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Research Letters |

Attitudes Toward Indoor Tanning Among Users of Sunless Tanning Products FREE

Anne Mahoney, MD; Susan M. Swetter, MD; Katie Brooks Biello, PhD, MPH; Elissa A. Resnick, MPH; Ilana Feuerstein, MD; Alan C. Geller, MPH, RN
[+] Author Affiliations

Author Affiliations: Boston University School of Medicine (Drs Mahoney and Feuerstein); Department of Dermatology, Pigmented Lesion and Melanoma Program, Stanford University School of Medicine, Stanford, California (Dr Swetter); Dermatology Service, Veterans Affairs Palo Alto Health Care System, Palo Alto, California (Dr Swetter); Department of Epidemiology, Yale University School of Public Health, New Haven Connecticut (Dr Biello); and Institute for Health Research and Policy, University of Illinois at Chicago, Chicago (Ms Resnick); and Department of Society, Human Development, and Health, Harvard School of Public Health (Mr Geller). Dr Mahoney is now with Rush University Medical Center, Chicago, Illinois.


Arch Dermatol. 2012;148(1):124-126. doi:10.1001/archderm.148.1.123.
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Despite primary prevention efforts aimed at reducing exposure to UV radiation (UVR), tanning bed use among women and girls remains high, ranging from 35% to 47% for young women aged 17 to 19 years.13 Rising melanoma incidence rates among women and girls aged 15 to 39 years4 coupled with high rates of tanning bed use1,2 call for innovative alternatives such as sunless tanning products (STPs).5 In the United States, few studies have examined the use of STPs. In a recent national survey of 1600 adolescents, nearly 20% of young women reported STP use in the previous year. Use was high among those with strong tan preferences and was also associated with higher rates of indoor tanning and recent sunburns.6 In a smaller sample, Sheehan et al7 found that 73% of STP users had or were planning to decrease their tanning bed use.

We report herein on young women's use of STPs, including lotions, creams, and salon-administered sprays, during the 12 months prior to a survey conducted in the summer of 2007. The purpose of this pilot study was to examine associations between use of STPs and use of tanning beds and to explore differences in tan-promoting attitudes among STP users.

We approached women who appeared to be between the ages of 18 and 40 years on Boston streets and at 2 local university campuses. From counts of respondents and nonrespondents, we estimated that more than 50% of passers-by completed the survey. Exempt approval to conduct this study was provided by the institutional review boards at Boston University Medical Center and the Harvard School of Public Health.

The survey instrument included questions from earlier surveys and new ones developed specifically for this survey.7,8 The pilot survey included 6 women aged 23 to 31 years. The survey asked for respondent demographic information and how often they had used tanning beds and STPs within the past year. Participants responded to statements addressing tan-promoting attitudes, for example, “It is worth burning to get a tan. ” They also addressed sun protection practices, exposures, and reasons for sunless tanning (Table).

Table Graphic Jump LocationTable. Attitudes and Sun Exposure Variables Associated With Changes in Tanning Bed Use Among Sunless Tanner (ST) and Tanning Bed Users (n  =  98)

Among STP users, bivariate associations were assessed between measures of attitudes, practices, tanning bed use, and changes in tanning bed use. Proportions were calculated, and differences were assessed using the χ2 test. Logistic regression was used to calculate odds ratios (ORs) and 95% CIs.

For this report, we restricted our analysis to the 181 women who had used STPs in the previous 12 months (ages ranged from 18 to 38 years, with a median age of 21 years). Among these, 131 used a sunless lotion only (72%); 8 used a spray tan only (4%); and 42 used both types of STPs (23%). Of the 181 respondents, 98 used a tanning bed at least once in the previous 12 months (54%). Of the 98 respondents who used a tanning bed and an STP at any time in the previous 12 months, 40 did not change their tanning bed use while using STPs; 9 increased their tanning bed use; 24 decreased tanning bed use; and 25 stopped using a tanning bed altogether while using STPs.

Among the 49 respondents who maintained or increased their tanning bed use, 43 agreed or strongly agreed with the statement that “people are more attractive if they have a tan ” (88%) compared with 28 of the 49 respondents who decreased or stopped tanning bed use (58%) (OR, 5.12; 95% CI, 1.83-14.32) (P   <  .001). Respondents who maintained or increased tanning bed use were more likely to report that they “found it hard not to tan ” (OR, 4.51; 95% CI, 1.81-11.28), to state that it was “worth burning to get a tan ” (OR, 3.11; 95% CI, 1.01-9.54), and to use sunscreen rarely or never (OR, 10.23; 95% CI, 2.19-47.81). Those respondents who reported that they had decreased or stopped tanning bed use were more likely to use STPs as a substitute for receiving a tan from tanning beds (OR for maintained or increased vs decreased or stopped, 0.34; 95% CI, 0.12-0.96), to use STPs for special occasions (OR, 0.36; 95% CI, 0.15-0.83), and to worry about wrinkles (OR, 0.33; 95% CI, 0.15-0.83) or skin cancer (OR, 0.40; 95% CI, 0.16-1.01) (Table).

