Indoor Tanning Among High School Students in the United States, 2009 and 2011 | Adolescent Medicine | JAMA Dermatology | JAMA Network
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Miller  DL, Weinstock  MA.  Nonmelanoma skin cancer in the United States: incidence.  J Am Acad Dermatol. 1994;30(5, pt 1):774-778.PubMedGoogle ScholarCrossref
Rogers  HW, Weinstock  MA, Harris  AR,  et al.  Incidence estimate of nonmelanoma skin cancer in the United States, 2006.  Arch Dermatol. 2010;146(3):283-287.PubMedGoogle ScholarCrossref
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. doi:10.1016/j.jaad.2011.04.032.PubMedGoogle ScholarCrossref
Bleyer  A, Viny  A, Barr  R.  Cancer in 15- to 29-year-olds by primary site.  Oncologist. 2006;11(6):590-601.PubMedGoogle ScholarCrossref
Strouse  JJ, Fears  TR, Tucker  MA, Wayne  AS.  Pediatric melanoma: risk factor and survival analysis of the surveillance, epidemiology and end results database.  J Clin Oncol. 2005;23(21):4735-4741.PubMedGoogle ScholarCrossref
Wu  XC, Eide  MJ, King  J,  et al.  Racial and ethnic variations in incidence and survival of cutaneous melanoma in the United States, 1999-2006.  J Am Acad Dermatol. 2011;65(5)(suppl 1):S26-S37.PubMedGoogle Scholar
Bickers  DR, Lim  HW, Margolis  D,  et al; American Academy of Dermatology Association; Society for Investigative Dermatology.  The burden of skin diseases: 2004: a joint project of the American Academy of Dermatology Association and the Society for Investigative Dermatology.  J Am Acad Dermatol. 2006;55(3):490-500.PubMedGoogle ScholarCrossref
Gilchrest  BA, Eller  MS, Geller  AC, Yaar  M.  The pathogenesis of melanoma induced by ultraviolet radiation.  N Engl J Med. 1999;340(17):1341-1348.PubMedGoogle ScholarCrossref
Boniol  M, Autier  P, Boyle  P, Gandini  S.  Cutaneous melanoma attributable to sunbed use: systematic review and meta-analysis.  BMJ. 2012;345:e4757.PubMedGoogle ScholarCrossref
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. doi:10.1136/bmj.e5909.PubMedGoogle ScholarCrossref
International Agency for Research on Cancer.  Exposure to Artificial UV Radiation and Skin Cancer. Accessed December 10, 2012.
Lazovich  D, Vogel  RI, Berwick  M, Weinstock  MA, Anderson  KE, Warshaw  EM.  Indoor tanning and risk of melanoma: a case-control study in a highly exposed population.  Cancer Epidemiol Biomarkers Prev. 2010;19(6):1557-1568.PubMedGoogle ScholarCrossref
El Ghissassi  F, Baan  R, Straif  K,  et al; WHO International Agency for Research on Cancer Monograph Working Group.  A review of human carcinogens, part D: radiation.  Lancet Oncol. 2009;10(8):751-752.PubMedGoogle ScholarCrossref
International Agency for Research on Cancer Working Group on artificial ultraviolet (UV) light and skin cancer.  The association of use of sunbeds with cutaneous malignant melanoma and other skin cancers: a systematic review.  Int J Cancer. 2007;120(5):1116-1122.PubMedGoogle Scholar
US Department of Health and Human Services.  Healthy People 2020. Accessed January 4, 2013.
Guy  GP  Jr, Tai  E, Richardson  LC.  Use of indoor tanning devices by high school students in the United States, 2009.  Prev Chronic Dis. 2011;8(5):A116. Accessed December 21, 2013.PubMedGoogle Scholar
Holman  DM, Watson  M.  Correlates of intentional tanning among adolescents in the United States: a systematic review of the literature.  J Adolesc Health. 2013;52(5)(suppl):S52-S59.PubMedGoogle ScholarCrossref
Cafri  G, Thompson  JK, Jacobsen  PB, Hillhouse  J.  Investigating the role of appearance-based factors in predicting sunbathing and tanning salon use.  J Behav Med. 2009;32(6):532-544.PubMedGoogle ScholarCrossref
O’Riordan  DL, Field  AE, Geller  AC,  et al.  Frequent tanning bed use, weight concerns, and other health risk behaviors in adolescent females (United States).  Cancer Causes Control. 2006;17(5):679-686.PubMedGoogle ScholarCrossref
Demko  CA, Borawski  EA, Debanne  SM, Cooper  KD, Stange  KC.  Use of indoor tanning facilities by white adolescents in the United States.  Arch Pediatr Adolesc Med. 2003;157(9):854-860.PubMedGoogle ScholarCrossref
Miyamoto  J, Berkowitz  Z, Jones  SE, Saraiya  M.  Indoor tanning device use among male high school students in the United States.  J Adolesc Health. 2012;50(3):308-310.PubMedGoogle ScholarCrossref
Blashill  AJ.  Psychosocial correlates of frequent indoor tanning among adolescent boys.  Body Image. 2013;10(2):259-262.PubMedGoogle ScholarCrossref
Graubard  BI, Korn  EL.  Predictive margins with survey data.  Biometrics. 1999;55(2):652-659.PubMedGoogle ScholarCrossref
Eaton  DK, Kann  L, Kinchen  S,  et al; Centers for Disease Control and Prevention (CDC).  Youth risk behavior surveillance—United States, 2011.  MMWR Surveill Summ. 2012;61(4):1-162.PubMedGoogle Scholar
Eaton  DK, Kann  L, Kinchen  S,  et al; Centers for Disease Control and Prevention (CDC).  Youth risk behavior surveillance—United States, 2009.  MMWR Surveill Summ. 2010;59(5):1-142.PubMedGoogle Scholar
Sales  JM, Irwin  CE  Jr. Theories of adolescent risk taking: the biopsychosocial model. In: DiClimente RJ, Santelli JS, Crosby RA, eds.  Adolescent Health: Understanding and Preventing Risk Behaviors. San Francisco, CA: Jossey-Bass; 2009:31-50.
