Predictors of Tanning Salon Use

Reasons for using indoor tanning devices: A systematic review of qualitative evidence

PURPOSE

Despite the established causal links to skin cancer, skin ageing and eye inflammation, people continue to use indoor tanning devices (hereafter 'sunbeds'). Understanding the reasons underlying the use of sunbeds is essential for developing effective interventions. The purpose of this study was to collate all existing evidence from qualitative papers published to date that had assessed motivations for using sunbeds.

METHODS

Six databases were searched from inception to February 2020 for qualitative studies that explored adults' experiences of using sunbeds. Sixteen studies met the inclusion criteria, and a narrative evidence synthesis was used to collate findings from each primary study.

RESULTS

Users of sunbeds were motivated primarily by aesthetic concerns but also by perceived psychological benefits (well-being, confidence and 'fitting in') and physical benefits (improvement in skin conditions such as acne, acquiring vitamin D and preventing sunburn). People also chose indoor tanning over alternatives such as fake tans because they considered the alternatives unacceptable and did not consider indoor tanning a serious health risk. To date, no studies have explored alternatives to meeting non-aesthetic needs related to the use of sunbeds.

CONCLUSIONS

This comprehensive explanation for the practice of indoor tanning provides the basis for development of complex interventions to reduce the harm caused by using sunbeds. Effective interventions should include promotion of alternatives, such as different methods of relaxing, to satisfy underlying motivations, changing social norms and correcting misperceptions about health benefits.

Appearance, Friends, and Feelings: A Two-Study Exploration of Young Women's Emotional Associations and Indoor Tanning Frequency

BACKGROUND

Knowledge of its potential cancer risk is often not enough to motivate individuals to avoid indoor tanning. Previous research has found that emotions toward indoor tanning and appearance motivations may prompt people to continue despite the risks.

METHODS

We conducted two online surveys of US young adult women. Study one included a convenience sample of female undergraduates (N = 502) at a university in the northwestern USA. Study two included young women from a nationwide US online panel (N = 270).

RESULTS

Results suggest that emotional associations, both positive and negative, with indoor tanning explain greater variances in indoor tanning behavior than demographics and previously established psychosocial predictors of tanning alone. Appearance motivations were also positively associated with indoor tanning in both samples.

CONCLUSIONS

This research has implications for health care providers and health communicators, as indoor tanning prevention messages and campaigns should consider the association between both positive and negative emotions on tanning behaviors as well as appearance motivations.

Trending on Pinterest: an examination of pins about skin tanning

Rates of melanoma and nonmelanoma skin cancers are on the rise in the USA with data revealing disproportionate increase in female young adults. The popularity of intentional skin tanning among U.S. adolescents is attributed to several factors, including prioritization of physical appearance, media images of tanned celebrities, ease of availability of artificial tanning facilities, and more recently, the prevalence and celebration of tanned skin on social media. Pinterest, as the third most popular social media platform, was searched for "pins" about skin tanning. The resultant "pins" were examined to understand the extent and characteristics of skin tanning portrayed on Pinterest. We analyzed pins on Pinterest about skin tanning (n = 501) through a quantitative content analysis. Overall, results indicated an overwhelmingly protanning characteristic of pins about skin tanning on Pinterest, with over 85% of pins promoting tanning behavior. The pins were generally characterized by the portrayal of a female subject (61%) and provided positive reinforcement for tanning (49%). Use of tanning for enhancing appearance was the main positive outcome expectancy portrayed in the pins (35%), and nudity or exposure of skin on arms (32%) and legs (31%) was evident in about a third of pins. With overwhelmingly positive pins promoting tanning, use of female subjects, exhibiting nudity, and appearance enhancement, there seems be to a consistent targeting of female users to accept tanning as a socially acceptable and popular behavior. The findings indicate a need for developing sun protection messages and the leveraging of social media for dissemination of skin cancer prevention and detection messages.

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.

