Indoor Tanning and Skin Cancer Risk Among Diverse US Youth: Results From a National Sample

Sexual minority males have one of the highest known prevalence rates of skin cancer, at 4.3% to 6.6% (an increased odds of 1.5 to 2.0) compared with heterosexual males.¹ One likely explanation for this health disparity is sexual minority males’ use of indoor tanning, a Group 1 carcinogen.² Indeed, recent research has found elevated indoor tanning among sexual minority men.³ However, no known studies have examined indoor tanning by sex, sexual orientation, and race/ethnicity, casting uncertainty regarding which groups are most vulnerable for developing skin cancer. Furthermore, no known studies have explored these relationships among youth, a salient limitation, given that indoor tanning before the age of 35 years is associated with disproportionate risk of developing skin cancer.

Data were used from the 2015 Youth Risk Behavior Survey,⁴ a nationally representative survey that examines the prevalence of health risk behaviors among 9th to 12th grade public and private school students. Sexual minority status was defined from responses to 2 items: sexual identity and sex of sexual partners, with sexual minorities denoted as participants who reported a nonheterosexual identity or reported sex with a member of their own sex (a common approach in the field).⁵ Past 12-month indoor tanning was dichotomized as 1 or more times vs none. The total sample was 10 644, with 1240 sexual minority participants (886 females; 354 males). Logistic regressions were used, with independent variables of sex (referent: male), sexual orientation (referent: heterosexual) and race/ethnicity (ie, dummy coded black, Hispanic, with white as the referent). Complex Samples in SPSS 24 (IBM Analytics) was used to account for weighting, cluster, and stratification. Institutional review board approval was not required, given that analyses were conducted on deidentified, secondary data.

Significant 3-way interactions were revealed, thus, analyses were stratified by race/ethnicity. Among black participants, there was a main effect of sexual orientation (odds ratio [OR], 4.48; 95% CI, 2.50-8.00; P < .001) and sex (OR, 2.63; 95% CI, 1.03-6.61; P = .04), with sexual minorities and males reporting elevated indoor tanning (Figure). Among Hispanic participants, there was a main effect of sexual orientation (OR, 3.92; 95% CI, 1.78-8.63; P < .001), with sexual minorities reporting elevated indoor tanning. Among white participants, there was a sexual orientation by sex interaction (F_1,35 = 17.97; P < .001). Follow-ups revealed that sexual minority status was a risk factor within males (OR, 3.17; 95% CI, 1.31-7.66; P = .001), and a buffer variable within females (OR, 0.41; 95% CI, 0.24-0.73; P < .001).

Results highlight the need to incorporate sex, sexual orientation, and race/ethnicity when developing skin cancer prevention programs for youth. For example, black sexual minority males reported the highest prevalence of indoor tanning, a rate equivalent if not higher than white females. Clinicians working with sexual minority males, particularly males of color, should consider assessing use of indoor tanning during routine evaluations. Future research would benefit from exploring motivations to tan among diverse groups of adolescents, as varied motives may drive sexual minorities’ use indoor tanning. For instance, appearance-based motives and the regulation of negative affect may be 2 prominent factors that predispose sexual minority youth to indoor tan.⁶

Corresponding Author: Aaron Blashill, PhD, Department of Psychology; San Diego State University, 6363 Alvarado Court, Ste 103, San Diego, CA 92120 (ablashill@mail.sdsu.edu).

Accepted for Publication: October 13, 2016.

Published Online: December 28, 2016. doi:10.1001/jamadermatol.2016.4787

Author Contributions: Dr Blashill had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Concept and design: Blashill.

Acquisition, analysis, or interpretation of data: Blashill.

Drafting of the manuscript: Blashill.

Critical revision of the manuscript for important intellectual content: Blashill.

Statistical analysis: Blashill.

Obtained funding: Blashill.

Administrative, technical, or material support: Blashill.

Conflict of Interest Disclosures: None reported.

Funding/Support: This research was supported in part by the National Institutes of Health National Institute of Mental Health (award K23MH096647).

Role of the Funder/Sponsor: The National Institutes of Health National Institute of Mental Health had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.