UV light abuse and high-risk tanning behavior among undergraduate college students

A Social Media-Delivered Melanoma Prevention Program for Young Women Engaged in Frequent UV Tanning: Protocol for a Randomized Controlled Trial

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.

Association of sun-seeking behaviors with indoor tanning habit in US females

Background

Frequent exposure to ultraviolet light in early life has more detrimental and long-term effects on skin than in adulthood. Teenagers with strong sun-seeking behaviors may be more likely to use an indoor tanning bed than those who seek less sun, probably due to addictiveness of ultraviolet exposure. We aimed to examine associations between sun exposure behaviors and average annual indoor tanning usage frequency during high school/college in US females.

Methods

In this cross-sectional study, we used data from The Nurses' Health Study II, a large prospective cohort of US female nurses. We included a total of 81,746 white females who answered the average annual frequency of indoor tanning during high school/college. Our study exposures were average weekly time spent outdoors in a swimsuit and average percentage of time of wearing sunscreen at the pool or beach during their teenage years, average weekly hours spent outdoors in direct sunlight in daytime during high school/college, and the number of severe sunburns which blistered between ages 15-20. Main outcomes was average annual frequency of indoor tanning bed usage during high school/college.

Results

In multivariable-adjusted logistic regression, we demonstrated positive associations between the sun exposure behaviors and the indoor tanning habit. Specifically, teenagers who spent daily outdoors in a swimsuit (adjusted odds ratio [aOR], 95% confidence interval [CI] for daily vs. <1/week: 2.68, 1.76-4.09) or who had ≥ 10 sunburns that blistered (aOR, 95% CI for ≥ 10 vs. never: 2.18, 1.53-3.10) were more likely to use indoor tanning beds ≥ 12 times/year. Also, teenagers/undergraduates who spent ≥ 5hours/week outdoors in direct sunlight during daytime used indoor tanning ≥ 12 times/year (aOR, 95% CI: 2.18, 1.39-3.44) than those who spent < 1/week. However, there was not a significant association between average uses of sunscreen at the pool/beach and indoor tanning bed. Multivariable-adjusted linear regression models also showed similar results.

Conclusions

Teenagers who spent more time outdoors or got more sunburns tended to use indoor tanning more frequently. These findings provide evidence that teenagers with strong sun-seeking behaviors may have excessive exposure to artificial ultraviolet radiation as well.

On the Relationship Between Sun Exposure and All-Cause Mortality

Increasing sun exposure is related to lower prevalence of death in cardiovascular disease (CVD), type 2 diabetes, and other noncancer non-CVD. In this chapter we aim to make a short update on the knowledge regarding sun exposure and all-cause mortality. Data support the hypothesis that low sun exposure habits are a major risk factor for all-cause mortality. Low sun exposure is related to an increased risk of death due to CVD and noncancer/non-CVD, and a minor reduction in risk of cancer. Active sun exposure habits have a dual effect; it increases the incidence of skin cancer, but also improves the prognosis in terms of all-cause mortality. In a low solar intensity region, we should carefully assess both risk and benefits of sun exposure in order to obtain balanced recommendations.

Tanning benefits, seasonal effects, and concerns about sunscreen: Measuring health beliefs about UV among college students

Objective: To develop and validate a scale measuring health beliefs about UV in cloudy climates that may impact UV exposure behaviors. Participants: Students at a large university in Oregon completed pilot (N = 115) and final (N = 335) scales online March-July, 2016. Five participants underwent cognitive interviews. Methods: Expert feedback, cognitive interviews, and pilot data guided item development and refinement. We conducted factor analysis and invariance testing. Results: The final four-factor model fit well (χ² = 37.97, df = 37, RMSEA = 0.000, CFI = 1.000). HBAU subscales are Sunscreen Toxicity, Seasonal Effects, Health Benefits of Tanning, and Tanning Through the Winter. Invariance testing supported strong invariance across sex and tanning status. Conclusion: The HBAU measures beliefs that encourage UV exposure and discourage protection (eg, the belief that sunscreen ingredients are toxic). This scale will enable more comprehensive measurement of cognitive predictors of UV exposure for student health, clinical, and research purposes.

