The Society of Behavioral Medicine (SBM), an interdisciplinary professional organization focused on the science of health behavior joins the American Academy of Dermatology, the American Academy of Pediatrics, and a host of other national and international organizations in support of a total ban on indoor tanning for minors under the age of 18. According to the International Agency for Research on Cancer, artificial sources of ultraviolet radiation are in the highest category of carcinogens, joining tobacco and asbestos. Strong evidence links indoor tanning to increased risk for melanoma with repeated exposure during childhood being associated with the greatest increase in risk. Several countries and five US states have passed legislation banning indoor tanning in minors. We strongly encourage the remaining US states to do the same in an effort to protect children and prevent new cases of melanoma. SBM also strongly encourages research that explores the use of tanning beds in the home. Home-based indoor tanning has the potential to be especially dangerous given the complete absence of safety regulations. Children are currently protected from exposure to health-harming substances like tobacco and lead; thus, legislation protecting them from artificial sources of ultraviolet radiation is yet another important step forward in improving public health.

Importance: Indoor tanning is widespread among young adults in the United States despite evidence establishing it as a risk factor for skin cancer. The availability of tanning salons on or near college campuses has not been formally evaluated. Objective: To evaluate the availability of indoor tanning facilities on US college and university campuses (colleges) and in off-campus housing surrounding but not owned by the college. Design, Setting, and Participants: This observational study sampled the top 125 US colleges and universities listed in US News and World Report. Investigators searched websites of the colleges and nearby housing and contacted them by telephone inquiring about tanning services. Main Outcomes and Measures: Frequency of indoor tanning facilities on college campus and in off-campus housing facilities, as well as payment options for tanning. Results: Of the 125 colleges, 48.0% had indoor tanning facilities either on campus or in off-campus housing, and 14.4% of colleges allow campus cash cards to be used to pay for tanning. Indoor tanning was available on campus in 12.0% of colleges and in off-campus housing in 42.4% of colleges. Most off-campus housing facilities with indoor tanning (96%) provide it free to tenants. Midwestern colleges had the highest prevalence of indoor tanning on campus (26.9%), whereas Southern colleges had the highest prevalence of indoor tanning in off-campus housing facilities (67.7%). Presence of on-campus tanning facilities was significantly associated with enrollment (P=.01), region (P=.02), and presence of a school of public health (P=.01) but not private vs public status (P=.18) or presence of a tobacco policy (P=.16). Presence of tanning facilities in off-campus housing was significantly associated with region (P=.002) and private vs public status (P=.01) but not enrollment (P=.38), tobacco policy (P=.80), or presence of a school of public health (P=.69). Conclusions and Relevance: Reducing the availability of indoor tanning on and around college campuses is an important public health target.

Indoor tanning is a public health threat,1 and the Surgeon General has called for its reduction in adolescents and young adults.2 Research on indoor tanning has not distinguished between tanning-only salons vs other businesses and private residences that provide tanning (ie, nonsalon tanning). For example, gyms often offer free tanning, which may lead to riskier tanning habits.3 Better understanding of nonsalon tanning could have policy, prevention, and clinical implications. Our study addresses this literature gap by examining the prevalence and correlates of nonsalon tanning in a nationally representative sample of young women, who have the highest rates of indoor tanning use.

The use of artificial ultraviolet (UV) indoor tanning (IT) beds increases the risk of skin cancer. The IT industry claims IT devices provide users with control over the amount of UV radiation exposure and thus reduces risks of sunburn (i.e., skin erythema) when tanning. This study aims to establish the prevalence and predictors of IT-related erythema using diary data. Six bimonthly diary surveys were administered to 198 female college IT users. Diaries assessed IT use and IT-related erythema. Among participants who used IT, 66 % experienced at least one episode of erythema and nearly one in five IT sessions resulted in skin erythema. Those who reported the most frequent IT use prior to the study were less likely to experience an IT-related erythema on a given IT session compared to the least experienced IT users. Perceived susceptibility to burns from IT use was positively associated with risk of erythema. Erythema was a frequently reported experience among IT users. Implications for policy makers and behavioral medicine practitioners are discussed

