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In this commentary, we discuss the skin cancer epidemic in the United States and provide data to indicate that the United States public is not protecting itself from ultraviolet radiation, the primary risk factor for melanoma, and nonmelanoma skin cancer. In our opinion, skin cancer control in this country may be hindered by uncertainty about the effectiveness of sun protection strategies, inconsistent messages about the relative effectiveness of sun protection measures by federal and national organizations, and conventional research approaches that have identified few effective sun protection interventions for adults and targeted individuals for behavior change without considering the environmental context. A policy and research agenda is put forth to remedy the apparent insufficiencies in the current approach to skin cancer prevention in the United States., (©2012 AACR.)

Background: Taft-Hartley Health and Welfare Funds ("funds") administer health insurance plans that cover approximately nine million U.S. adults. Unionized workers covered by funds work primarily in blue- and pink-collar occupations and smoke at a rate almost twice that of workers in other occupations. Most funds do not provide comprehensive coverage for tobacco cessation treatment for fund participants (workers, family members, and retirees)., Purpose: This study tested a pilot intervention to increase the provision and promotion of cessation benefits among Minnesota-based funds by educating the funds' advisors., Methods: Tailored educational outreach was conducted to advisors (administrators, consultants, attorneys) of 10 Minnesota-based funds (2009-2011). Pre- and post-intervention advisor interviews measured perceptions/knowledge/attitudes about tobacco use, cessation, coverage, and promotion of benefits. Pre- and post-intervention data on benefit provision were collected from Summary Plan Descriptions (SPDs) and Summary Material Modifications (SMMs) of 10 Minnesota-based funds and 19 comparison funds in Massachusetts and Washington, and compared in 2011. SPDs/SMMs were scored on benefit adequacy, comparing services covered and the extent to which they met DHHS recommendations., Results: Minnesota-based funds provided significantly higher coverage (except for copays and pre-conditions) pre-intervention. However, there were no significant differences between Minnesota and comparison funds in rate of improvement in benefits over time. At follow-up, advisors reported a significant increase in confidence in their knowledge to address smoking issues in funds. Advisors also reported sharing intervention information with fund trustees., Conclusions: Educational strategies to influence advisors who provide guidance to fund trustees may help to increase advisors' confidence to address cessation benefit improvement., (Copyright © 2012 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.)

Background: Young adults have the highest rate of smoking among any age group., Purpose: The purpose of this study is to assess the short-term effects of Minnesota's comprehensive statewide smokefree law on young adult smoking perceptions and behavior., Methods: Telephone surveys were conducted before and up to 18 months after Minnesota's statewide smokefree law went into effect on October 1, 2007 (data analyzed 2010-2011). Participants included young adults from a population-based cohort in Minnesota (n=1458) and from five other upper Midwest states that serve as a comparison (n=248). Differences in perceptions and smoking behavior were examined between Minnesota participants who lived with and without a local smokefree law prior to Minnesota's statewide law, and participants who lived in the comparison states., Results: The majority of youth in Minnesota were aware of the smoking restrictions in restaurants and bars following the law. After implementation of the law, Minnesota participants who previously lived without a local law (versus comparison) were more likely to perceive fewer adult and peer smokers and less likely to report leaving social events early because it was too smoky. No changes in smoking behaviors were observed before and after the law. Minnesota participants, however, who lived without a prior law (versus participants with a prior law) were more likely to attribute a quit attempt after the law to smoking restrictions in restaurant and bars., Conclusions: Results suggest that Minnesota's law has changed perceptions of the tobacco environment. Longer-term follow-up may be needed to observe changes in smoking behavior., (Copyright © 2012 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.)