Health Beliefs About UV and Skin Cancer Risk Behaviors

Our purpose was to examine the beliefs of college students about UV exposure and sunscreen use and their associations with skin cancer risk and protective behaviors in a cloudy climate. The sample was online survey participants (N = 334) recruited from a large university in Oregon. After fitting an initial measurement model, we fit a structural equation model including Health Beliefs About UV (HBAU) subscales (Health Benefits of Tanning, Seasonal Effects, Tanning Through the Winter, and Sunscreen Toxicity), outcome variables (sunscreen use, indoor tanning, and outdoor tanning), and covariates (eg, tanning and sunscreen use). A minority of participants held the beliefs represented by 3 HBAU subscales, but beliefs about negative health effects of the local weather (Tanning Through the Winter) were common. The measurement and adjusted models provided good fit to the data (χ2 = 143.30; P = .29; df = 136; Root-Mean Square Error of Approximation = .014; Comparative Fit Index = .992; Tucker-Lewis Index = .981). After adjusting for covariates, Sunscreen Toxicity predicted reduced sunscreen use (β = -.12, P = .021), Health Benefits of Tanning predicted outdoor tanning (β = .43, P < .001), and Tanning Through the Winter predicted indoor tanning (β = .31, P = .02). The small sample size, nonresponse rate, and cross-sectional nature of this study mean these findings should be interpreted cautiously. Beliefs about health benefits of sun exposure, the regional weather, and sunscreen safety play a role in skin cancer risk and protective behaviors.

A Closer Look at Descriptive Norms and Indoor Tanning: Investigating the Intermediary Role of Positive and Negative Outcome Expectations

Indoor tanning is a risky behavior that dramatically increases skin cancer risk. Researchers from multiple disciplines aim to better understand this behavior to develop interventions and messages to curtail it. As such, we investigated the role of social norms and outcome expectations as predictors of tanning behavior as part of a larger test of constructs included in the Theory of Normative Social Behavior. In addition to offering additional empirical results to support theoretical claims for the importance of social norms and outcome expectations in predicting health behaviors, we offer indoor tanning-specific operationalizations in a conditional process model with the aim of assessing how content-specific measurements predict indoor tanning intentions. Results of a survey of adult indoor tanners from across the U.S. (N = 262) highlight when and how descriptive norms influence tanning intentions through the mediating roles of anticipatory socialization, injunctive norms, and health threat, and through the moderating role of mood-based tanning motivations. Implications for theory building as well as for intervention and message design are discussed.

Tanning dependence and seasonal affective disorder are frequent among sunbathers but are not associated

Ultraviolet radiation (UVR) is a known risk factor for skin cancers. Those who are tanning dependent seek out UVR exposure. Many tanners have expressed symptoms of seasonal affective disorder (SAD), but conclusive evidence of a connection with tanning dependence is lacking. We evaluated the frequency of tanning dependence or abuse and symptoms of SAD among Finnish sunbathers and analysed whether phenomena are associated which could indicate a common biological mechanism. Sunbathing related tanning dependence/abuse among Finnish sunbathers were assessed using the Structured Interview for Tanning Abuse and Dependence measure (SITAD), and symptoms of SAD were assessed with the Seasonal Pattern Assessment Questionnaire (SPAQ). Of 229 sunbathers, 8% (n = 18) were classified as tanning-dependent, and 26% (n = 59) were classified as tanning abusers. Additionally, 16% (n = 37) met the criteria for SAD, and 26% (n = 60) met the criteria for subsyndromal seasonal affective disorder (S-SAD), but there was no significant association between tanning dependence or abuse and SAD or S-SAD. Sunbathing dependence or abuse and SAD/S-SAD were frequent among sunbathers, and they may promote sun-seeking risk behaviour. However, within this sample, tanning dependence and SAD/S-SAD were not associated.

Can neuroimmune mechanisms explain the link between ultraviolet light (UV) exposure and addictive behavior?

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.

An integrated model of skin cancer risk in sexual minority males

Sexual minority males are an at-risk group for developing skin cancer. Elevated rates of skin cancer among this population are thought to be driven by excess indoor tanning; however, motivations to indoor tan among this population are unknown. Theoretically, appearance-based and affect regulation motives may be proximal predictors of increased indoor tanning in this population. The current study tests an integrated biopsychosocial model of indoor tanning behaviors and future intentions among a sample of sexual minority males. Participants were 231 sexual minority males, between the age of 14 and 35 years, residing in San Diego County, California, who completed a battery of self-report questionnaires online. Constructs assessed included skin tone, perceived susceptibility to skin cancer, sociocultural pressures to tan, appearance-based motives to tan, affect regulation in regard to indoor tanning, indoor tanning behaviors over the previous 3 months, and future intentions to indoor tan. The three proposed proximal predictors of indoor tanning all displayed significant pathways; however, results varied depending upon the specific outcome measure modeled. Affect regulation was significantly associated with increased odds of indoor tanning, and future intentions to indoor tan. Increased appearance reasons to tan were significantly associated with future intentions to indoor tan, while increased appearance reasons not to tan were significantly associated with fewer number of indoor tanning sessions. Results underscore the unique pathways of affect regulation and appearance-based motives in indoor tanning behaviors. Skin cancer prevention programs focusing on sexual minority males may wish to address affect and appearance concerns.

First evaluation of the Behavioral Addiction Indoor Tanning Screener (BAITS) in a nationwide representative sample

BACKGROUND

Evidence suggests that indoor tanning may have addictive properties. However, many instruments for measuring indoor tanning addiction show poor validity and reliability. Recently, a new instrument, the Behavioral Addiction Indoor Tanning Screener (BAITS), has been developed.

