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Menzies S, Daly S, O’Connor R, Kelly A, Fitzgerald M, Bourke J, McKenna DB. A re-evaluation of teenage sunbed use following the introduction of banning legislation for under 18-year-olds. J Public Health (Oxf) 2020; 42:588-593. [DOI: 10.1093/pubmed/fdz015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2018] [Revised: 12/26/2018] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
There is little information on the effectiveness of introducing age restriction legislation alone to reduce the rate of sunbed usage by teenagers. Prior to the Public Health (Sunbed) Act of 2014 prohibiting the use of sunbeds in under 18-year-olds in Ireland we reported the rate of sunbed use at 7.5%.
Objectives
The aim of the study was to compare the rate of sunbed usage among Irish teenagers before and after the introduction of banning legislation to determine if it had the desired effect of reducing its rate of use.
Methods
In a cross-sectional survey, students from the same schools as in our previous study completed an anonymous, written questionnaire pertaining to sunbed usage.
Results
In total, 783 questionnaires, from 13 schools across Ireland, were completed. The rate of sunbed use in the current study was 7.2%, compared to 7.5% in the pre-ban study, (P = 0.76). A higher rate of sunbed use was observed in Dublin schools and female public students.
Conclusion
Our study suggests that legislation alone is ineffective at reducing sunbed usage in a teenage population. A multifaceted approach is required that includes enforcement of the legislation together with targeted public education and awareness campaigns using all aspects of the media.
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Affiliation(s)
- S Menzies
- Department of Dermatology, Sligo University Hospital, Sligo, Ireland
| | - S Daly
- Department of Dermatology, Sligo University Hospital, Sligo, Ireland
| | - R O’Connor
- Department of Dermatology, Cork University Hospital, Cork, Ireland
| | - A Kelly
- Department of Dermatology, Cork University Hospital, Cork, Ireland
| | - M Fitzgerald
- Department of Dermatology, Sligo University Hospital, Sligo, Ireland
| | - J Bourke
- Department of Dermatology, Cork University Hospital, Cork, Ireland
| | - D B McKenna
- Department of Dermatology, Sligo University Hospital, Sligo, Ireland
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Rodriguez-Acevedo AJ, Green AC, Sinclair C, van Deventer E, Gordon LG. Indoor tanning prevalence after the International Agency for Research on Cancer statement on carcinogenicity of artificial tanning devices: systematic review and meta-analysis. Br J Dermatol 2019; 182:849-859. [PMID: 31381131 DOI: 10.1111/bjd.18412] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/31/2019] [Indexed: 12/13/2022]
Abstract
BACKGROUND Exposure to artificial tanning devices is carcinogenic to humans, and government regulations to restrict or ban indoor tanning appear to be increasing. OBJECTIVES We evaluated changes in the international prevalence of indoor tanning among adolescents and adults after artificial tanning devices were classified as carcinogenic by the International Agency for Research on Cancer (IARC) in 2009. METHODS Systematic searches in PubMed and Web of Science databases were undertaken. Overall, 43 studies reporting 'ever' or 'past-year' indoor tanning exposure after 2009 were identified. We used metaregression analysis to evaluate the prevalence of indoor tanning over time. Random effects meta-analysis was used to summarize the prevalence of indoor tanning in adolescents and adults according to sex, region and presence of age prohibitions. RESULTS Global prevalence of indoor tanning in adolescents for 2013-2018 was 6·5% [95% confidence interval (CI) 3·3-10·6], 70% lower than the 22·0% (95% CI 17·2-26·8) prevalence for 2007-2012. Among adults, the prevalence was 10·4% (95% CI 5·7-16·3) for 2013-2018, a decrease of 35% from 18·2% for 2007-2012. Since 2009, the overall past-year prevalence among adolescents was 6·7% (95% CI 4·4-9·6) and 12·5% (95% CI 9·5-15·6) among adults. The prevalence of tanning indoors in the past year was similar in North America (adults, 12·5%; adolescents, 7·6%) and Europe (adults, 11·1%; adolescents, 5·1%). In 2009, three countries had regulations restricting indoor tanning, compared with 26 countries today. CONCLUSIONS Prevalence of indoor tanning has declined substantially and significantly in adolescents and adults since the 2009 IARC statement, reflecting the rise in regulations that limit this source of unnecessary exposure to carcinogenic ultraviolet radiation. What is already known about this topic? Indoor tanning is associated with an increased risk of melanoma. A meta-analysis of worldwide indoor tanning prevalence for 1986-2012 found a past-year prevalence of 18% in adolescents and 14% in adults, with higher prevalences during the period 2007-2012. Policies to regulate indoor tanning began to be implemented across the globe in 2009. Only one study carried out in the U.S.A. has evaluated the efficacy of such policies in reducing indoor tanning prevalence. What does this study add? For the period 2013-2018, we found indoor tanning prevalences of 6·7% in adolescents and 11·9% in adults. This implies a reduction in indoor tanning use of 70% in adolescents and 35% in adults during the last 10 years. Our study encourages policy makers to strengthen indoor tanning regulations that reduce sunbed use among the general population in order to produce maximum public health benefit.