Sales of STPs in the United States nearly quadrupled between 2003 and 2008,9 but, it is unclear whether these products are working to reduce tan-seeking practices. One trial found that STPs helped to decrease rates of sunbathing10; however, another study found conflicting results.11 Neither of these studies reported on STPs' association with tanning bed use. We found that of the 50% of STP users who used a tanning bed at least once in the prior 12 months, and 50% stopped or decreased the use of tanning beds while using STPs. These results leave room for cautious optimism.

Our findings suggest that specific tan-promoting attitudes might predispose particular individuals to use sunless tanners. We found that women who maintained or increased their use of tanning beds were more likely to have stronger tan-promoting attitudes than their counterparts who decreased or stopped such use and were also far more likely to practice other risky sun behaviors such as not using sunscreen. Understanding the foundations of these attitudes may provide direction for ways to reduce adverse UVR exposures.

Limitations

We cannot determine whether users of STPs might have used tanning beds more frequently had they not been using STPs. Participants were recruited in Boston using a nonrandomized sample. While a random sample from more localities would be preferable, similar methods have been used in surveys conducted at single beaches.1214

Conclusions

For half of the respondents, STPs appeared to work as a temporary harm reduction strategy; however, it remains to be seen whether reduction in tan-promoting behaviors can be sustained. In addition, this study revealed a significant majority of tan seekers who continue to incur skin damage through both natural and artificial UVR exposure, despite STP use.

Correspondence: Mr Geller, Department of Society, Human Development, and Health, Harvard School of Public Health, Kresge Bldg, 677 Huntington Ave, Room 701A, Boston MA, 02115 (ageller@hsph.harvard.edu).

Accepted for Publication: August 5, 2011.

Author Contributions: Dr Mahoney, Ms Biello, and Mr Geller had full access to all of the data in the study and take responsibility for the integrity of the data and accuracy of the data analysis. Study concept and design: Mahoney, Resnick, and Geller. Acquisition of data: Mahoney. Analysis and interpretation of data: Mahoney, Swetter, Biello, Feuerstein, and Geller. Drafting of the manuscript: Mahoney, Swetter, and Geller. Critical revision of the manuscript for important intellectual content: Mahoney, Swetter, Biello, Resnick, Feuerstein, and Geller. Statistical analysis: Biello. Administrative, technical, and material support: Resnick and Geller. Study supervision: Mahoney and Geller.

Financial Disclosure: None reported.

Additional Contributions: Marie-France Demierre, MD, provided writing assistance and guidance throughout the project.

Geller AC, Colditz G, Oliveria S,  et al.  Use of sunscreen, sunburning rates, and tanning bed use among more than 10  000 US children and adolescents.  Pediatrics. 2002;109(6):1009-1014
PubMed   |  Link to Article
Cokkinides VE, Weinstock MA, O ’Connell MC, Thun MJ. Use of indoor tanning sunlamps by US youth, ages 11-18 years, and by their parent or guardian caregivers: prevalence and correlates.  Pediatrics. 2002;109(6):1124-1130
PubMed   |  Link to Article
Demko CA, Borawski EA, Debanne SM, Cooper KD, Stange KC. Use of indoor tanning facilities by white adolescents in the United States.  Arch Pediatr Adolesc Med. 2003;157(9):854-860
PubMed   |  Link to Article
Purdue MP, Freeman LE, Anderson WF, Tucker MA. Recent trends in incidence of cutaneous melanoma among US Caucasian young adults.  J Invest Dermatol. 2008;128(12):2905-2908
PubMed   |  Link to Article
Maibach HI, Kligman AM. Dihydroxyacetone.  Arch Dermatol. 1960;82:73-75
Link to Article
Cokkinides VE, Bandi P, Weinstock MA, Ward E. Use of sunless tanning products among US adolescents aged 11 to 18 years.  Arch Dermatol. 2010;146(9):987-992
PubMed   |  Link to Article
Sheehan DJ, Lesher JL Jr. The effect of sunless tanning on behavior in the sun: a pilot study.  South Med J. 2005;98(12):1192-1195
PubMed   |  Link to Article
Zeller S, Lazovich D, Forster J, Widome R. Do adolescent indoor tanners exhibit dependency?  J Am Acad Dermatol. 2006;54(4):589-596
PubMed   |  Link to Article
Munther C. You're not bronzed: that tan is fake! http://www.boston.com/lifestyle/fashion/articles/2009/05/21/youre_not_bronzed_that_tan_is_fake/. Accessed November 11, 2010
Pagoto SL, Schneider KL, Oleski J, Bodenlos JS, Ma Y. The sunless study: a beach randomized trial of a skin cancer prevention intervention promoting sunless tanning.  Arch Dermatol. 2010;146(9):979-984
PubMed   |  Link to Article
Mahler HI, Kulik JA, Harrell J, Correa A, Gibbons FX, Gerrard M. Effects of UV photographs, photoaging information, and use of sunless tanning lotion on sun protection behaviors.  Arch Dermatol. 2005;141(3):373-380
PubMed   |  Link to Article
Emmett A, Uchida T, Wagner RF Jr. Sunburn risk factors for beachgoing children.  Dermatol Online J. 2008;14(1):28
PubMed
O ’Riordan DL, Steffen AD, Lunde KB, Gies P. A day at the beach while on tropical vacation: sun protection practices in a high-risk setting for UV radiation exposure.  Arch Dermatol. 2008;144(11):1449-1455
PubMed   |  Link to Article
Pagoto S, McChargue D, Fuqua RW. Effects of a multicomponent intervention on motivation and sun protection behaviors among Midwestern beachgoers.  Health Psychol. 2003;22(4):429-433
PubMed   |  Link to Article

