(Embargoed Until: 3 P.M. (CT), Monday, August 15, 2005)
(Embargoed Until: 3 P.M. (CT), Monday, August 15, 2005)
(Embargoed Until: 3 P.M. (CT), Monday, August 15, 2005)
EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, August 15, 2005
Media Advisory: To contact corresponding author Robert P. Dellavalle, M.D., Ph.D., M.S.P.H., call Deborah Mendez-Wilson at 303-724-1520. To contact editorialist Joel Hillhouse, Ph.D., call Joe Smith at 423-439-5707.
STATE REGULATIONS ASSOCIATED WITH DECREASED YOUTH ACCESS TO INDOOR TANNING FACILITIES
CHICAGO—In three states that have age regulations on indoor tanning access, 62 percent of surveyed facilities reported they would not allow a 12-year-old to tan, compared to 18 percent of facilities in a non-regulation state, according to a study in the August issue of the Archives of Dermatology, one of the JAMA/Archives journals.
Use of ultraviolet (UV) tanning beds by U.S. adolescents is widespread, despite UV's classification as a carcinogen (cancer-causing agent) and its association with numerous effects such as squamous and basal cell carcinoma and melanoma, background information in the article states. Changing the tanning behavior of minors is a goal for skin cancer prevention given that adolescence is a critical period during which UV radiation increases skin cancer risk. However, in 2003, only three states had set limits for indoor tanning customers: Texas at age 13 years, Illinois at age 14 years and Wisconsin at age 16 years. Most states do not set age limits on indoor tanning.
Eric J. Hester, M.D., from the University of Colorado at Denver and Health Sciences Center, and colleagues conducted phone surveys to assess youth access to indoor tanning facilities. In October 2003, 400 tanning facilities in Colorado, Illinois, Texas and Wisconsin were asked whether potential patrons aged 12 and 15 years would be allowed to tan in their facilities, and if so, whether a guardian or adult accompaniment or consent was required. The tanning facility personnel were also asked whether any price discounts were available for younger customers.
The researchers found that 62 percent of facilities in states with age restrictions had operators report that they would not allow a 12-year-old potential customer to tan in their facility (Texas, 23 percent; Illinois, 74 percent; Wisconsin 89 percent) compared with 18 percent in Colorado. For a 15-year-old potential customer, rates of access to tanning without parental accompaniment (not complying to respective state statutes) were 83 percent in Texas, 20 percent in Illinois, and 17 percent in Wisconsin. Noncompliance for 15-year-olds was higher for tanning facilities offering youth discounts (60 percent vs. 46 percent). Overall, 15 percent of the tanning facilities reported that youth discounts were available-23 percent in Texas, 14 percent in Illinois, 11 percent in Wisconsin, and 11 percent in Colorado.
"Given the prevalence of indoor UV tanning, especially by adolescent girls, and the known risks of indoor tanning, public health efforts need to be directed at this underrecognized carcinogen exposure," the authors write. "Despite high noncompliance with youth access laws in Texas, higher compliance levels in states with long-standing youth access regulations (Illinois and Wisconsin) suggest the potential for successful tanning industry youth access regulation."
(Arch Dermatol. 2005;141:959-962. Available post-embargo at archdermatol.com)
Editor's Note: This study was supported by a grants from the National Institutes of Health, Bethesda, Md.; the Health Services Research Award Faculty Development in Primary Care (co-author, Dr. Schilling); the National Cancer Institute, Bethesda, Md.; and a seed grant from the University of Colorado Cancer Center.
EDITORIAL: SKIN CANCER RISK BEHAVIORS
A Conceptual Framework for Complex Behavioral Change
In a related editorial, Joel Hillhouse, Ph.D., from East Tennessee State University, Johnson City, and Rob Turrisi, Ph.D., from Pennsylvania State University, University Park, discuss the complexities involved in and strategies for eliciting change in patients' sun-tanning behaviors.
"To effectively reduce tanning behaviors, it is critical to make the attitudes toward healthy alternatives more positive than the behaviors we wish to reduce.... This empirical approach provides a theoretical framework that explains why, in most cases, simply telling young people that their current behaviors will lead them to suffer future grave consequences will not alter their behaviors."
Examining current information from web sites devoted to skin cancer prevention, Drs. Hillhouse and Turrisi found little agreement on many recommendations for protecting oneself from the sun, including how much is safe and the times of day to avoid the sun. Additionally, indoor tanning was only sporadically mentioned as a risk factor.
The editorialists stated the need for a clear, consistent message about UV exposure and how that message should be delivered: "We have evidence that in many situations and with a number of individuals, other message deliverers [aside from one's physicians], such as parents and peers, can be more effective at leading young people to reduce skin-harming behaviors."
They conclude by saying: "We believe that the time is right for a paradigm shift in this field toward a more theoretical and empirical approach that attempts to maximize "skin-risky" behavior change in our patients and the general population."
(Arch Dermatol. 2005;141:1028-1031. Available post-embargo at archdermatol.com)
Editor's Note: This research was supported in part by a grant from the American Cancer Society, East Tennessee State University.
