Tanning Equipment Research Articles

Prevalence of tanning equipment use among Canadians.

The objective of this study was to collect prevalence estimates of indoor tanning usage and associated injuries in Canada. The rapid response component of the 2019 Canadian Community Health Survey collected data on the use of tanning equipment in the previous 12months, including reasons for use, frequency/duration of use, precautions taken and adverse reactions or injuries. The 2019 research findings were as follows, an estimated 3.0% (95% CI: 2.5-3.4%) of Canadians reported that they had used indoor tanning equipment in the past year. Among users, 71.1% (95% CI: 63.9-78.3%) were female and females aged 18-34 were significantly more prevalent users compared to females aged 45 or older. The prevalence of indoor tanning was higher among people without a university degree; however, there were no differences in prevalence by household income or region. Most users indicated they used indoor tanning equipment within a tanning salon (75.3%: 95% CI: 69.1-81.6%) and the most common reason for usage was to develop a "protective" base tan (72.1%: 95% CI: 65.2-78.9%). Over one third (39.2%: 95% CI: 31.1-47.2%) of all users reported 10 or more sessions in the past year. The prevalence of indoor UV tanning usage is declining in Canada. Similar to results in 2014, the majority of users continue to be female, with a large number in the 18 to 34 age group.

“I Think There Should Be Photos”: Female Indoor Tanners’ Perceptions of Health Warning Labels for Tanning Beds

ABSTRACT 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.

Screening and Intervention for Skin Cancer in the Galapagos.

This study aimed to assess the general dermatological needs and correlation of tentative skin cancer screening diagnoses with histopathological confirmation in the highly sun-exposed locals of the Galapagos Islands. An institutional review board-approved prospective study was performed at Blanca's House, a nonprofit surgical volunteer organization, free clinics in the Galapagos. After consent, a 40-item modified SPOTme-inspired questionnaire was completed. Partial or total body skin examinations were conducted by board-certified dermatologists. Board-certified plastic and general surgeons performed excisional biopsies on suspicious lesions. Individuals younger than 18 years, and non-Spanish or non-English speakers were excluded. A total of 273 patients were included in the study, of which 202 reported skin concerns. Benign nevi (n = 76), seborrheic keratosis (n = 42), melasma (n = 19), actinic keratosis (n = 16), acne (n = 15), eczema (n = 13), fungal infections (n = 12), seborrheic dermatitis (n = 5), and psoriasis (n = 5) were most commonly identified.Twelve patients (4.4%) had presumptive skin cancer after screening. Six of 8 biopsies confirmed cancer (group 1), 2 declined a biopsy and 2 were unresectable. Seven basal cell carcinomas and one squamous cell carcinoma were excised with clear margins. A right lower eyelid melanoma was diagnosed and subsequently treated in the United States where invasive melanoma with a Breslow thickness of 0.3 mm was found.Compared with the noncancer group (group 2: n = 265), group 1 had significantly higher likelihood of reporting having seen a dermatologist (P = 0.02), taking any medications (P = 0.0001), having blonde or red hair (P = 0.01), having blue or green eyes (P < 0.0001), and having used indoor tanning equipment (P < 0.0001). Group 1 was also more likely to report 4 or more blistering sunburns (P = 0.08), which approached significance. When evaluated by a dermatologist, group 1 was significantly more likely to be classified as "high risk" for developing cancerous lesions (P < 0.0001) compared with group 2. Skin concerns in the Galapagos included benign and malignant conditions. There is a need for dermatological care in this medically underserved population. This modified SPOTme-inspired skin cancer questionnaire, confirmed by histology, is a useful tool in identifying high-risk patients and detecting skin cancer in international communities that would have otherwise experienced delays in diagnosis or treatment.

Availability of tanning salons in Ontario relative to indoor tanning policy (2001-2017).

