DeAnn Lazovich - US grants

DESCRIPTION (Applicant's Description) The national prevalence of past month smoking among 9th - 12th graders has increased steadily, from 27.5 percent in 1991 to 34.5 percent in 1995. Although extensive research has been conducted to change adolescent smoking behavior, the scope of these studies has been limited in that they have largely focused on the primary prevention of smoking onset, have targeted young adolescents, and have mostly taken place in school settings. The reduction of overall smoking among high school-aged adolescents requires effective interventions that incorporate both smoking prevention and cessation, yet such research is lacking. We propose to conduct a randomized controlled trial to assess the effectiveness of a non-school based, multi-component intervention strategy to reduce prevalence of past month smoking by 1) changing normative expectations around the issue of smoking among adolescents, ages 14-17, and 2) providing cessation assistance for those adolescents who smoke. A total of 3000 adolescents who are dependents of members belonging to a large health maintenance organization and who respond to a mailed survey to collect baseline data will be randomized to receive either the multi-component intervention or usual care. The intervention will take place over 2 years and consist of 1) a youth advisory group, 2) youth action teams, 3) behavioral prescriptions, sent to all adolescents at regular intervals during the intervention, 4) a contest to increase motivation, and 5) cessation assistance to smoking adolescents using motivational interviewing techniques. A follow-up survey will be conducted at the end of the intervention period. The proposed intervention proposes to achieve a 5-6 percent reduction from baseline in the overall smoking prevalence among adolescents in the intervention compared to those in the control. The overall expected difference of 5-6 percent in smoking prevalence as a result of this study would have dramatic public health impact at the population level, and would be especially important, given the clear need for new, effective approaches to reverse the smoking trends in this population.

DESCRIPTION (provided by applicant): The rising popularity of indoor tanning, an artificial source of ultraviolet radiation (UV) raises concerns that the melanoma epidemic will continue to cause unnecessary morbidity and mortality. Most epidemiologic studies of this risk factor and melanoma predate the introduction of modern tanning equipment (ca 1980), thus new epidemiologic studies are urgently needed among individuals with substantial levels of exposure and collection of detailed exposure information. In addition, our understanding of the role of DNA repair in modifying the risks of melanoma associated with UV exposure is just emerging. The specific aims of our proposal are to assess whether frequent and/or long-term use of modern era indoor tanning increases the risk of melanoma, and whether the risk of melanoma may be influenced by variation in inherited polymorphisms that affect DNA repair. We propose to conduct a population-based case-control study of melanoma among 2660 residents of Minnesota (1330 cases, 1330 controls), ages 25-59, a group found to have a high prevalence of exposure to indoor tanning. We will identify cases through the Minnesota Cancer Surveillance System, a pathology-based, statewide cancer registry of high quality and completeness for case ascertainment. Each case and control subject's history of exposure to indoor tanning, and to potential confounders will be collected during a telephone interview. Buccal cell samples from cases and controls will be collected for DNA. Associations between indoor tanning or impaired capacity to repair DNA and melanoma will be measured by the odds ratio, controlling for known confounders. Differences in risk of melanoma associated with exposure to solar or artificial ultraviolet radiation will be explored by skin type and by DNA repair pathways specific to the repair of UVB- or UVA-induced DNA damage in skin. Except for sun exposure, established risk factors for melanoma, such as skin type or family history, are not amenable to change. Indoor tanning behavior, however, is under the control of the individual. If well-designed epidemiologic studies confirm that indoor tanning is a risk factor for melanoma and that some individuals are particularly susceptible to its effects, public health action may be indicated to discourage use and reduce the risk of the melanoma.

[unreadable] DESCRIPTION (provided by applicant): Although indoor tanning is a common behavior among both adolescents and their parents, and is associated with a range of acute and chronic health effects, few interventions have been developed to discourage its use. Our prior studies have shown that parental attitudes and practices are strongly related to adolescent use of indoor tanning. We have also identified characteristics associated with adolescents' use of indoor tanning such as positive attitudes towards tans and social influences and norms. In preparation for a randomized controlled trial to assess efficacy of interventions to decrease the prevalence of indoor tanning, we propose to develop and pilot an intervention consisting of written materials in the form of magazines that will be mailed to parents and adolescents within the same household. Our specific aims are 1) to develop and test magazine content suitable for parents that increase the knowledge and salience of the risks of indoor tanning, and convey the requirements for parental permission for adolescent tanning and the importance of parental influences on their child's indoor tanning; 2) to develop and test magazine content for adolescents that increase the knowledge and salience of the risks of indoor tanning and the social and appearance disadvantages of indoor tanning, and increase their receptivity to parental influences to avoid future use of indoor tanning, regardless of their past tanning experience; and 3) to assess parental and adolescent response to the materials (recall, of receipt, use of intervention materials, recall of content). These specific aims will be accomplished via focus groups with parents and adolescents, ages 14-15, to create relevant messages and materials and via telephone interviews with 50 families who received the magazines and 50 comparison families to gather information about receipt and use of the materials. This information will guide a future randomized controlled trial to assess whether a low-cost communication intervention be used to increase salience of, knowledge of, and change attitudes about indoor tanning as a health issue, and decrease prevalence of indoor tanning in parents and teens. [unreadable] [unreadable] [unreadable]

DESCRIPTION (provided by applicant): The Iowa Women's Health Study (IWHS) began in 1986 as a longitudinal cohort study to determine whether diet, body fat distribution, and other risk factors were related to cancer incidence among 41,836 post- menopausal women aged 55-69 years. Exposure and lifestyle information was collected in a baseline mailed survey in 1986, and five follow-up surveys in 1987, 1989, 1992, 1997 and 2004. Cancer incidence and mortality have been obtained by annual linkage with the Iowa Cancer Registry (a SEER cancer registry) and the National Death Index since 1986. The project has been extremely productive, with more than 260 research publications published to date. We propose, in this 5-year renewal, to continue to address important questions related to cancer in older women. The cohort is becoming especially informative with regard to less common cancers, and for lifestyle predictors of cancer occurrence and survival among the elderly. We also propose new linkages to sources of community-level data that will allow us to study how an individual's social and physical environment influences their cancer risk. These data sources include the Area Resource File (US Department of Health and Human Services), US Census Data, and data from the Rural Development Initiative Study based at Iowa State University. Our specific aims for the proposed funding period are to: 1) continue to follow the IWHS cohort, who are now 78-92 years old, through a total of 27 years (1986-2012), 2) expand our ongoing investigations of risk factors for incident cancers among women, 3) determine the factors associated with quality of life and mortality among female cancer survivors, and 4) determine the associations between community-level social and environmental characteristics and cancer outcomes and quality of life among elderly women. Continuation of funding for the IWHS is vital not only to completion of the research described in the specific aims, but is also key to supporting existing and several planned ancillary studies. The IWHS is also an active participant in several consortia of cohort studies. The combination of the extensive exposure and follow-up data already collected, linkage with community-level data that will be obtained at no cost, a productive research team, and the important research questions that are proposed make a 5-year continuation of the IWHS an extremely cost-effective means towards improving public health. PUBLIC HEALTH RELEVANCE: With the increasing number of Americans over the age of 65 years, prevention of cancer and its impact in later life is taking on greater importance. Research findings from the Iowa Women's Health Study will continue to add to our understanding of the potentially modifiable factors contributing to cancer prevention and survivorship, and will help public health and health care practitioners prioritize and better utilize health care resources.