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Tanning during adolescence increases skin cancer risk. Relatively few studies have examined the association between thinness attitudes and tanning attitudes and behaviors. The purpose of the current study was to examine psychosocial predictors of sunbathing and tanning bed use, specifically thin ideal internalization (TII) and motives for tanning among high school girls. Adolescent girls (N = 229) completed a 10-minute questionnaire designed to assess sunbathing and indoor tanning, TII and motives to tan (appearance, social and well-being). Hierarchical regression analyses showed that TII, β = .05, p

Background With the growing popularity of waterpipe smoking (WPS), it is important to understand how WPS may impact health. The aim of this study was to systematically review the literature to identify potential health effects of WPS, specifically on the head and neck region. Types of Studies Reviewed The authors systematically reviewed published articles that focused on WPS and head and neck conditions identified from the following databases: PubMed and MEDLINE, PsycInfo, and Google Scholar. Results The authors included 20 articles in the review. Ten of the articles pertained to oral tissue outcomes, 7 to head and neck cancer, and 3 to the voice and middle ear. The authors found that WPS was associated with greater inflammation, Candida , periodontitis, dry socket, blood chromium and nickel levels, premalignant lesions, oral cancer, esophageal squamous cell carcinoma, attic retraction, edema in the vocal cords, and lower habitual vocal pitch and voice turbulence index. Conclusions and Practical Implications WPS is associated with various head and neck conditions. Educational and policy approaches may be required to limit the spread of WPS and its potentially deleterious effects.

Indoor tanning is currently a $5 billion per year industry in the US with more than 40,000 indoor tanning establishments.1,2 Thirty million Americans indoor tan each year, and one million tan indoors each day.3 Hoerster and colleagues found more indoor tanning facilities in each of 116 large US cities than the number of Starbucks coffee shops and McDonald's restaurants in those cities.4 The Social Ecological Model has been used to help understand the various influences on health behaviors and includes intrapersonal, interpersonal, organizational, community, and public policy factors.5 Most research on indoor tanning thus far has focused on intrapersonal and interpersonal factors, indicating that individuals are motivated to tan most commonly for appearance-enhancement reasons.6 However, some individuals tan indoors due to social or normative factors or in order to improve mood or reduce stress.6 Much less attention has been paid to organizational, community, and public policy contextual factors. As is the case with tobacco use and obesity, contextual factors such as accessibility, governmental regulation, marketing, or cost may also be associated with the prevalence of indoor tanning. Salon accessibility, for example, having a higher density of tanning facilities and living within 2 miles of a tanning facility, has been found to be associated with indoor tanning in the last year.7 However, indoor tanning has been found to be unrelated to state tanning regulations, likely due to low levels of enforcement,7-11 suggesting that community norms and other factors may be more important in influencing indoor tanning behavior currently. Other contextual factors that have been found to encourage more frequent and continuous indoor tanning among tanning salon patrons include reasonable prices and the convenience of being able to tan anytime including at night.12 Ultraviolet radiation (UV) such as that emitted by indoor tanning devices is known to definitively increasing skin cancer risk.13-16 However, there are additional contextual issues related to indoor tanning that may contribute to even greater levels of risk than would otherwise exist. UV-related guidelines and regulations regularly go un-enforced.8-11 For example, very fair-skinned individuals at high risk for burning are often permitted to tan when they shouldn't be, and tanning session length guidelines based on skin types (ie, sensitivity to burning) are not followed. Additionally, many tanning devices are not monitored adequately and therefore may emit more UV than guidelines recommend. Salon staff sometimes do not even know what type or how much UV is emitted from their devices,9 thus, they would be unlikely to be able to follow Food and Drug Administration (FDA) or other guidelines regarding UV exposure. Moreover, indoor tanners are often adolescents and college-aged individuals, thus potentially leading to high levels of lifetime UV exposure.17,18 Besides contextual factors, an additional intrapersonal reason for frequent tanning is tanning dependence or addiction, colloquially referred to as “tanorexia”.19 Although tanning dependence in not an official disorder according to the American Psychiatric Association's Diagnostic and Statistical Manual,20 tanning dependence has been defined based on traditional substance dependence criteria and measures (ie, tolerance, withdrawal, difficulty controlling the behavior despite negative consequences). A number of studies have provided evidence for the phenomenon of tanning dependence, with plausible biologic underpinnings, primarily related to the opioid system.19 The prevalence of tanning dependence varies by population and measurement strategy. Rates range from 22% to 45% among college indoor tanners and 18% among college sunbathers.21-24 Among general college student samples in the US, rates range from 5% to 27%.21-25 Tanning dependent individuals may tan frequently and put themselves at even greater risk of skin cancer than other tanners. There are elements of the current indoor tanning context that may contribute to tanning dependence such as easy accessibility, lack of regulation/enforcement, marketing efforts by salons, and the relatively low cost of indoor tanning. Although seemingly important, relatively few studies have focused on such contextual factors related to indoor tanning. These studies have been focused on adolescents rather than college-aged individuals, and the results have been mixed in terms of the impact of state indoor tanning laws and indoor tanning behaviors.26 The purpose of the current study was to investigate the association of college-aged women's perceptions of contextual factors such as tanning salon accessibility, regulations, marketing, or cost and indoor tanning behavior or tanning dependence. We hypothesized that individuals who had tanned indoors in the last 30 days and/or women who scored higher on a measure of tanning dependence would be more likely to report greater salon accessibility, looser tanning regulations, more promotional efforts, and lower cost of individual indoor tanning sessions, yet more trouble paying for their tanning habit than others. Understanding the factors associated with more frequent indoor tanning may help inform policy and public health programming efforts. For example, the impact on young women's skin cancer risk of additional regulation and enforcement of contextual factors associated with frequent or dependent tanning could be investigated.