A Web-Based Intervention to Reduce Indoor Tanning Motivations in Adolescents: a Randomized Controlled Trial

Youthful indoor tanning as few as ten sessions can increase the risk of melanoma by two to four times with each additional session adding another 2 % to the risk. Recent research estimates that indoor tanning can be linked to approximately 450,000 cases of skin cancer annually in the USA, Europe, and Australia. Despite these risks, indoor tanning remains popular with adolescents. This study tested the efficacy of a web-based skin cancer prevention intervention designed to reduce indoor tanning motivations in adolescent females. A nationally representative sample of 443 female teens was enrolled from an online panel into a two-arm, parallel group design, randomized controlled trial. Treatment participants received an appearance-focused intervention grounded in established health behavior change models. Controls viewed a teen alcohol prevention website. Outcome variables included willingness and intentions to indoor tan, willingness to sunless tan, and measures of indoor tanning attitudes and beliefs. The intervention decreased willingness and intentions to indoor tan and increased sunless tanning willingness relative to controls. We also examined indirect mechanisms of change through intervening variables (e.g., indoor tanning attitudes, norms, positive and negative expectancies) using the product of coefficient approach. The web-based intervention demonstrated efficacy in changing adolescent indoor tanning motivations and improving their orientation toward healthier alternatives. Results from the intervening variable analyses give guidance to future adolescent skin cancer prevention interventions.

Does therapeutic writing help people with long-term conditions? Systematic review, realist synthesis and economic considerations

BACKGROUND

Writing therapy to improve physical or mental health can take many forms. The most researched model of therapeutic writing (TW) is unfacilitated, individual expressive writing (written emotional disclosure). Facilitated writing activities are less widely researched.

DATA SOURCES

Databases, including MEDLINE, EMBASE, PsycINFO, Linguistics and Language Behaviour Abstracts, Allied and Complementary Medicine Database and Cumulative Index to Nursing and Allied Health Literature, were searched from inception to March 2013 (updated January 2015).

REVIEW METHODS

Four TW practitioners provided expert advice. Study procedures were conducted by one reviewer and checked by a second. Randomised controlled trials (RCTs) and non-randomised comparative studies were included. Quality was appraised using the Cochrane risk-of-bias tool. Unfacilitated and facilitated TW studies were analysed separately under International Classification of Diseases, Tenth Revision chapter headings. Meta-analyses were performed where possible using RevMan version 5.2.6 (RevMan 2012, The Cochrane Collaboration, The Nordic Cochrane Centre, Copenhagen, Denmark). Costs were estimated from a UK NHS perspective and three cost-consequence case studies were prepared. Realist synthesis followed Realist and Meta-narrative Evidence Synthesis: Evolving Standards guidelines.

OBJECTIVES

To review the clinical effectiveness and cost-effectiveness of TW for people with long-term conditions (LTCs) compared with no writing, or other controls, reporting any relevant clinical outcomes. To conduct a realist synthesis to understand how TW might work, and for whom.

RESULTS

From 14,658 unique citations, 284 full-text papers were reviewed and 64 studies (59 RCTs) were included in the final effectiveness reviews. Five studies examined facilitated TW; these were extremely heterogeneous with unclear or high risk of bias but suggested that facilitated TW interventions may be beneficial in individual LTCs. Unfacilitated expressive writing was examined in 59 studies of variable or unreported quality. Overall, there was very little or no evidence of any benefit reported in the following conditions (number of studies): human immunodeficiency virus (six); breast cancer (eight); gynaecological and genitourinary cancers (five); mental health (five); asthma (four); psoriasis (three); and chronic pain (four). In inflammatory arthropathies (six) there was a reduction in disease severity [n = 191, standardised mean difference (SMD) -0.61, 95% confidence interval (CI) -0.96 to -0.26] in the short term on meta-analysis of four studies. For all other LTCs there were either no data, or sparse data with no or inconsistent, evidence of benefit. Meta-analyses conducted across all of the LTCs provided no evidence that unfacilitated emotional writing had any effect on depression at short- (n = 1563, SMD -0.06, 95% CI -0.29 to 0.17, substantial heterogeneity) or long-term (n = 778, SMD -0.04 95% CI -0.18 to 0.10, little heterogeneity) follow-up, or on anxiety, physiological or biomarker-based outcomes. One study reported costs, no studies reported cost-effectiveness and 12 studies reported resource use; and meta-analysis suggested reduced medication use but no impact on health centre visits. Estimated costs of intervention were low, but there was insufficient evidence to judge cost-effectiveness. Realist synthesis findings suggested that facilitated TW is a complex intervention and group interaction contributes to the perception of benefit. It was unclear from the available data who might benefit most from facilitated TW.

