Characteristics and Skin Cancer Risk Behaviors of Adult Sunless Tanners in the United States

Question  What are the demographic characteristics and skin cancer risk behaviors of sunless tanners?

Findings  This secondary analysis of a cross-sectional study of 27 353 men and women 18 years or older in the United States found that sunless tanning was most common among young, white, college-educated women and that sunless tanners were more likely to indoor tan and report recent sunburn and less likely to use sun protection methods. Among indoor tanners, sunless tanning was not associated with improved behaviors.

Meaning  Sunless tanning was associated with risky skin cancer–related behaviors and, among indoor tanners, may not be associated with improved behaviors; longitudinal studies are needed to better determine whether sunless tanning represents an effective public health strategy to reduce skin cancer rates.

Importance  Incidence rates of nonmelanoma and melanoma skin cancers are increasing rapidly in the United States likely because of increased UV light exposure. Sunless tanning is a safe alternative to achieve tanned skin that might help reduce skin cancer incidence by deterring risky behaviors. However, limited data exist on the characteristics and associated skin cancer risk behaviors of sunless tanners in the United States.

Objective  To assess the demographic characteristics and skin cancer risk behaviors of sunless tanners among adults in the United States.

Design, Setting, and Participants  This secondary analysis of a cross-sectional study used data from the 2015 National Health Interview Survey, a population-based survey of the US noninstitutionalized civilian population.Participants included 27 353 men and women 18 years or older.

Main Outcome and Measures  Participant demographics and skin cancer risk behaviors, including indoor tanning, skin cancer screening, sunburn, and sun protection behaviors.

Results  Of the 27 353 adults (representative of more than 198 million US adults; mean [SE] age, 46.0 [0.2] years) studied, 6.4% (SE, 0.2%) reported sunless tanning. Factors associated with sunless tanning included being young, female, non-Hispanic white, college educated, nonobese, and sun sensitive, living in the western United States, and having a family history of skin cancer. Sunless tanners were more likely to report indoor tanning (adjusted prevalence odds ratio [aPOR], 3.77; 95% CI, 3.19-4.43; P < .001), recent sunburn (aPOR, 1.55; 95% CI, 1.31-1.83; P < .001), use of sunscreen (β = 0.19; 95% CI, 0.09-0.28; P < .001), and having had a full-body skin examination (aPOR, 1.77; 95% CI, 1.51-2.08; P < .001) but less likely to seek shade (β = −0.12; 95% CI, −0.19 to −0.04; P = .001) or use protective clothing when outdoors (long pants: β = −0.18; 95% CI, −0.26 to −0.11; P < .001; long sleeves: β = −0.10; 95% CI, −0.18 to −0.03; P = .01). Among indoor tanners, sunless tanners compared with those who did not sunless tan reported increased frequency of indoor tanning (mean [SE], 19.2 [1.9] vs 14.9 [1.2] sessions in the past 12 months; P = .04) but no differences in other skin cancer risk behaviors.

Conclusions and Relevance  This study suggests that sunless tanning is associated with risky skin cancer–related behaviors. Longitudinal studies are needed to assess whether sunless tanning changes UV exposure behaviors to better determine whether sunless tanning represents an effective public health strategy to reduce rates of skin cancer in the United States.