Purpose. Indoor tanning (IT) increases risk for melanoma and is particularly common among young adult women. IT has also been linked with some psychiatric symptoms, and frequent tanning may indicate tanning dependence (addiction) associated with endorphin release during ultraviolet radiation exposure. The objective of the current study was to investigate associations between IT, tanning dependence, and psychiatric and substance use symptoms in young adult women. Design. Cross-sectional survey and psychiatric interview. Setting. Online, except for the Mini International Neuropsychiatric Interview (MINI), which was completed over the telephone. Subjects. Participants were 306 female university students aged 18 to 25 years. Measures. MINI, Seasonal Scale Index, tanning dependence scales, reporting ever having used a tanning bed or booth with tanning lamps (single item), reporting smoking a cigarette in the last 30 days (single item). Analysis. Descriptive statistics, χ2 analysis, multivariate logistic regression. Results. Forty-six percent of the sample reported a history of IT, and 25% were classified as tanning dependent. Multivariate logistic regression analyses showed that IT was significantly associated with symptoms of alcohol use disorders, generalized anxiety, and not having social anxiety. Tanning dependence was associated with symptoms of alcohol use disorders. Conclusion. Tanning is of concern not only for its association with skin cancer but for its association with psychiatric and substance use symptoms. Young women with certain psychological problems may seek relief from their symptoms by IT. These findings suggest that indoor tanners may benefit from health behavior and other psychosocial interventions.

Background Indoor tanning has been found to be addictive. However, the most commonly used tanning dependence measures have not been well validated. Objective The study's purpose was to explore the psychometric characteristics of and compare the modified Cut-down, Annoyed, Guilty, Eye-opener Scale (mCAGE), modified Diagnostic and Statistical Manual of Mental Disorders – Fourth Edition – Text Revised (mDSM-IV-TR) and Tanning Pathology Scale (TAPS) measures of tanning dependence and provide recommendations for research and practice. Methods This study was a cross-sectional online survey with 18- to 25-year-old female university students. The main outcome variable was tanning dependence measured by the mCAGE, mDSM-IV-TR and TAPS. Results Internal consistency of the TAPS subscales was good but was poor for the mCAGE and mDSM-IV-TR, except when their items were combined. Agreement between the mCAGE and mDSM-IV-TR was fair. Factor analysis of the TAPS confirmed the current four-factor structure. All of the tanning dependence scales were significantly correlated with one another. Likewise, most of the tanning dependence scales were significantly correlated with other measures of tanning attitudes and behaviours. However, the tolerance to tanning TAPS subscale was not significantly correlated with any measure of tanning attitudes or behaviours and had the lowest subscale internal reliability and eigenvalues. Conclusion Based on the data and existing literature, we make recommendations for the continued use of tanning dependence measures. Intervention may be needed for the approximately 5% of college women who tend to be classified as tanning dependent across measures. Monitoring of individuals reporting tanning dependence symptoms is warranted.

Thirdhand smoke (THS) refers to tobacco smoke contaminants and by-products that remain in the environment after a cigarette is extinguished. The purpose of this study was to assess beliefs and behaviors regarding THS among healthcare professionals, and to examine associations among smoking attitudes/beliefs, provider demographics, and THS beliefs and behaviors. Healthcare professionals (N = 204) at a comprehensive cancer center and affiliated general hospital in a northeastern urban area completed online questionnaires. About one third of the respondents had heard of THS before completing the survey, and more than two thirds of the sample believed that THS issues do not receive enough attention. Being female, likelihood of discussing THS with others, endorsing the belief that smoking affects the quality of parenting, and support for government action towards smoking bans were significantly associated with providers’ belief that THS is harmful. Endorsing the belief that smoking affects the quality of parenting and belief that THS is harmful were significantly associated with the likelihood of discussing THS with others. Findings shed light on THS beliefs and behaviors of healthcare providers (a group of individuals that could be trained to educate and advise patients about THS) and inform recommendations for new tobacco policies and clinical guidelines for best practices in tobacco control and prevention.