Background: Smoking in movies is associated with adolescent smoking worldwide. To date, studies of the association mostly are restricted to the exposure to smoking images viewed by 9-15-year-olds. The association among older adolescents is rarely examined. In addition, the reciprocal effect of smoking behaviour on subsequent reported exposure to smoking in movies has not been reported., Methods: Data were from the Minnesota Adolescent Community Cohort Study collected every 6 months from 2000 to 2007 when participants were between the ages of 12 and 18 (n=4745). We estimated the prospective effect of the perceived prevalence of smoking in movies (four levels, from never to most of the time) on smoking stage (SS) measured 6 months later (six stages, from never-smoker to established smoker) and the reciprocal prospective association between the two factors. Estimates were adjusted for demographic factors., Results: The perceived prevalence of smoking in movies measured between ages 13½ and 15½ consistently predicted subsequent SS. The association was inconsistent after the age of 15½. SS did not consistently predict subsequent perception of the prevalence of smoking in movies., Conclusions: Perceived exposure to movie smoking primarily influenced teenagers' smoking behaviour at younger ages. If future studies confirm this finding, developing and evaluating interventions to improve young teenagers' resistance to these images may complement policies to reduce smoking in movies to reduce prevalence of adolescent smoking.

Breast cancer is the most prevalent cancer in women worldwide and is classified into ductal and lobular carcinoma. Breast cancer as well as lobular carcinoma is associated with various risk factors such as gender, age, female hormone exposure, ethnicity, family history and genetic risk factor-associated genes. Genes associated with a high risk of developing breast cancer include BRCA1, BRCA2, p53, PTEN, CHEK2 and ATM. Surgery, chemotherapy, radiotherapy and hormone therapy are used to treat breast cancer but these therapies, except for surgery, have many side-effects such as alopecia, anesthesia, diarrhea and arthralgia. Gene-directed enzyme/prodrug therapy (GEPT) or suicide gene therapy, may improve the therapeutic efficacy of conventional cancer radiotherapy and chemotherapy without side-effects. GEPT most often involves the use of a viral vector to deliver a gene not found in mammalian cells and that produces enzymes which can convert a relatively non-toxic prodrug into a toxic agent. Examples of these systems include cytosine deaminase/5-fluorocytosine (CD/5-FC), carboxyl esterase/irinotecan (CE/CPT-11), and thymidine kinase/ganciclovir (TK/GCV). Recently, therapies based on genetically engineered stem cells (GESTECs) using a GEPT system have received a great deal of attention for their clinical and therapeutic potential to treat breast cancer. In this review, we discuss the potential of GESTECs via tumor tropism effects and therapeutic efficacy against several different types of cancer cells. GESTECs represent a useful tool for treating breast cancer without inducing injuries associated with conventional therapeutic modalities.

Introduction: Use of cigarette price-minimizing strategies may reduce the effectiveness of cigarette excise taxes on the prevalence of smoking. We examined the use of different price-minimizing strategies by smokers and their associations with subsequent smoking behaviors., Methods: Seven hundred eighteen current smokers from the Minnesota Adult Tobacco Survey Cohort Study provided information on the use of six different price-minimizing strategies in 2009; 602 of them were resurveyed in 2010 to assess their smoking behavior. Logistic regression was used to assess the effects of use of each strategy, use of at least one strategy, and the number of strategies used on quit smoking, attempted to quit, or cut back on cigarette consumption., Results: Overall, 78% of participants used at least one price-minimizing strategy in 2009 to save money on cigarettes. About 53% reported buying from less expensive places, 49% used coupons or promotions, 42% purchased by the carton, and 34% changed to a cheaper brand. Participants' characteristics differed somewhat by strategy. Participants who reported buying by the carton were less likely to attempt to quit smoking and cut back on cigarette consumption subsequently; those who used more strategies were less likely to cut back on their cigarette consumption., Conclusions: Use of cigarette price-minimizing strategies is common among smokers and appears to hinder smokers from attempting to quit and reducing cigarette consumption. Prohibiting the use of coupons and promotions may uphold the effect of cigarette taxes to reduce the prevalence of smoking.

