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

Background: Indoor tanning elevates the risk for melanoma, which is now the most common cancer in US women aged 25-29. Public policies restricting access to indoor tanning by minors to reduce melanoma morbidity and mortality in teens are emerging. In the United States, the most common policy restricting indoor tanning in minors involves parents providing either written or in person consent for the minor to purchase a tanning visit. The effectiveness of this policy relies on parents being properly educated about the harms of indoor tanning to their children. Objective: This randomized controlled trial will test the efficacy of a Facebook-delivered health communication intervention targeting mothers of teenage girls. The intervention will use health communication and behavioral modification strategies to reduce mothers’ permissiveness regarding their teenage daughters’ use of indoor tanning relative to an attention-control condition with the ultimate goal of reducing indoor tanning in both daughters and mothers. Methods: The study is a 12-month randomized controlled trial comparing 2 conditions: an attention control Facebook private group where content will be relevant to teen health with 25% focused on prescription drug abuse, a topic unrelated to tanning; and the intervention condition will enter participants into a Facebook private group where 25% of the teen health content will be focused on indoor tanning. A cohort of 2000 mother-teen daughter dyads will be recruited to participate in this study. Only mothers will participate in the Facebook groups. Both mothers and daughters will complete measures at baseline, end of intervention (1-year) and 6 months post-intervention. Primary outcomes include mothers’ permissiveness regarding their teenage daughters’ use of indoor tanning, teenage daughters’ perception of their mothers’ permissiveness, and indoor tanning by both mothers and daughters. Results: The first dyad was enrolled on March 31, 2016, and we anticipate completing this study by October 2019. Conclusions: This trial will deliver social media content grounded in theory and will test it in a randomized design with state-of-the-art measures. This will contribute much needed insights on how to employ social media for health behavior change and disease prevention both for indoor tanning and other health risk behaviors and inform future social media efforts by public health and health care organizations. ClinicalTrial: Clinicaltrials.gov NCT02835807; https://clinicaltrials.gov/ct2/show/NCT02835807 (Archived by WebCite at http://www.webcitation.org/6mDMICcCE).

Background Younger indoor tanning initiation leads to greater melanoma risk due to more frequent and persistent behavior. Despite this, there are no published studies exploring the predictors of indoor tanning initiation in teen populations. Purpose This longitudinal study uses latent profile analysis to examine indoor tanning initiation in indoor tanning risk subgroups from a national sample of female adolescents. Methods Latent profile analysis used indoor tanning beliefs and perceptions to identify indoor tanning initiation risk subgroups. The teens in each subgroup were reassessed on indoor tanning initiation after a year. Results Three subgroups were identified: a low risk, anti-tanning subgroup (18.6 %) characterized by low scores on positive indoor tanning belief scales and high scores on beliefs about indoor tanning dangers; a moderate risk aware social tanner subgroup (47.2 %) characterized by high scores on positive indoor tanning belief scales but also high scores on beliefs about indoor tanning dangers; and a high risk risky relaxation tanner subgroup (34.2 %) characterized by high scores on positive indoor tanning belief scales and low scores on beliefs about indoor tanning dangers. Teens in the aware social tanner and risky relaxation tanner subgroups were significantly more likely to initiate indoor tanning in the following year. Conclusions These findings highlight the need to identify teens at risk for indoor tanning initiation and develop tailored interventions that will move them to the lowest risk subgroup. Subgroup correlates suggest parent and peer-based interventions may be successful.

Youthful indoor tanning as few as ten sessions can increase the risk of melanoma by two to four times with each additional session adding another 2 % to the risk. Recent research estimates that indoor tanning can be linked to approximately 450,000 cases of skin cancer annually in the USA, Europe, and Australia. Despite these risks, indoor tanning remains popular with adolescents. This study tested the efficacy of a web-based skin cancer prevention intervention designed to reduce indoor tanning motivations in adolescent females. A nationally representative sample of 443 female teens was enrolled from an online panel into a two-arm, parallel group design, randomized controlled trial. Treatment participants received an appearance-focused intervention grounded in established health behavior change models. Controls viewed a teen alcohol prevention website. Outcome variables included willingness and intentions to indoor tan, willingness to sunless tan, and measures of indoor tanning attitudes and beliefs. The intervention decreased willingness and intentions to indoor tan and increased sunless tanning willingness relative to controls. We also examined indirect mechanisms of change through intervening variables (e.g., indoor tanning attitudes, norms, positive and negative expectancies) using the product of coefficient approach. The web-based intervention demonstrated efficacy in changing adolescent indoor tanning motivations and improving their orientation toward healthier alternatives. Results from the intervening variable analyses give guidance to future adolescent skin cancer prevention interventions.

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.

Indoor tanning (IT) before the age of 35 increases one’s risk for melanoma by 75%, and epidemiological data show a 6.1% annual increase in the incidence of melanomas in white women younger than age 44 in the US. Population-based studies reveal that 15% of adolescents and 8% to 14% of their primary caregivers have engaged in IT in the past year. The compelling case for IT being a significant risk factor for melanoma, together with the high rates of IT in teen girls and their mothers, provided a strong rationale for conducting an antitanning intervention directed at mother-daughter dyads. This study evaluated a strategy designed to prevent skin cancer in adolescent girls by using mothers as change agents to effectively communicate the risks of IT and to encourage teens to avoid high risk IT behaviors. Mother-daughter dyads were recruited over the telephone, randomly assigned to the intervention or control group, and surveyed on IT risk constructs including tanning-specific knowledge and communication. Forty-two mother-daughter dyads completed baseline surveys in the summer of 2012. Mothers in the intervention group were given a handbook educating them on the dangers of IT and how to convey information about skin cancer prevention to their daughters and encouraged to talk with their daughters about the issues covered in the handbook over a 1-month period. Participants completed follow-up assessments in October 2012 and January 2013. Among teens, past 3-month IT frequency, intentions, and willingness decreased in intervention group teens, while intentions and willingness increased among control teens. Intervention teens exhibited lower IT attitudes and higher levels of perceived susceptibility to appearance damage and health effects from IT when compared to control teens. Intervention teens reported higher levels of maternal monitoring and lower levels of maternal permissiveness toward IT. Qualitative data indicated mothers responded positively to the handbook, and it encouraged tanning-specific discussions with their daughters. Mothers provided suggestions on how to improve the handbook, that once incorporated, should lead to improved intervention efficacy. Overall, study results indicated this intervention strategy is feasible, as mothers did communicate with their teens and were able to convey the antitanning messages.

This chapter reviews the literature applying health behavior theories to indoor tanning. Few studies have tried to fit full versions of health behavior models to indoor tanning. Theoretical models from the family of theories referred to as the reasoned action approach (e.g., theory of planned behavior, behavioral alternative model, prototype willingness model, etc.) have been most commonly used to study indoor tanning. Results indicate that these models fit indoor tanning data moderately to extremely well. Two lesser known models, problem behavior theory and the terror management health model, have also demonstrated a reasonable fit. Two other common models, the health belief model and social cognitive theory, have never been fully tested with indoor tanning. However, key constructs from these models (e.g., perceived susceptibility and threat, modeling) have been used to understand indoor tanning. Empirical research conducted represents a solid start toward developing strong, comprehensive models of indoor tanning that can guide intervention efforts. This initial work needs to be expanded by conducting longitudinal studies and by including a broader age range in studies because the majority of existing work has focused on young adults. Incorporating findings related to tanning dependency, peer group affiliation, media influences and other constructs into these foundational models will also improve our understanding and ability to develop efficacious interventions to reduce engagement in this health risk behavior.