Compliance by California tanning facilities with the nation's first statewide ban on use before the age of 18 years.

BACKGROUND: Exposure to indoor tanning, especially at younger ages, is associated with increased risk of skin cancer. Even in states with parental consent requirements, teenagers used tanning facilities at high rates. In 2011, California became the first state to pass a complete ban on indoor tanning by those younger than 18 years. OBJECTIVE: We sought to determine whether tanning facilities in California were in compliance with the new law. METHODS: In a cross-sectional study, telephone calls were placed in May 2013 to a statewide random sample of tanning facilities by a study investigator indicating that she was 17 years old. RESULTS: Of 600 advertised indoor tanning facilities, 338 met inclusion criteria. A majority of respondents (77%, 95% confidence interval 72%-81%) told the underage caller that she could not use their ultraviolet tanning facility. Most facilities, however, denied any dangers from ultraviolet tanning (61%) and made unlawful claims of specific health benefits, including vitamin-D production (44%), skin disease treatment (22%), prevention of future sunburns (17%), and prevention or treatment of depression (8%). LIMITATIONS: Tanning facilities may respond differently to a 17-year-old's request to tan in person versus by telephone. CONCLUSION: Given strong evidence linking indoor tanning to skin cancer, and the tanning industry's documented history of marketing specifically to teenagers, this study suggests that laws banning indoor tanning younger than 18 years can meaningfully impact access. Additional enforcement, however, may be required to bring about accurate disclosure of risk and prevent claims of unproven health benefits.

Risk of Incident Liver Disease in Patients with Psoriasis, Psoriatic Arthritis, and Rheumatoid Arthritis: A Population-Based Study.

Relatively little is known about the risk for incident liver disease in psoriasis (PsO), psoriatic arthritis (PsA), and rheumatoid arthritis (RA). We performed a cohort study among patients with PsO, PsA, or RA and matched controls in The Health Improvement Network from 1994 to 2014. Outcomes of interest were any liver disease, nonalcoholic fatty liver disease, and cirrhosis (any etiology). Among patients with PsO (N = 197,130), PsA (N = 12,308), RA (N = 54,251), and matched controls (N = 1,279,754), the adjusted hazard ratios for any liver disease were elevated among patients with PsO (without systemic therapy [ST] 1.37; with ST 1.97), PsA (without ST 1.38; with ST 1.67), and RA without an ST (1.49) but not elevated in patients with RA prescribed an ST (0.96). Incident nonalcoholic fatty liver disease was highest in patients with PsO prescribed an ST (2.23) and PsA with an ST (2.11). The risk of cirrhosis was highest among patients with PsO with an ST (2.62) and PsA without an ST (3.15). Additionally, the prevalence of liver disease and cirrhosis increased in a stepwise fashion with increasing body surface area affected by PsO (P for trend <0.001). More so than RA, PsO and PsA are associated with liver disease, particularly nonalcoholic fatty liver disease and cirrhosis, and this was true even among patients without ST exposure.