Katie Baker

Strategies to Reduce Indoor Tanning: Current Research Gaps and Future Opportunities for Prevention

Exposure to ultraviolet radiation from indoor tanning device use is associated with an increased risk of skin cancer, including risk of malignant melanoma, and is an urgent public health problem. By reducing indoor tanning, future cases of skin cancer could be prevented, along with the associated morbidity, mortality, and healthcare costs. On August 20, 2012, the CDC hosted a meeting to discuss the current body of evidence on strategies to reduce indoor tanning as well as research gaps. Using the Action Model to Achieve Healthy People 2020 Overarching Goals as a framework, the current paper provides highlights on the topics that were discussed, including (1) the state of the evidence on strategies to reduce indoor tanning; (2) the tools necessary to effectively assess, monitor, and evaluate the short- and long-term impact of interventions designed to reduce indoor tanning; and (3) strategies to align efforts at the national, state, and local levels through transdisciplinary collaboration and coordination across multiple sectors. Although many challenges and barriers exist, a coordinated, multilevel, transdisciplinary approach has the potential to reduce indoor tanning and prevent future cases of skin cancer.

Prevalence and Correlates of Indoor Tanning and Sunless Tanning Product Use among Female Teens in the United States.

Background Indoor tanning (IT) before the age of 35 increases melanoma risk by 75%. Nevertheless, IT and sunless tanning product (STP) use have gained popularity among youth. However, there are limited data on the prevalence and sociodemographic correlates of both IT and STP use in a representative sample of American teens. Methods Teenage females (N = 778) aged 12–18 years were recruited as part of an on-going longitudinal study conducted between May 2011 and May 2013. Descriptive statistics explored IT and STP usage in teen females at baseline. Logistic regression was used to determine sociodemographic correlates of IT and STP use. Results Approximately 16% of female teens engaged in IT behavior and 25% engaged in using STPs. Female teens living in non-metropolitan areas were 82% more likely to indoor tan compared to those in metropolitan areas (OR = 1.82, 95% CI: 1.07–3.10). Age, geographic regions, and race increased the likelihood of IT and STP use. Conclusions Results indicate a significant proportion of teen females engage in IT and STP use. There was evidence that in teens that have never used IT before, STP use precedes IT initiation. Given the evidence for increased IT in rural populations, research focused on rural tanning bed use is needed.

The Behavioral Addiction Indoor Tanning Screener (BAITS): An Evaluation of a Brief Measure of Behavioral Addictive Symptoms

The use of indoor tanning beds (IT) that emit artificial ultraviolet radiation (UVR) is associated with an increased risk of skin cancer, particularly among frequent users (1–3). The physiologically reinforcing nature of UVR (4) may lead to symptoms of addiction to tanning among a subset of frequent IT users (5, 6). There is a need for evidence-based brief screening assessments to identify such users in order to further our understanding of the experience of tanning addiction. Although tanning addiction assessments have been developed by adapting existing substance addiction assessments (7), researchers have raised concerns about their validity (5, 8, 9) and assessment results do not appear to correspond to actual tanning behavior (9). The aim of this study is to evaluate the Behavioral Addiction Indoor Tanning Screener (BAITS), a novel screening assessment for symptoms of IT addiction. The BAITS was developed based on the behavioral addiction disorder model described for the first time in the recently published Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (10). The fundamental feature of a behavioral addiction is diminished control over a behavior that subsequently becomes disruptive, problematic, or harmful to an individual (10, 11). Diminished control over addictive behavior is characterized by impulses and temptations that lead to urges or cravings for the behavior that are difficult to resist. The BAITS is designed to capture the experience of diminished control and urges to use IT that would be expected in a behavioral addiction model of IT. Following our preliminary analyses of the BAITS assessment survey items (see Appendix S11), we created scoring criteria to classify participants as symptomatic of IT addiction based on their responses to the BAITS. In this study, we examined the validity of these classifications by comparing IT users who screened positive on the BAITS to those who did not on The Structured Interview for Tanning Abuse and Dependence (SITAD) clinical assessment (8) as well as IT behavior assessed 6 months later.

Indoor Tanning Initiation Among Tanners in the United States.

Author Contributions: Drs Asgari 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: Asgari. Acquisition, analysis, or interpretation of data: All authors. Drafting of the manuscript: Storer, Zhu, Ford, Neugebauer, Asgari. Critical revision of the manuscript for important intellectual content: Storer, Sokil, Neugebauer, Asgari. Statistical analysis: Zhu, Neugebauer. Obtained funding: Neugebauer, Asgari. Administrative, technical, or material support: Sokil, Neugebauer. Supervision: Neugebauer, Asgari.

Creating the first indoor tan-free skin smart college campus

Given the prevalence and risk associated with indoor tanning among college students, university campuses constitute a prime target for skin cancer prevention. This report identifies the successes and challenges faced in promoting a campus-wide tan-free policy through the National Council on Skin Cancer Prevention (NCSCP) Indoor Tan-Free Skin Smart Campus Initiative. Beginning in February 2016, we communicated with university faculty or staff members who have participated in skin cancer prevention via education, clinical care, or research at 20 universities regarding the steps to adopt the tan-free policy. One campus, East Tennessee State University (ETSU), successfully fulfilled all criteria and implemented the policy change to become the first US Indoor Tan-Free Skin Smart Campus. The greatest challenge faced in recruiting campuses was gaining administrative support. Reported reasons for not adopting the policy change included wanting to wait for other schools to join first and not seeing it as a top priority. Despite the importance of improving skin cancer awareness and decreasing tanning among university students, we faced several challenges in promoting campus-wide policy change. We identify a need for research on effective ways to disseminate university health policies and increased involvement of healthcare providers in policy-related work.