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Stapleton JL, Manne SL, Pagoto SL, Leip A, Greene K, Hillhouse JJ, Merritt AS, Shelton BJ. A Social Media-Delivered Melanoma Prevention Program for Young Women Engaged in Frequent UV Tanning: Protocol for a Randomized Controlled Trial. JMIR Res Protoc 2024; 13:e56562. [PMID: 38502173 PMCID: PMC10988380 DOI: 10.2196/56562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Revised: 02/08/2024] [Accepted: 02/09/2024] [Indexed: 03/20/2024] Open
Abstract
BACKGROUND Rates of melanoma have increased dramatically in the United States over the past 25 years, and it has become among the most prevalent cancers for young adult women. Intentional skin tanning leads to a pattern of intense and intermittent UV radiation exposure that is associated with increased risk of melanoma. Frequent tanning is most common among young women and is linked to a variety of sociocultural pressures that negatively impact body image and drive appearance control behaviors. Unfortunately, there are no established interventions designed for frequent tanners. This intervention addresses this gap with unique content informed by body image and acceptance-based interventions. The intervention is delivered using Facebook secret groups, an approach designed to support behavior change and ensure scalability. OBJECTIVE This study aims to describe the rationale and methodology of a randomized controlled trial of a melanoma prevention program targeting young women engaged in frequent indoor or outdoor UV tanning. METHODS Participants are women aged 18-25 years who report high-risk tanning (ie, at least 10 indoor tanning sessions in the past 12 months or 10 outdoor sessions in the previous summer). After recruitment and screening, participants completed a baseline survey and were randomly assigned to receive the intervention or an attention-matched control condition. Both conditions were 8-week-long Facebook groups (approximately 25 members each) with daily posting of content. Follow-up surveys are administered at 3, 8, and 18 months after baseline. The primary trial outcome is the combined number of indoor and outdoor tanning sessions reported at the 8-month follow-up. Hypothesized intervention mediators are assessed at the 3-month follow-up. RESULTS This project was funded by a National Cancer Institute award (R01 CA218068), and the trial procedures were approved by the University of Kentucky Institutional Review Board in February 2020. Trial recruitment and enrollment occurred in 6 waves of data collection, which started in February 2022 and closed in May 2023. The study is closed to enrollment but remains open for follow-ups, and this protocol report was prepared before data analyses. As of February 2024, all participants have completed the 8-month follow-up assessment, and data collection is scheduled to close by the end of 2024 after the collection of the 18-month follow-up. CONCLUSIONS This trial will contribute unique knowledge to the field of skin cancer prevention, as no fully powered trials have examined the efficacy of an intervention designed for frequent indoor or outdoor tanning. The trial may also contribute evidence of the value in translating principles of body image and acceptance-based interventions into the field of skin cancer prevention and beyond. If successful, the use of the Facebook platform is intended to aid in dissemination as it provides a way to embed the intervention into individuals' everyday routines. TRIAL REGISTRATION ClinicalTrials.gov NCT03441321; https://clinicaltrials.gov/study/NCT03441321. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/56562.
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Affiliation(s)
- Jerod L Stapleton
- Markey Cancer Center, College of Public Health, University of Kentucky, Lexington, KY, United States
| | - Sharon L Manne
- Rutgers Cancer Institute of New Jersey, Rutgers Robert Wood Johnson Medical School, Rutgers, The State University of New Jersey, New Brunswick, NJ, United States
| | - Sherry L Pagoto
- Institute for Collaboration on Health, Intervention and Policy, University of Connecticut, Storrs, CT, United States
| | - Allison Leip
- Department of Family Sciences, University of Kentucky, Lexington, KY, United States
| | - Kathryn Greene
- Department of Communication, Rutgers, The State University of New Jersey, New Brunswick, NJ, United States
| | - Joel J Hillhouse
- Department of Community and Behavioral Health, East Tennessee State University, Johnson City, TN, United States
| | - Allison S Merritt
- Markey Cancer Center, College of Public Health, University of Kentucky, Lexington, KY, United States
| | - Brent J Shelton
- Markey Cancer Center, College of Medicine, University of Kentucky, Lexington, KY, United States
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2
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Stockfleth E, Revol O. Encouraging sun protection early in life: from a successful prevention programme in children to the identification of psychological barriers in adolescents. J Eur Acad Dermatol Venereol 2022; 36 Suppl 6:12-21. [PMID: 35738808 DOI: 10.1111/jdv.18194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 04/26/2022] [Indexed: 11/26/2022]
Abstract
Children and adolescents have high rates of sunburn and high levels of ultraviolet radiation (UVR) exposure and are therefore at risk of developing skin cancer in later life. Minimizing UVR exposure in childhood and adolescence may be the most important component of skin cancer prevention efforts. Thus, age-adapted prevention campaigns, targeting children, adolescents and caregivers, are needed to change sun protection behaviour among individuals in these age groups. In the first part of this review, we describe the 'SunPass' programme, which was initiated in Germany in 2010 as the first nationwide educational intervention for sun safety designed to teach kindergarten children and their caregivers how to protect themselves from overexposure to the sun. Implemented in 55 kindergartens, this programme has been shown to be effective at improving sun protection behaviour (P < 0.001) and hat use (P = 0.029) among kindergarten children, as well as at improving shade practices and increasing demand for protective clothing (P < 0.001). Up to 40 000 children, 50 000 parents/grandparents and 2500 kindergarten caregivers took part in the SunPass programme in Germany from 2019 to June 2021. The programme has also been adapted and implemented in several other European countries and could be readily adapted for use elsewhere. In the second part of this review, we discuss the specific challenges faced by adolescents and consider how these issues may impact their sun protection behaviour. Adolescents have difficulties suppressing responses to reward-related cues and projecting themselves into the future. They also place a lot of importance on social acceptance and cosmetic appearance, and their higher risk of depression, addiction and impulsivity make them vulnerable to tanning addiction. These specificities need to be acknowledged by dermatologists, so they can adapt their therapeutic relationship and develop effective sun protection interventions for this generation.
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Affiliation(s)
- E Stockfleth
- Klinik für Dermatologie und Ruhr-Universität Bochum, Gudrunstrasse 52, Bochum, Germany
| | - O Revol
- Child Development Unit, Hospices Civils de Lyon, Bron, France
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3
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Kemény LV, Robinson KC, Hermann AL, Walker DM, Regan S, Yew YW, Lai YC, Theodosakis N, Rivera PD, Ding W, Yang L, Beyer T, Loh YHE, Lo JA, van der Sande AAJ, Sarnie W, Kotler D, Hsiao JJ, Su MY, Kato S, Kotler J, Bilbo SD, Chopra V, Salomon MP, Shen S, Hoon DSB, Asgari MM, Wakeman SE, Nestler EJ, Fisher DE. Vitamin D deficiency exacerbates UV/endorphin and opioid addiction. SCIENCE ADVANCES 2021; 7:7/24/eabe4577. [PMID: 34117054 PMCID: PMC8195487 DOI: 10.1126/sciadv.abe4577] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/23/2020] [Accepted: 04/26/2021] [Indexed: 06/12/2023]
Abstract
The current opioid epidemic warrants a better understanding of genetic and environmental factors that contribute to opioid addiction. Here we report an increased prevalence of vitamin D (VitD) deficiency in patients diagnosed with opioid use disorder and an inverse and dose-dependent association of VitD levels with self-reported opioid use. We used multiple pharmacologic approaches and genetic mouse models and found that deficiencies in VitD signaling amplify exogenous opioid responses that are normalized upon restoration of VitD signaling. Similarly, physiologic endogenous opioid analgesia and reward responses triggered by ultraviolet (UV) radiation are repressed by VitD signaling, suggesting that a feedback loop exists whereby VitD deficiency produces increased UV/endorphin-seeking behavior until VitD levels are restored by cutaneous VitD synthesis. This feedback may carry the evolutionary advantage of maximizing VitD synthesis. However, unlike UV exposure, exogenous opioid use is not followed by VitD synthesis (and its opioid suppressive effects), contributing to maladaptive addictive behavior.
