Every year more than 72,000 adolescents and young adults (AYAs) in the United States (US) aged 15-39 years are diagnosed with cancer. AYAs represent a population that falls into a care gap between pediatric and adult medical services. Additionally, AYAs have experienced increased cancer incidence and decreased five-year survival rates compared to other age groups. The spectrum of tumors seen in AYAs differs from children and older adults, with 90% of the tumors stemming from ten cancer types. Melanoma of the skin, characterized by the uncontrolled growth of pigment-producing cells, is the third most common cancer diagnosed among AYAs in the US. Overexposure to ultraviolet (UV) radiation from sunlight or artificial sources is the greatest risk factor for melanoma. AYAs seem to be particularly at risk for developing melanoma due to increased UV exposure early in life. This study’s objectives were to understand the unique characteristics of melanoma in AYAs in Tennessee and identify the predictors of late- stage diagnosis. The sample for this study includes all incident melanoma cancer cases (N=1109) in AYAs from the Tennessee Cancer Registry (TCR) for the years 2004-2008, inclusive. AYA cases were defined as cancer cases that were diagnosed in individuals ages 15-39 years, inclusive. Melanoma cases were defined according to the International Classification of Diseases- Oncology (ICD-O-3) site codes C440-C449. Melanoma cases that had a specified stage at diagnosis were included for final analysis (N= 315). Stage of diagnosis was determined through the SEER Summary Stage 2000 variable and coded into in situ, localized, and combined regional & distant stage. Univariate and multivariate analyses were performed for the following predictor variables: insurance status (private insurance vs. other), age group (5- year groups), and sex (male vs. female). The majority of the sample was white (96.5%), female (63.8%), had private insurance (85%) and was diagnosed with localized stage melanoma (69.4%). Individuals with government insurance were eight times more likely to be diagnosed with late stage melanoma compared to individuals with private insurance (OR 8.4, CI 3.0-23.3, p < 0.01). AYAs in the 15-19 year old age group were six times more likely to be diagnosed with late stage melanoma compared to 35-39 year olds (OR 6.3, CI 1.7-22.9, p=0.01). Females were 57% less likely to be diagnosed with late stage melanoma compared to males (OR 0.53, CI 0.30-0.93, p < 0.05). These findings indicate that individuals with government insurance may not receive adequate melanoma screening and preventative care compared to individuals with private insurance. While females were less likely to be diagnosed with late stage melanoma, females have a much greater risk of being diagnosed with melanoma at any stage. Finally, the increased risk of late stage diagnosis in the 15-19 year old age group may be associated with greater UV exposure from indoor and outdoor tanning. These data suggest the need for targeted cancer awareness and control activities specific to AYAs. Future studies are needed to explore the variations in late stage diagnosis of melanoma in AYAs in Tennessee.

Background: Indoor tanning elevates the risk for melanoma, which is now the most common cancer in US women aged 25-29. Public policies restricting access to indoor tanning by minors to reduce melanoma morbidity and mortality in teens are emerging. In the United States, the most common policy restricting indoor tanning in minors involves parents providing either written or in person consent for the minor to purchase a tanning visit. The effectiveness of this policy relies on parents being properly educated about the harms of indoor tanning to their children. Objective: This randomized controlled trial will test the efficacy of a Facebook-delivered health communication intervention targeting mothers of teenage girls. The intervention will use health communication and behavioral modification strategies to reduce mothers’ permissiveness regarding their teenage daughters’ use of indoor tanning relative to an attention-control condition with the ultimate goal of reducing indoor tanning in both daughters and mothers. Methods: The study is a 12-month randomized controlled trial comparing 2 conditions: an attention control Facebook private group where content will be relevant to teen health with 25% focused on prescription drug abuse, a topic unrelated to tanning; and the intervention condition will enter participants into a Facebook private group where 25% of the teen health content will be focused on indoor tanning. A cohort of 2000 mother-teen daughter dyads will be recruited to participate in this study. Only mothers will participate in the Facebook groups. Both mothers and daughters will complete measures at baseline, end of intervention (1-year) and 6 months post-intervention. Primary outcomes include mothers’ permissiveness regarding their teenage daughters’ use of indoor tanning, teenage daughters’ perception of their mothers’ permissiveness, and indoor tanning by both mothers and daughters. Results: The first dyad was enrolled on March 31, 2016, and we anticipate completing this study by October 2019. Conclusions: This trial will deliver social media content grounded in theory and will test it in a randomized design with state-of-the-art measures. This will contribute much needed insights on how to employ social media for health behavior change and disease prevention both for indoor tanning and other health risk behaviors and inform future social media efforts by public health and health care organizations. ClinicalTrial: Clinicaltrials.gov NCT02835807; https://clinicaltrials.gov/ct2/show/NCT02835807 (Archived by WebCite at http://www.webcitation.org/6mDMICcCE).

