Tanning Bed Use Research Articles

Reliability of self-reported behavior for exposure to tanning beds, self-tanning creams, and sun sensitivity

Exposure to ultraviolet radiation has consistently been linked to an increased risk of melanoma. Most studies rely upon retrospective self-report of exposure, which is susceptible to measurement error, which can distort the observed effect sizes. The reliability of self-report of many sun exposure factors has been previously described, but the self-report of use of tanning beds and self-tanning creams has been less well characterized. The purpose of this reliability study was to determine the reproducibility of a survey used in a case–control study of melanoma and to quantify the effect that measurement error could have had on the overall study results. A mailed survey was readministered after completion of the initial survey to 76 randomly selected participants in a case–control study of melanoma. Cases and controls were diagnosed in 1999 and 2000 and ascertained from the Iowa Cancer Registry in 2002. Colorectal cancer patients served as controls. We assessed the consistency of self-reported use of sunlamps and self-tanning creams, sun sensitivity, and history of sunburns using Cohen's kappa (κ). There was substantial reliability in reporting the use of sunlamps or self-tanning creams (κ = 0.83 and 0.94, respectively). Therefore, adjusting the observed odds ratios for use of sunlamps or self-tanning creams to account for measurement error had little effect. The reliability of other factors associated with melanoma was also substantial, with κ estimates of 0.62 to 0.78 for several sun-sensitivity factors. Overall, the survey instrument demonstrated substantial reproducibility for factors related to use of tanning beds and self-tanning creams and for sun sensitivity factors. This indicates that this survey instrument is reasonably reliable and that measurement error was unlikely to have biased the overall study results.

Tanning facility use: are we exceeding Food and Drug Administration limits?

Background The US Food and Drug Administration (FDA) recommends exposure limits for tanning bed use. Tanning patrons may not be following these recommendations and may be overexposed to damaging ultraviolet radiation (UV). Objective This study was conducted to assess tanning patrons' adherence to FDA-recommended exposure limits and to measure the amount of UVA and UVB radiation emitted by tanning beds. Methods A community-based survey was administered during routine state inspections of North Carolina tanning facilities (n = 50). At each facility, patron records were randomly selected (n = 483) for a survey of exposure records, and UVA and UVB outputs were measured for each tanning bed. Results The recommended limits were exceeded by 95% of patrons, and 33% of patrons began tanning at the maximum doses recommended for maintenance tanning. Average tanning bed output was 192.1 W/m 2 UVA and 0.35 W/m 2 erythemally weighted UVB. Conclusions Interventions for tanning bed operators and patrons are needed to increase compliance with federally recommended exposure limits.

Messages Influencing College Women's Tanning Bed Use: Statistical versus Narrative Evidence Format and a Self-Assessment to Increase Perceived Susceptibility

Understanding the effect of messages and other influences on health decision-making has the potential to decrease risky behavior such as tanning bed use. This study explores the effect of type of evidence, self-assessments of risk for skin cancer, and personality factors on intention to use and use of tanning beds among Caucasian female college students. Specifically, it targeted the perceived susceptibility component of the Health Belief Model and its impact on intention to tan as well as changes in actual tanning behavior. College students (N=141) in the southeast United States read randomly assigned messages and self-assessments, filled out surveys, and were later contacted for a follow-up telephone survey. The statistical message was rated higher on information value and also resulted in decreased intention to tan, decreased tanning behavior, and increased perceived susceptibility to skin cancer. The narrative message, in contrast, increased perceptions of realism and also worked to decrease intentions to tan. Additionally, the self-assessment manipulation resulted in increased susceptibility and decreased intention to tan and post tanning behavior. Personality factors explained small portions of variance. Key limitations and directions for future research are also addressed.

Melanoma etiology: where are we?

Melanoma incidence rates are rising rapidly, particularly in older men. Older men are also more likely to have thick melanomas, which confer high mortality and morbidity. The reasons for the rate of increase are not known; increasing sun and UV exposure, however, is the major hypothesized explanation. In the past several years, two major susceptibility genes for melanoma, CDKN2A and CDK4, have been identified, but the two genes together account for a minority of familial melanoma. Other high-risk susceptibility genes are being sought actively. Genetic epidemiologic studies suggest that penetrance of each of the two identified genes is altered by other factors, either genetic or environmental. Epidemiologic studies have also identified other major host factors important in the development of melanoma. In European, North American, and Australian populations, the presence of clinically identified dysplastic nevi confers greatly increased risk of melanoma. A new measure of sun exposure, based on individual residential history, confers substantially increased risk of melanoma. Recent surveys of sun behavior in the US reveal extensive sunburning and use of tanning beds in adolescents and adults. Sun protective behaviors are not as prevalent as in Australia, where population rates of melanoma are stabilizing.

