Global Tanning Bed Advertising: A Comparison of Legal Regulations on Three Continents.

Artificial ultraviolet radiation from tanning beds has been classified as carcinogenic by the International Agency for Research on Cancer in 2009. Several countries have subsequently introduced comprehensive legislation regulating commercial indoor tanning. Specific aspects of these regulations address tanning bed advertising and information requirements for tanning bed customers, which have been previously neglected in international comparisons of indoor tanning regulations. We performed a systematic search regarding legislation on these aspects in 131 legislative units across three continents (North America, Australia/New Zealand, Europe). The legal restrictions found varied widely in type and content. In 49 legislative units we identified total (n = 8) or partial legal bans (n = 41) on advertising for indoor tanning, while 64 legislative units enacted 5regulations that necessitate the dissemination of different types of specific health information to tanning bed customers. Nearly 40% of the legislative units of the study region lacked any legislation on these issues altogether. The heterogenous results emphasize the need for an international dialogue between health authorities and governments to harmonize the regulatory framework for tanning bed advertising and information requirements to a level better protecting the public from skin cancer. Our comprehensive international comparison can serve as a starting point for such a harmonization process that may ultimately protect the public worldwide from misleading tanning bed advertising.

Prediagnostic serum 25-hydroxyvitamin D and melanoma risk.

Previous studies of serum 25-hydroxyvitamin D (25(OH)D) in relation to melanoma have shown conflicting results. We conducted a nested case-control study of 708 cases and 708 controls, using prediagnostically collected serum, to study 25(OH)D and melanoma risk in the population-based Janus Serum Bank Cohort. Stratified Cox regression was used to estimate hazard ratios (HRs) with 95% confidence intervals (CIs) adjusted for ultraviolet radiation (UVR) indicators and stratified by ambient UVB of residence and body mass index (BMI). Non-linear associations were studied by restricted cubic splines. Missing data were handled with multiple imputation by chained equations. We found an HR of melanoma risk of 1.01 (95% CI: 0.99, 1.04) and an HRimputed of 1.02 (95% CI: 1.00, 1.04) per 5-nmol/L increase. The spline model showed exposure-risk curves with significantly reduced melanoma risk between 60 and 85 nmol/L 25(OH)D (reference 50 nmol/L). Non-significant J-shaped curves were found in sub-analyses of subjects with high ambient UVB of residence and of subjects with BMI < 25 kg/m2. Our data did not yield persuasive evidence for an association between 25(OH)D and melanoma risk overall. Serum levels within the medium range might be associated with reduced risk, an association possibly mediated by BMI.

Beliefs, attitudes and perceptions to sun-tanning behaviour in the Norwegian population: a cross-sectional study using the health belief model.

BACKGROUND: Norway has one of the highest incidences of melanoma in the world. It has been suggested that the majority of all skin cancers could be prevented by changes related to sun-tanning behaviour. This study explores the sun-tanning behaviour of the Norwegian population using a modified Health Belief Model (HBM). Increased knowledge about beliefs, attitudes and sun-tanning behaviour can provide information which may be useful for future sun protection interventions. METHODS: In 2017, 1004 members of the Norwegian population completed cross-sectional online surveys. People who seek the sun for tanning purposes was the eligibility criterion for this study, reducing the study population to 569. With the aid of the constructs from the HBM, predictive factors explaining sun-tanning behaviour were determined using multivariate linear regression adjusted for demographics (gender, age, education and income). Furthermore, the predictor variables, empowerment and benefits of tanning, were added to the model. RESULTS: Five of the constructs in the modified HBM showed significant correlation with sun-tanning behaviour using bivariate analysis. The strongest correlation was perceived barriers of sun protection (0.42), with the next strongest being the benefits of tanning (0.30). The modified model explained 31% of the variation in sun-tanning behaviour using multivariate analysis. Significant predictors from the HBM to sun-tanning behaviour were perceived barriers to sun protection (Beta = 0.36, p < 0.001) and the severity of melanoma (Beta = - 0.20, p < 0.001). In addition, empowerment (Beta = 0.05, p = 0.05) and the benefits of tanning (Beta = 0.28, p < 0.001) proved to be variables with significant effect on sun-tanning behaviour. The demographic factors age, education and income were also associated with sun-tanning behaviour (p < 0.05). CONCLUSION: Based on the results of this study, several factors in the modified HBM had a significant impact on Norwegians' sun-tanning behaviour. The results indicate that future sun protection interventions should focus on reducing barriers in relation to sun protection behaviour, as well as emphasizing the severity of adverse tanning behaviour and melanoma. Efforts to alter the perceptions of the beneficial factors of tanning behaviour can also be appropriate in health promotion campaigns and interventions. Finally, implementing empowerment strategies could have a positive effect on promoting healthy sun-tanning behaviour.

Anthropometric factors and cutaneous melanoma: Prospective data from the population-based Janus Cohort.

