Are children younger than 18 years still using sunbeds after the ban? A survey of school children aged 15–17 years in Sandwell, UK

Abstract

BackgroundSunbed use in childhood increases risk of melanoma. In April, 2011, a ban on use of sunbeds by children younger than 18 years was introduced in England. Effect on use has not been investigated since. This study estimated the prevalence of sunbed use by children younger than 18 years in Sandwell after the commercial ban and identified factors associated with use or intention to use. MethodsWe undertook a cross-sectional survey of schoolchildren aged 15–17 years using anonymous questionnaires self-completed in class. Data obtained included demographics, sunbed use, tanning attitudes, knowledge of risks, and ban awareness. All state secondary schools in Sandwell, West Midlands, UK, were approached; children available on the survey days were included. Attitudes and knowledge were measured by the percentage of participants who indicated “agree” or “disagree” for related statements, and comparisons between users or potential users and non-users were made with the χ2 test. All variables collected were entered in the multiple logistic regression model to identify factors associated with sunbed use or intention to use. FindingsFive of 22 schools participated, all school types were represented; 407 children responded (95%). Sex was equally distributed (194 [51%] of 381 were girls). Most were aged 15 years (234 [60%] of 388) and the proportion of white ethnic origin (256 [67%] of 381) was lower than the Sandwell population (223 200 [77%] of 291 000). 20 participants (5·3%, 95% CI 3·4–8·0) had used sunbeds after the ban, of whom 16 reported use in commercial settings. 78 (20·6%, 16·8–24·9) expressed intention to use in the future. After exclusion of one school cohort with atypical use (possibly associated with beauty vocational training course and European migrants), the prevalence of sunbed use was 1·7% (95% CI 0·7–3·9, n=5). Less than half of all children surveyed were aware of the ban (177 of 367 children, 48·2%, 43·2–53·3). Users or potential users were less aware of risks associated with sunbed use than were non-users. Only 63 (67%) of 93 users or potential users were aware that using sunbeds can cause skin cancer (versus 224 [83%] of 269 non-users, χ2=10·632, p=0·005). Factors independently associated with sunbed use or intention to use included being female (odds ratio 2·57, 1·12–5·91) or having family members (3·53, 1·52–8·19) or friends (4·54, 1·94–10·63) who use sunbeds. InterpretationIn view of the single area studied and the low participation rate from schools, the study has restricted generalisability. A small number of children younger than 18 years in Sandwell still have access to sunbeds despite the ban. Greater publicity, stricter enforcement of the ban by local authorities, and raising awareness of skin cancer risk associated with sunbed use are strategies that could be considered. Further research exploring the possible association between specific vocational courses, migrants (whom conventional public health communication campaigns might not be reaching), and sunbed use is needed. FundingUniversity of Birmingham and the Wolfson Foundation.