Objective To evaluate the Structured Interview for Tanning Abuse and Dependence (SITAD). Design Longitudinal survey. Setting College campus. Participants A total of 296 adults. Main Outcome Measures The SITAD modified items from the Structured Clinical Interview for DSM-IV Axis I Disorders that focus on opiate abuse and dependence. Indoor tanning (IT) behavioral patterns and opiate-like reactions to tanning were measured, and IT behavior was measured 6 months later. Results Of 296 participants, 32 (10.8%) met the SITAD criteria for tanning abuse (maladaptive pattern of tanning as manifested by failure to fulfill role obligations, physically hazardous tanning, legal problems, or persistent social or interpersonal problems) and 16 (5.4%) for tanning dependence as defined by 3 or more of the following: loss of control, cut down, time, social problems, physical or psychological problems, tolerance, and withdrawal. The IT frequency in dependent tanners was more than 10 times the rate in participants who do not meet the SITAD criteria for tanning abuse or dependence. Tanning-dependent participants were more likely to report being regular tanners (75%; odds ratio, 7.0). Dependent tanners scored higher on the opiate-like reactions to tanning scale than did abuse tanners, who scored higher than those with no diagnosis. Conclusions The SITAD demonstrated some evidence of validity, with tanning-dependent participants reporting regular IT, higher IT frequency, and higher scores on an opiate-like reactions to tanning scale. A valid tanning dependence screening tool is essential for researchers and physicians as a tanning-dependent diagnosis may facilitate a better understanding of tanning motivations and aid in the development of efficacious intervention programs. Recent research has explored the idea that some patterns of tanning behavior may be dependent1- 7 by using a common alcohol screening questionnaire, the CAGE,8 or, alternatively, by adapting criteria for substance-related disorders from the Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition, Text Revision) (DSM-IV-TR)9 modified to reflect UV light tanning (ie, sunbathing or indoor tanning [IT]).1,4,6,7Whereas data from the National Household Survey on Drug Abuse10 report prevalence rates for alcohol and any illicit drug combined as 2.6% to 9.3%, the modified CAGE and modified DSM report tanning dependence rates ranging from 12% to 55%.1,4,6,7,11Prevalence rates for dependence on alcohol and various drugs do differ. However, even in settings enriched for dependent behavior, such as bars,12 prevalence rates are not nearly as high as the tanning dependence rates reported. The high prevalence rates reported suggest that the current assessments tend to overidentify tanning dependence. Feldman and others suggest that the mechanism for tanning dependence is most likely the release of endogenous opioids when the skin is exposed to UV radiation (see Nolan and Feldman5 for a review). It is probable that exploring tanning behavior by following the approach used in the DSM-IV-TR to categorize opioid use behaviors will lead to improved accuracy in the categorization of tanning dependence. The Structured Interview for Tanning Abuse and Dependence (SITAD) is a tanning dependence assessment based on opioid use items adapted from the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID).13 The use of modified opioid SCID items was chosen specifically for good content and face validity in the measure. The self-administered structured interview format was chosen because this format has been demonstrated to achieve valid psychiatric categorization for opioid dependence in a previous study.14 Evaluation of the SITAD involved exploring differences in variables (ie, IT frequency, IT behavioral patterns, and scores on a scale measuring opiate-like reactions to tanning) that would theoretically be expected to differ among individuals exhibiting tanning abuse, those with tanning dependence, and those who do not meet the SITAD criteria for tanning abuse or dependence. We also expect that use of the SITAD will result in lower prevalence rates for tanning dependence than have been reported in previous studies.1,6,7

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Purpose of Review: The purpose of this review is to address infection with HIV and hepatitis C in the Appalachian region of the USA and the driving forces underlying this epidemic. We seek to discuss epidemiology of disease and the possible interventions to reduce incidence and burden of disease in this resource-limited area. Recent Findings: The rise of the opioid crisis has fueled a rise in new hepatitis C infection, and a rise in new HIV infection is expected to follow. Injection drug use has directly contributed to the epidemic and continues to remain a risk factor. Men who have sex with men remains a significant risk factor for HIV acquisition as well. Summary: Progress has been made in the battle against HIV and, to a lesser extent, hepatitis C, but much more can be done. Limited data on co-infection with HIV/HCV are currently available for this at-risk region, but it is clear that Appalachia is highly vulnerable to co-infection outbreaks. A multipronged approach that includes advances in assessment of co-infection and education for both patients and clinicians can help to recognize, manage, and ideally prevent these illnesses.

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