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Williams MS, Buhalog B, Blumenthal L, Stratman EJ. Tanning Salon Compliance Rates in States With Legislation to Protect Youth Access to UV Tanning. JAMA Dermatol 2019; 154:67-72. [PMID: 29071349 DOI: 10.1001/jamadermatol.2017.3736] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance The US Food and Drug Administration has classified tanning beds as carcinogenic. Most states have enacted legislation to prevent or create barriers for minors accessing tanning establishments. Determining tanning salon compliance with legislation would provide an indication of the influence of legislation at preventing exposure to the carcinogen in minors. Objectives To investigate compliance rates in the 42 states and the District of Columbia with legislation restricting tanning bed use in minors and to identify differences in compliance based on population, regional location, salon ownership, age group being regulated, and time since the law was enacted. Design, Setting, and Participants This investigation was a cross-sectional telephone survey conducted between February 1, 2015, and April 30, 2016, by callers posing as minors attempting to schedule a tanning appointment. The setting was tanning salons in the 42 states and the District of Columbia that currently have legislation restricting tanning bed use in minors. Included in the study were 427 tanning salons, 10 randomly selected from each state or territory with tanning legislation. Main Outcomes and Measures Overall compliance of tanning salons with state tanning legislation and differences in compliance based on community population, regional location, independent vs chain tanning salon, age group being regulated, and time since the law was enacted. Results Of the 427 tanning salons surveyed, overall noncompliance with state legislation was 37.2% (n = 159). There were more noncompliant tanning salons in rural locations (45.5%; 95% CI, 37.5%-53.7%; P = .009), southern regions of the United States (49.4%; 95% CI, 41.4%-57.4%; P = .001), independently owned salons (43.9%; 95% CI, 37.3%-50.6%; P = .003), states with younger age groups being regulated (53.5%; 95% CI, 45.7%-61.2%; P < .001), and states with more than one tanning regulation (50.0%; 95% CI, 42.0%-58.0%; P < .001). No difference was found based on time since the law was enacted. Conclusions and Relevance Compliance with state legislation aimed at limiting tanning bed use among US minors is unsatisfactory, indicating that additional efforts to enforce the laws and education of the harmful effects of UV tanning are necessary, especially in rural, independently owned, and tanning salons in southern regions, which have decreased compliance rates.
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Affiliation(s)
| | | | - Laura Blumenthal
- Department of Internal Medicine, Loyola University Medical Center, Maywood, Illinois
| | - Erik J Stratman
- Department of Dermatology, Marshfield Clinic, Marshfield, Wisconsin
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Daniel CL, Gassman NR. A truly safer alternative? Sunless tanning products and the unknown. Prev Med 2018; 112:45-46. [PMID: 29626559 DOI: 10.1016/j.ypmed.2018.04.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Revised: 02/24/2018] [Accepted: 04/02/2018] [Indexed: 11/29/2022]
Affiliation(s)
- Casey L Daniel
- University of South Alabama, Mitchell Cancer Institute, United States
| | - Natalie R Gassman
- University of South Alabama, Mitchell Cancer Institute, United States.
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3
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Huang CM, Kirchhof MG. A Cross-Sectional Study of Indoor Tanning in Fitness Centres. J Cutan Med Surg 2017; 21:401-407. [DOI: 10.1177/1203475417706059] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Background: Ultraviolet (UV) radiation is a human carcinogen and is associated with the development of skin cancer. The promotion of indoor tanning (IT) at fitness centres is of particular concern as it reinforces the idea that a tan is associated with health and fitness. The purpose of this study was to investigate the prevalence of IT in fitness centres, with an emphasis on determining the financial costs, adherence to regulations, and safety precautions. Methods: Ten cities, representing 9 different Canadian provinces, were chosen for the study. From each province, a minimum of 20 and a maximum of 30 fitness centres were randomly selected from the Yellow Pages website. Each fitness centre was contacted by the principal investigator and inquiries were made from a consumer’s perspective. Results: Of the 203 gyms surveyed, 43% (88/203) offered tanning facilities. Of these, 10.23% (9/88) were found to be noncompliant with the provincial IT regulations for age and/or time between tanning sessions. Interpretation: Despite the known risks of IT, not all fitness centres are compliant with provincial legislations regarding IT, and some continue to promote tanning access to minors.
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Affiliation(s)
| | - Mark G. Kirchhof
- Division of Dermatology, Department of Medicine, Queen’s University, Kingston, Ontario, Canada
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Affiliation(s)
- Elyse Julian
- Nova Southeastern University, Fort Lauderdale, FL, USA
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Noar SM, Myrick JG, Zeitany A, Kelley D, Morales-Pico B, Thomas NE. Testing a social cognitive theory-based model of indoor tanning: implications for skin cancer prevention messages. HEALTH COMMUNICATION 2015; 30:164-174. [PMID: 25470441 DOI: 10.1080/10410236.2014.974125] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
The lack of a theory-based understanding of indoor tanning is a major impediment to the development of effective messages to prevent or reduce this behavior. This study applied the Comprehensive Indoor Tanning Expectations (CITE) scale in an analysis of indoor tanning behavior among sorority women (total N = 775). Confirmatory factor analyses indicated that CITE positive and negative expectations were robust, multidimensional factors and that a hierarchical structure fit the data well. Social cognitive theory-based structural equation models demonstrated that appearance-oriented variables were significantly associated with outcome expectations. Outcome expectations were, in turn, significantly associated with temptations to tan, intention to tan indoors, and indoor tanning behavior. The implications of these findings for the development of messages to prevent and reduce indoor tanning behavior are discussed in two domains: (a) messages that attempt to change broader societal perceptions about tan skin, and (b) messages that focus more narrowly on indoor tanning-challenging positive expectations, enhancing negative expectations, and encouraging substitution of sunless tanning products.
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Affiliation(s)
- Seth M Noar
- a School of Journalism and Mass Communication , University of North Carolina at Chapel Hill
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Haluza D, Moshammer H, Kundi M, Cervinka R. Public (Skin) Health perspectives of gender differences in tanning habits and sun protective behaviour: a cross-sectional questionnaire survey. Wien Klin Wochenschr 2014; 127:124-31. [DOI: 10.1007/s00508-014-0643-0] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2013] [Accepted: 10/13/2014] [Indexed: 12/18/2022]
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8
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Banerjee SC, Greene K, Yanovitzky I, Bagdasarov Z, Choi SY, Magsamen-Conrad K. Adolescent egocentrism and indoor tanning: is the relationship direct or mediated? JOURNAL OF YOUTH STUDIES 2014; 18:357-375. [PMID: 28042281 PMCID: PMC5198897 DOI: 10.1080/13676261.2014.963536] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
This paper explored how imaginary audience and personal fable ideations contribute to adolescent indoor tanning intentions directly and indirectly through the way they shape pro-tanning attitude and association with peers who use tanning beds. Five hundred and ninety-five male (n = 207) and female (n = 387) adolescents, ranging in age from 11 to 19 (M = 16.87; SD = 1.34) years completed a cross-sectional survey. Measures included imaginary audience, personal fable (three dimensions: invulnerability, uniqueness, and omnipotence), pro-tanning attitude, association with peers who use tanning beds, and tanning bed use intentions. Bootstrapping analyses documented that imaginary audience ideations are indirectly associated with indoor tanning intentions through the mediation of pro-tanning attitude and association with peers who use tanning beds. Of the personal fable ideations, only invulnerability ideation is indirectly associated with indoor tanning intentions through the mediation of association with peers who use tanning beds. Design and evaluation of interventions and campaigns to reduce indoor tanning must be targeted to adolescents varying in imaginary audience ideations differently.