LIMITATION

Difficulties with developing realist synthesis programme theory meant that mechanisms operating during TW remain obscure.

CONCLUSIONS

Overall, there is little evidence to support the therapeutic effectiveness or cost-effectiveness of unfacilitated expressive writing interventions in people with LTCs. Further research focused on facilitated TW in people with LTCs could be informative.

STUDY REGISTRATION

This study is registered as PROSPERO CRD42012003343.

FUNDING

The National Institute for Health Research Health Technology Assessment programme.

An online skin cancer risk-reduction intervention for young adults: Mechanisms of effects

OBJECTIVE

The study's purpose was to investigate moderator, implementation, and mediator variables related to the efficacy of UV4.me, an Internet intervention that decreased ultraviolet radiation (UV) exposure and increased skin protection behaviors among young adults.

METHOD

A total of 965 18-25 year olds at risk for skin cancer were recruited nationally online. Participants were randomized to an experimental website (UV4.me), a control website, or assessment only. Participant characteristics (moderators), engagement with and perceptions of interventions (implementation measures), and exposure and protection attitudinal variables (mediators) were assessed. Linear regression and mediation analyses were conducted.

RESULTS

Intervention effects on skin protection were greater for participants with a family history of skin cancer (p = .01). Intervention effects on UV exposure were greater among recent indoor tanners (p = .04). Improvements in skin protection (but not UV exposure) were associated with perceiving the interventions as satisfying or helpful (ps < .01). The experimental group had better outcomes if they completed more modules (ps < .01) or set more behavioral goals (ps < .01). Knowledge and exposure decisional balance mediated intervention effects for UV exposure (ps < .05), and protection decisional balance, self-efficacy, and intentions mediated intervention effects for protection (ps < .05).

CONCLUSIONS

The experimental intervention was more efficacious for certain high risk groups. The more individuals liked and engaged with the interventions (e.g., by setting goals), the better their outcomes. Mediation results inform theory about change mechanisms and differed by behavioral outcome. (PsycINFO Database Record

Efficacy of an Intervention to Alter Skin Cancer Risk Behaviors in Young Adults

INTRODUCTION

Skin cancer is the most common cancer, and its incidence is increasing. Young adults expose themselves to large amounts of ultraviolet radiation (UV) and engage in minimal skin protection, which increases their risk. Internet interventions are effective in modifying health behaviors and are highly disseminable. The current study's purpose was to test an Internet intervention to decrease UV exposure and increase skin protection behavior among young adults.

STUDY DESIGN

RCT conducted in 2014, with data analyzed in 2015.

SETTING/PARTICIPANTS

A national sample of adults aged 18-25 years at moderate to high risk of developing skin cancer by a self-report measure was recruited online.

INTERVENTION

Participants were randomized to one of three intervention conditions: assessment only, the website of a skin cancer organization, or a tailored interactive multimedia Internet intervention program (UV4.me) based on the Integrative Model of Behavioral Prediction.

MAIN OUTCOME MEASURES

Self-reported overall UV exposure and skin protection assessed at 3 and 12 weeks after baseline. Secondary outcomes were self-reported intentional and incidental UV exposure, sunburns, sunscreen use, and skin cancer screening.

RESULTS

For the intervention arm, there were significant decreases in UV exposure and increases in skin protection at both follow-up time points compared with the assessment-only condition (p<0.001). The effect sizes (Cohen's d) comparing the experimental and assessment-only arm for exposure behaviors were 0.41 at 3-week follow-up and 0.43 at 12-week follow-up. The effect sizes for protection behaviors were 0.41 at 3-week follow-up and 0.53 at 12-week follow-up. The control condition was not significantly different from the assessment only condition. All three conditions exhibited decreased exposure and increased protection at both follow-ups (p<0.01), but the effect was much stronger in the intervention group. Secondary outcomes were generally also significantly improved in the intervention condition compared with the other conditions.

