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Indoor tanners less likely to practice sun protection
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White adults who were indoor tanners were more likely to report sunburns and poor sun-protective practices, and were not significantly more likely to undergo a full-body skin examination compared with those who were not indoor tanners, according to study results recently published in JAMA Dermatology.
Researchers conducted a cross-sectional study using the 2015 National Health Interview Survey, which represents a sample of the U.S. civilian noninstitutional population. There were 10,262 non-Hispanic white adults aged 18 to 60 years (49% women; median age, 39 years) included in the study. The analysis was limited to non-Hispanic whites due to a high prevalence of indoor tanning and high incidence of skin cancer compared with other subgroups.
Respondents were excluded if they had a history of skin cancer.
There were 787 people (7%) in the study who reported tanning indoors in the prior year. Frequent indoor tanners who were younger (aged 18 to 34 years) were more likely to rarely or never use protective clothing (adjusted prevalence ratio = 1.28; 95% CI, 1.1-1.49) or seek shade (aPR = 1.32; 95% CI, 1.03-1.72) when compared with those who did not tan indoors.
Among women, those who rarely or never using sunscreen (aPR = 1.34; 95% CI, 1.11-1.62), protective clothing (aPR = 1.27; 95% CI, 1.15-1.42) and shade (aPR = 1.54; 95% CI, 1.25-1.9) on a sunny day, as well as multiple sunburns in the prior year (aPR = 1.21; 95% CI, 1-1.45) were more likely to be reported by those who frequently tanned indoors compared with those who did not tan.
Indoor tanners were also not more likely to have undergone a full body skin examination, the researchers wrote.
“Individuals who frequently tan indoors already have a worrisome risk factor profile for skin cancer, yet they continue to practice poor photoprotection along with increase sun exposure, increasing their risk for skin cancer beyond that associated with the use of indoor tanning alone,” the researchers wrote. “Yet, despite their heightened risk factor profile, individuals who frequently tan indoors are not significantly more likely to engage in skin cancer screening.”
“Thus, taking an active approach to sun protection and skin cancer screening in high-risk populations, such as indoor tanners, may reduce the morbidity and mortality associated with skin cancer.” – by Bruce Thiel
Disclosure: The researchers report no relevant financial disclosures.
Perspective
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Carolyn Heckman, PhD
Skin cancer is by far the most common cancer. It is largely preventable by simple prevention practices and is relatively easy to detect at early, more treatable stages.
The recent JAMA Dermatology article by Fischer and colleagues is important and timely. National Health Interview Survey (NHIS) data from 2015 from 10,262 sun-exposed non-Hispanic white 18-60 year olds who had not had skin cancer were analyzed.
The authors found that among individuals aged 18 to 34 years, frequent (≥10 times in the past year) indoor tanners were less likely to use shade or wear protective clothing when outdoors than non-indoor tanners.
Among women aged 18 to 60 years, individuals who frequently indoor tanned were less likely to use shade, protective clothing, or sunscreen, and were also more likely to have sunburned in the past year than non-indoor tanners.
In addition, individuals who had indoor tanned in the last year were not more likely to have been screened by a doctor for skin cancer than non-tanners, despite the FDA’s recommendation that indoor tanners be screened regularly.
Study strengths include the large national sample and the focus on relatively understudied issues. Limitations include the self-reported and cross-sectional nature of the data. In summary, although white indoor tanners’ have other established risk factors for skin cancer due to indoor tanning and sun-burning, they are still less likely to engage in sun protection practices and receive skin cancer screening than non-indoor tanners.
Despite indoor tanning industry efforts to the contrary, studies show that many indoor tanners are aware of primary prevention recommendations such as the use of shade, but tend to avoid them, in part, due to perceiving that the appearance of their natural skin color is enhanced with a tan. However, the FDA recommendation is likely unfamiliar to most indoor tanners and even primary care providers. These primary and secondary prevention practices need to be addressed in this high-risk population in order to reduce the morbidity, mortality, and costs due to skin cancer.
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