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Affiliation(s)
- Lajos V Kemény
- Cutaneous Biology Research Center, Department of Dermatology and Cancer Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Kathleen C Robinson
- Cutaneous Biology Research Center, Department of Dermatology and Cancer Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Andrea L Hermann
- Cutaneous Biology Research Center, Department of Dermatology and Cancer Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Deena M Walker
- Nash Family Department of Neuroscience and Friedman Brain Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Susan Regan
- Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | | | - Yi Chun Lai
- Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Nicholas Theodosakis
- Cutaneous Biology Research Center, Department of Dermatology and Cancer Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Phillip D Rivera
- Program in Neuroscience, Harvard Medical School, Boston, MA, USA
- Department of Pediatrics, Lurie Center for Autism, Massachusetts General Hospital for Children, Boston, MA, USA
- Department of Biology, Hope College, Holland, MI, USA
| | - Weihua Ding
- MGH Center for Translational Pain Research, Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Liuyue Yang
- MGH Center for Translational Pain Research, Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Tobias Beyer
- Cutaneous Biology Research Center, Department of Dermatology and Cancer Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Yong-Hwee E Loh
- Nash Family Department of Neuroscience and Friedman Brain Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- USC Libraries Bioinformatics Services, University of Southern California, Los Angeles, CA, USA
| | - Jennifer A Lo
- Cutaneous Biology Research Center, Department of Dermatology and Cancer Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Anita A J van der Sande
- Cutaneous Biology Research Center, Department of Dermatology and Cancer Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - William Sarnie
- Cutaneous Biology Research Center, Department of Dermatology and Cancer Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - David Kotler
- Cutaneous Biology Research Center, Department of Dermatology and Cancer Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Jennifer J Hsiao
- Cutaneous Biology Research Center, Department of Dermatology and Cancer Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Mack Y Su
- Cutaneous Biology Research Center, Department of Dermatology and Cancer Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Shinichiro Kato
- Cutaneous Biology Research Center, Department of Dermatology and Cancer Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Joseph Kotler
- Cutaneous Biology Research Center, Department of Dermatology and Cancer Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Staci D Bilbo
- Program in Neuroscience, Harvard Medical School, Boston, MA, USA
- Department of Pediatrics, Lurie Center for Autism, Massachusetts General Hospital for Children, Boston, MA, USA
| | - Vanita Chopra
- Department of Neurology, Harvard Medical School, Massachusetts General Hospital, Charlestown, MA, USA
| | - Matthew P Salomon
- Department of Translational Molecular Medicine, Division of Molecular Oncology, John Wayne Cancer Institute at Providence Saint John's Health Center, Santa Monica, CA, USA
| | - Shiqian Shen
- MGH Center for Translational Pain Research, Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Dave S B Hoon
- Department of Translational Molecular Medicine, Division of Molecular Oncology, John Wayne Cancer Institute at Providence Saint John's Health Center, Santa Monica, CA, USA
| | - Maryam M Asgari
- Department of Dermatology, Massachusetts General Hospital and Department of Population Medicine, Harvard Medical School, Boston, MA, USA
| | - Sarah E Wakeman
- Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Eric J Nestler
- Nash Family Department of Neuroscience and Friedman Brain Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - David E Fisher
- Cutaneous Biology Research Center, Department of Dermatology and Cancer Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
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Stapleton JL, Ray AE, Glenn SD, McLouth LE, Parmar V, Manne SL. A randomized controlled trial of a web-based personalized feedback intervention targeting frequent indoor tanning bed users: Engagement, acceptability, and preliminary behavioral outcomes. J Health Psychol 2020; 27:923-935. [PMID: 33353412 DOI: 10.1177/1359105320982038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Frequent indoor tanning bed use is an established public health concern, yet research on tanning cessation interventions for frequent tanners is lacking. We describe the protocol for a brief, web-based tanning behavior change intervention and present evidence that it is acceptable and engaging to frequent indoor tanners. Lower tanning rates were not observed among participants receiving the intervention in a randomized controlled trial but participants' interest in changing tanning increased. This intervention could be a useful approach to increasing frequent tanners' interest in behavior change and openness to engaging within a more intensive, multi-component tanning cessation program.Trial Registration: NCT03448224 Clinical Trials.gov (https://clinicaltrials.gov/ct2/show/NCT03448224?cond=NCT03448224&draw=2&rank=1).
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Affiliation(s)
| | - Anne E Ray
- University of Kentucky College of Public Health, USA
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5
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Phan MN, Kohn J, Dao H. Skin cancer risk and tanning in pageant contestants. Proc (Bayl Univ Med Cent) 2020; 33:557-559. [DOI: 10.1080/08998280.2020.1775166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Affiliation(s)
- Mimi N. Phan
- College of Medicine, Texas A&M Health Science Center, Houston, Texas
| | - Jaden Kohn
- Department of Obstetrics and Gynecology, John Hopkins University School of Medicine, Baltimore, Maryland
| | - Harry Dao
- Department of Dermatology, Loma Linda University Health, Loma Linda, California
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Abstract
Sexual and gender minorities have unique risk factors that may increase their risk of developing skin cancer. In particular, sexual minority men report a higher prevalence of skin cancer (including both keratinocytes carcinomas and melanoma), higher rates of indoor tanning, and overall poorer sun protection behaviors. Sexual and gender minorities also have high rates of alcohol and tobacco use, and infection with human immunodeficiency virus and human papillomavirus, which may increase overall risk of developing skin cancer in these populations. In this review, we discuss the evidence surrounding skin cancer and associated risk factors among sexual and gender minorities.
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7
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Dermatology today and tomorrow: from symptom control to targeted therapy. J Eur Acad Dermatol Venereol 2018; 33 Suppl 1:3-36. [DOI: 10.1111/jdv.15335] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Accepted: 11/05/2018] [Indexed: 02/07/2023]
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8
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Iacopetta K, Collins-Praino LE, Buisman-Pijlman FTA, Hutchinson MR. Can neuroimmune mechanisms explain the link between ultraviolet light (UV) exposure and addictive behavior? Brain Behav Immun 2018; 73:125-132. [PMID: 30009997 DOI: 10.1016/j.bbi.2018.07.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Revised: 07/03/2018] [Accepted: 07/12/2018] [Indexed: 12/22/2022] Open
Abstract
High ultraviolet (UV) light exposure on the skin acts as a reinforcing stimulus, increasing sun-seeking behavior and even addiction-like sun seeking behavior. However, the physiological mechanisms that underlie this process remain to be defined. Here, we propose a novel hypothesis that neuroimmune signaling, arising from inflammatory responses in UV-damaged skin cells, causes potentiated signaling within the cortico-mesolimbic pathway, leading to increased sun-seeking behaviors. This hypothesized UV-induced, skin-to-brain signaling depends upon cell stress signals, termed alarmins, reaching the circulation, thereby triggering the activation of innate immune receptors, such as toll-like receptors (TLRs). This innate immune response is hypothesized to occur both peripherally and centrally, with the downstream signaling from TLR activation affecting both the endogenous opioid system and the mesolimbic dopamine pathway. As both neurotransmitter systems play a key role in the development of addiction behaviors through their actions at key brain regions, such as the nucleus accumbens (NAc), we hypothesize a novel connection between UV-induced inflammation and the activation of pathways that contribute to the development of addiction. This paper is a review of the existing literature to examine the evidence which suggests that chronic sun tanning resembles a behavioral addiction and proposes a novel pathway by which persistent sun-seeking behavior could affect brain neurochemistry in a manner similar to that of repeated drug use.
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Affiliation(s)
- Krystal Iacopetta
- Adelaide Centre for Neuroscience Research, Adelaide Medical School, University of Adelaide, SA, Australia
| | - Lyndsey E Collins-Praino
- Adelaide Centre for Neuroscience Research, Adelaide Medical School, University of Adelaide, SA, Australia
| | - Femke T A Buisman-Pijlman
- Adelaide Centre for Neuroscience Research, Adelaide Medical School, University of Adelaide, SA, Australia
| | - Mark R Hutchinson
- Adelaide Centre for Neuroscience Research, Adelaide Medical School, University of Adelaide, SA, Australia; Australian Research Council Centre of Excellence for Nanoscale BioPhotonics, University of Adelaide, Adelaide, SA, Australia.
