Tanning Bed Use Research Articles

Skin Cancer Risk Perception and Tanning Bed Use: A Population-Based Survey to Identify Persons at Risk for Melanoma in Olmsted County, Minnesota

Cutaneous melanoma is strongly associated with tanning bed use. To describe local residents' knowledge, attitudes, and behavior regarding skin cancer and tanning bed use and to estimate prevalence of high risk for melanoma. A survey was mailed to 886 local residents (549, aged 18-39 years; 337, aged ≥40 years). Logistic and linear regression and univariate and multivariable analysis were used to assess perceived risk and skin cancer knowledge. The response rate was 21%; 55% of the younger group and 37% of the older group had used indoor tanning, and prevalence of high risk for melanoma according to a skin cancer risk calculator was 18% in the younger group and 33% in the older group. Individuals with high risk scores were more likely to correctly perceive that they were at high risk for skin cancer. Most participants with high risk scores and those who previously used tanning beds reported low likelihood of future indoor tanning. Female sex, high risk score, and previous indoor tanning were associated with participants' views of higher skin cancer risk. No specific knowledge gaps were identified. Understanding community residents' attitudes about skin cancer and indoor tanning can help guide interventions.

Sunburn, Sun Safety and Indoor Tanning Among Schoolchildren in Ireland.

Objectives: We present patterns of sunburn, sun safety behaviors and indoor tanning bed use in a nationally representative sample of schoolchildren aged 10–17. These behaviors were explored across gender, age, and social class groups.Methods: Within the Health Behaviour in School-aged Children (HBSC) Ireland study, 10,271 young people (aged 13.54 ± 1.92, percentage girls 53.3%) reported frequency of sun safety behaviors, sunburn, and frequency and circumstances of indoor tanning bed use.Results: Children frequently experienced sunburn (90% lifetime, 74% last year), and 3% reported never using any sun protection. Applying sunscreen and wearing sunglasses were the most commonly used sun safety measures; other ways of sun protection were less popular. Indoor tanning bed use was reported by around 5%, and a large proportion of users were not advised of any indoor tanning safety measures. Sun safety behaviors varied by age and gender, with some socio-economic differences in tanning bed use. An association was found between frequency of family holidays abroad and sunburn.Conclusion: Targeted interventions are needed to increase sun safety behaviors and eliminate tanning bed use among children in Ireland.

Contribution of family history of melanoma to associated risk factors: Analysis of an Internet-based risk assessment tool.

10546 Background: Risk factors for melanoma (ML) include UV exposure, sunburns, multiple nevi, and fair skin. Smoking and alcohol use may also play a role. Demographics associated with increased UV exposure include male gender, white race, age 18-29, and high-income. Those with family history (FH) of ML have increased risk of developing ML themselves yet are often unaware or do not engage in preventive behaviors. We sought to understand the association between FH of ML and other personal risk factors for cancer. Methods: Since 2009, voluntary participants could receive personalized information regarding their cancer risk via the OncoLink.org Reduce My Risk tool. Survey data was collected on demographics, FH, risk-factors, and risk-associated behaviors. Use of data was IRB approved. Differences between respondents with v. without FH of ML were analyzed using chi-square test and adjusted via logistic regression. Results: 25255 responses were analyzed; 1928 (7.6%) had FH of ML. Of these, median age was 26 (range 18-75), 73.1% were female, 88.6% from North America, 91.4% White, 78.2% had at least some college, and 62.0% household income > $45,000. Comparing those with FH of ML to those without, no significant differences were observed in education, income, or home setting. Those with a FH of ML were less likely to be “light” smokers ( < 1 pack per day) but were more likely to be both “light” drinkers and “heavy” drinkers (Table). There were no significant differences in BMI or exercise habits. Those with FH of ML were more likely to sunbathe, to have had “blistering” sunburns, have 50+ moles, show signs of sun damage on their skin, and have dysplastic nevi (Table). There were no differences in use of indoor tanning beds (Table). Conclusions: Those with a FH of ML were more likely to sunbathe and to report skin damage and history of blistering sunburns; they were more likely to use tanning beds, though not statistically significant. These behaviors are modifiable and may suggest parental influence on sun-protective behaviors. Those with FH also reported increased non-modifiable risks. Future work should continue to explore targeted intervention for those with a FH of ML to educate on risk and promote sun-protective behaviors.[Table: see text]

Invasive and insitu squamous cell carcinoma of the skin: a nationwide study in Iceland.

