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Indoor tanning rates decline among US adults
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Indoor tanning rates among adults in the United States declined significantly between 2010 and 2013, according to study results.
Gery P. Guy Jr., PhD, MPH, health economist in the CDC’s division of cancer prevention and control, and colleagues analyzed data from the National Health Interview Survey, a nationally representative sample of the U.S. population aged 18 years and older (n=59,145).
Researchers defined indoor tanning as use of an indoor tanning device within the previous 12 months. The investigators calculated indoor tanning prevalence and used log-linear regression to evaluate factors associated with indoor tanning.
The percentage of adults who reported indoor tanning declined from 5.5% in 2010 to 4.2% in 2013 (P < .001). Indoor tanning rates declined from 8.6% to 6.5% (P < .001) among women, and from 2.2% to 1.7% (P = .03) among men.
“The decrease in indoor tanning may be partly attributable to the increased awareness of its harms,” Guy and colleagues wrote. “Indoor tanning devices have been classified as carcinogenic to humans, their use has consistently been shown to increase skin cancer risk, and laws restricting access among minors may have changed public perceptions of their safety. In addition, a 10% excise tax on indoor tanning was implemented in 2010, which may have contributed to the decrease in indoor tanning.”
Among infrequent tanners — defined as those who tan one to nine times per year — indoor tanning rates declined from 1.4% to 1% (P < .05) for men, and from 3.7% to 2.8% (P < .01) for women.
Among women who identified themselves as frequent tanners — meaning they use indoor tanning devices at least 10 times per year — the rate declined from 4.8% to 3.6% (P < .001).
Results of an adjusted analyses showed indoor tanning frequency declined 28% among women aged 50 years and older, 45% among women who identified themselves as college graduates, and 33% among women in fair or poor health.
However, adjusted analyses showed indoor tanning frequency increased by 177% among men aged 40 to 49 years and by 71% among men aged 50 years or older.
Overall, researchers determined 1.6 million fewer women and about 400,000 fewer men engaged in indoor tanning in 2013 compared with 2010. Still, the survey results show an estimated 7.8 million women and 1.9 million men continue to engage in indoor tanning.
“The Surgeon General has highlighted the importance of reducing the harms from indoor tanning and of continued public health efforts to identify and implement effective strategies to reduce indoor tanning,” Guy and colleagues wrote. “Research regarding the motivations of indoor tanners could inform the development of new interventions. Physicians can also play a role through behavioral counseling, which is recommended for fair-skinned persons aged 10 to 24 years. Continued surveillance of indoor tanning will aid program planning and evaluation by measuring the effect of skin cancer prevention policies and monitoring progress.” – by Bruce Thiel
Perspective
Back to TopJeffrey M. Farma, MD
Guy and colleagues published a research letter entitled, “Recent changes in the prevalence of and factors associated with frequency of indoor tanning among U.S. adults” in JAMA Dermatology. With increased legislations internationally banning and regulating indoor tanning, this is a very timely and interesting study. Using the National Health Interview Survey from 2010 to 2013, the researchers evaluated frequency of indoor tanning based on demographics. They identified a reduction in indoor tanning from 5.5% to 4.2% among all adults, with women decreasing from 8.6% to 6.5% and men decreasing from 2.2% to 1.7%. This trend is important and may help to identify the benefit of national campaigns designed to highlight the risks for indoor tanning. However, the numbers are still striking and concerning with almost 8 million women and 2 million men engaging in indoor tanning. The incidence of melanoma has been increasing with trends of increased prevalence in younger women. There needs to be continued education of the public and legislation to reduce the use of indoor tanning nationally, and studies like this highlight the potential effectiveness of these types of campaigns.
Perspective
Back to TopJulia Siegel, BA and Martin A. Weinstock, MD, PhD
The decrease in indoor tanning among adults in the United States is an important sign of progress in the effort to prevent melanoma and keratinocyte carcinomas, such as basal and squamous cell carcinomas of the skin. This study shows a decline across multiple demographic categories, including gender, race, education level, and region.
Educational efforts on the dangers of indoor tanning likely play a role in this trend, but this decline also may be due in part to the 10% excise tax on indoor tanning that went into effect in 2010. We have seen the success of increased taxes in the reduction of tobacco use among current smokers, as well as in the prevention of initiation of use among young adults. It also is likely that the trend of legislative restriction on indoor tanning for minors may be sending a public health message to people of all ages.
Although this decline in indoor tanning is an encouraging step forward, it is only one step. As an estimated 7.8 million women and 1.9 million men continue to indoor tan, further public health efforts are needed. Programs for teens and young adults at risk of developing a tanning addiction that could shape their actions into adulthood are particularly important, especially because so many of the melanomas that occur in younger adult years are attributable to indoor tanning exposure. As of this writing, 13 states and the District of Columbia have banned those aged younger than 18 years from commercial tanning facilities. Extending this to the remaining states is a worthwhile goal. Increasing the current tax on indoor tanning also would contribute to decreasing this harmful practice. Finally, clinicians and others can play an important role in education about the harms of indoor tanning and counseling regarding the benefits of and procedures for reducing exposure to ultraviolet radiation.
Julia Siegel, BA
Dermatoepidemiology fellow
Brown University
Martin A. Weinstock, MD, PhD
Center for Dermatoepidemiology
Brown University
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