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Vogel RI, Ahmed RL, Nelson HH, Berwick M, Weinstock MA, Lazovich D. Exposure to indoor tanning without burning and melanoma risk by sunburn history. J Natl Cancer Inst 2014; 106:dju219. [PMID: 25031276 DOI: 10.1093/jnci/dju219] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
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.
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Affiliation(s)
- Rachel Isaksson Vogel
- Affiliations of authors: Masonic Cancer Center (RIV, HHN, DL), Department of Dermatology (RLA), and Division of Epidemiology and Community Health (HHN, DL), University of Minnesota, Minneapolis, MN; Department of Internal Medicine and University of New Mexico Cancer Center, Albuquerque, NM (MB); Division of Epidemiology and Biostatistics, University of New Mexico, Albuquerque, NM (MB); Dermatoepidemiology Unit, VA Medical Center, Providence, RI (MAW); Department of Dermatology, Rhode Island Hospital, Providence, RI (MAW); Departments of Dermatology and Community Health, Brown University, Providence, RI (MAW)
| | - Rehana L Ahmed
- Affiliations of authors: Masonic Cancer Center (RIV, HHN, DL), Department of Dermatology (RLA), and Division of Epidemiology and Community Health (HHN, DL), University of Minnesota, Minneapolis, MN; Department of Internal Medicine and University of New Mexico Cancer Center, Albuquerque, NM (MB); Division of Epidemiology and Biostatistics, University of New Mexico, Albuquerque, NM (MB); Dermatoepidemiology Unit, VA Medical Center, Providence, RI (MAW); Department of Dermatology, Rhode Island Hospital, Providence, RI (MAW); Departments of Dermatology and Community Health, Brown University, Providence, RI (MAW)
| | - Heather H Nelson
- Affiliations of authors: Masonic Cancer Center (RIV, HHN, DL), Department of Dermatology (RLA), and Division of Epidemiology and Community Health (HHN, DL), University of Minnesota, Minneapolis, MN; Department of Internal Medicine and University of New Mexico Cancer Center, Albuquerque, NM (MB); Division of Epidemiology and Biostatistics, University of New Mexico, Albuquerque, NM (MB); Dermatoepidemiology Unit, VA Medical Center, Providence, RI (MAW); Department of Dermatology, Rhode Island Hospital, Providence, RI (MAW); Departments of Dermatology and Community Health, Brown University, Providence, RI (MAW)
| | - Marianne Berwick
- Affiliations of authors: Masonic Cancer Center (RIV, HHN, DL), Department of Dermatology (RLA), and Division of Epidemiology and Community Health (HHN, DL), University of Minnesota, Minneapolis, MN; Department of Internal Medicine and University of New Mexico Cancer Center, Albuquerque, NM (MB); Division of Epidemiology and Biostatistics, University of New Mexico, Albuquerque, NM (MB); Dermatoepidemiology Unit, VA Medical Center, Providence, RI (MAW); Department of Dermatology, Rhode Island Hospital, Providence, RI (MAW); Departments of Dermatology and Community Health, Brown University, Providence, RI (MAW)
| | - Martin A Weinstock
- Affiliations of authors: Masonic Cancer Center (RIV, HHN, DL), Department of Dermatology (RLA), and Division of Epidemiology and Community Health (HHN, DL), University of Minnesota, Minneapolis, MN; Department of Internal Medicine and University of New Mexico Cancer Center, Albuquerque, NM (MB); Division of Epidemiology and Biostatistics, University of New Mexico, Albuquerque, NM (MB); Dermatoepidemiology Unit, VA Medical Center, Providence, RI (MAW); Department of Dermatology, Rhode Island Hospital, Providence, RI (MAW); Departments of Dermatology and Community Health, Brown University, Providence, RI (MAW)
| | - DeAnn Lazovich
- Affiliations of authors: Masonic Cancer Center (RIV, HHN, DL), Department of Dermatology (RLA), and Division of Epidemiology and Community Health (HHN, DL), University of Minnesota, Minneapolis, MN; Department of Internal Medicine and University of New Mexico Cancer Center, Albuquerque, NM (MB); Division of Epidemiology and Biostatistics, University of New Mexico, Albuquerque, NM (MB); Dermatoepidemiology Unit, VA Medical Center, Providence, RI (MAW); Department of Dermatology, Rhode Island Hospital, Providence, RI (MAW); Departments of Dermatology and Community Health, Brown University, Providence, RI (MAW).
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Vogel RI, Ahmed RL, Nelson HH, Berwick M, Weinstock MA, Lazovich D. Exposure to indoor tanning without burning and melanoma risk by sunburn history. J Natl Cancer Inst 2014; 106:dju112. [PMID: 24872541 DOI: 10.1093/jnci/dju112] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
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.
