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Mathes S, Lindwedel KS, Nilsen LT, Kaiser I, Pfahlberg AB, Gefeller O. Global Tanning Bed Advertising: A Comparison of Legal Regulations on Three Continents. Cancers (Basel) 2023; 15:4362. [PMID: 37686637 PMCID: PMC10486637 DOI: 10.3390/cancers15174362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Revised: 08/29/2023] [Accepted: 08/30/2023] [Indexed: 09/10/2023] Open
Abstract
Artificial ultraviolet radiation from tanning beds has been classified as carcinogenic by the International Agency for Research on Cancer in 2009. Several countries have subsequently introduced comprehensive legislation regulating commercial indoor tanning. Specific aspects of these regulations address tanning bed advertising and information requirements for tanning bed customers, which have been previously neglected in international comparisons of indoor tanning regulations. We performed a systematic search regarding legislation on these aspects in 131 legislative units across three continents (North America, Australia/New Zealand, Europe). The legal restrictions found varied widely in type and content. In 49 legislative units we identified total (n = 8) or partial legal bans (n = 41) on advertising for indoor tanning, while 64 legislative units enacted 5regulations that necessitate the dissemination of different types of specific health information to tanning bed customers. Nearly 40% of the legislative units of the study region lacked any legislation on these issues altogether. The heterogenous results emphasize the need for an international dialogue between health authorities and governments to harmonize the regulatory framework for tanning bed advertising and information requirements to a level better protecting the public from skin cancer. Our comprehensive international comparison can serve as a starting point for such a harmonization process that may ultimately protect the public worldwide from misleading tanning bed advertising.
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Affiliation(s)
- Sonja Mathes
- Department of Dermatology and Allergy, Technical University of Munich, 80802 Munich, Germany;
| | - Karla S. Lindwedel
- Department of Medical Informatics, Biometry and Epidemiology, Friedrich-Alexander-Universität Erlangen-Nürnberg, 91054 Erlangen, Germany; (K.S.L.); (I.K.); (A.B.P.)
| | - Lill Tove Nilsen
- Section for Environmental Monitoring and Radon- and UV-Protection, Norwegian Radiation and Nuclears Safety Authority, NO-1332 Østeras, Norway;
| | - Isabelle Kaiser
- Department of Medical Informatics, Biometry and Epidemiology, Friedrich-Alexander-Universität Erlangen-Nürnberg, 91054 Erlangen, Germany; (K.S.L.); (I.K.); (A.B.P.)
| | - Annette B. Pfahlberg
- Department of Medical Informatics, Biometry and Epidemiology, Friedrich-Alexander-Universität Erlangen-Nürnberg, 91054 Erlangen, Germany; (K.S.L.); (I.K.); (A.B.P.)
| | - Olaf Gefeller
- Department of Medical Informatics, Biometry and Epidemiology, Friedrich-Alexander-Universität Erlangen-Nürnberg, 91054 Erlangen, Germany; (K.S.L.); (I.K.); (A.B.P.)
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2
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Carpenter CS, Churchill BF, Marcus M. Bad lighting: Effects of youth indoor tanning prohibitions. JOURNAL OF HEALTH ECONOMICS 2023; 88:102738. [PMID: 36808016 DOI: 10.1016/j.jhealeco.2023.102738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 12/13/2022] [Accepted: 02/09/2023] [Indexed: 06/18/2023]
Abstract
Indoor tanning beds (ITBs) emit UV light at high intensity and have been classified as carcinogenic to humans by the World Health Organization since 2009. We are the first to study the role of state laws prohibiting youths from indoor tanning using a difference-in-differences research design. We find that youth ITB prohibitions reduced population search intensity for tanning-related information. Among white teen girls, ITB prohibitions reduced self-reported indoor tanning and increased sun protective behaviors. We also find that youth ITB prohibitions significantly reduced the size of the indoor tanning market by increasing tanning salon closures and reducing tanning salon sales.
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Affiliation(s)
- Christopher S Carpenter
- University Distinguished Professor and E. Bronson Ingram Professor of Economics, Research Associate at the National Bureau of Economic Research, Vanderbilt University, 306 Calhoun Hall, Nashville, TN 37027, United States.
| | - Brandyn F Churchill
- Assistant Professor of Resource Economics, University of Massachusetts Amherst, 221 Stockbridge Hall, Amherst, MA 01003, United States.
| | - Michelle Marcus
- Assistant Professor of Economics, Vanderbilt University, Faculty Research Fellow, National Bureau of Economic Research, 306 Calhoun Hall, Nashville, TN 37027, United States.
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3
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Buller DB, Pagoto S, Henry KL, Baker K, Walkosz BJ, Hillhouse J, Berteletti J, Bibeau J. Effects of Engagement with a Social Media Campaign for Mothers to Prevent Indoor Tanning by Teens in a Randomized Trial. JOURNAL OF HEALTH COMMUNICATION 2022; 27:394-406. [PMID: 35993376 PMCID: PMC9643633 DOI: 10.1080/10810730.2022.2113839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
In a social media campaign aimed at reducing mothers' permissiveness for indoor tanning (IT) by their teenage daughters, a secondary analysis of campaign engagement effects on IT outcomes was performed. Mothers (n = 869) with daughters aged 14-17 were recruited in 34 states that did not ban IT by minors under age 18 for a randomized trial with follow-up at 12 months (end of intervention) and 18 months (6 months after intervention) post-randomization. Daughters' (n = 469) baseline and follow-up responses were analyzed too. Mothers received a Facebook feed on adolescent health topics that included posts about preventing IT (intervention) or prescription drug misuse (control). Engagement was measured by extracting reactions (e.g., like, sad, etc.) and comments posted by mothers to the campaign posts. Overall, 76.4% of posts received a reaction and/or comment. Mothers who engaged with IT posts were less permissive of daughters' IT immediately at the conclusion of the campaign (permit IT: -0.39, p < .05; facilitate IT: -0.29, p < .05) and 6 months after intervention (permit IT: -0.32, p < .05; facilitate IT: -0.31, p < .05) than mothers who did not engage with posts. Engagement with posts was essential to the success of a social media campaign for preventing IT by minors by reducing mothers' permissiveness.
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Affiliation(s)
| | - Sherry Pagoto
- Department of Allied Health Sciences, University of Connecticut, Storrs, Connecticut, USA
| | - Kimberly L Henry
- Department of Psychology, Colorado State University, Ft. Collins, Colorado, USA
| | - Katie Baker
- Department of Community and Behavioral Health, College of Public Health, Sherrod Library 353, East Tennessee State University, Johnson City, Tennessee, USA
| | | | - Joel Hillhouse
- Department of Community and Behavioral Health, College of Public Health, Lamb Hall, Suite 300, East Tennessee State University, Johnson City, Tennessee, USA
| | | | - Jessica Bibeau
- Department of Allied Health Sciences, University of Connecticut, Storrs, Connecticut, USA
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4
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Bowers JM, Hamilton JG, Wu YP, Moyer A, Hay JL. Acculturation, Sun Tanning Behavior, and Tanning Attitudes Among Asian College Students in the Northeastern USA. Int J Behav Med 2022; 29:25-35. [PMID: 33942255 PMCID: PMC9272584 DOI: 10.1007/s12529-021-09993-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/19/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND College students participate in high levels of tanning, a skin cancer risk behavior due to ultraviolet radiation exposure, yet little is known about Asian college students' behavior. This study examined the relationship between tanning attitudes, acculturation to the USA (cultural assimilation), and tanning behavior. METHOD An online survey was used to recruit 211 Asian college students in the northeastern USA (47.4% born outside of the USA) to respond to questions about recent tanning behavior, sun protection strategies, attitudes about tanning, and acculturation to the USA. RESULTS Attitudes about tanning, particularly desire for a darker skin tone and social norms, along with acculturation to the USA, were predictive of intentional tanning. The sample reported high levels of sun protection, which was associated with low acculturation. CONCLUSION The significant role of acculturation in this study indicates that it may be a useful factor to include in future tanning intervention studies of relevant populations.
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Affiliation(s)
- Jennifer M. Bowers
- Department of Psychology, Stony Brook University, 100 Nichols Road, Stony Brook, NY 11794-2500, USA,Department of Psychiatry & Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY 10022, USA
| | - Jada G. Hamilton
- Department of Psychiatry & Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY 10022, USA
| | - Yelena P. Wu
- Department of Dermatology, University of Utah, Salt Lake City, UT 84132, USA
| | - Anne Moyer
- Department of Psychology, Stony Brook University, 100 Nichols Road, Stony Brook, NY 11794-2500, USA
| | - Jennifer L. Hay
- Department of Psychiatry & Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY 10022, USA
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5
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Persisting Effects of a Social Media Campaign to Prevent Indoor Tanning: A Randomized Trial. Cancer Epidemiol Biomarkers Prev 2022; 31:885-892. [DOI: 10.1158/1055-9965.epi-21-0059] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 05/10/2021] [Accepted: 01/10/2022] [Indexed: 11/16/2022] Open
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6
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Menzies S, Daly S, O’Connor R, Kelly A, Fitzgerald M, Bourke J, McKenna DB. A re-evaluation of teenage sunbed use following the introduction of banning legislation for under 18-year-olds. J Public Health (Oxf) 2020; 42:588-593. [DOI: 10.1093/pubmed/fdz015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2018] [Revised: 12/26/2018] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
There is little information on the effectiveness of introducing age restriction legislation alone to reduce the rate of sunbed usage by teenagers. Prior to the Public Health (Sunbed) Act of 2014 prohibiting the use of sunbeds in under 18-year-olds in Ireland we reported the rate of sunbed use at 7.5%.
Objectives
The aim of the study was to compare the rate of sunbed usage among Irish teenagers before and after the introduction of banning legislation to determine if it had the desired effect of reducing its rate of use.
Methods
In a cross-sectional survey, students from the same schools as in our previous study completed an anonymous, written questionnaire pertaining to sunbed usage.
Results
In total, 783 questionnaires, from 13 schools across Ireland, were completed. The rate of sunbed use in the current study was 7.2%, compared to 7.5% in the pre-ban study, (P = 0.76). A higher rate of sunbed use was observed in Dublin schools and female public students.
Conclusion
Our study suggests that legislation alone is ineffective at reducing sunbed usage in a teenage population. A multifaceted approach is required that includes enforcement of the legislation together with targeted public education and awareness campaigns using all aspects of the media.
