Reducing indoor tanning is a Healthy People 2020 objective and an important strategy for preventing skin cancer.1 We examined changes in the prevalence and frequency of indoor tanning factors associated with frequency of indoor tanning among US adults.
We analyzed data collected from the 2010 and 2013 National Health Interview Survey, a nationally representative sample of the US civilian, noninstitutionalized population 18 years or older (N = 59 145). The data were collected from January 1st to December 31st for each survey year. The final response rates were 60.8% in 2010 and 61.2% in 2013.2 Our analysis was exempted from Centers for Disease Control and Prevention Institutional Review Board approval. Indoor tanning was defined as using an indoor tanning device 1 or more times during the 12 months before each survey. We calculated the prevalence of indoor tanning in 2010 and 2013 and used log-linear regression to examine the factors associated with indoor tanning frequency among indoor tanners using pooled data from both years. Differences between categories within a variable were assessed with linear contrasts. Sample weights were applied to account for the complex study design and provide nationally representative estimates. P < .05 was considered statistically significant; all P values were 2-sided. Data were analyzed using SUDAAN, version 10.1 (RTI International).
We observed significant reductions in indoor tanning from 2010 to 2013: from 5.5% to 4.2% (P < .001) among all adults, from 8.6% to 6.5% (P < .001) among women, and from 2.2% to 1.7% (P = .03) among men (Table 1). A reduction was also observed among male and female infrequent (1-9 times per year) tanners (male, from 1.4% to 1.0%, P < .05; female, from 3.7% to 2.8%, P < .01) and female frequent (≥10 times per year) tanners (from 4.8% to 3.6%, P < .001).
In the adjusted analysis (Table 2), compared with their respective reference groups, indoor tanning frequency among female tanners was 28% lower among the oldest group (P = .006), 45% lower among college graduates (P < .001), 33% lower among women in fair or poor health (P = .02), and 23% lower among women meeting aerobic or strength physical activity criteria (P = .01). Compared with their respective reference groups, indoor tanning frequency among male tanners was 177% higher among men aged 40 to 49 years and 71% higher in men aged 50 years or older (P < .001) but 45% lower among cancer survivors (P = .046).
Our findings indicate a temporal decrease in the prevalence of indoor tanning across several demographic groups. In our study in 2013, a total of 1.6 million fewer women and 0.4 million fewer men engaged in indoor tanning compared with 2010. Despite these reductions, our study found that an estimated 7.8 million women and 1.9 million men continue to engage in indoor tanning. Further research examining indoor tanning behavior among the estimated 0.8 million male indoor tanners 40 years or older is warranted given their increased frequency of indoor tanning and the lack of research or interventions focused on this demographic group.
The decrease in indoor tanning may be partly attributable to the increased awareness of its harms. Indoor tanning devices have been classified as carcinogenic to humans,3 their use has consistently been shown to increase skin cancer risk,4 and laws restricting access among minors may have changed public perceptions of their safety. In addition, a 10% excise tax on indoor tanning was implemented in 2010, which may have contributed to the decrease in indoor tanning.5
This study is subject to certain limitations. Results from the National Health Interview Survey are generalizable only to the noninstitutionalized civilian adult population. In addition, the use of cross-sectional data does not permit a causal inference between behaviors and the frequency of indoor tanning.
The Surgeon General has highlighted the importance of reducing the harms from indoor tanning and of continued public health efforts to identify and implement effective strategies to reduce indoor tanning.5 Research regarding the motivations of indoor tanners could inform the development of new interventions. Physicians can also play a role through behavioral counseling, which is recommended for fair-skinned persons aged 10 to 24 years.6 Continued surveillance of indoor tanning will aid program planning and evaluation by measuring the effect of skin cancer prevention policies and monitoring progress.
Accepted for Publication: April 22, 2015.
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 F76, Atlanta, GA 30341 (email@example.com).
Published Online: July 1, 2015. doi:10.1001/jamadermatol.2015.1568.
Author Contributions: Dr Guy and Ms Berkowitz had full access to all 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, analysis, or interpretation of data: All authors.
Drafting of the manuscript: Guy.
Critical revision of the manuscript for important intellectual content: All authors.
Statistical analysis: Guy, Berkowitz, Hartman.
Administrative, technical, or material support: Guy.
Study supervision: Guy, Berkowitz.
Conflict of Interest Disclosures: None reported.
Disclaimer: The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention or the National Institutes of Health.
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
J. The association of indoor tanning and melanoma in adults: systematic review and meta-analysis. J Am Acad Dermatol
. 2014;70(5):847-857, e1-e18.PubMedGoogle ScholarCrossref
US Department of Health and Human Services. The Surgeon General’s Call to Action to Prevent Skin Cancer. Washington, DC: US Dept of Health and Human Services, Office of the Surgeon General; 2014.
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