc was, respectively, 2.7% and 24.3% in males, 2.3% and 19% in females. Prevalence was inversely related to socioeconomic level as defined by occupation, educational level and area of residence. Prevalence of HBV markers in 1989 was compared with that of a sample of sera taken in 1982 and stored at -20 degrees C. Prevalence was lower in 1989 for age groups under 20, while no difference was seen in older age groups.

The purpose of the present study was to assess the effect of a time limited cognitive-behavioral stress management program (CBSM) on mood state and serum cortisol among men and women rowers (N = 34) undergoing a period of heavy exercise training. After controlling for life-event stress (LES), CBSM was hypothesized to reduce negative mood state and cortisol among rowers during a period of heavy training; mood and cortisol changes over the intervention period were hypothesized to be positively correlated. LES was positively associated with negative affect at study entry. After covariance for LES, rowing athletes randomly assigned to the CBSM group experienced significant reductions in depressed mood, fatigue, and cortisol when compared to those randomized to a control group. Decreases in negative affect and fatigue were also significantly associated with cortisol decrease. These results suggest that CBSM may exert a positive effect on athletes' adaptation to heavy exercise training.