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Affiliation(s)
- S Menzies
- Department of Dermatology, Sligo University Hospital, Sligo, Ireland
| | - S Daly
- Department of Dermatology, Sligo University Hospital, Sligo, Ireland
| | - R O’Connor
- Department of Dermatology, Cork University Hospital, Cork, Ireland
| | - A Kelly
- Department of Dermatology, Cork University Hospital, Cork, Ireland
| | - M Fitzgerald
- Department of Dermatology, Sligo University Hospital, Sligo, Ireland
| | - J Bourke
- Department of Dermatology, Cork University Hospital, Cork, Ireland
| | - D B McKenna
- Department of Dermatology, Sligo University Hospital, Sligo, Ireland
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7
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Wu YP, Parsons BG, Nagelhout E, Haaland B, Jensen J, Zaugg K, Caputo H, Lensink R, Harding G, Yancey J, Klein SZ, Leachman SA, Tercyak KP. A four-group experiment to improve Western high school students' sun protection behaviors. Transl Behav Med 2020; 9:468-479. [PMID: 31094440 DOI: 10.1093/tbm/ibz021] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Multicomponent skin cancer preventive interventions for adolescents that aim to decrease ultraviolet radiation (UVR) exposure and sunburns are particularly needed given their intentional tanning and infrequent use of sun protection. The purpose of this study was to conduct an early-phase study within the Multiphase Optimization Strategy framework that experimentally tested four unique intervention components targeting high school students' skin cancer prevention behaviors. Schools (11 total, N = 1,573 students) were assigned to receive one of four interventions: skin cancer education (control), education plus a sunscreen activity (to illustrate sunscreen's UVR-blocking properties), or behavior change worksheet (sun protection goal setting and planning) or receipt of a personalized UV damage photograph (photograph of facial damage). Sun protection, sunburn, and tanning outcomes were assessed before intervention and at 1-month follow-up. Within- and between-intervention changes in outcomes were examined using generalized estimating equation modeling. All interventions were associated with significant improvements in sun protection. The photograph was superior in controlling intentional tanning and sunburn when compared to the behavior change worksheet (ps < .05). In contrast, the worksheet was associated with greater increases in sun protection use when compared with the photograph (ps < .05). In this experiment testing four skin cancer preventive intervention components that varied in approach, content, and interactivity, the behavior change worksheet was superior in improving sun protection use whereas the UV photograph was superior in controlling intentional tanning and sunburn. Future randomized trials to test combinations of these intervention components are needed, and could identify mechanisms underlying improved effects and demographic or behavioral moderators of intervention effects.
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Affiliation(s)
- Yelena P Wu
- Department of Dermatology, University of Utah, Salt Lake City, UT, USA.,Cancer Control and Population Sciences, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
| | - Bridget G Parsons
- Cancer Control and Population Sciences, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
| | - Elizabeth Nagelhout
- Department of Family and Preventive Medicine, University of Utah, Salt Lake City, UT, USA
| | - Benjamin Haaland
- Cancer Control and Population Sciences, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA.,Population Health Sciences, University of Utah, Salt Lake City, UT, USA
| | - Jakob Jensen
- Cancer Control and Population Sciences, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA.,Department of Communication, University of Utah, Salt Lake City, UT, USA
| | - Kelsey Zaugg
- Cancer Control and Population Sciences, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
| | - Heloisa Caputo
- Cancer Control and Population Sciences, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
| | - Riley Lensink
- Cancer Control and Population Sciences, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
| | - Garrett Harding
- Community Outreach and Prevention Education, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
| | - Jeffrey Yancey
- Community Outreach and Prevention Education, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
| | - Stephanie Z Klein
- Department of Dermatology, University of Utah, Salt Lake City, UT, USA
| | - Sancy A Leachman
- Department of Dermatology, Oregon Health & Science University, Portland, OR, USA.,Knight Cancer Institute, Oregon Health & Science University, Portland, OR, USA
| | - Kenneth P Tercyak
- Cancer Prevention and Control Program, Georgetown Lombardi Comprehensive Cancer Center, NW Washington, DC, USA
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8
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Gandini S, Doré JF, Autier P, Greinert R, Boniol M. Epidemiological evidence of carcinogenicity of sunbed use and of efficacy of preventive measures. J Eur Acad Dermatol Venereol 2019; 33 Suppl 2:57-62. [PMID: 30811691 DOI: 10.1111/jdv.15320] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Accepted: 09/20/2018] [Indexed: 11/29/2022]
Abstract
The International Agency for Research on Cancer classified, in July 2009, exposure to artificial tanning devices (sunbeds) as carcinogenic to humans. This classification was based on evidence from epidemiological and experimental animal studies. The present chapter will review these epidemiological evidences. The summary risk estimates from 27 epidemiological studies obtained through a meta-analysis showed an increased risk of melanoma: summary relative risk (SRR) = 1.20 [95% confidence interval (CI) 1.08-1.34]. The risk was higher when exposure took place at younger age (SRR = 1.59; 95% CI 1.36-1.85). The risk was independent of skin sensitivity or population and a dose response was evident. A meta-analysis of 12 studies was conducted for non-melanoma skin cancers and showed a significantly increased risk for basal cell carcinoma (SRR = 1.29; 95% CI 1.08-1.53) and for squamous cell carcinoma (SRR = 1.67; 95% CI 1.29-2.17). As for melanoma, the risk for other skin cancers increased for first exposures at young age. Epidemiological studies have gradually strengthened the evidence for a causal relationship between indoor tanning and skin cancer and they fit with prior knowledge on relationship between UV exposure and skin cancer. Additionally, several case-control studies provided consistent evidence of a positive association between use of sunbed and ocular melanoma, also with greater risk for first exposures at younger age. Preventive measures based on information on risk or by requiring parental authorization for young users proved to be inefficient in several studies. The significant impact of strong actions or total ban, such as performed in Iceland, or a total ban of sunbed use, as in Brazil or Australian states, needs to be further assessed.
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Affiliation(s)
- S Gandini
- Molecular and Pharmaco-Epidemiology Unit, Department of Experimental Oncology, European Institute of Oncology, IRCCS, Milan, Italy
| | - J-F Doré
- Centre de Recherche en Cancérologie de Lyon, Inserm U1052, Lyon, France
| | - P Autier
- International Prevention Research Institute, Lyon, France
| | - R Greinert
- Department of Molecular Cell biology, Dermatology Center Buxtehude, Elbekliniken Stade/Buxtehude, Klinikum Buxtehude, Buxtehude, Germany
| | - M Boniol
- International Prevention Research Institute, Lyon, France
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9
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Reimann J, McWhirter JE, Cimino A, Papadopoulos A, Dewey C. Impact of legislation on youth indoor tanning behaviour: A systematic review. Prev Med 2019; 123:299-307. [PMID: 30940571 DOI: 10.1016/j.ypmed.2019.03.041] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2018] [Revised: 03/21/2019] [Accepted: 03/28/2019] [Indexed: 11/29/2022]
Abstract
Jurisdictions around the world have implemented indoor tanning legislations, which aim to protect all individuals, especially youth, from dangers of artificial ultraviolet radiation exposure. The objective of this study was to conduct a systematic review to synthesize the available peer-reviewed literature to determine whether indoor tanning legislation has impacted the prevalence of youth indoor tanning. Following PRISMA guidelines, six databases were searched in 2016. Reference lists from relevant articles were also searched. An updated literature search was conducted in 2018. Each article was critically appraised using a merged checklist created from two previously validated checklists. All articles meeting the inclusion criteria were retained after appraisal. Seven studies, all conducted in the U.S., met the inclusion criteria. All studies used an observational, cross-sectional design. There were small absolute decreases in youth indoor tanning prevalence after legislation vs before (n = 3, mean = 3% decrease, range = 1%-6% decrease). Prevalence of youth indoor tanning was significantly lower in states with indoor tanning legislation vs states without legislation (n = 4, mean = 5% lower, range = 1%-18% lower). Prevalence of youth indoor tanning was lower in states with longer standing indoor tanning legislation vs states with more recently implemented legislation (n = 2, mean = 9% lower, range = 2%-20% lower). Indoor tanning legislation is generally associated with lower indoor tanning prevalence among youth. The small percent differences equate to millions of youth at the population level. Longer time lapses from legislation implementation to evaluation, coupled with greater enforcement, compliance, legislative stringency, and public education may result in even more pronounced declines in youth indoor tanning prevalence.
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Affiliation(s)
- Jessica Reimann
- Department of Population Medicine, University of Guelph, Guelph, Ontario N1G 2W1, Canada.
| | - Jennifer E McWhirter
- Department of Population Medicine, University of Guelph, Guelph, Ontario N1G 2W1, Canada.
| | - Andrea Cimino
- Department of Population Medicine, University of Guelph, Guelph, Ontario N1G 2W1, Canada.
| | - Andrew Papadopoulos
- Department of Population Medicine, University of Guelph, Guelph, Ontario N1G 2W1, Canada.
| | - Cate Dewey
- Department of Population Medicine, University of Guelph, Guelph, Ontario N1G 2W1, Canada.
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10
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Calzavara-Pinton P, Arisi M, Wolf P. Sunbeds and carcinogenesis: the need for new regulations and restrictions in Europe from the Euromelanoma perspective. J Eur Acad Dermatol Venereol 2019; 33 Suppl 2:104-109. [DOI: 10.1111/jdv.15314] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Accepted: 09/20/2018] [Indexed: 12/27/2022]
Affiliation(s)
- P.G. Calzavara-Pinton
- Dermatology Department; University of Brescia; ASST Spedali Civili di Brescia; Brescia Italy
| | - M. Arisi
- Dermatology Department; University of Brescia; ASST Spedali Civili di Brescia; Brescia Italy
| | - P. Wolf
- Research Unit for Photodermatology; Department of Dermatology and Venereology; Medical University of Graz; Graz Austria
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11
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Qin J, Holman DM, Jones SE, Berkowitz Z, Guy GP. State Indoor Tanning Laws and Prevalence of Indoor Tanning Among US High School Students, 2009-2015. Am J Public Health 2018; 108:951-956. [PMID: 29771612 DOI: 10.2105/ajph.2018.304414] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
OBJECTIVES To examine the association between state indoor tanning laws and indoor tanning behavior using nationally representative samples of US high school students younger than 18 years. METHODS We combined data from the 2009, 2011, 2013, and 2015 national Youth Risk Behavior Surveys (n = 41 313) to analyze the association between 2 types of state indoor tanning laws (age restriction and parental permission) and the prevalence of indoor tanning during the 12 months before the survey, adjusting for age, race/ethnicity, and survey year, and stratified by gender. RESULTS Age restriction laws were associated with a 47% (P < .001) lower indoor tanning prevalence among female high school students. Parental permission laws were not found to be associated with indoor tanning prevalence among either female or male high school students. CONCLUSIONS Age restriction laws could contribute to less indoor tanning, particularly among female high school students. Such reductions may reduce the health and economic burden of skin cancer.