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9
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Daniel CL, Hay JL, Welles BF, Geller AC. The urgent need to ban youth indoor tanning: evidence from college undergraduates. Transl Behav Med 2018; 7:645-647. [PMID: 28144835 DOI: 10.1007/s13142-017-0469-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Affiliation(s)
- Casey L Daniel
- Mitchell Cancer Institute, University of South Alabama, 1660 Springhill Avenue, Mobile, AL, 36604-1405, USA.
| | - Jennifer L Hay
- Department of Psychiatry & Behavioral Sciences, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | | | - Alan C Geller
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA
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11
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Andreassen C, Pallesen S, Torsheim T, Demetrovics Z, Griffiths M. Tanning addiction: conceptualization, assessment and correlates. Br J Dermatol 2018; 179:345-352. [DOI: 10.1111/bjd.16480] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/17/2018] [Indexed: 11/27/2022]
Affiliation(s)
| | - S. Pallesen
- Department of Psychosocial Science; University of Bergen; Bergen Norway
| | - T. Torsheim
- Department of Psychosocial Science; University of Bergen; Bergen Norway
| | - Z. Demetrovics
- Institute of Psychology; Eötvös Loránd University; Budapest Hungary
| | - M.D. Griffiths
- International Gaming Research Unit; Nottingham Trent University; Nottingham U.K
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12
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Prevalence of Tanning Addiction and Behavioral Health Conditions among Ethnically and Racially Diverse Adolescents. J Invest Dermatol 2018; 138:1511-1517. [PMID: 29481903 DOI: 10.1016/j.jid.2018.02.018] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2017] [Revised: 02/13/2018] [Accepted: 02/14/2018] [Indexed: 12/15/2022]
Abstract
Evidence indicates that tanning may be addictive and is associated with other behavioral health conditions. Few studies have examined tanning addiction among adolescents. We performed a cross-sectional study to explore the relationship between tanning addiction, substance use, and psychological conditions among a racially and ethnically diverse adolescent population. Tanning addiction was assessed using the modified CAGE measure among 11th grade students in Los Angeles (N = 2,637; response rate 78%). Overall, 7.02% of the sample met tanning addiction criteria. Tanning addiction was significantly associated with past 30-day smoking and marijuana use, problem substance use, depression, panic disorder, obsessive-compulsive disorder, and bipolar disorder in regression models. After controlling for all significant substance use and psychological variables, we found that problem marijuana use and obsessive-compulsive disorder remained significantly associated with tanning addiction (odds ratio = 2.06 [95% confidence interval = 1.03-4.09] and odds ratio = 2.54 [95% confidence interval = 1.73-3.72], respectively.) Tanning addiction was also significantly associated with multiple problem substance use and behavioral health conditions. Our findings indicate an appreciable prevalence of tanning addiction among ethnically and racially diverse adolescents and suggest the importance of addressing tanning addiction in the context of comorbid behavioral conditions to reduce this high-risk behavior among diverse youth.
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13
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Harth W. Überbraune Ästhetik. Hautarzt 2017; 68:968-972. [DOI: 10.1007/s00105-017-4052-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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14
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Nahar VK, Rosenthal M, Lemon SC, Kane K, Cheng J, Oleski JL, Li W, Hillhouse JJ, Pagoto SL. Youth access to indoor tanning salons in urban versus rural/suburban communities. PHOTODERMATOLOGY PHOTOIMMUNOLOGY & PHOTOMEDICINE 2017; 34:112-116. [PMID: 29080373 DOI: 10.1111/phpp.12364] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/18/2017] [Indexed: 11/29/2022]
Abstract
BACKGROUND/PURPOSE Research suggests that youth proximity to tanning salons may promote use; however, little is known about tanning salon proximity to schools. We assessed the proximity of tanning salons to schools in urban versus rural/suburban communities across Worcester County, Massachusetts (population > 800K). To put findings in context, we compared school proximity to tanning salons to school proximity to McDonald's restaurants, a large franchise that also caters to young people. MATERIALS & METHODS Accessibility was measured by ArcGIS 10.2 Network Analyzer (ESRI, Redlands, CA, USA) and the most current road network data layer from Massachusetts Department of Transportation (MassDOT). RESULTS A total of 145 schools were observed in the study area, of which about 39% of schools were within 1 mile from a tanning salon. Urban schools (53.41%) had a higher proportion within 1 mile of a tanning salon than rural/suburban schools (17.54%; P < .001). More schools (39.31%) were within 1 mile of a tanning salon than schools within 1 mile of a McDonald's (22.70%; P < .001). CONCLUSIONS Schools may be particularly impactful for implementing skin cancer prevention programing.
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Affiliation(s)
- Vinayak K Nahar
- Center for Animal and Human Health in Appalachia, College of Veterinary Medicine, DeBusk College of Osteopathic Medicine, and School of Mathematics and Sciences, Lincoln Memorial University, Harrogate, TN, USA.,Department of Dermatology, University of Mississippi Medical Center, Jackson, MS, USA
| | - Meagen Rosenthal
- Department of Pharmacy Administration, School of Pharmacy, University of Mississippi, Oxford, MS, USA
| | - Stephenie C Lemon
- Division of Preventive and Behavioral Medicine, Department of Medicine, University of Massachusetts Medical School, Worcester, MA, USA
| | - Kevin Kane
- Division of Preventive and Behavioral Medicine, Department of Medicine, University of Massachusetts Medical School, Worcester, MA, USA
| | - Jie Cheng
- Division of Preventive and Behavioral Medicine, Department of Medicine, University of Massachusetts Medical School, Worcester, MA, USA
| | - Jessica L Oleski
- Division of Preventive and Behavioral Medicine, Department of Medicine, University of Massachusetts Medical School, Worcester, MA, USA
| | - Wenjun Li
- Division of Preventive and Behavioral Medicine, Department of Medicine, University of Massachusetts Medical School, Worcester, MA, USA
| | - Joel J Hillhouse
- Department of Community and Behavioral Health, College of Public Health, East Tennessee State University, Johnson City, TN, USA
| | - Sherry L Pagoto
- Division of Preventive and Behavioral Medicine, Department of Medicine, University of Massachusetts Medical School, Worcester, MA, USA
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15
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Falzone AE, Brindis CD, Chren MM, Junn A, Pagoto S, Wehner M, Linos E. Teens, Tweets, and Tanning Beds: Rethinking the Use of Social Media for Skin Cancer Prevention. Am J Prev Med 2017; 53:S86-S94. [PMID: 28818251 PMCID: PMC5886032 DOI: 10.1016/j.amepre.2017.04.027] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2016] [Revised: 03/22/2017] [Accepted: 04/20/2017] [Indexed: 12/14/2022]
Abstract
The incidence of skin cancer is rising in the U.S., and melanoma, the deadliest form, is increasing disproportionately among young white women. Indoor tanning is a modifiable risk factor for all skin cancers and continues to be used at the highest rates in young white women. Adolescents and young adults report personal appearance-based reasons for using indoor tanning. Previous research has explored the influences on tanning bed use, including individual factors as well as relationships with peers, family, schools, media influences, legislation, and societal beauty norms. Adolescents and young adults also have high rates of social media usage, and research is emerging on how best to utilize these platforms for prevention. Social media has the potential to be a cost-effective way to reach large numbers of young people and target messages at characteristics of specific audiences. Recent prevention efforts have shown that comprehensive prevention campaigns that include technology and social media are promising in reducing rates of indoor tanning among young adults. This review examines the literature on psychosocial influences on indoor tanning among adolescents and young adults, and highlights ways in which technology and social media can be used for prevention efforts.
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Affiliation(s)
- Ashley E Falzone
- School of Medicine, the Program for Clinical Research, Department of Dermatology, University of California, San Francisco, San Francisco, California
| | - Claire D Brindis
- Philip R. Lee Institute for Health Policy Studies and the Adolescent and Young Adult Health National Resource Center at the University of California, San Francisco, San Francisco, California
| | - Mary-Margaret Chren
- School of Medicine, the Program for Clinical Research, Department of Dermatology, University of California, San Francisco, San Francisco, California; Dermatology Service, San Francisco Veterans Affairs Medical Center, San Francisco, California
| | - Alexandra Junn
- School of Medicine, the Program for Clinical Research, Department of Dermatology, University of California, San Francisco, San Francisco, California
| | - Sherry Pagoto
- Department of Medicine, University of Massachusetts Medical School, Worchester, Massachusetts
| | - Mackenzie Wehner
- Department of Dermatology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Eleni Linos
- School of Medicine, the Program for Clinical Research, Department of Dermatology, University of California, San Francisco, San Francisco, California.