Ultraviolet (UV) radiation from indoor tanning equipment is a known cause of skin cancer; however, little is known about how the availability of indoor tanning salons has been impacted by indoor tanning legislation, including Ontario's Skin Cancer Prevention Act: Tanning Beds (SCPA). Tanning salon listings were obtained from the 2001 to 2017 editions of InfoCanada's Ontario Business to Business Sales and Marketing directories. Using descriptive statistics and regression analysis, we assessed the number of tanning salons before and after: 1) the 2006 International Agency for Research on Cancer (IARC) report on indoor tanning and skin cancer; 2) the 2009 World Health Organization (WHO) reclassification of artificial UV radiation as carcinogenic; and 3) the passing and enactment of Ontario's SCPA in 2013 and 2014, respectively. There were fewer tanning salon listings in the years after vs. before the IARC report, the WHO reclassification, and the passing and enactment of the SCPA. The number of tanning salons in Ontario, Canada has been declining since 2006, which may reflect a decline in indoor tanning bed use. Key public health policy instruments, including legislation and public education, appear to be associated with this trend, suggesting they may contribute to deterring indoor tanning.

Commercial tanning salons and melanoma risk.

There have been many case-control studies of melanoma and the use of indoor tanning equipment. A recent meta analysis of 8 credible studies in North America estimated an overall significant odds ratio of 1.23. Three of these 8 studies also reported separately on commercial use and home use of indoor tanning equipment. For home use the overall odds ratio was a significant 1.53 while for commercial use there was a non significant 1.05.

"Oh yeah, they're looking": A thematic analysis of indoor UV tanning industry advertising and articles.

Skin cancers are becoming more prevalent even though many can be prevented. Women are more knowledgeable than men about skin cancer, yet they are more likely to sunbathe deliberately and to use artificial tanning equipment. The purpose of this article is to examine messages that women receive about the benefits of a tan. Particularly, we focused on how the indoor UV tanning industry represents the value of a tan to women. We subjected five issues of Smart Tan Canada to thematic analysis. We examined language in advertisements and articles that promote an artificial tan to women. Four themes emerged: Be Beautiful and Sexy; Look Young; Feel Better; and Science, Health, and Nature. These themes are especially effective in a culture that routinely objectifies women and places a high degree of value on their appearance. We suggest that appearance-based interventions, media literacy training, and legislation could counteract the messages in the themes.

190: Banning Tanning

The World Health Organization lists artificial tanning beds as a class one physical carcinogen. Tanning bed use is associated with a 75% increased risk of cutaneous malignant melanoma if used before the age of 35. In 2012, the Manitoba government announced a parental consent law that requires minors to have a guardian present or sign a permission form for children and youth to use artificial tanning equipment. This law falls below the national standards as set by the Canadian Pediatric Society (CPS); furthermore, parental consent laws have been shown to be ineffective at changing commercial tanning exposure in youth. Our group of senior pediatric residents worked on a project advocating for a complete ban of commercial tanning use for all youth under the age of 18 in Manitoba. The first component of the project focused on community education. Residents presented to middle and high school students about the harmful consequences of tanning, and created educational pamphlets that were made available at several general pediatric clinics. The second component of our project focused on legislative change and public forum advocacy. Residents engaged with the media to bring awareness to the general public about the risks of artificial tanning. A petition calling for a complete ban of artificial tanning for minors was also created. This petition, which included over 1000 signatures, along with evidence supporting a full ban for artificial tanning was presented to the Manitoba Ministers of Health and Healthy Living in an invited forum to advocate for legislative change. These efforts were successful and resulted in the recent proposed legislation calling for a full ban on artificial tanning for minors; this is expected to pass into Manitoba law in the spring of 2015. This project serves as an example of how physicians can promote the health of their patients via community education, collaboration with public health experts, and involvement in local government.

Melanoma attributable to sunbed use and tan seeking behaviours: an Italian survey

Melanoma is the most deadly form of skin cancer and its incidence is increasing worldwide. In 2009, the International Agency for Research on Cancer classified the entire UV spectrum as carcinogenic. In many countries, including Italy, the use of tanning equipment by minors and individuals with high risk phenotypes has been banned. This study assessed tan-seeking behaviour in a Mediterranean population with a relatively high melanoma incidence, where a considerable time is spent tanning outdoors. Subjects spending the most time in the sun were typically young single men, who use significantly less sunscreen and sunglasses. The overall prevalence of sunbed use was 22% in youth (≤35 years old) and 18% of them used sunbeds throughout the year. Sunbed use in youth was greater for phenotypes at risk. In Italy, 3.8% of melanoma cases are attributable to sunbed use, more in women (4.2% vs 3.1%, for women and men respectively) and much more in the young (17%). Of 8013 new melanoma cases in 2008 in Italy, 293 were attributable to sunbed use, with a high proportion of these in women (168) and 1045 were attributable to sun exposure. Among youth, 172 cases were attributable to sunbed use and 140 exclusively to sunbed use. This analysis reveals that a large number of cancers each year in Italy could be avoided by changing cultural attitudes to tanning. Sun avoidance and protection is generally inadequate in adults, especially young men. These results have important implications for the primary prevention of melanoma.