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Affiliation(s)
| | - A C Green
- QIMR Berghofer Medical Research Institute, Brisbane, Queensland, 4006, Australia.,CRUK Manchester Institute and University of Manchester, Manchester Academic Health Science Centre, Manchester, M13 9PL, U.K
| | - C Sinclair
- Cancer Council Victoria, Melbourne, Victoria, 3004, Australia
| | - E van Deventer
- Department of Public Health, Environmental and Social Determinants of Health (PHE), CH1211 Geneva 27, Switzerland
| | - L G Gordon
- QIMR Berghofer Medical Research Institute, Brisbane, Queensland, 4006, Australia.,Queensland University of Technology, School of Nursing, Kelvin Grove, Brisbane, Q4059, Australia.,School of Medicine, The University of Queensland, Brisbane, Australia
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Reimann J, McWhirter JE, Cimino A, Papadopoulos A, Dewey C. Impact of legislation on youth indoor tanning behaviour: A systematic review. Prev Med 2019; 123:299-307. [PMID: 30940571 DOI: 10.1016/j.ypmed.2019.03.041] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2018] [Revised: 03/21/2019] [Accepted: 03/28/2019] [Indexed: 11/29/2022]
Abstract
Jurisdictions around the world have implemented indoor tanning legislations, which aim to protect all individuals, especially youth, from dangers of artificial ultraviolet radiation exposure. The objective of this study was to conduct a systematic review to synthesize the available peer-reviewed literature to determine whether indoor tanning legislation has impacted the prevalence of youth indoor tanning. Following PRISMA guidelines, six databases were searched in 2016. Reference lists from relevant articles were also searched. An updated literature search was conducted in 2018. Each article was critically appraised using a merged checklist created from two previously validated checklists. All articles meeting the inclusion criteria were retained after appraisal. Seven studies, all conducted in the U.S., met the inclusion criteria. All studies used an observational, cross-sectional design. There were small absolute decreases in youth indoor tanning prevalence after legislation vs before (n = 3, mean = 3% decrease, range = 1%-6% decrease). Prevalence of youth indoor tanning was significantly lower in states with indoor tanning legislation vs states without legislation (n = 4, mean = 5% lower, range = 1%-18% lower). Prevalence of youth indoor tanning was lower in states with longer standing indoor tanning legislation vs states with more recently implemented legislation (n = 2, mean = 9% lower, range = 2%-20% lower). Indoor tanning legislation is generally associated with lower indoor tanning prevalence among youth. The small percent differences equate to millions of youth at the population level. Longer time lapses from legislation implementation to evaluation, coupled with greater enforcement, compliance, legislative stringency, and public education may result in even more pronounced declines in youth indoor tanning prevalence.
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Affiliation(s)
- Jessica Reimann
- Department of Population Medicine, University of Guelph, Guelph, Ontario N1G 2W1, Canada.
| | - Jennifer E McWhirter
- Department of Population Medicine, University of Guelph, Guelph, Ontario N1G 2W1, Canada.
| | - Andrea Cimino
- Department of Population Medicine, University of Guelph, Guelph, Ontario N1G 2W1, Canada.
| | - Andrew Papadopoulos
- Department of Population Medicine, University of Guelph, Guelph, Ontario N1G 2W1, Canada.
| | - Cate Dewey
- Department of Population Medicine, University of Guelph, Guelph, Ontario N1G 2W1, Canada.
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Augustin M, Schäfer I, Krensel M, Reusch M, Mohr P, Greinert R, John SM, Zander N. Decreasing sunbed use in the German population between 2001 and 2015: survey in 155 679 working persons. J Eur Acad Dermatol Venereol 2018; 33:541-545. [PMID: 30408254 DOI: 10.1111/jdv.15309] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Accepted: 09/20/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND UV radiation is a proven cause of skin cancer. Use of sunbeds has been shown to provide an attributable risk. OBJECTIVE To evaluate the proportion of regular sunbed use in Germany based on large-scale population-based surveys over 15 years. METHODS Skin cancer screenings by dermatologists were conducted between 2001 and 2015 in more than 500 German companies, including a clinical examination and interviews on the risk behaviour related to sunburns and sunbeds. RESULTS Among 155 679 persons included regular sunbed use significantly declined from 11.0% in 2001 to 1.6% in 2015 (P < 0.001). There were significantly higher rates of sunbed use in women (12.5%/2.0%) vs. men (7.3%/1.3%; P < 0.001), in younger persons and in participants with darker skin (type II and III) vs. fair skin (type I). Individuals with sunburns in childhood were significantly more often sunbed users (5.1% vs. 4.6%; P = 0.002). A remarkable decline of sunbed use was observed after 2009 (7.0% in 2001-2008 and 2.2% in 2009-2015). This reduction occurred in the time of a legal ban of sunbed use for minors but also with the start of the national skin cancer screening programme. CONCLUSION Use of sunbeds in the German adult population has dropped by more than 85% in the past decade. Primary prevention, including the large public awareness following the legal ban of sunbed use for young people and the effects of the statutory skin cancer screening programme may have contributed to this.