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16
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Stapleton JL, Hillhouse J, Levonyan-Radloff K, Manne SL. Review of interventions to reduce ultraviolet tanning: Need for treatments targeting excessive tanning, an emerging addictive behavior. PSYCHOLOGY OF ADDICTIVE BEHAVIORS 2017. [PMID: 28639816 DOI: 10.1037/adb0000289] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Millions of Americans engage in tanning each year, defined as intentional ultraviolet radiation (UVR) exposure in the form of sunbathing or the use of indoor tanning beds. An emerging body of research suggests that UVR has addictive properties and some tanners engage in excessive tanning. This article provides an overview of the evidence of tanning addiction and a systematic review of existing tanning interventions with the goal of evaluating their potential to impact addicted tanners. Our search identified 24 intervention studies that were summarized and discussed according to 3 primary themes. First, there is a dearth of tanning interventions that target excessive tanning or are designed as treatments for tanning addiction. Second, tanning interventions are primarily educational interventions designed to increase knowledge of the risks of tanning. Third, there are notable aspects of existing tanning interventions that are relevant to addiction science, including the use of brief motivational and cognitive-behavioral-based interventions. Future directions are considered including recommendations for utilizing the existing evidence base to formulate interventions targeting excessive tanners. (PsycINFO Database Record
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Affiliation(s)
- Jerod L Stapleton
- Division of Population Sciences, Rutgers Cancer Institute of New Jersey
| | - Joel Hillhouse
- Department of Community and Behavioral Health, East Tennessee State University College of Public Health
| | | | - Sharon L Manne
- Division of Population Sciences, Rutgers Cancer Institute of New Jersey
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The Clinical Significance of Craving Across the Addictive Behaviors: a Review. CURRENT ADDICTION REPORTS 2017. [DOI: 10.1007/s40429-017-0138-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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18
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Bargeron AH, Hormes JM. Psychosocial correlates of internet gaming disorder: Psychopathology, life satisfaction, and impulsivity. COMPUTERS IN HUMAN BEHAVIOR 2017. [DOI: 10.1016/j.chb.2016.11.029] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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Aubert PM, Seibyl JP, Price JL, Harris TS, Filbey FM, Jacobe H, Devous MD, Adinoff B. Dopamine efflux in response to ultraviolet radiation in addicted sunbed users. Psychiatry Res 2016; 251:7-14. [PMID: 27085608 PMCID: PMC5241090 DOI: 10.1016/j.pscychresns.2016.04.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2015] [Revised: 04/03/2016] [Accepted: 04/05/2016] [Indexed: 01/21/2023]
Abstract
Compulsive tanning despite awareness of ultraviolet radiation (UVR) carcinogenicity may represent an "addictive" behavior. Many addictive disorders are associated with alterations in dopamine (D2/D3) receptor binding and dopamine reactivity in the brain's reward pathway. To determine if compulsive tanners exhibited neurobiologic responses similar to other addictive disorders, this study assessed basal striatal D2/D3 binding and UVR-induced striatal dopamine efflux in ten addicted and ten infrequent tanners. In a double-blind crossover trial, UVR or sham UVR was administered in separate sessions during brain imaging with single photon emission computerized tomography (SPECT). Basal D2/D3 receptor density and UVR-induced dopamine efflux in the caudate were assessed using (123)I-iodobenzamide ((123)I-IBZM) binding potential non-displaceable (BPnd). Basal BPnd did not significantly differ between addicted and infrequent tanners. Whereas neither UVR nor sham UVR induced significant changes in bilateral caudate BPnd in either group, post-hoc analyses revealed left caudate BPnd significantly decreased (reflecting increased dopamine efflux) in the addicted tanners - but not the infrequent tanners - during the UVR session only. Bilateral ∆BPnd correlated with tanning severity only in the addicted tanners. These preliminary findings are consistent with a stronger neural rewarding response to UVR in addicted tanners, supporting a cutaneous-neural connection driving excessive sunbed use.
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Affiliation(s)
- Pamela M Aubert
- Department of Dermatology, University of Texas Southwestern, Dallas, TX, USA
| | - John P Seibyl
- Institute for Neurodegenerative Disorders, Molecular Neuroimaging, LLC, and Yale University, New Haven, MA, USA
| | - Julianne L Price
- Department of Psychiatry, University of Texas Southwestern, Dallas, TX, USA
| | - Thomas S Harris
- Department of Neurology, University of Texas Southwestern, Dallas, TX, USA
| | | | - Heidi Jacobe
- Department of Dermatology, University of Texas Southwestern, Dallas, TX, USA
| | - Michael D Devous
- Department of Neurology, University of Texas Southwestern, Dallas, TX, USA; Avid Radiopharmaceuticals, Inc, Philadelphia, PA, USA
| | - Bryon Adinoff
- Department of Psychiatry, University of Texas Southwestern, Dallas, TX, USA; VA North Texas Health Care System, Dallas, TX, USA.
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Kelley DE, Noar SM, Myrick JG, Morales-Pico B, Zeitany A, Thomas NE. An Empirical Analysis of Indoor Tanners: Implications for Audience Segmentation in Campaigns. JOURNAL OF HEALTH COMMUNICATION 2016; 21:564-574. [PMID: 27115046 DOI: 10.1080/10810730.2015.1114051] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Tanning bed use before age 35 has been strongly associated with several types of skin cancer. The current study sought to advance an understanding of audience segmentation for indoor tanning among young women. Panhellenic sorority systems at two universities in the Southeastern United States participated in this study. A total of 1,481 young women took the survey; 421 (28%) had tanned indoors in the previous 12 months and were the focus of the analyses reported in this article. Results suggested two distinct tanner types: regular (n = 60) and irregular (n = 353) tanners. Regular tanners tanned more frequently (M = 36.2 vs. 8.6 times per year) and reported significantly higher positive outcome expectations (p < .001) and lower negative outcome expectations (p < .01) than irregular tanners, among other significant differences. Hierarchical logistic regression analysis revealed several significant (p < .001) predictors of regular tanning type, with tanning dependence emerging as the strongest predictor of this classification (OR = 2.25). Implications for developing anti-tanning messages directed at regular and irregular tanners are discussed.
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Affiliation(s)
- Dannielle E Kelley
- a School of Media and Journalism , University of North Carolina at Chapel Hill , Chapel Hill , North Carolina , USA
| | - Seth M Noar
- a School of Media and Journalism , University of North Carolina at Chapel Hill , Chapel Hill , North Carolina , USA
- b Lineberger Comprehensive Cancer Center , University of North Carolina at Chapel Hill , Chapel Hill , North Carolina , USA
| | | | - Brenda Morales-Pico
- d School of Medicine , University of North Carolina at Chapel Hill , Chapel Hill , North Carolina , USA
| | - Alexandra Zeitany
- d School of Medicine , University of North Carolina at Chapel Hill , Chapel Hill , North Carolina , USA
| | - Nancy E Thomas
- b Lineberger Comprehensive Cancer Center , University of North Carolina at Chapel Hill , Chapel Hill , North Carolina , USA
- d School of Medicine , University of North Carolina at Chapel Hill , Chapel Hill , North Carolina , USA
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Hillhouse J, Stapleton JL, Florence LC, Pagoto S. Prevalence and Correlates of Indoor Tanning in Nonsalon Locations Among a National Sample of Young Women. JAMA Dermatol 2015; 151:1134-6. [PMID: 26108092 PMCID: PMC5087140 DOI: 10.1001/jamadermatol.2015.1323] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Indoor tanning is a public health threat,1 and the Surgeon General has called for its reduction in adolescents and young adults.2 Research on indoor tanning has not distinguished between tanning-only salons vs other businesses and private residences that provide tanning (ie, nonsalon tanning). For example, gyms often offer free tanning, which may lead to riskier tanning habits.3 Better understanding of nonsalon tanning could have policy, prevention, and clinical implications. Our study addresses this literature gap by examining the prevalence and correlates of nonsalon tanning in a nationally representative sample of young women, who have the highest rates of indoor tanning use.