OBJECTIVES

To test the validity and reliability of the BAITS by using a multimethod approach.

METHODS

We used data from the first wave of the National Cancer Aid Monitoring on Sunbed Use, which included a cognitive pretest (August 2015) and a Germany-wide representative survey (October to December 2015). In the cognitive pretest 10 users of tanning beds were interviewed and 3000 individuals aged 14-45 years were included in the representative survey. Potential symptoms of indoor tanning addiction were measured using the BAITS, a brief screening survey with seven items (answer categories: yes vs. no). Criterion validity was assessed by comparing the results of BAITS with usage parameters. Additionally, we tested internal consistency and construct validity.

RESULTS

A total of 19·7% of current and 1·8% of former indoor tanning users were screened positive for symptoms of a potential indoor tanning addiction. We found significant associations between usage parameters and the BAITS (criterion validity). Internal consistency (reliability) was good (Kuder-Richardson-20, 0·854). The BAITS was shown to be a homogeneous construct (construct validity).

CONCLUSIONS

Compared with other short instruments measuring symptoms of a potential indoor tanning addiction, the BAITS seems to be a valid and reliable tool. With its short length and the binary items the BAITS is easy to use in large surveys.

Intentional outdoor tanning in the United States: Results from the 2015 Summer ConsumerStyles survey

There is limited literature about adults in the United States who usually or always spend time outdoors for the purpose of developing a tan, defined as intentional outdoor tanning. Using data from the 2015 Summer ConsumerStyles, an online cross-sectional survey weighted to the US adult population (n=4,127), we performed unadjusted and adjusted multivariable logistic regressions to examine the associations between demographic characteristics, behaviors, and belief factors related to skin cancer risk and intentional outdoor tanning. Nearly 10% of the study population intentionally tanned outdoors. Outdoor tanning was more prevalent among women (11.4%), non-Hispanic white individuals (11.5%), those aged 18-29years (14.1%), those without a high school diploma (12.7%), and those in the northeast United States (13.2%). The adjusted odds of outdoor tanning were significantly higher among women than men (adjusted odds ratio [AOR] 1.51, 95% confidence interval [CI] 1.12-2.04); those with a history of indoor tanning or recent sunburn than those without (AOR 2.61, CI 1.94-3.51; AOR 1.96, CI 1.46-2.63, respectively); those who agreed they looked better with a tan than those who did not (AOR 6.69, CI 3.62-12.35); and those who did not try to protect their skin from the sun when outdoors than those who did (AOR 2.17, CI 1.56-3.04). Adults who engaged in other risky behaviors that expose a person to ultraviolet (UV) radiation were more likely to tan outdoors, further increasing their risk of skin cancer. These findings may guide potential interventions to reduce UV exposure from outdoor tanning.

Review of interventions to reduce ultraviolet tanning: Need for treatments targeting excessive tanning, an emerging addictive behavior

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

Psychosocial aspects associated with use of sunscreen, natural sunlight exposure, and artificial tanning

Natural and artificial tanning have become very popular in Western culture, yet at the same time, there is still a psychodermatology concern for this activity. Not much has been examined with the psychological aspects of tanning and sunscreen use. The purpose of this study is to examine the psychosocial effects associated with sun protection, natural, and artificial tanning among individuals 18 years old or older visiting the University of Miami Dermatology Outpatient Clinic. We distributed a survey on tanning and sunscreen use to 150 dermatology outpatients, hospital employees, and hospital visitors for three weeks during June/July 2015 asking about how often they tan, use sunscreen, and how they feel about this topic. Demographics, such as gender, ethnicity, and education were taken into consideration to examine the different responses in each category. Our results suggest that people's perception to tanning and sunscreen use have evolved over time. Most people in South Florida nowadays feel guilty when exposed to natural sunlight without sunscreen and do not tan frequently. The majority of the people, specifically women, utilize the recommended amount of sunscreen with a sun protection factor of 30-50. However, we can conclude that communication between social media and the general public can affect people's decision-making on tanning and sunscreen use with physician advice being the most effective method of encouraging people to use sunscreen. This study will add to the growing knowledge about psychodermatology.

How Do Perceived Descriptive Norms Influence Indoor Tanning Intentions? An Application of the Theory of Normative Social Behavior

Indoor tanning bed use is highly influenced by perceived norms about a tanned appearance. The theory of normative social behavior (TNSB) details the many ways in which norms can impact intentions and behavior, but has never been assessed in the context of indoor tanning. Considering this, we conducted a survey among female university students (N = 274) to determine the extent to which the TNSB predicted intentions to use indoor tanning beds. Overall, the path model predicted about 46% of the variance in intentions, and the majority of significant indirect effects were witnessed through the outcome expectation variables included in the TNSB, suggesting that these may be the most salient mechanisms-as predicted by the TNSB-through which norms can impact tanning intentions. In light of these results, theoretical and practical implications are discussed, and specific recommendations are given to extend the predictive utility of the TNSB in the context of indoor tanning.