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Affiliation(s)
- Rachel Isaksson Vogel
- Affiliations of authors: Masonic Cancer Center (RIV, HHN, DL), Department of Dermatology (RLA), and Division of Epidemiology and Community Health (HHN, DL), University of Minnesota, Minneapolis, MN; Department of Internal Medicine and University of New Mexico Cancer Center, Albuquerque, NM (MB); Division of Epidemiology and Biostatistics, University of New Mexico, Albuquerque, NM (MB); Dermatoepidemiology Unit, VA Medical Center, Providence, RI (MAW); Department of Dermatology, Rhode Island Hospital, Providence, RI (MAW); Departments of Dermatology and Community Health, Brown University, Providence, RI (MAW)
| | - Rehana L Ahmed
- Affiliations of authors: Masonic Cancer Center (RIV, HHN, DL), Department of Dermatology (RLA), and Division of Epidemiology and Community Health (HHN, DL), University of Minnesota, Minneapolis, MN; Department of Internal Medicine and University of New Mexico Cancer Center, Albuquerque, NM (MB); Division of Epidemiology and Biostatistics, University of New Mexico, Albuquerque, NM (MB); Dermatoepidemiology Unit, VA Medical Center, Providence, RI (MAW); Department of Dermatology, Rhode Island Hospital, Providence, RI (MAW); Departments of Dermatology and Community Health, Brown University, Providence, RI (MAW)
| | - Heather H Nelson
- Affiliations of authors: Masonic Cancer Center (RIV, HHN, DL), Department of Dermatology (RLA), and Division of Epidemiology and Community Health (HHN, DL), University of Minnesota, Minneapolis, MN; Department of Internal Medicine and University of New Mexico Cancer Center, Albuquerque, NM (MB); Division of Epidemiology and Biostatistics, University of New Mexico, Albuquerque, NM (MB); Dermatoepidemiology Unit, VA Medical Center, Providence, RI (MAW); Department of Dermatology, Rhode Island Hospital, Providence, RI (MAW); Departments of Dermatology and Community Health, Brown University, Providence, RI (MAW)
| | - Marianne Berwick
- Affiliations of authors: Masonic Cancer Center (RIV, HHN, DL), Department of Dermatology (RLA), and Division of Epidemiology and Community Health (HHN, DL), University of Minnesota, Minneapolis, MN; Department of Internal Medicine and University of New Mexico Cancer Center, Albuquerque, NM (MB); Division of Epidemiology and Biostatistics, University of New Mexico, Albuquerque, NM (MB); Dermatoepidemiology Unit, VA Medical Center, Providence, RI (MAW); Department of Dermatology, Rhode Island Hospital, Providence, RI (MAW); Departments of Dermatology and Community Health, Brown University, Providence, RI (MAW)
| | - Martin A Weinstock
- Affiliations of authors: Masonic Cancer Center (RIV, HHN, DL), Department of Dermatology (RLA), and Division of Epidemiology and Community Health (HHN, DL), University of Minnesota, Minneapolis, MN; Department of Internal Medicine and University of New Mexico Cancer Center, Albuquerque, NM (MB); Division of Epidemiology and Biostatistics, University of New Mexico, Albuquerque, NM (MB); Dermatoepidemiology Unit, VA Medical Center, Providence, RI (MAW); Department of Dermatology, Rhode Island Hospital, Providence, RI (MAW); Departments of Dermatology and Community Health, Brown University, Providence, RI (MAW)
| | - DeAnn Lazovich
- Affiliations of authors: Masonic Cancer Center (RIV, HHN, DL), Department of Dermatology (RLA), and Division of Epidemiology and Community Health (HHN, DL), University of Minnesota, Minneapolis, MN; Department of Internal Medicine and University of New Mexico Cancer Center, Albuquerque, NM (MB); Division of Epidemiology and Biostatistics, University of New Mexico, Albuquerque, NM (MB); Dermatoepidemiology Unit, VA Medical Center, Providence, RI (MAW); Department of Dermatology, Rhode Island Hospital, Providence, RI (MAW); Departments of Dermatology and Community Health, Brown University, Providence, RI (MAW).
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Day AK, Wilson CJ, Hutchinson AD, Roberts RM. The role of skin cancer knowledge in sun-related behaviours: A systematic review. J Health Psychol 2013; 19:1143-62. [DOI: 10.1177/1359105313485483] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Skin cancer is the most commonly diagnosed cancer in many Western countries. This systematic review provides a comprehensive overview of the relationship between skin cancer knowledge and sun-protective, exposure and tanning behaviours in the general population. A total of 34 studies, published in peer-reviewed journals over three decades, were reviewed and synthesised. Sun-protective behaviour was positively associated with skin cancer knowledge in most cases. Findings were inconsistent regarding other sun-related behaviours. Heterogeneity in measurement compromised the capacity to definitively link knowledge and sun-related behaviours. There is a need for development and utilisation of a standardised skin cancer knowledge scale, and guidelines are suggested.