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Affiliation(s)
- Joel Hillhouse
- Department of Community and Behavioral Health, College of Public Health, East Tennessee State University, Johnson City
| | - Jerod L Stapleton
- Rutgers Cancer Institute of New Jersey, Rutgers, The State University of New Jersey, New Brunswick
| | - L Carter Florence
- Department of Community and Behavioral Health, College of Public Health, East Tennessee State University, Johnson City
| | - Sherry Pagoto
- Department of Medicine, University of Massachusetts Medical School, Worcester
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Friedman B, English JC, Ferris LK. Indoor Tanning, Skin Cancer and the Young Female Patient: A Review of the Literature. J Pediatr Adolesc Gynecol 2015; 28:275-83. [PMID: 26119073 DOI: 10.1016/j.jpag.2014.07.015] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2014] [Revised: 07/03/2014] [Accepted: 07/16/2014] [Indexed: 12/18/2022]
Abstract
Young, non-Hispanic white females represent the population most likely to use indoor tanning facilities. This population may be at increased risk of skin cancer as recent meta-analyses support a strong association between cutaneous malignancy and indoor tanning. Public perception of the purported health benefits of indoor tanning may be partially to blame for the popularity of tanning salons as a desire to prepare skin prior to sun exposure is among the most commonly cited motivations for indoor tanning. Improving education and counseling to address misconceptions regarding tanning safety will require the participation of healthcare providers for both physical and psychological screenings as well as for information dissemination. This review presents the association between tanning bed use and skin cancer, biological effects of UV radiation exposure, UV burden associated with tanning devices, public perception of tanning, demographic and psychological profile of indoor tanners, and current legislation regulating tanning bed use.
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Affiliation(s)
- Blake Friedman
- Department of Dermatology, University of Pittsburgh, Pittsburgh, PA
| | - Joseph C English
- Department of Dermatology, University of Pittsburgh, Pittsburgh, PA.
| | - Laura K Ferris
- Department of Dermatology, University of Pittsburgh, Pittsburgh, PA
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Heckman CJ, Munshi T, Darlow S, Kloss JD, Manne SL, Perlis C, Oslin D. The association of tanning behavior with psycho-tropic medication use among young adult women. PSYCHOL HEALTH MED 2015; 21:60-6. [PMID: 26068581 DOI: 10.1080/13548506.2015.1051060] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Despite its known association with skin cancer, tanning remains popular among young adult women. Indoor tanning behavior has been found to be associated with affective and addictive disorders. To better understand potential psychological and biological mechanisms of tanning behavior, we investigated associations between tanning and medication (psychotropic and other) use among young women. Two hundred and fifty-three women age 18-29 years old were recruited from two northeastern university campus communities. Women self-reported tanning frequency and chronic medication use. In both univariate and multivariate analyses, indoor tanning ≥12 times last year was significantly associated with use of psychotropic medication and anti-depressants in particular. Sunbathing was not associated with medication use. Potential reasons for associations between tanning and psychotropic medication use are discussed. Indoor tanners should be warned that some psychotropic medications are photosensitizing, thus increasing risk for burns and other skin damage from indoor tanning.
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Affiliation(s)
- Carolyn J Heckman
- a Cancer Prevention and Control Program , Fox Chase Cancer Center , Philadelphia , PA , USA
| | - Teja Munshi
- a Cancer Prevention and Control Program , Fox Chase Cancer Center , Philadelphia , PA , USA
| | - Susan Darlow
- a Cancer Prevention and Control Program , Fox Chase Cancer Center , Philadelphia , PA , USA
| | - Jacqueline D Kloss
- b Department of Psychology , Drexel University , 3141 Chestnut St, Philadelphia , PA 19104 , USA
| | - Sharon L Manne
- c Cancer Prevention and Control Program , Rutgers Cancer Institute of New Jersey , New Brunswick , NJ , USA
| | - Clifford Perlis
- d Department of Dermatology , Fox Chase Cancer Center , Philadelphia , PA , USA
| | - David Oslin
- e Department of Psychiatry , University of Pennsylvania School of Medicine , Philadelphia , PA , USA
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Reed DD. Ultra-violet indoor tanning addiction: a reinforcer pathology interpretation. Addict Behav 2015; 41:247-51. [PMID: 25452072 DOI: 10.1016/j.addbeh.2014.10.026] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2014] [Revised: 09/23/2014] [Accepted: 10/24/2014] [Indexed: 10/24/2022]
Abstract
Ultra-violet indoor tanning (UVIT) is a pervasive issue that is increasing at record rates, despite obvious and well-publicized links to skin cancer. Recent studies on UVIT have found that frequent users face difficulty quitting and report symptomatology similar to substance-related disorders, causing the medical field to begin classifying excessive UVIT use as an addicting behavior. Despite calls for research, relatively little behavioral research has been aimed at determining the psychology of UVIT. This mini-review reinterprets the existing dermatology literature in light of the reinforcer pathology model of addiction. The relevancy of this model, in conjunction with the similarities between UVIT addiction and other substance-related addiction, suggests that behavioral economic research on UVIT is overdue. This mini-review concludes with directions for future research in this area.
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Hormes JM, Kearns B, Timko CA. Craving Facebook? Behavioral addiction to online social networking and its association with emotion regulation deficits. Addiction 2014; 109:2079-88. [PMID: 25170590 DOI: 10.1111/add.12713] [Citation(s) in RCA: 172] [Impact Index Per Article: 17.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2013] [Revised: 03/03/2014] [Accepted: 08/14/2014] [Indexed: 12/22/2022]
Abstract
AIMS To assess disordered online social networking use via modified diagnostic criteria for substance dependence, and to examine its association with difficulties with emotion regulation and substance use. DESIGN Cross-sectional survey study targeting undergraduate students. Associations between disordered online social networking use, internet addiction, deficits in emotion regulation and alcohol use problems were examined using univariate and multivariate analyses of covariance. SETTING A large University in the Northeastern United States. PARTICIPANTS Undergraduate students (n = 253, 62.8% female, 60.9% white, age mean = 19.68, standard deviation = 2.85), largely representative of the target population. The response rate was 100%. MEASUREMENTS Disordered online social networking use, determined via modified measures of alcohol abuse and dependence, including DSM-IV-TR diagnostic criteria for alcohol dependence, the Penn Alcohol Craving Scale and the Cut-down, Annoyed, Guilt, Eye-opener (CAGE) screen, along with the Young Internet Addiction Test, Alcohol Use Disorders Identification Test, Acceptance and Action Questionnaire-II, White Bear Suppression Inventory and Difficulties in Emotion Regulation Scale. FINDINGS Disordered online social networking use was present in 9.7% [n = 23; 95% confidence interval (5.9, 13.4)] of the sample surveyed, and significantly and positively associated with scores on the Young Internet Addiction Test (P < 0.001), greater difficulties with emotion regulation (P = 0.003) and problem drinking (P = 0.03). CONCLUSIONS The use of online social networking sites is potentially addictive. Modified measures of substance abuse and dependence are suitable in assessing disordered online social networking use. Disordered online social networking use seems to arise as part of a cluster of symptoms of poor emotion regulation skills and heightened susceptibility to both substance and non-substance addiction.
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Affiliation(s)
- Julia M Hormes
- Department of Psychology, University at Albany, State University of New York, Albany, NY, USA
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26
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Skin β-endorphin mediates addiction to UV light. Cell 2014; 157:1527-34. [PMID: 24949966 DOI: 10.1016/j.cell.2014.04.032] [Citation(s) in RCA: 165] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2012] [Revised: 02/12/2014] [Accepted: 04/03/2014] [Indexed: 01/29/2023]
Abstract
UV light is an established carcinogen, yet evidence suggests that UV-seeking behavior has addictive features. Following UV exposure, epidermal keratinocytes synthesize proopiomelanocortin (POMC) that is processed to melanocyte-stimulating hormone, inducing tanning. We show that, in rodents, another POMC-derived peptide, β-endorphin, is coordinately synthesized in skin, elevating plasma levels after low-dose UV. Increases in pain-related thresholds are observed and reversed by pharmacologic opioid antagonism. Opioid blockade also elicits withdrawal signs after chronic UV exposure. This effect was sufficient to guide operant behavioral choices to avoidance of opioid withdrawal (conditioned place aversion). These UV-induced nociceptive and behavioral effects were absent in β-endorphin knockout mice and in mice lacking p53-mediated POMC induction in epidermal keratinocytes. Although primordial UV addiction, mediated by the hedonic action of β-endorphin and anhedonic effects of withdrawal, may theoretically have enhanced evolutionary vitamin D biosynthesis, it now may contribute to the relentless rise in skin cancer incidence in humans.
