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Table 1.  
Prevalence of Indoor Tanning (IT) Among Non-Hispanic White Female High School Students, Youth Risk Behavior Survey, 2011
Prevalence of Indoor Tanning (IT) Among Non-Hispanic White Female High School Students, Youth Risk Behavior Survey, 2011
Table 2.  
Prevalence of Indoor Tanning (IT) Among Non-Hispanic White Women Ages 18 to 34 Years, National Health Interview Survey, 2010a
Prevalence of Indoor Tanning (IT) Among Non-Hispanic White Women Ages 18 to 34 Years, National Health Interview Survey, 2010a
1.
Boniol  M, Autier  P, Boyle  P, Gandini  S.  Cutaneous melanoma attributable to sunbed use: systematic review and meta-analysis. BMJ. 2012;345:e4757.
PubMedArticle
2.
Wehner  MR, Shive  ML, Chren  MM, Han  J, Qureshi  AA, Linos  E.  Indoor tanning and non-melanoma skin cancer: systematic review and meta-analysis. BMJ. 2012;345:e5909.
PubMedArticle
3.
Jemal  A, Saraiya  M, Patel  P,  et al.  Recent trends in cutaneous melanoma incidence and death rates in the United States, 1992-2006. J Am Acad Dermatol. 2011;65(5)(suppl 1):S17-S25, e1-e3.
PubMedArticle
4.
Centers for Disease Control and Prevention. Use of indoor tanning devices by adults—United States, 2010. MMWR Morb Mortal Wkly Rep. 2012; 61(18);323-326. http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6118a2.htm. Accessed July 13, 2013.
5.
Moyer  VA.  Behavioral counseling to prevent skin cancer: US Preventive Services Task Force recommendation statement. Ann Intern Med. 2012;157(1):59-65.
PubMedArticle
6.
US Food and Drug Administration. Proposed order: reclassification of ultraviolet lamps for tanning, henceforth to be known as sunlamp products. https://www.federalregister.gov/articles/2013/05/09/2013-10982/general-and-plastic-surgery-devices-reclassification-of-ultraviolet-lamps-for-tanning-henceforth-to. Accessed July 22, 2013.
7.
Patient Protection and Affordable Care Act, pl 111-148, sec. 10907(b).
Research Letter
November 11, 2013

Indoor Tanning Among Young Non-Hispanic White Females

Author Affiliations
  • 1Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
  • 2now with Division of Blood Disorders, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia
JAMA Intern Med. 2013;173(20):1920-1922. doi:10.1001/jamainternmed.2013.10013

Indoor tanning is associated with an increased risk of skin cancer, especially among frequent users and those initiating use at a young age.1,2 Indoor tanning before age 35 years increases melanoma risk by 59% to 75%,1 while use before age 25 years increases nonmelanoma skin cancer risk by 40% to 102%.2 Moreover, melanoma risk increases by 1.8% with each additional tanning session per year.1 Melanoma incidence rates are steadily increasing, especially among young non-Hispanic white females, which may be due, in part, to indoor tanning.1,3 Currently, prevalence estimates of indoor tanning among this population are limited. Therefore, we examined the prevalence of indoor tanning and frequent indoor tanning (≥10 times) using nationally representative data among non-Hispanic white female high school students and adults ages 18 to 34 years.

Methods

We used data from the 2011 national Youth Risk Behavior Survey (YRBS) of high school students and the 2010 National Health Interview Survey (NHIS) for adults aged 18 to 34 years. We estimated the prevalence of indoor tanning and frequent indoor tanning, overall and by age and US census region. Indoor tanning was defined as using an indoor tanning device (eg, a sunlamp, sunbed, or tanning booth, not including a spray-on tan) at least 1 time during the 12 months before each survey. Frequent indoor tanning was defined as using an indoor tanning device at least 10 times during the same period. Differences in prevalence between subgroups were assessed with χ2 tests. Data were analyzed with SUDAAN software (version 10.1; RTI International) to account for sampling design and nonresponse.

Results

Among non-Hispanic white female high school students, 29.3% engaged in indoor tanning and 16.7% engaged in frequent indoor tanning during the previous 12 months. The prevalence of indoor tanning and frequent indoor tanning increased with age (Table 1).