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Affiliation(s)
- Jin Qin
- Jin Qin, Dawn M. Holman, Zahava Berkowitz, and Gery P. Guy Jr are with the Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA. Sherry Everett Jones is with the Division of Adolescent and School Health, Centers for Disease Control and Prevention, Atlanta, GA
| | - Dawn M Holman
- Jin Qin, Dawn M. Holman, Zahava Berkowitz, and Gery P. Guy Jr are with the Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA. Sherry Everett Jones is with the Division of Adolescent and School Health, Centers for Disease Control and Prevention, Atlanta, GA
| | - Sherry Everett Jones
- Jin Qin, Dawn M. Holman, Zahava Berkowitz, and Gery P. Guy Jr are with the Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA. Sherry Everett Jones is with the Division of Adolescent and School Health, Centers for Disease Control and Prevention, Atlanta, GA
| | - Zahava Berkowitz
- Jin Qin, Dawn M. Holman, Zahava Berkowitz, and Gery P. Guy Jr are with the Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA. Sherry Everett Jones is with the Division of Adolescent and School Health, Centers for Disease Control and Prevention, Atlanta, GA
| | - Gery P Guy
- Jin Qin, Dawn M. Holman, Zahava Berkowitz, and Gery P. Guy Jr are with the Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA. Sherry Everett Jones is with the Division of Adolescent and School Health, Centers for Disease Control and Prevention, Atlanta, GA
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12
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Auerbach MV, Heckman CJ, Darlow S. To protect or not to protect: examining reasons for sun protection among young women at risk for skin cancer. J Behav Med 2018; 41:528-536. [PMID: 29589257 DOI: 10.1007/s10865-018-9920-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2017] [Accepted: 03/20/2018] [Indexed: 11/26/2022]
Abstract
We aimed to further the understanding of the low rates of sun protection in young women at risk for skin cancer. Six-hundred-sixty-one daily diary entries were received via text message over 14 days from 56 young women at moderate to high risk of developing skin cancer. Women reported whether or not they used sun protection and also listed what their reasons were for using protection or not using sun protection each day. Multi-level modeling was used to examine the influence of study variables when predicting daily sun protection or lack of protection. The number of days in which sun protection was reported was positively associated with "habit" and "prevention" as reasons for protection and negatively associated with "not-needed" and "unprepared" as reasons for non-protection. Self-reported sun protection increased over the 14-day study period. Results of this study suggest the potential value of interventions aimed at motives for sun-protection behaviors.
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Affiliation(s)
- M V Auerbach
- Cancer Prevention and Control Program, Fox Chase Cancer Center, Philadelphia, PA, 19111, USA
- Department of Psychology, Temple University, Philadelphia, PA, 19122, USA
| | - C J Heckman
- Cancer Prevention and Control Program, Fox Chase Cancer Center, Philadelphia, PA, 19111, USA.
- Population Science, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, 08903, USA.
| | - S Darlow
- Cancer Prevention and Control Program, Fox Chase Cancer Center, Philadelphia, PA, 19111, USA
- National Comprehensive Cancer Network, Fort Washington, PA, 19034, USA
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13
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Cho H, Yu B, Cannon J, Zhu YM. Efficacy of a Media Literacy Intervention for Indoor Tanning Prevention. JOURNAL OF HEALTH COMMUNICATION 2018; 23:643-651. [PMID: 30058942 PMCID: PMC6605049 DOI: 10.1080/10810730.2018.1500659] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
Indoor tanning leads to melanoma, the fifth most common cancer in the USA. The highest rate of indoor tanning is among young women whose exposure to tanned images in the media is linked to protanning attitudes. This study evaluated the efficacy of a media literacy intervention for reducing young women's indoor tanning. Intervention participants analyzed the content and functions of the media influencing protanning attitudes and produced counter-messages to help themselves and peers resist harmful media effects. The message production was of two types: digital argument production or digital story production. The control group received assessments only. This three-group randomized design involved 26 sorority chapters and 247 members in five Midwestern states where indoor tanning is prevalent. At 2- and 6-month follow-up assessments, those in the two intervention conditions were less likely to be indoor tanners (p = .033) and reported lower indoor tanning intentions (p = .002) compared to those in the control condition. No difference between the two intervention groups was found for behavior. Although the argument group exhibited slightly weaker indoor tanning intentions than the story group, the difference was not significant. The results provide the first evidence of the efficacy of a media literacy intervention for indoor tanning reduction. Implications for participative engagement interventions are discussed.
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Affiliation(s)
- Hyunyi Cho
- Corresponding author Hyunyi Cho, School of Communication, The Ohio State University 154 N. Oval Mall Columbus, OH 43210 Phone: 614-247-1691,
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Gilkey MB, Mays D, Asgari MM, Kornides ML, McRee AL. Parental Support for Age-based Indoor Tanning Restrictions. Am J Prev Med 2017; 53:473-480. [PMID: 28522236 PMCID: PMC5610053 DOI: 10.1016/j.amepre.2017.03.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2016] [Revised: 02/07/2017] [Accepted: 03/14/2017] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Regulatory agencies, including the U.S. Food and Drug Administration, are considering policies to ban indoor tanning for youth aged <18 years. Using data from a nationally representative sample, this study assessed parental support for age-based bans as well as less restrictive parental permission requirements. METHODS Data came from an online survey completed by 1,244 parents of adolescents aged 11-17 years. Weighted multivariable logistic regression models assessed correlates of supporting an indoor tanning ban for youth aged <18 years. Data collection and analysis occurred in 2016. RESULTS Almost two thirds (65%) of parents agreed with indoor tanning bans for youth, with smaller proportions having no opinion (23%) or disagreeing (12%). Support for bans increased with greater perceived harm of indoor tanning for adolescents (OR=2.66, 95% CI=1.97, 3.59) and decreased with greater perceived benefits (OR=0.49, 95% CI=0.36, 0.67). Compared with support for bans, support for parental permission requirements was somewhat higher, with 79% of parents agreeing with the policy. Most parents (60%) agreed with both policies; only 4% disagreed with both. CONCLUSIONS Age-based indoor tanning restrictions, including bans, engender broad-based support among parents. Communicating the harm of indoor tanning may facilitate the implementation of these policies.
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Affiliation(s)
- Melissa B Gilkey
- Department of Population Medicine, Harvard Medical School, Boston, Massachusetts; Harvard Pilgrim Health Care Institute, Boston, Massachusetts.
| | - Darren Mays
- Department of Oncology, Georgetown University Medical Center, Washington, District of Columbia; Cancer Prevention and Control Program, Lombardi Comprehensive Cancer Center, Washington, District of Columbia
| | - Maryam M Asgari
- Department of Population Medicine, Harvard Medical School, Boston, Massachusetts; Harvard Pilgrim Health Care Institute, Boston, Massachusetts; Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts
| | - Melanie L Kornides
- Department of Population Medicine, Harvard Medical School, Boston, Massachusetts; Harvard Pilgrim Health Care Institute, Boston, Massachusetts
| | - Annie-Laurie McRee
- Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota
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Darlow S, Heckman C. Results From a Tailored SMS and Behavior-Tracking Pilot Study on Sun-Safe Behaviors in Young Women. HEALTH EDUCATION & BEHAVIOR 2017; 44:937-944. [PMID: 28363246 DOI: 10.1177/1090198117699507] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND The elevated rates of ultraviolet radiation (UVR) exposure and low rates of sun protection in young adult women indicate a need for age- and gender-appropriate interventions that address these behaviors. AIMS To examine the effects of daily behavior tracking and individually tailored text messages on sun protection and UVR exposure behaviors in young adult women at moderate to high risk of developing skin cancer. METHOD One hundred and four young adult women at risk of skin cancer were randomized to receive the behavior-tracking intervention only, tailored text messages only, both interventions, or neither. Outcomes were self-reported UVR exposure and sun protection behaviors. RESULTS Those who received the behavior-tracking intervention reported significantly fewer UVR exposure behaviors at 4-week follow-up, relative to those who did not receive behavior tracking. At 4-week follow-up, those who received daily tailored text messages reported significantly greater UVR exposure behaviors but were more likely to report wearing a hat as a form of sun protection, relative to those who did not receive tailored messages. DISCUSSION Daily behavior tracking may be repetitive, but repetition may facilitate cognitive processing and the development of healthy habits. Health messages that are less interactive, on the other hand, need to be adequately tailored and delivered with the most advantageous timing to be impactful. CONCLUSION Future research should continue to examine how these interventions differentially affect behavior and how they can be adapted to apply to other health behaviors.
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Affiliation(s)
- Susan Darlow
- 1 National Comprehensive Cancer Network, Washington, PA, USA
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Ghiasvand R, Rueegg CS, Weiderpass E, Green AC, Lund E, Veierød MB. Ghiasvand et al. Respond to "Indoor Tanning-A Melanoma Accelerator?". Am J Epidemiol 2017; 185:160-161. [PMID: 28077361 DOI: 10.1093/aje/kww150] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2016] [Accepted: 09/29/2016] [Indexed: 01/02/2023] Open
Affiliation(s)
- Reza Ghiasvand
- Oslo Centre for Biostatistics and Epidemiology, Institute of Basic Medical Sciences, University of Oslo, Blindern,Oslo, Norway
| | - Corina S Rueegg
- Department of Biostatistics, Oslo Centre for Biostatistics and Epidemiology, University of Oslo, Oslo, Norway
| | - Elisabete Weiderpass
- Department of Community Medicine, Faculty of Health Sciences, UiT, The Artic University of Tromsø, Tromsø, Norway
- Department of Research, Cancer Registry of Norway, Institute of Population-Based Cancer Research, Oslo, Norway
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Genetic Epidemiology Group, Folkhälsan Research Center, Helsinki, Finland
| | - Adele C Green
- QIMR Berghofer Medical Research Institute, 300 Herston Road, Herston, Australia
- The University of Queensland, School of Public Health, Herston Road, Herston, Australia
- Cancer Research UK Manchester Institute and Institute of Inflammation and Repair, University of Manchester, Manchester, United Kingdom
| | - Eiliv Lund
- Department of Community Medicine, UiT The Arctic University of Norway, Tromsø, Norway
| | - Marit B Veierød
- Oslo Center for Biostatistics and Epidemiology, Department of Biostatistics, University of Oslo, Oslo, Norway
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Pagoto SL, Baker K, Griffith J, Oleski JL, Palumbo A, Walkosz BJ, Hillhouse J, Henry KL, Buller DB. Engaging Moms on Teen Indoor Tanning Through Social Media: Protocol of a Randomized Controlled Trial. JMIR Res Protoc 2016; 5:e228. [PMID: 27899339 PMCID: PMC5147712 DOI: 10.2196/resprot.6624] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2016] [Revised: 10/25/2016] [Accepted: 10/28/2016] [Indexed: 12/13/2022] Open
Abstract
Background Indoor tanning elevates the risk for melanoma, which is now the most common cancer in US women aged 25-29. Public policies restricting access to indoor tanning by minors to reduce melanoma morbidity and mortality in teens are emerging. In the United States, the most common policy restricting indoor tanning in minors involves parents providing either written or in person consent for the minor to purchase a tanning visit. The effectiveness of this policy relies on parents being properly educated about the harms of indoor tanning to their children. Objective This randomized controlled trial will test the efficacy of a Facebook-delivered health communication intervention targeting mothers of teenage girls. The intervention will use health communication and behavioral modification strategies to reduce mothers’ permissiveness regarding their teenage daughters’ use of indoor tanning relative to an attention-control condition with the ultimate goal of reducing indoor tanning in both daughters and mothers. Methods The study is a 12-month randomized controlled trial comparing 2 conditions: an attention control Facebook private group where content will be relevant to teen health with 25% focused on prescription drug abuse, a topic unrelated to tanning; and the intervention condition will enter participants into a Facebook private group where 25% of the teen health content will be focused on indoor tanning. A cohort of 2000 mother-teen daughter dyads will be recruited to participate in this study. Only mothers will participate in the Facebook groups. Both mothers and daughters will complete measures at baseline, end of intervention (1-year) and 6 months post-intervention. Primary outcomes include mothers’ permissiveness regarding their teenage daughters’ use of indoor tanning, teenage daughters’ perception of their mothers’ permissiveness, and indoor tanning by both mothers and daughters. Results The first dyad was enrolled on March 31, 2016, and we anticipate completing this study by October 2019. Conclusions This trial will deliver social media content grounded in theory and will test it in a randomized design with state-of-the-art measures. This will contribute much needed insights on how to employ social media for health behavior change and disease prevention both for indoor tanning and other health risk behaviors and inform future social media efforts by public health and health care organizations. ClinicalTrial Clinicaltrials.gov NCT02835807; https://clinicaltrials.gov/ct2/show/NCT02835807 (Archived by WebCite at http://www.webcitation.org/6mDMICcCE).
