Comprehensive evaluation of indoor tanning regulations: a 50-state analysis, 2012

Assessing the content and comprehensiveness of provincial and territorial indoor tanning legislation in Canada

INTRODUCTION

Canadian provincial and territorial governments have enacted legislation in response to health risks of artificial ultraviolet radiation from indoor tanning. This legislation, which differs from jurisdiction to jurisdiction, regulates the operation of indoor tanning facilities. The content and comprehensiveness of such legislation-and its differences across jurisdictions-have not been analyzed. To address this research gap, we conducted a systematic, comprehensive scan and content analysis on provincial and territorial indoor tanning legislation, including regulations and supplementary information.

METHODS

Legislative information was collected from the Canadian Legal Information Institute database and an environmental scan was conducted to locate supplementary information. Through a process informed by the content of the legislation, previous research and health authority recommendations, we developed a 59-variable codebook. Descriptive statistics were calculated.

RESULTS

All provinces and one of three territories have legislation regulating indoor tanning. Areas of strength across jurisdictions are youth access restrictions (n = 11), posting of warning signs (n = 11), penalties (n = 11) and restrictions on advertising and marketing targeted to youth (n = 7). Few jurisdictions, however, cover areas such as protective eyewear (n = 4), unsupervised tanning (n = 4), provisions for inspection frequency (n = 4), misleading health claims in advertisements directed toward the general public (n = 2) and screening of high-risk clients (n = 0).

CONCLUSION

All provinces and one territory have made progress in regulating the indoor tanning industry, particularly by prohibiting youth and using warning labels to communicate risk. Legislative gaps should be addressed in order to better protect Canadians from this avoidable skin cancer risk.

Pediatric melanoma: Characterizing 256 cases from the Colorado Central Cancer Registry

BACKGROUND

Melanoma is a rare diagnosis in the pediatric population. Differences in incidence, presentation, and survival distinguish pediatric melanoma from adult melanoma. In order to improve our understanding of pediatric melanoma, our case series investigates differences in incidence, age of onset, and anatomic site between male and female pediatric melanoma patients in Colorado between 1988 and 2015.

METHODS

All data were gathered from the Colorado Central Cancer Registry. A request for de-identified data on pediatric melanoma patients between 1988 and 2015 was made by the University of Colorado Department of Dermatology. Chi-square tests were used to compare the differences reported in melanoma between sex, age-groups, and site of lesion.

RESULTS

A total of 256 cases of melanoma were reported in Colorado in patients < 20 years of age between 1988 and 2015. Overall incidence of pediatric melanoma in Colorado increased from 1988 to 1999 but declined from 2001 to 2011. There was a significant predominance of female cases in the 10-14 age-group (P = 0.0477) and 15-19 age-group (P = 0.0472). Both groups had increased incidence of melanoma with increasing age. The mean age of onset for both sexes was 16 years old. Boys were more likely to have melanoma of the scalp and neck (P = 0.0523) and less likely to have melanoma of the leg (P = 0.0049).

CONCLUSION

Among the pediatric population, girls 10-14 and 15-19 years old are at a significantly increased risk of melanoma compared to boys in these age-groups. Our study found sex-specific differences in anatomic site consistent with prior literature. Further investigations should aim to identify causes for these sex-specific differences in order to better guide public health initiatives.

Engaging Moms on Teen Indoor Tanning Through Social Media: Protocol of a Randomized Controlled Trial

BACKGROUND

Indoor tanning elevates the risk for melanoma, which is now the most common cancer in US women aged 25-29. Public policies restricting access to indoor tanning by minors to reduce melanoma morbidity and mortality in teens are emerging. In the United States, the most common policy restricting indoor tanning in minors involves parents providing either written or in person consent for the minor to purchase a tanning visit. The effectiveness of this policy relies on parents being properly educated about the harms of indoor tanning to their children.

OBJECTIVE

This randomized controlled trial will test the efficacy of a Facebook-delivered health communication intervention targeting mothers of teenage girls. The intervention will use health communication and behavioral modification strategies to reduce mothers' permissiveness regarding their teenage daughters' use of indoor tanning relative to an attention-control condition with the ultimate goal of reducing indoor tanning in both daughters and mothers.

METHODS

The study is a 12-month randomized controlled trial comparing 2 conditions: an attention control Facebook private group where content will be relevant to teen health with 25% focused on prescription drug abuse, a topic unrelated to tanning; and the intervention condition will enter participants into a Facebook private group where 25% of the teen health content will be focused on indoor tanning. A cohort of 2000 mother-teen daughter dyads will be recruited to participate in this study. Only mothers will participate in the Facebook groups. Both mothers and daughters will complete measures at baseline, end of intervention (1-year) and 6 months post-intervention. Primary outcomes include mothers' permissiveness regarding their teenage daughters' use of indoor tanning, teenage daughters' perception of their mothers' permissiveness, and indoor tanning by both mothers and daughters.

RESULTS

The first dyad was enrolled on March 31, 2016, and we anticipate completing this study by October 2019.

CONCLUSIONS

This trial will deliver social media content grounded in theory and will test it in a randomized design with state-of-the-art measures. This will contribute much needed insights on how to employ social media for health behavior change and disease prevention both for indoor tanning and other health risk behaviors and inform future social media efforts by public health and health care organizations.

