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

Global Tanning Bed Advertising: A Comparison of Legal Regulations on Three Continents

Artificial ultraviolet radiation from tanning beds has been classified as carcinogenic by the International Agency for Research on Cancer in 2009. Several countries have subsequently introduced comprehensive legislation regulating commercial indoor tanning. Specific aspects of these regulations address tanning bed advertising and information requirements for tanning bed customers, which have been previously neglected in international comparisons of indoor tanning regulations. We performed a systematic search regarding legislation on these aspects in 131 legislative units across three continents (North America, Australia/New Zealand, Europe). The legal restrictions found varied widely in type and content. In 49 legislative units we identified total (n = 8) or partial legal bans (n = 41) on advertising for indoor tanning, while 64 legislative units enacted 5regulations that necessitate the dissemination of different types of specific health information to tanning bed customers. Nearly 40% of the legislative units of the study region lacked any legislation on these issues altogether. The heterogenous results emphasize the need for an international dialogue between health authorities and governments to harmonize the regulatory framework for tanning bed advertising and information requirements to a level better protecting the public from skin cancer. Our comprehensive international comparison can serve as a starting point for such a harmonization process that may ultimately protect the public worldwide from misleading tanning bed advertising.

"I Think There Should Be Photos": Female Indoor Tanners' Perceptions of Health Warning Labels for Tanning Beds

This study explores female indoor tanners' perceptions of the current, text-only Canadian health warning label (HWL) for tanning equipment, as well as pictorial, evidence-based alternative HWLs. We created 10 test HWLs that depicted skin health effects, eye damage, premature aging, and death. Young women who had tanned indoors in the past year discussed these and the current federal HWL in focus groups. Although the current Canadian HWL was seen as informative, several participants did not recognize it, and many said that they would not read it due to the small text, wordiness, and lack of an image. Graphic images, particularly those depicting permanent conditions affecting the face, eyes, or appearance, were seen as effective. Common criticisms of the images were lack of believability, relatability, and comprehensibility. Although concise text was important for encouraging reading, many participants expressed a desire for more information in the test HWLs. Premature aging was of great concern to many participants, but the images selected for these HWLs were not perceived as effective. Although the text was seen as effective in the death HWLs, most participants dismissed the images. This research has implications for IT HWLs in Canada and globally. These results suggest that graphic images may be impactful in IT HWLs. Images must be supplemented with informative text that increases believability, relatability, and comprehensibility. These modifications would create HWLs that are engaging, informative, and that form part of a wider effort to spread awareness about the harmful effects of IT.

Tanning Bed Legislation for Minors: A Comprehensive International Comparison

Tanning beds have been classified as carcinogenic to humans. As a result, many countries have enacted laws regulating the use of commercial tanning beds, including bans for minors. However, there is no international overview of the current legal status of access restrictions for minors that provides details on their specific design regarding age limits and possible exceptions to the statutory regulation. Therefore, we performed a comprehensive web search of current tanning bed legislation for minors on the three continents North America, Australia, and Europe. Our findings regarding the existence and concrete design of access restrictions are presented graphically, using maps. We found a wide variety of different legislations. In Australia, a total ban on tanning beds exists, while in New Zealand, tanning bed use is banned for minors. In Europe, about half of the countries have implemented a strict ban for minors. In North America, we found differences in the age limit for access restrictions between the states, provinces, and territories for those regions that implemented a ban for minors. In the United States, some states have rather “soft bans” that allow use by minors with different types of parental consent. The patchwork in legislation calls for harmonization. Therefore, our comparison is an important starting point for institutions such as the World Health Organization or the European Commission to advance their goals toward a harmonization of tanning bed legislation in general and for minors in particular.

A Process Evaluation of the Skin Cancer Prevention Act (Tanning Beds): A Survey of Ontario Public Health Units

Evidence of the dangers of indoor tanning and its popularity, including among youth, led the Government of Ontario to pass the Skin Cancer Prevention Act (Tanning Beds) (SCPA) in 2014. This legislation includes prohibiting the sale of indoor tanning services to individuals under 18, requiring warning signs be posted, and other safety regulations. We collected information from Ontario Public Health Units to conduct a process evaluation of the SCPA to: understand legislation implementation; assess available evidence about compliance, inspection, and enforcement; and, note barriers and facilitators related to inspection and enforcement. Data was collected March-April 2018. All 36 Ontario Public Health Units were invited to participate in an online questionnaire about the SCPA. Questions covered complaints, inspection, and enforcement, and used both close- and open-ended questions. Participants from 20 Public Health Units responded to the questionnaire; a response rate of 56%. These agencies reported 485 facilities offer indoor tanning. Since 2014, there have been 242 infractions by tanning facility owner/operators related to the SCPA, with most being uncovered during non-mandatory routine inspections (n = 234, 97%), rather than mandatory complaint-based inspections (n = 8, 3%). Most infractions were related to warning signs (n = 201, 83%). No charges were issued for any infractions. Instead, providing education (n = 90, 62%) and issuing warnings (n = 33, 23%) were the most common enforcement strategies. SCPA amendments are needed, including mandatory, routinely scheduled inspections. In addition to providing education, fines may improve compliance. More resources are required for inspection and enforcement of the SCPA.