Despite its known association with skin cancer, tanning remains popular among young adult women. Indoor tanning behavior has been found to be associated with affective and addictive disorders. To better understand potential psychological and biological mechanisms of tanning behavior, we investigated associations between tanning and medication (psychotropic and other) use among young women. Two hundred and fifty-three women age 18-29 years old were recruited from two northeastern university campus communities. Women self-reported tanning frequency and chronic medication use. In both univariate and multivariate analyses, indoor tanning ≥12 times last year was significantly associated with use of psychotropic medication and anti-depressants in particular. Sunbathing was not associated with medication use. Potential reasons for associations between tanning and psychotropic medication use are discussed. Indoor tanners should be warned that some psychotropic medications are photosensitizing, thus increasing risk for burns and other skin damage from indoor tanning.

Background Patient-reported outcome (PRO) instruments are important tools for monitoring disease activity and response to treatment in clinical trials and clinical practice. In recent years, there have been movements away from traditional pen-and-paper PROs towards electronic administration. When using electronic PROs (ePROs), evidence that respondents complete ePROs in a similar way to their paper counterparts provides assurance that the two modes of administration are comparable or equivalent. The European Organisation for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire-Core 30 item (EORTC QLQ-C30) and associated disease-specific modules are among the most widely used PROs in oncology. Although studies have evaluated the comparability and equivalence of electronic and original paper versions of the EORTC QLQ-C30, no such studies have been conducted to date for the head and neck cancer specific module (EORTC QLQ-H&N35). Objective This study aimed to qualitatively assess the comparability of paper and electronic versions of the EORTC QLQ-H&N35. Methods Ten head and neck cancer patients in the United States underwent structured cognitive debriefing and usability interviews. An open randomized crossover design was used in which participants completed the two modes of administration allocated in a randomized order. Using a “think-aloud” process, participants were asked to speak their thoughts aloud while completing the EORTC QLQ-H&N35. They were thoroughly debriefed on their responses to determine consistency in interpretation and cognitive process when completing the instrument in both paper and electronic format. Results Participants reported that the EORTC QLQ-H&N35 demonstrated excellent qualitative comparability between modes of administration. The proportion of noncomparable responses (ie, where the thought process used by participants for selecting responses appeared to be different) observed in the study was low (11/350 response pairs [35 items x 10 participants]; 3.1%). Evidence of noncomparability was observed for 9 of the 35 items of the EORTC QLQ-H&N35 and in no more than 2 participants per item. In addition, there were no apparent differences in level of comparability between individual participants or between modes of administration. Conclusions Mode of administration does not affect participants’ response to, or interpretation of, items in the EORTC QLQ-H&N35. The findings from this study add to the existing evidence supporting the use of electronic versions of the EORTC instruments when migrated to electronic platforms according to best practice guidelines.

Skin cancer is the most common cancer in the US, with almost three million individuals being diagnosed annually [1]. Both melanoma and non-melanoma (or keratinocyte) skin cancer (NMSC) incidence rates have been increasing in recent decades [2]-[4]. In 2012, melanoma is predicted to be the fifth most common cancer among US men and the sixth most common cancer among women [2]. Risk factors for melanoma and NMSC include male sex, age over 50 years, personal or family history of melanoma or NMSC, red hair, blue or green eyes, Fitzpatrick skin type I (very fair skin sensitive to ultraviolet radiation [UV]) with freckles, actinic keratosis on the head, familial atypical mole-melanoma syndrome, or numerous (i.e., > 100) moles [2], [5]-[15]. Additionally, many melanomas and NMSCs can be attributed to UV exposure such as via outdoor occupations, one blistering sunburn prior to age 18, multiple sunburns at any age, or indoor tanning [15]-[21].

Skin cancer is an increasingly common disease, particularly among young adult women. Sunburn early in life is a risk factor for skin cancer. Few studies have reported on psychosocial correlates of sunburn. The current study consisted of an online survey of undergraduate women from a university in the northeastern part of the USA. A logistic regression demonstrated that young women who reported a history of four or more sunburns were significantly more likely to report fair skin, higher perceived susceptibility to skin cancer, greater perceived benefits of tanning (e.g., appearance enhancement), lower perceived control over skin protection, and more frequent sunscreen use. Sunbathing was not associated with a greater number of sunburns. These results suggest that young women who sunburn more often possess other skin cancer risk factors, are aware of their susceptibility to skin cancer, and try to use sunscreen, but feel limited control over their skin protection behavior and are not less likely to sunbathe than others. Therefore, interventions are needed to assist high risk young women in asserting more control over their sun protection behavior and perhaps improve the effectiveness of the sunscreen or other skin protection methods they do employ.

