Enforcement of State Indoor Tanning Laws in the United States

Introduction Twenty-eight US states have passed legislation for indoor tanning facilities. To our knowledge, whether these state laws are actually enforced has not been evaluated previously in all 28 states. Therefore, we interviewed key informants in these states to assess enforcement practices. Methods Two trained interviewers used a structured survey instrument to interview 28 key informants who were knowledgeable about enforcement practices for laws regarding indoor tanning. Respondents provided information specific to the most populous city in their states. Results Licensure for indoor tanning businesses was required in 22 of the 28 cities. Slightly less than half of the cities gave citations to tanning facilities that violated state law. Approximately 32% of the cities did not inspect indoor tanning facilities for compliance with state law, and another 32% conducted inspections less than annually. Of those cities that inspected at all, most conducted unannounced inspections. Conclusion The relatively low rates of annual inspections and citations are of concern. We recommend that future studies assess whether legislation, enforcement practices, or a combination of the 2 affects the practices of indoor tanning facilities or of consumers

Impact of individual, environmental, and policy level factors on healthcare utilization among United States farmworkers

Farmworkers face significant disease burden. Meanwhile, farmworker healthcare utilization is low. This study examined individual, environmental, and policy level correlates of U.S. farmworker healthcare utilization, guided by the Behavioral Model for Vulnerable Populations and the Ecological Model. The 2006-2008 administrations of the National Agricultural Workers Survey (NAWS) (N=4,891) provided the primary data for this cross-sectional study. Geographic Information Systems, the 2005 and 2006 Uniform Data System, and rurality/border proximity indices provided environmental variables. To identify factors associated with healthcare use, logistic regression was performed using Hierarchical Linear Modeling. Probability weights were applied in descriptive, bivariate, and multivariate analyses. The alpha level was set at .05 for all analyses. The majority of farmworkers were Hispanic (80.0%) and male (78.4%), with an average age of 35.6 (SE=.3) years. Annual family income (M=22,668.0; SE=304.9) and educational attainment (M=7.7; SE=.1) were low. Just over half (57.3%) used formal U.S. healthcare in the previous two years. Multiple factors were independently associated with healthcare use in multilevel models (all in the expected direction), including, at the individual level: sex, immigration and migrant status, English proficiency, access to transportation, and need; at the environmental level: total FQHC full-time equivalent medical professionals/staff and U.S.-Mexico border proximity; and, at the policy level: insurance status and payment structure. Findings were consistent with those from previous studies of Hispanic populations, as well as the limited literature documenting healthcare use correlates for farmworkers. Numerous individual and policy level moderators of associations between environmental level variables and healthcare use were identified. Using Stata, rates of healthcare use among farmworkers were compared to those among U.S. and other subpopulations with similar sociodemographic characteristics (from the 2006 Medical Expenditure Panel Survey). Rates of use were significantly lower for farmworkers than for the U.S. and low-income populations. However, they were significantly higher than rates for U.S. Hispanics and a comparison group (i.e., Hispanic, low income, and no educational degree). The low rate of use is concerning due to farmworkers' disproportionate disease burden. Multilevel recommendations for change, emphasizing change to the FQHC system, are made so that healthcare access can be improved for this vulnerable populatio

Impact of individual, environmental, and policy level factors on healthcare utilization among United States farmworkers

Farmworkers face significant disease burden. Meanwhile, farmworker healthcare utilization is low. This study examined individual, environmental, and policy level correlates of U.S. farmworker healthcare utilization, guided by the Behavioral Model for Vulnerable Populations and the Ecological Model. The 2006-2008 administrations of the National Agricultural Workers Survey (NAWS) (N=4,891) provided the primary data for this cross-sectional study. Geographic Information Systems, the 2005 and 2006 Uniform Data System, and rurality/border proximity indices provided environmental variables. To identify factors associated with healthcare use, logistic regression was performed using Hierarchical Linear Modeling. Probability weights were applied in descriptive, bivariate, and multivariate analyses. The alpha level was set at .05 for all analyses. The majority of farmworkers were Hispanic (80.0%) and male (78.4%), with an average age of 35.6 (SE=.3) years. Annual family income (M=22,668.0; SE=304.9) and educational attainment (M=7.7; SE=.1) were low. Just over half (57.3%) used formal U.S. healthcare in the previous two years. Multiple factors were independently associated with healthcare use in multilevel models (all in the expected direction), including, at the individual level: sex, immigration and migrant status, English proficiency, access to transportation, and need; at the environmental level: total FQHC full-time equivalent medical professionals/staff and U.S.-Mexico border proximity; and, at the policy level: insurance status and payment structure. Findings were consistent with those from previous studies of Hispanic populations, as well as the limited literature documenting healthcare use correlates for farmworkers. Numerous individual and policy level moderators of associations between environmental level variables and healthcare use were identified. Using Stata, rates of healthcare use among farmworkers were compared to those among U.S. and other subpopulations with similar sociodemographic characteristics (from the 2006 Medical Expenditure Panel Survey). Rates of use were significantly lower for farmworkers than for the U.S. and low-income populations. However, they were significantly higher than rates for U.S. Hispanics and a comparison group (i.e., Hispanic, low income, and no educational degree). The low rate of use is concerning due to farmworkers' disproportionate disease burden. Multilevel recommendations for change, emphasizing change to the FQHC system, are made so that healthcare access can be improved for this vulnerable populatio

Hopelessness and Suicidal Ideation in Iraq and Afghanistan War Veterans Reporting Subthreshold and Threshold Posttraumatic Stress Disorder