The worldwide incidence of cutaneous squamous cell carcinoma (cSCC) is increasing. To evaluate the tumour burden of insitu and invasive cSCC in Iceland, where the population is exposed to limited ultraviolet radiation. This whole-population study used the Icelandic Cancer Registry, which contains records of all insitu and invasive cSCC cases from 1981 to 2017. Incidence of cSCC was evaluated according to age, anatomical location, residence and multiplicity, and trends were assessed using joinpoint analysis. Age-standardized rates (WSR) and age-specific incidence rates per 100000 person-years were calculated, along with cumulative and lifetime risks. Between 1981 and 2017, insitu cSCC WSR increased from 1·2 to 19·1 for men and from 2·0 to 22·3 for women. Invasive cSCC WSR rose from 4·6 to 14 for men and from 0·3 to 13·2 for women. The average number of insitu cSCC lesions was 1·71 per woman and 1·39 per man. Women developed more insitu cSCCs than invasive cSCCs in almost all anatomical locations, whereas men developed more invasive cSCCs, mostly on the head and neck. The rates of insitu cSCC were higher in Reykjavik compared with rural areas. Furthermore, women more commonly developed multiple insitu lesions. For lip cSCCs, invasive lesions occurred more frequently than insitu lesions among both sexes. Joinpoint analysis showed that insitu cSCC in women exhibited the most rapid incidence increase. cSCC has become an increasingly significant public health problem in Iceland. Tanning bed use and travelling abroad may contribute to skin cancer development. Public health efforts are needed to stem the behaviours leading to this rapid rise in cSCC.

To ban or not to ban tanning bed use for minors: A cost-effectiveness analysis from multiple US perspectives for invasive melanoma.

Tanning bed use is common among US adolescents, but is associated with increased melanoma risk. The decision to ban tanning bed use by adolescents should be made in consideration of the potential health benefits and costs. The US population aged 14 to 17 years was modeled by microsimulation, which compared ban versus no ban strategies. Lifetime quality-adjusted life years (QALYs) and costs were estimated from a health care sector perspective and two societal perspectives: with and without the costs of policy enforcement and the economic losses of the indoor-tanning bed industry. Full adherence to the ban prevented 15,102 melanoma cases and 3299 recurrences among 17.1 million minors, saving $61in formal and informal health care costs per minor and providing an increase of 0.0002 QALYs. Despite the intervention costs of the ban and the economic losses to the indoor-tanning industry, banning was still the dominant strategy, with a savings of $12 per minor and $205.4 million among 17.1 million minors. Findings were robust against varying inspection costs and ban compliance, but were sensitive to lower excess risk of melanoma with early exposure to tanning beds. A ban on tanning beds for minors potentially lowers costs and increases cost effectiveness. Even after accounting for the costs of implementing a ban, it may be considered cost effective. Even after accounting for the costs of implementing a ban and economic losses in the indoor-tanning industry, a tanning bed ban for US minors may be considered cost effective. A ban has the potential to reduce the number of melanoma cases while decreasing health care costs. Previous meta-analyses have linked tanning bed use with an increased risk of melanoma, particularly with initial use at a young age. Yet, it remains unclear whether a ban of adolescents would be cost effective. Overall, a ban has the potential to reduce the number of melanoma cases while promoting a decrease in health care costs. Even after accounting for the costs of implementing a ban and the economic losses incurred by the indoor-tanning industry, a ban would be cost effective.

Ban on tanning-bed use for minors reduces risk of melanoma, saves cost in the US

Ban on tanning-bed use for minors reduces risk of melanoma, saves cost in the US

A randomized controlled trial of a web-based personalized feedback intervention targeting frequent indoor tanning bed users: Engagement, acceptability, and preliminary behavioral outcomes.

Frequent indoor tanning bed use is an established public health concern, yet research on tanning cessation interventions for frequent tanners is lacking. We describe the protocol for a brief, web-based tanning behavior change intervention and present evidence that it is acceptable and engaging to frequent indoor tanners. Lower tanning rates were not observed among participants receiving the intervention in a randomized controlled trial but participants' interest in changing tanning increased. This intervention could be a useful approach to increasing frequent tanners' interest in behavior change and openness to engaging within a more intensive, multi-component tanning cessation program.Trial Registration: NCT03448224 Clinical Trials.gov (https://clinicaltrials.gov/ct2/show/NCT03448224?cond=NCT03448224&draw=2&rank=1).