The relationship between sun exposure and all-cause mortality

Women with low sun exposure are at a dose-dependently increased risk of all-cause mortality, mainly due to an increased risk of death from cardiovascular or noncancer/noncardiovascular disease compared higher exposure.

Toward quantifying the abuse liability of ultraviolet tanning: A behavioral economic approach to tanning addiction

Many adults engage in ultraviolet indoor tanning despite evidence of its association with skin cancer. The constellation of behaviors associated with ultraviolet indoor tanning is analogous to that in other behavioral addictions. Despite a growing literature on ultraviolet indoor tanning as an addiction, there remains no consensus on how to identify ultraviolet indoor tanning addictive tendencies. The purpose of the present study was to translate a behavioral economic task more commonly used in substance abuse to quantify the "abuse liability" of ultraviolet indoor tanning, establish construct validity, and determine convergent validity with the most commonly used diagnostic tools for ultraviolet indoor tanning addiction (i.e., mCAGE and mDSM-IV-TR). We conducted a between-groups study using a novel hypothetical Tanning Purchase Task to quantify intensity and elasticity of ultraviolet indoor tanning demand and permit statistical comparisons with the mCAGE and mDSM-IV-TR. Results suggest that behavioral economic demand is related to ultraviolet indoor tanning addiction status and adequately discriminates between potential addicted individuals from nonaddicted individuals. Moreover, we provide evidence that the Tanning Purchase Task renders behavioral economic indicators that are relevant to public health research. The present findings are limited to two ultraviolet indoor tanning addiction tools and a relatively small sample of high-risk ultraviolet indoor tanning users; however, these pilot data demonstrate the potential for behavioral economic assessment tools as diagnostic and research aids in ultraviolet indoor tanning addiction studies.

Skin Cancer Risk and Other Health Risk Behaviors: A Scoping Review

Purpose. To present results of a scoping review focused on skin cancer risk behaviors and other related health risk behaviors. Skin cancer is highly preventable, yet it is the most common form of cancer in the United States with melanoma rates increasing. Limited research has been conducted examining the relationship between skin cancer prevention behaviors and other health risks, yet multiple behavioral health risk interventions have shown great promise for health promotion and reduced health care costs. Methods. Online databases were searched for research articles on skin cancer risk behaviors and related health risk behaviors. Results. Thirty-seven articles met inclusion criteria examining skin cancer behaviors including risk, sun protection behaviors, sunburn, and indoor tanning. The majority of existing studies focused on the relationship between skin cancer prevention behaviors and physical activity, body mass index, smoking, and alcohol abuse. Adults were the primary population of interest with some studies of adolescents. Conclusions. Poor skin cancer prevention behaviors were associated with alcohol use, marijuana use, and smoking among adolescents and adults. Studies on body mass index and physical activity had mixed relationships with skin cancer prevention behaviors and warrant further investigation. Indoor tanning was associated with other risky behaviors but other skin cancer prevention behaviors were not studied.

Mood Changes After Indoor Tanning Among College Women: Associations with Psychiatric/Addictive Symptoms

Indoor tanning (IT) has been linked with psychiatric and addictive symptoms, and frequent tanning may indicate tanning dependence (addiction). The current study evaluated the effects of an IT episode on mood states and the association of these effects with psychiatric and addictive symptoms among young adult female indoor tanners. One-hundred thirty-nine female university students aged 18-25 years who had indoor tanned completed an online survey including the Positive and Negative Affects Scales and a standardized psychiatric interview (the MINI International Neuropsychiatric Interview) via telephone. Psychiatric and addictive symptoms were relatively common among these young adult female indoor tanners. Overall, participants reported significant decreases in both negative (upset, scared, irritable, nervous, jittery, afraid) and positive (feeling interested) mood states after their most recent tanning episode. Multivariable linear regression analyses showed that more frequent indoor tanning in the past month and symptoms of illicit drug use disorders were associated with decreases in negative mood, and symptoms of generalized anxiety disorder were associated with a decrease in feeling interested. In summary, indoor tanners report relatively high rates of psychiatric and substance use symptoms, including symptoms of tanning dependence, and indoor tanning appears to alter mood. Women with certain substance use and psychiatric characteristics may be more vulnerable to such mood changes after tanning indoors. Further research is needed to clarify the relationships among these variables.

Dopamine efflux in response to ultraviolet radiation in addicted sunbed users

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.

The association of tanning behavior with psycho-tropic medication use among young adult women

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.