Sunbed use among subjects at high risk of melanoma: an Italian survey after the ban

The World Health Organization classified the entire ultraviolet (UV) spectrum and artificial UV tanning devices as carcinogenic to humans. Italian law has prohibited the use of tanning equipment by children under 18 years of age and by high-risk populations. The present large survey aimed to determine the prevalence of current sunbed use in Italy and to identify user characteristics. This study identifies starting points for future national interventions to reduce the health risks of exposure to artificial UV radiation. In 2011 we conducted a survey of 4703 people in an area on the sunny Mediterranean coast in Italy. Through multivariate logistic models we investigated the associations of sunbed use with phenotypical factors. Overall prevalence of sunbed use was 20%, higher among women (22% vs. 16%; P < 0·0001), and young (22% vs. 17% for age < 35 years; P < 0·0001) and highly educated people (22% vs. 14%; P < 0·0001). Subjects at high risk of melanoma used sunbeds significantly more; i.e. people with freckles (25% vs. 18%; P < 0·0001), red hair (30% vs. 19%; P = 0·01) or fair eyes (22% vs. 19%; P = 0·006). Associations were confirmed in multivariate models. More skin cancer monitoring is needed at tanning centres, and educational campaigns should be promoted, especially for young women and subjects at high risk of melanoma.

Public Health and the Tanning Bed Controversy

Public Health and the Tanning Bed Controversy

Adverse effects of ultraviolet radiation from the use of indoor tanning equipment: Time to ban the tan

Adverse effects of ultraviolet radiation from the use of indoor tanning equipment: Time to ban the tan

FDA-SUNLAMP RECOMMENDED MAXIMUM TIMER INTERVAL AND EXPOSURE SCHEDULE: CONSENSUS ISO/CIE DOSE EQUIVALENCE

The authors compared calculations of sunlamp maximum exposure times following current USFDA Guidance Policy on the Maximum Timer Interval and Exposure Schedule, with USFDA/CDRH proposals revising these to equivalent erythemal exposures of ISO/CIE Standard Erythema Dose (SED). In 2003, [USFDA/CDRH proposed replacing their unique CDRH/Lytle] erythema action spectrum with the ISO/CIE erythema action spectrum and revising the sunlamp maximum exposure timer to 600 J m(-2) ISO/CIE effective dose, presented as being biologically equivalent. Preliminary analysis failed to confirm said equivalence, indicating instead ∼38% increased exposure when applying these proposed revisions. To confirm and refine this finding, a collaboration of tanning bed and UV lamp manufacturers compiled 89 UV spectra representing a broad sampling of U.S. indoor tanning equipment. USFDA maximum recommended exposure time (Te) per current sunlamp guidance and CIE erythemal effectiveness per ISO/CIE standard were calculated. The CIE effective dose delivered per Te averaged 456 J(CIE) m(-2) (SD = 0.17) or ∼4.5 SED. The authors found that CDRH's proposed 600 J(CIE) m(-2) recommended maximum sunlamp exposure exceeds current Te erythemal dose by ∼33%. The current USFDA 0.75 MED initial exposure was ∼0.9 SED, consistent with 1.0 SED initial dose in existing international sunlamp standards. As no sunlamps analyzed exceeded 5 SED, a revised maximum exposure of 500 J(CIE) m(-2) (∼80% of CDRH's proposal) should be compatible with existing tanning equipment. A tanning acclimatization schedule is proposed beginning at 1 SED thrice-weekly, increasing uniformly stepwise over 4 wk to a 5 SED maximum exposure in conjunction with a tan maintenance schedule of twice-weekly 5 SED sessions, as biologically equivalent to current USFDA sunlamp policy.

