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A Deadly Beauty Regimen

Indoor tanning has been rapidly gaining popularity in the United States since the 1980s.  It currently generates more than $5 billion in annual revenues¹³, increased from approximately $1 billion in 1992.⁸  This increase in popularity likely stems from the growing attitude that a person looks better with a tan.¹²  A meta-analysis of studies completed in North America and Europe on the use of indoor tanning equipment and melanoma conducted by the International Agency for Research on Cancer in 2006 found that among people who first used indoor  tanning before 35 years of age, the relative risk of melanoma is 1.75, or a 75% increased risk of developing melanoma.  This study demonstrated that young adults are more susceptible to the carcinogenic potential of ultraviolet radiation from indoor tanning.  It also found that having ever used a tanning bed was associated with an increased risk of melanoma with a relative risk of 1.15 as compared to those who have never used a tanning bed.¹  Recently, a population based case-control study conducted in Minnesota, a state with known high prevalence of tanning bed use, found an adjusted odds ratio of 1.74 for the likelihood of developing melanoma in relation to having ever used tanning beds.  Melanoma risk also increases with frequency of use, including number of hours, sessions and years of tanning bed use.  This study suggests that early age exposure to tanning beds is an indicator of cumulative exposure.¹⁴

Many studies have examined the prevalence of indoor tanning as well as the characteristics of those using tanning beds.  Use of indoor tanning facilities continues to rise, with the highest reported use among young women.  A study of data from the 2005 National Health Interview Survey to describe the prevalence of indoor tanning throughout adulthood found rates vary from 20.4% in those aged 18-29 years to 7.8% in those over 65 years of age.  Higher prevalence of indoor tanning in younger individuals (age 18-49) is found among those living in the Midwest, Caucasian women, those with a higher level of education, and those who visited a physician in the past year.  Additionally, those with moderate to high tanning ability, who sunburned one or more times in the past year, and who do not stay in the shade or wear long-sleeved shirts and long pants while out in the sun are more likely to use tanning beds.¹⁵

The prevalence of and attitudes about tanning among adolescents has also been extensively studied.  According to a recent study based on nationally represented samples from the United States, 24% of adolescents aged 13-19 years reported use of indoor tanning.  Frequent use of tanning beds, defined as ten or more times, was reported by 11.7% of the adolescents studied.¹⁶  Another study examining the 2009 national Youth Risk Behavior Survey taken by students in grades 9 through 12, reported that 15.6% of students used an indoor tanning device one or more times in the previous 12 months.  Of these, 7.9% of the students used an indoor tanning device one to nine times, and 7.7% used an indoor tanning device ten or more times.¹⁷  Among adolescents, those most likely to use tanning beds are Caucasian females, frequent sunbathers, those who reside in the Midwest or South, have a personal income or allowance, do not have a college-degreed mother, report the use of two or three illicit substances (tobacco, alcohol or marijuana), and attempt weight loss.¹⁸  Studies among college students have shown that approximately 50% of college-aged adults report use of indoor tanning facilities in the past 12 months.  Interestingly, more than 90% of college users of tanning beds report that they are aware of the risks of premature aging and skin cancer associated with their use.¹⁹

Several factors motivate teens to use indoor tanning facilities.  Many of these are appearance-related. Today, tanning is considered to not only be attractive but is also considered healthy by most of the population.  However, most indoor tanners do not visit tanning facilities for the health benefits, but to look better, relax, enjoy warmth and light, and achieve an elevated mood.^{3, 12, 19}  Many teens see it as a social activity to do with friends, and more than 50% report going to a tanning salon for the first time with friends.¹²  Several studies have suggested the addictive nature of tanning.  Ultraviolet light exposure activates p53, a tumor suppressor gene, which induces transcription of the pro-opiomelanocortin (POMC) gene and leads to increased melanogenesis and transfer of melanosomes to keratinocytes.  This results in tanning and epidermal release of beta-endorphin, an opioid which causes a sense of well-being and reinforces the stimulus to tan.^{3, 20}

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