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Affiliation(s)
- Sherry L Pagoto
- Division of Preventive and Behavioral Medicine, Department of Medicine, University of Massachusetts Medical School, Worcester, MA, United States
| | - Katie Baker
- Department of Community & Behavioral Health, College of Public Health, East Tennessee State University, Johnson City, TN, United States
| | | | - Jessica L Oleski
- Division of Preventive and Behavioral Medicine, Department of Medicine, University of Massachusetts Medical School, Worcester, MA, United States
| | - Ashley Palumbo
- Division of Preventive and Behavioral Medicine, Department of Medicine, University of Massachusetts Medical School, Worcester, MA, United States
| | | | - Joel Hillhouse
- Department of Community & Behavioral Health, College of Public Health, East Tennessee State University, Johnson City, TN, United States
| | - Kimberly L Henry
- Department of Psychology, Colorado State University, Fort Collins, CO, United States.,Colorado School of Public Health, Colorado State University, Fort Collins, CO, United States
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Tripp MK, Watson M, Balk SJ, Swetter SM, Gershenwald JE. State of the science on prevention and screening to reduce melanoma incidence and mortality: The time is now. CA Cancer J Clin 2016; 66:460-480. [PMID: 27232110 PMCID: PMC5124531 DOI: 10.3322/caac.21352] [Citation(s) in RCA: 113] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Answer questions and earn CME/CNE Although overall cancer incidence rates are decreasing, melanoma incidence rates continue to increase about 3% annually. Melanoma is a significant public health problem that exacts a substantial financial burden. Years of potential life lost from melanoma deaths contribute to the social, economic, and human toll of this disease. However, most cases are potentially preventable. Research has clearly established that exposure to ultraviolet radiation increases melanoma risk. Unprecedented antitumor activity and evolving survival benefit from novel targeted therapies and immunotherapies are now available for patients with unresectable and/or metastatic melanoma. Still, prevention (minimizing sun exposure that may result in tanned or sunburned skin and avoiding indoor tanning) and early detection (identifying lesions before they become invasive or at an earlier stage) have significant potential to reduce melanoma incidence and melanoma-associated deaths. This article reviews the state of the science on prevention and early detection of melanoma and current areas of scientific uncertainty and ongoing debate. The US Surgeon General's Call to Action to Prevent Skin Cancer and US Preventive Services Task Force reviews on skin cancer have propelled a national discussion on melanoma prevention and screening that makes this an extraordinary and exciting time for diverse disciplines in multiple sectors-health care, government, education, business, advocacy, and community-to coordinate efforts and leverage existing knowledge to make major strides in reducing the public health burden of melanoma in the United States. CA Cancer J Clin 2016;66:460-480. © 2016 American Cancer Society.
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Affiliation(s)
- Mary K Tripp
- Instructor, Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Meg Watson
- Epidemiologist, Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA
| | - Sophie J Balk
- Attending Pediatrician, Children's Hospital at Montefiore, and Professor of Clinical Pediatrics, Albert Einstein College of Medicine, Bronx, NY
| | - Susan M Swetter
- Professor, Department of Dermatology, and Director, Pigmented Lesion and Melanoma Program, Stanford University Medical Center and Cancer Institute, Stanford, CA
- Professor and Assistant Chief, Dermatology Service, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA
| | - Jeffrey E Gershenwald
- Dr. John M. Skibber Professor, Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
- Professor, Department of Cancer Biology, The University of Texas MD Anderson Cancer Center, Houston, TX
- Medical Director, Melanoma and Skin Center, The University of Texas MD Anderson Cancer Center, Houston, TX
- Co-Leader, Melanoma Moon Shot, The University of Texas MD Anderson Cancer Center, Houston, TX
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19
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Heckman C, Darlow S, Cohen-Filipic J, Kloss J. Mood Changes After Indoor Tanning Among College Women: Associations with Psychiatric/Addictive Symptoms. Health Psychol Res 2016; 4:5453. [PMID: 27403462 PMCID: PMC4926028 DOI: 10.4081/hpr.2016.5453] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2015] [Revised: 02/25/2016] [Accepted: 02/26/2016] [Indexed: 12/26/2022] Open
Abstract
Indoor tanning (IT) has been linked with psychiatric and addictive symptoms, and frequent tanning may indicate tanning dependence (addiction). The current study evaluated the effects of an IT episode on mood states and the association of these effects with psychiatric and addictive symptoms among young adult female indoor tanners. One-hundred thirty-nine female university students aged 18-25 years who had indoor tanned completed an online survey including the Positive and Negative Affects Scales and a standardized psychiatric interview (the MINI International Neuropsychiatric Interview) via telephone. Psychiatric and addictive symptoms were relatively common among these young adult female indoor tanners. Overall, participants reported significant decreases in both negative (upset, scared, irritable, nervous, jittery, afraid) and positive (feeling interested) mood states after their most recent tanning episode. Multivariable linear regression analyses showed that more frequent indoor tanning in the past month and symptoms of illicit drug use disorders were associated with decreases in negative mood, and symptoms of generalized anxiety disorder were associated with a decrease in feeling interested. In summary, indoor tanners report relatively high rates of psychiatric and substance use symptoms, including symptoms of tanning dependence, and indoor tanning appears to alter mood. Women with certain substance use and psychiatric characteristics may be more vulnerable to such mood changes after tanning indoors. Further research is needed to clarify the relationships among these variables.
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Affiliation(s)
- Carolyn Heckman
- Cancer Prevention and Control Program, Fox Chase Cancer Center , Philadelphia, PA
| | - Susan Darlow
- Cancer Prevention and Control Program, Fox Chase Cancer Center , Philadelphia, PA
| | | | - Jacqueline Kloss
- Department of Psychology, Drexel University , Philadelphia, PA, USA
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Le Clair MZ, Cockburn MG. Tanning bed use and melanoma: Establishing risk and improving prevention interventions. Prev Med Rep 2016; 3:139-44. [PMID: 27419006 PMCID: PMC4929140 DOI: 10.1016/j.pmedr.2015.11.016] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
PURPOSE Exposure to ultraviolet radiation (UVR) from indoor tanning devices is thought to cause melanoma and other negative health consequences. Despite these findings, the practice of indoor tanning in the United States remains prevalent. In this paper we aim to present a clear discussion of the relationship between indoor tanning and melanoma risk, and to identify potential strategies for effective melanoma prevention by addressing indoor tanning device use. BASIC PROCEDURES We reviewed relevant literature on the risks of indoor tanning, current indoor tanning legislation, and trends in indoor tanning and melanoma incidence. Study was conducted at the University of Southern California, Los Angeles, CA between the years of 2014 and 2015. MAIN FINDINGS Our findings reaffirm the relationship between indoor tanning and melanoma risk, and suggest a widespread public misunderstanding of the negative effects of indoor tanning. PRINCIPAL CONCLUSIONS This review argues for an aggressive initiative to reduce indoor tanning in the United States, to design prevention efforts tailored towards specific high risk groups, and the need to better inform the public of the risks of indoor tanning.
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Affiliation(s)
- Marie Z. Le Clair
- Keck School of Medicine, University of Southern California, 2001 N. Soto St., Los Angeles, CA 90089, USA
| | - Myles G. Cockburn
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, 2001 N. Soto St., Los Angeles, CA 90089, USA
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21
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Kelley DE, Noar SM, Myrick JG, Morales-Pico B, Zeitany A, Thomas NE. An Empirical Analysis of Indoor Tanners: Implications for Audience Segmentation in Campaigns. JOURNAL OF HEALTH COMMUNICATION 2016; 21:564-574. [PMID: 27115046 DOI: 10.1080/10810730.2015.1114051] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Tanning bed use before age 35 has been strongly associated with several types of skin cancer. The current study sought to advance an understanding of audience segmentation for indoor tanning among young women. Panhellenic sorority systems at two universities in the Southeastern United States participated in this study. A total of 1,481 young women took the survey; 421 (28%) had tanned indoors in the previous 12 months and were the focus of the analyses reported in this article. Results suggested two distinct tanner types: regular (n = 60) and irregular (n = 353) tanners. Regular tanners tanned more frequently (M = 36.2 vs. 8.6 times per year) and reported significantly higher positive outcome expectations (p < .001) and lower negative outcome expectations (p < .01) than irregular tanners, among other significant differences. Hierarchical logistic regression analysis revealed several significant (p < .001) predictors of regular tanning type, with tanning dependence emerging as the strongest predictor of this classification (OR = 2.25). Implications for developing anti-tanning messages directed at regular and irregular tanners are discussed.
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Affiliation(s)
- Dannielle E Kelley
- a School of Media and Journalism , University of North Carolina at Chapel Hill , Chapel Hill , North Carolina , USA
| | - Seth M Noar
- a School of Media and Journalism , University of North Carolina at Chapel Hill , Chapel Hill , North Carolina , USA
- b Lineberger Comprehensive Cancer Center , University of North Carolina at Chapel Hill , Chapel Hill , North Carolina , USA
| | | | - Brenda Morales-Pico
- d School of Medicine , University of North Carolina at Chapel Hill , Chapel Hill , North Carolina , USA
| | - Alexandra Zeitany
- d School of Medicine , University of North Carolina at Chapel Hill , Chapel Hill , North Carolina , USA
| | - Nancy E Thomas
- b Lineberger Comprehensive Cancer Center , University of North Carolina at Chapel Hill , Chapel Hill , North Carolina , USA
- d School of Medicine , University of North Carolina at Chapel Hill , Chapel Hill , North Carolina , USA
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Friedman B, English JC, Ferris LK. Indoor Tanning, Skin Cancer and the Young Female Patient: A Review of the Literature. J Pediatr Adolesc Gynecol 2015; 28:275-83. [PMID: 26119073 DOI: 10.1016/j.jpag.2014.07.015] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2014] [Revised: 07/03/2014] [Accepted: 07/16/2014] [Indexed: 12/18/2022]
Abstract
Young, non-Hispanic white females represent the population most likely to use indoor tanning facilities. This population may be at increased risk of skin cancer as recent meta-analyses support a strong association between cutaneous malignancy and indoor tanning. Public perception of the purported health benefits of indoor tanning may be partially to blame for the popularity of tanning salons as a desire to prepare skin prior to sun exposure is among the most commonly cited motivations for indoor tanning. Improving education and counseling to address misconceptions regarding tanning safety will require the participation of healthcare providers for both physical and psychological screenings as well as for information dissemination. This review presents the association between tanning bed use and skin cancer, biological effects of UV radiation exposure, UV burden associated with tanning devices, public perception of tanning, demographic and psychological profile of indoor tanners, and current legislation regulating tanning bed use.
