Prevalence and Location of Indoor Tanning Among High School Students in New Jersey 5 Years After the Enactment of Youth Access Restrictions.

Importance: Several state governments have enacted bans on the use of indoor tanning beds at tanning salons among minors, but studies of the association of such restrictions with tanning behavior have produced mixed results. Little is known about the prevalence of tanning in nonsalon locations that are typically not covered by restrictions. Evidence that age bans are associated with a reduction in tanning bed use is needed to support policy makers' efforts to expand tanning regulations. Objective: To determine the prevalence and location of indoor tanning among New Jersey youths after a 2013 statewide indoor tanning ban for minors younger than 17 years. Design, Setting, and Participants: This survey study comprised 4 biennial (2012-2018) and representative cross-sectional surveys conducted among 12 659 high school students (grades 9-12) in New Jersey. Main Outcomes and Measures: The main outcome was the frequency of indoor tanning in the past year. Location of tanning bed use (ie, tanning salons or nonsalon locations, such as private residences or gyms) was also assessed. Results: Survey responses from a total of 12 659 high school students (6499 female [51%]; mean [SD] age, 15.8 [1.3] years) were analyzed across the 4 survey waves. Tanning prevalence among students younger than 17 years (ie, younger than the legal tanning age) was 48% lower in 2018 compared with 2012 (adjusted odds ratio, 0.52; 95% CI, 0.33-0.81; P = .002). Tanning prevalence was 72% lower among female students 17 years or older (adjusted odds ratio, 0.28; 95% CI, 0.18-0.44; P < .001). Prevalence rates were not significantly different for male students 17 years or older and for racial/ethnic minority students. The prevalence of tanning in salons and private residences was similar among students younger than 17 years. Conclusions and Relevance: This study suggests that the prevalence of tanning in New Jersey has begun to decrease among all youths younger than the legal tanning age and among female students of legal age in the 5 years after a statewide tanning ban. These findings provide valuable evidence to policy makers to support ongoing state-level efforts to enact age-specific bans on indoor tanning. The unique assessment of tanning location demonstrates the need for both greater enforcement of existing tanning salon regulations to ensure compliance and broadening restrictions to cover nonsalon tanning locations.

Sunbeds and carcinogenesis: the need for new regulations and restrictions in Europe from the Euromelanoma perspective.

Experimental investigations have definitely assessed that ultraviolet A (UVA) as well as ultraviolet B (UVB) radiation induce mutagenic DNA photoproducts and other cell damages with a carcinogenic potential. Artificial tanning increases significantly the lifetime risk for basal cell carcinoma, squamous cell carcinoma and melanoma particularly in subjects with fair skin type, subjects with a history of skin cancer or frequent childhood sunburn or if exposures took place at an age younger than 18 years. In addition, experimental and clinical evidence indicate that UVA exposure promotes skin photoageing. Therefore we are dealing with a recreational activity (for customers) and a profitable business (for the tanning industry) with human costs, i.e. an increase in morbidity and mortality by skin cancer, and health and social costs leading to an increased expenditure by the European national health systems. In a few European countries, legislation has recently prohibited the use of sunbeds for minors, pregnant women, people with skin cancer or a history of skin cancer and individuals who do not tan or who burn easily from sun exposure. However, this legislation seems to be insufficient from a photobiological perspective, and importantly, it is largely disregarded by consumers and tanning industry. Therefore the Euromelanoma group proposes a new, more stringent regulation for the tanning industry and restrictions for customers, particularly for those individuals with constitutional and anamnestic risk factors. Finally, we ask for an enhanced commitment to increase the awareness of the general population on the risk of artificial tanning.

Sunbed use legislation in Europe: assessment of current status.

BACKGROUND: The use of UV-emitting tanning devices for cosmetic purposes is associated with an increased risk of melanoma and non-melanoma skin cancer. Young women are the most frequent users, therefore, there is an increasing concern about the regulation of sunbed use. OBJECTIVE: The primary objective is to assess the current legislation on sunbed use among European countries. METHODS: We developed a 30-item questionnaire to gather the most relevant information about sunbed use legislation. The questionnaire was sent to Euromelanoma coordinators and to designated coordinators out of the Euromelanoma network. RESULTS: We obtained a response rate of 64%. More than 25% of the countries did not report any specific legislation. Roughly one-third of the countries does not have a restriction for minors. Even in countries with a specific legislation, a lack or insufficient enforcement of age limit was observed in up to 100% of the inspections based on the PROSAFE report from 2012. Self-tanning devices were reported in 50%, and almost 40% of countries do not require supervision of use. Although a warning display is required in 77% of cases, a signed informed consent is not required in 80%. In the vast majority of cases, the number of licensed or closed tanning centres is unknown. CONCLUSIONS: Despite the evidence of its harmful effects, and its frequent use by young people, many of whom are at high risk of skin cancer because of fair skin, a significant number of European countries lack a specific legislation on tanning devices. In order to limit the access of young people to sunbeds, a more strictly enforced regulation is needed, as well as regulation regarding advertisement, and location of tanning centres, in addition to health promotion campaigns that target the vulnerable population of young women seeking its use for improved cosmesis.

