Tobacco control strategies may aid in preventing skin cancers caused by indoor tanning

December 8, 2014

Indoor tanning booths were once the domain of college-age and working women who toasted their pale skins in late winter, before donning a new strapless dress or the first bikini of the season.

Today, however, the authors of a new study call the indoor tanning craze “a present and emerging public health crisis.” Despite adverse health consequences, including skin cancers, eye damage, premature aging and burns, many people, both adults and youth, ignore documented dangers of indoor tanning and depend upon it as part of their regular beauty regimens.

The effects of ultraviolet light exposure are cumulative, which means those who start tanning early are more likely to experience its consequences. This is bad news, given that nearly 30 percent of white female high school students currently report having used a tanning bed in the past year, and more than 25 percent of all high school students report regular use (more than 20 times in the past year).

In an article published online Nov. 6 in the American Journal of Preventive Medicine, lead author Andrew B. Seidenberg, MPH, health behavior doctoral student at the UNC Gillings School of Global Public Health, and colleagues propose to combat the use of indoor tanning by teens, employing strategies already successfully used in campaigns to stop teen tobacco use.

Smoking and tanning have this in common, the authors note: both cause harm when used exactly as intended. If society is to counter teens’ attraction to pernicious products, strategies and evidence-based policies that target social, environmental and business aspects of the epidemic must be employed.

The authors draw lessons from tobacco control’s employment of price regulation, youth access, advertising restrictions and mass media campaigns – and propose ways those strategies can help decrease indoor tanning by teens.

For every 10 percent increase in the price of cigarettes, youth smoking declines by 7 percent, the authors note. Minimum pricing policies – and the banning of coupons, free samples and other incentives to override the higher cost – have proven effective in reducing teen smoking. In 2010, the Affordable Care Act added a 10 percent tax for indoor tanning, but few data have been collected about the impact of the tax. Study authors call for more research about how such a tax can be more effective, including earmarking tax funds for counter-advertising, research and education.

A 1992 law prohibited tobacco sales to those ages 18 and under. Between 1997 and 2011, tobacco sales to youth at retail outlets decreased from 40.1 percent to 8.5 percent. Other states have limited access by raising the legal age of smoking or placing additional restrictions on online tobacco sales. Despite encouragement from the American academies of pediatrics and dermatology, the U.S. is one of few developed nations that do not restrict use of indoor tanning to people over age 18.

The U.S. Food and Drug Administration only recently required that tanning beds include warning labels stating that people under 18 should not use the equipment, but the warning has no judicial backbone. The authors call for state and federal legislation to prevent teen use of tanning beds, sting operations that include fines and revocation of licensure for violators, and decreased availability of unsupervised tanning, such as in apartment complexes.

Television and radio advertising of cigarettes was banned in 1971, and a 1998 law prohibits ads that target youth, e.g., by using cartoons and displaying advertising in video arcades, malls and other places young people frequent. Just as the tobacco industry used deceptive techniques to attract young customers, so has the tanning industry. Sponsorship of beauty pageants and the employment of celebrities to market the industry’s services are widespread practices.

“Legislation restricting marketing of indoor tanning services and products may be needed to ensure the industry stops making fraudulent health claims and denials of risk,” the authors write.

Mass media campaigns, notably the “Truth Campaign,” which graphically portray the negative consequences of tobacco addiction, have been shown to reduce the number of youth who start smoking. In 2014, the Centers for Disease Control and Prevention launched a social media campaign on the dangers of indoor tanning, but more such campaigns are needed. Further research should identify which campaign themes are most effective.

Co-authors of the study are Aditya Mahalingam-Dhingra, MPH, of Yale University; Martin A. Weinstock, MD, PhD, professor of dermatology at Brown University; Craig Sinclair, BEd, MPPM, head of the World Health Organization’s Collaborative Centre for UV Radiation and director of the Cancer Prevention Centre at Cancer Council Victoria, in Victoria, Australia; and Allan C. Geller, MPH, RN, senior lecturer on social and behavioral sciences at Harvard University.

When the article was written, Seidenberg worked at the Harvard School of Public Health, now the Harvard T.H. Chan School of Public Health.