For decades, it has been well known that there is a strong correlation between the use of tanning beds, which emit ultraviolet rays, and skin cancer. Yet, tanning beds are widely used and readily available in communities throughout the United States and in other countries. In fact, according to an article published in 2015 in the American Journal of Preventive Medicine, almost 30 percent of white female high school students and 13 percent of all high school students reported tanning indoors during the previous year, and about 25 percent of the high school tanners had used a tanning bed more than 20 times during that same time period. The tanning rates rise dramatically during the teen years. Seven percent of teens who are 14 years old use indoor tanners; by the time they are 17 years old, the rate has risen to 35 percent. The article noted that “the popularity of indoor tanning beds has risen amid mounting evidence of adverse health consequences.” 1 Clearly, the use of tanning beds among younger people has become a serious public health concern.
In a study published in 2014 in the American Journal of Health Promotion, researchers from Pennsylvania, Oregon, and New Jersey wanted to learn more about the association between indoor tanning in young adult females and psychiatric and addictive symptoms. The cohort consisted of 306 female university students between the ages of 18 and 25 years, with an average age of 19.9 years. All of the women completed questionnaires and telephone interviews. The researchers found that 46 percent of the women reported a history of indoor tanning; of these, 25 percent were classified as “tanning dependent.” There was also a significant association between indoor tanning and the symptoms of alcohol use disorders and generalized anxiety and a marginal association with the symptoms of seasonal affective disorder. The researchers underscored the importance of their findings. “Not only is the association between tanning and skin cancer a significant public health concern, but the association between tanning and psychiatric and substance use disorders may represent an important mental health concern.” 2
In a study published in 2012 in the Journal of the American Academy of Dermatology, researchers from New Haven, Connecticut, examined the association between early exposure to indoor tanning and the early onset of basal cell cancer. The researchers identified 376 people with basal cell cancer and another 390 with minor benign skin conditions; all of the participants were under the age of 40 years and almost 70 percent were female. The participants provided detailed information on their use of indoor tanning. The researchers learned that the people who had ever used an indoor tanner had a 69 percent increased risk of early-onset basal cell cancer. The risk increased in those with years of regular indoor tanning, number of overall burns, and burns to biopsy site. According to the researchers, about 27 percent of all early onset basal cell cancers could be prevented if people never used indoor tanners. Moreover, women who tanned indoors were two times more likely to have basal cell cancer than women who never tanned indoors. In addition, indoor tanning was strongly associated with basal cell cancers that were located on the trunk and extremities, body sites that are particularly exposed during indoor tanning. The researchers concluded that “both policy-based and behavioral interventions to restrict or reduce indoor tanning in young people are needed to alter the increasing incidence of this most common human malignancy.” 4
In a study published in 2013 in the Journal of the American Academy of Dermatology, researchers from Pennsylvania and California noted that in 2011 California became the first state to pass a ban on indoor tanning for those under the age of 18 years. Since then, several other states have followed. But has the ban actually prevented younger people from tanning? A researcher posing as a 17-year-old teen contacted 338 tanning operations throughout California and asked to make an appointment. When she noted her age, 77 percent of the tanning salons refused to schedule a time. That means that in almost one-quarter of the salons the researcher could schedule tanning. Of these, 12 percent said that she could come and 11 percent said that she could come with parental consent. One facility indicated that she could tan with a doctor’s note and another said to come and discuss the situation in person. Even more alarming is the fact that almost 80 percent of the tanning facilities told the researcher that when she turned 18, she could tan daily, as often as she wanted. When asked about any risks associated with tanning, 61 percent of the facilities denied there was any danger. Almost half of the facilities noted that tanning increased the body’s production of vitamin D. Some indicated that tanning was useful for medical conditions such as acne, eczema, psoriasis, depression, and arthritis. The researchers commented that “California has substantial work ahead to achieve more uniform compliance.” 6
In a study published in 2010 in the journal Clinical and Experimental Dermatology, researchers from Dallas, Texas, assessed the presence of addictive-like behaviors in people who frequently use indoor tanning facilities. The cohort consisted of 64 women and 36 men who completed two questionnaires; their mean age was 29.3 years. In total, 41 of the subjects met the criteria of tanning addictive behavior and an additional 33 met the criteria for problematic tanning behavior. That means that 74 of the 100 participants reported some level of aberrant tanning behaviors. The researchers concluded that “a high percentage of subjects who tan frequently in indoor salons experience behaviours and consequences to their tanning consistent with other identified addictive disorders.” 8
1. Andrew B. Seidenberg, Aditya Mahalingam-Dhingra, Martin A. Weinstock et al., “Youth Indoor Tanning and Skin Cancer Prevention,” American Journal of Preventive Medicine 48, no. 2 (2015): 188-94.