Figures

Tables

Table Graphic Jump LocationTable. Attitudes and Sun Exposure Variables Associated With Changes in Tanning Bed Use Among Sunless Tanner (ST) and Tanning Bed Users (n  =  98)

References

Geller AC, Colditz G, Oliveria S,  et al.  Use of sunscreen, sunburning rates, and tanning bed use among more than 10  000 US children and adolescents.  Pediatrics. 2002;109(6):1009-1014
PubMed   |  Link to Article
Cokkinides VE, Weinstock MA, O ’Connell MC, Thun MJ. Use of indoor tanning sunlamps by US youth, ages 11-18 years, and by their parent or guardian caregivers: prevalence and correlates.  Pediatrics. 2002;109(6):1124-1130
PubMed   |  Link to Article
Demko CA, Borawski EA, Debanne SM, Cooper KD, Stange KC. Use of indoor tanning facilities by white adolescents in the United States.  Arch Pediatr Adolesc Med. 2003;157(9):854-860
PubMed   |  Link to Article
Purdue MP, Freeman LE, Anderson WF, Tucker MA. Recent trends in incidence of cutaneous melanoma among US Caucasian young adults.  J Invest Dermatol. 2008;128(12):2905-2908
PubMed   |  Link to Article
Maibach HI, Kligman AM. Dihydroxyacetone.  Arch Dermatol. 1960;82:73-75
Link to Article
Cokkinides VE, Bandi P, Weinstock MA, Ward E. Use of sunless tanning products among US adolescents aged 11 to 18 years.  Arch Dermatol. 2010;146(9):987-992
PubMed   |  Link to Article
Sheehan DJ, Lesher JL Jr. The effect of sunless tanning on behavior in the sun: a pilot study.  South Med J. 2005;98(12):1192-1195
PubMed   |  Link to Article
Zeller S, Lazovich D, Forster J, Widome R. Do adolescent indoor tanners exhibit dependency?  J Am Acad Dermatol. 2006;54(4):589-596
PubMed   |  Link to Article
Munther C. You're not bronzed: that tan is fake! http://www.boston.com/lifestyle/fashion/articles/2009/05/21/youre_not_bronzed_that_tan_is_fake/. Accessed November 11, 2010
Pagoto SL, Schneider KL, Oleski J, Bodenlos JS, Ma Y. The sunless study: a beach randomized trial of a skin cancer prevention intervention promoting sunless tanning.  Arch Dermatol. 2010;146(9):979-984
PubMed   |  Link to Article
Mahler HI, Kulik JA, Harrell J, Correa A, Gibbons FX, Gerrard M. Effects of UV photographs, photoaging information, and use of sunless tanning lotion on sun protection behaviors.  Arch Dermatol. 2005;141(3):373-380
PubMed   |  Link to Article
Emmett A, Uchida T, Wagner RF Jr. Sunburn risk factors for beachgoing children.  Dermatol Online J. 2008;14(1):28
PubMed
O ’Riordan DL, Steffen AD, Lunde KB, Gies P. A day at the beach while on tropical vacation: sun protection practices in a high-risk setting for UV radiation exposure.  Arch Dermatol. 2008;144(11):1449-1455
PubMed   |  Link to Article
Pagoto S, McChargue D, Fuqua RW. Effects of a multicomponent intervention on motivation and sun protection behaviors among Midwestern beachgoers.  Health Psychol. 2003;22(4):429-433
PubMed   |  Link to Article

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