Indoor tanning (IT) increases risk of developing skin cancer. A social media campaign to reduce mother's permissiveness toward their teenage daughters IT was evaluated. Mothers (N = 869) of daughters aged 14–17 in 34 states without bans on IT by minors were enrolled in a randomized trial with assessments at baseline and 12-months follow-up in 2017–19. A year-long adolescent health campaign was delivered to all mothers. The intervention group received posts on preventing IT and the control group, posts about preventing prescription drug misuse. Daughters (n = 469; 54.0%) completed the assessments at baseline and 12 months. At 12-month follow-up, intervention-group mothers were less permissive of IT by daughters (unadjusted means = 1.70 [95% CI: 1.59, 1.80] v. 1.85 [1.73, 1.97] [5-point Likert scale], b = -0.152), reported more communication about avoiding IT with daughters (4.09 [3.84, 4.35] v. 3.42 [3.16, 3.68] [sum of 7 yes/no items], b = 0.213), and had lower intentions to indoor tan (1.41 [1.28, 1.55] v. 1.60 [1.43, 1.76] [7-point likelihood scale], b = -0.221) than control-group mothers. Daughters confirmed intervention-group mothers communicated about IT (3.81 [3.49, 4.14] v. 3.20 [2.87, 3.53] [sum of 7 yes/no items], b = 0.237) and shared IT posts (unadjusted percentages = 52.4% v. 36.4%, b = 0.438) more than control-group mothers. No differences were found in IT behavior, self-efficacy to refuse permission, and negative attitudes toward IT. A social media campaign may be an effective strategy to convince mothers to withhold permission for IT, which may help increase the effectiveness of state laws designed to reduce IT by minors by requiring parental permission.

Cognitions relevant to tanning salon decision making were studied using Jaccard's Theory of Alternative Behavior. Questionnaires were administered assessing tanning salon use, attitudes toward tanning salon use, attitudes toward reasonable behavioral alternatives, and cognitive variables underlying these variables. Tanning salon use reports were very high in this sample. The results support the notion that young people make decisions regarding using tanning salons based on the behavioral alternatives available to them. Specifically, subjects with stronger preferences for using clothing to enhance appearance were less likely to use tanning salons. Furthermore, the multivariate approach used clearly delineates the specific cognitive beliefs and orientations that might be targeted to change these attitudes. The relevance of these findings to skin cancer prevention is discussed.

The reduction of intentional exposure to ultraviolet (UV) radiation is an important area of skin cancer prevention. Hillhouse et al. (Cancer 113:3257-3266, 2008) have developed an appearance-focused intervention with evidence of efficacy in lowering indoor tanning UV exposure in young women. In the current study, a subgroup approach was used to determine moderators of intervention efficacy. Undergraduate females in two regions of the United States (n = 362) were randomized into an intervention or control condition. Latent profile analysis was used to identify subgroups of indoor tanners based on patterns of indoor tanning motives. Intervention efficacy was examined within each subgroup. We found evidence for 4 subgroups of tanners: knowledgeable-appearance tanners, low-knowledge tanners, low-knowledge, relaxation tanners, and knowledgeable, low-appearance and lowrelaxation tanners. The intervention significantly reduced indoor tanning for the low-knowledge subgroup (34% of the sample). The utility of the subgroup approach in developing targeted behavioral skin cancer interventions is discussed.

Objectives: To evaluate the effects of an appearance-focused intervention to reduce the risk of skin cancer by decreasing indoor tanning, examine potential heterogeneity in tanning across this time, and correlate the subtypes with predictors collected at baseline. Design: Randomized controlled trial with 379 female college students measured at 6 monthly time points. Main Outcome Measure: Self-reported indoor tanning frequency. Results: The intervention was effective at decreasing tanning over the period between the fall and spring. Longitudinal latent class analysis found 3 patterns of tann1ers among the treatment individuals: abstainers, moderate tanners, and heavy tanners. These classes appeared in both the treatment and control conditions, and the intervention had a harm reduction effect by reducing levels of exposure within the moderate and heavy tanner classes. Participant age and self-reported tanning patterns were found to be predictive of class membership. Conclusions: This research suggests that brief intervention approaches can be effective at reducing risk for skin cancer and illustrates several ways in which these protective effects can be enhanced.

Background: Risk for skin cancer is increased by UV exposure and decreased by sun protection. Appearance reasons to tan and not tan have consistently been shown to be related to intentions and behaviors to UV exposure and protection. Purpose: This study was designed to determine the factor structure of appearance motives to tan and not tan, evaluate the extent to which this factor structure is gender invariant, test for mean differences in the identified factors, and evaluate internal consistency, temporal stability, and criterion-related validity. Method: Five-hundred eighty-nine females and 335 male college students were used to test confirmatory factor analysis models within and across gender groups, estimate latent mean differences, and use the correlation coefficient and Cronbach's alpha to further evaluate the reliability and validity of the identified factors. Results: A measurement invariant (i.e., factor-loading invariant) model was identified with three higher-order factors: sociocultural influences to tan (lower order factors: media, friends, family, significant others), appearance reasons to tan (general, acne, body shape), and appearance reasons not to tan (skin aging, immediate skin damage). Females had significantly higher means than males on all higher-order factors. All subscales had evidence of internal consistency, temporal stability, and criterion-related validity. Conclusions: This study offers a framework and measurement instrument that has evidence of validity and reliability for evaluating appearance-based motives to tan and not tan.

Indoor tanning remains a popular activity in Western cultures despite a growing body of literature suggesting its link to skin cancer and melanoma. Advances in indoor tanning research have illuminated problematic patterns of its use. With problems such as difficulty quitting, devoting resources toward its use at the expense of healthy activities, and excessive motivation and urges to tan, symptoms of excessive indoor tanning appear consistent with behavioral addiction. The present study bridges the gap between clinical approaches to understanding indoor tanning problems and behavioral economic considerations of unhealthy habits and addiction. Eighty undergraduate females completed both the Behavioral Addiction Indoor Tanning Screener and the Tanning Purchase Task. Results suggest that behavioral economic demand for tanning significantly differs between risk classification groups, providing divergent validity to the Behavioral Addiction Indoor Tanning Screener and offering additional evidence of the sensitivity of the Tanning Purchase Task to differentiating groups according to tanning profiles.

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.

This study explored the attitudes and behaviors of adolescents toward sunbathing and sunscreen use by employing the Theory of Alternative Behaviors (Jaccard, 1981) with adolescent participants and a respective parent co-participant. Females were found to be more likely to engage in intentional suntanning efforts, to stay in the sun for a longer duration, and to be more likely to use sunscreen yet to report higher incidence of sunburns. Those with a healthy lifestyle attitude are as likely to engage in intentional tanning, although they are more likely to wear sunscreen. Self-report of tanning behavior was positively correlated to parent's observation of adolescent's behavior. Results of this study support the position that sunscreen partially allows for longer sunlight exposure resulting in higher amounts of UV radiation exposure. Participants who were more likely to wear sunscreen were likewise more likely to spend more time in the sun and to sunburn more frequently.

Studies linking exposure to indoor tanning beds that emit ultraviolet radiation with melanoma and other skin cancers began to emerge as early as the 1980s, and a compelling body of evidence now exists to support the carcinogenic effect of indoor tanning. Incidence rates for melanoma have increased among populations with high use of indoor tanning beds, including young women, mirroring increasing rates of use.1 These persuasive data have led to increased attention on the dangers of indoor tanning, along with warnings from the world’s leading public health and medical organizations. Regulatory efforts including restricting access for minors have followed throughout the UK and globally.

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