Indoor Tanning Bed Use Research Articles

A Social Media–Based Public Health Campaign to Reduce Indoor Tanning in High-Risk Populations

Indoor tanning beds cause more than 450,000 new skin cancers each year, yet their use remains common, with a global indoor tanning prevalence of 10.4%. Social media provides an opportunity for cost-effective, targeted public health messaging. We sought to direct Instagram users at high risk of indoor tanning to accurate health information about the risks of indoor tanning and to reduce indoor tanning bed use. We disseminated a public health campaign on Instagram on April 6-27, 2022 with 34 video and still-image advertisements. We had 2 target audiences at high risk of indoor tanning: women aged 18-30 years in Kentucky, Nebraska, Ohio, or Tennessee interested in indoor tanning and men aged 18-45 years in California interested in indoor tanning. To evaluate the impact of the campaign, we tracked online metrics, including website visits, and conducted an interrupted time-series analysis of foot traffic data in our target states for all tanning salons documented on SafeGraph from January 1, 2018 to 3 months after the campaign. Our indoor tanning health information advertisements appeared on Instagram feeds 9.1 million times, reaching 1.06 million individuals. We received 7,004 views of our indoor tanning health information landing page (Average Time on Page of 56 seconds). We did not identify a significant impact on foot traffic data on tanning salons. We show the successful use of social media advertising to direct high-risk groups to online health information about indoor tanning. Future research quantifying tanning visits before and after indoor tanning interventions is needed to guide future public health efforts.

Use of the multi-theory model (MTM) in explaining initiation and sustenance of indoor tanning cessation among college students.

Skin cancer, including melanoma, is the most common cancer worldwide and a significant public health concern. A significant risk factor for melanoma is through increased exposure to ultraviolet (UV) radiation through the use of indoor tanning beds. Although rates of indoor tanning bed use have decreased in recent years, young adults, particularly White, college-age women, comprise the majority of indoor tanning bed users in the United States. The purpose of this cross-sectional study was to explore and explain the initiation and sustenance of indoor tanning cessation among college students using the multi-theory model (MTM) of health behavior change. Data were collected from 254 college students who reported current indoor tanning use using a validated 46-item survey to assess demographics and the MTM constructs. Data were analyzed using multiple linear regression to determine the ability of the MTM constructs to predict the initiation and sustenance of indoor tanning cessation. For initiation of indoor tanning cessation, participatory dialogue: advantages (B = 0.038, p = 0.001), behavioral confidence (B = 0.129, p < 0.001) and changes in the physical environment (B = 0.088, p < 0.001) were significantly associated with indoor tanning cessation following covariate adjustment. For sustenance, only emotional transformation (B = 0.140, p < 0.001) demonstrated a significant relationship with indoor tanning cessation, following adjustment. Findings from this study demonstrate the utility of the MTM in explaining indoor tanning cessation and designing intervention strategies and clinical recommendations to encourage indoor tanning cessation among college students.

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 &gt; $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 ( &lt; 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]

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).

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.

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.

Review of interventions to reduce ultraviolet tanning: Need for treatments targeting excessive tanning, an emerging addictive behavior.

Millions of Americans engage in tanning each year, defined as intentional ultraviolet radiation (UVR) exposure in the form of sunbathing or the use of indoor tanning beds. An emerging body of research suggests that UVR has addictive properties and some tanners engage in excessive tanning. This article provides an overview of the evidence of tanning addiction and a systematic review of existing tanning interventions with the goal of evaluating their potential to impact addicted tanners. Our search identified 24 intervention studies that were summarized and discussed according to 3 primary themes. First, there is a dearth of tanning interventions that target excessive tanning or are designed as treatments for tanning addiction. Second, tanning interventions are primarily educational interventions designed to increase knowledge of the risks of tanning. Third, there are notable aspects of existing tanning interventions that are relevant to addiction science, including the use of brief motivational and cognitive-behavioral-based interventions. Future directions are considered including recommendations for utilizing the existing evidence base to formulate interventions targeting excessive tanners. (PsycINFO Database Record