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Ashrafioun L, Bonar EE. Psychometric assessment of the craving to tan questionnaire. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2014; 41:74-81. [PMID: 25140759 DOI: 10.3109/00952990.2014.939754] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Researchers and clinicians suggest that excessive tanning may be a behavioral addiction. Given the significance of craving in substance use, craving may be a useful construct to assess in those who tan. OBJECTIVE We designed this study to assess the psychometric properties of an alcohol craving measure adapted to measure past-week craving to tan. METHODS Undergraduate students (n = 421) who reported past-month tanning completed a battery of questionnaires that assessed demographics, tanning-related characteristics, and psychopathology, in addition to the Craving to Tan Questionnaire (CTQ). RESULTS Analyses provided support for a single factor CTQ with good internal consistency, construct validity and convergent validity. CTQ scores were significantly higher among problematic versus non-problematic and dependent versus non-dependent tanners. CTQ scores were also associated with several tanning-related characteristics, such money spent on tanning in a typical month, frequency of tanning, and frequency of tanning-related problems. Additional analyses found that past-week craving to tan was significantly associated with greater obsessive compulsive and body dysmorphic symptoms. CONCLUSIONS It may be useful in clinical settings to identify those experiencing problems with tanning and in research to further clarify the conceptualization of addiction-like tanning. However, the CTQ needs further evaluation.
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Affiliation(s)
- Lisham Ashrafioun
- Department of Psychology, Bowling Green State University , Bowling Green, OH
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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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Petit A, Karila L, Lejoyeux M. Quel cadre nosographique pour le bronzage excessif ? Encephale 2014; 40:174-9. [DOI: 10.1016/j.encep.2013.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2012] [Accepted: 03/04/2013] [Indexed: 10/26/2022]
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Pagoto S, Hillhouse J, Heckman CJ, Coups EJ, Stapleton J, Buller D, Turrisi R, Robinson J, Geller AC. Society of Behavioral Medicine (SBM) position statement: ban indoor tanning for minors. Transl Behav Med 2014; 4:124-6. [PMID: 24653783 DOI: 10.1007/s13142-013-0240-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
The Society of Behavioral Medicine (SBM), an interdisciplinary professional organization focused on the science of health behavior joins the American Academy of Dermatology, the American Academy of Pediatrics, and a host of other national and international organizations in support of a total ban on indoor tanning for minors under the age of 18. According to the International Agency for Research on Cancer, artificial sources of ultraviolet radiation are in the highest category of carcinogens, joining tobacco and asbestos. Strong evidence links indoor tanning to increased risk for melanoma with repeated exposure during childhood being associated with the greatest increase in risk. Several countries and five US states have passed legislation banning indoor tanning in minors. We strongly encourage the remaining US states to do the same in an effort to protect children and prevent new cases of melanoma. SBM also strongly encourages research that explores the use of tanning beds in the home. Home-based indoor tanning has the potential to be especially dangerous given the complete absence of safety regulations. Children are currently protected from exposure to health-harming substances like tobacco and lead; thus, legislation protecting them from artificial sources of ultraviolet radiation is yet another important step forward in improving public health.
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Affiliation(s)
- Sherry Pagoto
- University of Massachusetts Medical School, Worcester, MA USA
| | | | | | - Elliot J Coups
- University of Medicine and Dentistry New Jersey, New Brunswick, NJ USA
| | - Jerod Stapleton
- University of Medicine and Dentistry New Jersey, New Brunswick, NJ USA
| | | | - Rob Turrisi
- Penn State University, University Park, PA USA
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Petit A, Karila L, Chalmin F, Lejoyeux M. Phenomenology and psychopathology of excessive indoor tanning. Int J Dermatol 2014; 53:664-72. [PMID: 24601904 DOI: 10.1111/ijd.12336] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Excessive indoor tanning, defined by the presence of an impulse towards and repetition of tanning that leads to personal distress, has only recently been recognized as a psychiatric disorder. This finding is based on the observations of many dermatologists who report the presence of addictive relationships with tanning salons among their patients despite being given diagnoses of malignant melanoma. This article synthesizes the existing literature on excessive indoor tanning and addiction to investigate possible associations. This review focuses on the prevalence, clinical features, etiology, and treatment of this disorder. A literature review was conducted, using PubMed, Google Scholar, EMBASE and PsycINFO, to identify articles published in English from 1974 to 2013. Excessive indoor tanning may be related to addiction, obsessive-compulsive disorder, impulse control disorder, seasonal affective disorder, anorexia, body dysmorphic disorder, or depression. Excessive indoor tanning can be included in the spectrum of addictive behavior because it has clinical characteristics in common with those of classic addictive disorders. It is frequently associated with anxiety, eating disorders, and tobacco dependence. Further controlled studies are required, especially in clinical psychopathology and neurobiology, to improve our understanding of excessive indoor tanning.
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Affiliation(s)
- Aymeric Petit
- Department of Psychiatry and Addiction Medicine, Bichat-Claude Bernard Hospital, Assistance Publique Hôpitaux de Paris (AP-HP), Paris, France
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Slominski AT, Zmijewski MA, Zbytek B, Tobin DJ, Theoharides TC, Rivier J. Key role of CRF in the skin stress response system. Endocr Rev 2013; 34:827-84. [PMID: 23939821 PMCID: PMC3857130 DOI: 10.1210/er.2012-1092] [Citation(s) in RCA: 282] [Impact Index Per Article: 25.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2012] [Accepted: 08/02/2013] [Indexed: 02/08/2023]
Abstract
The discovery of corticotropin-releasing factor (CRF) or CRH defining the upper regulatory arm of the hypothalamic-pituitary-adrenal (HPA) axis, along with the identification of the corresponding receptors (CRFRs 1 and 2), represents a milestone in our understanding of central mechanisms regulating body and local homeostasis. We focused on the CRF-led signaling systems in the skin and offer a model for regulation of peripheral homeostasis based on the interaction of CRF and the structurally related urocortins with corresponding receptors and the resulting direct or indirect phenotypic effects that include regulation of epidermal barrier function, skin immune, pigmentary, adnexal, and dermal functions necessary to maintain local and systemic homeostasis. The regulatory modes of action include the classical CRF-led cutaneous equivalent of the central HPA axis, the expression and function of CRF and related peptides, and the stimulation of pro-opiomelanocortin peptides or cytokines. The key regulatory role is assigned to the CRFR-1α receptor, with other isoforms having modulatory effects. CRF can be released from sensory nerves and immune cells in response to emotional and environmental stressors. The expression sequence of peptides includes urocortin/CRF→pro-opiomelanocortin→ACTH, MSH, and β-endorphin. Expression of these peptides and of CRFR-1α is environmentally regulated, and their dysfunction can lead to skin and systemic diseases. Environmentally stressed skin can activate both the central and local HPA axis through either sensory nerves or humoral factors to turn on homeostatic responses counteracting cutaneous and systemic environmental damage. CRF and CRFR-1 may constitute novel targets through the use of specific agonists or antagonists, especially for therapy of skin diseases that worsen with stress, such as atopic dermatitis and psoriasis.
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Affiliation(s)
- Andrzej T Slominski
- MD, PhD, Department of Pathology and Laboratory Medicine, University of Tennessee Health Science Center; 930 Madison Avenue, Suite 500, Memphis, Tennessee 38163.