Background Younger indoor tanning initiation leads to greater melanoma risk due to more frequent and persistent behavior. Despite this, there are no published studies exploring the predictors of indoor tanning initiation in teen populations. Purpose This longitudinal study uses latent profile analysis to examine indoor tanning initiation in indoor tanning risk subgroups from a national sample of female adolescents. Methods Latent profile analysis used indoor tanning beliefs and perceptions to identify indoor tanning initiation risk subgroups. The teens in each subgroup were reassessed on indoor tanning initiation after a year. Results Three subgroups were identified: a low risk, anti-tanning subgroup (18.6 %) characterized by low scores on positive indoor tanning belief scales and high scores on beliefs about indoor tanning dangers; a moderate risk aware social tanner subgroup (47.2 %) characterized by high scores on positive indoor tanning belief scales but also high scores on beliefs about indoor tanning dangers; and a high risk risky relaxation tanner subgroup (34.2 %) characterized by high scores on positive indoor tanning belief scales and low scores on beliefs about indoor tanning dangers. Teens in the aware social tanner and risky relaxation tanner subgroups were significantly more likely to initiate indoor tanning in the following year. Conclusions These findings highlight the need to identify teens at risk for indoor tanning initiation and develop tailored interventions that will move them to the lowest risk subgroup. Subgroup correlates suggest parent and peer-based interventions may be successful.

Youthful indoor tanning as few as ten sessions can increase the risk of melanoma by two to four times with each additional session adding another 2 % to the risk. Recent research estimates that indoor tanning can be linked to approximately 450,000 cases of skin cancer annually in the USA, Europe, and Australia. Despite these risks, indoor tanning remains popular with adolescents. This study tested the efficacy of a web-based skin cancer prevention intervention designed to reduce indoor tanning motivations in adolescent females. A nationally representative sample of 443 female teens was enrolled from an online panel into a two-arm, parallel group design, randomized controlled trial. Treatment participants received an appearance-focused intervention grounded in established health behavior change models. Controls viewed a teen alcohol prevention website. Outcome variables included willingness and intentions to indoor tan, willingness to sunless tan, and measures of indoor tanning attitudes and beliefs. The intervention decreased willingness and intentions to indoor tan and increased sunless tanning willingness relative to controls. We also examined indirect mechanisms of change through intervening variables (e.g., indoor tanning attitudes, norms, positive and negative expectancies) using the product of coefficient approach. The web-based intervention demonstrated efficacy in changing adolescent indoor tanning motivations and improving their orientation toward healthier alternatives. Results from the intervening variable analyses give guidance to future adolescent skin cancer prevention interventions.

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Abstract available through Journal of the American Pharmacists Association.