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Affiliation(s)
- Smita C. Banerjee
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Kathryn Greene
- Department of Communication, Rutgers University, New Brunswick, NJ, USA
| | - Itzhak Yanovitzky
- Department of Communication, Rutgers University, New Brunswick, NJ, USA
| | - Zhanna Bagdasarov
- Communication and Health Issues Partnership for Education and Research, Rutgers University, New Brunswick, NJ, USA
| | - Soe Yoon Choi
- Department of Communication, Rutgers University, New Brunswick, NJ, USA
| | - Kate Magsamen-Conrad
- Department of Communication, Bowling Green State University, Bowling Green, OH, USA
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Roberts AL, Rosario M, Calzo JP, Corliss HL, Frazier L, Austin SB. Masculine boys, feminine girls, and cancer risk behaviors: an 11-year longitudinal study. J Adolesc Health 2014; 55:373-9. [PMID: 24746678 PMCID: PMC4143439 DOI: 10.1016/j.jadohealth.2014.02.020] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2013] [Revised: 12/20/2013] [Accepted: 02/19/2014] [Indexed: 10/25/2022]
Abstract
OBJECTIVE Cancer risk behaviors often begin in adolescence and persist through adulthood. Tobacco use, indoor tanning, and physical inactivity are highly prevalent, socially patterned cancer risk behaviors, and their prevalence differs strongly by sex. It is therefore possible that these behaviors also differ by gender expression within the sexes due to social patterning. METHODS We examined whether five cancer risk behaviors differed by childhood gender expression within the sexes and whether patterns of media engagement (e.g., magazine readership and trying to look like media personalities) explained possible differences, in a U.S. population-based cohort (N = 9,435). RESULTS The most feminine girls had higher prevalence of indoor tanning (prevalence risk ratio [pRR] = 1.32, 95% confidence interval [CI] = 1.23-1.42) and physical inactivity (pRR = 1.16, 95% CI = 1.01-1.34) and lower prevalence of worse smoking trajectory (prevalence odds ratio = .75, 95% CI = .65-.88) and smoking cigars (pRR = .61, 95% CI = .47-.79) compared with least feminine girls. Media engagement accounted for part of the higher prevalence of indoor tanning. The most masculine boys were more likely to chew tobacco (pRR = 1.78, 95% CI = 1.14-2.79) and smoke cigars (pRR = 1.55, 95% CI = 1.17-2.06) but less likely to follow a worse smoking trajectory (prevalence odds ratio = .69, 95% CI = .55-.87) and be physically inactive (pRR = .54, 95% CI = .43-.69) compared with least masculine boys. CONCLUSIONS We found some strong differences in patterns of cancer risk behaviors by gender expression within the sexes. Prevention efforts that challenge the "masculinity" of smoking cigarettes and cigars and chewing tobacco and the "femininity" of indoor tanning to reduce their appeal to adolescents should be explored.
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Affiliation(s)
- Andrea L Roberts
- Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, Massachusetts.
| | - Margaret Rosario
- Department of Psychology, City College of New York|City University of New York Graduate Center, New York, New York
| | - Jerel P Calzo
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, Massachusetts; Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | - Heather L Corliss
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, Massachusetts; Department of Pediatrics, Harvard Medical School, Boston, Massachusetts; The Channing Division of Network Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Lindsay Frazier
- Dana-Farber Cancer Institute, The Harvard Medical School, Boston, Massachusetts; Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts
| | - S Bryn Austin
- Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, Massachusetts; Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, Massachusetts; Department of Pediatrics, Harvard Medical School, Boston, Massachusetts; The Channing Division of Network Medicine, Brigham and Women's Hospital, Boston, Massachusetts
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Karagas MR, Zens MS, Li Z, Stukel TA, Perry AE, Gilbert-Diamond D, Sayarath V, Stephenson RS, Barton D, Nelson HH, Spencer SK. Early-onset basal cell carcinoma and indoor tanning: a population-based study. Pediatrics 2014; 134:e4-12. [PMID: 24958589 PMCID: PMC4067637 DOI: 10.1542/peds.2013-3559] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/15/2014] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVE Indoor tanning with UV radiation-emitting lamps is common among adolescents and young adults. Rising incidence rates of basal cell carcinoma (BCC) have been reported for the United States and elsewhere, particularly among those diagnosed at younger ages. Recent epidemiologic studies have raised concerns that indoor tanning may be contributing to early occurrence of BCC, and younger people may be especially vulnerable to cancer risk associated with this exposure. Therefore, we sought to address these issues in a population-based case-control study from New Hampshire. METHODS Data on indoor tanning were obtained on 657 cases of BCC and 452 controls ≤50 years of age. RESULTS Early-onset BCC was related to indoor tanning, with an adjusted odds ratio (OR) of 1.6 (95% confidence interval, 1.3-2.1). The strongest association was observed for first exposure as an adolescent or young adult, with a 10% increase in the OR with each age younger at first exposure (OR per year of age ≤23 = 1.1; 95% confidence interval, 1.0-1.2). Associations were present for each type of device examined (ie, sunlamps, tanning beds, and tanning booths). CONCLUSIONS Our findings suggest early exposure to indoor tanning increases the risk of early development of BCC. They also underscore the importance of counseling adolescents and young adults about the risks of indoor tanning and for discouraging parents from consenting minors to this practice.
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Affiliation(s)
- Margaret R Karagas
- Children's Environmental Health and Disease Prevention Research Center at Dartmouth, Hanover, New Hampshire;Section of Biostatistics and Epidemiology, Department of Community and Family Medicine, Geisel School of Medicine, Hanover, New Hampshire;
| | - M Scot Zens
- Children's Environmental Health and Disease Prevention Research Center at Dartmouth, Hanover, New Hampshire;Section of Biostatistics and Epidemiology, Department of Community and Family Medicine, Geisel School of Medicine, Hanover, New Hampshire
| | - Zhigang Li
- Children's Environmental Health and Disease Prevention Research Center at Dartmouth, Hanover, New Hampshire;Section of Biostatistics and Epidemiology, Department of Community and Family Medicine, Geisel School of Medicine, Hanover, New Hampshire
| | - Therese A Stukel
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
| | - Ann E Perry
- Department of Pathology, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire; and
| | - Diane Gilbert-Diamond
- Children's Environmental Health and Disease Prevention Research Center at Dartmouth, Hanover, New Hampshire;Section of Biostatistics and Epidemiology, Department of Community and Family Medicine, Geisel School of Medicine, Hanover, New Hampshire
| | - Vicki Sayarath
- Children's Environmental Health and Disease Prevention Research Center at Dartmouth, Hanover, New Hampshire;Section of Biostatistics and Epidemiology, Department of Community and Family Medicine, Geisel School of Medicine, Hanover, New Hampshire
| | - Rita S Stephenson
- Children's Environmental Health and Disease Prevention Research Center at Dartmouth, Hanover, New Hampshire;Section of Biostatistics and Epidemiology, Department of Community and Family Medicine, Geisel School of Medicine, Hanover, New Hampshire
| | - Dorothea Barton
- Department of Pathology, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire; and
| | - Heather H Nelson
- Masonic Cancer Center, University of Minnesota, Minneapolis, Minnesota
| | - Steven K Spencer
- Department of Pathology, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire; and
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Wehner MR, Chren MM, Nameth D, Choudhry A, Gaskins M, Nead KT, Boscardin WJ, Linos E. International prevalence of indoor tanning: a systematic review and meta-analysis. JAMA Dermatol 2014; 150:390-400. [PMID: 24477278 DOI: 10.1001/jamadermatol.2013.6896] [Citation(s) in RCA: 195] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Indoor tanning is a known carcinogen, but the scope of exposure to this hazard is not known. OBJECTIVE To summarize the international prevalence of exposure to indoor tanning. DATA SOURCES Studies were identified through systematic searches of PubMed (1966 to present), Scopus (1823 to present), and Web of Science (1898 to present) databases, last performed on March 16, 2013. We also hand searched reference lists to identify records missed by database searches and publicly available data not yet published in the scientific literature. STUDY SELECTION Records reporting a prevalence of indoor tanning were eligible for inclusion. We excluded case-control studies, reports with insufficient study information, and reports of groups recruited using factors related to indoor tanning. Two independent investigators performed searches and study selection. Our search yielded 1976 unique records. After exclusions, 161 records were assessed for eligibility in full text, and 88 were included. DATA EXTRACTION AND SYNTHESIS Two independent investigators extracted data on characteristics of study participants, inclusion/exclusion criteria, data collection format, outcomes, and statistical methods. Random-effects meta-analyses were used to summarize the prevalence of indoor tanning in different age categories. We calculated the population proportional attributable risk of indoor tanning in the United States, Europe, and Australia for nonmelanoma skin cancer (NMSC) and melanoma. MAIN OUTCOMES AND MEASURES Ever and past-year exposure to indoor tanning. RESULTS The summary prevalence of ever exposure was 35.7% (95% CI, 27.5%-44.0%) for adults, 55.0% (33.0%-77.1%) for university students, and 19.3% (14.7%-24.0%) for adolescents. The summary prevalence of past-year exposure was 14.0% (95% CI, 11.5%-16.5%) for adults, 43.1% (21.7%-64.5%) for university students, and 18.3% (12.6%-24.0%) for adolescents. These results included data from 406 696 participants. The population proportional attributable risk were 3.0% to 21.8% for NMSC and 2.6% to 9.4% for melanoma, corresponding to more than 450 000 NMSC cases and more than 10 000 melanoma cases each year attributable to indoor tanning in the United States, Europe, and Australia. CONCLUSIONS AND RELEVANCE Exposure to indoor tanning is common in Western countries, especially among young persons. Given the large number of skin cancer cases attributable to indoor tanning, these findings highlight a major public health issue.
