Motivations among sexual-minority men for starting and stopping indoor tanning

The New Media Landscape and Its Effects on Skin Cancer Diagnostics, Prognostics, and Prevention: Scoping Review

BACKGROUND

The wide availability of web-based sources, including social media (SM), has supported rapid, widespread dissemination of health information. This dissemination can be an asset during public health emergencies; however, it can also present challenges when the information is inaccurate or ill-informed. Of interest, many SM sources discuss cancer, specifically cutaneous melanoma and keratinocyte cancers (basal cell and squamous cell carcinoma).

OBJECTIVE

Through a comprehensive and scoping review of the literature, this study aims to gain an actionable perspective of the state of SM information regarding skin cancer diagnostics, prognostics, and prevention.

METHODS

We performed a scoping literature review to establish the relationship between SM and skin cancer. A literature search was conducted across MEDLINE, Embase, Cochrane Library, Web of Science, and Scopus from January 2000 to June 2023. The included studies discussed SM and its relationship to and effect on skin cancer.

RESULTS

Through the search, 1009 abstracts were initially identified, 188 received full-text review, and 112 met inclusion criteria. The included studies were divided into 7 groupings based on a publication's primary objective: misinformation (n=40, 36%), prevention campaign (n=19, 17%), engagement (n=16, 14%), research (n=12, 11%), education (n=11, 10%), demographics (n=10, 9%), and patient support (n=4, 3%), which were the most common identified themes.

CONCLUSIONS

Through this review, we gained a better understanding of the SM environment addressing skin cancer information, and we gained insight into the best practices by which SM could be used to positively influence the health care information ecosystem.

A Social Media-Based Public Health Campaign to Reduce Indoor Tanning in High-Risk Populations

Introduction

Indoor tanning beds cause more than 450,000 new skin cancers each year, yet their use remains common, with a global indoor tanning prevalence of 10.4%. Social media provides an opportunity for cost-effective, targeted public health messaging. We sought to direct Instagram users at high risk of indoor tanning to accurate health information about the risks of indoor tanning and to reduce indoor tanning bed use.

Methods

We disseminated a public health campaign on Instagram on April 6-27, 2022 with 34 video and still-image advertisements. We had 2 target audiences at high risk of indoor tanning: women aged 18-30 years in Kentucky, Nebraska, Ohio, or Tennessee interested in indoor tanning and men aged 18-45 years in California interested in indoor tanning. To evaluate the impact of the campaign, we tracked online metrics, including website visits, and conducted an interrupted time-series analysis of foot traffic data in our target states for all tanning salons documented on SafeGraph from January 1, 2018 to 3 months after the campaign.

Results

Our indoor tanning health information advertisements appeared on Instagram feeds 9.1 million times, reaching 1.06 million individuals. We received 7,004 views of our indoor tanning health information landing page (Average Time on Page of 56 seconds). We did not identify a significant impact on foot traffic data on tanning salons.

Conclusions

We show the successful use of social media advertising to direct high-risk groups to online health information about indoor tanning. Future research quantifying tanning visits before and after indoor tanning interventions is needed to guide future public health efforts.

Indoor Tanning among Sexual and Gender Minority Adolescents and Adults: Results from the 2020 Pennsylvania LGBT Health Needs Assessment

Sexual and gender minority (SGM) populations include individuals whose sexual orientation, gender identity, or reproductive development is characterized by nonbinary sexual constructs (e.g., lesbian, gay, bisexual, and transgender (LGBT) individuals). Previous research suggests that some SGM populations have higher rates of skin cancer. The purpose of this study was to assess the association of diverse SGM identities with indoor tanning, a risk factor for skin cancer, while exploring other relevant co-occurring risk factors. A secondary analysis was performed on the 2020 LGBT Health Needs Assessment collected by the Pennsylvania Department of Health. Measures included sexual orientation, gender identity, healthcare utilization, and cancer risk factors. Cisgender SGM men are more likely to use indoor tanning devices (adjusted odds ratio (aOR) = 1.79; 95% CI: 1.31-2.44) compared to other SGM subpopulations independent of sexual orientation. Indoor tanning was also associated with alcohol (aOR = 1.94; 95% CI: 1.50-2.51) and tobacco use (aOR = 1.64; 95% CI: 1.21-2.21). Findings suggest that targeted screening for skin cancer risk behaviors could accompany standard tobacco and alcohol screenings in clinical practice.