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Affiliation(s)
- M Augustin
- Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - I Schäfer
- Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - M Krensel
- Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - M Reusch
- Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany.,Dermatological Practice Tibarg, Hamburg, Germany
| | - P Mohr
- Department of Dermatology, Elbe Kliniken Buxtehude, Buxtehude, Germany
| | - R Greinert
- Department of Dermatology, Elbe Kliniken Buxtehude, Buxtehude, Germany
| | - S M John
- Institute for Interdisciplinary Dermatological Prevention and Rehabilitation (iDerm), University of Osnabrück, Osnabrück, Germany
| | - N Zander
- Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
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Gajda M, Kamińska-Winciorek G, Wydmański J, Tukiendorf A, Kowalska M. Behaviors of active sunbeds users and their knowledge on the potential health risks; results of cross-sectional study in Poland. J Cosmet Dermatol 2018; 17:538-544. [DOI: 10.1111/jocd.12548] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/06/2018] [Indexed: 11/30/2022]
Affiliation(s)
- Maksymilian Gajda
- Department of Epidemiology; School of Medicine in Katowice Medical University of Silesia; Katowice Poland
| | - Grażyna Kamińska-Winciorek
- The Department of Bone Marrow Transplantation and Onco-Hematology; Maria Skłodowska-Curie Memorial Cancer Centre and Institute of Oncology Gliwice Branch; Gliwice Poland
| | - Jerzy Wydmański
- Department of Conventional and Intraoperative Radiotherapy; Maria Skłodowska-Curie Memorial Cancer Centre and Institute of Oncology Gliwice Branch; Gliwice Poland
| | - Andrzej Tukiendorf
- Department of Biostatistics; Maria Skłodowska-Curie Memorial Cancer Centre and Institute of Oncology Gliwice Branch; Gliwice Poland
| | - Małgorzata Kowalska
- Department of Epidemiology; School of Medicine in Katowice Medical University of Silesia; Katowice Poland
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Nadalin V, Marrett L, Atkinson J, Tenkate T, Rosen CF. Tanning among Ontario adolescents pre-legislation: Prevalence and beliefs. Prev Med 2016; 91:244-249. [PMID: 27576785 DOI: 10.1016/j.ypmed.2016.08.045] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2015] [Revised: 07/04/2016] [Accepted: 08/25/2016] [Indexed: 10/21/2022]
Abstract
To establish adolescent tanning beliefs and behaviors, prevalence and location of UV tanning device (beds/lamps) use, awareness of risk and restriction signage, and frequency of tanning service refusal, noting differences by grade and sex, prior to a ban on UV tanning device use among those under 18 in Ontario, Canada. Data were collected May 5 to 20 of 2014. Children in grades 7 to 12, and under age 18 completed an on-line questionnaire that asked their age, sex, grade, methods used to tan, frequency, length and location of UV tanning device use, if services were refused and why, awareness and content of signs/warning labels, tanning beliefs and knowledge, and use of eye protection. Of 1561 participants (10% response rate), 49% were male, 51% female. There were significant differences between the sexes regarding tanning behaviors (e.g. not tanning, tanning outside). Seven percent (108) had 'ever' used UV tanning devices, females more than males (p=0.0026). Over half (57%) of the 104 using UV tanning devices in the past 12months noticed warning signs/labels, of which most noticed that UV tanning devices can cause cancer (65%), and that UV exposure can contribute to premature aging (67%). While most (66%) tanned at tanning salons/studios and beauty salons/studios, gyms/fitness clubs (35%) and home use were common (25%). A relatively low proportion of adolescents used UV tanning devices prior to the ban, with use more common among females and those in higher grades.