Calkins  SD.  Psychobiological models of adolescent risk: implications for prevention and intervention.  Dev Psychobiol. 2010;52(3):213-215.PubMedGoogle Scholar
DiClimente  RJ, Santelli  JS, Crosby  RA. Adolescents at risk: a generation in jeopardy. In: DiClimente RJ, Santelli JS, Crosby RA, eds.  Adolescent Health: Understanding and Preventing Risk Behaviors. San Francisco, CA: Jossey-Bass; 2009:3-6.
Casey  BJ, Jones  RM, Hare  TA.  The adolescent brain.  Ann N Y Acad Sci. 2008;1124:111-126.PubMedGoogle ScholarCrossref
Mosher  CE, Danoff-Burg  S.  Indoor tanning, mental health, and substance use among college students: the significance of gender.  J Health Psychol. 2010;15(6):819-827.PubMedGoogle ScholarCrossref
Blashill  AJ, Traeger  L.  Indoor tanning use among adolescent males: the role of perceived weight and bullying.  Ann Behav Med. 2013;46(2):232-236.PubMedGoogle ScholarCrossref
Pawlak  MT, Bui  M, Amir  M, Burkhardt  DL, Chen  AK, Dellavalle  RP.  Legislation restricting access to indoor tanning throughout the world.  Arch Dermatol. 2012;148(9):1006-1012.PubMedGoogle ScholarCrossref
National Conference of State Legislatures.  Indoor tanning restrictions for minors—a state-by-state comparison. Accessed December 30, 2013.
Cokkinides  V, Weinstock  M, Lazovich  D, Ward  E, Thun  M.  Indoor tanning use among adolescents in the US, 1998 to 2004.  Cancer. 2009;115(1):190-198.PubMedGoogle ScholarCrossref
Mayer  JA, Woodruff  SI, Slymen  DJ,  et al.  Adolescents’ use of indoor tanning: a large-scale evaluation of psychosocial, environmental, and policy-level correlates.  Am J Public Health. 2011;101(5):930-938.PubMedGoogle ScholarCrossref
Hester  EJ, Heilig  LF, D’Ambrosia  R, Drake  AL, Schilling  LM, Dellavalle  RP.  Compliance with youth access regulations for indoor UV tanning.  Arch Dermatol. 2005;141(8):959-962.PubMedGoogle Scholar
Hirst  N, Gordon  L, Gies  P, Green  AC.  Estimation of avoidable skin cancers and cost-savings to government associated with regulation of the solarium industry in Australia.  Health Policy. 2009;89(3):303-311.PubMedGoogle ScholarCrossref
Patient Protection and Affordable Care Act, pl 111-148, §10907(b) (2010).
Zaza  S, Briss  PA, Harris  KW.  The Guide to Community Preventive Services: What Works to Promote Health? New York, NY: Oxford University Press; 2005.
Lim  HW, James  WD, Rigel  DS, Maloney  ME, Spencer  JM, Bhushan  R.  Adverse effects of ultraviolet radiation from the use of indoor tanning equipment: time to ban the tan.  J Am Acad Dermatol. 2011;64(5):893-902.PubMedGoogle ScholarCrossref
Sinclair  C, Makin  JK.  Implications of lessons learned from tobacco control for tanning bed reform.  Prev Chronic Dis. 2013;10:E28. doi:10.5888/pcd10.120186.PubMedGoogle ScholarCrossref
Jain  N, Rademaker  A, Robinson  JK.  Implementation of the federal excise tax on indoor tanning services in Illinois.  Arch Dermatol. 2012;148(1):122-124.PubMedGoogle ScholarCrossref
Food and Drug Administration.  Proposed order: reclassification of ultraviolet lamps for tanning, henceforth to be known as sunlamp products. Accessed December 30, 2013.
US House of Representatives Committee on Energy and Commerce–Minority Staff.  False and Misleading Health Information Provided to Teens by the Indoor Tanning Industry: Investigative Report.2012. Accessed December 30, 2013.
Balk  SJ, Fisher  DE, Geller  AC.  Teens and indoor tanning: a cancer prevention opportunity for pediatricians.  Pediatrics. 2013;131(4):772-785.PubMedGoogle ScholarCrossref
Moyer  VA; US Preventive Services Task Force.  Behavioral counseling to prevent skin cancer: US Preventive Services Task Force recommendation statement.  Ann Intern Med. 2012;157(1):59-65.PubMedGoogle ScholarCrossref
Stapleton  J, Turrisi  R, Hillhouse  J, Robinson  JK, Abar  B.  A comparison of the efficacy of an appearance-focused skin cancer intervention within indoor tanner subgroups identified by latent profile analysis.  J Behav Med. 2010;33(3):181-190.PubMedGoogle ScholarCrossref
Hillhouse  J, Turrisi  R, Stapleton  J, Robinson  J.  A randomized controlled trial of an appearance-focused intervention to prevent skin cancer.  Cancer. 2008;113(11):3257-3266.PubMedGoogle ScholarCrossref
Johnson  KR, Heilig  LF, Hester  EJ, Francis  SO, Deakyne  SJ, Dellavalle  RP.  Indoor tanning attitudes and practices of US dermatologists compared with other medical specialists.  Arch Dermatol. 2006;142(4):465-470.PubMedGoogle Scholar
Frieden  TR.  A framework for public health action: the health impact pyramid.  Am J Public Health. 2010;100(4):590-595.PubMedGoogle ScholarCrossref
Brener  ND, Kann  L, McManus  T, Kinchen  SA, Sundberg  EC, Ross  JG.  Reliability of the 1999 Youth Risk Behavior Survey Questionnaire.  J Adolesc Health. 2002;31(4):336-342.PubMedGoogle ScholarCrossref
Yoo  JJ, Kim  HY.  Adolescents’ body‐tanning behaviours: influences of gender, body mass index, sociocultural attitudes towards appearance and body satisfaction.  Int J Consum Stud. 2012;36(3):360-366.Google ScholarCrossref
Original Investigation
May 2014