The Development and Validation of the Mood-based Indoor Tanning Scale

Research indicates that mood-based motivations may be an important predictor of indoor tanning bed use and may be related to indoor tanning dependence. Problematically, little research has been conducted to develop a psychometric measure of mood-based tanning motivations. The current study seeks to develop and validate the moodbased indoor tanning scale (MITS). Two studies were conducted to identify and verify the MITS factor structure as well as assess construct validity. Study 1 was conducted at 5 geographically diverse universities in the United States. Study 2 was conducted by using a national online sample in the United States. Results from study 1 specified the factor structure of the MITS. Results from study 2 suggest that a one-point increase in the MITS measure corresponds with using indoor tanning beds 11 more times in the past year. These findings demonstrate that moodbased tanning motivations are a strong predictor of indoor tanning intentions and behavior. Further, they suggest that health behavior researchers and healthcare practitioners can use the MITS to assess the extent to which mood-based motivations impact indoor tanning bed use.

Tanning bed use, risk of melanoma and opportunity for prevention with sulforaphane

The use of indoor tanning beds for cosmetic purposes has been very popular among the Caucasian population in the US. It is estimated that almost one in three Caucasian women aged 16 to 25 years use indoor tanning devices each year. Indoor tanning beds produce concentrated UV-A and UV-B rays and can be more harmful than the natural rays of the sun. The International Agency for Research on Cancer classified UV-emitting tanning devices as group 1 carcinogens in 2009. UV exposure from sunlight and indoor tanning bed has been linked to the risk of melanoma and non-melanoma skin cancers. Although the incidence rate of melanoma is higher among men than women, melanoma is more common among women among those aged 50 years or younger, which can be, at least partially, attributed to the use of indoor tanning beds. Recently, it has been reported that volunteers subjected to UV light and treated with sulforaphane showed a decrease in the development of skin erythema. Sulforaphane is a natural compound that is present abundantly in broccoli and broccoli sprouts. Commercially available sulforaphane supplements have been demonstrated to be safe and lack of toxicity. Data indicates that sulforaphane has anti-cancerous activity via a reduction of glutathione levels, which is regulated by nuclear factor erythroid 2-related factor-2 (Nrf2). The knowledge gained so far may present a unique opportunity for chemoprevention trials examining the efficacy of sulforaphane in melanoma prevention. Well-planned and well-characterized trials examining molecular pathways could also further our understanding of the carcinogenic mechanisms for melanoma.

Indoor tanning bed use and risk of food addiction based on the modified Yale Food Addiction Scale.

The popularity of indoor tanning may be partly attributed to the addictive characteristics of tanning for some individuals. We aimed to determine the association between frequent indoor tanning, which we view as a surrogate for tanning addiction, and food addiction. A total of 67,910 women were included from the Nurses’ Health Study II. In 2005, we collected information on indoor tanning during high school/college and age 25-35 years, and calculated the average use of indoor tanning during these periods. Food addiction was defined as ≥3 clinically significant symptoms plus clinically significant impairment or distress, assessed in 2009 using a modified version of the Yale Food Addiction Scale. Totally 23.3% (15,822) of the participants reported indoor tanning at high school/college or age 25-35 years. A total of 5,557 (8.2%) women met the criteria for food addiction. We observed a dose–response relationship between frequency of indoor tanning and the likelihood of food addiction (Ptrend < 0.0001), independent of depression, BMI, and other confounders. Compared with never indoor tanners, the odds ratio (95% confidence interval) of food addiction was 1.07 (0.99-1.17) for average indoor tanning 1-2 times/year, 1.25 (1.09-1.43) for 3-5 times/year, 1.34 (1.14-1.56) for 6-11 times/year, 1.61 (1.35-1.91) for 12-23 times/year, and 2.98 (1.95-4.57) for 24 or more times/year. Frequent indoor tanning before or at early adulthood is associated with prevalence of food addiction at middle age. Our data support the addictive property of frequent indoor tanning, which may guide intervention strategies to curb indoor tanning and prevent skin cancer.

