Prevalence and correlates of intentional outdoor and indoor tanning among adolescents in the United States: Findings from the FLASHE survey

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.

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“…Forest plot for past‐year exposure in adults and college students. Table S1 Studies included in the meta‐analysis …”

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confidence: 99%

Indoor tanning prevalence after the International Agency for Research on Cancer statement on carcinogenicity of artificial tanning devices: systematic review and meta‐analysis

et al. 2019

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“…For example, young people who report frequent use of sunscreen, a skin protective behaviour, have been found to be more likely to use indoor tanning beds than people who use less sunscreen (Heckman et al, 2008). In a USA national study on adolescents' indoor and outdoor tanning behaviours, researchers found that outdoor tanning was significantly higher among non-Hispanic White girls and those who spent more time on cell phones (Niu et al, 2018). Indoor tanning rates were significantly higher among participants who spent more time on a computer or cell phone.…”

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confidence: 99%

Entertainment, social media use and young women’s tanning behaviours

Willoughby

Myrick

2018

Health Education Journal

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Objective: While research suggests media use is positively associated with skin-damaging behaviours, especially among US college-aged women, less is known about the role of specific media types in potentially promoting indoor or outdoor tanning. Design: We used an online survey to examine the relationship between demographic variables, entertainment media and social media use, attitudes towards looking like people in the media and indoor tanning and outdoor sunbathing frequency. Setting: US Pacific Northwest. Method: Online survey with a convenience sample of college women ( N = 502) in September 2016. Results: Attitudes towards looking like people in media were a significant predictor of frequency of indoor and outdoor tanning, above and beyond demographic variables and media use. Greater magazine use predicted increased indoor tanning and social media use predicted outdoor sunbathing frequency. Greater use of visual-oriented social media platforms like Instagram, SnapChat and Pinterest predicted increased sunbathing. Conclusion: Health communicators should consider specific channels for prevention efforts, particularly social media for targeting sunbathers.

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“…This supposition is also in line with mood management theory, which argues that people often seek stimuli (be it a behavior or a media message) that help them achieve a more positive mood [33,34]. For example, recent work using the National Cancer Institute's Family Life, Activity, Sun, Health, and Eating (FLASHE) cross-sectional survey found that adolescents who reported being frequent outdoor tanners were more likely to experience loneliness than adolescents who reported they did not tan outdoors [7]. Although more research is needed to understand this relationship, it could be that adolescents in the survey tanned outdoors in order to reap the positive emotional benefits that could help them cope with feelings of loneliness.…”

Section: Emotions and Tanningmentioning

confidence: 98%

“…In US culture, tan skin is a commonly held beauty standard, and women often engage in outdoor or indoor tanning to achieve this standard. Although previous research has observed how media sources such as television [38] and magazines [35,36] influence tanning behaviors, a recent focus has been on social media [6,7]. Social media expands on traditional media platforms, as there are greater opportunities to interact within the media and exchange images.…”

Section: Social Media and Tanningmentioning

confidence: 99%

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Associations Between Emotions, Social Media Use, and Sun Exposure Among Young Women: Ecological Momentary Assessment Study

Willoughby¹,

Myrick²,

Gibbons³

et al. 2020

JMIR Dermatol

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Background Research has pointed to a connection between social media use, emotions, and tanning behaviors. However, less is known about the role specific emotions may play in influencing social media use and how emotions and social media use may each be associated with outdoor tanning. Objective This paper aims to examine the connection between emotions, social media use, and outdoor tanning behaviors among young women, a group particularly important for skin cancer prevention efforts. Methods We used ecological momentary assessment to collect data from 197 women aged 18 to 25 years 3 times a day for 7 days in July 2018. We collected data from women in 2 states. Results We found that boredom was associated with increased time spent on social media and that increased time spent on social media was associated with increased time spent outdoors without sun protection. Conclusions Our results highlight that social media may be a particularly important channel for skin cancer prevention efforts targeting young women, as more social media use was associated with increased time spent outdoors with skin exposed. Researchers should consider the role of emotions in motivating social media use and subsequent tanning behaviors. Additionally, as boredom was associated with social media use, intervention developers would benefit from developing digital and social media interventions that entertain as well as educate.

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Prevalence and correlates of intentional outdoor and indoor tanning among adolescents in the United States: Findings from the FLASHE survey

Cited by 8 publications

References 17 publications

Indoor tanning prevalence after the International Agency for Research on Cancer statement on carcinogenicity of artificial tanning devices: systematic review and meta‐analysis

Indoor tanning prevalence after the International Agency for Research on Cancer statement on carcinogenicity of artificial tanning devices: systematic review and meta‐analysis

Entertainment, social media use and young women’s tanning behaviours

Associations Between Emotions, Social Media Use, and Sun Exposure Among Young Women: Ecological Momentary Assessment Study

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