CONCLUSIONS

This is the first published report describing the results of an RCT of an Internet intervention to modify skin cancer risk behaviors among young adults. The UV4.me intervention significantly improved self-reported skin cancer prevention behaviors. Future research will investigate mechanisms of change and approaches for dissemination.

TRIAL REGISTRATION

This study is registered at www.clinicaltrials.gov NCT02147080.

Development of an Internet Intervention to Address Behaviors Associated with Skin Cancer Risk among Young Adults

PURPOSE

Skin cancer is the most common cancer in the US, and its incidence is increasing. The major risk factor for skin cancer is exposure to ultraviolet radiation (UV). Young adults tend to expose themselves to large amounts of UV and engage in minimal skin protection, which increases their skin cancer risk. Interventions are needed to address risk behaviors among young adults that may lead to skin cancer. The nternet offers a cost-effective way to widely disseminate efficacious interventions. The current paper describes the development of an online skin cancer risk reduction intervention (UV4.me) for young adults.

PROCEDURES

The iterative development process for UV4.me followed best-practice guidelines and included the following activities: individual interviews, focus groups, content development by the expert team, acceptability testing, cognitive interviewing for questionnaires, quality control testing, usability testing, and a pilot randomized controlled trial. Participant acceptability and usability feedback was assessed.

PRINCIPAL RESULTS

The development process produced an evidence-informed intervention that is individually-tailored, interactive, and multimedia in nature based on the Integrative Model of Behavior Prediction, a model for internet interventions, and other best-practice recommendations, expert input, as well as user acceptability and usability feedback gathered before, during, and after development.

MAJOR CONCLUSIONS

Development of an acceptable intervention intended to have a significant public health impact requires a relatively large investment in time, money, expertise, and ongoing user input. Lessons learned and recommendations are discussed. The comprehensive process used may help prepare others interested in creating similar behavioral health interventions.

Body-tanning attitudes among female college students

This study investigated the attitudes of body-tanning behaviors: suntanning, tanning bed, tanning spray, and sunless tanning product use. Data collected from 208 female college students (M age = 19.8 yr., SD = 2.0; M weight = 63.3 kg, SD = 2.0; M height = 165.9 cm, SD = 8.1) online. The questionnaire comprised four constructs: appearance-based, health-based, and emotion-based tanning attitudes, and body-tanning behaviors. Both appearance-based and emotion-based pro-tanning attitudes were associated with significantly higher body-tanning behaviors. However, health-based pro-tanning attitudes did not significantly affect body-tanning behaviors. The results from both UV- and non-UV exposure-related tanning behaviors provide future intervention strategies, such as establishing a positive body image without a tan and identifying negative emotional consequences as a result of 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.

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.

The role of body image and depression in tanning behaviors and attitudes

In the current study, we examined correlates of tanning behaviors and attitudes. Undergraduates (N = 277; 53% female; average age = 19.27 years) completed measures of appearance orientation and appearance evaluation from the Multidimensional Body-Self Relations Questionnaire, the Center for Epidemiological Studies Depression Scale, and questions addressing tanning behaviors and attitudes. Women were more likely to engage in indoor tanning and perceived greater susceptibility to photoaging than men. Body image and depression were associated with tanning behaviors and attitudes. Results suggest that psychological factors are important motivators of both indoor and outdoor tanning, although each has unique correlates. Implications for reducing risky tanning behaviors 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.

The Role of Skin Color on Hispanic Women’s Perceptions of Attractiveness

This study relies on qualitative methods to investigate Hispanic women’s skin color perceptions. The primary goal is to identify the relevance of these perceptions on their beliefs about their own physical attractiveness. Thirty-four self-identified White-Hispanic women attending a large Hispanic Serving Institution in the southeastern United States were interviewed for this study. Unlike previous research findings on Hispanic women’s skin color preferences, findings identified a “tan” skin color as preferred; pale skin was viewed as “plain” and unattractive. This preference was associated with four themes about physical attractiveness: (1) desirability among their peer groups, (2) increased value in dating contexts, (3) sexual appeal to men, and (4) marker of Hispanic identity in social contexts. Findings from this study are important for those researchers addressing identity development and relationship issues among Hispanic populations in the United States.