A Qualitative Analysis of Canadian Indoor Tanning Policies.

BACKGROUND: The International Agency for Research on Cancer classifies artificial tanning devices as Group 1 human carcinogens. Studies have shown that use of indoor tanning before age 35 can increase the risk of melanoma development by 75%. It has therefore been recommended that indoor tanning use be restricted in individuals younger than age 18. OBJECTIVES: This study aims to review the state of provincial indoor tanning policies, especially in regards to use by youth across Canada, and what strategies are being implemented to enforce them. METHODS: Focused interviews were conducted with representatives from the provincial Ministries of Health across Canada in May and June 2014. Follow-up interviews were performed between February and May 2017. RESULTS: As of January 2018, regulations are in effect in all Canadian provinces restricting indoor tanning by minors and requiring display of signage warning of the risks of indoor tanning by salons. However, there are discrepancies among the provinces on how and if tanning salons are monitored and how and if these regulations are enforced. CONCLUSIONS: While implementing youth bans on indoor tanning is a promising start, all Canadian provinces need to ensure that efforts are being undertaken to ensure compliance with these policies to effectively combat the rising incidence of skin cancer among the Canadian population.

Factors influencing health and safety practices among Vietnamese nail salon technicians and owners: A qualitative study.

OBJECTIVE: This qualitative study explored factors that influence health and safety practices among Vietnamese nail salon technicians and owners. METHODS: We conducted semi-structured focus group discussions and individual interviews with a sample of 17 Vietnamese nail salon technicians and owners in the Philadelphia metropolitan area, Pennsylvania. RESULTS: Analysis of transcripts revealed perceived health benefits/concerns, knowledge about work-related hazards, salon's management and policies attributed to owners, client influence, external policies/regulations, and protective equipment-specific challenges were among factors affecting workplace health promotion practices at the salons. CONCLUSIONS: The study highlighted a complex interplay among the various stakeholders including nail technicians, owners, clients, policy makers, and enforcers. Interventions addressing barriers at the personal and organizational levels, as well as public policy change and enforcement are needed to create sustainable behavioral and organizational change in nail salons.

A systematic review of compliance with indoor tanning legislation.

BACKGROUND: Many jurisdictions have enacted indoor tanning legislation in response to the health risks of artificial ultraviolet (UV) radiation exposure. Key components of these legislations include banning minors' access, requiring parental consent or accompaniment, providing protective eyewear, posting health warning signs, and communicating important health risk information. However, legislation must be complied with to be impactful. Evidence around compliance with indoor tanning legislations has not been synthesized and is an important step toward determining changes in practice due to legislation. METHODS: A systematic review was conducted to obtain peer-reviewed literature about compliance with indoor tanning legislation worldwide. Six databases were searched, resulting in 12,398 citations. Sixteen studies met the inclusion criteria (peer-reviewed scientific studies, published in English, focused primarily on compliance with indoor tanning legislations, and focused on commercial indoor tanning in indoor tanning facilities). RESULTS: Compliance with most aspects of indoor tanning legislation varied widely. There was good compliance for provision of protective eyewear (84 to 100%; mean = 92%; SD = 8). Compliance with age restrictions ranged from 0 to 100% (mean = 65%; SD = 25), while compliance with posting warning labels in the required locations within a tanning facility ranged from 8 to 72% (mean = 44%; SD = 27). Variation in compliance may be due to true differences, study methodology, or temporal trends. CONCLUSIONS: Variability in compliance with indoor tanning legislation, as found in this systematic review, indicates the legislations may not be having their intended protective effects on the public's health. The reasons for such low and varied compliance with certain aspects of legislation, and high compliance with other aspects of legislation, deserve further attention in future research to inform best practices around ensuring high and consistent compliance with indoor tanning legislations worldwide.

State Indoor Tanning Laws and Prevalence of Indoor Tanning Among US High School Students, 2009-2015.

OBJECTIVES: To examine the association between state indoor tanning laws and indoor tanning behavior using nationally representative samples of US high school students younger than 18 years. METHODS: We combined data from the 2009, 2011, 2013, and 2015 national Youth Risk Behavior Surveys (n = 41 313) to analyze the association between 2 types of state indoor tanning laws (age restriction and parental permission) and the prevalence of indoor tanning during the 12 months before the survey, adjusting for age, race/ethnicity, and survey year, and stratified by gender. RESULTS: Age restriction laws were associated with a 47% (P < .001) lower indoor tanning prevalence among female high school students. Parental permission laws were not found to be associated with indoor tanning prevalence among either female or male high school students. CONCLUSIONS: Age restriction laws could contribute to less indoor tanning, particularly among female high school students. Such reductions may reduce the health and economic burden of skin cancer.