Tanning beds: Impact on health, and recent regulations

As the use of indoor tanning beds gained popularity in the decades after their appearance in the market in the early 1970s, concerns arose regarding their use. Clinical research has revealed an association between indoor tanning and several health risks, including the subsequent occurrence of melanoma and nonmelanoma skin cancers, the development of psychologic dependence, and a tendency toward other high-risk health behaviors. In the face of mounting evidence, legislation has been passed, which includes the restriction of access to tanning beds by minors in 42 states and the District of Columbia, and the recent reclassification by the Food and Drug Administration, which now categorizes tanning beds as class II devices and worthy of restrictions and oversight. Early evidence suggests that these labors are resulting in cultural change, although continued efforts are necessary to limit further exposure and better inform the public of the dangers associated with indoor tanning use.

216 Indoor tanning bed use and increased risk of food addiction in US women

216 Indoor tanning bed use and increased risk of food addiction in US women

Characterizing the risk of melanoma and use of indoor tanning beds in high-risk groups to inform public health regulations

There is concern about increasing incidence of melanoma and its association with indoor tanning devices. Overall, melanoma and indoor tanning devices exhibit a dose–response relationship; risk factors characterized for melanoma include age, gender, skin complexion, knowledge level, social norms, and location. Currently, legislative practices differ across Canada. Recommendations regarding intervention strategies, information dissemination, and legislation are discussed to inform public health regulations regarding the use of indoor tanning devices.

Emergency Department Visits for Indoor Tanning Bed Injuries

The FDA recently reclassified indoor tanning devices that emit ultraviolet (UV) radiation from low risk (class I) to moderate risk (class II). This action was prompted primarily by data showing that indoor tanning bed use is linked to both melanoma and nonmelanoma skin cancers. Tanning bed use can also result in acute adverse effects, but little information has been published on such incidence. In …

In-group rationalizations of risk and indoor tanning: A textual analysis of an online forum.

Unlike other health behaviors, there does not appear to be a strong relationship between perceived skin cancer risk and reduction or cessation of indoor tanning bed use. This study seeks to address this inconsistency by determining how indoor tanning bed users rationalize skin cancer risk with their tanning behavior. Qualitative textual analysis of indoor tanning message board posts (N = 330) revealed varied perceptions of risk, including acknowledging the risk of indoor tanning; denying or downplaying risk, often citing perceived health benefits associated with tanning; blaming outside forces for cancer, such as lotion or genetics; and fatalistic beliefs about cancer. These results highlight the nuanced relationship between perceived skin cancer risk and indoor tanning bed use.

Youth indoor tanning and skin cancer prevention: lessons from tobacco control.

Youth use of ultraviolet-emitting indoor tanning beds represents a present and emerging public health crisis. Nearly 30% of white female high school students report tanning indoors, and a quarter of high school tanners have used a tanning bed more than 20 times in the past year. Despite the significant health risks of tanning beds, including potentially deadly melanoma and eye problems, limited actions have been taken in the U.S. to protect youth. Tobacco control policies and campaigns, which have sharply reduced youth smoking, may provide a useful framework to control indoor tanning among young people. This article describes several evidence-based tobacco control strategies with potential applicability to indoor tanning within the context of the U.S. Further, current tobacco control policies and current indoor tanning policies in the U.S. are compared, and recommendations on how to curtail youth indoor tanning are discussed.

Tanning Industry

Tanning Industry

Dramatic rise in skin cancer seen in young adults

Young adults, particularly people aged 40 years and younger, are experiencing a dramatic increase in skin cancer, according to Mayo Clinic researchers. Melanoma incidence has risen, and young women in their 20s and 30s have been hit the hardest, according to a recent study.1 Mayo Clinic dermatologist Jerry Brewer, MD, notes that the rates are higher than the National Cancer Institute reported using the Surveillance, Epidemiology and End Results (SEER) database. He and colleagues looked at first-time diagnoses of melanoma in patients aged 18 to 39 years from 1970 to 2009 and found an 8-fold increase among young women and a 4-fold increase in young men. They note that the use of indoor tanning beds may play a role in the rising rate in young women. Although the lifetime risk of melanoma is higher in males, the opposite is true for young adults and adolescents, Dr. Brewer says. At the same time, they found that the disease mortality rate has improved through the years. Researchers say their results indicate the need for active interventions to reduce risk factors and to continue educating young women about the carcinogenic effects of tanning beds. Reference