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Affiliation(s)
- Mackenzie R Wehner
- Department of Dermatology, University of California, San Francisco2Stanford University School of Medicine, Stanford, California3Department of Public Health and Primary Care, University of Cambridge, Cambridge, England
| | - Mary-Margaret Chren
- Department of Dermatology, University of California, San Francisco4Department of Dermatology, San Francisco Veterans Affairs Medical Center, San Francisco, California
| | | | - Aditi Choudhry
- Department of Internal Medicine, John Muir Medical Center, Walnut Creek, California
| | - Matthew Gaskins
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, England
| | - Kevin T Nead
- Stanford University School of Medicine, Stanford, California
| | - W John Boscardin
- Department of Epidemiology and Biostatistics, University of California, San Francisco
| | - Eleni Linos
- Department of Dermatology, University of California, San Francisco
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12
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Guy GP, Berkowitz Z, Jones SE, Olsen EO, Miyamoto JN, Michael SL, Saraiya M. State indoor tanning laws and adolescent indoor tanning. Am J Public Health 2014; 104:e69-74. [PMID: 24524515 PMCID: PMC4025696 DOI: 10.2105/ajph.2013.301850] [Citation(s) in RCA: 96] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/14/2013] [Indexed: 11/04/2022]
Abstract
OBJECTIVES Recently, several state indoor tanning laws, including age restrictions, were promulgated to reduce indoor tanning among minors. We examined the effects of these laws on adolescent indoor tanning. METHODS We used nationally representative data from the 2009 and 2011 national Youth Risk Behavior Surveys (n = 31 835). Using multivariable logistic regression, we examined the association between state indoor tanning laws and indoor tanning among US high school students. RESULTS Female students in states with indoor tanning laws were less likely to engage in indoor tanning than those in states without any laws. We observed a stronger association among female students in states with systems access, parental permission, and age restriction laws than among those in states without any laws. We found no significant association among female students in states with only systems access and parental permission laws or among male students. CONCLUSIONS Indoor tanning laws, particularly those including age restrictions, may be effective in reducing indoor tanning among female high school students, for whom rates are the highest. Such reductions have the potential to reduce the health and economic burden of skin cancer.
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Affiliation(s)
- Gery P Guy
- Gery P. Guy Jr, Zahava Berkowitz, and Mona Saraiya are with the Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA. Sherry Everett Jones, Emily O'Malley Olsen, and Shannon L. Michael are with the Division of Adolescent and School Health, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention. Justin N. Miyamoto is with the Department of Pediatrics, Seattle Children's Hospital, Seattle, WA
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Wehner MR, Chren MM, Nameth D, Choudhry A, Gaskins M, Nead KT, Boscardin WJ, Linos E. International prevalence of indoor tanning: a systematic review and meta-analysis. JAMA Dermatol 2014. [PMID: 24477278 DOI: 10.1001/jamadermatol.2013.6896.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Indoor tanning is a known carcinogen, but the scope of exposure to this hazard is not known. OBJECTIVE To summarize the international prevalence of exposure to indoor tanning. DATA SOURCES Studies were identified through systematic searches of PubMed (1966 to present), Scopus (1823 to present), and Web of Science (1898 to present) databases, last performed on March 16, 2013. We also hand searched reference lists to identify records missed by database searches and publicly available data not yet published in the scientific literature. STUDY SELECTION Records reporting a prevalence of indoor tanning were eligible for inclusion. We excluded case-control studies, reports with insufficient study information, and reports of groups recruited using factors related to indoor tanning. Two independent investigators performed searches and study selection. Our search yielded 1976 unique records. After exclusions, 161 records were assessed for eligibility in full text, and 88 were included. DATA EXTRACTION AND SYNTHESIS Two independent investigators extracted data on characteristics of study participants, inclusion/exclusion criteria, data collection format, outcomes, and statistical methods. Random-effects meta-analyses were used to summarize the prevalence of indoor tanning in different age categories. We calculated the population proportional attributable risk of indoor tanning in the United States, Europe, and Australia for nonmelanoma skin cancer (NMSC) and melanoma. MAIN OUTCOMES AND MEASURES Ever and past-year exposure to indoor tanning. RESULTS The summary prevalence of ever exposure was 35.7% (95% CI, 27.5%-44.0%) for adults, 55.0% (33.0%-77.1%) for university students, and 19.3% (14.7%-24.0%) for adolescents. The summary prevalence of past-year exposure was 14.0% (95% CI, 11.5%-16.5%) for adults, 43.1% (21.7%-64.5%) for university students, and 18.3% (12.6%-24.0%) for adolescents. These results included data from 406 696 participants. The population proportional attributable risk were 3.0% to 21.8% for NMSC and 2.6% to 9.4% for melanoma, corresponding to more than 450 000 NMSC cases and more than 10 000 melanoma cases each year attributable to indoor tanning in the United States, Europe, and Australia. CONCLUSIONS AND RELEVANCE Exposure to indoor tanning is common in Western countries, especially among young persons. Given the large number of skin cancer cases attributable to indoor tanning, these findings highlight a major public health issue.
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Affiliation(s)
- Mackenzie R Wehner
- Department of Dermatology, University of California, San Francisco2Stanford University School of Medicine, Stanford, California3Department of Public Health and Primary Care, University of Cambridge, Cambridge, England
| | - Mary-Margaret Chren
- Department of Dermatology, University of California, San Francisco4Department of Dermatology, San Francisco Veterans Affairs Medical Center, San Francisco, California
| | | | - Aditi Choudhry
- Department of Internal Medicine, John Muir Medical Center, Walnut Creek, California
| | - Matthew Gaskins
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, England
| | - Kevin T Nead
- Stanford University School of Medicine, Stanford, California
| | - W John Boscardin
- Department of Epidemiology and Biostatistics, University of California, San Francisco
| | - Eleni Linos
- Department of Dermatology, University of California, San Francisco
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Prior SM, Fenwick KD, Peterson JC. Adolescents' reasons for tanning and appearance motives: a preliminary study. Body Image 2014; 11:93-6. [PMID: 24129215 DOI: 10.1016/j.bodyim.2013.09.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2013] [Revised: 09/03/2013] [Accepted: 09/03/2013] [Indexed: 11/16/2022]
Abstract
We examined adolescents' reasons for tanning and how these relate to appearance evaluation and orientation. Two hundred and sixty-four Canadian adolescents (age range 15-19 years) in grades 10, 11, and 12 completed a survey that included scales measuring their reasons for tanning, appearance evaluation, and appearance orientation. It was found that girls and boys differed on four of nine subscales measuring reasons for tanning. Girls believed more strongly than boys that tanning improved their general appearance and that friends influenced their decision to tan. Girls also expressed less concern than boys that tanning caused immediate skin damage or premature aging. The pattern of correlations between the reasons for tanning and appearance orientation was similar for girls and boys. For both, appearance reasons for tanning and sociocultural influences on tanning were positively associated with appearance orientation. Suggestions for future research with adolescents and a proposal for a guiding model are provided.