Contextual factors, indoor tanning, and tanning dependence in young women

OBJECTIVES

To investigate the association of contextual factors such as cost, tanning accessibility, regulations, or marketing and indoor tanning or tanning dependence.

METHODS

One hundred thirty-nine college-aged female indoor tanners completed a questionnaire between 2009 and 2011.

RESULTS

Higher scores on tanning dependence and assessment in the spring/summer (versus the fall/winter) were associated with more frequent indoor tanning in the last 30 days (ps < .05). More frequent indoor tanning, greater session length, and more trouble paying for tanning were associated with higher scores on tanning dependence (ps < .05).

CONCLUSIONS

Public health research and practice could benefit from attention to such contextual factors as tanning cost and regulations regarding session length.

Associations between seasonal sleep change and indoor tanning

Identification of risk factors for indoor tanning may ultimately aid the development of better indoor tanning prevention strategies, which is pertinent given the association between indoor tanning and skin cancer. This study aimed to examine the relationship between seasonal sleep change and indoor tanning. Female tanners (N=139) completed self-report measures including items relating to seasonal sleep changes, seasonal affective disorder (SAD), reasons for tanning, tanning during the winter months, and the Tanning Pathology Scale (TAPS), which measures problematic tanning motives and symptoms of tanning dependence. It was hypothesized that seasonal sleep change and SAD would be associated with greater indoor tanning during the winter, more tanning to improve mood and to relax, and higher scores on the TAPS. Findings indicated that more seasonal sleep change was associated with tanning to improve mood and higher scores on the TAPS. Similarly, the presence of SAD was related to tanning to improve mood, tanning to relax, and more problematic tanning.

Ultra-violet indoor tanning addiction: a reinforcer pathology interpretation

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.

Craving Facebook? Behavioral addiction to online social networking and its association with emotion regulation deficits

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.

Psychometric assessment of the craving to tan questionnaire

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.

Exposure to indoor tanning without burning and melanoma risk by sunburn history

Indoor tanning is carcinogenic to humans. Individuals report that they tan indoors before planning to be in the sun to prevent sunburns, but whether skin cancer is subsequently reduced is unknown. Using a population-based case-control study, we calculated the association between melanoma and indoor tanning after excluding exposed participants reporting indoor tanning-related burns, stratified by their number of lifetime sunburns (0, 1-2, 3-5, >5). Confounding was addressed using propensity score analysis methods. All statistical tests were two-sided. We observed increased risk of melanoma across all sunburn categories for participants who had tanned indoors without burning compared with those who never tanned indoors, including those who reported zero lifetime sunburns (odds ratio = 3.87; 95% confidence interval = 1.68 to 8.91; P = .002). These data provide evidence that indoor tanning is a risk factor for melanoma even among persons who reported never experiencing burns from indoor tanning or outdoor sun exposure.

Avoidance of sun exposure is a risk factor for all-cause mortality: results from the Melanoma in Southern Sweden cohort

BACKGROUND

Sunlight exposure and fair skin are major determinants of human vitamin D production, but they are also risk factors for cutaneous malignant melanoma (MM). There is epidemiological evidence that all-cause mortality is related to low vitamin D levels.

METHODS

We assessed the avoidance of sun exposure as a risk factor for all-cause mortality for 29 518 Swedish women in a prospective 20-year follow-up of the Melanoma in Southern Sweden (MISS) cohort. Women were recruited from 1990 to 1992 and were aged 25 to 64 years at the start of the study. We obtained detailed information at baseline on their sun exposure habits and potential confounders. Multivariable flexible parametric survival analysis was applied to the data.

RESULTS

There were 2545 deaths amongst the 29 518 women who responded to the initial questionnaire. We found that all-cause mortality was inversely related to sun exposure habits. The mortality rate amongst avoiders of sun exposure was approximately twofold higher compared with the highest sun exposure group, resulting in excess mortality with a population attributable risk of 3%.

CONCLUSION

The results of this study provide observational evidence that avoiding sun exposure is a risk factor for all-cause mortality. Following sun exposure advice that is very restrictive in countries with low solar intensity might in fact be harmful to women's health.

International prevalence of indoor tanning: a systematic review and meta-analysis

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.

Exposure to indoor tanning without burning and melanoma risk by sunburn history

Indoor tanning is carcinogenic to humans. Individuals report that they tan indoors before planning to be in the sun to prevent sunburns, but whether skin cancer is subsequently reduced is unknown. Using a population-based case-control study, we calculated the association between melanoma and indoor tanning after excluding exposed participants reporting indoor tanning-related burns, stratified by their number of lifetime sunburns (0, 1-2, 3-5, >5). Confounding was addressed using propensity score analysis methods. All statistical tests were two-sided. We observed increased risk of melanoma across all sunburn categories for participants who had tanned indoors without burning compared with those who never tanned indoors, including those who reported zero lifetime sunburns (odds ratio = 3.87; 95% confidence interval = 1.68 to 8.91; P = .002). These data provide evidence that indoor tanning is a risk factor for melanoma even among persons who reported never experiencing burns from indoor tanning or outdoor sun exposure.

