Summary Background Exposure to artificial tanning devices is carcinogenic to humans, and government regulations to restrict or ban indoor tanning appear to be increasing. Objectives We evaluated changes in the international prevalence of indoor tanning among adolescents and adults after artificial tanning devices were classified as carcinogenic by the International Agency for Research on Cancer (IARC) in 2009. Methods Systematic searches in PubMed and Web of Science databases were undertaken. Overall, 43 studies reporting ‘ever’ or ‘past‐year’ indoor tanning exposure after 2009 were identified. We used metaregression analysis to evaluate the prevalence of indoor tanning over time. Random effects meta‐analysis was used to summarize the prevalence of indoor tanning in adolescents and adults according to sex, region and presence of age prohibitions. Results Global prevalence of indoor tanning in adolescents for 2013–2018 was 6·5% [95% confidence interval (CI) 3·3–10·6], 70% lower than the 22·0% (95% CI 17·2–26·8) prevalence for 2007–2012. Among adults, the prevalence was 10·4% (95% CI 5·7–16·3) for 2013–2018, a decrease of 35% from 18·2% for 2007–2012. Since 2009, the overall past‐year prevalence among adolescents was 6·7% (95% CI 4·4–9·6) and 12·5% (95% CI 9·5–15·6) among adults. The prevalence of tanning indoors in the past year was similar in North America (adults, 12·5%; adolescents, 7·6%) and Europe (adults, 11·1%; adolescents, 5·1%). In 2009, three countries had regulations restricting indoor tanning, compared with 26 countries today. Conclusions Prevalence of indoor tanning has declined substantially and significantly in adolescents and adults since the 2009 IARC statement, reflecting the rise in regulations that limit this source of unnecessary exposure to carcinogenic ultraviolet radiation. What is already known about this topic? Indoor tanning is associated with an increased risk of melanoma. A meta‐analysis of worldwide indoor tanning prevalence for 1986–2012 found a past‐year prevalence of 18% in adolescents and 14% in adults, with higher prevalences during the period 2007–2012. Policies to regulate indoor tanning began to be implemented across the globe in 2009. Only one study carried out in the U.S.A. has evaluated the efficacy of such policies in reducing indoor tanning prevalence. What does this study add? For the period 2013–2018, we found indoor tanning prevalences of 6·7% in adolescents and 11·9% in adults. This implies a reduction in indoor tanning use of 70% in adolescents and 35% in adults during the last 10 years. Our study encourages policy makers to strengthen indoor tanning regulations that reduce sunbed use among the general population in order to produce maximum public health benefit.

Background A long‐term complication among organ transplant recipients (OTRs) is skin malignancies which are associated with level and duration of immunosuppressive treatment, sun exposure and age. Dermatological surveillance is recommended for OTRs at high risk of skin malignancies, but evidence is lacking on the benefits of such services. Objective To examine the economic impact on patients and on the hospital service of a multidisciplinary high‐throughput skin cancer clinic in Brisbane, Australia, dedicated to dermatological and surgical care of high‐risk OTRs. Methods In a pre/postdesign, hospital admission and cost data were obtained for 101 consecutively enrolled study participants from 12 months prior to the introduction of the clinic (to February 2016), the 3‐month ‘run‐in’ period (March to May 2016) and 12 months subsequent (to June 2017). Differences between pre‐ and post‐clinic hospital costs were tested using non‐parametric bootstrapping and interrupted time series analysis. A survey of patient out‐of‐pocket costs and perceived financial burden was also undertaken during the clinic. Results Overall hospital costs were higher after the clinic but 3‐monthly hospital costs for skin procedures trended downwards. Despite 3‐monthly mean, hospital visits increasing from 85 to 314, mean 3‐monthly costs reduced by AU$1491 (P < 0.001) indicating greater cost efficiency. Total patient out‐of‐pocket costs were AU$18 377 over 3 months. Conclusion Clinical costing data revealed higher, more rapid throughput and significantly lower per patient costs pre‐ and postestablishment of a multidisciplinary skin cancer clinic for OTRs.

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