After completing this learning activity, participants should be aware of the most recent melanoma epidemiologic data, both in the United States and internationally; worldwide early detection and screening programs; clinical strategies to recognize and improve the detection of early melanoma; the latest technologies for early detection of melanoma; and public and professional education programs designed to enhance early detection.

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Parental tobacco use is a serious health issue for all family members. Child health care clinicians are in a unique and important position to address parental smoking because of the regular, multiple contacts with parents and the harmful health consequences to their patients. This article synthesizes the current evidence-based interventions for treatment of adults and applies them to the problem of addressing parental smoking in the context of the child health care setting. Brief interventions are effective, and complementary strategies such as quitlines will improve the chances of parental smoking cessation. Adopting the 5 A's framework strategy (ask, advise, assess, assist, and arrange) gives each parent the maximum chance of quitting. Within this framework, specific recommendations are made for child health care settings and clinicians. Ongoing research will help determine how best to implement parental smoking-cessation strategies more widely in a variety of child health care settings.

The 2004 National Action Plan for Tobacco Cessation recommended that the US Department of Health and Human Services convene a diverse group of experts to ensure that competency in tobacco dependence interventions be a core graduation requirement for all new physicians and other key health care professionals. Core competencies would guide the design of new modules and explicitly outline the learning objectives for all graduating medical students. In 2002, the National Cancer Institute funded a consortium to develop, test, and integrate tobacco curricula at 12 US medical schools. Because there was neither an explicit set of tobacco competencies for medical schools nor a process to develop them, one of the consortium's tasks was to articulate competencies and learning objectives.

dents with diabetes had a history of a lower-extremity ulcer. Respondents with diabetes demonstrated a high rate of correct knowledge and attitudes regarding lower extremity skin care. Correct response rates exceeded 70% for all questions in these categories except for 2 items: twothirds of Latinos with diabetes felt they should soak their feet, and one-third agreed or strongly agreed that "It is too difficult to check my own feet" (Table 1). Correct practices did not fare as well as correct knowledge and attitudes. Only half of Latino respondents with diabetes reported that they inspected their feet every day for the last 7 days. Fewer than half reported daily inspection of their shoes. Only 60% stated that they washed their feet and dried between their toes daily during the previous week (Table 2). The number of years since diagnosis of diabetes was not correlated with any knowledge, attitude, or practice. Weak correlations existed between respondent characteristics, knowledge, attitudes, and lower-extremity skin-care practices. The Cronbach ␣ for the survey as a whole was 0.74 (knowledge, 0.73; attitudes, 0.75; and practices, 0.80). Intraclass correlation coefficients ranged from 0.60 to 0.81. The survey took 5 to 10 minutes to complete. Comment. Latinoswithdiabetesmeritfocusedattentionwith respect to lower-extremity skin care, but busy clinicians do not have an easy-to-use tool to rapidly assess gaps in practices. Although knowledge and attitudes were found to be highly favorable in this study, the true clinical benefit can only be derived from consistent practices such as coupling daily foot inspections with ingrained daily habits. To our knowledge, this study was the first to survey the knowledge, attitudes, and practices regarding lower-extremity skin care of Latinos with diabetes. It will hopefully serve as a basis to further explore effective strategies to improve skin ulcer preventioninthisandothergroupsathighriskoflower-extremity skin ulceration. The survey developed in this study is a fast, reliablemethodtoassesspatientpractices,highlightingwhere deficits exist and prompting discussion of ways to resolve barriers to good lower-extremity skin care.

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Objective:To determine factors associated with physician discovery of early melanoma in middle-aged and older men. Design: Survey.Setting: Three institutional melanoma clinics.Participants: A total of 227 male participants (aged Ն40 years) with invasive melanoma who completed surveys within 3 months of diagnosis.Intervention: Survey. Main Outcome Measures: Factors associated with physician-detected thin melanoma.Results: Patients with physician-detected melanoma were older, 57% were 65 years or older compared with 34% for other-detected (odds ratio [OR], 2.57; 95% confidence interval [CI], 1.19-5.55) and 42% for patient-detected mela-

Antibody-inducing vaccines are a major focus in the preventive HIV vaccine field. Because the most common tests for HIV infection rely on detecting antibodies to HIV, they may also detect antibodies induced by a candidate HIV vaccine. The detection of vaccine-induced antibodies to HIV by serological tests is most commonly referred to as vaccine-induced sero-reactivity (VISR). VISR can be misinterpreted as a sign of HIV infection in a healthy study participant. In a participant who has developed vaccine-induced antibodies, accurate diagnosis of HIV infection (or lack thereof) may require specialized tests and algorithms (differential testing) that are usually not available in community settings. Organizations sponsoring clinical testing of preventive HIV vaccine candidates have an ethical obligation not only to inform healthy volunteers about the potential problems associated with participating in a clinical trial but also to help manage any resulting issues. This article explores the scope of VISR-related issues that become increasingly prevalent as the search for an effective HIV vaccine continues and will be paramount once a preventive vaccine is deployed. We also describe ways in which organizations conducting HIV vaccine trials have addressed these issues and outline areas where more work is needed.