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Table 1. Baseline Characteristics of 393 Participants
Table 1. Baseline Characteristics of 393 Participants
Table 2. Participants Who Agreed or Strongly Agreed With Each of the Following Statements
Table 2. Participants Who Agreed or Strongly Agreed With Each of the Following Statements
1.
Herzog C, Pappo A, Bondy M, Bleyer A, Kirkwood J. Malignant melanoma: cancer epidemiology in older adolescents and young adults. 2007:53-63. http://seer.cancer.gov/publications/aya/5_melanoma.pdf. Accessed January 2012
2.
Hillhouse J, Turrisi R, Shields AL. Patterns of indoor tanning use: implications for clinical interventions.  Arch Dermatol. 2007;143(12):1530-1535PubMedArticle
3.
Stryker JE, Yaroch AL, Moser RP, Atienza A, Glanz K. Prevalence of sunless tanning product use and related behaviors among adults in the United States: results from a national survey.  J Am Acad Dermatol. 2007;56(3):387-390PubMedArticle
4.
Choi K, Lazovich D, Southwell B, Forster J, Rolnick SJ, Jackson J. Prevalence and characteristics of indoor tanning use among men and women in the United States.  Arch Dermatol. 2010;146(12):1356-1361PubMedArticle
Research Letter
July 2012

Patterns of Use of Sunless Tanning Product Alternatives to Indoor Tanning Among Female College Students

Author Affiliations

Author Affiliations: Division of Dermatology and Cutaneous Sciences and Center for Investigative Dermatology, Michigan State University College of Human Medicine, East Lansing (Drs Sinha and Russo and Ms Van Acker); Department of Psychology, Saint Louis University, St Louis, Missouri (Dr Vander Wal). Dr Sinha is now with the Department of Dermatology, University at Buffalo and Roswell Park Cancer Institute, Buffalo, New York. Dr Russo is now with the Department of Medicine, St Joseph Mercy Hospital, Ann Arbor, Michigan.

Arch Dermatol. 2012;148(7):855-857. doi:10.1001/archdermatol.2012.491

The rise of melanoma in young women, particularly manifesting in trunk skin,1 suggests deliberate UV radiation (UVR) exposure as a plausible cause. Sunless tanning products (STPs), including lotions, spray-on tans, and bronzers, impart a tanned appearance. The role of STPs as substitutes to indoor tanning (IT) remains largely uncharacterized among indoor tanners. The objective of this study was to determine the knowledge and use of STPs among women who tan indoors. To our knowledge, no previous study has described STP use among IT behavioral subtypes.2 Therefore, we also explored whether differences exist between IT subtypes. These findings may inform prevention strategies to reduce IT.

Methods

This study was conducted at 2 Midwestern universities. Following institutional review board approval, female students enrolled in fall semester psychology courses were invited to take an online survey assessing IT and STP knowledge and use. Participants were required to have engaged in IT in the past 2 years. Participants were categorized according to how strongly they agreed with statements on IT frequency using descriptions illustrating IT behaviors.2 Resultant subtypes included event tanners, who tanned only occasionally; seasonal tanners, who tanned 1 to 7 times per week seasonally; and regular tanners, who tanned 1 to 7 times per week all year.

Results

Participant characteristics are listed in Table 1. Although over 90% of participants associated IT with skin cancers and photoaging, 85% had engaged in IT in the past year. Generally, increased IT visits correlated with fewer sun-protective behaviors (P = .05).

Eighty-seven percent of participants used STPs, including bronzers (79%), lotions (45%), and spray-on tans (14%). Primary motives for use included appearance enhancement and the belief that STPs were safer than IT, whereas an unnatural orange or streaked look deterred use. Knowledge about IT risks and STP properties differed significantly between users and nonusers (P = .01). Users agreed more strongly that lotions and spray-on tans (P = .03) and bronzers (P < .001) were safer than IT. Moreover, lotion (P = .01) and spray-on tan (P = .03) users reported greater application of daily facial sunscreens than nonusers. Interestingly, lotion users were more likely to report a sunburn tendency (P = .01)

The distribution of IT behavioral subtypes is similar to patterns previously reported.2 Event tanners composed 72% of the sample, and regular tanners were the least represented subtype (6%). Although STP use did not significantly vary between subtypes, regular tanners were more likely to report intent to use spray-on tans (P = .003). Knowledge about IT risks and properties of STPs differed significantly between subtypes (F2,387 = 8.09, P < .001), and regular tanners exhibited less knowledge than event tanners (P < .001) and seasonal tanners (P = .01) (Table 2).