Decrease in artificial tanning by French teenagers: 2011-2016.

BACKGROUND: The major risk factor for skin cancers is exposure to solar and artificial ultraviolet radiation, in particular during childhood and adolescence. In France, a law was restricted for tanning-bed access to adults (≥18 years) since 1997. OBJECTIVE: To evaluate teenagers' artificial tanning behaviour in 2016 and to compare results with those obtained in a similar survey performed in 2011. METHODS: The SOLADO 2011 and 2016 surveys were conducted in a general school in Antony and a technical school in Fontenay-aux-Roses (Paris suburb). RESULTS: In 2016, 630 teenagers (mean age: 14.2 ± 1.9 y: Males/Females: 301/329) completed the questionnaire, 1.3% of teenagers reported using tanning beds, 1.1% tanning pills and 8.9% tanning creams. Between 2011 and 2016, the use of tanning beds decreased from 1.4% to 0.7% in Antony (P = .26) and from 9.5% to 4.8% in Fontenay-aux-Roses (P = .01), and the use of tanning creams from 39.8% to 17.6% in Fontenay-aux-Rose (P = .0007). The incidence of sunburn decreased from 60.5% to 54.0% in Antony (P = .02) and from 55.4% to 42.4% in Fontenay-aux-Roses (P = .05). CONCLUSION: As compared to 2011, teenagers used artificial tanning methods less frequently in 2016. In particular, they used tanning beds less frequently, suggesting that the new stricter legislation has been effective.

Tanning Salon Compliance Rates in States With Legislation to Protect Youth Access to UV Tanning.

Importance: The US Food and Drug Administration has classified tanning beds as carcinogenic. Most states have enacted legislation to prevent or create barriers for minors accessing tanning establishments. Determining tanning salon compliance with legislation would provide an indication of the influence of legislation at preventing exposure to the carcinogen in minors. Objectives: To investigate compliance rates in the 42 states and the District of Columbia with legislation restricting tanning bed use in minors and to identify differences in compliance based on population, regional location, salon ownership, age group being regulated, and time since the law was enacted. Design, Setting, and Participants: This investigation was a cross-sectional telephone survey conducted between February 1, 2015, and April 30, 2016, by callers posing as minors attempting to schedule a tanning appointment. The setting was tanning salons in the 42 states and the District of Columbia that currently have legislation restricting tanning bed use in minors. Included in the study were 427 tanning salons, 10 randomly selected from each state or territory with tanning legislation. Main Outcomes and Measures: Overall compliance of tanning salons with state tanning legislation and differences in compliance based on community population, regional location, independent vs chain tanning salon, age group being regulated, and time since the law was enacted. Results: Of the 427 tanning salons surveyed, overall noncompliance with state legislation was 37.2% (n = 159). There were more noncompliant tanning salons in rural locations (45.5%; 95% CI, 37.5%-53.7%; P = .009), southern regions of the United States (49.4%; 95% CI, 41.4%-57.4%; P = .001), independently owned salons (43.9%; 95% CI, 37.3%-50.6%; P = .003), states with younger age groups being regulated (53.5%; 95% CI, 45.7%-61.2%; P < .001), and states with more than one tanning regulation (50.0%; 95% CI, 42.0%-58.0%; P < .001). No difference was found based on time since the law was enacted. Conclusions and Relevance: Compliance with state legislation aimed at limiting tanning bed use among US minors is unsatisfactory, indicating that additional efforts to enforce the laws and education of the harmful effects of UV tanning are necessary, especially in rural, independently owned, and tanning salons in southern regions, which have decreased compliance rates.

Are tanning salons in compliance with German law? An evaluation based on a nationwide representative survey.

BACKGROUND: Given the evidence for increased skin cancer risk due to the sunbed use, a regulation of hazardous artificial ultraviolet radiation (UVR regulation) was passed in Germany in 2012. The aim of this study was to explore the advisory services in tanning studios as reported by sunbed users and to evaluate the information provided by the personnel of tanning salons after the UVR regulation was enacted. METHODS: The first wave of the representative National Cancer Aid Monitoring on Sunbed Use included a subgroup of 357 German citizens between 14 and 45 years who had used sunbeds since the UVR regulation was implemented. The participants provided data on sunbed use and related issues in telephone interviews. RESULTS: Although sunbed operators are mandated to offer their customers certain services at least once since the implementation of the UVR regulation, 15.4% of sunbed users were never advised to use protective eyewear during tanning and 13.1% were not provided with eyewear during their last sunbed use. Overall, 66.0% were never offered to develop a tanning schedule, 56.9% were never advised on the risks of UVR, 43.4% were never offered a determination of their skin type and 40.0% of users were never advised on how to use a sunbed safely. CONCLUSIONS: The data showed that 3 years after the UVR regulation was enacted, compliance with this legislation is still not optimal. Binding wording in the legal text and making them applicable to unsupervised sunbeds as well is necessary to extend the impact of this legislation.