Objective: To understand how factors at multiple levels of influence impact adolescent smoking initiation., Method: Data from the Minnesota Adolescent Community Cohort, a population-based cohort, were analyzed. Adolescents were recruited from randomly selected geopolitical units (GPUs) in Minnesota at ages 12 to 13 (n=1953), and were surveyed every six months (2000-2006) until 18. The association between baseline social factors and smoking initiation was analyzed using logistic regression. Linear regression was used to analyze predictors and age of initiation among smokers (n=603)., Results: Higher proportion of 15-16 year-olds who smoke at the area-level (GPU) was associated with younger initiation (15.47 vs 15.87, p<.05). Higher proportion of the population employed and higher median household income were associated with older initiation (15.90 vs. 15.56 p<.05). Parent education, living with parents or siblings who smoke, living in homes that allow smoking, and having friends who smoke at baseline were associated with smoking initiation or younger initiation (p<.05). Participants whose parents had less than a high school education were 1.6 times more likely than those with college educated parents to have smoked at least a whole cigarette (CI=1.06, 2.26)., Conclusion: Factors at multiple levels of influence effect adolescent smoking initiation. Smoking by older age peers and lower SES predicts earlier smoking., (Copyright © 2011 Elsevier Inc. All rights reserved.)

Background: Smoking in movies is prevalent. However, use of content analysis to describe trends in smoking in movies has provided mixed results and has not tapped what adolescents actually perceive., Purpose: To assess the prospective trends in the prevalence of smoking in movies as perceived by teenagers and identify predictors associated with these trends., Methods: Using data from the Minnesota Adolescent Community Cohort Study collected during 2000-2006 when participants were aged between 12 and 18 years (N=4735), latent variable growth models were employed to describe the longitudinal trends in the perceived prevalence of smoking in movies using a four-level scale (never to most of the time) measured every 6 months, and examined associations between these trends and demographic, smoking-related attitudinal and socio-environmental predictors. Analysis was conducted in 2009., Results: At baseline, about 50% of participants reported seeing smoking in movies some of the time, and another 36% reported most of the time. The prevalence of smoking in movies as perceived by teenagers declined over time, and the decline was steeper in those who were aged 14-16 years than those who were younger at baseline (p≤0.05). Despite the decline, teenagers still reported seeing smoking in movies some of the time. Teenagers who reported more close friends who smoked also reported a higher prevalence of smoking in movies at baseline (regression coefficients=0.04-0.18, p<0.01)., Conclusions: Teenagers' perception of the prevalence of smoking in movies declined over time, which may be attributable to changes made by the movie industry. Despite the decline, teenagers were still exposed to a moderate amount of smoking imagery. Interventions that further reduce teenage exposure to smoking in movies may be needed to have an effect on adolescent smoking., (Copyright © 2011 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.)

Unlabelled: Objectives  To describe the prevalence and characteristics related to indoor tanning use among adults in the United States in the past year., Design: Cross-sectional study., Setting: Health Information National Trends Study, 2005., Participants: The study included 2869 participants who were white and aged 18 to 64 years; a random subset of 821 participants were also asked questions about skin cancer prevention knowledge and attitudes., Main Outcome Measures: The study assessed the prevalence of self-reported use of indoor tanning in the past 12 months and its associations with demographic and lifestyle factors, knowledge, and attitudes., Results: Overall, 18.1% of women and 6.3% of men reported tanning indoors in the past 12 months. Women who were older, were less educated, had lower income, and used sunscreen regularly were less likely to report the behavior, while women residing in the Midwest and the South and who used spray tanning products were more likely to report the behavior. Men who were less likely to report the behavior were older and obese but more likely to report the behavior if they lived in metropolitan areas and used spray tanning products. In an open-response format, only 13.3% of women and 4.2% of men suggested that avoidance of tanning bed use could reduce their risks of skin cancer. Greater skin cancer knowledge and higher perceived risk of skin cancer were inversely associated with the behavior in women., Conclusions: Prevalence and some characteristics associated with indoor tanning use, such as sunscreen use, differed between women and men in the United States. Most adults did not volunteer avoidance of tanning bed use to prevent skin cancer. Clinician-patient communication on risks of indoor tanning may be helpful to reduce indoor tanning use.