Recreational and residential sun exposure and risk of endometriosis: a prospective cohort study.

Is recreational and residential sun exposure associated with risk of endometriosis? Tanning bed use in early adulthood, sunscreen use and history of sunburns were associated with a greater risk of endometriosis; however, higher residential UV exposure was associated with a lower endometriosis risk. Previous research has reported an association between endometriosis and skin cancer, with evidence of shared risk factors between the two diseases. We investigated the potential associations between ultraviolet radiation and endometriosis risk. The Nurses' Health Study II is a prospective cohort of 116429 female US nurses aged 25-42 years at enrolment in 1989. Participants completed self-administered biennial questionnaires through June 2015. We investigated self-reported measures of recreational sun-exposure and geocoded residential UV exposure in childhood and adulthood in relation to risk of laparoscopically confirmed endometriosis among premenopausal white women. We used Cox proportional hazards models to calculate hazard ratios (HRs) and 95% CIs. During follow-up, 4791 incident cases of laparoscopically confirmed endometriosis were reported among 1252 248 person-years. Tanning bed use during high school/college (≥6 times per year vs. never use: HR = 1.19, 95% CI = 1.01-1.40; Ptrend = 0.04) and at ages 25-35 (HR = 1.24, 95% CI = 1.12-1.39; Ptrend ≤ 0.0001), number of sunburns during adolescence (Ptrend = 0.03) and percentage of time using sunscreen in adulthood (Ptrend = 0.002) were positively associated with risk of endometriosis. In contrast, residential UV level at birth (highest vs. lowest quintile: HR = 0.81, 95% CI = 0.72-0.92; Ptrend = 0.0001), at age 15 (HR = 0.79, 95% CI = 0.70-0.88; Ptrend ≤ 0.0001) and at age 30 (HR = 0.90, 95% CI = 0.82-0.99; Ptrend = 0.21) were associated with a decreased risk of endometriosis. Self-reported endometriosis diagnosis may be prone to misclassification; however, we restricted our definition to laparoscopically confirmed endometriosis, which has been shown to have high validity compared to medical records. Our results suggest that tanning bed use in early adulthood increases endometriosis risk, potentially through a harmful effect of ultraviolet A wavelengths, and that residential UV exposure reduces risk, possibly via optimal vitamin D synthesis. These findings should be investigated further to enhance our understanding of endometriosis aetiology. This project was supported by NICHD grants HD48544 and HD52473, HD57210, NIH grant CA50385, CA176726. M.K. was supported by a Marie Curie International Outgoing Fellowship within the 7th European Community Framework Programme (#PIOF-GA-2011-302078) and is grateful to the Philippe Foundation and the Bettencourt-Schueller Foundation for their financial support. H.R.H. is supported by the National Cancer Institute, National Institutes of Health (K22 CA193860). The authors have nothing to disclose. N/A.

13286 A cross-sectional analysis of tanning habits among undergraduate students at the University of Michigan

American Cancer Society data show that skin cancer is the most common malignancy in the US, with the number of diagnosed melanoma cases on the rise. Ann Arbor faces a rising number of luxury off-campus student apartment complexes offering free access to tanning beds, which raises concern on its effect on the frequency of tanning bed use. An unvalidated 31-question cross-sectional survey was distributed to 125 registered undergraduate student organizations. Ninety-six individuals completed the survey.

Influence of Parental Attachment and Life Satisfaction on Social Tanning Behavior

The goal of the study was to explore college students’ social tanning behavior based on their parental attachment and life satisfaction. The data were collected from a sample of 333 college students using a self-administered online survey tool. The questionnaire consisted of multi-item scales measuring parental attachment, life satisfaction, and social tanning behaviors (tanning bed use vs. sun tanning) along with demographic questions. The majority of the participants were female (80.2%) and Caucasian (76.9%), with an average age of 19.8 years. Results suggest that there is an association between having a high parental attachment and engaging in “social sun tanning.” College students who are highly satisfied with their life are less likely to use tanning beds with friends and families. Intervention strategies to deter harmful body-tanning should be designed to consider ways of improving quality of relationships and life.

