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Table.  Prevalence and Number of Tanning Beds in Gyms by Chain and Region
Prevalence and Number of Tanning Beds in Gyms by Chain and Region
1.
Vogel  RI, Ahmed  RL, Nelson  HH, Berwick  M, Weinstock  MA, Lazovich  D.  Exposure to indoor tanning without burning and melanoma risk by sunburn history.  J Natl Cancer Inst. 2014;106(6):dju112. doi:10.1093/jnci/dju219PubMedGoogle Scholar
2.
Heckman  CJ, Manning  M.  The relationship between indoor tanning and body mass index, physical activity, or dietary practices: a systematic review.  J Behav Med. 2019;42(2):188-203. doi:10.1007/s10865-018-9991-yPubMedGoogle ScholarCrossref
3.
Moore  SC, Lee  IM, Weiderpass  E,  et al.  Association of leisure-time physical activity with risk of 26 types of cancer in 1.44 million adults.  JAMA Intern Med. 2016;176(6):816-825. doi:10.1001/jamainternmed.2016.1548PubMedGoogle ScholarCrossref
4.
Huang  CM, Kirchhof  MG.  A cross-sectional study of indoor tanning in fitness centres.  J Cutan Med Surg. 2017;21(5):401-407. doi:10.1177/1203475417706059PubMedGoogle ScholarCrossref
5.
Internal Revenue Service. Excise tax on indoor tanning services frequently asked questions. https://www.irs.gov/businesses/small-businesses-self-employed/excise-tax-on-indoor-tanning-services-frequently-asked-questions. Accessed July 8, 2019.
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    1 Comment for this article
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    Sources of Endorphins
    Richard Stanwick, MD, MSc. Epi & Health | University of Victoria
    While exercise has been well established as endorphin-generating (1), the association between tanning and B beta-endorphin release is somewhat more recent (2). Have gym chains simply capitalized on providing their customers with the opportunity to experience a second, consecutive 'high' while in their establishments? Compounding the issue is the social marketing of looking good by being both buff and tanned. To differentiate and manage a possible co-dependency for the UV damage from tanning beds and the established benefits of exercise for gym attendees may require not only a change in social norms but also approaches used for other physiological and psychological addiction.

    References

    1. Endorphins and exercise. Harber VJ, Sutton JR. Sports Med. 1984 Mar-Apr;1(2):154-71.
    2. Central role of p53 in the suntan response and pathologic hyperpigmentation. Cui R1, Widlund HR, Feige E, Lin JY, Wilensky DL, Igras VE, D'Orazio J, Fung CY, Schanbacher CF, Granter SR, Fisher DE. Cell. 2007 Mar 9;128(5):853-64.
    CONFLICT OF INTEREST: None Reported
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    Research Letter
    Public Health
    December 20, 2019

    Assessment of Tanning Beds in 3 Popular Gym Chains

    Author Affiliations
    • 1Department of Allied Health, University of Connecticut, Storrs
    • 2Department of Kinesiology, Pennsylvania State University, University Park
    • 3School of Health Sciences, Oakland University, Rochester, Michigan
    JAMA Netw Open. 2019;2(12):e1918058. doi:10.1001/jamanetworkopen.2019.18058
    Introduction

    The proliferation of gym chains across the United States increases US individuals’ access to physical activity. Unfortunately, some gym amenities used to attract consumers are harmful, namely, tanning beds. Tanning bed use is reported to be a risk factor for malignant melanoma.1 A systematic review reported an association between indoor tanning and physical activity.2 Indoor tanning among physically active people is concerning, given the reported association between physical activity and melanoma risk.3

    Little is known about how pervasive the presence of tanning beds is in gyms. The present cross-sectional study examined the proportion of gyms from 3 popular US gym chains that have tanning beds, the number of tanning beds offered, and regional differences in the number of gyms with tanning beds.

    Methods

    All locations from 3 of the 6 largest US national gym chains (Anytime Fitness, Gold’s Gym, and Planet Fitness) in 33 states and Washington, DC, were sampled across all 5 geographic regions of the US (Northeast, Southeast, Midwest, Southwest, and West). We extracted data on locations from websites and searched each gym name with a state abbreviation on Google Maps. Three of us (K.A., J.G., and A.B.W.) and 2 raters (A. Argueta and M. Campbell) independently verified all gyms. Between June 2018 and February 2019, each gym was contacted by telephone up to 3 times to ask whether they offered tanning and, if so, how many tanning beds were available for use. We included 7 of 11 states in the West, 3 of 4 states in the Southwest, 8 of 12 states in the Midwest, 7 of 11 states in the Northeast, and 9 of 12 states in the Southeast (including Washington, DC). We compared availability of tanning beds by chain and region using χ2 tests followed by pairwise comparisons. We used analysis of variance followed by pairwise comparisons comparing total and mean number of tanning beds per gym by chain and region. The institutional review board of the University of Connecticut determined that this study does not constitute human participant research, and therefore approval and informed consent were waived. This study followed the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) reporting guideline for cross-sectional studies. Data were collected between June 2018 and February 2019 and were analyzed in May 2019.

