Assessment of Compliance With Texas Legislation Banning Indoor UV Tanning by Minors

Abstract

Indoor tanning (IT) before age 35 years increases melanoma risk by 59%. 1 Indoor tanning before 18 years increases risk by 85%. 2 In 2013, 1.6 million US youth younger than 18 years reported IT. 3 Multiple states have passed legislation banning IT by minors, but compliance by IT facilities is largely unknown. We evaluated Texas IT facilities' compliance with the state's 2013 ban on IT by individuals younger than 18 years.Methods | Female employees, aged 17 to 19 years, of a mystery shopping firm posed as 17-year-old potential customers and called IT facilities to inquire about using tanning beds. In July 2015, 1681 facilities were identified from the Texas Department of State Health Services. Ineligible facilities were fitness centers (n = 349), campus housing and/or residential apartments (n = 198), retail outlets unsuitable for minors (n = 3), or not licensed (n = 302). Eligible facilities (n = 829) were contacted July through August 2015. Excluding facilities that no longer offered IT (n = 13), were unreachable (n = 173), or had missing call data (n = 8), 635 (77% of eligible) study facilities were identified: 445 (70%) free-standing establishments that provided IT exclusively and 133 (21%) beauty salons and/or spas and 57 (9%) retail businesses that housed an IT device.Shoppers followed a script that mimicked conversation between a potential teenage customer and IT facility (Table 1). Calls were audiorecorded, transcribed, and deidentified by the firm prior to analysis. Two independent coders analyzed transcripts to determine compliance and facilities' responses to questions about tanning frequency and burn risk. Coding dis-crepancies were resolved through discussion. The University of Texas MD Anderson Cancer Center's institutional review board determined that this study was not human subjects research and exempted it from requiring approval.Results | Overall, 81% (n = 512 of 632; 95% CI, 78%-84%) of facilities reportedly complied with the ban on tanning by minors. Reported compliance was associated with facility type (χ 2 = 21.74, df = 2; P < .001) and was highest in free-standing facilities (n = 380 of 444; 86%; 95% CI, 83%-89%), followed by retail businesses (n = 43 of 57; 75%; 95% CI, 64%-86%) and salons and/or spas (n = 89 of 131; 68%; 95% CI, 60%-76%). Of noncompliant facilities (n = 120 [19%]), most responded that shoppers could tan with (n = 43 [36%]) or without (n = 10 [8%]) a parent's note, or with parental accompaniment (n = 42 [35%]). Overall, 492 (83%) reported that clients could tan daily (Table 2). Most responded directly (384 [68%]) or indirectly ( 139[25%]) that a burn was possible.

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

“…While the majority of respondents from indoor tanning businesses did inform the female minor over the telephone that she was not allowed to use the facilities, nearly 20% told the minor that she could use the facility. This proportion of non-compliant respondents is similar to that reported in similar studies in California [13], Texas [18], and Wisconsin [17]. Earlier studies in several states reported even higher percentages of respondents who did not comply with state laws and restrictions regarding indoor tanning [14][15][16].…”

“…A study assessing industry compliance in California, the first state to pass an indoor tanning ban for minors, found that 77% of 338 indoor tanning facilities did not allow a researcher posing as a 17-year-old customer to make an appointment during a telephone call [13]. Studies of businesses in other states also reveal a lack of compliance with regulations and guidelines related to age of sale, safety, and communication of risks [14][15][16][17][18].…”

Tanning and Teens: Is Indoor Exposure the Tip of the Iceberg?

“…In summary, we join others (51, 52) in calling for heightened focus on skin cancer prevention research given increasing rates of melanoma in the United States (1), especially among young people (1, 9). More specifically, we advocate for research to understand the behavioral and attitudinal impact of IT regulation, and recent reductions in IT in the United States.…”

Differences in Sun Protection Behaviors Between Rural and Urban Communities in Texas

“…Clearly, increased physician counseling, targeting those at high risk and with a history of blistering sunburn, would be expected to yield benefit. In Texas, policy makers have been educated on the harms of indoor tanning and this has led to new legislation banning minors from using public tanning bed facilities in Texas . Although it is clear that much more work needs to be done, our current findings should further help guide cancer prevention and control activities across the state, particularly in the rural areas.…”