When female employees of a mystery shopping firm called posing as 17-year-olds interested in tanning, 81 percent of indoor tanning facilities complied with the Texas ban on indoor tanning for those under the age of 18 in a study conducted by The University of Texas MD Anderson Cancer Center.
Upon discovering the caller's age, employees at those facilities told the caller she could not use indoor tanning, even with the permission of her parents.
"This level of compliance with the under-18 ban enacted by the Texas Legislature in 2013 underscores the importance of this approach as a strategy for skin cancer prevention," said Mary Tripp, Ph.D., instructor in Behavioral Science and lead author of the study, published as a letter to JAMA Dermatology.
Research shows that indoor tanning before the age of 18 increases a person's risk of developing melanoma - the most lethal form of skin cancer - by 85 percent. In 2013, 1.6 million youths under the age of 18 reported indoor tanning, including 20 percent of female high school students.
The incidence of melanoma has been rising in the United States for 30 years, while the frequency of most other solid tumors declined. From 1975 to 2012, cases of melanoma grew by about 3 percent per year. In 2016, an estimated 76,380 people will receive a diagnosis of invasive melanoma and 10,130 will die of the disease.
Researchers identified 829 tanning facilities in Texas to contact in July and August of 2015. Of these, 635 could be reached by the mystery shopping firm callers; 445 were free-standing indoor tanning establishments, 133 were beauty salons or spas and 57 were other retail businesses that housed a tanning device.
Free-standing centers have best compliance
Of the 635 surveyed, 512 provided responses that complied with the ban and 120 did not, with the most common non-compliant responses indicating the shoppers could tan with a note from their parents or accompanied by a parent. Free-standing centers (86 percent) were most likely to comply, with beauty salons/spas (68 percent) least likely.
Tripp noted an alarming proportion of facilities, 83 percent, told callers their clients could tan daily, in contrast to a schedule of three or fewer sessions during the first week recommended by the U.S. Food and Drug Administration.
The vast majority of facilities responded directly (68 percent) or indirectly (25 percent) that a burn is possible with indoor tanning.
Given that 15 states have enacted similar prohibitions and the FDA has proposed limiting indoor tanning to those age 18 and older, evaluating and improving compliance with under-18 bans will be critical to reducing the incidence of skin cancer, Tripp said.
Moon Shots Program™ prevention efforts
Providing educational information in support of indoor tanning bans for minors has been a central part of prevention efforts under MD Anderson's Cancer Moon Shots Program™, launched in 2012 to accelerate the pace of converting scientific discoveries into prevention, detection and treatment advances that significantly reduce cancer deaths.
Faculty and governmental relations leaders in the Melanoma Moon Shot and the Cancer Prevention and Control Platform provided educational information about indoor tanning and cancer risk to Texas legislators and served as the primary clinical and research resources on the Texas prohibition law, which took effect in September 2013. Texas was the fourth state to enact a ban, and since then moon shots educational efforts have shifted to other states.
Co-authors with Tripp are Jeffrey Gershenwald, M.D., of Surgical Oncology; Michael Davies, M.D., Ph.D., of Melanoma Medical Oncology; Joxel Garcia, M.D., executive director of the Cancer Prevention and Control Platform; Ernest Hawk, M.D., vice president and head of the division of Cancer Prevention and Population Sciences; and Ellen Gritz, Ph.D., and Susan Peterson, Ph.D., of Behavioral Science. Gershenwald and Davies are co-leaders of the Melanoma Moon Shot.
The research was funded by contributions by the Lyda Hill Foundation to the Melanoma Moon Shot; MD Anderson's Cancer Center Support Grant from the National Cancer Institute of the National Institutes of Health (CA 16672), the Robert and Lynne Grossman Family Foundation and the Michael and Patricia Booker Melanoma Research Endowment.