For more information, contact JAMA/Archives media relations at 312/464-JAMA (5262) or e-mail mediarelations{at}jama-archives.org.
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EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, August 15, 2005
Media Advisory: To contact Alain Dupuy, M.D., M.P.H., email: alain.dupuy{at}sls.aphp.fr. To contact editorialist Mark Naylor, M. D., call Adam Cohen at 405-271-7159.
"HIGH PROTECTION" SUNSCREEN DOES NOT APPEAR TO INFLUENCE LONGER DURATION OF SUNBATHING
CHICAGO—Sunbathers wearing sunscreen labeled as "high protection" did not spend more time in the sun during a week-long vacation compared to those wearing "basic protection" sunscreen, according to an article in the August issue of the Archives of Dermatology, one of the JAMA/Archives journals.
"Sun exposure is the most important environmental factor involved in the development of skin cancer," according to background information in the article. Melanoma has had one of the greatest increases in incidence among solid tumors in the past three decades and accounts for the vast majority of skin cancer deaths. Although daily sunscreen use has been shown to prevent squamous cell skin carcinoma, several studies suggest that sunscreen use may be a risk factor instead of a protective one for melanoma. Some believe that higher protection by stronger sunscreens may encourage more time in the sun by delaying warning signs such as sunburn, giving one a false sense of safety.
Alain Dupuy, M.D., M.P.H., from the Hôpital Saint Louis, Paris, and colleagues, conducted a week-long, randomized, controlled trial during the summer of 2001 to determine the effect of sunscreen protection on sun-exposure behavior. Three hundred sixty-seven vacationers from four French seaside resorts were given one of three sunscreens: SPF 40 labeled as "high protection," SPF 40 labeled as "basic protection," and SPF 12 labeled as "basic protection." No mention of actual SPF was made on the labels. Participants were given an initial questionnaire about general sun-exposure behavior and completed self-administered questionnaires each evening, detailing their sun exposure and protection for every half-hour period during the day. Eighty percent of the participants were women, with an average age of 39 years.
The researchers found that neither SPF nor labeling was associated with significantly different durations of sunbathing during the week. Average weekly sun-exposure time was 14.2 hours in the high/SPF 40 group, 12.9 hours in the basic/40 group, and 14.6 hours in the basic/12 group. Ninety-six percent (343) of the vacationers said they'd used the sunscreen at least once, with 77 percent (276) saying they used it exclusively. The proportion of those who experienced sunburn during the week was higher in the low-SPF group (24 percent) than the high-SPF group with the same label (14 percent). In total, 63 participants experienced sunburn, with six of them having severe sunburn.
"In this population, our findings do not support the hypothesis that a higher SPF induces a higher exposure by delaying the alarm signs nor the hypothesis that mentioning 'high protection' on the label may induce longer exposure by giving an impression of safety," the authors write. "In addition, this study logically confirms that the use of higher-SPF sunscreens does reduce the number of sunburns in real life. Finally, our results suggest that people tend to self-regulate their sun protection with sunscreens, by inversely adapting the amount of sunscreen to the SPF, at least when sunscreens are freely delivered."
(Arch Dermatol. 2005;141;950-956. Available post-embargo at archdermatol.com)
Editor's Note: This study was supported by a grant from Société Française de Dermatologie, Paris, and by Pierre Fabre Dermo-Cosmétique, Castanet-Tolosan, France, which provided sunscreens.
EDITORIAL: SUNSCREEN, SUN PROTECTION, AND OUR MANY FAILURES
In an accompanying editorial, Mark Naylor, M.D., from the Oklahoma Medical Research Foundation, Oklahoma City, and June K. Robinson, M.D., editor Archives of Dermatology, discuss sun-exposure behavior and its risks.
"As long as the great majority of the population intentionally seeks UV exposure for purposes of tanning and 'sunning,' melanoma incidence will continue to rise as leisure time and average population age increase," the editorialists write. "Unfortunately, it seems likely that a significant percentage of the population will continue to ignore our recommendations for minimizing lifetime UV exposure and, worse, that a substantial number will continue to intentionally seek UV exposure for the purpose of cosmetic tanning."
"One of the most chilling findings of Dupuy et al was not the featured data concerning sunscreen use; rather, it was the self-reported intent of 96 percent of the participants to get a tan during their vacation week, and this while they were participating in a sunscreen study!" the editorialists write. "Clearly, this population views sunscreens more as tanning aids than as a means of limiting UV exposure. Unfortunately, it is very clear from these and other studies that measure sun-exposure behavior that we have a long way to go to get this situation headed in the right direction."
(Arch Dermatol. 2005;141;1025-1027. Available post-embargo at archdermatol.com)
For more information, contact JAMA/Archives media relations at 312/464-JAMA (5262) or e-mail mediarelations{at}jama-archives.org.
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EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, August 15, 2005
Media Advisory: To contact corresponding author Myriam J. Curet, M.D., call Michelle Brandt at 650-723-0272.
ROBOTIC GASTRIC BYPASS SURGERY SHOWS PROMISE
CHICAGO—A system that allows surgeons to perform laparoscopic gastric bypass surgery from a remote console, controlling up to three robotic arms and a binocular camera, was successfully tested in 10 patients, according to a study in the August issue of Archives of Surgery, one of the JAMA/Archives journals.