Risk-awareness of cutaneous malignancies among rural populations.

The prevention of skin cancer relies not only on the knowledge of the risks of ultraviolet rays, but also on the appropriate measures to minimize solar exposure. We conducted a questionnaire-based survey among a rural population to evaluate perceptions regarding (i) sun-related behaviors, (ii) measures taken to protect themselves, and (iii) self-skin assessment knowledge. Questions included data on patients' knowledge of deleterious effects of sun exposure, their habits and perceptions about adequate protection, their knowledge of a suspicious cutaneous lesion, and if a physician had spoken to them about the risks of ultraviolet/solar exposure. One hundred and six adults (38 males and 68 females) seen in a primary care clinic were enrolled in our study. Of these, only 38.7% of our patients were concerned about their risk of cutaneous malignancies. On analysis of the sun-protection variables, we found an increased use of tanning beds among women and an increased use of hats in men. Interestingly, we also found that only 18% of respondents used sunscreen when anticipating sun exposure. With suspicious skin lesions, color of the lesion appeared to be the most concerning factor for the subjects, with increasing size being the second most likely factor of concern. Only 11.3% of respondents had a physician-performed skin assessment and only 19.8% performed self-skin assessments at least yearly. There seems to be a lack of appropriate knowledge regarding precancerous and cancerous skin lesions among rural communities. Increased patient education is urgently necessary in rural populations to decrease the growing incidence of cutaneous malignancies.

Youth Access to Tanning Parlors

Attitudes toward tanning bed use are inconsistent in industrialized societies. Dermatologists sometimes appear to be shouting their opposition to this practice into the wind, but is anyone listening? Researchers compared public health policies and legal strictures governing youth access …

Use of sunscreen, sunburning rates, and tanning bed use among more than 10 000 US children and adolescents.

To describe the association of sunscreen use, sunburning, and tanning bed use by age, sex, residence, and psychosocial variables associated with tan-seeking behaviors, and to compare these findings with sun protection recommendations from federal agencies and cancer organizations. A cross-sectional study, from all 50 states, of 10 079 boys and girls 12 to 18 years of age in 1999. Data were collected from self-report questionnaires with the children of the participants from the Nurses Health Study (Growing Up Today Study). The prevalence of sunscreen use was 34.4% with girls more likely to use sunscreen than boys (40.0 vs 26.4, odds ratio: 1.86; 95% confidence interval: 1.70-2.03). Eighty-three percent of respondents had at least 1 sunburn during the previous summer, and 36% had 3 or more sunburns. Nearly 10% of respondents used a tanning bed during the previous year. Girls were far more likely than boys to report tanning bed use (14.4 vs 2.4), and older girls (ages 15-18) were far more likely than younger girls (ages 12-14) to report tanning bed use (24.6% vs 4.7). Tanning bed use increased from 7% among 14-year-old girls to 16% by age 15, and more than doubled again by age 17 (35%; N = 244). Multivariate analysis demonstrated that attitudes associated with tanning, such as the preference for tanned skin, having many friends who were tanned, and belief in the worth of burning to get a tan, were generally associated with sporadic sunscreen use, more frequent sunburns, and increased use of tanning beds. Our findings suggest that many children are at subsequent risk of skin cancer because of suboptimal sunscreen use, high rates of sunburning, and tanning bed use. Recommendations in the United States for improved sun protection and avoidance of tanning beds and sunburning, which began in the early 1990s, have been primarily unheeded. Nationally coordinated campaigns with strong policy components must be developed and sustained to prevent skin cancer in a new generation of children and adolescents.