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Affiliation(s)
- Suzanne M Prior
- Department of Psychology, St. Thomas University, Fredericton, NB, Canada.
| | | | - Jasmine C Peterson
- Department of Psychology, St. Thomas University, Fredericton, NB, Canada
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Abstract
In Denmark, melanoma is the most common type of cancer in individuals aged 15-34 years. Ultraviolet radiation from sunbeds is a risk factor for melanoma. Knowledge of the characteristics of sunbed users is important in the development and implementation of prevention strategies of sunbed use. The objective of this study was to examine sunbed use and its association with smoking, parental socioeconomic status (SES), friends' attitudes towards artificial tanning, and school environment among adolescents aged 14-18 years at continuation schools in Denmark. We conducted a survey among adolescents in Danish continuation schools in 2011. We examined sunbed use and its association with age, smoking, friends' attitudes towards artificial tanning, parental SES, and shared environment of the continuation school, using logistic regression. Within the past 12 months, 38% of the pupils had used a sunbed (70% girls and 28% boys). There was no difference in sunbed use according to age. Smoking and friends' positive attitudes towards, and higher use of sunbeds were associated with increased use of sunbeds. High SES of mothers' was associated with lower odds for sunbed use among girls. The association of school environment with sunbed use was modest compared with the other variables. Adolescents in continuation schools report a higher use of sunbeds than Danish adolescents as such. Educational interventions should be targeted at preteens, as sunbed use is common in 14-year-olds. Special educational tools are tested in the continuation school environment and may prove effective in this population.
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Olson AL, Carlos HA, Sarnoff RA. Community variation in adolescent access to indoor tanning facilities. J Community Health 2013; 38:221-4. [PMID: 23011517 DOI: 10.1007/s10900-012-9603-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Melanoma rates among younger women in New Hampshire (NH) are rising. In urban studies, youth proximity to tanning facilities has been linked to indoor tanning, a proven cause of melanoma. Youth access has not been examined in rural settings. To determine on a statewide basis the influence of rurality and community income level on female students' ease of access to tanning facilities, all NH tanning facilities (N = 261) and high schools (N = 77) in 2011 were spatially and statistically analyzed to determine schools with more facilities within 2 miles of the school and greater capacity (fewer female students per facility), for indoor tanning. Schools above the state-wide average for both measures were classified as "Easy Access" to indoor tanning. Among NH high schools, 74 % have 1 or more tanning facility within two miles and 22 % have "Easy Access" to tanning facilities. Ease of access did not differ by rurality. Lower-income school status was an independent predictor of both greater capacity and "Easy Access". While urban and rural teens have similar access to indoor tanning, female students in lower-income communities have easier access. Variations in access by community size and income must be considered in planning interventions to address youth indoor tanning.
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Affiliation(s)
- Ardis L Olson
- Department of Pediatrics, Geisel School of Medicine at Dartmouth, Lebanon, NH 03756, USA
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Banerjee SC, Hay JL, Greene K. Cognitive rationalizations for tanning-bed use: a preliminary exploration. Am J Health Behav 2013; 37:577-86. [PMID: 23985280 DOI: 10.5993/ajhb.37.5.1] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVES To examine construct and predictive utility of an adapted cognitive rationalization scale for tanning-bed use. METHODS Current/former tanning-bedusing undergraduate students (N = 216; 87.6% females; 78.4% white) at a large northeastern university participated in a survey. A cognitive rationalization for tanning-bed use scale was adapted. Standardized self-report measures of past tanning-bed use, advantages of tanning, perceived vulnerability to photoaging, tanning-bed use dependence, and tanning-bed use intention were also administered. RESULTS The cognitive rationalization scale exhibited strong construct and predictive validity. Current tanners and tanning-bed-use-dependent participants endorsed rationalizations more strongly than did former tanners and not-tanning-bed-use-dependent participants respectively. CONCLUSIONS Findings indicate that cognitive rationalizations help explain discrepancy between inconsistent cognitions.
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Affiliation(s)
- Smita C Banerjee
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan-Kettering Cancer Center, New York, NY, USA.
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19
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Stanganelli I, Gandini S, Magi S, Mazzoni L, Medri M, Agnoletti V, Lombi L, Falcini F. Sunbed use among subjects at high risk of melanoma: an Italian survey after the ban. Br J Dermatol 2013; 169:351-7. [DOI: 10.1111/bjd.12384] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/09/2013] [Indexed: 11/30/2022]
Affiliation(s)
- I. Stanganelli
- Skin Cancer Unit IRCCS; Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori; Piero Maroncelli 40 - 47014 Meldola FC Italy
| | - S. Gandini
- Division of Epidemiology and Biostatistics; European Institute of Oncology; via Ramusio 1 - 20141 Milan Italy
| | - S. Magi
- Skin Cancer Unit Istituto Oncologico Romagnolo; Forlì IRCCS; Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori; Piero Maroncelli 40 - 47014 Meldola FC Italy
| | - L. Mazzoni
- Skin Cancer Unit Istituto Oncologico Romagnolo; Forlì IRCCS; Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori; Piero Maroncelli 40 - 47014 Meldola FC Italy
| | - M. Medri
- Skin Cancer Unit IRCCS; Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori; Piero Maroncelli 40 - 47014 Meldola FC Italy
| | - V. Agnoletti
- Centro di Studi Avanzati sull'Umanizzazione delle Cure e sulla Salute Sociale; University of Bologna; via Strada Maggiore 45 - 40125 Bologna Italy
| | - L. Lombi
- Centro di Studi Avanzati sull'Umanizzazione delle Cure e sulla Salute Sociale; University of Bologna; via Strada Maggiore 45 - 40125 Bologna Italy
| | - F. Falcini
- Registro Tumori Romagna IRCCS - Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori; Piero Maroncelli 40 - 47014 Meldola FC Italy
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Lazovich D, Choi K, Rolnick C, Jackson JM, Forster J, Southwell B. An intervention to decrease adolescent indoor tanning: a multi-method pilot study. J Adolesc Health 2013; 52:S76-82. [PMID: 23601614 PMCID: PMC3734796 DOI: 10.1016/j.jadohealth.2012.08.009] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2012] [Revised: 08/10/2012] [Accepted: 08/28/2012] [Indexed: 01/05/2023]
Abstract
PURPOSE Indoor tanning usually begins during adolescence, but few strategies exist to discourage adolescent use. We developed and tested a parent-teenager intervention to decrease indoor tanning use. METHODS Through focus groups, we identified key messages to enhance parent-teenager communication about indoor tanning, and then developed a pamphlet for parents and postcards for adolescents to use in a direct mail experiment with randomly selected households. Two weeks after the mailing, we asked intervention parents (n = 87) and adolescents (n = 69) and nonintervention parents (n = 31) and adolescents (n = 28) about intervention receipt and content recall, parental concern, monitoring, parent-teenager conversations, and indoor tanning intention. RESULTS In intervention households, 54% of mothers and 56% of girls recalled receipt and reported reading materials, but few boys and no fathers did. Among mothers, 57% in intervention households indicated concern about daughters' indoor tanning, and 25% would allow daughters to tan indoors, whereas 43% of nonintervention mothers had concerns and 46% would allow indoor tanning. Fewer girls in intervention households than in nonintervention households thought parents would allow indoor tanning (44% vs. 65%), and fewer intended to tan indoors (36% vs. 60%). Most mothers and daughters who read the intervention materials also reported discussions about indoor tanning. Moreover, the less likely girls were to think that their mothers would allow indoor tanning, the less likely it was that they intended to tan indoors, a relationship mediated by perceptions of maternal monitoring. CONCLUSIONS A systematic qualitative and quantitative research approach yielded well-received indoor tanning prevention messages for mothers and female adolescents. Enhancing maternal monitoring has potential to decrease adolescent indoor tanning.
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Affiliation(s)
- DeAnn Lazovich
- Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, Minnesota 55454, USA.
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21
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Mahler HIM, Kulik JA, Gerrard M, Gibbons FX. Effects of photoaging information and UV photo on sun protection intentions and behaviours: a cross-regional comparison. Psychol Health 2013; 28:1009-31. [PMID: 23537173 DOI: 10.1080/08870446.2013.777966] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
There is limited empirical evidence regarding differences in sun protection practices in different regions of the USA. This study examined whether there are regional differences in the efficacy of exposure to UV photographs and photoaging information (e.g. wrinkles and age spots) for increasing sun protection behaviours. Students attending a public university in either the Midwestern (Iowa) or Southwestern (Southern California) US reported baseline sun exposure and protection practices and were then randomly assigned to either receive information about photoaging, have a UV photo taken, both receive photoaging information and have a UV photo taken, or to receive neither intervention. Sun protection intentions were assessed immediately after the interventions, and both self-reported sun protection behaviours and an objective assessment (via spectrophotometry) of skin colour change were measured at the end of summer and one year following the interventions. The results showed a pervasive pattern of more risky UV exposure and less sun protection use at the Iowa site than at the Southern California site both prior to and following the interventions. Both interventions increased future sun protection intentions regardless of region. However, the intervention effects on skin colour and UV exposure differed across region, with generally more reliable effects at the Iowa site.