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Affiliation(s)
- Blake Friedman
- Department of Dermatology, University of Pittsburgh, Pittsburgh, PA
| | - Joseph C English
- Department of Dermatology, University of Pittsburgh, Pittsburgh, PA.
| | - Laura K Ferris
- Department of Dermatology, University of Pittsburgh, Pittsburgh, PA
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Robinson KC, Fisher DE. Tanning as a substance abuse. Commun Integr Biol 2014; 7:971579. [PMID: 26842945 PMCID: PMC4594601 DOI: 10.4161/cib.29890] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2014] [Revised: 07/08/2014] [Accepted: 07/11/2014] [Indexed: 12/14/2022] Open
Abstract
While few people would deny the appeal of a day in the sun there are some who seem to
take it too far. In recent years the concept of ‘tanning addiction’ has
become popular and several studies have supported the notion of viewing exposure to UV
radiation as a form of substance abuse. In this article we will review some of the
literature on sun seeking behavior.
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Affiliation(s)
- Kathleen C Robinson
- Cutaneous Biology Research Center; Department of Dermatology and MGH Cancer Center; Massachusetts General Hospital; Harvard Medical School ; Boston, MA USA
| | - David E Fisher
- Cutaneous Biology Research Center; Department of Dermatology and MGH Cancer Center; Massachusetts General Hospital; Harvard Medical School ; Boston, MA USA
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Guy GP, Berkowitz Z, Tai E, Holman DM, Everett Jones S, Richardson LC. Indoor tanning among high school students in the United States, 2009 and 2011. JAMA Dermatol 2014; 150:501-11. [PMID: 24577222 DOI: 10.1001/jamadermatol.2013.7124] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
IMPORTANCE Indoor tanning is associated with an increased risk of skin cancer, including melanoma, and is particularly dangerous for younger and more frequent indoor tanners. OBJECTIVE To examine the prevalence of indoor tanning and frequent indoor tanning (≥10 times during the 12 months before each survey) and their association with health-related behaviors. DESIGN, SETTING, AND PARTICIPANTS A cross-sectional study examined data from the 2009 and 2011 national Youth Risk Behavior Surveys, which used nationally representative samples of US high school students representing approximately 15.5 million students each survey year. The study included 25,861 students who answered the indoor tanning question. MAIN OUTCOMES AND MEASURES The prevalence of indoor tanning and frequent indoor tanning were examined as well as their association with demographic characteristics and health-related behaviors using multivariable logistic regression modeling. RESULTS The prevalence of indoor tanning was greater among female, older, and non-Hispanic white students. Indoor tanning was highest among female students aged 18 years or older, with 31.5% engaging in indoor tanning in 2011, and among non-Hispanic white female students, with 29.3% engaging in indoor tanning in 2011. Among female students, the adjusted prevalence of indoor tanning decreased from 26.4% in 2009 to 20.7% in 2011. Among female and male students, indoor tanning was associated with other risk-taking behaviors, such as binge drinking (P < .001 and P = .006, respectively), unhealthy weight control practices (P < .001, for both), and having sexual intercourse (P < .001, for both). Additionally, indoor tanning among female students was associated with using illegal drugs (P < .001) and having sexual intercourse with 4 or more persons (P = .03); use among male students was associated with taking steroids without a physician's prescription (P < .001), smoking cigarettes daily (P = .03), and attempting suicide (P = .006). More than half of respondents engaging in indoor tanning reported frequent use of the devices. CONCLUSIONS AND RELEVANCE Indoor tanning is common among high school students. Public health efforts are needed to change social norms regarding tanned skin and to increase awareness, knowledge, and behaviors related to indoor tanning. The clustering of risky behaviors suggests a need for coordinated, multifaceted approaches, including primary care physician counseling, to address such behaviors among adolescents.
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Wehner MR, Chren MM, Nameth D, Choudhry A, Gaskins M, Nead KT, Boscardin WJ, Linos E. International prevalence of indoor tanning: a systematic review and meta-analysis. JAMA Dermatol 2014; 150:390-400. [PMID: 24477278 DOI: 10.1001/jamadermatol.2013.6896] [Citation(s) in RCA: 195] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Indoor tanning is a known carcinogen, but the scope of exposure to this hazard is not known. OBJECTIVE To summarize the international prevalence of exposure to indoor tanning. DATA SOURCES Studies were identified through systematic searches of PubMed (1966 to present), Scopus (1823 to present), and Web of Science (1898 to present) databases, last performed on March 16, 2013. We also hand searched reference lists to identify records missed by database searches and publicly available data not yet published in the scientific literature. STUDY SELECTION Records reporting a prevalence of indoor tanning were eligible for inclusion. We excluded case-control studies, reports with insufficient study information, and reports of groups recruited using factors related to indoor tanning. Two independent investigators performed searches and study selection. Our search yielded 1976 unique records. After exclusions, 161 records were assessed for eligibility in full text, and 88 were included. DATA EXTRACTION AND SYNTHESIS Two independent investigators extracted data on characteristics of study participants, inclusion/exclusion criteria, data collection format, outcomes, and statistical methods. Random-effects meta-analyses were used to summarize the prevalence of indoor tanning in different age categories. We calculated the population proportional attributable risk of indoor tanning in the United States, Europe, and Australia for nonmelanoma skin cancer (NMSC) and melanoma. MAIN OUTCOMES AND MEASURES Ever and past-year exposure to indoor tanning. RESULTS The summary prevalence of ever exposure was 35.7% (95% CI, 27.5%-44.0%) for adults, 55.0% (33.0%-77.1%) for university students, and 19.3% (14.7%-24.0%) for adolescents. The summary prevalence of past-year exposure was 14.0% (95% CI, 11.5%-16.5%) for adults, 43.1% (21.7%-64.5%) for university students, and 18.3% (12.6%-24.0%) for adolescents. These results included data from 406 696 participants. The population proportional attributable risk were 3.0% to 21.8% for NMSC and 2.6% to 9.4% for melanoma, corresponding to more than 450 000 NMSC cases and more than 10 000 melanoma cases each year attributable to indoor tanning in the United States, Europe, and Australia. CONCLUSIONS AND RELEVANCE Exposure to indoor tanning is common in Western countries, especially among young persons. Given the large number of skin cancer cases attributable to indoor tanning, these findings highlight a major public health issue.
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Affiliation(s)
- Mackenzie R Wehner
- Department of Dermatology, University of California, San Francisco2Stanford University School of Medicine, Stanford, California3Department of Public Health and Primary Care, University of Cambridge, Cambridge, England
| | - Mary-Margaret Chren
- Department of Dermatology, University of California, San Francisco4Department of Dermatology, San Francisco Veterans Affairs Medical Center, San Francisco, California
| | | | - Aditi Choudhry
- Department of Internal Medicine, John Muir Medical Center, Walnut Creek, California
| | - Matthew Gaskins
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, England
| | - Kevin T Nead
- Stanford University School of Medicine, Stanford, California
| | - W John Boscardin
- Department of Epidemiology and Biostatistics, University of California, San Francisco
| | - Eleni Linos
- Department of Dermatology, University of California, San Francisco
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Guy GP, Berkowitz Z, Jones SE, Olsen EO, Miyamoto JN, Michael SL, Saraiya M. State indoor tanning laws and adolescent indoor tanning. Am J Public Health 2014; 104:e69-74. [PMID: 24524515 PMCID: PMC4025696 DOI: 10.2105/ajph.2013.301850] [Citation(s) in RCA: 96] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/14/2013] [Indexed: 11/04/2022]
Abstract
OBJECTIVES Recently, several state indoor tanning laws, including age restrictions, were promulgated to reduce indoor tanning among minors. We examined the effects of these laws on adolescent indoor tanning. METHODS We used nationally representative data from the 2009 and 2011 national Youth Risk Behavior Surveys (n = 31 835). Using multivariable logistic regression, we examined the association between state indoor tanning laws and indoor tanning among US high school students. RESULTS Female students in states with indoor tanning laws were less likely to engage in indoor tanning than those in states without any laws. We observed a stronger association among female students in states with systems access, parental permission, and age restriction laws than among those in states without any laws. We found no significant association among female students in states with only systems access and parental permission laws or among male students. CONCLUSIONS Indoor tanning laws, particularly those including age restrictions, may be effective in reducing indoor tanning among female high school students, for whom rates are the highest. Such reductions have the potential to reduce the health and economic burden of skin cancer.
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Affiliation(s)
- Gery P Guy
- Gery P. Guy Jr, Zahava Berkowitz, and Mona Saraiya are with the Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA. Sherry Everett Jones, Emily O'Malley Olsen, and Shannon L. Michael are with the Division of Adolescent and School Health, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention. Justin N. Miyamoto is with the Department of Pediatrics, Seattle Children's Hospital, Seattle, WA
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Abstract
Indoor tanning and eating disorder behaviors are both significant adolescent public health risks. Recent results by Amrock and Weitzman provocatively suggest a link between the two, perhaps because of a shared cause of dysfunctional cognition about body image. This commentary discusses a possible model to explain the association between indoor tanning and eating disorder behaviors among teenagers. It also presents various strategies to prevent the negative outcomes, with a focus on preventing adolescent tanning behavior. Prevention strategies worth consideration include counseling by pediatricians or other health professionals, improved parental supervision and monitoring, and policy change to prohibit adolescent use of tanning facilities.
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Pagoto S, Hillhouse J, Heckman CJ, Coups EJ, Stapleton J, Buller D, Turrisi R, Robinson J, Geller AC. Society of Behavioral Medicine (SBM) position statement: ban indoor tanning for minors. Transl Behav Med 2014; 4:124-6. [PMID: 24653783 DOI: 10.1007/s13142-013-0240-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
The Society of Behavioral Medicine (SBM), an interdisciplinary professional organization focused on the science of health behavior joins the American Academy of Dermatology, the American Academy of Pediatrics, and a host of other national and international organizations in support of a total ban on indoor tanning for minors under the age of 18. According to the International Agency for Research on Cancer, artificial sources of ultraviolet radiation are in the highest category of carcinogens, joining tobacco and asbestos. Strong evidence links indoor tanning to increased risk for melanoma with repeated exposure during childhood being associated with the greatest increase in risk. Several countries and five US states have passed legislation banning indoor tanning in minors. We strongly encourage the remaining US states to do the same in an effort to protect children and prevent new cases of melanoma. SBM also strongly encourages research that explores the use of tanning beds in the home. Home-based indoor tanning has the potential to be especially dangerous given the complete absence of safety regulations. Children are currently protected from exposure to health-harming substances like tobacco and lead; thus, legislation protecting them from artificial sources of ultraviolet radiation is yet another important step forward in improving public health.