Basal cell carcinoma in young women: An evaluation of the association of tanning bed use and smoking

Basal cell carcinomas (BCCs) typically occur in middle-aged to elderly patients but less commonly in younger ones. In our experience, most BCCs seen in patients younger than 40 years are found in women. We evaluated 30 women with biopsy-proven BCC and 30 control patients matched for sex, age, and skin type to determine potential risk factors for this population. Tanning bed visits, pack-years of cigarette smoking, recreational sun exposure, number of blistering sunburns, and use of sunscreens were determined for both groups. Among patients with a BCC, the histologic type of tumor, site of involvement, method of treatment, follow-up period, incidence of recurrence, and presence of actinic keratoses were also evaluated. Patients with a BCC had a statistically greater number of pack years of smoking (P = .045), and a greater percentage of these women had experienced blistering sunburns (P = .028). Although women with a BCC had, on average, almost twice as many tanning salon visits (152.2 vs 83.1), this was not statistically significant. Sunscreen use and amount of recreational ultraviolet light exposure were essentially equal between the two groups. Young women with a BCC are more likely to have a past or current history of cigarette smoking and blistering sunburns. Repeated exposure to tanning beds may also be a contributory factor. (J Am Acad Dermatol 2002;46:709-9.)

A population-based survey on the use of artificial tanning devices in the Province of Québec, Canada

Background: The suntanning industry has grown up over the last decade in North America, mainly because tanned skin is socially desirable and artificial tanning is perceived as a “safe tan.” However, exposure to UV radiation is known to cause adverse health effects. Objective: The purpose of this study was to estimate the prevalence of use of tanning equipment in the Province of Québec and to characterize people who reported using these devices. Methods: In 1996, a telephone survey was carried out among adults from the two most densely populated regions (Montréal, Québec) of the Province of Québec. The final sample included 1003 white persons 18 to 60 years old. Interviewers used a standardized questionnaire to document the characteristics of the participant, skin phototype, and exposure habits to artificial UV radiation sources. Results: During the last 5 years before the survey, 20.2% of the respondents reported they had used, at least once, a tanning device in a commercial tanning salon. The rate of use during the last 12 months before the study was 11.1%. A significantly higher proportion of female, young people (18 to 34 years old) and single persons was found among tanning bed users. Twenty-six percent of users experienced one or more acute adverse health effects from the artificial UV irradiation. Most of these were cases of skin burns. A high proportion (77.5%) of those who used tanning equipment during the last year before the study said they would return to tanning salons. The intention of returning to a tanning salon was not influenced by the occurrence of the acute adverse health effects. The most prevalent reason given for using tanning equipment was “to improve their appearance by a tan.” Most people (60.4%) who used a tanning bed during the last 5 years before the study believe that tanning salons are not dangerous. Conclusion: This survey indicates that tanning bed use is very prevalent in the Province of Québec, mainly among young women. The high rate of acute adverse health effects related to artificial tanning, particularly skin burns, is of concern. Finally, our results underline the importance of changing attitudes and beliefs in the population regarding artificial tanning. (J Am Acad Dermatol 1999;40:572-6.)

Tobacco smoking contributes little to facial wrinkling

The potential detrimental effects of tobacco smoking have been widely cited. Tobacco smoking has been linked with facial wrinkling, but some previous studies have failed to take into account a number of potential confounders or were unblinded and thus subjective to bias. This study was designed to determine if there was increased facial wrinkling in smokers directly associated with tobacco usage after controlling for solar risk behavior. Eighty-two smokers (> 10 cigarettes per day) and 118 non-smokers (< 100 lifetime cigarettes) were recruited. Caucasian participants completed a questionnaire designed to assess demographic variables and other suspected factors related to wrinkling. Three dermatologists, blinded to demographic information, reviewed three photographs of each subject and rated the wrinkling on a 100 mm visual analog scale. Stepwise linear regression was performed on all variables which attained a P < 0.1 level of independent significance. Overall the model accounted for 75.4% (P = 0.0001) of the variance in wrinkling, and predictive variables (P < or = 0.02) included age (partial R2 = 0.69), smoking pack years (R2 = 0.04), hours of outdoor work (R2 = 0.008), freckling (R2 = 0.007), and eye color (R2 = 0.004). A second model was created excluding age which accounted for 37.8% of the variance. The predictive variables in the second model (P < 0.08) included education (partial R2 = 0.08), smoking pack years (R2 = 0.05), hours of outdoor work (R2 = 0.03), weight change (R2 = 0.02), female sex (R2 = 0.02), hours of lifetime sun (R2 = 0.03), tanning bed use (R2 = 0.01), and sunscreen use (R2 = 0.02). Smoking may significantly contribute to facial wrinkling, but accounts for only 6% of the explained variance. If there is a role for tobacco smoking in causing wrinkling, this role is a minor one.