Among non-Hispanic white women ages 18 to 34 years, 24.9% engaged in indoor tanning and 15.1% engaged in frequent indoor tanning during the previous 12 months. The prevalence of indoor tanning and frequent indoor tanning decreased with age (Table 2).

Discussion

Indoor tanning is widespread among non-Hispanic white female high school students and adults ages 18 to 34 years, and the frequent use of indoor tanning is common. This widespread use is of great concern given the elevated risk of skin cancer among younger users and frequent users.1,2

Reducing exposure to UV radiation from indoor tanning is an important strategy for reducing the burden of skin cancer. The US Preventive Services Task Force recommends counseling fair-skinned individuals ages 10 to 24 years to minimize exposure to UV radiation to reduce skin cancer risk.5 Appearance-focused interventions, such as self-guided booklets, videos on photoaging, and peer counseling sessions, have been shown to reduce indoor tanning among young adults by up to 35%.5 Changing the social norms related to tanned skin and attractiveness may also be an effective strategy in reducing indoor tanning.

Other approaches to reducing UV exposure from indoor tanning include the US Food and Drug Administration’s proposed reclassification of indoor tanning devices from low- to moderate-risk devices requiring premarket notification and labels designed to warn young people not to use them,6 the 10% excise tax on indoor tanning services established through the Patient Protection and Affordable Care Act,7 limiting deceptive advertising claims about indoor tanning, and limiting indoor tanning among minors.

Limitations of this study include its reliance on self-reported data, which are subject to various biases. In addition, the NHIS is generalizable only to the noninstitutionalized civilian adult population, and the YRBS is generalizable only to high school students. Despite these limitations, this study provides nationally representative estimates, allowing for the continued monitoring of indoor tanning and evaluation of efforts aimed at curbing the widespread use of indoor tanning among young women and reducing the burden of skin cancer.

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Article Information

Corresponding Author: Gery P. Guy Jr, PhD, MPH, Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, 4770 Buford Hwy NE, Mail Stop K-55, Atlanta, GA 30341 (irm2@cdc.gov).

Published Online: August 19, 2013. doi:10.1001/jamainternmed.2013.10013.

Author Contributions: Dr Guy and Ms Berkowitz 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: All authors.

Acquisition of data: Guy, Berkowitz.

Analysis and interpretation of data: Guy, Berkowitz, Holman.

Drafting of the manuscript: Guy.

Critical revision of the manuscript for important intellectual content: All authors.

Statistical analysis: Guy, Berkowitz.

Administrative, technical, or material support: Guy, Watson, Holman, Richardson.

Study supervision: Guy, Richardson.

Conflict of Interest Disclosures: None reported.

Disclaimer: The findings and conclusions in this article are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.

References
1.
Boniol  M, Autier  P, Boyle  P, Gandini  S.  Cutaneous melanoma attributable to sunbed use: systematic review and meta-analysis. BMJ. 2012;345:e4757.
PubMedArticle
2.
Wehner  MR, Shive  ML, Chren  MM, Han  J, Qureshi  AA, Linos  E.  Indoor tanning and non-melanoma skin cancer: systematic review and meta-analysis. BMJ. 2012;345:e5909.
PubMedArticle
3.
Jemal  A, Saraiya  M, Patel  P,  et al.  Recent trends in cutaneous melanoma incidence and death rates in the United States, 1992-2006. J Am Acad Dermatol. 2011;65(5)(suppl 1):S17-S25, e1-e3.
PubMedArticle
4.
Centers for Disease Control and Prevention. Use of indoor tanning devices by adults—United States, 2010. MMWR Morb Mortal Wkly Rep. 2012; 61(18);323-326. http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6118a2.htm. Accessed July 13, 2013.
5.
Moyer  VA.  Behavioral counseling to prevent skin cancer: US Preventive Services Task Force recommendation statement. Ann Intern Med. 2012;157(1):59-65.
PubMedArticle
6.
US Food and Drug Administration. Proposed order: reclassification of ultraviolet lamps for tanning, henceforth to be known as sunlamp products. https://www.federalregister.gov/articles/2013/05/09/2013-10982/general-and-plastic-surgery-devices-reclassification-of-ultraviolet-lamps-for-tanning-henceforth-to. Accessed July 22, 2013.
7.
Patient Protection and Affordable Care Act, pl 111-148, sec. 10907(b).
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