An exploration of the attitudes and risk taking behaviours amongst young people who are regular users of sunbeds and the development of a prevention strategy

Abstract

Background The year on year increase in the incidence of malignant melanoma skin cancer is a global health problem. In 2009 the International Agency on Research on Cancer raised exposure to artificial UV to the highest category, “carcinogenic to humans”. Surveys in England in 2006-10 indicated that young people were using sunbeds regularly, with the North West, especially Merseyside, having some of the highest rates. There has however, been little research conducted that attempts to understand the attitudes and motivations of young sunbed users. Inadequate regulation coupled with their desire to use sunbeds has meant that young people have been using sunbeds hazardously. In 2010 the English government introduced legislation to ban under-18 sunbed use. Aims The study aimed to explore the attitudes, motivations and experiences of young people aged 14 to 16 years living in Merseyside, in relation to sunbed use in the context of the imminent legislation. The study also aimed to use the findings to promote the development of an evidence-based local skin cancer prevention strategy for Liverpool, in an attempt to begin to tackle hazardous sunbed use by young people in the locality. Methods Qualitative research was conducted in five schools in the North West of England between September 2009 and March 2010, prior to the implementation of the sunbed legislation banning under-18 year olds using them. Girls and boys aged between 14-16 years were recruited to the study. Eight focus groups were conducted, involving a mixture of sunbed users and non-users, sunbed users only, boys and girl only focus group and separate year groups. Twenty-two in-depth one-to-one interviews were also conducted. An interpretive approach was taken to the analysis of the qualitative data, drawing on the approach taken by Edwards and Tichen (2003). For the development of the skin cancer prevention strategy, a stakeholder workshop was organised in March 2013, bringing together approximately sixty key stakeholders from a variety of organisations in Liverpool and including representatives from the public, public health, primary care and voluntary sectors and the local authority. Findings from the qualitative research with young people were fed into the strategy development, with the author also acting as facilitator and coordinator. Findings Key motivations for sunbed use among these young people in Merseyside were to improve self-esteem and confidence and to conform to social norms and peer-expectation. Mothers and older siblings were reported to influence sunbed initiation or continued use. Poor salon practice emerged as a risk to over-exposure to UV rays. Young people were quick to play down the risks associated with sunbed use; however some young people also reported being addicted to sunbeds. Young people feared the introduction of the legislation banning sunbed use because some had become dependent on using sunbeds as a way of expressing their identity, to socialise and as a strategy to improve their self-esteem and confidence. The study demonstrated how the qualitative findings could be used to influence the development of national and local health policy. Following the developmental process, the strategy was endorsed and supported by the Mayor of Liverpool, the head of policy at Cancer Research UK and the head of policy at the Chartered Institute of Environmental Health. Conclusions Whilst some young people reported the physical and psycho-social benefits of sunbed use, young sunbed users were also exposed to increased risks associated with artificial UV damage. Poor salon practice, inadequate regulation and policy and continued pressure to conform to social ideals left sunbed users vulnerable to the effects of UV damage. Moreover, the research also highlighted the need for health providers to develop psychological support pathways for young people who may be addicted to sunbeds. Prevention initiatives should take into consideration young people’s ideals concerning appearance when aiming to reduce or prevent sunbed use among young people.