Sunscreen and Tanning Bed Use in High-Risk College-Aged Students

ABSTRACT Skin cancer is the most prevalent cancer in the United States. Contributing factors include phenotypic exposure to ultraviolet radiation, lack of protective measures, and using high-risk behaviors. Protective measures (sunblock/protective clothing) are not popular with college-aged individuals, whereas tanning bed use is highly prevalent. The purpose of this study was to describe phenotypic risk factors for skin cancer, application of sunscreen, and tanning bed use in college students. A convenience sample of 673 students (55% male) completed a descriptive survey during winter, spring, and summer months. Researchers collected information about phenotypic risk factors using the Fitzpatrick Skin Scale, use of sunscreen, previous tanning bed use, and gender. Furthermore, 9.5% of college-aged individuals reported using sunscreen. Sunscreen use varied by season (p = .009) but not by skin type. Women reported higher sunscreen use (p = .0001). In addition, 12.6% disclosed a history of tanning bed use (M = 1.2). Male participants were more likely to use tanning beds during winter months (p = .015). Skin type did not influence tanning bed use. College-aged individuals are not sufficiently protecting themselves from the sun. More attention is needed to help melano-compromised individuals, especially men, understand how risk factors influence the development of skin cancer.

Abstract 4651: Interaction between outdoor ultraviolet radiation and indoor tanning bed use on skin cancer risk

Abstract Background: Solar ultraviolet (UV) radiation and the use of UV-emitting tanning devices are risk factors for melanoma and non-melanoma skin cancer (NMSC). Despite abundant evidence, frequent outdoor sunbathers are more likely to use indoor tanning beds. In our study, we aim to investigate the interaction between indoor tanning bed use and exposure to solar UV radiation associated with the risk of skin cancer. Methods: The study population was participants of the Nurses' Health Study II, which started in 1989 including 116,430 registered female nurses aged 25-42. Participants biennially self-reported diagnosis of skin cancer: melanoma, basal cell carcinoma (BCC), and squamous cell carcinoma (SCC). Cases for melanoma and SCC were confirmed by medical records. Information on indoor tanning bed use during high school/college or age 25-35 was collected. Cumulative average UV exposure at residence during follow-up was calculated for each participant. We built Cox proportional hazards models adjusting for potential confounders. Interactions between cumulative UV exposure and indoor tanning use were tested in multivariable-adjusted models for three types of skin cancer. Results: We found significant interactions between cumulative average UV during follow-up and indoor tanning bed use during high school/college years (P for interaction=0.01) on the risk of BCC, but not during the age 25-35 (P for interaction=0.15). Subjects who were exposed to high UV and used tanning bed during high school/college (RR: 1.54, 95% CI 1.38, 1.72) or during age 25-35 (RR: 1.56, 95% CI: 1.43, 1.69) had nearly 50% increased risk of BCC compared to subjects who were exposed to low UV and did not use tanning bed. Increased risk but non-significant interactions were found for SCC (indoor tanning during high school/college years: P for interaction=0.29, during age 25-35: P for interaction=0.09). Subjects who were exposed to high UV and used tanning bed during age 25-35 had approximately double the risk of SCC (RR: 2.04, 95% CI: 1.51, 2.76), compared to the reference group. No significant interactions were found for the risk of melanoma. Conclusions: We found significant interaction between outdoor UV and indoor tanning bed use during high school/college years on the risk of BCC but not SCC or melanoma. Citation Format: Jongeun Rhee, Tricia Li, Wen-Qing Li, Abrar A. Qureshi, Eunyoung Cho. Interaction between outdoor ultraviolet radiation and indoor tanning bed use on skin cancer risk [abstract]. In: Proceedings of the Annual Meeting of the American Association for Cancer Research 2020; 2020 Apr 27-28 and Jun 22-24. Philadelphia (PA): AACR; Cancer Res 2020;80(16 Suppl):Abstract nr 4651.

105 Trends in the interest of indoor tanning beds internationally

Keratinocyte carcinoma and melanoma are associated with a history of indoor tanning bed use. Despite strong evidence for the effect of indoor tanning on skin cancer and photo-aging, people continue to use UV-emitting tanning devices. We sought to assess and compare interest in indoor tanning among countries with different indoor tanning regulations with Google Trends. From 2004 - 2019 we extracted search queries for “σολαριουμ” (“solarium”) which is greek for indoor tanning and “indoor tanning” for the United States, “solarium” for Australia, France, Sweden, Belgium, Italy, Spain and Brazil.

