Use of ultraviolet (UV) tanning beds by U.S. adolescents is widespread, despite UV's classification as a carcinogen (cancer-causing agent) and its association with numerous effects such as squamous and basal cell carcinoma and melanoma, background information in the article states. Changing the tanning behavior of minors is a goal for skin cancer prevention given that adolescence is a critical period during which UV radiation increases skin cancer risk. However, in 2003, only three states had set limits for indoor tanning customers: Texas at age 13 years, Illinois at age 14 years and Wisconsin at age 16 years. Most states do not set age limits on indoor tanning.
Eric J. Hester, M.D., from the University of Colorado at Denver and Health Sciences Center, and colleagues conducted phone surveys to assess youth access to indoor tanning facilities. In October 2003, 400 tanning facilities in Colorado, Illinois, Texas and Wisconsin were asked whether potential patrons aged 12 and 15 years would be allowed to tan in their facilities, and if so, whether a guardian or adult accompaniment or consent was required. The tanning facility personnel were also asked whether any price discounts were available for younger customers.
The researchers found that 62 percent of facilities in states with age restrictions had operators report that they would not allow a 12-year-old potential customer to tan in their facility (Texas, 23 percent; Illinois, 74 percent; Wisconsin 89 percent) compared with 18 percent in Colorado. For a 15-year-old potential customer, rates of access to tanning without parental accompaniment (not complying to respective state statutes) were 83 percent in Texas, 20 percent in Illinois, and 17 percent in Wisconsin. Noncompliance for 15-year-olds was higher for tanning facilities offering youth discounts (60 percent vs. 46 percent). Overall, 15 percent of the tanning facilities reported that youth discounts were available--23 percent in Texas, 14 percent in Illinois, 11 percent in Wisconsin, and 11 percent in Colorado.
"Given the prevalence of indoor UV tanning, especially by adolescent girls, and the known risks of indoor tanning, public health efforts need to be directed at this underrecognized carcinogen exposure," the authors write. "Despite high noncompliance with youth access laws in Texas, higher compliance levels in states with long-standing youth access regulations (Illinois and Wisconsin) suggest the potential for successful tanning industry youth access regulation."
(Arch Dermatol. 2005; 141: 959 – 962. Available pre-embargo to the media at www.jamamedia.org.)
Editor's Note: This study was supported by a grants from the National Institutes of Health, Bethesda, Md.; the Health Services Research Award Faculty Development in Primary Care (co-author, Dr. Schilling); the National Cancer Institute, Bethesda, Md.; and a seed grant from the University of Colorado Cancer Center.
Editorial: Skin Cancer Risk Behaviors
A Conceptual Framework for Complex Behavioral Change
In a related editorial, Joel Hillhouse, Ph.D., from East Tennessee State University, Johnson City, and Rob Turrisi, Ph.D., from Pennsylvania State University, University Park, discuss the complexities involved in and strategies for eliciting change in patients' sun-tanning behaviors.
"To effectively reduce tanning behaviors, it is critical to make the attitudes toward healthy alternatives more positive than the behaviors we wish to reduce…. This empirical approach provides a theoretical framework that explains why, in most cases, simply telling young people that their current behaviors will lead them to suffer future grave consequences will not alter their behaviors."
Examining current information from web sites devoted to skin cancer prevention, Drs. Hillhouse and Turrisi found little agreement on many recommendations for protecting oneself from the sun, including how much is safe and the times of day to avoid the sun. Additionally, indoor tanning was only sporadically mentioned as a risk factor.
The editorialists stated the need for a clear, consistent message about UV exposure and how that message should be delivered: "We have evidence that in many situations and with a number of individuals, other message deliverers [aside from one's physicians], such as parents and peers, can be more effective at leading young people to reduce skin-harming behaviors."
They conclude by saying: "We believe that the time is right for a paradigm shift in this field toward a more theoretical and empirical approach that attempts to maximize "skin-risky" behavior change in our patients and the general population."
(Arch Dermatol. 2005; 141: 959 – 962. Available pre-embargo to the media at www.jamamedia.org.)
Editor's Note: This research was supported in part by a grant from the American Cancer Society, East Tennessee State University.
Media Advisory: To contact corresponding author Robert P. Dellavalle, M.D., Ph.D., M.S.P.H., call Deborah Mendez-Wilson at 303-724-1520. To contact editorialist Joel Hillhouse, Ph.D., call Joe Smith at 423-439-5707.
Journal
Archives of Dermatology