Importance Skin cancer is common among older adults. Some national organizations recommend total cutaneous examination (TCE) and skin self-examination (SSE) for skin cancer detection. Although the spousal relationship is a known influence on health behavior, little is known about the level of correspondence in skin screening among couples. Objective To investigate correspondence of TCE and SSE among older couples, demographic correlates of correspondence, and correspondence among barriers to skin examinations. Design, Setting, and Participants Cross-sectional online survey of cohabitating partners 50 years or older performed from June 1, 2010, through July 31, 2010, via the nationally representative GfK (Gesellschaft fur Konsumforschung or Society for Consumer Research) Internet panel. Main Outcomes and Measures Both TCE in the past 3 years and SSE in the past year. Results Correspondence among partners was high. For TCE, both partners had completed TCE in 23.9%, and both partners had not completed TCE in 47.3%. With regard to SSE, both partners had completed SSE in 39.8%, and both partners had not completed SSE in 38.9%. Correlates of both partners not completing TCE include lower household income, larger household size, nonmetropolitan residence, living in the Midwest, and being in a same-sex relationship. Correlates of both members not completing SSE included larger household size and being in a same-sex relationship. Barriers to screening that members of couples reported were similar to one another. Conclusions and Relevance Couples were mostly concordant with regard to engagement in skin examinations. Therefore, dyadic interventions to increase screening rates could be useful. Certain sociodemographic groups should especially be targeted.

Skin cancer is the most common cancer in the US, and incidence continues to increase. Studies have shown that screening is helpful in detecting skin cancer at an earlier more treatable stage and can be done by oneself, with the assistance of a close other, or by a health professional. Many people fail to screen for skin cancer. The purpose of this study was to examine screening rates in married couples, as well as the reasons for failing to screen. Participants were recruited and assessed by KnowledgePanel from Knowledge Networks (http://www.knowledgenetworks.com/). This is a probability-based panel of potential participants for online surveys, designed to be representative of the US population. Married individuals over 50 years of age with another person living in the home were invited to participate. Participants completed an online survey in which both husbands and wives were asked to indicate whether they received a skin exam from a clinician, or performed a skin exam themselves or with the assistance of a partner. If they answered in the negative, they were asked to endorse reasons for failing to screen from a provided list and could write in other reasons. This questionnaire was completed as part of larger study examining other cancer screening behaviors. The questionnaire was completed by 3,048 husbands and 2,942 wives (a 77% response rate). Within husbands, 39% reported receiving a clinical skin exam, while 35% of wives reported doing so. Regarding a self- or partner-assisted skin exam, 47% of husbands reported doing so, as opposed to 49% of wives. Forty-eight percent of couples matched in terms of both failing to receive a clinical skin exam, 28% did not match (i.e., one spouse had an exam, while the other did not), and 25% matched in terms of both having had a clinical skin exam. For self- or partner-assisted skin exam, 40% of married couples matched in terms of neither having an exam, 21% did not match (i.e., one spouse performed an exam, while the other did not), and 39% matched in terms of both partners performing a self- or partner-assisted skin exam. The most commonly endorsed reason among both husbands and wives for failing to obtain a skin exam by a clinician and also not screening oneself is that a doctor did not recommend one, followed by not having any noticeable symptoms of skin cancer, and not perceiving oneself as at risk for skin cancer. Kappa coefficients were calculated to assess husbands' and wives' agreement on the reasons endorsed. Husbands and wives reached moderate agreement for the following reasons for not obtaining a clinical skin exam: healthcare provider hadn't recommended, exam would be inconvenient, did not have noticeable symptoms of skin cancer, would rather have a partner do the exam, and not perceiving oneself as at risk for skin cancer. Similar reasons for not conducting a self- or partner-assisted exam were endorsed and had similar levels of agreement (other than preferring a partner exam), though husbands and wives also had moderate agreement for not conducting an exam due to being too busy. Results show that more than half of individuals over age 50 do not receive clinical or partner skin exams. Most couples matched in terms of both either having or not having had a skin exam and also endorsed similar reasons for not being screened. Based on these similarities and spousal influence on one another, intervening with couples as a unit may be beneficial in increasing skin cancer screening rates. Findings also highlight the role health professionals may play in encouraging screening for skin cancer, as the most highly cited reason for not getting screened is lack of recommendation from a healthcare provider. Finally, results suggest opportunities for education regarding “symptoms of” and risks for skin cancer and the fact that skin cancer may be asymptomatic. Citation Information: Cancer Prev Res 2011;4(10 Suppl):B28.