Indoor tanning by adolescents: prevalence, practices and policies

The association of use of sunbeds with cutaneous malignant melanoma and other skin cancers: A systematic review

Exposure to solar ultraviolet (UV) radiation is a known cause of skin cancer. Sunbed use represents an increasingly frequent source of artificial UV exposure in light-skinned populations. To assess the available evidence of the association between sunbed use and cutaneous malignant melanoma (melanoma) and other skin cancers, a systematic review of the literature till March 2006 on epidemiological and biological studies on sunbed use was performed in Pubmed, ISI Web of Science, Embase, Pascal, Cochrane library, Lilacs and Medcarib. Search for keywords in the title and in the abstract was done systematically and supplemented by manual searches. Only case-control, cohort or cross-sectional studies were selected. Data were abstracted by means of a standardized data-collection protocol. Based on 19 informative studies, ever-use of sunbeds was positively associated with melanoma (summary relative risk, 1.15; 95% CI, 1.00-1.31), although there was no consistent evidence of a dose-response relationship. First exposure to sunbeds before 35 years of age significantly increased the risk of melanoma, based on 7 informative studies (summary relative risk, 1.75; 95% CI, 1.35-2.26). The summary relative risk of 3 studies of squamous cell carcinoma showed an increased risk. For basal cell carcinoma, the studies did not support an association. The evidence does not support a protective effect of the use of sunbeds against damage to the skin from subsequent sun exposure. Young adults should be discouraged from using indoor tanning equipment and restricted access to sunbeds by minors should be strongly considered.

Measuring the stringency of states' indoor tanning regulations: instrument development and outcomes

OBJECTIVES

We sought to describe the development of an instrument to quantify the stringency of state indoor tanning legislation in the United States, and the instrument's psychometric properties. The instrument was then used to rate the stringency of state laws.

METHODS

A 35-item instrument was developed. An overall stringency measure and 9 stringency subscales were developed, including one measuring minors' access to indoor tanning. Stringency measures showed good internal consistency and interrater reliability.

RESULTS

In all, 55% of the 50 states and the District of Columbia had any indoor tanning law, and 41% had any law addressing minors' access. Oregon, Illinois, South Carolina, Florida, Indiana, Iowa, and Rhode Island had high overall stringency scores, and Texas and New Hampshire were the most restrictive with regard to minors' access.

LIMITATIONS

Measurement of actual enforcement of the laws was not included in this study.

CONCLUSIONS

The instrument appears to be an easy-to-use, reliable, and valid methodology. Application of the instrument to actual laws showed that, in general, state laws are relatively weak, although there was considerable variability by state.

Internet advertising of artificial tanning in Australia

Artificial tanning, defined as deliberate exposure to ultraviolet rays produced by artificial tanning devices, is a new and emerging public health issue in Australia and globally. Epidemiological research suggests that artificial tanning may contribute to the incidence of melanoma, nonmelanoma skin cancer as well as other health problems. Given that Australia has a high incidence of skin cancer, we have undertaken a study to explore how artificial tanning has been promoted to its users. The aim was to analyze the completeness and accuracy of information about artificial tanning. A content analysis of web sites of tanning salons and distributors of tanning equipment in Australia was conducted. A total of 22 web sites were analyzed. None of the solarium operators or distributors of equipment provided full information about the risks of artificial tanning. Fifty-nine percent of web advertisements had no information and 41% provided only partial information regarding the risks of artificial tanning. Pictures with the image of bronze-tanned bodies, predominantly women, were used by all web advertisers. In light of the success of sun-safety campaigns in Australia, the findings of future epidemiological research on the prevalence of artificial tanning and sociological and anthropological research on why people utilize artificial tanning should be a basis for developing effective targeted health promotion on the elimination of artificial tanning in the country.

Frequent tanning bed use, weight concerns, and other health risk behaviors in adolescent females (United States)

OBJECTIVE

To examine the association between tanning bed use and weight concerns, health risk behaviors, and peer influence.

METHODS

The Growing Up Today Study (GUTS) is an ongoing prospective cohort study of adolescents established in 1996. In 1999, a total of 6,373 adolescent females ages 12-18 (offspring of participants in the Nurses Health Study 2) completed the survey.

RESULTS

Almost nine percent (8.6%) of the adolescent girls had used a tanning bed 1-9 times and an additional 5.4% had used tanning beds at least 10 times in the past year (frequent users). Logistic regression models revealed that frequent tanning bed use was associated with being highly concerned about weight (OR = 1.5, 95%CI = 1.1, 2.0), frequently dieting to lose weight (OR = 1.5, 95%CI = 1.1, 2.0), using laxatives or vomiting to control weight (OR = 3.6; 95%CI = 2.2-5.8), having friends who placed a lot of importance on being thin (OR = 2.6; 95%CI = 1.3-5.1), smoking cigarettes (OR=1.7, 95%CI = 1.1, 2.6), binge drinking (OR = 2.1, 95%CI = 1.3, 3.1), using recreational drugs (OR = 3.0; 95%CI = 2.4, 3.8), and trying to look like females in the media (sometimes/pretty much: OR = 1.3, 95%CI = 1.0, 1.8).