Adolescent indoor tanning use and unhealthy weight control behaviors

OBJECTIVE

Youth indoor tanning rates remain high despite the potential for increased melanoma risk. No previous study has assessed the prevalence of unhealthy weight control behaviors in both male and female adolescent indoor tanning users using a nationally representative survey.

METHODS

Pooled data on high school students from the 2009 and 2011 Youth Risk Behavior Survey were used (n = 26,951). Multivariate logistic regression was used to assess associations between the recent indoor tanning use and recently doing the following to lose weight: fasting for more than 24 hours; taking a pill, powder, or liquid without a doctor's consent; and vomiting or taking a laxative.

RESULTS

Pooled data showed 23.3% of females reported indoor tanning within the past year; 6.5% of males did so as well. Adjusted multivariate results show that females who indoor tan were, on average, more likely to have fasted (odds ratio [OR], 1.2; 95% confidence interval [CI], 1.0-1.5), taken a pill, powder, or liquid (OR, 2.4; 95% CI, 1.9-3.0), and vomited or taken a laxative to lose weight (OR, 1.4; 95% CI, 1.1-1.7) within the past 30 days than those who did not. Males who indoor tanned within the past year were, on average, more likely to have fasted (OR, 2.3; 95% CI, 1.7-3.1), taken a pill, powder, or liquid (OR, 4.4; 95% CI, 3.3-6.0), and vomited or taken a laxative to lose weight (OR, 7.1; 95% CI, 4.4-11.4) within the past 30 days.

CONCLUSIONS

Significant associations between indoor tanning use and unhealthy weight control behaviors exist for both male and female adolescents, with a stronger association observed among males.

Society of Behavioral Medicine (SBM) position statement: ban indoor tanning for minors

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.

Phenomenology and psychopathology of excessive indoor tanning

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.

International prevalence of indoor tanning: a systematic review and meta-analysis

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.

Tanning addiction and psychopathology: Further evaluation of anxiety disorders and substance abuse

BACKGROUND

Little research has investigated the correlates of problematic tanning and tanning dependence.

OBJECTIVE

We sought to identify characteristics associated with problematic tanning and tanning dependence, and to evaluate simultaneously the associations of variables as correlates of problematic tanning and tanning dependence.

METHOD

To assess tanning-related characteristics, psychopathology, and demographics, we administered questionnaires to 533 tanning university students; 31% met criteria for tanning dependence, 12% for problematic tanning.

RESULTS

Both problematic tanning and tanning dependence were significantly associated with being female (P < .001 and P < .001, respectively) and with screening positive on measures of obsessive-compulsive (P < .001 and P = .005, respectively) and body dysmorphic (P = .019 and P < .001, respectively) disorders. Frequency of tanning in the past month was the strongest correlate of problematic tanning (P < .001) and tanning dependence (P < .001) when included in a model that controlled for shared variance among demographics and psychopathology.

LIMITATIONS

The sample was recruited from 1 university and contained only self-report measures.

CONCLUSION

Results suggest that many who engage in excessive tanning may also have significant psychiatric distress. Additional research is needed to characterize compulsive, problematic tanning and its rates, correlates, and risk factors among diverse samples.

Does artificial UV use prior to spring break protect students from sunburns during spring break?

BACKGROUND

Dark-skinned individuals are less likely than light-skinned individuals to become sunburned or develop skin cancer. Some have extrapolated this relationship and surmised that developing and maintaining a tan will reduce the risk of sunburns and melanoma. In order to examine whether this strategy indeed protects against sunburns, we surveyed college students about both their tanning habits prior to spring break and their spring break activities.

METHODS

Sorority and fraternity students were recruited after spring break. Analyses examined associations between potential risk factors and the development of one or more sunburns during spring break.

RESULTS

As expected, the risk of obtaining a sunburn increased with: time spent in the sun during spring break; light complexion, as assessed by various sun-sensitivity factors; and lack of sunscreen use. We also found that tanning using an artificial UV source during the 10 weeks prior to spring break was not associated with reduced risk of sunburns during spring-break, but rather with a marginal increase in this risk.

CONCLUSIONS

These data provide evidence that maintaining a tan may not provide protection from sunburns. Public health messages need to address this misconception, stating clearly that a tan does not protect against or reduce the chances of developing a sunburn.

Measurement of tanning dependence

BACKGROUND

Indoor tanning has been found to be addictive. However, the most commonly used tanning dependence measures have not been well validated.