Adverse effects of ultraviolet radiation from the use of indoor tanning equipment: Time to ban the tan

The incidence of melanoma skin cancer is increasing rapidly, particularly among young women in the United States. Numerous studies have documented an association between the use of indoor tanning devices and an increased risk of skin cancer, especially in young women. Studies have shown that ultraviolet exposure, even in the absence of erythema or burn, results in DNA damage. Countries and regulatory bodies worldwide have recognized the health risks associated with indoor tanning. In the United States, 32 states have passed legislation to regulate the indoor tanning industry, but there is an urgent need to restrict the use of indoor tanning devices at the federal level. The Food and Drug Administration is currently reviewing the classification of these devices. For all of these reasons, the Food and Drug Administration should prohibit the use of tanning devices by minors and reclassify tanning devices to at least class II to protect the public from the preventable cancers and other adverse effects caused by ultraviolet radiation from indoor tanning.

Adverse effects of ultraviolet radiation from the use of indoor tanning equipment: Time to ban the tan

The incidence of melanoma skin cancer is increasing rapidly, particularly among young women in the United States. Numerous studies have documented an association between the use of indoor tanning devices and an increased risk of skin cancer, especially in young women. Studies have shown that ultraviolet exposure, even in the absence of erythema or burn, results in DNA damage. Countries and regulatory bodies worldwide have recognized the health risks associated with indoor tanning. In the United States, 32 states have passed legislation to regulate the indoor tanning industry, but there is an urgent need to restrict the use of indoor tanning devices at the federal level. The Food and Drug Administration is currently reviewing the classification of these devices. For all of these reasons, the Food and Drug Administration should prohibit the use of tanning devices by minors and reclassify tanning devices to at least class II to protect the public from the preventable cancers and other adverse effects caused by ultraviolet radiation from indoor tanning.

The association of use of sunbeds with cutaneous malignant melanoma and other skin cancers: A systematic review

Exposure to solar ultraviolet (UV) radiation is a known cause of skin cancer. Sunbed use represents an increasingly frequent source of artificial UV exposure in light-skinned populations. To assess the available evidence of the association between sunbed use and cutaneous malignant melanoma (melanoma) and other skin cancers, a systematic review of the literature till March 2006 on epidemiological and biological studies on sunbed use was performed in Pubmed, ISI Web of Science, Embase, Pascal, Cochrane library, Lilacs and Medcarib. Search for keywords in the title and in the abstract was done systematically and supplemented by manual searches. Only case-control, cohort or cross-sectional studies were selected. Data were abstracted by means of a standardized data-collection protocol. Based on 19 informative studies, ever-use of sunbeds was positively associated with melanoma (summary relative risk, 1.15; 95% CI, 1.00-1.31), although there was no consistent evidence of a dose-response relationship. First exposure to sunbeds before 35 years of age significantly increased the risk of melanoma, based on 7 informative studies (summary relative risk, 1.75; 95% CI, 1.35-2.26). The summary relative risk of 3 studies of squamous cell carcinoma showed an increased risk. For basal cell carcinoma, the studies did not support an association. The evidence does not support a protective effect of the use of sunbeds against damage to the skin from subsequent sun exposure. Young adults should be discouraged from using indoor tanning equipment and restricted access to sunbeds by minors should be strongly considered.

Tanning Devices: Behaviour of French Adults Participating to the SU.VI.MAX Cohort