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Affiliation(s)
- Sherry Pagoto
- University of Massachusetts Medical School, Worcester, MA USA
| | | | | | - Elliot J Coups
- University of Medicine and Dentistry New Jersey, New Brunswick, NJ USA
| | - Jerod Stapleton
- University of Medicine and Dentistry New Jersey, New Brunswick, NJ USA
| | | | - Rob Turrisi
- Penn State University, University Park, PA USA
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Colantonio S, Bracken MB, Beecker J. The association of indoor tanning and melanoma in adults: systematic review and meta-analysis. J Am Acad Dermatol 2014; 70:847-57.e1-18. [PMID: 24629998 DOI: 10.1016/j.jaad.2013.11.050] [Citation(s) in RCA: 120] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2013] [Revised: 11/05/2013] [Accepted: 11/26/2013] [Indexed: 10/25/2022]
Abstract
BACKGROUND Tanning beds are associated with increased risk of melanoma. OBJECTIVE We sought to update the evidence of the association of melanoma and indoor tanning focusing on frequency of use and exposure to newer tanning beds. METHODS We searched Scopus, MEDLINE, and Cumulative Index to Nursing and Allied Health Literature on August 14, 2013. We included all observational studies that included patients with melanoma who had indoor tanned. Odds ratios (OR) with 95% confidence intervals (CI) were extracted and combined using generic inverse variance methods assuming a random effects model. RESULTS In all, 31 studies were included with data available on 14,956 melanoma cases and 233,106 controls. Compared with never using, the OR for melanoma associated with ever using indoor tanning beds was 1.16 (95% CI 1.05-1.28). Similar findings were identified in recent studies with enrollment occurring in the year 2000 onward (OR 1.22, 95% CI 1.03-1.45) and in subjects attending more than 10 tanning sessions (OR 1.34, 95% CI 1.05-1.71). LIMITATIONS The quality of evidence contributing to review results ranges from poor to mediocre. CONCLUSION Using tanning beds is associated with a subsequent melanoma diagnosis. Exposure from more than 10 tanning sessions is most strongly associated and there was no statistically significant difference in this association before and after 2000, suggesting that newer tanning technology is not safer than older models.
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Affiliation(s)
| | - Michael B Bracken
- Center for Perinatal, Pediatric, and Environmental Epidemiology, Yale School of Public Health, New Haven, Connecticut.
| | - Jennifer Beecker
- Division of Dermatology, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
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Wehner MR, Chren MM, Nameth D, Choudhry A, Gaskins M, Nead KT, Boscardin WJ, Linos E. International prevalence of indoor tanning: a systematic review and meta-analysis. JAMA Dermatol 2014. [PMID: 24477278 DOI: 10.1001/jamadermatol.2013.6896.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Indoor tanning is a known carcinogen, but the scope of exposure to this hazard is not known. OBJECTIVE To summarize the international prevalence of exposure to indoor tanning. DATA SOURCES Studies were identified through systematic searches of PubMed (1966 to present), Scopus (1823 to present), and Web of Science (1898 to present) databases, last performed on March 16, 2013. We also hand searched reference lists to identify records missed by database searches and publicly available data not yet published in the scientific literature. STUDY SELECTION Records reporting a prevalence of indoor tanning were eligible for inclusion. We excluded case-control studies, reports with insufficient study information, and reports of groups recruited using factors related to indoor tanning. Two independent investigators performed searches and study selection. Our search yielded 1976 unique records. After exclusions, 161 records were assessed for eligibility in full text, and 88 were included. DATA EXTRACTION AND SYNTHESIS Two independent investigators extracted data on characteristics of study participants, inclusion/exclusion criteria, data collection format, outcomes, and statistical methods. Random-effects meta-analyses were used to summarize the prevalence of indoor tanning in different age categories. We calculated the population proportional attributable risk of indoor tanning in the United States, Europe, and Australia for nonmelanoma skin cancer (NMSC) and melanoma. MAIN OUTCOMES AND MEASURES Ever and past-year exposure to indoor tanning. RESULTS The summary prevalence of ever exposure was 35.7% (95% CI, 27.5%-44.0%) for adults, 55.0% (33.0%-77.1%) for university students, and 19.3% (14.7%-24.0%) for adolescents. The summary prevalence of past-year exposure was 14.0% (95% CI, 11.5%-16.5%) for adults, 43.1% (21.7%-64.5%) for university students, and 18.3% (12.6%-24.0%) for adolescents. These results included data from 406 696 participants. The population proportional attributable risk were 3.0% to 21.8% for NMSC and 2.6% to 9.4% for melanoma, corresponding to more than 450 000 NMSC cases and more than 10 000 melanoma cases each year attributable to indoor tanning in the United States, Europe, and Australia. CONCLUSIONS AND RELEVANCE Exposure to indoor tanning is common in Western countries, especially among young persons. Given the large number of skin cancer cases attributable to indoor tanning, these findings highlight a major public health issue.
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Affiliation(s)
- Mackenzie R Wehner
- Department of Dermatology, University of California, San Francisco2Stanford University School of Medicine, Stanford, California3Department of Public Health and Primary Care, University of Cambridge, Cambridge, England
| | - Mary-Margaret Chren
- Department of Dermatology, University of California, San Francisco4Department of Dermatology, San Francisco Veterans Affairs Medical Center, San Francisco, California
| | | | - Aditi Choudhry
- Department of Internal Medicine, John Muir Medical Center, Walnut Creek, California
| | - Matthew Gaskins
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, England
| | - Kevin T Nead
- Stanford University School of Medicine, Stanford, California
| | - W John Boscardin
- Department of Epidemiology and Biostatistics, University of California, San Francisco
| | - Eleni Linos
- Department of Dermatology, University of California, San Francisco
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Stapleton JL, Hillhouse J, Turrisi R, Robinson JK, Baker K, Manne SL, Coups EJ. Erythema and ultraviolet indoor tanning: findings from a diary study. Transl Behav Med 2013; 3:10-6. [PMID: 24073158 DOI: 10.1007/s13142-012-0155-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
The use of artificial ultraviolet (UV) indoor tanning (IT) beds increases the risk of skin cancer. The IT industry claims IT devices provide users with control over the amount of UV radiation exposure and thus reduces risks of sunburn (i.e., skin erythema) when tanning. This study aims to establish the prevalence and predictors of IT-related erythema using diary data. Six bimonthly diary surveys were administered to 198 female college IT users. Diaries assessed IT use and IT-related erythema. Among participants who used IT, 66 % experienced at least one episode of erythema and nearly one in five IT sessions resulted in skin erythema. Those who reported the most frequent IT use prior to the study were less likely to experience an IT-related erythema on a given IT session compared to the least experienced IT users. Perceived susceptibility to burns from IT use was positively associated with risk of erythema. Erythema was a frequently reported experience among IT users. Implications for policy makers and behavioral medicine practitioners are discussed.
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Affiliation(s)
- Jerod L Stapleton
- The Cancer Institute of New Jersey, 195 Little Albany Street, New Brunswick, NJ 08901 USA ; Department of Medicine, Robert Wood Johnson Medical School, The University of Medicine and Dentistry of New Jersey, New Brunswick, NJ USA
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Stanganelli I, Gandini S, Magi S, Mazzoni L, Medri M, Agnoletti V, Lombi L, Falcini F. Sunbed use among subjects at high risk of melanoma: an Italian survey after the ban. Br J Dermatol 2013; 169:351-7. [DOI: 10.1111/bjd.12384] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/09/2013] [Indexed: 11/30/2022]
Affiliation(s)
- I. Stanganelli
- Skin Cancer Unit IRCCS; Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori; Piero Maroncelli 40 - 47014 Meldola FC Italy
| | - S. Gandini
- Division of Epidemiology and Biostatistics; European Institute of Oncology; via Ramusio 1 - 20141 Milan Italy
| | - S. Magi
- Skin Cancer Unit Istituto Oncologico Romagnolo; Forlì IRCCS; Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori; Piero Maroncelli 40 - 47014 Meldola FC Italy
| | - L. Mazzoni
- Skin Cancer Unit Istituto Oncologico Romagnolo; Forlì IRCCS; Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori; Piero Maroncelli 40 - 47014 Meldola FC Italy
| | - M. Medri
- Skin Cancer Unit IRCCS; Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori; Piero Maroncelli 40 - 47014 Meldola FC Italy
| | - V. Agnoletti
- Centro di Studi Avanzati sull'Umanizzazione delle Cure e sulla Salute Sociale; University of Bologna; via Strada Maggiore 45 - 40125 Bologna Italy
| | - L. Lombi
- Centro di Studi Avanzati sull'Umanizzazione delle Cure e sulla Salute Sociale; University of Bologna; via Strada Maggiore 45 - 40125 Bologna Italy
| | - F. Falcini
- Registro Tumori Romagna IRCCS - Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori; Piero Maroncelli 40 - 47014 Meldola FC Italy
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33
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Preventing skin cancer through reduction of indoor tanning: current evidence. Am J Prev Med 2013; 44:682-9. [PMID: 23683987 PMCID: PMC4535424 DOI: 10.1016/j.amepre.2013.02.015] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2012] [Revised: 02/28/2013] [Accepted: 02/28/2013] [Indexed: 12/31/2022]
Abstract
Exposure to ultraviolet radiation from indoor tanning devices (tanning beds, booths, and sun lamps) or from the sun contributes to the risk of skin cancer, including melanoma, which is the type of skin cancer responsible for most deaths. Indoor tanning is common among certain groups, especially among older adolescents and young adults, adolescent girls and young women, and non-Hispanic whites. Increased understanding of the health risks associated with indoor tanning has led to many efforts to reduce use. Most environmental and systems efforts in the U.S. (e.g., age limits or requiring parental consent/accompaniment) have occurred at the state level. At the national level, the U.S. Food and Drug Administration and the Federal Trade Commission regulate indoor tanning devices and advertising, respectively. The current paper provides a brief review of (1) the evidence on indoor tanning as a risk factor for skin cancer; (2) factors that may influence use of indoor tanning devices at the population level; and (3) various environmental and systems options available for consideration when developing strategies to reduce indoor tanning. This information provides the context and background for the companion paper in this issue of the American Journal of Preventive Medicine, which summarizes highlights from an informal expert meeting convened by the CDC in August 2012 to identify opportunities to prevent skin cancer by reducing use of indoor tanning devices.
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Holman DM, Watson M. Correlates of intentional tanning among adolescents in the United States: a systematic review of the literature. J Adolesc Health 2013; 52:S52-9. [PMID: 23601612 PMCID: PMC4538996 DOI: 10.1016/j.jadohealth.2012.09.021] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2012] [Revised: 09/13/2012] [Accepted: 09/18/2012] [Indexed: 12/16/2022]
Abstract
PURPOSE Exposure to ultraviolet radiation and a history of sunburn in childhood contribute to risk of skin cancer in adolescence and in adulthood, but many adolescents continue to seek a tan, either from the sun or from tanning beds (i.e., intentional tanning). To understand tanning behavior among adolescents, we conducted a systematic review of the literature to identify correlates of intentional tanning in the United States. METHODS We included articles on original research published in English between January 1, 2001, and October 31, 2011, that used self-reported data on intentional tanning by U.S. adolescents aged 8 to 18 years and examined potential correlates of tanning behaviors. Thirteen articles met our criteria; all used cross-sectional survey data and quantitative methods to assess correlates of intentional tanning. RESULTS Results indicate that multiple factors influence tanning among adolescents. Individual factors that correlated with intentional tanning include demographic factors (female sex, older age), attitudes (preferring tanned skin), and behaviors (participating in other risky or appearance-focused behaviors such as dieting). Social factors correlated with intentional tanning include parental influence (having a parent who tans or permits tanning) and peer influence (having friends who tan). Only four studies examined broad contextual factors such as indoor tanning laws and geographic characteristics; they found that proximity to tanning facilities and geographic characteristics (living in the Midwest or South, living in a low ultraviolet area, and attending a rural high school) are associated with intentional tanning. CONCLUSIONS These findings inform future public health research and intervention efforts to reduce intentional tanning.