An Epidemiological Update on Indoor Tanning and the Risk of Skin Cancers

Indoor tanning (sunbeds, solarium) uses artificial ultraviolet radiation (UVR) to stimulate cosmetic tanning of the skin. Indoor tanning has been officially classified as a human carcinogen in 2009 by the International Agency for Research on Cancer of the World Health Organization (WHO). The differences in the prevalence of sunbed use across countries and over the years highlight underlying legislative, climatic, and cultural differences. Indoor tanning-seeking behaviors may be driven by motivations for an appealing appearance, largely influenced by gender and age, and several misconceptions that a prevacation tan safeguards the skin, that sunbeds can be used to treat acne or to increase vitamin D, or that tanning is a healthy habit. This review provides an epidemiological update on the prevalence of sunbed use, who tends to use sunbeds and why, and details the current evidence on the association of sunbeds with skin cancers, including cutaneous melanoma, basal cell carcinoma (BCC), and cutaneous squamous cell carcinoma (cSCC). A statistically significant higher risk of cutaneous melanoma, BCC and cSCC with the use of sunbeds has been consistently demonstrated. This risk of skin cancer is even higher with the more frequent use of sunbeds, underscoring a dose-response relationship, and in those first exposed to sunbeds at a younger age. Preventive measures against sunbed use include legislation restricting sunbed use, educational campaigns to inform and discourage from indoor tanning, as well as using the internet, online advertising messages and the social media to reach larger audiences and to promote an untanned appearance.

Association Between Sexual Orientation and Lifetime Prevalence of Skin Cancer in the United States

Importance

Sexual minority men have reported higher rates of both indoor tanning and skin cancer than heterosexual men, and sexual minority women have reported lower or equal rates of both indoor tanning and skin cancer compared with heterosexual women. Bisexual men, in particular, have reported higher rates of indoor tanning bed use than heterosexual men; however, no study has investigated skin cancer prevalence among gay, lesbian, and bisexual individuals as separate groups.

Objective

To evaluate the association between sexual orientation and lifetime prevalence of skin cancer.

Design, Setting, and Participants

This cross-sectional study analyzed data from the 2014-2018 Behavioral Risk Factor Surveillance System (BRFSS) surveys of a noninstitutionalized population in the United States that included 877 650 adult participants who self-identified as being heterosexual, gay, lesbian, or bisexual.

Main Outcomes and Measures

Self-reported lifetime history of skin cancer.

Results

The study included 877 650 participants, including 364 833 heterosexual men (mean age, 47.7; 95% CI, 47.5-47.8), 7823 gay men (mean age, 42.7; 95% CI, 41.8-43.6), 5277 bisexual men (mean age, 39.4; 95% CI, 38.4-40.5), 484 341 heterosexual women (mean age, 49.7; 95% CI, 49.6-49.8), 5609 lesbian women (mean age, 41.8; 95% CI, 40.6-43.0), and 9767 bisexual women (mean age, 32.8; 95% CI, 32.3-33.3). The adjusted odds ratios (AORs) of skin cancer prevalence were significantly higher among both gay (AOR, 1.25; 95% CI, 1.03-1.50; P = .02) and bisexual men (AOR, 1.46; 95% CI, 1.01-2.10; P = .04) compared with heterosexual men. The AORs of skin cancer were statistically significantly lower among bisexual women (AOR, 0.75; 95% CI, 0.60-0.95; P = .02) but not among gay or lesbian women (AOR, 1.01; 95% CI, 0.77-1.33; P = .95) compared with the AORs of skin cancer among heterosexual women.

Conclusions and Relevance

In this study, gay and bisexual men had an increased self-reported lifetime prevalence of skin cancer compared with the prevalence among heterosexual men. Patient education and community outreach initiatives focused on reducing skin cancer risk behaviors among gay and bisexual men may help reduce the lifetime development of skin cancer in this population. Continued implementation of the Behavioral Risk Factor Surveillance System's sexual orientation and gender identity module is imperative to improve understanding of the health and well-being of sexual minority populations.

Skin cancer and skin cancer risk behaviors among sexual and gender minority populations: A systematic review

BACKGROUND

Individuals of sexual and gender minorities may have different lifetime risk of skin cancer and ultraviolet radiation exposure than heterosexual persons.

OBJECTIVE

To systematically review the prevalence of skin cancer and behaviors that increase risk of skin cancer among sexual and gender minority populations.

METHODS

We performed a systematic literature review in PubMed/MEDLINE, Embase, Cochrane, and Web of Science, searching for articles through October 18, 2019, that investigated risk of skin cancer and behaviors among sexual and gender minority populations.