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Affiliation(s)
- Heike I M Mahler
- a Department of Psychology , California State University , San Marcos , CA , USA
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22
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Tella E, Beauchet A, Vouldoukis I, Séi JF, Beaulieu P, Sigal ML, Mahé E. French teenagers and artificial tanning. J Eur Acad Dermatol Venereol 2012; 27:e428-32. [PMID: 23078037 DOI: 10.1111/jdv.12015] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
BACKGROUND Exposure to solar and artificial ultraviolet (UV) radiations is a major risk factor for skin cancers. France has enacted one of the strictest laws that, notably, restrict tanning-bed access to adults ≥18 years old. OBJECTIVE We evaluated artificial tanning behaviours of French teenagers (11-17 years old): sunless-tanning products, sunlamps and artificial tanning beds. METHODS An anonymous questionnaire evaluating sunburn history, skin phototype, behaviours with sunless-tanning products and indoor tanning, and parents' behaviours was distributed to students enrolled in two middle and high schools in Antony, a typical city of the middle class French population, located in the Paris suburbs. RESULTS Among 713 teenagers (mean age: 13.5 years: male/female: 1.1) responding, more than half declared that it was important to be tanned during the summer, 1% reported having already used tanning pills, 9.9% tanning creams and 1.4% indoor tanning. Female teenagers significantly more frequently resorted to indoor tanning (P = 0.02), cited the importance of being tanned all year long (P < 0.0001), used tanning pills (P < 0.0001) or tanning creams (P < 0.006), and their parents relied on indoor tanning (P < 0.0001). Profiles of tanning-pill and -cream users were similar. Mean ages for the two groups were comparable. CONCLUSION French regulations for indoor tanning seem quite effective. Our analyses revealed a typical teenager profile with sun-exposure risk behaviours, for example, indoor tanning, and use of tanning pills or creams. They could be a selective target for sun-protection information campaigns.
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Affiliation(s)
- E Tella
- Department of Dermatology, Victor-Dupouy Hospital, Argenteuil, France Public Health Department, Ambroise-Paré University Hospital, University of Versailles-Saint-Quentin-en-Yvelines, Boulogne- Billancourt Cedex, France INSERM/UPMC-UMRS 945, Pitié-Salpêtrière University Hospital, Paris, France Department of Dermatology, Saint-Germain-en-Laye, France Department of Dermatology, Pontoise, France
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23
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Makin JK, Hearne K, Dobbinson SJ. Compliance with age and skin type restrictions following the introduction of indoor tanning legislation in Melbourne, Australia. PHOTODERMATOLOGY PHOTOIMMUNOLOGY & PHOTOMEDICINE 2012; 27:286-93. [PMID: 22092731 DOI: 10.1111/j.1600-0781.2011.00613.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND/PURPOSE The study aimed to establish compliance of indoor tanning businesses with 2009 legislation, particularly with requirements to provide information on skin cancer and exclude people under 18 or with fair skin. METHODS Compliance was tested through surveys and in-person visits to 30 businesses in Melbourne, Australia. Research assistants presented as potential customers with different profiles: young adults eligible to use a sunbed, young adults with fair skin, under age customers who prompted with their age and under age customers who concealed their age and claimed to be 18 if asked. RESULTS Communicating the risks of skin cancer during the visit improved from 70% in 2003, prior to the introduction of legislation, to 97% in 2009. While there were improvements in restricting access to sunbeds among high-risk groups, compliance of indoor tanning businesses with age and skin type restrictions remained less than optimal. Almost half (47%) allowed access to fair-skinned research assistants, compared with 90% in 2003. Only one of the 30 operators allowed access to a teenager who prompted with her age; in 2003, 52% of under age teenagers were granted access without parental consent. However, when teenagers concealed their age or claimed to be 18, 80% of operators granted them access. CONCLUSIONS The findings suggest that regulation of the indoor tanning industry is a better approach to this health issue than voluntary standards and/or education. Nonetheless, inadequate compliance with requirements to exclude high-risk groups lends weight to calls for stricter monitoring and enforcement, or an absolute ban.
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Affiliation(s)
- Jennifer K Makin
- Centre for Behavioural Research in Cancer, Cancer Council Victoria, Carlton, Vic., Australia.
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24
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Reviews on sun exposure and artificial light and melanoma. PROGRESS IN BIOPHYSICS AND MOLECULAR BIOLOGY 2011; 107:362-6. [DOI: 10.1016/j.pbiomolbio.2011.09.011] [Citation(s) in RCA: 80] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/29/2011] [Accepted: 09/13/2011] [Indexed: 12/31/2022]
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25
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Krarup A, Køster B, Thorgaard C, Philip A, Clemmensen I. Sunbed use by children aged 8-18 years in Denmark in 2008: a cross-sectional study. Br J Dermatol 2011; 165:214-6. [DOI: 10.1111/j.1365-2133.2011.10352.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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26
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Cust AE, Armstrong BK, Goumas C, Jenkins MA, Schmid H, Hopper JL, Kefford RF, Giles GG, Aitken JF, Mann GJ. Sunbed use during adolescence and early adulthood is associated with increased risk of early-onset melanoma. Int J Cancer 2011; 128:2425-35. [PMID: 20669232 DOI: 10.1002/ijc.25576] [Citation(s) in RCA: 145] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Sunbed use is associated with increased risk of melanoma. Younger people might be more susceptible to the carcinogenic effects of ultraviolet radiation. We investigated the association between sunbed use and risk of early-onset cutaneous malignant melanoma. From the Australian Melanoma Family Study, a multicentre, population-based, case-control-family study, we analysed data for 604 cases diagnosed between ages 18 and 39 years and 479 controls. Data were collected by interview. Associations were estimated as odds ratios (ORs) using unconditional logistic regression, adjusting for age, sex, city, education, family history, skin color, usual skin response to sunlight and sun exposure. Compared with having never used a sunbed, the OR for melanoma associated with ever-use was 1.41 (95% confidence interval (CI) 1.01-1.96), and 2.01 (95% CI 1.22-3.31) for more than 10 lifetime sessions (P(trend) 0.01 with cumulative use). The association was stronger for earlier age at first use (P(trend) 0.02). The association was also stronger for melanoma diagnosed when aged 18-29 years (OR for more than 10 lifetime sessions = 6.57, 95% CI 1.41-30.49) than for melanoma diagnosed when 30-39 years (OR 1.60, 95% CI 0.92-2.77; P(interaction) 0.01). Among those who had ever used a sunbed and were diagnosed between 18 and 29 years of age, three quarters (76%) of melanomas were attributable to sunbed use. Sunbed use is associated with increased risk of early-onset melanoma, with risk increasing with greater use, an earlier age at first use and for earlier onset disease.
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Affiliation(s)
- Anne E Cust
- Centre for Molecular, Environmental, Genetic and Analytic Epidemiology, School of Population Health, University of Melbourne, Melbourne, Australia.
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Mayer JA, Woodruff SI, Slymen DJ, Sallis JF, Forster JL, Clapp EJ, Hoerster KD, Pichon LC, Weeks JR, Belch GE, Weinstock MA, Gilmer T. Adolescents' use of indoor tanning: a large-scale evaluation of psychosocial, environmental, and policy-level correlates. Am J Public Health 2011; 101:930-8. [PMID: 21421947 PMCID: PMC3076411 DOI: 10.2105/ajph.2010.300079] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/19/2010] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We evaluated psychosocial, built-environmental, and policy-related correlates of adolescents' indoor tanning use. METHODS We developed 5 discrete data sets in the 100 most populous US cities, based on interviews of 6125 adolescents (aged 14-17 years) and their parents, analysis of state indoor tanning laws, interviews with enforcement experts, computed density of tanning facilities, and evaluations of these 3399 facilities' practices regarding access by youths. After univariate analyses, we constructed multilevel models with generalized linear mixed models (GLMMs). RESULTS In the past year, 17.1% of girls and 3.2% of boys had used indoor tanning. The GLMMs indicated that several psychosocial or demographic variables significantly predicted use, including being female, older, and White; having a larger allowance and a parent who used indoor tanning and allowed their adolescent to use it; and holding certain beliefs about indoor tanning's consequences. Living within 2 miles of a tanning facility also was a significant predictor. Residing in a state with youth-access legislation was not significantly associated with use. CONCLUSIONS Current laws appear ineffective in reducing indoor tanning; bans likely are needed. Parents have an important role in prevention efforts.