The laparoscopic gastric bypass surgery (a Roux-en-Y procedure) is often considered the most challenging minimally invasive procedure in general surgery, requiring a learning curve of 75 to100 cases for even experienced surgeons to achieve the highest level of proficiency, according to background information in the article. Although robotic surgical techniques have been developed to assist laparoscopic gastric bypass surgery, the complex geometry of the surgery has required repositioning of the robot, complicating its use.
Catherine J. Mohr, M.S.M.E., of the Stanford School of Medicine, Calif., and colleagues report the first 10 patients to undergo a totally robotic laparoscopic Roux-en-Y gastric bypass surgery (during March and April 2004) using a technique developed to minimize robot repositioning. The results were compared with a sample of 10 patients who had undergone standard laparoscopic Roux-en-Y gastric bypass surgery during July to September 2002. There were no significant differences in the general health, age or body mass index (BMI, calculated as weight in kilograms divided by the square of height in meters) of the two sets of patients. All patients were women. The researchers compared surgical times as well as the ratio of the procedure time to the patient's BMI.
The number and severity of complication were comparable, the researchers found. "The median length of time to complete the procedure was significantly shorter with the robot (169 vs. 208 minutes)," the authors report. "In addition, the ratio of procedure time to BMI was considerably lower with the robot (median, 3.8 vs. 5.0 minutes per BMI for the laparoscopic cases). Moreover, the rate at which the operative times improved indicate that the learning curve for the robotic procedure is considerably shorter. We found that the mean minutes per BMI of our second five robotic procedures was 3.45 minutes, whereas the laparoscopic data for our senior attending surgeon did not attain a comparable five-case mean of the metric until case 42. In addition, when the data from a bariatric fellow from the same institution [Stanford Medical School] were compared, that surgeon did not match the metric until surgical case 85."
"Reluctance to use new technology such as the ... surgical robot often reflects surgeon concern over increasing complication rates, increased operative times, and steep learning curves," the authors conclude. "Any new technology must be proven feasible and safe. Our results support the robot's feasibility in the Roux-en-Y gastric bypass as we achieved comparable operating room times with an extremely short learning curve. ... Likewise, both major and minor complications were similar between the robotic and laparoscopic group, suggesting that a totally robotic laparoscopic gastric bypass is a safe and potentially superior alternative to traditional laparoscopic gastric bypass."
(Arch Surg. 2005;140:779-786. Available post-embargo at archsurg.com)
For more information, contact JAMA/Archives media relations at 312/464-JAMA (5262) or e-mail mediarelations{at}jama-archives.org.
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EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, August 15, 2005
Media Advisory: To contact Maj. Mark Boston, U.S.A.F., M.C., F.S., e-mail: mark.boston{at}luke.af.mil.
PARENTS FIND USEFUL INFORMATION ON THE INTERNET ABOUT THEIR CHILD'S SURGERY
CHICAGO—Parents of children scheduled to undergo outpatient otolaryngology procedures turned to the Internet to learn more about their child's medical condition and used the information in making medical decisions, according to a study in the August issue of the Archives of Otolaryngology—Head & Neck Surgery, one of the JAMA/Archives journals.
Although the Internet has become an increasingly important source of health and medical information, how Internet information may influence parent's medical decisions for their children is not known, according to background information in the article. Physicians are often not prepared to discuss information obtained from the Internet or to direct parents to reliable sites.
Maj. Mark Boston, U.S.A.F., M.C., F.S., of the 56th Medical Group, Luke Air Force Base, Ariz., and colleagues surveyed parents of children undergoing routine otolaryngology procedures, such as tonsillectomy or placement of ear tubes, as outpatients at Cincinnati Children's Hospital Medical Center during September 2003 and January 2004. Parents were asked questions about their access to the Internet and whether they had searched for information on their child's medical condition and/or surgery, whether they found the information understandable and helpful and whether the information they found on the Internet influenced medical decisions about their child's treatment.
Of 204 surveyed parents, 170 (83 percent) had Internet access. Of these 170 parents, 83 (48 percent) used the Internet to look for information about their child's diagnosis and/or surgical procedure, the authors report. Nearly all (92 percent) found the information regarding the medical condition was understandable and 90 percent found the information helpful. Most (67 percent) said the Internet information influenced the medical decisions they made on behalf of their child. Only 35 parents (47 percent) discussed the information they obtained from the Internet with their child's surgeon.
"In conclusion, nearly all parents who used the Internet to search for medical information about their child's outpatient otolaryngology procedure found the information to be understandable, helpful, and influential," the authors write. "Otolaryngologists need to be aware of the content of specific medical Web sites and be able to direct and discuss parent and patient use of the Internet as a medical information source."
(Arch Otolaryngol Head Neck Surg. 2005;131:719-722. Available post-embargo at archoto.com)
For more information, contact JAMA/Archives media relations at 312/464-JAMA (5262) or e-mail mediarelations{at}jama-archives.org.
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