P-378 Abstract: The adverse effects of excessive ultraviolet radiation on the skin are widely documented. In spite of precautionary warnings, a suntan is still considered as a sign of good health and attractiveness. The use of commercial tanning facilities still increases mainly because of the belief that cosmetic tanning represents a “safe” tan. The objective of the present study is to describe the use of tanning equipment within the SU.VI.MAX cohort. A self-administered questionnaire on sun exposure behaviour was specifically developed and addressed in 2001 to 12,741 French adult volunteers enrolled in the SU.VI.MAX cohort. Among the 7,359 individuals who answered the questionnaire, 1,179 (16%) – 953 women and 226 men – declared having experienced indoor tanning practice during lifetime. Seven percent of women declared a regular usage (6% for men), and 10% for duration of at least five years (10% for men). Among women, 44% of users belonged to the youngest classes of age at inclusion (35–44), versus 33% in non-users (in men data non available for these classes of age), 48% of users lived in North or in Ile-de-France, versus 39% in non-users (45% and 36% for men, respectively), 56% declared having lifetime tanning practices between 11 a.m. and 4 p.m. in users, versus 37% in non-users (53% and 38%), 39% declared regular use of protection products during tanning in users, versus 24% in non-users (17% and 7%), 54% declared gradual sun exposure in users, versus 43% in non-users (53% and 38%), 13% declared having naturism practices in users, versus 6% in non-users (19% and 8%), and 93% declared having experienced sunburns in adulthood in users, versus 88% in non-users (93% and 89%). The awareness of the risk appears as good in users as in non-users whatever the gender: more than 95% have already heard about melanoma and know that sunburn can have significant consequences on the skin. Reasons evoked for justification of skin exposure to artificial UV light were: aesthetic reasons (35%), skin preparation before sun exposure (34%), medical reasons (10%), experimentation of the device because it was at their disposal or by curiosity (6%), physical or mental well-being (2%), to avoid natural sunlight (1%), other reasons (2%) and no admit reason (23%). Furthermore, a link was found between the fairest phototypes (Fitzpatrick’s classification) and the reason “skin preparation”. Whereas cosmetic tanning using artificial UV should be discouraged, it appears that the indoor tanners are also regular sunbathers. Moreover, the awareness of the risk of cancer and of photoageing appears not efficient to dishearten the indoor tanners.

Internet advertising of artificial tanning in Australia

Artificial tanning, defined as deliberate exposure to ultraviolet rays produced by artificial tanning devices, is a new and emerging public health issue in Australia and globally. Epidemiological research suggests that artificial tanning may contribute to the incidence of melanoma, nonmelanoma skin cancer as well as other health problems. Given that Australia has a high incidence of skin cancer, we have undertaken a study to explore how artificial tanning has been promoted to its users. The aim was to analyze the completeness and accuracy of information about artificial tanning. A content analysis of web sites of tanning salons and distributors of tanning equipment in Australia was conducted. A total of 22 web sites were analyzed. None of the solarium operators or distributors of equipment provided full information about the risks of artificial tanning. Fifty-nine percent of web advertisements had no information and 41% provided only partial information regarding the risks of artificial tanning. Pictures with the image of bronze-tanned bodies, predominantly women, were used by all web advertisers. In light of the success of sun-safety campaigns in Australia, the findings of future epidemiological research on the prevalence of artificial tanning and sociological and anthropological research on why people utilize artificial tanning should be a basis for developing effective targeted health promotion on the elimination of artificial tanning in the country.

Ultraviolet tanning equipment: six questions

Recreational tanning, particularly as promoted by commercial salons with 'sunbeds' or booths, has generated increasing attention from the regulatory and the biomedical communities. Several agencies have weighed in with opinions on recommended modifications in guidelines, training procedures, regulatory controls, and consumer awareness. Currently there is little uniformity in the guidance provided by trade groups, in recommendations supplied by health agencies and medical associations, or in regulatory approaches taken or proposed by the many countries involved. In an effort to provide a clearer focus for its concerns in this area, the EU Directorate General Health and Consumer Affairs formulated six questions on ultraviolet (UV) tanning, all of a technical or biomedical nature. The questions were stimulated in part by the fact that the European Commission no longer regards the European standard EN 60335-2-27:1997 ('Particular requirements for appliances for skin exposure to ultraviolet and infrared radiation') as giving presumption of conformity to the Low Voltage Directive 73/23/EEC. (The latter Directive governs marketing of electrical devices in EC countries.) Initially, the questions were posed to an EU Scientific Committee. Subsequently, industry representatives and the European Commission jointly requested that the scientific community provide answers to the questions. We received the questions with a request for our technical responses and opinions. Our response was in the form of the following essay, submitted earlier this year to the European Commission. We offer it here in the hope of stimulating constructive discussion and comment.

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.)

Inadvertent phototoxicity from home tanning equipment

Inadvertent phototoxicity from home tanning equipment