LB936 Tanning bed use and the risk of anxiety and depression

LB936 Tanning bed use and the risk of anxiety and depression

Skin Cancer and UV Exposure-Related Behaviors Among Appalachian and Non-Appalachian Adults.

IntroductionAppalachian communities experience elevated rates of cancer incidence and mortality relative to other regions in the U.S. Specifically, melanoma mortality rates are higher in Appalachia compared to the national average, despite comparable incidence rates.PurposeTo examine differences in self-reported history of skin cancer and prevalence of two UV exposure behaviors between Appalachian and non-Appalachian adults in a nationally representative sample.MethodsData are from four cross-sectional cycles of the Health Information National Trends Survey (2011–2014) (N=14,451). We examined sunscreen use and tanning bed use, and self-reported history of melanoma and non-melanoma skin cancer. Descriptive and weighted multivariable analyses were conducted to examine sunscreen and tanning bed use, controlling for sociodemographic characteristics.ResultsApproximately 8% of the study sample resided in Appalachia (n=1,015). Self-reported melanoma (0.6%) and non-melanoma (3.2%) skin cancer histories were low among Appalachians and did not differ statistically from non-Appalachians (p>0.05). Only 21.2% of Appalachians reported using sunscreen often or always when going outside for more than one hour on a warm, sunny day compared to 27.4% of non-Appalachians (pp=0.04), but there were no regional differences in tanning bed use (OR=1.48, p=0.23) when controlling for sociodemographics and general health status.ImplicationsAppalachians had comparable histories of self-reported melanoma and non-melanoma skin cancer but were less likely to report sunscreen use than non-Appalachians. Enhanced communication efforts to promote sunscreen use and other UV protection behaviors in Appalachia may be valuable.

Sunscreen Use among a Population of Saudi University Students.

Introduction Sunscreen is an important method of sun protection. Many studies were conducted worldwide on the use of sunscreen but only few done in Saudi Arabia. The aim of our study is to assess the prevalence, practices, and factors associated with sunscreen use among Saudi university students. Materials and Methods A cross-sectional study was performed at King Saud bin Abdulaziz University for Health Sciences in Riyadh, Saudi Arabia. A questionnaire on the use of sunscreen was created in English. Quota sampling technique was used since the sample was divided according to gender and college year. Results A total of 1,011 students were enrolled. Approximately half were males (n = 510). Half of the students used sunscreen (n = 515, 51%). Female gender, high family income, previous history of sunburn, tanning bed use, and use of other sun protection methods were factors independently associated with sunscreen use. The main reasons for using sunscreen were prevention of sunburns, dark spots, skin cancer, and overall skin darkening. Eighty percent of participants used other methods of sun protection. Sunscreen with a sun protection factor (SPF) > 30 was used in 59% of students. However, the majority did not know if the sunscreen they use provided broad-spectrum coverage or not. Only 35% of students apply sunscreen in both sunny and cloudy days. Most students apply sunscreen less than 10 minutes before going out and do not repeat the application throughout the day. More than 90% of students seem to apply insufficient amount of sunscreen. Conclusion Almost half of the population in the study use sunscreen. We have identified several areas of improper use of sunscreen. Increasing the awareness of effective sunscreen use in our community might be needed.

Abstract P543: Association Of Tanning Bed Use With Depression In A Preventive Medicine Cohort: The Cooper Center Longitudinal Study