Comment

Overall, 87% of study participants used STPs in the past year. This finding is consistent with trends of STP use in the United States.3 Generally, STP users were more knowledgeable than nonusers about the adverse effects of tanning. However, users were more likely to report a sunburn tendency. Users may be unaware of the limited UVR protection STPs afford or may be motivated to use STPs by having a higher photosensitivity skin type. Further exploration of these possibilities is warranted, and both suggest that the addition of UVR protection to STPs may be beneficial.

Use of STPs did not differ significantly between IT subtypes. However, regular tanners demonstrated less knowledge of STP properties and IT effects. An individual's IT subtype is not static; rather, reported IT frequency may be based on recent tanning patterns reflective of one's current psychosocial experiences. We suggest refinement of frequency questions to more accurately depict IT behaviors over the course of a typical year.

Although few participants believed that IT was safe, over 25% reported engaging in IT during the previous month. This incongruity of perceived risk and behavior merits continued investigation of the public's knowledge about IT. Likewise, restricting minors' access to IT is imperative, given that the median age of IT debut was 16 years.

Self-report and limited geographic representation are study limitations. However, since IT prevalence is greatest in the Midwest and among educated women, the college sample is likely representative of typical indoor tanners.4

The desire to appear tan among women is prominent. This study demonstrates that all IT subtypes exhibit high rates of STP use. While continued investigation of the acceptability of alternatives to IT is essential, our findings suggest that encouraging exclusive use of STPs may be a practical prevention strategy. Event tanners, who have the greatest knowledge of IT risks and the most appropriate use of STPs, may be the most amenable to change through education about these appearance-enhancing alternatives. Conversely, since regular tanners' impetus to indoor tan is so salient,2 promoting sole use of STPs may prove ineffective.

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Article Information

Correspondence: Dr Sinha, Department of Dermatology, University at Buffalo and Roswell Park Cancer Institute, Roswell Park Cancer Institute, Elm and Carlton Streets, Buffalo, NY 14263 (aasinha@buffalo.edu).

Accepted for Publication: January 27, 2012.

Author Contributions: All authors had full access to all of 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: Sinha, Russo, and Van Acker. Acquisition of data: Russo, Van Acker, and Vander Wal. Analysis and interpretation of data: Sinha, Russo, Van Acker, and Vander Wal. Drafting of the manuscript: Russo, Van Acker, and Vander Wal. Critical revision of the manuscript for important intellectual content: Sinha, Russo, Van Acker, and Vander Wal. Statistical analysis: Russo and Vander Wal. Administrative, technical, and material support: Russo and Van Acker. Study supervision: Sinha.

Financial Disclosure: None reported.

Previous Presentation: An earlier version of these data was presented as a poster at the 71st Annual Meeting of the Society for Investigative Dermatology; May 5, 2011; Phoenix, Arizona.

Additional Information: Dr Russo and Ms Van Acker are co–first authors and contributed equally to this work.

References
1.
Herzog C, Pappo A, Bondy M, Bleyer A, Kirkwood J. Malignant melanoma: cancer epidemiology in older adolescents and young adults. 2007:53-63. http://seer.cancer.gov/publications/aya/5_melanoma.pdf. Accessed January 2012
2.
Hillhouse J, Turrisi R, Shields AL. Patterns of indoor tanning use: implications for clinical interventions.  Arch Dermatol. 2007;143(12):1530-1535PubMedArticle
3.
Stryker JE, Yaroch AL, Moser RP, Atienza A, Glanz K. Prevalence of sunless tanning product use and related behaviors among adults in the United States: results from a national survey.  J Am Acad Dermatol. 2007;56(3):387-390PubMedArticle
4.
Choi K, Lazovich D, Southwell B, Forster J, Rolnick SJ, Jackson J. Prevalence and characteristics of indoor tanning use among men and women in the United States.  Arch Dermatol. 2010;146(12):1356-1361PubMedArticle
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