OBJECTIVE

The study's purpose was to explore the psychometric characteristics of and compare the modified Cut-down, Annoyed, Guilty, Eye-opener Scale (mCAGE), modified Diagnostic and Statistical Manual of Mental Disorders - Fourth Edition - Text Revised (mDSM-IV-TR) and Tanning Pathology Scale (TAPS) measures of tanning dependence and provide recommendations for research and practice.

METHODS

This study was a cross-sectional online survey with 18- to 25-year-old female university students. The main outcome variable was tanning dependence measured by the mCAGE, mDSM-IV-TR and TAPS.

RESULTS

Internal consistency of the TAPS subscales was good but was poor for the mCAGE and mDSM-IV-TR, except when their items were combined. Agreement between the mCAGE and mDSM-IV-TR was fair. Factor analysis of the TAPS confirmed the current four-factor structure. All of the tanning dependence scales were significantly correlated with one another. Likewise, most of the tanning dependence scales were significantly correlated with other measures of tanning attitudes and behaviours. However, the tolerance to tanning TAPS subscale was not significantly correlated with any measure of tanning attitudes or behaviours and had the lowest subscale internal reliability and eigenvalues.

CONCLUSION

Based on the data and existing literature, we make recommendations for the continued use of tanning dependence measures. Intervention may be needed for the approximately 5% of college women who tend to be classified as tanning dependent across measures. Monitoring of individuals reporting tanning dependence symptoms is warranted.

UV radiation and the skin

UV radiation (UV) is classified as a "complete carcinogen" because it is both a mutagen and a non-specific damaging agent and has properties of both a tumor initiator and a tumor promoter. In environmental abundance, UV is the most important modifiable risk factor for skin cancer and many other environmentally-influenced skin disorders. However, UV also benefits human health by mediating natural synthesis of vitamin D and endorphins in the skin, therefore UV has complex and mixed effects on human health. Nonetheless, excessive exposure to UV carries profound health risks, including atrophy, pigmentary changes, wrinkling and malignancy. UV is epidemiologically and molecularly linked to the three most common types of skin cancer, basal cell carcinoma, squamous cell carcinoma and malignant melanoma, which together affect more than a million Americans annually. Genetic factors also influence risk of UV-mediated skin disease. Polymorphisms of the melanocortin 1 receptor (MC1R) gene, in particular, correlate with fairness of skin, UV sensitivity, and enhanced cancer risk. We are interested in developing UV-protective approaches based on a detailed understanding of molecular events that occur after UV exposure, focusing particularly on epidermal melanization and the role of the MC1R in genome maintenance.

Psychiatric and addictive symptoms of young adult female indoor tanners

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.

Children's skin cancer prevention: a systematic review of parents' psychosocial measures

CONTEXT

Parents' knowledge, attitudes, and beliefs may be influenced through intervention to increase children's sun protection. Little is known about measures of these psychosocial characteristics, including psychometric properties. This paper systematically reviews parents' psychosocial measures in children's skin cancer prevention studies.

EVIDENCE ACQUISITION

A search of standard databases conducted in 2008, updated in 2011, yielded 5797 unique citations. A study was eligible if (1) it was published between January 1980 and March 2011; (2) it was published in English; (3) it reported a psychosocial measure relevant to children's skin cancer prevention; and (4) the psychosocial measure was administered to parents, the majority of whom had children aged ≤12 years. Screening yielded 57 eligible studies. Data were analyzed in 2008 and 2011.

EVIDENCE SYNTHESIS

Most studies measured one (n=24) or two (n=18) psychosocial constructs; few (n=7) measured more than three. The most frequently measured constructs were knowledge (n=41); attitudes (n=22); perceived susceptibility/risk (n=11); self-efficacy (n=9); and perceived barriers (n=9). Most studies did not mention theory. Theoretic mechanisms underlying interventions were not examined. There was little description of measure validity. Reliability, usually internal consistency, was reported more often (n=19).

CONCLUSIONS

Few studies assessed more than two parent-related psychosocial constructs, so it was not possible to test theoretic models of parental influences on children's sun protection. Validated measures were lacking. There was conceptual overlap of measures because of the presence of analogous constructs across theories and assessment of multiple constructs within a single measure.

Watching reality television beauty shows is associated with tanning lamp use and outdoor tanning among college students

BACKGROUND

Ultraviolet radiation exposure through natural sunlight or tanning lamps is a risk factor for skin cancer.

OBJECTIVE

As the media can influence behavior, we studied whether watching reality television (TV) beauty shows is associated with tanning lamp use or outdoor tanning.

METHODS

College students (n = 576) were surveyed on their reality TV beauty show watching, their use of tanning lamps, and outdoor tanning behavior. We asked media attitude questions about connectivity with reality TV shows and Internet use of Facebook to discuss reality TV shows.