Harm minimization in tan seekers: an exploration of tanning behaviour and the potential for substitutional use of sunless tanning products

Exposure to ultraviolet (UV) light from the sun or solaria is a major contributor to high rates of skin cancer. The study aimed to explore the intentions of active tan seekers in relation to the substitutional use of sunless tanning products. Participants were reluctant to reduce UV exposure in favour of using sunless tanning products, which were considered to be another tanning method rather than an avenue for reducing skin cancer risk. The 'sunless tan' approach is unlikely to reduce UV exposure in the majority of tan seekers, but may be valuable in targeting women with fairer skin.

Moderated mediation regarding the sun-safe behaviors of U.S. Latinos: advancing the theory and evidence for acculturation-focused research and interventions

Recent studies revealed a negative association between acculturation and sun-safe behaviors, possibly mediated by education level, health status, and social networks. We sought to elucidate this relationship by exploring the moderating effects of gender and health insurance on each mediated path. We used data from 496 Latino respondents to the 2005 Health Information National Trends Survey. Acculturation, assessed by a four-item index, was the primary predictor; use of sunscreen and protective clothing were the primary outcomes, assessed by frequency scales. Moderated mediation was tested with an established causal moderation method. The mediated association between acculturation, education level and sunscreen use might be stronger among women than men (P < 0.08). We found no evidence of moderated mediation for use of protective clothing. The findings suggest ways of refining the theoretical and empirical rationale for sun safety research and interventions with Latinos. Studies should replicate these models with longitudinal data.

Indoor tanning, mental health, and substance use among college students: the significance of gender

This study examined relations among indoor tanning frequency, symptoms of depression, anxiety, and obsessive-compulsive disorder, and substance use. A total of 421 college students (68% female) completed self-report measures on one occasion. Among men, indoor tanning was positively associated with symptoms of anxiety and obsessive-compulsive disorder, whereas indoor tanning was unrelated to these symptoms among women. Among women, indoor tanning was positively associated with the use of alcohol, tobacco, and other substances. Further research is needed to explore contextual and coping processes that may underlie these gender differences.

A comparison of the efficacy of an appearance-focused skin cancer intervention within indoor tanner subgroups identified by latent profile analysis

The reduction of intentional exposure to ultraviolet (UV) radiation is an important area of skin cancer prevention. Hillhouse et al. (Cancer 113:3257-3266, 2008) have developed an appearance-focused intervention with evidence of efficacy in lowering indoor tanning UV exposure in young women. In the current study, a subgroup approach was used to determine moderators of intervention efficacy. Undergraduate females in two regions of the United States (n = 362) were randomized into an intervention or control condition. Latent profile analysis was used to identify subgroups of indoor tanners based on patterns of indoor tanning motives. Intervention efficacy was examined within each subgroup. We found evidence for 4 subgroups of tanners: knowledgeable-appearance tanners, low-knowledge tanners, low-knowledge, relaxation tanners, and knowledgeable, low-appearance and low-relaxation tanners. The intervention significantly reduced indoor tanning for the low-knowledge subgroup (34% of the sample). The utility of the subgroup approach in developing targeted behavioral skin cancer interventions is discussed.

Who uses sunbeds? A systematic literature review of risk groups in developed countries

Skin cancer is caused by ultraviolet radiation (UVR). Indoor tanning is a totally avoidable risk behaviour. This review addresses the specific characteristics of sunbed users and the differences in motivation and risk perception compared with non-users. This review is based solely on empirical original articles. Based on literature searches with widely used reference databases ('PubMed', 'OVID', 'Social Citation Index', 'ERIC--Educational Resources Information Center', 'Web of Science' and the 'International Bibliography of the Social Sciences'), we included studies from developed nations with a publication date between 1 January 2000 and 12 August 2008. All studies were selected, classified and coded simultaneously by both authors on a blinded basis. All searches were performed on 13 and 14 August 2008. In accordance with the QUOROM and the MOOSE Statements, we identified 16 original studies. The typical sunbed user is female, between 17 and 30 years old, and tends to live a comparatively unhealthy lifestyle: Users smoke cigarettes and drink alcohol more frequently and eat less healthy food than non-users. Users are characterized by a lack of knowledge about health risks of UVR, and prompted by the frequent use of sunbeds by friends or family members and the experience of positive emotions and relaxation by indoor tanning. This review is the first systematic review on risk groups among sunbed users that has been published in a scientific journal. There is still a lack of information among users, particularly among young people regarding the safety of solariums.