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Purpose: Nonmedical use of stimulant medications (NMUS) among college students is an important and growing problem. The annual prevalence of NMUS among four-year college students has nearly doubled since 2008 and exceeds NMUS in non-college peers. Community college students are an understudied population regarding NMUS. Given noted NMUS differences in 4-year students and non-college peers, one cannot assume community college students’ cognitions, perceptions, and behaviors mirror either peer cohort. We conducted a web-based survey across 10 community colleges in Tennessee (TN) to assess correlates and consequences of NMUS. Methods: We developed an initial version of the 60-item survey questionnaire using previously validated, theoretically based survey items and other items developed by the research team. The survey instrument was then reviewed and assessed for content validity by our research team, and thereafter pilot tested with East Tennessee State University undergraduate students for range measures, item order, and best practices for survey construction. The final 55-item survey instrument was designed using web-based survey software (i.e., Qualtrics). Ten of 13 community colleges in TN granted approval for their students to participate in the study (N=53096). A modified Tailored Design Method approach was utilized to maximize response rate across four email contacts, and monetary incentives were offered to encourage participation in the study. Regulatory authorities (e.g., institutional review boards, institutional offices) from East Tennessee State University and participating community colleges approved the conduct of this study. Data were analyzed using SPSS (version 22). Descriptive statistics were calculated to evaluate prevalence, source, motives and consequences of NMUS. Student’s t-tests and chi-square tests were conducted to compare nonmedical stimulant users and nonusers across a number of variables. Results were considered significant for p < 0.05. Results: A total of 3113 students completed the survey (response-rate = 5.8%), of which 302 (9.7%) were past-year nonmedical stimulant users. A significantly greater proportion of users were diagnosed with a mental health condition (22.2%) than non-users (9.6%). Compared to non-users, significantly greater proportions of users reported using tobacco products, such as cigarettes (34.5% vs. 14%), e-cigarettes (12.5% vs. 4%), and vapors (18.4% vs. 6.7%). Users further reported using more types of illicit drugs (1.9 ± 0.1), more alcoholic drinks per week (2.9±0.3), and more occasions of binge drinking per month (1.8±0.2) than non-users (1.1±0.02, 1.3±0.07, 0.7±0.04, respectively). Only 14.2% of users (n=43 from 302) reported having prescriptions for prescription stimulants. Common sources of prescription stimulants were friends (62.9%), family members (12.3%), and street suppliers (9.9%). Commonly endorsed reasons for NMUS were ‘to improve academic performance’ (63.9%), ‘to have more energy’ (49.7 %), ‘to relieve tension’ (22.2%), and ‘to feel good or get high’ (16.6 %). Adverse effects resulting from NMUS included: lack of appetite (45.4%), difficulty sleeping (38.4 %), and racing heart (31.1%). Unlike the published findings from 4-year college students, low GPA, male gender, Caucasian race and membership in fraternity organizations were not associated with NMUS in community colleges. Conclusion: The present study provides useful information on characteristics of users and patterns and consequences of NMUS in community colleges students. NMUS appears to be associated with illicit substance use, binge drinking and disrupted mental health in community college students in TN. Friends are the most common source and desire to enhance academic performance is the most salient motive for NMUS. Despite facing adverse consequences, college students continued using stimulants nonmedically. These findings underscore the need for development of public health programs that target prevention of NMUS in community colleges.

Purpose of Review: This review aims to (1) conceptualize the complexity of the opioid use disorder epidemic using a conceptual model grounded in the disease continuum and corresponding levels of prevention and (2) summarize a select set of interventions for the prevention and treatment of opioid use disorder. Recent Findings: Epidemiologic data indicate non-medical prescription and illicit opioid use have reached unprecedented levels, fueling an opioid use disorder epidemic in the USA. A problem of this magnitude is rooted in multiple supply- and demand-side drivers, the combined effect of which outweighs current prevention and treatment efforts. Multiple primary, secondary, and tertiary prevention interventions, both evidence-informed and evidence-based, are available to address each point along the disease continuum—non-use, initiation, dependence, addiction, and death. Summary: If interventions grounded in the best available evidence are disseminated and implemented across the disease continuum in a coordinated and collaborative manner, public health systems could be increasingly effective in responding to the epidemic./p>