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Affiliation(s)
| | - Carlene J Wilson
- Flinders University, Australia
- Cancer Council South Australia, Australia
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Day AK, Oxlad M, Roberts RM. Predictors of sun-related behaviors among young women: comparisons between outdoor tanners, fake tanners, and tan avoiders. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2013; 61:315-322. [PMID: 23930746 DOI: 10.1080/07448481.2013.806926] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
OBJECTIVE Skin cancer incidence continues to rise as a tanned appearance remains desirable, particularly among young women. Fake tanning provides a tanned appearance without exposure to ultraviolet radiation. In order to advance our understanding of the factors that contribute to long-term behavior change, this study explores determinants associated with different types of tanning. PARTICIPANTS The sample included 162 female students from the University of Adelaide, Australia, aged 18-26 years. Data were collected in July 2010. METHODS The current study measured differences in skin type, skin cancer knowledge, unrealistic optimism, appearance motivation, and sun-protective and sun exposure behaviors amongst outdoor tanners, fake tanners, and tan avoiders through an online survey. RESULTS Differences were observed for skin type, skin cancer knowledge, unrealistic optimism, sun protection, and sun exposure. CONCLUSIONS A "one-size-fits-all" approach to skin cancer prevention may not be appropriate; type of tanning behavior may need to be considered in health promotion work.
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Affiliation(s)
- Ashley K Day
- School of Psychology , University of Adelaide, Adelaide, SA 5005, Australia.
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Altsitsiadis E, Undheim T, de Vries E, Hinrichs B, Stockfleth E, Trakatelli M. Health literacy, sunscreen and sunbed use: an uneasy association. Br J Dermatol 2012; 167 Suppl 2:14-21. [DOI: 10.1111/j.1365-2133.2012.11082.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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A population-based survey on tanning bed use in Germany. BMC DERMATOLOGY 2009; 9:6. [PMID: 19619281 PMCID: PMC2724378 DOI: 10.1186/1471-5945-9-6] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/27/2008] [Accepted: 07/20/2009] [Indexed: 11/10/2022]
Abstract
BACKGROUND The suntanning industry has grown up over the last decade in Europe, mainly because tanned skin is considered socially desirable and attractive. Because of the potential negative impact of artificial tanning on public health, this study was to investigate tanning bed use behaviour, UV related risk perception and beliefs about tanning in the German population. METHODS In 2007, a representative telephone survey was carried out among 1501 German residents aged 14 years and older. RESULTS More than one fourth (28%) of the German population have used tanning beds at least once before in their lifetime. High-frequency tanning behaviour, i.e. using tanning beds more than 10 times per year, were recorded for 11%. Men and women aged 18 to 44 years and young women under the age of 18 used tanning beds more frequently (>10 times per year). Tanning bed use was positively related to appearance and lifestyle related beliefs as well as to the perception that tanned skin is healthy. CONCLUSION This analysis indicates that tanning bed use is common in Germany. The positive relationships of appearance and health related beliefs with tanning bed use are of great concern. The results indicate underlying misconceptions about the positive effect of artificial UV radiation compared to natural UV radiation particular for high-frequency tanners. The data shows the importance as well as the limitations for risk communication in its current effort to inform effectively about the dangers of artificial UV radiation.
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Salomone C, Majerson D, Molgó M, de Santa María MLS, Romero W. Tanning salons in Santiago, Chile: the knowledge of the staff in charge and the quality of information provided to potential clients before and after a new regulatory law. PHOTODERMATOLOGY, PHOTOIMMUNOLOGY & PHOTOMEDICINE 2009; 25:86-89. [PMID: 19292784 DOI: 10.1111/j.1600-0781.2009.00412.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
INTRODUCTION In recent years, the use of artificial tanning devices has become very popular in Chile. In April, 2007, a new law was established to regulate the non-medical use of tanning beds and tanning booths. The aim of this study was to evaluate the level and quality of information provided by tanning salon staff to clients before deciding on using the services. This information was collected before and 6 months after the law was enacted by researchers visiting tanning salons posing as potential clients. METHODS Using a previously designed questionnaire, 24 tanning salons in Santiago, Chile, were evaluated by researchers acting as potential customers without experience with artificial tanning devices. Employees were questioned using a hidden questionnaire before and 6 months after enactment of the law. RESULTS Before the law, 25% of the establishments gave spontaneous information about the risks of using tanning beds, which increased to 45.8% after enactment of the law. Clients never received written information, either before or after enactment of the law. On both evaluations, more than 1/3 of the employees affirmed that there were no risks in using tanning beds. Before enactment of the law, only 12.5% of the tanning salons required the use of goggles, while after the law, this increased to 25% (P=NS). Only two establishments required that clients sign an informed consent form after enactment of the law. DISCUSSION The level of knowledge among employees in tanning salons was very low and the quality of the information they provided to the clients was very poor. It was important to legislate on ultraviolet tanning services, but at present, the impact of the law has been very limited.