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Affiliation(s)
- Dawn M Holman
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia 30341, USA.
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35
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Lazovich D, Choi K, Rolnick C, Jackson JM, Forster J, Southwell B. An intervention to decrease adolescent indoor tanning: a multi-method pilot study. J Adolesc Health 2013; 52:S76-82. [PMID: 23601614 PMCID: PMC3734796 DOI: 10.1016/j.jadohealth.2012.08.009] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2012] [Revised: 08/10/2012] [Accepted: 08/28/2012] [Indexed: 01/05/2023]
Abstract
PURPOSE Indoor tanning usually begins during adolescence, but few strategies exist to discourage adolescent use. We developed and tested a parent-teenager intervention to decrease indoor tanning use. METHODS Through focus groups, we identified key messages to enhance parent-teenager communication about indoor tanning, and then developed a pamphlet for parents and postcards for adolescents to use in a direct mail experiment with randomly selected households. Two weeks after the mailing, we asked intervention parents (n = 87) and adolescents (n = 69) and nonintervention parents (n = 31) and adolescents (n = 28) about intervention receipt and content recall, parental concern, monitoring, parent-teenager conversations, and indoor tanning intention. RESULTS In intervention households, 54% of mothers and 56% of girls recalled receipt and reported reading materials, but few boys and no fathers did. Among mothers, 57% in intervention households indicated concern about daughters' indoor tanning, and 25% would allow daughters to tan indoors, whereas 43% of nonintervention mothers had concerns and 46% would allow indoor tanning. Fewer girls in intervention households than in nonintervention households thought parents would allow indoor tanning (44% vs. 65%), and fewer intended to tan indoors (36% vs. 60%). Most mothers and daughters who read the intervention materials also reported discussions about indoor tanning. Moreover, the less likely girls were to think that their mothers would allow indoor tanning, the less likely it was that they intended to tan indoors, a relationship mediated by perceptions of maternal monitoring. CONCLUSIONS A systematic qualitative and quantitative research approach yielded well-received indoor tanning prevention messages for mothers and female adolescents. Enhancing maternal monitoring has potential to decrease adolescent indoor tanning.
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Affiliation(s)
- DeAnn Lazovich
- Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, Minnesota 55454, USA.
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36
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Heckman CJ, Cohen-Filipic J, Darlow S, Kloss JD, Manne SL, Munshi T. Psychiatric and addictive symptoms of young adult female indoor tanners. Am J Health Promot 2013; 28:168-74. [PMID: 23621780 DOI: 10.4278/ajhp.120912-quan-442] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
PURPOSE Indoor tanning (IT) increases risk for melanoma and is particularly common among young adult women. IT has also been linked with some psychiatric symptoms, and frequent tanning may indicate tanning dependence (addiction) associated with endorphin release during ultraviolet radiation exposure. The objective of the current study was to investigate associations between IT, tanning dependence, and psychiatric and substance use symptoms in young adult women. DESIGN Cross-sectional survey and psychiatric interview. SETTING Online, except for the Mini International Neuropsychiatric Interview (MINI), which was completed over the telephone. SUBJECTS Participants were 306 female university students aged 18 to 25 years. MEASURES MINI, Seasonal Scale Index, tanning dependence scales, reporting ever having used a tanning bed or booth with tanning lamps (single item), reporting smoking a cigarette in the last 30 days (single item). ANALYSIS Descriptive statistics, χ(2) analysis, multivariate logistic regression. RESULTS Forty-six percent of the sample reported a history of IT, and 25% were classified as tanning dependent. Multivariate logistic regression analyses showed that IT was significantly associated with symptoms of alcohol use disorders, generalized anxiety, and not having social anxiety. Tanning dependence was associated with symptoms of alcohol use disorders. CONCLUSION Tanning is of concern not only for its association with skin cancer but for its association with psychiatric and substance use symptoms. Young women with certain psychological problems may seek relief from their symptoms by IT. These findings suggest that indoor tanners may benefit from health behavior and other psychosocial interventions.
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37
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Balk SJ, Fisher DE, Geller AC. Teens and indoor tanning: a cancer prevention opportunity for pediatricians. Pediatrics 2013; 131:772-85. [PMID: 23509165 PMCID: PMC4535027 DOI: 10.1542/peds.2012-2404] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/17/2012] [Indexed: 01/25/2023] Open
Abstract
In October 2011, California became the first US state to ban indoor tanning for minors under age 18 years. Vermont followed in May 2012. Increasingly, scientific evidence shows that artificial tanning raises the risk of skin cancer, including melanoma, a common cancer in adolescents and young adults and the type most likely to result in death. The World Health Organization, the American Academy of Pediatrics, the American Academy of Dermatology, the American Medical Association, and other organizations strongly recommend legislation to ban minors under age 18 from indoor tanning. Several nations have banned teen tanning. Yet, tanning in salons is still a prevalent practice in the United States, especially among teen girls, where rates for the oldest teens approach 40%. There is no federal legislation to restrict minors from salon tanning. More than 60% of states have some kind of legislation regarding minors' use of tanning salons, but only California and Vermont have passed complete bans of indoor tanning for minors. The Indoor Tanning Association, an industry advocacy group, has vigorously opposed legislative efforts. Pediatricians can play key roles in counseling families and with legislative efforts. In this update, we review the prevalence of salon tanning, association with skin cancer risk, tanning addiction, the roles of the federal and state governments in regulation and legislation, and responses to arguments created by industry to oppose legislation. Preventing exposure to artificial tanning may save lives, including young lives, and is a key cancer prevention opportunity for pediatricians.
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Affiliation(s)
- Sophie J Balk
- Children's Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, New York, USA.
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38
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Guy GP, Ekwueme DU, Tangka FK, Richardson LC. Melanoma treatment costs: a systematic review of the literature, 1990-2011. Am J Prev Med 2012; 43:537-45. [PMID: 23079178 PMCID: PMC4495902 DOI: 10.1016/j.amepre.2012.07.031] [Citation(s) in RCA: 72] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2012] [Revised: 05/01/2012] [Accepted: 07/03/2012] [Indexed: 10/27/2022]
Abstract
CONTEXT Melanoma is the most deadly form of skin cancer and an important public health concern. Given the substantial health burden associated with melanoma, it is important to examine the economic costs associated with its treatment. The purpose of the current study was to systematically review the literature on the direct medical care costs of melanoma. EVIDENCE ACQUISITION A systematic review was performed using multiple databases including MEDLINE, Embase, CINAHL, and Econlit. Nineteen articles on the direct medical costs of melanoma were identified. EVIDENCE SYNTHESIS Detailed information on the study population, study country/setting, study perspective, costing approach, disease severity (stage), and key study results were abstracted. The overall costs of melanoma were examined as well as per-patient costs, costs by phase of care, stage of diagnosis, and setting/type of care. Among studies examining all stages of melanoma, annual treatment costs ranged from $44.9 million among Medicare patients with existing cases to $932.5 million among newly diagnosed cases across all age groups. CONCLUSIONS Melanoma leads to substantial direct medical care costs, with estimates varying widely because of the heterogeneity across studies in terms of the study setting, populations studied, costing approach, and study methods. Melanoma treatment costs varied by phase of care and stage at diagnoses; costs were highest among patients diagnosed with late-stage disease and in the initial and terminal phases of care. Aggregate treatment costs were generally highest in the outpatient/office-based setting; per-patient/per-case treatment costs were highest in the hospital inpatient setting. Given the substantial costs of treating melanoma, public health strategies should include efforts to enhance both primary prevention (reduction of ultraviolet light exposure) and secondary prevention (earlier detection) of melanoma.
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Affiliation(s)
- Gery P Guy
- Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, CDC, Atlanta, Georgia 30341, USA.
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39
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Boniol M, Autier P, Boyle P, Gandini S. Cutaneous melanoma attributable to sunbed use: systematic review and meta-analysis. BMJ 2012; 345:e4757. [PMID: 22833605 PMCID: PMC3404185 DOI: 10.1136/bmj.e4757] [Citation(s) in RCA: 402] [Impact Index Per Article: 33.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/02/2012] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To estimate the burden of melanoma resulting from sunbed use in western Europe. DESIGN Systematic review and meta-analysis. DATA SOURCES PubMed, ISI Web of Science (Science Citation Index Expanded), Embase, Pascal, Cochrane Library, LILACS, and MedCarib, along with published surveys reporting prevalence of sunbed use at national level in Europe. STUDY SELECTION Observational studies reporting a measure of risk for skin cancer (cutaneous melanoma, squamous cell carcinoma, basal cell carcinoma) associated with ever use of sunbeds. RESULTS Based on 27 studies ever use of sunbeds was associated with a summary relative risk of 1.20 (95% confidence interval 1.08 to 1.34). Publication bias was not evident. Restricting the analysis to cohorts and population based studies, the summary relative risk was 1.25 (1.09 to 1.43). Calculations for dose-response showed a 1.8% (95% confidence interval 0% to 3.8%) increase in risk of melanoma for each additional session of sunbed use per year. Based on 13 informative studies, first use of sunbeds before age 35 years was associated with a summary relative risk of 1.87 (1.41 to 2.48), with no indication of heterogeneity between studies. By using prevalence data from surveys and data from GLOBOCAN 2008, in 2008 in the 15 original member countries of the European Community plus three countries that were members of the European Free Trade Association, an estimated 3438 cases of melanoma could be attributable to sunbed use, most (n=2341) occurring among women. CONCLUSIONS Sunbed use is associated with a significant increase in risk of melanoma. This risk increases with number of sunbed sessions and with initial usage at a young age (<35 years). The cancerous damage associated with sunbed use is substantial and could be avoided by strict regulations.
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Affiliation(s)
- Mathieu Boniol
- International Prevention Research Institute, 95 cours Lafayette, 69006 Lyon, France.
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Abstract
Skin cancer is a major public health concern, and tanning remains a modifiable risk factor. Multidimensional influences, including psychosocial, individual, environmental, and policy-related factors, create the milieu for individuals to engage in tanning. Parents and physicians can modify the behavior of teens and young adults using strategies based on harm reduction. Environmental and policy-related factors similar to those used to limit smoking by restricting access of minors to cigarettes in the United States in the 20th century need to be created. Federal regulations can restrict direct advertising and the excise tax can be increased to a prohibitive amount. Social networking may assist with affect regulation.
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Affiliation(s)
- June K Robinson
- Department of Dermatology, Northwestern University Feinberg School of Medicine, 676 North St Clair Street, Chicago, IL 60611, USA.