CLINICALTRIAL

Clinicaltrials.gov NCT02835807; https://clinicaltrials.gov/ct2/show/NCT02835807 (Archived by WebCite at http://www.webcitation.org/6mDMICcCE).

Correlates of Sun Protection and Sunburn in Children of Melanoma Survivors

INTRODUCTION

Sunburns during childhood increase melanoma risk. Children of melanoma survivors are at higher risk, but little is known about their sunburn and sun protection. One study showed that almost half of melanoma survivors' children experienced sunburn in the past year. This study evaluated sunburn and sun protection in melanoma survivors' children, and relevant survivor characteristics from Social Cognitive Theory and the Health Belief Model.

METHODS

Melanoma survivors (N=340) were recruited from a comprehensive cancer center. Survivors completed a baseline questionnaire administered by telephone to report on the behavior of their children (N=340) as part of an RCT of a sun protection intervention. Data were collected in 2008 and analyzed in 2015.

RESULTS

In the prior 6 months, 28% of children experienced sunburn. "Always" or "frequent" sun protection varied by behavior: sunscreen, 69%; lip balm, 15%; wide-brimmed hats, 9%; sleeved shirts, 28%; pants, 48%; sunglasses, 10%; shade, 33%; and limiting time outdoors, 45%. Survivors' sunburn and sun protection were positively associated with these outcomes in children. Correlates of sunburn also included older child age and higher risk perceptions. Correlates of sun protection behaviors included younger child age; stronger intentions, higher self-efficacy, and more positive outcome expectations about sun protection; and greater number of melanomas in survivors.

CONCLUSIONS

Melanoma survivors may have a heightened awareness of the importance of their children's sun protection, but their children are not routinely protected. Correlates of children's sunburn and sun protection suggest subgroups of survivors to target with interventions to improve sun protection.

Enforcement Provisions of Indoor Tanning Bans for Minors: An Analysis of the First 6 US States

Several states have passed legislation banning minors from indoor tanning; however, concern has been raised regarding enforcement. We explored the statutes pertaining to enforcement in the first 6 US states to pass legislation banning minors younger than 18 years from indoor tanning. The findings reflect significant variability in enforcement provisions across the 6 states. Further investigations are needed to determine whether the statutes are successful in curbing indoor tanning among youths and ultimately whether indoor tanning bans among minors help to reduce skin cancer incidence.

Indoor tanning in businesses and homes and risk of melanoma and nonmelanoma skin cancer in 2 US case-control studies

BACKGROUND

Indoor tanning increases skin cancer risk. Beyond early research describing melanoma and sun lamps, few recent reports describe where individuals indoor tan and whether skin cancer risk varies by location (business, home-based).

OBJECTIVE

We sought to assess where individuals tanned indoors and skin cancer risk by tanning device location.

METHODS

Multivariate logistic regression was conducted in 2 US case-control studies of melanoma (1161 cases, 1083 controls, ages 25-59 years) and early-onset basal cell carcinoma (375 cases, 382 controls, age<40 years) conducted between 2004 and 2010.

RESULTS

Most indoor tanners (86.4%-95.1%), especially younger individuals, tanned exclusively in businesses. Persons who used indoor tanning exclusively in businesses were at increased risk of melanoma (odds ratio 1.82, 95% confidence interval 1.47-2.26) and basal cell carcinoma (odds ratio 1.69, 95% confidence interval 1.15-2.48) compared with non-users. Melanoma risk was also increased in the small number who reported tanning indoors only at home relative to non-users (odds ratio 4.14, 95% confidence interval 1.75-9.78); 67.6% used sun lamps.

LIMITATIONS

Self-reported tanning and potential recall bias are limitations.

CONCLUSION

Business-only tanning, despite claims of "safe" tanning, was positively associated with a significant risk of melanoma and basal cell carcinoma. Home tanning was uncommon and mostly from sun lamps, which were rarely used by younger participants. Regardless of location, indoor tanning was associated with increased risk of skin cancer.

Early-onset basal cell carcinoma and indoor tanning: a population-based study

OBJECTIVE

Indoor tanning with UV radiation-emitting lamps is common among adolescents and young adults. Rising incidence rates of basal cell carcinoma (BCC) have been reported for the United States and elsewhere, particularly among those diagnosed at younger ages. Recent epidemiologic studies have raised concerns that indoor tanning may be contributing to early occurrence of BCC, and younger people may be especially vulnerable to cancer risk associated with this exposure. Therefore, we sought to address these issues in a population-based case-control study from New Hampshire.

METHODS

Data on indoor tanning were obtained on 657 cases of BCC and 452 controls ≤50 years of age.

RESULTS

Early-onset BCC was related to indoor tanning, with an adjusted odds ratio (OR) of 1.6 (95% confidence interval, 1.3-2.1). The strongest association was observed for first exposure as an adolescent or young adult, with a 10% increase in the OR with each age younger at first exposure (OR per year of age ≤23 = 1.1; 95% confidence interval, 1.0-1.2). Associations were present for each type of device examined (ie, sunlamps, tanning beds, and tanning booths).

CONCLUSIONS

Our findings suggest early exposure to indoor tanning increases the risk of early development of BCC. They also underscore the importance of counseling adolescents and young adults about the risks of indoor tanning and for discouraging parents from consenting minors to this practice.