Abstract: We examined hopelessness and suicidal ideation in association with subthreshold and threshold posttraumatic stress disorder (PTSD) in a sample of Iraq and Afghanistan War Veterans (U.S., N 275) assessed within a specialty VA postdeployment health clinic. Veterans completed paper-and-pencil questionnaires at intake. The military version of the PTSD Checklist was used to determine PTSD levels (No PTSD; subthreshold PTSD; PTSD), and endorsement of hopelessness or suicidal ideation were used as markers of elevated suicide risk. Veterans were also asked if they received mental health treatment in the prior 6 months. Veterans reporting subthreshold PTSD were 3 times more likely to endorse these markers of elevated suicide risk relative to the Veterans without PTSD. We found no significant differences in likelihood of endorsing hopelessness or suicidal ideation comparing subthreshold and threshold PTSD groups, although the subthreshold PTSD group was less likely to report prior mental health treatment. Clinicians should be attentive to suicide risk in returned Veterans reporting both subthreshold and threshold PTSD

Measuring skin cancer risk in African Americans: Is the Fitzpatrick skin type classification scale culturally sensitive?

Objective: Fitzpatrick\u27s Skin Type Classification Scale often is used to assess sun sensitivity and skin cancer risk. Because the scale was developed with Whites, its utility and validity with Blacks may be limited by its reliance on the European-cultural terms suntan and sunburn. We tested the hypothesis that most Blacks would be unable to classify their skin into the four Fitzpatrick skin types. Design, setting, participants: A random, statewide sample of 2085 California Black adults were administered a survey to categorize their skin into the Fitzpatrick types of always burn/never tan (I), usually burn/rarely tan (II), rarely burn/usually tan (III), and never burn/always tan (IV). We also added a response option not available in the scale, none of the above describes me. Questions on sunscreen use and demographics were included. Main outcomemeasure: Self-reported skin type. Results: 1231 (59%) selected none of the above, and only 559 (26.8%) categorized themselves as type IV. When the none option is removed and the 59% who chose it were excluded as non-responders, the 559 who selected type IV constitute 65.5% of the remaining sample. Those who selected none were significantly less likely than all others to use sunscreen, and income and residential segregation were the strongest predictors of type I/II skin. Conclusion: Standard administration of the Fitzpatrick Scale excludes the majority of Blacks, yields data that overestimate Black population prevalence of type IV skin, and excludes the Blacks who are least likely to use sunscreen. Suggestions are provided for improving the cultural sensitivity of the skin-type assessment

Enforcement of state indoor tanning laws in the United States

Introduction Twenty-eight US states have passed legislation for indoor tanning facilities. To our knowledge, whether these state laws are actually enforced has not been evaluated previously in all 28 states. Therefore, we interviewed key informants in these states to assess enforcement practices. Methods Two trained interviewers used a structured survey instrument to interview 28 key informants who were knowledgeable about enforcement practices for laws regarding indoor tanning. Respondents provided information specific to the most populous city in their states. Results Licensure for indoor tanning businesses was required in 22 of the 28 cities. Slightly less than half of the cities gave citations to tanning facilities that violated state law. Approximately 32% of the cities did not inspect indoor tanning facilities for compliance with state law, and another 32% conducted inspections less than annually. Of those cities that inspected at all, most conducted unannounced inspections. Conclusion The relatively low rates of annual inspections and citations are of concern. We recommend that future studies assess whether legislation, enforcement practices, or a combination of the 2 affects the practices of indoor tanning facilities or of consumers

Measuring the stringency of states\u27 indoor tanning regulations: Instrument development and outcomes

Objectives: We sought to describe the development of an instrument to quantify the stringency of state indoor tanning legislation in the United States, and the instrument\u27s psychometric properties. The instrument was then used to rate the stringency of state laws. Methods: A 35-item instrument was developed. An overall stringency measure and 9 stringency subscales were developed, including one measuring minors\u27 access to indoor tanning. Stringency measures showed good internal consistency and interrater reliability. Results: In all, 55% of the 50 states and the District of Columbia had any indoor tanning law, and 41% had any law addressing minors\u27 access. Oregon, Illinois, South Carolina, Florida, Indiana, Iowa, and Rhode Island had high overall stringency scores, and Texas and New Hampshire were the most restrictive with regard to minors\u27 access. Limitations: Measurement of actual enforcement of the laws was not included in this study. Conclusions: The instrument appears to be an easy-to-use, reliable, and valid methodology. Application of the instrument to actual laws showed that, in general, state laws are relatively weak, although there was considerable variability by state. © 2007 American Academy of Dermatology, Inc

Dog walking: Its association with physical activity guideline adherence and its correlates

Objective: We examined the prevalence and correlates of dog walking among dog owners, and whether dog walking is associated with meeting the American College of Sports Medicine/American Heart Association physical activity guidelines. Methods: In March 2008, we mailed a survey to dog-owning clients from two San Diego County veterinary clinics. Useable data were obtained from 984 respondents, and 75 of these completed retest surveys. We assessed associations between potential correlates and dog walking (i.e., yes/no dog walking for at least 10 min in past week). Results: Test–retest reliability of measures was generally high. Approximately one-third of the sample (31.5%) were not dog walkers. Proportions of dog walkers versus non-dog walkers meeting United States guidelines were 64.3% and 55.0%, respectively. Dog walking was independently associated with meeting guidelines in a multivariate model (odds ratio = 1.59, p = 0.004). Three variables were independently associated with dog walking in a multivariate model: dog encouragement of dog walking, dog-walking obligation, and dog-walking self-efficacy. Conclusion: Dog walking was associated with meeting physical activity guidelines, making it a viable method for promoting physical activity. Dog-walking obligation and self-efficacy may be important mediators of dog walking and may need to be targeted if interventions are to be successful