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33
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Holman DM, Watson M. Correlates of intentional tanning among adolescents in the United States: a systematic review of the literature. J Adolesc Health 2013; 52:S52-9. [PMID: 23601612 PMCID: PMC4538996 DOI: 10.1016/j.jadohealth.2012.09.021] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2012] [Revised: 09/13/2012] [Accepted: 09/18/2012] [Indexed: 12/16/2022]
Abstract
PURPOSE Exposure to ultraviolet radiation and a history of sunburn in childhood contribute to risk of skin cancer in adolescence and in adulthood, but many adolescents continue to seek a tan, either from the sun or from tanning beds (i.e., intentional tanning). To understand tanning behavior among adolescents, we conducted a systematic review of the literature to identify correlates of intentional tanning in the United States. METHODS We included articles on original research published in English between January 1, 2001, and October 31, 2011, that used self-reported data on intentional tanning by U.S. adolescents aged 8 to 18 years and examined potential correlates of tanning behaviors. Thirteen articles met our criteria; all used cross-sectional survey data and quantitative methods to assess correlates of intentional tanning. RESULTS Results indicate that multiple factors influence tanning among adolescents. Individual factors that correlated with intentional tanning include demographic factors (female sex, older age), attitudes (preferring tanned skin), and behaviors (participating in other risky or appearance-focused behaviors such as dieting). Social factors correlated with intentional tanning include parental influence (having a parent who tans or permits tanning) and peer influence (having friends who tan). Only four studies examined broad contextual factors such as indoor tanning laws and geographic characteristics; they found that proximity to tanning facilities and geographic characteristics (living in the Midwest or South, living in a low ultraviolet area, and attending a rural high school) are associated with intentional tanning. CONCLUSIONS These findings inform future public health research and intervention efforts to reduce intentional tanning.
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Affiliation(s)
- Dawn M Holman
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia 30341, USA.
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Heckman CJ, Cohen-Filipic J, Darlow S, Kloss JD, Manne SL, Munshi T. Psychiatric and addictive symptoms of young adult female indoor tanners. Am J Health Promot 2013; 28:168-74. [PMID: 23621780 DOI: 10.4278/ajhp.120912-quan-442] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
PURPOSE Indoor tanning (IT) increases risk for melanoma and is particularly common among young adult women. IT has also been linked with some psychiatric symptoms, and frequent tanning may indicate tanning dependence (addiction) associated with endorphin release during ultraviolet radiation exposure. The objective of the current study was to investigate associations between IT, tanning dependence, and psychiatric and substance use symptoms in young adult women. DESIGN Cross-sectional survey and psychiatric interview. SETTING Online, except for the Mini International Neuropsychiatric Interview (MINI), which was completed over the telephone. SUBJECTS Participants were 306 female university students aged 18 to 25 years. MEASURES MINI, Seasonal Scale Index, tanning dependence scales, reporting ever having used a tanning bed or booth with tanning lamps (single item), reporting smoking a cigarette in the last 30 days (single item). ANALYSIS Descriptive statistics, χ(2) analysis, multivariate logistic regression. RESULTS Forty-six percent of the sample reported a history of IT, and 25% were classified as tanning dependent. Multivariate logistic regression analyses showed that IT was significantly associated with symptoms of alcohol use disorders, generalized anxiety, and not having social anxiety. Tanning dependence was associated with symptoms of alcohol use disorders. CONCLUSION Tanning is of concern not only for its association with skin cancer but for its association with psychiatric and substance use symptoms. Young women with certain psychological problems may seek relief from their symptoms by IT. These findings suggest that indoor tanners may benefit from health behavior and other psychosocial interventions.
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Abstract
Skin cancer is a major public health concern, and tanning remains a modifiable risk factor. Multidimensional influences, including psychosocial, individual, environmental, and policy-related factors, create the milieu for individuals to engage in tanning. Parents and physicians can modify the behavior of teens and young adults using strategies based on harm reduction. Environmental and policy-related factors similar to those used to limit smoking by restricting access of minors to cigarettes in the United States in the 20th century need to be created. Federal regulations can restrict direct advertising and the excise tax can be increased to a prohibitive amount. Social networking may assist with affect regulation.
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Affiliation(s)
- June K Robinson
- Department of Dermatology, Northwestern University Feinberg School of Medicine, 676 North St Clair Street, Chicago, IL 60611, USA.
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Enquête sur l’exposition aux rayons ultraviolets parmi le personnel de quatre hôpitaux bruxellois. Ann Dermatol Venereol 2012; 139:91-102. [DOI: 10.1016/j.annder.2011.10.412] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2011] [Revised: 08/08/2011] [Accepted: 10/26/2011] [Indexed: 11/17/2022]
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Lim HW, James WD, Rigel DS, Maloney ME, Spencer JM, Bhushan R. Adverse effects of ultraviolet radiation from the use of indoor tanning equipment: time to ban the tan. J Am Acad Dermatol 2011; 64:893-902. [PMID: 21496701 DOI: 10.1016/j.jaad.2011.03.007] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/21/2010] [Indexed: 12/13/2022]
Abstract
The incidence of melanoma skin cancer is increasing rapidly, particularly among young women in the United States. Numerous studies have documented an association between the use of indoor tanning devices and an increased risk of skin cancer, especially in young women. Studies have shown that ultraviolet exposure, even in the absence of erythema or burn, results in DNA damage. Countries and regulatory bodies worldwide have recognized the health risks associated with indoor tanning. In the United States, 32 states have passed legislation to regulate the indoor tanning industry, but there is an urgent need to restrict the use of indoor tanning devices at the federal level. The Food and Drug Administration is currently reviewing the classification of these devices. For all of these reasons, the Food and Drug Administration should prohibit the use of tanning devices by minors and reclassify tanning devices to at least class II to protect the public from the preventable cancers and other adverse effects caused by ultraviolet radiation from indoor tanning.
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Affiliation(s)
- Henry W Lim
- Department of Dermatology, Henry Ford Hospital, Detroit, Michigan, USA
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Adverse effects of ultraviolet radiation from the use of indoor tanning equipment: Time to ban the tan. J Am Acad Dermatol 2011; 64:e51-60. [DOI: 10.1016/j.jaad.2010.11.032] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2010] [Revised: 11/02/2010] [Accepted: 11/21/2010] [Indexed: 01/08/2023]
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Kourosh AS, Harrington CR, Adinoff B. Tanning as a behavioral addiction. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2010; 36:284-90. [PMID: 20545604 DOI: 10.3109/00952990.2010.491883] [Citation(s) in RCA: 109] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Persistent tanning despite potentially fatal consequences suggests a compulsive behavior similar to other addictive disorders. OBJECTIVES To review the literature supporting tanning addiction from an epidemiological, behavioral, and neurobiological perspective. METHODS A comprehensive review of the medical literature was conducted to assess the health consequences of tanning, behaviors and other psychiatric disorders associated with tanning, and central rewarding effects of ultraviolet light. RESULTS Many frequent tanners endorse signs and symptoms adapted from Diagnostic and Statistical Manual-IV (DSM IV) substance abuse or dependence criteria. Recent studies suggest biochemical mechanisms may reinforce ultraviolet light seeking behavior. CONCLUSIONS AND SCIENTIFIC SIGNIFICANCE Frequent and persistent tanning may reveal itself to be a dermatologic-psychiatric disorder with carcinogenic sequelae. Multidisciplinary studies are required to determine the validity of an addiction diagnosis and to explore pharmacologic and cognitive therapeutic options for affected persons.
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A comparison of the efficacy of an appearance-focused skin cancer intervention within indoor tanner subgroups identified by latent profile analysis. J Behav Med 2010; 33:181-90. [PMID: 20058183 DOI: 10.1007/s10865-009-9246-z] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2009] [Accepted: 12/27/2009] [Indexed: 10/20/2022]
Abstract
The reduction of intentional exposure to ultraviolet (UV) radiation is an important area of skin cancer prevention. Hillhouse et al. (Cancer 113:3257-3266, 2008) have developed an appearance-focused intervention with evidence of efficacy in lowering indoor tanning UV exposure in young women. In the current study, a subgroup approach was used to determine moderators of intervention efficacy. Undergraduate females in two regions of the United States (n = 362) were randomized into an intervention or control condition. Latent profile analysis was used to identify subgroups of indoor tanners based on patterns of indoor tanning motives. Intervention efficacy was examined within each subgroup. We found evidence for 4 subgroups of tanners: knowledgeable-appearance tanners, low-knowledge tanners, low-knowledge, relaxation tanners, and knowledgeable, low-appearance and low-relaxation tanners. The intervention significantly reduced indoor tanning for the low-knowledge subgroup (34% of the sample). The utility of the subgroup approach in developing targeted behavioral skin cancer interventions is discussed.