Importance: The use of tanning beds continues despite evidence of increased skin cancer risk among users. In the US, the prevalence of indoor tanning ranges from 35% of adults to 59% of college students. Objective: To investigate the association between depressive symptoms and tanning bed use. Design: Cross-sectional study. Setting: A preventive medicine clinic in Dallas, Texas. Participants: Between September 2013 and June 2019, a total of 11,823 generally healthy men and women presented for preventive medical examinations. Exposure: Self-reported tanning bed use. Main Outcome and Measures: Depressive symptoms as indicated by a score of greater than or equal to 10 on the Center for Epidemiologic Studies Depression (CES-D) Scale. Results: Fifteen percent of participants had used a tanning bed prior to their examination. For men, tanning bed use was associated with an increased risk of depressive symptoms (OR: 1.86; 95% CI:1.41-2.44). For women, the association between the use of tanning beds and depressive symptoms was significant in an unadjusted model, but was no longer significant after adjustment for confounders (OR: 1.26; 95% CI:0.99-1.61). However, the odds ratio was still in the direction of increased risk. Women with a personal history of depression were more likely to tan frequently and have higher CES-D scores than women with no personal history of depression ( p = .003). Conclusions and Relevance: In a generally healthy population, depressive symptoms were associated with the use of a tanning bed. This association was more evident in those with a history of depression, although remained true for those without a history of depression. As recurrent tanning bed use is known to contribute to the diagnosis of melanoma, it is critical to help patients identify other options to treat depression as well as to educate them on the risks of routine tanning bed use.

Fertility drugs and cutaneous melanoma risk: a French prospective cohort study.

Cutaneous melanoma has been suspected to be influenced by female sex hormones. A review of the literature in 2018 indicated that fertility drug (FD) use was associated with increased melanoma risk among parous women only. However, most studies so far were based on a retrospective design and the current evidence is unclear. We sought to prospectively investigate the associations between FD use and melanoma risk in women. E3N is a prospective cohort of 98 995 French women aged 40-65 years at inclusion in 1990. Information on use of FDs, including duration and time of administration, was assessed through self-administered questionnaires. We used Cox proportional hazards regression models adjusted for age and melanoma risk factors. Over 1990-2008, about 611 melanoma cases were ascertained among 86 653 women. Compared with never use, ever use of FDs was not associated with melanoma risk overall [hazard ratio (HR) = 1.15; 95% confidence interval (CI) = 0.75-1.74], or among parous women (HR = 1.08; 95% CI = 0.67-1.73). Among ever users of FDs, duration of use and age at first use were not associated with melanoma risk. Associations were similar after adjustment for UV exposure, although FD users were more likely to report tanning bed use than never-users (odds ratio = 1.50; CI = 1.01-2.22) in a subsample with recreational UV exposure data. Our data do not support an association between FD use and melanoma risk, but underlie the importance of taking into consideration potential confounding from sun exposure in future research.

Melanoma Characteristics in Patients with a History of UV Tanning Bed Usage

The purpose of this study was to evaluate the effect of tanning bed use on the behavior of subsequent melanomas. Cases of invasive cutaneous melanoma who completed a baseline questionnaire within 1 year of biopsy were ascertained using an institutional registry. Patients were categorized into one of two groups: (1) no history of UV tanning bed usage or (2) any history of tanning bed usage. Data analysis looked for group differences on the following variables: TNM staging, mitotic rate, family history of melanoma, and basic demographic variables. Among 141 cases, a higher percentage of women (48.28%) reported tanning bed usage compared to men (26.51%, P < .01). Additionally, the average age at biopsy for people who reported tanning bed usage was significantly lower compared to those who had not reported using a tanning bed. There was no significant difference in stage at presentation (P = .56). Those with tanning bed usage presented significantly less often with melanoma of unknown primary (MUP). After controlling for the effects of gender and nodal status, tanning bed usage was not a significant independent predictor of 5 year overall survival. If we remove the subject with MUP on the basis that more of these are mucosal in origin, lower TNM stage at presentation are found in patients with no tanning bed melanoma compared to those with history of tanning bed usage. In addition, tanning bed patients are younger and more likely female but with an equivalent mortality rate. Case Series.

Recurrent and Invasive Primary Squamous Cell Carcinoma of the Chest Wall: A Case Report

Squamous cell carcinoma is a type of skin cancer with abnormal proliferation of keratinocytes. Its incidence reaches approximately 20% of cases of non-melanoma skin cancer, which has increased in recent decades due to growth in life expectancy, increased sun exposure, the use of tanning beds and improved detection of this type of tumors. We present a patient who was diagnosed with a squamous cell skin carcinoma in the chest wall, treated initially with surgical resection. A few years recurred in the same place, so the patient received radiotherapy with poor response. Ultimately a new surgical approach was performed with a wide margin resection by a multidisciplinary surgical team. Multidisciplinary management in this type of procedure is important so that the long-term result is optimal for the patient.