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Affiliation(s)
- V Nadalin
- Prevention & Cancer Control, Cancer Care Ontario, Toronto, Canada.
| | - L Marrett
- Prevention & Cancer Control, Cancer Care Ontario, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - J Atkinson
- Cancer Prevention and Tobacco Control, Canadian Cancer Society, Ontario Division, Toronto, Canada
| | - T Tenkate
- School of Occupational and Public Health Ryerson University, Toronto, Canada
| | - C F Rosen
- Division of Dermatology, Toronto Western Hospital, University of Toronto, Toronto, Canada
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Prävalenz, Risikogruppen und Motive der Solariennutzung in Deutschland. DER HAUTARZT 2016; 67:226-33. [DOI: 10.1007/s00105-015-3753-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Grange F, Mortier L, Crine A, Robert C, Sassolas B, Lebbe C, Lhomel C, Saiag P. Prevalence of sunbed use, and characteristics and knowledge of sunbed users: results from the French population-based Edifice Melanoma survey. J Eur Acad Dermatol Venereol 2015; 29 Suppl 2:23-30. [PMID: 25639930 DOI: 10.1111/jdv.12899] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2014] [Accepted: 10/22/2014] [Indexed: 11/28/2022]
Abstract
BACKGROUND In addition to natural sunlight, indoor tanning has emerged as a common source of ultraviolet (UV) radiation associated with an increased risk of melanoma. It is classified as a class I human carcinogen by the World Health Organization. OBJECTIVES This analysis presents data on the prevalence of sunbed use in France, on factors associated with sunbed use, and on risk factors, attitude and awareness of risk among sunbed users and non-users. METHODS Edifice Melanoma, a nationwide observational survey, was conducted in France via telephone interviews among a representative sample of 1502 subjects aged ≥18 years, using the quota method. Sunbed users were defined as individuals who reported having used a sunbed at least once in their lifetime. Logistical regressions were conducted in order to identify which factors differentiate the population of sunbed users from that of non-users. RESULTS One in ten respondents was a sunbed user and three out of four declared having used tanning facilities for over one year. In multivariate analysis, factors significantly associated with the sunbed-user group were female gender (OR = 3.897 [2.573-5.903], P < 0.001), a higher socio-professional category (OR = 2.227 [1.542-3.217]; P < 0.001), fair hair (OR = 1.583 [1.025-2.447], P = 0.039), fair skin (OR = 1.879 [1.086-3.253]; P = 0.024), freckles (OR = 1.570 [1.071-2.302]; P = 0.021) and a history of smoking (OR = 2.383 [1.633-3.476]; P < 0.001). In a second multivariate model, the fact of having a large number of melanoma risk factors was strongly associated with sunbed use (P = 0.001). Sunbed users were more likely to be informed of the role of sun exposure in reducing the skin's regenerative capacity (OR = 2.181 [1.319-3.607]; P = 0.002) but were nevertheless more likely to consider that a tan makes a person look more attractive (OR = 2.309 [1.312-4.064]; P = 0.004) and protects the skin (OR = 2.490 [1.532-4.046]; P < 0.001); they were also more frequently exposed to natural sunlight (OR = 2.214 [1.196-4.102]; P = 0.011). CONCLUSIONS Compared to non-users, sunbed users cumulate risk factors for melanoma. Knowledge, attitudes and intentions of individuals are critical targets for public education programmes. However, awareness campaigns focusing on sunbed use, and more generally on skin cancer, should also take social and cultural norms into account.
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Affiliation(s)
- F Grange
- Department of Dermatology, Robert Debré University Hospital, Reims, France
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Decrease in Self-Reported Tanning Frequency among Utah Teens following the Passage of Utah Senate Bill 41: An Analysis of the Effects of Youth-Access Restriction Laws on Tanning Behaviors. J Skin Cancer 2014; 2014:839601. [PMID: 25215240 PMCID: PMC4158105 DOI: 10.1155/2014/839601] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2014] [Revised: 08/06/2014] [Accepted: 08/07/2014] [Indexed: 11/17/2022] Open
Abstract
Introduction. Adolescent use of indoor tanning facilities is associated with an increased risk in later development of melanoma skin cancers. States that have imposed age restrictions on access to indoor tanning generally show lower self-reported rates of indoor tanning than states with no restrictions, but currently no studies have assessed indoor tanning use before and after such restrictions. Methods. In 2013, we compared self-reported indoor tanning data collected in the Prevention Needs Assessment (PNA) survey in 2011 to PNA 2013 data. We also assessed predictors of continued tanning after passage of the bill. Results. Prior to the passage of Senate Bill 41, 12% of students reported at least one incident of indoor tanning in the past 12 months. After passage, only 7% of students reported indoor tanning in the past 12 months (P < 0.0001). Students who continued indoor tanning were more likely to be older and female and to engage in other risk behaviors, including smoking and alcohol use. Lower parental education levels were also associated with continued tanning. Conclusion. Indoor tanning restrictions showed beneficial impact on tanning rates in adolescents in Utah. Stricter restrictions may show even greater impact than restrictions that allow for parental waivers. Stronger enforcement of bans is needed to further reduce youth access.
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