Case-control studies have found evidence linking UV radiation exposure through indoor artificial UV tanning to all forms of skin cancer, and these risks increase exponentially for those who indoor tan more than 10 times a year.1,2 Compounding the problem are the high rates of indoor UV tanning among young women, who engage in significantly more indoor tanning than men.3,4 Despite these risks, few prevention efforts have been developed specifically targeting indoor tanners who tan very frequently.
The present pilot study tested the efficacy of 2 brief intervention approaches, shown to be successful in modifying other difficult-to-change health behaviors, in reducing very frequent indoor tanning behavior in young women: (1) the peer-delivered Motivational Interview5 (PMI) and (2) personalized graphic feedback (PGF).6 The PMI uses a one-on-one, 30-minute counseling session to provide cognitive-behavioral skills information and help participants evaluate the effects of current indoor tanning behaviors with the aim of enhancing their desire to reduce harmful behaviors. The benefit of the PMI is that the health and appearance information can be tailored to the salient aspects of the participants' concerns. The PMI uses a personalized graphic feedback sheet that incorporates information on the participants' indoor tanning behaviors, normative beliefs about tanning, beliefs about tanning effects, tanning-related problems, tanning financial costs, family history of skin cancers, and skin-protective behaviors (Figure).
One-on-one peer-counseling intervention personalized graphic feedback sheet.
The PGF uses the same feedback sheet used in the PMI (Figure) but is delivered via mail with no person-to-person contact. To ensure that our subjects read the PGF material, we had them log on to a secured Web site and answer questions regarding its content. A benefit of the PGF is its low cost and ease of implementation, making it potentially more sustainable than the PMI. We hypothesized that individuals completing either of the 2 interventions (PMI or PGF) would engage in fewer indoor tanning sessions than subjects in a nonintervention control group during the 3-month postintervention follow-up period.
Participants were all undergraduates drawn from an introductory health course often taken as a general education requirement at a large northeastern US university. They were offered course extra credit and a nominal payment in exchange for their participation. The eligibility requirements were female sex and having indoor tanned 10 or more times in the past year. Of the initial 245 participants invited to take a baseline screen assessment consisting of questions on skin type, number of indoor tanning sessions within the past year, and intentions to tan, 105 met the eligibility criteria and were randomly assigned to conditions (39, PMI; 34, PGF; and 32, a no-intervention control group). No significant differences between the groups were observed at baseline with regard to number of indoor tanning sessions the previous winter, skin type, or measures of attitudes toward indoor tanning (P > .05 for all categories). Interventions were administered during the month of November. The university institutional review board approved the research protocol.
Between-group analysis of variance was used to compare the conditions on 3-month postintervention total number of indoor tanning sessions during the months of December, January, and February. These months were chosen because we believe they are generally the months of most frequent indoor tanning activity in the geographic area of the university. Significant differences between the conditions were observed (F2,102 = 4.05, P < .02, η2 = 0.07). Follow-up comparisons using the Tukey-Kramer7 post hoc test revealed a significant difference (P < .006) between the mean (SD) number of indoor tanning sessions during December through February for the PMI group (4.40 [7.74]) and the control group (11.78 [13.03]). We also observed a difference between the mean (SD) number of indoor tanning sessions during December through February for the PGF group (9.03 [11.92]) and the PMI group, although the difference was not significant (P < .08). No significant difference was observed between the PGF and control groups.
The indoor tanning behavior of participants in the PMI group was markedly reduced compared with the behavior of those in the control and PGF groups, possibly because the nonjudgmental session with a trained PMI peer counselor provided information not provided to the control or PGF participants. In interventions that use peer counselors, the participant's behavior change may be influenced by identification with the counselor and/or by the validation and support provided by the counselor to aid in reducing risky behaviors.
It is unclear which components of the PMI (appearance concerns, health concerns, or both) were most effective in reducing indoor tanning sessions or if it was the combination of all aspects that led to behavior change. More research is needed to identify mediational components involved with behavior change. However, the PMI approach is a low-cost, sustainable, and potentially effective technique that could be integrated into existing university health or residential life programs that use peer counselors to reduce indoor tanning behaviors in a high-risk population.
Despite the positive effects identified, some limitations to the research must be considered. First, our convenience sample of participants may have introduced some bias into the results. Second, the follow-up period was brief and did not permit the examination of the potential for decay in the observed effects. Third, the brevity of the outcome assessments did not permit a formal examination of the underlying sources of change (eg, health or appearance motives, both, or other mechanisms). Fourth, significant intervention effects were not found for the PGF despite a reduction in indoor tanning behaviors by almost 25% at follow-up. We believe that this may be owing to a lack of power caused by the small sample size. Despite the limitations, the current study highlights the promise of such interventions, which warrant further examination on a larger scale.
Correspondence: Dr Turrisi, Prevention Research Center, The Pennsylvania State University, S109 Henderson Bldg, University Park, PA 16802 (firstname.lastname@example.org).
Author Contributions: Dr Turrisi and Ms Mastroleo had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. Study concept and design: Turrisi, Mastroleo, and Mallett. Analysis and interpretation of data: Turrisi, Mastroleo, and Stapleton. Drafting of the manuscript: Turrisi, Mastroleo, and Stapleton. Critical revision of the manuscript for important intellectual content: Turrisi, Stapleton, and Mallett. Statistical analysis: Turrisi and Stapleton. Obtained funding: Turrisi. Administrative, technical, and material support: Mastroleo. Study supervision: Mastroleo, Mallett.
Financial Disclosure: None reported.
Funding/Support: This study was funded by Prevention Research Center, The Pennsylvania State University (Dr Turrisi).
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