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Woo DK, Eide MJ. Tanning beds, skin cancer, and vitamin D: an examination of the scientific evidence and public health implications. Dermatol Ther 2010; 23:61-71. [DOI: 10.1111/j.1529-8019.2009.01291.x] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Schneider S, Krämer H. Who uses sunbeds? A systematic literature review of risk groups in developed countries. J Eur Acad Dermatol Venereol 2009; 24:639-48. [PMID: 20015180 DOI: 10.1111/j.1468-3083.2009.03509.x] [Citation(s) in RCA: 65] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Skin cancer is caused by ultraviolet radiation (UVR). Indoor tanning is a totally avoidable risk behaviour. This review addresses the specific characteristics of sunbed users and the differences in motivation and risk perception compared with non-users. This review is based solely on empirical original articles. Based on literature searches with widely used reference databases ('PubMed', 'OVID', 'Social Citation Index', 'ERIC--Educational Resources Information Center', 'Web of Science' and the 'International Bibliography of the Social Sciences'), we included studies from developed nations with a publication date between 1 January 2000 and 12 August 2008. All studies were selected, classified and coded simultaneously by both authors on a blinded basis. All searches were performed on 13 and 14 August 2008. In accordance with the QUOROM and the MOOSE Statements, we identified 16 original studies. The typical sunbed user is female, between 17 and 30 years old, and tends to live a comparatively unhealthy lifestyle: Users smoke cigarettes and drink alcohol more frequently and eat less healthy food than non-users. Users are characterized by a lack of knowledge about health risks of UVR, and prompted by the frequent use of sunbeds by friends or family members and the experience of positive emotions and relaxation by indoor tanning. This review is the first systematic review on risk groups among sunbed users that has been published in a scientific journal. There is still a lack of information among users, particularly among young people regarding the safety of solariums.
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Affiliation(s)
- S Schneider
- Mannheim Institute of Public Health, Social and Preventive Medicine, Mannheim Medical Faculty, Heidelberg University, Heidelberg, Germany.
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Abstract
PURPOSE OF REVIEW Skin cancer incidence is higher than that of any other human malignancy, and yet one of its root causes [ultraviolet (UV) radiation] is perhaps better understood than any other human carcinogen. The roles of UV radiation exposure and indoor tanning behaviors on skin cancer risk are explored here. RECENT FINDINGS Studies from the past several years have shown a significant association between ever-use of an indoor tanning facility and an increased risk of basal cell carcinoma, squamous cell carcinoma, and melanoma. The association between indoor tanning and skin cancer is particularly strong among those who first used a tanning facility in early adulthood. Elevated vitamin D levels have been suggested to protect against various internal malignancies and other disease states, but sources of vitamin D that do not require UV exposure are easily available. SUMMARY Although additional research is needed to understand fully the relationship between UV and skin cancer, it is already clear that indoor tanning bed use represents an avoidable risk factor for melanoma and nonmelanoma skin cancer - both of which may be lethal. Acting upon this information provides a unique opportunity for protecting the public health.
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Abstract
Behavioral studies of ultraviolet light exposure behavior have provided insight into motivations for tanning, which include not only the desire for a tanned appearance but also the physiologic response to ultraviolet light. Many frequent tanners continue to tan despite knowledge or personal experience of adverse consequences. Efforts to reduce tanning behavior need to account for the interplay between physiologic effects of tanning and psychosocial drives behind tanning behavior.
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Affiliation(s)
- Bridgit V Nolan
- SUNY Upstate Medical University, Weiskotten Hall, 766 Irving Avenue, Syracuse, NY 13210, USA
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Sivamani RK, Crane LA, Dellavalle RP. The benefits and risks of ultraviolet tanning and its alternatives: the role of prudent sun exposure. Dermatol Clin 2009; 27:149-54, vi. [PMID: 19254658 DOI: 10.1016/j.det.2008.11.008] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Sunlight- and indoor ultraviolet (UV)-induced tanning is a common behavior, especially among adolescents, young adults, and individuals who have lighter skin. Excessive sun exposure is associated with several health risks, including the acceleration of skin aging and the promotion of skin cancers. Several health benefits of UV exposure include vitamin D production and improved mood. This article analyzes these health risks and benefits and discusses pertinent issues surrounding indoor tanning, the role of sunless tanning products, and prudent sun exposure.
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Affiliation(s)
- Raja K Sivamani
- University of California, Davis, School of Medicine, 4610 X Street, Sacramento, CA 95817, USA
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Abstract
BACKGROUND The World Health Organization recommends that tanning parlors not be used by individuals under age 18 years. The impact of self-tanners on tanning parlor and sunscreen use by Canadian teens is unknown. OBJECTIVE To determine teens' use of, knowledge of, attitudes toward, and behavior regarding tanning parlors, self-tanning products, and sunscreen. METHODS Self-report questionnaire of grade 10 students in Thames Valley district, Ontario. RESULTS Indoor tanning parlors were used by 14%, self-tanners by 28%, and sunscreen daily or most days by 36%. Use was more common in females. There was a strong association between parental and child use of tanning parlors and use of self-tanners. Sixty-two percent believe that self-tanners give adequate photoprotection. CONCLUSIONS Further education is required to address teen tanning parlor use, infrequent sunscreen use, and lack of knowledge about the safety of tanning parlors and self-tanning products.
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Affiliation(s)
- Danielle Gordon
- Department of Medicine, Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON.
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The benefits and risks of ultraviolet tanning and its alternatives: the role of prudent sun exposure. Dermatol Clin 2009. [PMID: 19254658 DOI: 10.1016/j.det.2008.11.008.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Sunlight- and indoor ultraviolet (UV)-induced tanning is a common behavior, especially among adolescents, young adults, and individuals who have lighter skin. Excessive sun exposure is associated with several health risks, including the acceleration of skin aging and the promotion of skin cancers. Several health benefits of UV exposure include vitamin D production and improved mood. This article analyzes these health risks and benefits and discusses pertinent issues surrounding indoor tanning, the role of sunless tanning products, and prudent sun exposure.
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Abstract
OBJECTIVES To investigate possible predictors of tanning dependence including demographic variables, exposure and protective behaviors, and other health-related behaviors. METHODS This study consisted of an online survey of 400 students and other volunteers from a university community. RESULTS Twenty-seven percent of the sample was classified as tanning dependent. Tanning dependence was predicted by ethnicity and skin type, indoor and outdoor tanning and burning, and lower skin protective behaviors, as well as smoking and body mass index. CONCLUSIONS Young adults are at risk for tanning dependence, which can be predicted by specific demographic and behavioral variables.
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Pagoto SL, Hillhouse J. Not all tanners are created equal: implications of tanning subtypes for skin cancer prevention. ACTA ACUST UNITED AC 2009; 144:1505-8. [PMID: 19015427 DOI: 10.1001/archderm.144.11.1505] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Heckman CJ, Coups EJ, Manne SL. Prevalence and correlates of indoor tanning among US adults. J Am Acad Dermatol 2008; 58:769-80. [PMID: 18328594 PMCID: PMC2601681 DOI: 10.1016/j.jaad.2008.01.020] [Citation(s) in RCA: 94] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2007] [Revised: 01/16/2008] [Accepted: 01/25/2008] [Indexed: 01/14/2023]
Abstract
BACKGROUND Little is known about the prevalence of indoor tanning among the US general adult population. OBJECTIVES This study sought to: (1) describe the prevalence of indoor tanning throughout adulthood; (2) identify demographic and psychosocial correlates of indoor tanning; and (3) determine whether these correlates vary by age group. METHODS This study used data from the 2005 National Health Interview Survey, an annual health survey of the US adult population. RESULTS Indoor tanning rates were higher among individuals who were young, white, and female. Rates of indoor tanning in the last year varied from 20.4% for those aged 18 to 29 years to 7.8% for those aged 65 years and older. A variety of demographic, health, and behavioral health risk factors correlated with indoor tanning. LIMITATIONS The study design was cross-sectional and all data were self-reported. CONCLUSIONS Health care providers should address indoor tanning as a health risk factor across the lifespan.
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Affiliation(s)
- Carolyn J Heckman
- Division of Population Science, Fox Chase Cancer Center, Philadelphia, Pennsylvania, USA.
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