Objectives-We sought to describe the development of an instrument to quantify the stringency of state indoor tanning legislation in the United States, and the instrument's psychometric properties. The instrument was then used to rate the stringency of state laws.Methods-A 35-item instrument was developed. An overall stringency measure and 9 stringency subscales were developed, including one measuring minors' access to indoor tanning. Stringency measures showed good internal consistency and interrater reliability.Results-In all, 55% of the 50 states and the District of Columbia had any indoor tanning law, and 41% had any law addressing minors' access. Oregon, Illinois, South Carolina, Florida, Indiana, Iowa, and Rhode Island had high overall stringency scores, and Texas and New Hampshire were the most restrictive with regard to minors' access.
Limitations-Measurement of actual enforcement of the laws was not included in this study.Conclusions-The instrument appears to be an easy-to-use, reliable, and valid methodology. Application of the instrument to actual laws showed that, in general, state laws are relatively weak, although there was considerable variability by state.Skin cancer rates in the United States are high, with an estimated 62,190 cases of melanoma and more than 1 million cases of nonmelanoma skin cancer diagnosed in 2006. 1 Exposure to ultraviolet (UV) lamps through indoor tanning is a risk factor for both melanoma 2,3 and nonmelanoma skin cancer, 4 can cause acute skin and ocular damage, 5-9 and causes molecular damage associated with skin cancer. 10According to the US indoor tanning industry, as of 2006 the industry is worth $5 billion, has a customer base of 30 million, and serves approximately 10% of the US public annually. 11 The use of indoor tanning by adolescents is particularly disturbing. 12-14 Approximately 10%
METHODS
Instrument developmentWe developed a comprehensive instrument to measure the restrictiveness/stringency of state indoor tanning laws, with an emphasis on minors' access. The goal was to develop an instrument that would grade the stringency on ordinal scales when possible (ie, weakest or no provision, to most restrictive), rather than simple presence/absence measures. In addition, we wanted to create a practical instrument that was easy to use with little training. We wanted to avoid range effects by providing response options that left room at the higher (ie, more restrictive) end, making the instrument applicable even as state indoor tanning laws change.Development of the stringency instrument began with reviewing similar instruments assessing quality of state tobacco control policies, 23-28 reviewing the scant literature on the characteristics of indoor tanning laws to identify important stringency dimensions/areas, 13,15,16,20,21 and reading several of the state indoor tanning laws to identify key elements. Items were then constructed and organized into broader topic areas. Feedback from the project's multidisciplinary research team (ie, health economics, health...