The aim of the present study was to prospectively examine risk of cutaneous melanoma (CM) according to measured anthropometric factors, adjusted for exposure to ultraviolet radiation (UVR), in a large population-based cohort in Norway. The Janus Cohort, including 292,851 Norwegians recruited 1972-2003, was linked to the Cancer Registry of Norway and followed for CM through 2014. Cox regression was used to estimate hazard ratios (HRs) of CM with 95% confidence intervals (CIs). Restricted cubic splines were incorporated into the Cox models to assess possible non-linear relationships. All analyses were adjusted for attained age, indicators of UVR exposure, education, and smoking status. During a mean follow-up of 27 years, 3,000 incident CM cases were identified. In men, CM risk was positively associated with body mass index, body surface area (BSA), height and weight (all ptrends < 0.001), and the exposure-response curves indicated an exponential increase in risk for all anthropometric factors. Weight loss of more than 2 kg in men was associated with a 53% lower risk (HR 0.47, 95% CI: 0.39, 0.57). In women, CM risk increased with increasing BSA (ptrend = 0.002) and height (ptrend < 0.001). The shape of the height-CM risk curve indicated an exponential increase. Our study suggests that large body size, in general, is a CM risk factor in men, and is the first to report that weight loss may reduce the risk of CM among men.

UVB and UVA irradiances from indoor tanning devices.

Indoor tanning is common in spite of its classification as carcinogenic. Too high an ultraviolet (UV) irradiance and a lack of compliance with regulations have been reported. We measured UV irradiance from a large number of Norwegian solariums (sunbeds and stand-up cabinets) currently in use. Compliance (solariums and facilities) with national regulations and the effect of inspections delegated to local authorities (since 2004) were also studied. In 2008, 78 tanning facilities were selected from six regions throughout Norway that contained municipalities with and without local inspections. UV irradiance was measured with a CCD spectroradiometer in 194 out of 410 inspected solariums. Mean erythema weighted short (280-320 nm) and long (320-400 nm) wave UV irradiances were 0.194 (95% confidence interval (CI) 0.184-0.205) and 0.156 (95% CI 0.148-0.164) W m(-2), respectively. Only 23% of the solariums were below the UV type 3 limit (<0.15 W m(-2), short and long wave). Irradiances varied between solariums: spectral UVB (280-315 nm) and UVA (315-400 nm) irradiances were 0.5-3.7 and 3-26 times, respectively, higher than from Oslo summer sun. In total, 89.9% of the tanning facilities were unattended. Overall compliance increased since the first study in 1998-1999, but total UV irradiance did not decrease, mainly because of higher UVA irradiance in 2008. Solariums have become even less similar to natural sun due to higher UVA irradiance. Local inspections gave better compliance with regulations, but irradiances were significantly higher in municipalities with inspections (p ≤ 0.001, compared to without). Unpredictable UV irradiance combined with insufficient customer guidance may give a high risk of negative health effects from solarium use.

[Solaria, vitamin D, and skin cancer]. / Solarier, vitamin D og hudkreft.

BACKGROUND: Some researchers have suggested to use an indoor tanning device (solarium) as a vitamin D source for disease prevention. MATERIAL AND METHODS: The article is based on non-systematic searches in PubMed and ISI, and the authors' experience from epidemiologic research and studies of solarium irradiance. RESULTS: Vitamin D deficiency is an established risk factor for rickets in children and osteomalacia in adults; and is associated with an increased risk of osteoporosis and fractures. Several studies have found a beneficial role of vitamin D on both incidence and prognosis for other diseases, e.g. cancer, but causal relationships with vitamin D cannot yet be concluded. Sun exposure, our main source of vitamin D, is also an established risk factor of skin cancer. Moderate sun exposure generally provides an adequate amount of vitamin D during summer. Dietary intake of vitamin D is adamant when sun exposure is low. Solarium use seems to increase. Mean irradiance from solariums is higher than that from the summer sun in Oslo; 1.5 times higher for UVB and 3.5 times for UVA . Use of solarium increases the risk of skin cancer and was classified as carcinogenic to humans in 2009; positive health effects are not sufficiently documented. INTERPRETATION: Recommendations on restricted solarium use should be maintained.

Trends in UV irradiance of tanning devices in Norway: 1983-2005.

Indoor tanning increases skin cancer risk, but the importance of different parts of the UV spectrum is unclear. We assessed irradiance of tanning devices in Norway for the period 1983-2005. Since 1983, all tanning models needed approval before being sold or used. UV Type 3 limits were valid from late 1992 (<0.15 W m(-2) for CIE-weighted, i.e. erythemally weighted, short and long wave irradiances). We analyzed data from 90% of the approved tanning models (n = 446 models) and two large inspection surveys in 1998/1999 and 2003 (n = 1,341 tanning devices). Mean CIE-weighted short wave irradiance of approved models increased from 0.050 W m(-2) (95% confidence interval [CI] 0.045-0.055) in 1983-1992 to 0.101 W m(-2) (95% CI 0.098-0.105) in 1993-2005, and mean long wave from 0.091 W m(-2) (95% CI 0.088-0.095) to 0.112 W m(-2) (95% CI 0.109-0.115), respectively. Inspection surveys revealed short wave irradiances much higher than that approved. In 1998-1999, only 28% (293/1034) of the devices were equipped with correct sunlamps and only 1 out of 130 inspected establishments fulfilled all requirements. In 2003, corresponding numbers were 59% (180/307) of devices and 2 out of 52 establishments. Mean short and long wave irradiances of the inspected tanning devices in 2003 were 1.5 and 3.5 times, respectively, higher than the irradiance of natural summer sun in Oslo. In conclusion, the short wave irradiance has increased in indoor tanning devices in Norway over the last 20 years. Due to the high long wave irradiance throughout this period, the percentage of short wave irradiance was much lower than for natural sun.