CONCLUSION

Frequent tanning bed use among adolescent females is associated with a range of health risk behaviors. This effect may be mediated by peer influence and a desire to look like other females in the media. Multi-pronged approaches, particularly those that target attitudes of young females, are needed to combat increased use of tanning beds.

Compliance with restrictions on sale of indoor tanning sessions to youth in Minnesota and Massachusetts

BACKGROUND

Minnesota and Massachusetts require parental permission, for persons younger than 16 or 18 years of age, respectively, for indoor tanning.

OBJECTIVES

This report examines business practices and characteristics associated with sales of indoor tanning to underage girls.

METHODS

Fifteen-year-old girls tried to purchase an ultraviolet tanning session in 200 indoor tanning businesses in the Minneapolis-St Paul and Boston areas without parental consent. Business characteristics were recorded. Later, businesses were interviewed by telephone about their facilities and practices.

RESULTS

Eighty-one percent of businesses sold a session to an underaged buyer on at least one of two tries. Illegal purchases did not differ by state. Businesses least likely to sell were larger, dedicated to indoor tanning, required employee certification, and had a minimum age of sale for their business. However, businesses in each of these categories still sold tanning sessions to underaged adolescents at 44% to 62% of the visits. Employees who requested parental consent or age identification almost never sold a session.

LIMITATIONS

Businesses in Minnesota and Massachusetts only were included.

CONCLUSION

Minnesota and Massachusetts laws specifying a minimum age of sale for indoor tanning are ineffective.

The challenge of intentional tanning in teens and young adults

Changing UV exposure in adolescents and young adults has the potential to prevent years of excess exposure and subsequent skin cancer. Initial expectations were that an individual or media campaign informational approach would change this behavior. It is being recognized that current efforts have failed. Changing UV behaviors is challenging and has much in common with changing other health risk behaviors. The tanning industry benefits from recruiting new participants in this risky behavior. Research is just beginning to show some promising approaches, and will benefit from our experience attempting to change other risky behaviors.

Do adolescent indoor tanners exhibit dependency?

BACKGROUND

Indoor tanning is a common adolescent risk behavior that has been hypothesized to be motivated and maintained by the mood-altering effects of ultraviolet light.

OBJECTIVE

Our purpose was to explore heretofore anecdotal reports that indoor tanning leads to dependency.

METHODS

A telephone interview was conducted among 1275 adolescents, ages 14 to 17 years. Self-reported difficulty in quitting indoor tanning was assessed among 267 adolescents (20.9% of total) who tanned indoors more than once in the previous year in relation to age of initiation, frequency of use, and positive or negative consequences of the practice.

RESULTS

Difficulty in quitting was more likely with younger age at initiation (age 13 years or younger vs ages 16 to 17; odds ratio = 4.3, 95% confidence interval 1.3-14.7) and higher frequency of use (P = .009), even after accounting for positive or negative consequences of indoor tanning and other demographic characteristics.

LIMITATIONS

This was a cross-sectional study design with a limited outcome measure.

CONCLUSION

Although preliminary, our findings for age at initiation and frequency of use in relation to difficulty in quitting indoor tanning are consistent with other potentially addictive behaviors taken up during adolescence.

Comparing two methods of measuring legislation compliance among indoor tanning facilities

BACKGROUND

Accurate measurement of compliance by tanning facilities to indoor tanning legislation is important.

OBJECTIVE

This study compared a telephone-based measurement procedure with a face-to-face visit.

METHODS

Indoor tanning facilities (N = 115) in San Diego County, California, were contacted by two adolescents posing as prospective customers using each method. Two compliance variables were assessed: number of times one can tan during 1 week and written parental consent for minors.

RESULTS

Facility compliance with the frequency variable by face-to-face and telephone was 25.5% and 17.5%, respectively. These rates for the parental consent variable were 73.3% and 80.8%, respectively. Percent agreement between data collection methods was 71.3% for compliance with the frequency recommendation and 76.3% for parental consent regulation. Although traditional statistical tests indicated poor concordance, an alternative test indicated good concordance.

LIMITATIONS

Levels of concordance for the confederates differed.

CONCLUSION

Telephone assessment of compliance is fairly comparable with the more labor-intensive, face-to-face assessment.