Indoor Tanning Among High School Students in the United States, 2009 and 2011

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
  • 2Division of Adolescent and School Health, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
JAMA Dermatol. 2014;150(5):501-511. doi:10.1001/jamadermatol.2013.7124

Importance  Indoor tanning is associated with an increased risk of skin cancer, including melanoma, and is particularly dangerous for younger and more frequent indoor tanners.

Objective  To examine the prevalence of indoor tanning and frequent indoor tanning (≥10 times during the 12 months before each survey) and their association with health-related behaviors.

Design, Setting, and Participants  A cross-sectional study examined data from the 2009 and 2011 national Youth Risk Behavior Surveys, which used nationally representative samples of US high school students representing approximately 15.5 million students each survey year. The study included 25 861 students who answered the indoor tanning question.

Main Outcomes and Measures  The prevalence of indoor tanning and frequent indoor tanning were examined as well as their association with demographic characteristics and health-related behaviors using multivariable logistic regression modeling.

Results  The prevalence of indoor tanning was greater among female, older, and non-Hispanic white students. Indoor tanning was highest among female students aged 18 years or older, with 31.5% engaging in indoor tanning in 2011, and among non-Hispanic white female students, with 29.3% engaging in indoor tanning in 2011. Among female students, the adjusted prevalence of indoor tanning decreased from 26.4% in 2009 to 20.7% in 2011. Among female and male students, indoor tanning was associated with other risk-taking behaviors, such as binge drinking (P < .001 and P = .006, respectively), unhealthy weight control practices (P < .001, for both), and having sexual intercourse (P < .001, for both). Additionally, indoor tanning among female students was associated with using illegal drugs (P < .001) and having sexual intercourse with 4 or more persons (P = .03); use among male students was associated with taking steroids without a physician’s prescription (P < .001), smoking cigarettes daily (P = .03), and attempting suicide (P = .006). More than half of respondents engaging in indoor tanning reported frequent use of the devices.

Conclusions and Relevance  Indoor tanning is common among high school students. Public health efforts are needed to change social norms regarding tanned skin and to increase awareness, knowledge, and behaviors related to indoor tanning. The clustering of risky behaviors suggests a need for coordinated, multifaceted approaches, including primary care physician counseling, to address such behaviors among adolescents.