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Affiliation(s)
- Joni A Mayer
- School of Public Health, San Diego State University, CA, USA.
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28
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Mahler HIM, Kulik JA, Gerrard M, Gibbons FX. Effects of upward and downward social comparison information on the efficacy of an appearance-based sun protection intervention: a randomized, controlled experiment. J Behav Med 2010; 33:496-507. [PMID: 20652391 PMCID: PMC2967703 DOI: 10.1007/s10865-010-9279-3] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2010] [Accepted: 07/01/2010] [Indexed: 11/30/2022]
Abstract
This experiment examined the impact of adding upward and/or downward social comparison information on the efficacy of an appearance-based sun protection intervention (UV photos and photoaging information). Southern California college students (N = 126) were randomly assigned to one of four conditions: control, intervention, intervention plus upward social comparison, intervention plus downward social comparison. The results demonstrated that all those who received the basic UV photo/photoaging intervention reported greater perceived susceptibility to photoaging (d = .74), less favorable tanning cognitions (d = .44), and greater intentions to sun protect (d = 1.32) relative to controls. Of more interest, while the basic intervention increased sun protective behavior during the subsequent 5 weeks relative to controls (d = .44), the addition of downward comparison information completely negated this benefit. Upward comparison information produced sun protection levels that were only slightly (and nonsignificantly) greater than in the basic intervention condition and, as such, does not appear to be a cost-effective addition. Possible mechanisms that may have reduced the benefits of upward comparison information and contributed to the undermining effects of downward comparison information are discussed.
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Affiliation(s)
- Heike I M Mahler
- Department of Psychology 0109, University of California, San Diego, La Jolla, CA 92093, USA.
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Abstract
The Icelandic study of melanoma trends by Héry et al. in this issue of the Journal (Am J Epidemiol. 2010;172(7):762-767) is a fascinating analysis of an ecologic association. The authors noted a sharp increase in melanoma incidence that appeared to lag a few years behind the increased prevalence of sunbeds in Iceland. Caution, however, must be exercised in interpreting the data because of the lack of understanding of emissions of ultraviolet radiation from sunbeds and the ecologic nature of the data.
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Affiliation(s)
- Marianne Berwick
- University of New Mexico Cancer Center and Division of Epidemiology and Biostatistics, Department of Internal Medicine, University of New Mexico, Albuquerque, New Mexico 87131-0001, USA.
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Francis K, Dobbinson S, Wakefield M, Girgis A. Solarium use in Australia, recent trends and context. Aust N Z J Public Health 2010; 34:427-30. [PMID: 20649786 DOI: 10.1111/j.1753-6405.2010.00578.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVES To describe the prevalence of solarium use among representative samples of Australian adolescents (12-17 years) and adults (18-69 years). METHODS In national surveys conducted in 2003/04 and 2006/07 using equivalent methods, n=11,509 Australian adolescents and adults self-reported their use of solaria. RESULTS In 2006/07 10.6% of adults had 'ever' used a solarium, and use was most prevalent among women aged 18 to 24 (17.1%) and 25 to 44 (20.7%). Few adolescents (2.5%) had ever used a solarium. The prevalence of past year use was much lower (0.6% of adolescents, 1.5% of adults) and there was a significant reduction among adults between surveys (OR=0.69, 95% CI=0.52-0.94). Adults' attitudes related to past year solarium use were preference for a suntan (OR=4.68, 95% CI=2.48-8.85); perceived protan attitudes of peers (OR=2.10, 95% CI=1.17-3.77), belief that a suntan looks healthy (OR=1.92, 95% CI=1.09-3.39); and perceiving they have some risk of getting skin cancer (OR=1.69, 95% CI=1.03-2.78). CONCLUSIONS AND IMPLICATIONS Although solarium use in Australia is relatively low, it is highest among young adult women. These data show encouraging downward trends in use, and provide a foundation for monitoring the impact of forthcoming regulatory changes to the solarium industry.
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Affiliation(s)
- Kate Francis
- Problem Gambling Research and Treatment Centre, University of Melbourne, Victoria
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Dodd LJ, Forshaw MJ. Assessing the efficacy of appearance-focused interventions to prevent skin cancer: a systematic review of the literature. Health Psychol Rev 2010. [DOI: 10.1080/17437199.2010.485393] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Bradford PT, Anderson WF, Purdue MP, Goldstein AM, Tucker MA. Rising melanoma incidence rates of the trunk among younger women in the United States. Cancer Epidemiol Biomarkers Prev 2010; 19:2401-6. [PMID: 20826837 PMCID: PMC2939095 DOI: 10.1158/1055-9965.epi-10-0503] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Melanoma rates are rising among young women, possibly due to increasing UV radiation to previously protected body sites. Therefore, we examined melanoma incidence trends by age, gender, and body site. Descriptive methods were complemented with the age-period-cohort parameters net drift and longitudinal age trend. METHODS Case and population data were obtained from the Surveillance, Epidemiology, and End Results (SEER) 9 Registries Database (1975-2006). Net drift summarized the average annual percentage change in log-linear rates per year of calendar-time (or year of diagnosis). Longitudinal age trend summarized the average annual percentage change by attained age at diagnosis. Early- and late-onset melanomas have low and high longitudinal age trends, respectively. RESULTS There were 105,829 melanomas diagnosed in the SEER 9 Registries. The overall age-adjusted incidence rate (IR) for melanoma was 17.7/100,000 person-years. Age-specific IRs were greater among women than men prior to age 40 years. Among women, IRs decreased for all anatomic sites relative to the trunk. The highest net drift occurred in truncal lesions among women (net drift, 3.8%/year of calendar time; 95% confidence interval, 3.5-4.0%). The lowest longitudinal age trends also were observed for truncal lesions among women (longitudinal age trend, 5.4%/year of attained age; 95% confidence interval, 5.1-5.7). CONCLUSIONS Although melanoma IRs overall have risen for decades, the combination of high net drift and low longitudinal age trend show that melanomas are rising preferentially on the trunk among young women. IMPACT Future surveillance and analytic studies should consider melanoma effect modification by age, gender, and body site.
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Affiliation(s)
- Porcia T Bradford
- Genetic Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, Bethesda, Maryland 20852, USA.
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Kemp GA, Eagle L, Verne J. Mass media barriers to social marketing interventions: the example of sun protection in the UK. Health Promot Int 2010; 26:37-45. [PMID: 20713412 DOI: 10.1093/heapro/daq048] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
The role of the mass media in communicating health-related information to the wider population is the focus of this paper. Using the example of sun protection within the UK, we highlight some of the major challenges to raising awareness of steadily increasing melanoma rates and of effective sun protection strategies. The implications of potential barriers to official sun protection messages via conflicting messages in the media are discussed in terms of editorial on sun protection and in the way in which television programme content portrays the issues. Implications for public policy and future research conclude the paper.
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Affiliation(s)
- Gillian Ann Kemp
- University of the West of England, Coldharbour Road, Frenchay, Bristol, Bristol BS16 1QY, UK.
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Greenman J, Jones DA. Comparison of advertising strategies between the indoor tanning and tobacco industries. J Am Acad Dermatol 2010; 62:685.e1-18. [PMID: 20138395 DOI: 10.1016/j.jaad.2009.02.045] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2008] [Revised: 02/05/2009] [Accepted: 02/07/2009] [Indexed: 11/17/2022]
Abstract
The indoor tanning industry is large and continues to grow, with 2007 domestic sales in excess of $5 billion. Advertising is central to shaping the consumer's perception of indoor tanning as well as driving industry demand. This article aims to identify key drivers of consumer appeal by comparing tanning advertising strategies to those used by tobacco marketers. Tobacco advertising was selected as a reference framework because it is both well documented and designed to promote a product with known health hazards. Two thousand advertisements from 4 large tobacco advertisement databases were analyzed for type of advertisement strategy used, and 4 advertising method categories were devised to incorporate the maximum number of advertisements reviewed. Subsequently, contemporary tanning advertisements were collected from industry magazines and salon websites and evaluated relative to the identified strategy profiles. Both industries have relied on similar advertising strategies, including mitigating health concerns, appealing to a sense of social acceptance, emphasizing psychotropic effects, and targeting specific population segments. This examination is a small observational study, which was conducted without rigorous statistical analysis, and which is limited both by the number of advertisements and by advertising strategies examined. Given the strong parallels between tobacco and tanning advertising methodologies, further consumer education and investigation into the public health risks of indoor tanning is needed.