RESULTS

Sexual minority men have a higher lifetime risk of any skin cancer (odds ratio range: 1.3-2.1) and indoor tanning bed use (odds ratio range: 2.8-5.9) compared with heterosexual men, whereas sexual minority women may use indoor tanning beds less frequently than heterosexual women and do not have an elevated risk of lifetime history of skin cancer. Gender-nonconforming individuals have higher lifetime prevalence of any skin cancer compared with cisgender men.

LIMITATIONS

Most variables rely on self-reporting in their original studies.

CONCLUSIONS

Sexual minority men disproportionately engage in use of indoor tanning beds, which may result in increased lifetime risk of skin cancer. Recognition of this risk is important for providing appropriate screening for patients in this population.

Historical and Current State of Dermatologic Care for Sexual and Gender Minority Populations

The lesbian, gay, bisexual, transgender, and queer or questioning/sexual and gender minority (LGBTQ/SGM) community is a growing population with unique lifestyles, sexual practices, beliefs, health issues, and concerns. Although significant advances have been achieved in recent years to establish better care for LGBTQ/SGM patients, they still face insurmountable stigmatization and health care inequality. Dermatologists play an important role in LGBTQ/SGM patients' well-being because they not only treat their skin conditions, but also help them achieve desirable physical characteristics. This article discusses historical perspectives and current state of LGBTQ/SGM dermatology and attempts to define directions for future research and improvement.

Skin Cancer and Skin Cancer Risk Factors in Sexual and Gender Minorities

Sexual and gender minorities have unique risk factors that may increase their risk of developing skin cancer. In particular, sexual minority men report a higher prevalence of skin cancer (including both keratinocytes carcinomas and melanoma), higher rates of indoor tanning, and overall poorer sun protection behaviors. Sexual and gender minorities also have high rates of alcohol and tobacco use, and infection with human immunodeficiency virus and human papillomavirus, which may increase overall risk of developing skin cancer in these populations. In this review, we discuss the evidence surrounding skin cancer and associated risk factors among sexual and gender minorities.

Association of Number of Indoor Tanning Salons With Neighborhoods With Higher Concentrations of Male-Male Partnered Households

IMPORTANCE

Both indoor tanning and skin cancer are more common among sexual-minority men, defined as gay and bisexual men, than among heterosexual men. Convenient access to indoor tanning salons may influence use patterns.

OBJECTIVE

To investigate whether indoor tanning salons are disproportionately located in areas with higher concentrations of gay men.

DESIGN, SETTING, AND PARTICIPANTS

This cross-sectional study used geographic information systems to integrate census data and business location data obtained from ArcGIS and Google Maps for the 10 US cities with the largest lesbian, gay, bisexual, and transgender populations in 2010, ie, Los Angeles, California; Chicago, Illinois; San Francisco, California; Seattle, Washington; San Diego, California; Dallas, Texas; Phoenix, Arizona; Washington, DC; Portland, Oregon; and Denver, Colorado. The association of indoor tanning salon locations with proportions of gay men, using the concentration of male-male partnered households as a proxy measure for the latter, was examined. Data analysis was performed in October 2018.

EXPOSURES

Census tracts with at least 1%, 5%, or 10% male-male partnered households, adjusting for median household income, percentage young women, and percentage non-Hispanic white residents.

MAIN OUTCOMES AND MEASURES

Presence of 1 or more indoor tanning salons within census tracts.

RESULTS

Across the 10 cities and 4091 census tracts in this study, there were 482 823 unmarried partnered households, of which 35 164 (7.3%) were male-male. The median (interquartile range) percentage of male-male partnered households per census tract was 0% (0%-10.6%). Odds of indoor tanning salon presence in areas with at least 10% male-male households were more than twice those of areas with less than 10% male-male households (odds ratio, 2.17; 95% CI, 1.59-2.97). When sensitivity analyses using a 1-mile euclidian buffer around each tanning salon were conducted, this association remained significant (odds ratio, 2.48; 95% CI, 2.14-2.88). After adjusting for median household income, percentage young women, and percentage non-Hispanic white residents, the odds of an indoor tanning salon being within 1 mile of a census tract with at least 10% male-male households remained twice that of census tracts with less than 10% male-male households (odds ratio, 2.00; 95% CI, 1.71-2.35).

CONCLUSIONS AND RELEVANCE

In this study, indoor tanning salons were more likely to be located near neighborhoods with higher concentrations of male-male partnered households, possibly contributing to the disproportionate use of indoor tanning by sexual-minority men.