Compliance with indoor tanning bans for minors among businesses in the USA.

Indoor tanning is a known risk factor for skin cancer and is especially dangerous for adolescents. Some states have passed indoor tanning bans for minors, but business compliance with the bans is not well understood. Thus far, studies have assessed ban compliance in one or two states at a time. This study aimed to assess compliance with indoor tanning bans for minors and knowledge of dangers and benefits of tanning among indoor tanning businesses. Female research assistants posing as minors telephoned a convenience sample of 412 businesses in 14 states with tanning bans for minors under age 17 or 18. We evaluated differences in compliance by census region and years since ban was implemented and differences in reported dangers and benefits by compliance. Most (80.1%) businesses told the "minor" caller she could not use the tanning facilities. Businesses in the south and in states with more recent bans were less compliant. Among those (n = 368) that completed the full interview, 52.2% identified burning and 20.1% mentioned skin cancer as potential dangers. However, 21.7% said dangers were no worse than the sun and 10.3% denied any dangers. Stated benefits included vitamin D (27.7%), social/cosmetic (27.2%), and treats skin diseases (26.4%), with only 4.9% reporting no benefits. While most businesses followed the indoor tanning ban when a minor called, one-fifth did not. Many stated inaccurate health claims. Additional enforcement or education might increase compliance with indoor tanning bans and action is needed to prevent businesses from stating false health information.

Effect of Legislation on Indoor Tanning Prevalence in Alabama.

OBJECTIVES: To examine changes in indoor tanning prevalence among Alabama high school students the year before and after its 2014 legal restrictions compared with Florida, which had more lenient legislation. METHODS: We analyzed the Alabama and Florida 2015 Youth Risk Behavior Survey (n = 14 389; population = 1 864 241) by gender, age, year (2013, 2015), state (Alabama, Florida), and year-by-state interactions. RESULTS: Prevalence of indoor tanning was higher among Alabama youths, but the difference did not significantly change after the law was passed in Alabama (between-state change differences ranged from a 3.3% increase among 14-year-old Alabama girls to a 9.7% decrease among 14-year-old Alabama boys). CONCLUSIONS: We found no significant changes in indoor tanning among adolescents since the enactment of Alabama's tanning restrictions in 2014. More oversight and monitoring are needed to ensure that indoor tanning facilities are compliant with emerging laws.

Tanning beds: Impact on health, and recent regulations.

As the use of indoor tanning beds gained popularity in the decades after their appearance in the market in the early 1970s, concerns arose regarding their use. Clinical research has revealed an association between indoor tanning and several health risks, including the subsequent occurrence of melanoma and nonmelanoma skin cancers, the development of psychologic dependence, and a tendency toward other high-risk health behaviors. In the face of mounting evidence, legislation has been passed, which includes the restriction of access to tanning beds by minors in 42 states and the District of Columbia, and the recent reclassification by the Food and Drug Administration, which now categorizes tanning beds as class II devices and worthy of restrictions and oversight. Early evidence suggests that these labors are resulting in cultural change, although continued efforts are necessary to limit further exposure and better inform the public of the dangers associated with indoor tanning use.

Impact of an outright ban on the availability of commercial tanning services in Victoria, Australia.

Australian states have introduced an outright ban on commercial artificial tanning sunbeds. This was based on evidence from systematic reviews affirming a strong association between tanning bed use and increased risk of melanoma. The implementation of the ban provides an opportunity to assess the effectiveness of the legislation in preventing access to artificial UV radiation. Compliance with the ban has been enforced and monitored by government departments. We additionally monitored online tanning bed advertisements before and after the ban, showing a decline over time in the number of sunbeds advertised for sale on gumtree.com.au and ebay.com.au, from a peak of 115 advertisements in May 2014 to 50 or fewer per month from February 2015. There was also an increase in advertised price, with the percentage of sunbeds offered in Victoria on gumtree.com.au at higher than $2 000 increasing from around 25% between January and June 2014 to 65% in the quarter following the introduction of the ban. Advertisements on gumtree.com.au from individuals wishing to access a sunbed in a private home in Victoria increased from only isolated instances in the months immediately prior to the ban, to between 25 and 77 advertisements per month in the quarter following the ban. In summary, the introduction of an outright ban of commercial sunbeds has achieved a dramatic reduction in the availability of harmful artificial UV radiation sources in Australia. Long-term benefits to the health of the population and a reduction in costs to the health system are expected to result.