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Eubel J, Enk AH. Dendritic cell vaccination as a treatment modality for melanoma. Expert Rev Anticancer Ther 2010; 9:1631-42. [PMID: 19895246 DOI: 10.1586/era.09.139] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
As melanoma is an immunogenic tumor, immunotherapy has been investigated as a possible treatment modality for melanoma patients at high risk of relapse and those with metastatic disease. In the past decade progress has been made, ranging from rather nonspecific stimulations of the immune system with IL-2 and IFN-alpha to more specific approaches based on vaccination with tumor antigens. Owing to their unique features, dendritic cells (DCs) represent an important tool for tumor antigen-specific immunotherapy. However, clinical vaccination trials with DCs showed sobering results with respect to objective responses and improvement of overall survival. In this review, principles and methods of DC-based vaccination are presented. Mechanisms impairing clinically successful vaccination strategies are described. Finally, we will discuss perspectives for future developments of DC-based vaccines that might lead melanoma treatment to a new era.
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Affiliation(s)
- Jana Eubel
- Department of Dermatology, University of Heidelberg, Heidelberg, Germany.
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Thomson CS, Woolnough S, Wickenden M, Hiom S, Twelves CJ. Sunbed use in children aged 11-17 in England: face to face quota sampling surveys in the National Prevalence Study and Six Cities Study. BMJ 2010; 340:c877. [PMID: 20299396 PMCID: PMC2841745 DOI: 10.1136/bmj.c877] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To quantify the use of sunbeds in young people across England, identify geographical variation, and explore patterns of use, including supervision. DESIGN Two random location sampling surveys. SETTING National Prevalence Study in England; Six Cities Study in Liverpool, Stoke/Stafford, Sunderland, Bath/Gloucester, Oxford/Cambridge, and Southampton. PARTICIPANTS 3101 children aged 11-17 in the National Prevalence study and 6209 in the Six Cities study. RESULTS In the National Prevalence Study 6.0% (95% confidence interval 5.1% to 6.8%) of those aged 11-17 had used a sunbed. Use was higher in girls than in boys (8.6% (7.2% to 10.0%) v 3.5% (2.6% to 4.4%), respectively), in those aged 15-17 compared with those aged 11-14 (11.2% (9.5% to 12.9%) v 1.8% (1.2% to 2.4%), respectively), and in those from lower rather than higher social grades (7.6% (5.7% to 9.5%) v 5.4% (4.5% to 6.3%), respectively). Sunbed use was higher in the "north" (11.0%, 8.9% to 13.0%) than in the "midlands" (4.2%, 2.5% to 5.8%) and the "south" (4.2%, 3.3% to 5.2%). In the Six Cities Study, sunbed use was highest in Liverpool and Sunderland (20.0% (17.5% to 22.4%) and 18.0% (15.6% to 20.3%), respectively), with rates especially high in girls, those aged 15-17, or from lower social grades. Mean age of first use was 14, and 38.4% (34.7% to 42.1%) of children used a sunbed at least once a week. Nearly a quarter (23.0%, 19.8% to 26.1%) of children had used a sunbed at home (including home of friends/relatives), and 24.7% (21.0% to 28.4%) said they had used sunbeds unsupervised in a tanning/beauty salon or gym/leisure centre. CONCLUSIONS Sunbed use by children is widespread in England, is often inadequately supervised, and is a health risk. National legislation is needed to control sunbed outlets.
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Obayan B, Geller AC, Resnick EA, Demierre MF. Enacting legislation to restrict youth access to tanning beds: a survey of advocates and sponsoring legislators. J Am Acad Dermatol 2010; 63:63-70. [PMID: 20226565 DOI: 10.1016/j.jaad.2009.09.019] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2009] [Revised: 09/02/2009] [Accepted: 09/03/2009] [Indexed: 10/19/2022]
Abstract
BACKGROUND Passing tanning bed legislation restricting underage use has remained challenging. OBJECTIVE We sought to determine the resources required to pass tanning bed legislation restricting use to children and identify key barriers to its passage. METHODS A total of 15 states sought to pass tanning bed legislation in 2006; in-depth surveys were completed with advocates in 10 states and legislators in 5 states. RESULTS Advocates sought advice from the sponsoring legislator or legislators (n = 9), held discussions with other organizations (n = 8), and used a lobbyist (n = 5). The 3 major barriers were strong lobbying efforts by the tanning bed industry (n = 10), proceedings after the bill was filed (n = 5), and obtaining support from other organizations (n = 4). For legislators, the most significant barrier was making colleagues aware of the health effects of tanning bed use. LIMITATIONS Five of 10 legislators and 10 of 15 advocates responded to the survey. CONCLUSION Barriers to passage of tanning bed legislation can potentially be surmounted with advice to advocates and coordinated efforts by multiple organizations.
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Affiliation(s)
- Busayo Obayan
- Boston University School of Medicine, Boston, Massachusetts 02118, USA
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A population-based survey on tanning bed use in Germany. BMC DERMATOLOGY 2009; 9:6. [PMID: 19619281 PMCID: PMC2724378 DOI: 10.1186/1471-5945-9-6] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/27/2008] [Accepted: 07/20/2009] [Indexed: 11/10/2022]
Abstract
BACKGROUND The suntanning industry has grown up over the last decade in Europe, mainly because tanned skin is considered socially desirable and attractive. Because of the potential negative impact of artificial tanning on public health, this study was to investigate tanning bed use behaviour, UV related risk perception and beliefs about tanning in the German population. METHODS In 2007, a representative telephone survey was carried out among 1501 German residents aged 14 years and older. RESULTS More than one fourth (28%) of the German population have used tanning beds at least once before in their lifetime. High-frequency tanning behaviour, i.e. using tanning beds more than 10 times per year, were recorded for 11%. Men and women aged 18 to 44 years and young women under the age of 18 used tanning beds more frequently (>10 times per year). Tanning bed use was positively related to appearance and lifestyle related beliefs as well as to the perception that tanned skin is healthy. CONCLUSION This analysis indicates that tanning bed use is common in Germany. The positive relationships of appearance and health related beliefs with tanning bed use are of great concern. The results indicate underlying misconceptions about the positive effect of artificial UV radiation compared to natural UV radiation particular for high-frequency tanners. The data shows the importance as well as the limitations for risk communication in its current effort to inform effectively about the dangers of artificial UV radiation.
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Linton CP, Jones KD. Ultraviolet Protection Behaviors and Beliefs Among Young Adult Dermatology Patients. JOURNAL OF THE DERMATOLOGY NURSES ASSOCIATION 2009. [DOI: 10.1097/jdn.0b013e3181a822d0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Cokkinides V, Weinstock M, Lazovich D, Ward E, Thun M. Indoor tanning use among adolescents in the US, 1998 to 2004. Cancer 2009; 115:190-8. [PMID: 19085965 DOI: 10.1002/cncr.24010] [Citation(s) in RCA: 70] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND A recent meta-analysis found that indoor tanning use before the age of 35 years increases the risk of melanoma, supporting policies to restrict indoor tanning use among adolescents. The objectives of the current study were to provide a national assessment of prevalence and trends of indoor tanning use among US adolescents, to examine changes in the prevalence of indoor tanning use from 1998 to 2004 in relation to state policies on minors' access, and to assess the prevalence of burns, rashes, and infections among users. METHODS Two cross-sectional population-based surveys of US youths ages 11 to 18 years and their parents/guardians conducted in 1998 (N=1196) and 2004 (N=1613) used identical questions to assess use of indoor tanning and correlates of this behavior. RESULTS The prevalence of indoor tanning use by adolescents within the past year changed little from 1998 to 2004 (10% to 11%). In states with policies regarding minors' access to indoor tanning, the prevalence stayed the same or decreased from 1998 to 2004, whereas it increased in states without such policies. Neither trend was found to be statistically significant. Youth tanning attitudes, parental indoor tanning use, and parents' permission were strongly associated with youth use of indoor tanning. Fifty-eight percent of users reported burns from indoor tanning. CONCLUSIONS The presence of state legislation restricting minors' access to indoor tanning appears to have limited effectiveness, perhaps because most states' policies permit use with parental consent. Multipronged approaches are needed to reduce indoor tanning use in youths.