    Results

    Three gym chains had 1927 locations in 33 states and Washington, DC. Anytime Fitness had the most locations (n = 1067), followed by Planet Fitness (n = 732) and Gold’s Gym (n = 128). Contact rates were 98% for Gold’s Gym (126 of 128), 99% for Planet Fitness (727 of 732), and 82% for Anytime Fitness (874 of 1067) for a total of 1727 gyms reached. Calls to Anytime Fitness were often directed to a call service and more frequently went unanswered.

    Overall, 78% of the gyms (1347 of 1727) reached had tanning beds, which exceeded the rate reported in Canada (43% [88 of 203]).4 A greater proportion of Planet Fitness gyms (99% [726 of 727]) had tanning beds than Anytime Fitness (65% [569 of 874]; P < .001) and Gold’s Gym (41% [52 of 126]; P < .001) (Table). A total of 4660 tanning beds were found in 1347 gyms. Planet Fitness provided more tanning beds than the other gyms (Planet Fitness, 3736 tanning beds; mean [SD] tanning beds per gym, 5.14 [1.9]; 95% CI, 5.0-5.20 vs Anytime Fitness, 798 tanning beds; mean [SD] tanning beds per gym, 0.97 [0.86]; 95% CI, 0.91-1.03; P < .001) (Table), accounting for 80% (3736 of 4660) of total tanning beds. The Midwest had the highest proportion of gyms with tanning beds (87% [446 of 514]; 95% CI, 84%-90%; P < .001) (Table).

    Discussion

    A total of 4660 tanning beds were found across 33 states and Washington, DC, with the highest concentration being in the Midwest. Gyms that offer tanning services may be perpetuating the notion that tanning is part of a healthy lifestyle, which undermines public health warnings about the dangers of indoor tanning.

    Limitations of this study include the focus on only 3 gym chains. These gyms are among the 6 largest US gym chains, among which only 1 other has tanning beds (SNAP Fitness). The other 2, LA Fitness and 24 Hour Fitness, do not have tanning beds at any locations according to their corporate offices. Only 33 states and Washington, DC, were studied, which represents 41% of gyms from these chains nationwide. Some gyms could not be reached despite numerous attempts, but our response rate of 90% was high.

    Gyms can circumvent the federal 10% tanning tax by not charging per visit5; thus, future tanning legislation should address tanning beds in diversified business environments. Gym chains make exercise accessible and affordable to the public; however, clinicians should counsel patients who use gyms to avoid tanning beds.

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    Article Information

    Accepted for Publication: November 2, 2019.

    Published: December 20, 2019. doi:10.1001/jamanetworkopen.2019.18058

    Open Access: This is an open access article distributed under the terms of the CC-BY License. © 2019 Pagoto SL et al. JAMA Network Open.

    Corresponding Author: Sherry L. Pagoto, PhD, UConn Center for Health and Social Media, UConn Institute for Collaboration on Health, Interventions, and Policy, Department of Allied Health Sciences, University of Connecticut, 2006 Hillside Rd, Unit 1248, Room 22, Storrs, CT 06269 (sherry.pagoto@uconn.edu).

    Author Contributions: Dr Pagoto 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: Pagoto.

    Acquisition, analysis, or interpretation of data: All authors.

    Drafting of the manuscript: Pagoto, Arroyo, Goetz, West.

    Critical revision of the manuscript for important intellectual content: Pagoto, Conroy, Arroyo, Goetz, Mulcahy, Waring.

    Statistical analysis: Pagoto, Arroyo, West.

    Administrative, technical, or material support: Pagoto, Conroy, Goetz, Mulcahy.

    Supervision: Pagoto, Conroy.

    Conflict of Interest Disclosures: None reported.

    Funding/Support: Dr Pagoto received support from grant K24HL124366 from the National Heart, Lung, and Blood Institute.

    Role of the Funder/Sponsor: The funding source 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.

    Additional Contributions: Alicia Argueta (Smith College) and Mercy Campbell (Columbia University) provided assistance in contacting gyms. No compensation was received.

    References
    1.
    Vogel  RI, Ahmed  RL, Nelson  HH, Berwick  M, Weinstock  MA, Lazovich  D.  Exposure to indoor tanning without burning and melanoma risk by sunburn history.  J Natl Cancer Inst. 2014;106(6):dju112. doi:10.1093/jnci/dju219PubMedGoogle Scholar
    2.
    Heckman  CJ, Manning  M.  The relationship between indoor tanning and body mass index, physical activity, or dietary practices: a systematic review.  J Behav Med. 2019;42(2):188-203. doi:10.1007/s10865-018-9991-yPubMedGoogle ScholarCrossref
    3.
    Moore  SC, Lee  IM, Weiderpass  E,  et al.  Association of leisure-time physical activity with risk of 26 types of cancer in 1.44 million adults.  JAMA Intern Med. 2016;176(6):816-825. doi:10.1001/jamainternmed.2016.1548PubMedGoogle ScholarCrossref
    4.
    Huang  CM, Kirchhof  MG.  A cross-sectional study of indoor tanning in fitness centres.  J Cutan Med Surg. 2017;21(5):401-407. doi:10.1177/1203475417706059PubMedGoogle ScholarCrossref
    5.
    Internal Revenue Service. Excise tax on indoor tanning services frequently asked questions. https://www.irs.gov/businesses/small-businesses-self-employed/excise-tax-on-indoor-tanning-services-frequently-asked-questions. Accessed July 8, 2019.
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