RESULTS

Those who did versus did not watch reality TV beauty shows used tanning lamps (12.9% vs 3.7%, P < .001) and tanned outdoors (43.3% vs 28.7%, P < .001) at significantly greater percentages. Significant predictors of tanning lamp use included watching reality TV beauty shows (odds ratio [OR] 2.58, 95% confidence interval [CI] 1.11-6.00), increasing age (OR 1.17, 95% CI 1.04-1.32), and female sex (OR 10.16, 95% CI 3.29-31.41). Significant predictors of outdoor tanning included watching reality TV beauty shows (OR 2.11, 95% CI 1.33-3.34).

LIMITATIONS

The specific names of the reality TV beauty shows watched were not obtained and therefore we cannot determine if particular shows were more or less associated with this behavior.

CONCLUSION

Watching reality TV beauty shows is associated with both tanning lamp use and outdoor tanning. Dermatologists should consider discussing the potential harmful aspects of tanning beds and outdoor tanning, especially with their patients who watch reality TV beauty shows.

Knowledge, attitudes and practices about sun exposure and photoprotection in outpatients attending dermatology clinics at four hospitals in Lima, Peru

BACKGROUND

To establish the knowledge, about sun exposure and photoprotection in outpatients treated at the dermatology clinics in four hospitals in Lima, Peru.

MATERIAL AND METHODS

A cross-sectional study was conducted involving a sample of 364 patients selected using a systematic random sampling process in the four participating hospitals. The selected patients were interviewed to determine their knowledge, behavior and practices in relation to sun exposure and photoprotection. The chi-square test was used to identify any significant differences between knowledge and practices.

RESULTS

The mean age of the patients in this sample was 45.1 ± 21.4 years. Of the 364 patients, 55.9% were women and 54.8% had skin phototype IV. The principal risks related to sun exposure were skin cancer (80.5%) and sunburn (77.8%). Knowledge regarding sun protection was more evident in individuals with university/college education (p<0.001). In addition, 78.9% of the individuals reported that they knew about photo-protectors and 52.3% stated that they used them regularly. In general, women were more knowledgeable regarding sun protection (p=0.001). Of the total number of users of photoprotection, 38.4% used these products daily, while 61.6% used them only occasionally. The use of photo-protectors differed significantly in accordance with the individual's education level (p<0.001). In the majority of cases there was a statistically significant difference between knowledge and practice with respect to solar protection.

CONCLUSIONS

The level of awareness of the outpatients treated at the dermatology clinics in these four hospitals in Lima, Peru about the risks of sun exposure is acceptable; however, a large proportion fail to incorporate regular solar protection as a practice in their daily life.

Evaluating a measure of tanning abuse and dependence

OBJECTIVE

To evaluate the Structured Interview for Tanning Abuse and Dependence (SITAD).

DESIGN

Longitudinal survey.

SETTING

College campus.

PARTICIPANTS

A total of 296 adults.

MAIN OUTCOME MEASURES

The SITAD modified items from the Structured Clinical Interview for DSM-IV Axis I Disorders that focus on opiate abuse and dependence. Indoor tanning (IT) behavioral patterns and opiate-like reactions to tanning were measured, and IT behavior was measured 6 months later.

RESULTS

Of 296 participants, 32 (10.8%) met the SITAD criteria for tanning abuse (maladaptive pattern of tanning as manifested by failure to fulfill role obligations, physically hazardous tanning, legal problems, or persistent social or interpersonal problems) and 16 (5.4%) for tanning dependence as defined by 3 or more of the following: loss of control, cut down, time, social problems, physical or psychological problems, tolerance, and withdrawal. The IT frequency in dependent tanners was more than 10 times the rate in participants who do not meet the SITAD criteria for tanning abuse or dependence. Tanning-dependent participants were more likely to report being regular tanners (75%; odds ratio, 7.0). Dependent tanners scored higher on the opiate-like reactions to tanning scale than did abuse tanners, who scored higher than those with no diagnosis.

CONCLUSIONS

The SITAD demonstrated some evidence of validity, with tanning-dependent participants reporting regular IT, higher IT frequency, and higher scores on an opiate-like reactions to tanning scale. A valid tanning dependence screening tool is essential for researchers and physicians as a tanning-dependent diagnosis may facilitate a better understanding of tanning motivations and aid in the development of efficacious intervention programs.

Process and outcomes of a skin protection intervention for young adults

Efforts to reduce skin cancer risk behaviors using appearance-oriented interventions (e.g. ultraviolet (UV) light photos showing skin damage) or motivational interviewing (MI) have shown promise in recent trials. In the study a randomized 2 (UV photo versus no UV photo) x 2 (MI versus no MI) factorial design with longitudinal follow up was used. Results showed that progression in stage of change (SOC) was significantly more likely in the photo than the education condition. Treatment credibility as rated by participants and counselor perceived positive therapeutic alliance predicted SOC progression. There was also preliminary evidence for differential intervention effectiveness by baseline SOC. The implications are discussed.

New approaches to melanoma prevention

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.