Tobacco smoking contributes little to facial wrinkling

BackgroundThe potential detrimental effects of tobacco smoking have been widely cited. Tobacco smoking has been linked with facial wrinkling, but some previous studies have failed to take into account a number of potential confounders or were unblinded and thus subjective to bias.ObjectiveThis study was designed to determine if there was increased facial wrinkling in smokers directly associated with tobacco usage after controlling for solar risk behavior.SubjectsEighty-two smokers (>10 cigarettes per day) and 118 non-smokers (<100 lifetime cigarettes) were recruited. Caucasian participants completed a questionnaire designed to assess demographic variables and other suspected factors related to wrinkling.MethodsThree dermatologists, blinded to demographic information, reviewed three photographs of each subject and rated the wrinkling on a 100 mm visual analog scale. Stepwise linear regression was performed on all variables which attained a P<0.1 level of independent significance.ResultsOverall the model accounted for 75.4% (P=0.0001) of the variance in wrinkling, and predictive variables (P≤0.02) included age (partial R2=0.69), smoking pack years (R2=0.04), hours of outdoor work (R2=0.008), freckling (R2=0.007), and eye color (R2=0.004). A second model was created excluding age which accounted for 37.8% of the variance. The predictive variables in the second model (P<0.08) included education (partial R2=0.08), smoking pack years (R2=0.05), hours of outdoor work (R2=0.03), weight change (R2=0.02), female sex (R2=0.02), hours of lifetime sun (R2=0.03), tanning bed use (R2=0.01), and sunscreen use (R2=0.02).ConclusionsSmoking may significantly contribute to facial wrinkling, but accounts for only 6% of the explained variance. If there is a role for tobacco smoking in causing wrinkling, this role is a minor one.

Dermatological surgical care of patients with skin cancers occurring after use of tanning beds

Dermatological surgical care of patients with skin cancers occurring after use of tanning beds

A survey of attitudes, beliefs, and behavior regarding tanning bed use, sunbathing, and sunscreen use

Although cosmetic tanning and unprotected solar exposure are common, little is known about general attitudes, beliefs, and behavior regarding sunbathing, sunscreen use, and tanning salon use. We sought to determine the frequency of UV exposure in a select sample and to assess the knowledge and beliefs of the effects of UV irradiation. A written, anonymous questionnaire was distributed to a sample of 477 persons in a shopping mall, at a social gathering, and on a vacation cruise ship. The instrument explored demographic information, sunscreen use, sunbathing habits, tanning bed use, and cutaneous solar effects. Forty-two percent of respondents seldom or never used sunscreen, and 33% sunbathed at least once a week. Although the three sample populations differed in education, sunbathing habits, sunscreen use, and tanning bed use, they were equally informed about UV light hazards. Compared with those who had not used tanning beds, tanning bed users were more likely to be female and more knowledgeable about the long-term effects of UV. Tanning beds were most commonly used in tanning or hair salons, (mean 23 +/- 7 minutes at 2.3 +/- 1.1 times per week). Reported positive psychologic sequelae from tanning bed use were more common than negative physical sequelae. At least 10% would continue to use tanning beds if these were proved to cause skin cancer. In this select sample, sunbathing and tanning bed use were common. No group surveyed universally practiced sun protection and avoidance. Clientele of tanning beds may be aware of the damaging effects of the sun, but may not be aware that tanning bed use is associated with skin damage.

Persistent melanocytic lesions associated with cosmetic tanning bed use: “Sunbed lentigines”

A patient with persistent melanocytic lesions after tanning bed use is described. A review of the literature provides two additional examples of similar clinical and histologic presentations after UVA exposure without psoralen. To our knowledge, this is the first reported case of “sunbed lentigines” in the United States.

Possible ultraviolet A—induced lentigines: A side effect of chronic tanning salon usage

A patient who developed lentigines after prolonged ultraviolet A (UVA) exposure in a tanning booth is described. The patient had no exposure to psoralens or furocoumarins. Histologic examination of a representative lentigo revealed melanocytic hyperplasia and cytologic atypia. Increased nevocytic activity with histologic dysplasia was present in several junctional nevi excised during the period of UVA exposure. Several studies have revealed significant effects of UVA on melanocytes. Patients should be cautioned to avoid tanning bed use in view of these potentially deleterious effects.