Adolescent attitudes towards tanning: does age matter?

Adolescents seem to be obsessed with tanning. One third of both adolescents and adults report sunbathing. On average, about 20% of adolescents report ever-using of artificial UV tanning devices with 15% currently using them. Tanning attitudes appear similar for adolescents and adults. The top three reasons for tanning included beliefs that a tan makes them more comfortable socializing with friends, looks better and is attractive. The top reason for using artificial UV tanning devices is also aesthetics, followed by relaxation. Other reasons for using artificial UV tanning devices include vacation preparation and to gain a protective base. Attitudes related to appearance that result in more frequent tanning may be difficult to change.

Unveiled

This study investigated the prevalence of appearance and weight-related concerns in 879 Australian brides-to-be recruited from five bridal websites. Close to 75 per cent of the sample intended to exercise more and follow a ‘healthy eating plan’, while over 35 per cent planned to cut fat or carbohydrates out of their diets. On average, participants wished to lose over 8kg (18lbs) by their wedding day, and one-third had been told to lose weight by someone else for the wedding. These findings demonstrate the salience of appearance concerns among brides-to-be and highlight the need to promote a healthier bridal body ideal.

A population-based survey on tanning bed use in Germany

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.

A randomized controlled trial of an appearance-focused intervention to prevent skin cancer

BACKGROUND

Skin cancer represents a significant health threat with over 1.3 million diagnoses, 8000 melanoma deaths, and more than $1 billion spent annually for skin cancer healthcare in the US. Despite findings from laboratory, case-control, and prospective studies that indicate a link between youthful indoor tanning (IT) and skin cancer, IT is increasing among US youth. Appearance-focused interventions represent a promising method to counteract these trends.

METHODS

A total of 430 female indoor tanners were randomized into intervention or no intervention control conditions. Intervention participants received an appearance-focused booklet based on decision-theoretical models of health behavior. Outcome variables included self-reports of IT behavior and intentions, as well as measures of cognitive mediating variables.

RESULTS

Normative increases in springtime IT rates were significantly lower (ie, over 35%) at 6-month follow-up in intervention versus control participants with similar reductions in future intentions. Mediation analyses revealed 6 cognitive variables (IT attitudes, fashion attitudes, perceived susceptibility to skin cancer and skin damage, subjective norms, and image norms) that significantly mediated change in IT behavior.

CONCLUSIONS

The appearance-focused intervention demonstrated strong effects on IT behavior and intentions in young indoor tanners. Appearance-focused approaches to skin cancer prevention need to present alternative behaviors as well as alter IT attitudes. Mediational results provide guides for strengthening future appearance-focused interventions directed at behaviors that increase risk of skin cancer.

Update on sun protection and tanning in children

PURPOSE OF REVIEW

In this article we examine the latest information regarding pediatric sun protection and specifically focus on the impact of indoor tanning on children.

RECENT FINDINGS

We examine and discuss the prevailing views and trends on ultraviolet radiation exposure, sun protection and the attendant adverse health effects among children. We identify the challenges related to limiting ambient ultraviolet exposure in children. As children, particularly adolescents, gain an understanding of sun protection, their use of ultraviolet radiation protection does not increase concordantly. We discuss health policies regarding ultraviolet radiation protection, compliance with these policies and potential methods to increase compliance. We also examine addiction-like behavior and other psychosocial factors affecting those who are regular indoor tanners. Finally, we consider possible alternatives to ultraviolet radiation induced tanning and whether encouraging these options leads to a confusing, mixed message from healthcare providers.

SUMMARY

In this article we examine and discuss current practices, attitudes and recent trends in sun protection. We discuss indoor tanning, with special emphasis on the potential addictive qualities of ultraviolet radiation. Our goal is to identify opportunities and future directions to promote sun safety and protect children from harmful ultraviolet radiation exposure.