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Affiliation(s)
- Claudia Salomone
- Department of Dermatology, Pontificia Universidad Católica de Chile, Santiago, Chile.
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Chouela E. Reply to sunbathing versus indoor tanning: a realistic perspective. PHOTODERMATOLOGY PHOTOIMMUNOLOGY & PHOTOMEDICINE 2008; 19:268. [PMID: 14535899 DOI: 10.1034/j.1600-0781.2003.00030.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Ezzedine K, Malvy D, Mauger E, Nageotte O, Galan P, Hercberg S, Guinot C. Artificial and natural ultraviolet radiation exposure: beliefs and behaviour of 7200 French adults. J Eur Acad Dermatol Venereol 2008; 22:186-94. [PMID: 18211412 DOI: 10.1111/j.1468-3083.2007.02367.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Despite the increasing use of indoor tanning facilities, little is known regarding the behaviour of adults with respect to artificial and natural ultraviolet (UV) radiation exposure and the relationship between the two forms of exposure. OBJECTIVES To describe the beliefs and behaviour of French middle-aged volunteers regarding artificial and natural UV exposure. METHODS Cross-sectional study of a French national cohort using a self-completed questionnaire. RESULTS Participants were identified as 'indoor UV tanners' (n= 1076) and as 'non-users' (n= 6124). Predictor factors associated with indoor tanning were gender, age, smoking, phototype, region of residence, sun exposure during hobbies, voluntary sun exposure in particular during the hottest hours of the day, nudism practice, facial sunscreen habits, sunglass use, importance for lying in the sun and the claim 'ever heard of melanoma'. LIMITATIONS The quality of information may be limited by the data collection method. CONCLUSION Whereas indoor tanning should be discouraged, it seems that indoor tanners are also regular sunbathers unconcerned about the risk of photoageing and skin cancer occurrence. Moreover, indoor tanners seem to have more behavioural risk factors for cancer, such as smoking.
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Affiliation(s)
- K Ezzedine
- Unité 557, Unité mixte de recherche INSERM/INRA/CNAM, Paris, France
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Sayre RM, Dowdy JC. Indoor tanning exposure schedule: FDA pilot study flawed. PHOTODERMATOLOGY PHOTOIMMUNOLOGY & PHOTOMEDICINE 2007; 23:57-8; author reply 59-60. [PMID: 17254041 DOI: 10.1111/j.1600-0781.2007.00271.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Autier P. Perspectives in melanoma prevention: the case of sunbeds. Eur J Cancer 2004; 40:2367-76. [PMID: 15519507 DOI: 10.1016/j.ejca.2004.07.018] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2004] [Revised: 07/14/2004] [Accepted: 07/23/2004] [Indexed: 11/26/2022]
Abstract
The incidence of cutaneous malignant melanoma (melanoma) and of basal cell carcinoma is still increasing in most fair-skinned populations. The fashion of intermittent exposure to solar ultraviolet (UV) radiations is considered the main cause of this increase. In 20 years time, tan acquisition through exposure to artificial sources of UV radiations has become frequent among fair-skinned adolescents and young adults. Modern sunbeds are powerful sources of UV radiations that do not exist in the nature, and repeated exposures to high doses of UVA constitute a new phenomenon in humans. A large prospective cohort study on 106,379 Norwegian and Swedish women conducted between 1991 and 1999 has provided evidence for a significant, moderate increase in melanoma risk among regular sunbed users. Failure of past case-control studies to document with consistency the sunbed-melanoma association was probably due to a too short latency period between sunbed use and melanoma diagnosis, and to too few subjects with high total durations of sunbed use. Regulations of sunbed installation, operation and use should become standardised across the 25 European Union countries. Enforcement of regulations in tanning parlours remains inadequate. In contrast, the existence of regulations is presented by many tanning salon operators as a guarantee that sunbed use is safe. We stress the need for the control of information disseminated by the "tanning industry" on suppositions that sunbed use is safer than sun exposure, and on the hypothetical health benefits of tanning. New fluorescent UV lamps are proposed that have a spectrum similar to the midday sun. Given the known association between intermittent sun exposure and melanoma, public-health authorities should reconsider the soundness of the commercialisation of these lamps.
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Affiliation(s)
- Philippe Autier
- Unit of Epidemiology, Prevention and Screening, Jules Bordet Institute, Bd of Waterloo 121, Brussels 1000, Belgium.
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