2. Carolyn J. Heckman, Jessye Cohen-Filipic, Susan Darlow et al., “Psychiatric and Addictive Symptoms of Young Adult Female Indoor Tanners,” American Journal of Health Promotion 28, no. 3 (2014): 168-74.
3. Mingfeng Zhang, Abrar A. Qureshi, Alan C. Geller et al., “Use of Tanning Beds and Incidence of Skin Cancer,” Journal of Clinical Oncology 30, no. 14 (2012): 1588-93.
4. Leah M. Ferrucci, Brenda Cartmel, Annette M. Molinaro et al., “Indoor Tanning and Risk of Early-Onset Basal Cell Carcinoma,” Journal of the American Academy of Dermatology 67, no. 4 (2012): 552-62.
5. Sherry L. Pagoto, Stephenie C. Lemon, Jessica L. Oleski et al., “Availability of Tanning Beds on US College Campuses,” JAMA Dermatology 151, no. 1 (2015): 59-63.
6. Sungat K. Grewal, Ann F. Haas, Mark J. Pletcher et al., “Compliance by California Tanning Facilities with the Nation’s First Statewide Ban on Use Before the Age of 18 Years,” Journal of the American Academy of Dermatology 69, no. 6 (2013): 883-89.
7. Derek D. Reed, “Ultra-Violet Indoor Tanning Addiction: A Reinforcer Pathology Interpretation,” Addictive Behaviors 41 (2015): 247-51.
8. C. R. Harrington, T. C. Beswick, J. Leitenberger et al., “Addictive-Like Behaviours to Ultraviolet Light Among Frequent Indoor Tanners,” Clinical and Experimental Dermatology 36 (2010): 33-38.
Banerjee, Smita C., Jennifer L. Hay, Alan C. Geller et al. “Quitting the ‘Cancer Tube’: A Qualitative Examination of the Process of Indoor Tanning Cessation.” Translational Behavioral Medicine 4, no. 2 (2014): 209-19.
Ferrucci, Leah M., Brenda Cartmel, Annette M. Molinaro et al. “Indoor Tanning and Risk of Early-Onset Basal Cell Carcinoma.” Journal of the American Academy of Dermatology 67, no. 4 (2012): 552-62.
Grewal, Sungat K., Ann F. Haas, Mark J. Pletcher et al. “Compliance by California Tanning Facilities with the Nation’s First Statewide Ban on Use Before the Age of 18 Years.” Journal of the American Academy of Dermatology 69, no. 6 (2013): 883-89.
Harrington, C. R., T. C. Beswick, J. Leitenberger et al. “Addictive-Like Behaviours to Ultraviolet Light Among Frequent Tanners.” Clinical and Experimental Dermatology 36 (2010): 33-38.
Heckman, Carolyn J., Jessye Cohen-Filipic, Susan Darlow et al. “Psychiatric and Addictive Symptoms of Young Adult Female Indoor Tanners.” American Journal of Health Promotion 28, no. 3 (2014): 168-74.
Heckman, Carolyn J., Teja Munshi, Susan Darlow et al. “The Association of Tanning Behavior with Psychotropic Medication Use Among Young Adult Women.” Psychology, Health & Medicine 21 (2016): 60-66.
Mosher, Catherine, and Sharon Danoff-Burg. “Addiction to Indoor Tanning: Relation to Anxiety, Depression, and Substance Use.” Archives of Dermatology 146, no. 4 (2010): 412-17.
Pagoto, Sherry L., Stephenie C. Lemon, Jessica L. Oleski et al. “Availability of Tanning Beds on U.S. College Campuses.” JAMA Dermatology 151, no. 1 (2015): 59-63.
Reed, Derek D. “Ultra-Violet Indoor Tanning Addiction: A Reinforcer Pathology Interpretation.” Addictive Behaviors 41 (2015): 247-51.
Seidenberg, Andrew B., Aditya Mahalingam-Dhingra, Martin A. Weinstock et al. “Youth Indoor Tanning and Skin Cancer Prevention.” American Journal of Preventive Medicine 48, no. 2 (2015): 188-94.
Zhang, Mingfeng, Abar A. Qureshi, Alan C. Geller et al. “Use of Tanning Beds and Incidence of Skin Cancer.” Journal of Clinical Oncology 30, no. 14 (2012): 1588-93.
American Academy of Dermatology. www.aad.org .
U.S. Food and Drug Administration. www.fda.gov .