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41
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Makin JK, Hearne K, Dobbinson SJ. Compliance with age and skin type restrictions following the introduction of indoor tanning legislation in Melbourne, Australia. PHOTODERMATOLOGY PHOTOIMMUNOLOGY & PHOTOMEDICINE 2012; 27:286-93. [PMID: 22092731 DOI: 10.1111/j.1600-0781.2011.00613.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND/PURPOSE The study aimed to establish compliance of indoor tanning businesses with 2009 legislation, particularly with requirements to provide information on skin cancer and exclude people under 18 or with fair skin. METHODS Compliance was tested through surveys and in-person visits to 30 businesses in Melbourne, Australia. Research assistants presented as potential customers with different profiles: young adults eligible to use a sunbed, young adults with fair skin, under age customers who prompted with their age and under age customers who concealed their age and claimed to be 18 if asked. RESULTS Communicating the risks of skin cancer during the visit improved from 70% in 2003, prior to the introduction of legislation, to 97% in 2009. While there were improvements in restricting access to sunbeds among high-risk groups, compliance of indoor tanning businesses with age and skin type restrictions remained less than optimal. Almost half (47%) allowed access to fair-skinned research assistants, compared with 90% in 2003. Only one of the 30 operators allowed access to a teenager who prompted with her age; in 2003, 52% of under age teenagers were granted access without parental consent. However, when teenagers concealed their age or claimed to be 18, 80% of operators granted them access. CONCLUSIONS The findings suggest that regulation of the indoor tanning industry is a better approach to this health issue than voluntary standards and/or education. Nonetheless, inadequate compliance with requirements to exclude high-risk groups lends weight to calls for stricter monitoring and enforcement, or an absolute ban.
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Affiliation(s)
- Jennifer K Makin
- Centre for Behavioural Research in Cancer, Cancer Council Victoria, Carlton, Vic., Australia.
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42
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Harris K, Vanderhooft L, Burt L, Vanderhooft S, Hull C. Tanning business practices in Salt Lake County, Utah. J Am Acad Dermatol 2012; 66:513-4. [DOI: 10.1016/j.jaad.2011.08.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2011] [Revised: 07/28/2011] [Accepted: 08/15/2011] [Indexed: 11/24/2022]
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Affiliation(s)
- Jean-François Doré
- Centre de Recherche en Cancérologie de Lyon, UMR Inserm U1052 - CNRS U5286, Centre Léon Bérard, 28, rue Laënnec, 69373, Lyon Cedex 08, France.
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Melanoma in adolescents and young adults (ages 15-39 years): United States, 1999-2006. J Am Acad Dermatol 2011; 65:S38-49. [PMID: 22018066 DOI: 10.1016/j.jaad.2011.04.038] [Citation(s) in RCA: 79] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2011] [Revised: 04/04/2011] [Accepted: 04/20/2011] [Indexed: 11/21/2022]
Abstract
BACKGROUND Invasive melanoma of the skin is the third most common cancer diagnosed among adolescents and young adults (aged 15-39 years) in the United States. Understanding the burden of melanoma in this age group is important to identifying areas for etiologic research and in developing effective prevention approaches aimed at reducing melanoma risk. METHODS Melanoma incidence data reported from 38 National Program of Cancer Registries and/or Surveillance Epidemiology and End Results statewide cancer registries covering nearly 67.2% of the US population were used to estimate age-adjusted incidence rates for persons 15-39 years of age. Incidence rate ratios were calculated to compare rates between demographic groups. RESULTS Melanoma incidence was higher among females (age-adjusted incidence rates = 9.74; 95% confidence interval 9.62-9.86) compared with males (age-adjusted incidence rates = 5.77; 95% confidence interval 5.68-5.86), increased with age, and was higher in non-Hispanic white compared with Hispanic white and black, American Indians/Alaskan Natives, and Asian and Pacific Islanders populations. Melanoma incidence rates increased with year of diagnosis in females but not males. The majority of melanomas were diagnosed on the trunk in all racial and ethnic groups among males but only in non-Hispanic whites among females. Most melanomas were diagnosed at localized stage, and among those melanomas with known histology, the majority were superficial spreading. LIMITATIONS Accuracy of melanoma cases reporting was limited because of some incompleteness (delayed reporting) or nonspecific reporting including large proportion of unspecified histology. CONCLUSIONS Differences in incidence rates by anatomic site, histology, and stage among adolescents and young adults by race, ethnicity, and sex suggest that both host characteristics and behaviors influence risk. These data suggest areas for etiologic research around gene-environment interactions and the need for targeted cancer control activities specific to adolescents and young adult populations.
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Reviews on sun exposure and artificial light and melanoma. PROGRESS IN BIOPHYSICS AND MOLECULAR BIOLOGY 2011; 107:362-6. [DOI: 10.1016/j.pbiomolbio.2011.09.011] [Citation(s) in RCA: 80] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/29/2011] [Accepted: 09/13/2011] [Indexed: 12/31/2022]
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Buller DB, Cokkinides V, Hall HI, Hartman AM, Saraiya M, Miller E, Paddock L, Glanz K. Prevalence of sunburn, sun protection, and indoor tanning behaviors among Americans: Review from national surveys and case studies of 3 states. J Am Acad Dermatol 2011; 65:S114-23. [DOI: 10.1016/j.jaad.2011.05.033] [Citation(s) in RCA: 166] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2011] [Revised: 04/26/2011] [Accepted: 05/19/2011] [Indexed: 02/08/2023]
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Abstract
PURPOSE Genetic testing of minors is controversial, as ethical considerations depend on multiple aspects of the particular disease and familial context. For melanoma, there is a well-established and avoidable environmental influence and a documented benefit of early detection. METHODS We surveyed 61 CDKN2A/p16 mutation-tested adults from two kindreds about their attitudes toward genetic testing of minors immediately posttesting and 2 years later. RESULTS Overall, 86.9% expressed support of melanoma genetic testing of minors, with the importance of risk awareness (77.4%) and the likelihood of improved prevention and screening behaviors (69.8%) as the most frequently cited potential benefits. Among mutation carriers, 82.6% wanted genetic testing for their own children. These preferences remained stable over a 2-year period. Most respondents (62.3%) favored complete involvement of their children in genetic counseling and test reporting; 19.7% suggested that children be tested but not informed of the results. Concerns about inducing psychological distress or compromising children's decision autonomy were infrequently cited. Testing preferences did not vary by respondent age, gender, or melanoma history. CONCLUSION Respondents strongly supported melanoma genetic testing of minors, with most citing improved health behavior as a likely outcome. We discuss options for melanoma genetic counseling and testing of minors.
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Cust AE, Armstrong BK, Goumas C, Jenkins MA, Schmid H, Hopper JL, Kefford RF, Giles GG, Aitken JF, Mann GJ. Sunbed use during adolescence and early adulthood is associated with increased risk of early-onset melanoma. Int J Cancer 2011; 128:2425-35. [PMID: 20669232 DOI: 10.1002/ijc.25576] [Citation(s) in RCA: 160] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Sunbed use is associated with increased risk of melanoma. Younger people might be more susceptible to the carcinogenic effects of ultraviolet radiation. We investigated the association between sunbed use and risk of early-onset cutaneous malignant melanoma. From the Australian Melanoma Family Study, a multicentre, population-based, case-control-family study, we analysed data for 604 cases diagnosed between ages 18 and 39 years and 479 controls. Data were collected by interview. Associations were estimated as odds ratios (ORs) using unconditional logistic regression, adjusting for age, sex, city, education, family history, skin color, usual skin response to sunlight and sun exposure. Compared with having never used a sunbed, the OR for melanoma associated with ever-use was 1.41 (95% confidence interval (CI) 1.01-1.96), and 2.01 (95% CI 1.22-3.31) for more than 10 lifetime sessions (P(trend) 0.01 with cumulative use). The association was stronger for earlier age at first use (P(trend) 0.02). The association was also stronger for melanoma diagnosed when aged 18-29 years (OR for more than 10 lifetime sessions = 6.57, 95% CI 1.41-30.49) than for melanoma diagnosed when 30-39 years (OR 1.60, 95% CI 0.92-2.77; P(interaction) 0.01). Among those who had ever used a sunbed and were diagnosed between 18 and 29 years of age, three quarters (76%) of melanomas were attributable to sunbed use. Sunbed use is associated with increased risk of early-onset melanoma, with risk increasing with greater use, an earlier age at first use and for earlier onset disease.
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Affiliation(s)
- Anne E Cust
- Centre for Molecular, Environmental, Genetic and Analytic Epidemiology, School of Population Health, University of Melbourne, Melbourne, Australia.
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Mayer JA, Woodruff SI, Slymen DJ, Sallis JF, Forster JL, Clapp EJ, Hoerster KD, Pichon LC, Weeks JR, Belch GE, Weinstock MA, Gilmer T. Adolescents' use of indoor tanning: a large-scale evaluation of psychosocial, environmental, and policy-level correlates. Am J Public Health 2011; 101:930-8. [PMID: 21421947 PMCID: PMC3076411 DOI: 10.2105/ajph.2010.300079] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/19/2010] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We evaluated psychosocial, built-environmental, and policy-related correlates of adolescents' indoor tanning use. METHODS We developed 5 discrete data sets in the 100 most populous US cities, based on interviews of 6125 adolescents (aged 14-17 years) and their parents, analysis of state indoor tanning laws, interviews with enforcement experts, computed density of tanning facilities, and evaluations of these 3399 facilities' practices regarding access by youths. After univariate analyses, we constructed multilevel models with generalized linear mixed models (GLMMs). RESULTS In the past year, 17.1% of girls and 3.2% of boys had used indoor tanning. The GLMMs indicated that several psychosocial or demographic variables significantly predicted use, including being female, older, and White; having a larger allowance and a parent who used indoor tanning and allowed their adolescent to use it; and holding certain beliefs about indoor tanning's consequences. Living within 2 miles of a tanning facility also was a significant predictor. Residing in a state with youth-access legislation was not significantly associated with use. CONCLUSIONS Current laws appear ineffective in reducing indoor tanning; bans likely are needed. Parents have an important role in prevention efforts.
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Affiliation(s)
- Joni A Mayer
- School of Public Health, San Diego State University, CA, USA.
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Mogensen M, Jemec GB. The potential carcinogenic risk of tanning beds: clinical guidelines and patient safety advice. Cancer Manag Res 2010; 2:277-82. [PMID: 21188119 PMCID: PMC3004589 DOI: 10.2147/cmr.s7403] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2010] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION In 2009, the WHO listed ultraviolet (UV) radiation as a group 1 carcinogen. In spite of this, each year, millions of people tan indoor in Western countries. The aim of this review is to summarize evidence of tanning bed carcinogenesis and to present guidelines for use of tanning beds and patient safety advice. METHODS A narrative review of the literature was conducted based on both PubMed and Medline searches and on literature review of the retrieved papers. RESULTS Use of indoor tanning beds represents a significant and avoidable risk factor for the development of both melanoma and nonmelanoma skin cancers. Frequent tanners are more often adolescent females. Tanning beds have additional potential adverse effects such as burns, solar skin damage, infection, and possibly also addictive behavior. DISCUSSION The effort in preventing UV light-induced carcinogenesis should currently be aimed at developing new strategies for public health information. Tanning beds are one preventable source of UV radiation. In the majority of people solar UV radiation continues to be the major factor and therefore anti-tanning campaigns must always include sunbathers.
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Affiliation(s)
- Mette Mogensen
- Department of Dermatology, Gentofte Hospital, Hellerup, Denmark
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