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Affiliation(s)
- Vilma Cokkinides
- Department of Epidemiology and Surveillance Research, American Cancer Society, Atlanta, Georgia 30303-1002, USA.
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Abstract
Controversy continues over the carcinogenic properties of tanning beds. The tanning industry "sells" tanning beds as a safe alternative to UV exposure for both tanning as well as vitamin D biosynthesis. But, how safe are tanning beds? Epidemiologic data - incomplete and unsatisfactory - suggests that tanning beds are not safer than solar ultraviolet radiation and that they may have independent effects from solar exposure that increase risk for melanoma.
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Affiliation(s)
- Marianne Berwick
- University of New Mexico Cancer Research and Treatment Center, Albuquerque, NM, USA.
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Estimation of avoidable skin cancers and cost-savings to government associated with regulation of the solarium industry in Australia. Health Policy 2008; 89:303-11. [PMID: 18760857 DOI: 10.1016/j.healthpol.2008.07.003] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2008] [Revised: 07/01/2008] [Accepted: 07/12/2008] [Indexed: 11/21/2022]
Abstract
OBJECTIVE In Australia there is growing concern about the expanding solarium industry, and the additive effect of persons seeking exposure to artificial ultraviolet radiation (UVR) against already intense background levels of solar UVR. We estimated the numbers of potential skin cancers prevented through regulation of solaria and the associated cost-savings to the Federal Government. METHODS A lifetime decision-analytic model was created using relative risk estimates based on a meta-analysis of the literature assessing the link between skin cancer risk and solarium use. The costs were limited to those incurred by Medicare Australia, for the medical care of individuals treated for skin cancer. RESULTS With stricter regulations, we estimated between 18 and 31 melanomas, 200-251 squamous cell carcinomas and associated costs of $AU 256,054 would be avoided per 100,000 persons. Our base findings were sensitive to estimates for prevalence of use, skin cancer risk and discounting rates. CONCLUSIONS Continued growth in the Australian solarium industry is likely to inflate the already substantial skin cancer burden. Subject to some limitations, our study indicates that by successfully enforcing solarium regulations to prohibit use by minors and by those with fair skin colour, the Federal Government could expect favourable cost and health benefits.
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Recent trends in incidence of cutaneous melanoma among US Caucasian young adults. J Invest Dermatol 2008; 128:2905-8. [PMID: 18615112 DOI: 10.1038/jid.2008.159] [Citation(s) in RCA: 173] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Ezzedine K, Malvy D, Mauger E, Nageotte O, Galan P, Hercberg S, Guinot C. Artificial and natural ultraviolet radiation exposure: beliefs and behaviour of 7200 French adults. J Eur Acad Dermatol Venereol 2008; 22:186-94. [PMID: 18211412 DOI: 10.1111/j.1468-3083.2007.02367.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Despite the increasing use of indoor tanning facilities, little is known regarding the behaviour of adults with respect to artificial and natural ultraviolet (UV) radiation exposure and the relationship between the two forms of exposure. OBJECTIVES To describe the beliefs and behaviour of French middle-aged volunteers regarding artificial and natural UV exposure. METHODS Cross-sectional study of a French national cohort using a self-completed questionnaire. RESULTS Participants were identified as 'indoor UV tanners' (n= 1076) and as 'non-users' (n= 6124). Predictor factors associated with indoor tanning were gender, age, smoking, phototype, region of residence, sun exposure during hobbies, voluntary sun exposure in particular during the hottest hours of the day, nudism practice, facial sunscreen habits, sunglass use, importance for lying in the sun and the claim 'ever heard of melanoma'. LIMITATIONS The quality of information may be limited by the data collection method. CONCLUSION Whereas indoor tanning should be discouraged, it seems that indoor tanners are also regular sunbathers unconcerned about the risk of photoageing and skin cancer occurrence. Moreover, indoor tanners seem to have more behavioural risk factors for cancer, such as smoking.
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Affiliation(s)
- K Ezzedine
- Unité 557, Unité mixte de recherche INSERM/INRA/CNAM, Paris, France
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Affiliation(s)
- Margaret A Tucker
- Genetic Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, 6120 Executive Boulevard, Room 7122, Bethesda, MD 20892-7236, USA.
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Autier P, Boyle P. Artificial ultraviolet sources and skin cancers: rationale for restricting access to sunbed use before 18 years of age. ACTA ACUST UNITED AC 2008; 5:178-9. [PMID: 18268545 DOI: 10.1038/ncponc1069] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2007] [Accepted: 12/07/2007] [Indexed: 11/09/2022]
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Dobbinson SJ, Wakefield MA, Jamsen KM, Herd NL, Spittal MJ, Lipscomb JE, Hill DJ. Weekend sun protection and sunburn in Australia trends (1987-2002) and association with SunSmart television advertising. Am J Prev Med 2008; 34:94-101. [PMID: 18201638 DOI: 10.1016/j.amepre.2007.09.024] [Citation(s) in RCA: 103] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2007] [Revised: 08/29/2007] [Accepted: 09/26/2007] [Indexed: 10/22/2022]
Abstract
BACKGROUND The Australian state of Victoria has run a population-based skin cancer prevention program called SunSmart since 1988, incorporating substantial public education efforts and environmental change strategies. Trends over 15 years in behavioral risk factors for skin cancer were examined in a population exposed to the SunSmart program. Whether outcomes were associated with extent of SunSmart television advertising was then assessed. METHODS In nine cross-sectional surveys from 1987 to 2002, 11,589 adults were interviewed by telephone about their sun exposure and sun protection during outdoor activities on summer weekends. Analyses completed in 2007 adjusted for ambient temperature and ultraviolet radiation. RESULTS Sun protection and sunburn show substantial general improvement over time, but have stalled in recent years. Use of hats and sunscreens significantly increased over time and peaked during the mid to late 1990s, compared with the pre-SunSmart baseline. The mean proportion of unprotected skin was reduced and was lowest in the summer of 1997-1998. Summer sunburn incidence declined over time and was 9.1% in 2002, almost half baseline (OR=0.53; 95% CI=0.39-0.73). Higher exposure to SunSmart advertising in the 4 weeks before the interview increased: (1) preference for no tan, (2) hat and sunscreen use, and (3) proportion of body surface protected from the sun. CONCLUSIONS The general improvement in sun-protective behaviors over time highlight that a population's sun-protective behaviors are amenable to change. Population-based prevention programs incorporating substantial television advertising campaigns into the mix of strategies may be highly effective in improving a population's sun-protective behaviors.
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Affiliation(s)
- Suzanne J Dobbinson
- Centre for Behavioural Research in Cancer, The Cancer Council Victoria, Melbourne, Australia. Suzanne.
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Abstract
BACKGROUND Exposure to ultraviolet radiation (UVR) results in a darkening of the skin known as tanning. Recently, it has been shown that tanning is a response to UVR-induced DNA damage and represents the skin's efforts to protect itself against further injury. Despite the link between UVR and cutaneous malignancy, people continue to pursue tanning from natural and artificial sources. This trend is reflected in the exponential rise in skin cancer incidence. OBJECTIVE The objective of this study was to review our current understanding of the factors controlling the tanning response and the relationship to cutaneous carcinogenesis, as well as the impact that the multibillion dollar tanning industry has had on the practice of dermatology. MATERIALS AND METHODS Extensive literature review was conducted in subjects related to tanning and the relationship to cutaneous malignancy. RESULTS Our knowledge of tanning and its effects on the skin has increased tremendously. It is clear that tanning contributes to the development of skin cancer. Despite this information, the incidence of skin cancer continues to increase exponentially. CONCLUSIONS Skin cancer poses a major public health concern and tanning remains the most modifiable risk factor in its etiology. Social, economic, and legislative issues have become tightly intertwined with the complex nature of human behavior in the continued pursuit of an activity that clearly has detrimental effects on one's health.
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Affiliation(s)
- Sherrif F Ibrahim
- Department of Dermatology, University of Rochester, Rochester, New York 60612-7300, USA.
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