Dermatology Association Calls for Tighter Regulations on Indoor Tanning

For most teens, getting a tan during spring break or in preparation for the prom is as common as these rites of passage themselves. Although teens hear dermatologists' warnings that tanning is the most avoidable risk factor in the prevention of skin cancer, studies find they forgo this advice in favor of the bronzed look.
Speaking at the American Academy of Dermatology's (AAD) Melanoma/Skin Cancer Detection and Prevention Month news conference, dermatologist James M. Spencer, M.D., vice chairman, department of dermatology, Mount Sinai School of Medicine in New York City, addressed the incidence of teens and tanning and how the AAD is trying to combat it.
Alarming Trends This year, more than 1 million new cases of skin cancer will be diagnosed in the United States – exceeding the incidence of all other cancers combined. It is estimated that there will be about 95,880 new cases of melanoma (the deadliest form of skin cancer) in 2004, which represents a 4 percent increase in new cases of melanoma from 2003.
"While many health issues are complex and involve multiple factors, in the case of skin cancer we know that ultraviolet light is the culprit and avoiding excessive exposure is the solution," said Dr. Spencer. "Yet despite this knowledge, the number of skin cancers continues to rise each year. Even more disheartening is the fact that teens continue to tan despite the known health risks."
A national study of 6,903 non-Hispanic white adolescents – between the ages of 13 and 19 – found that indoor tanning is not only prevalent, but influenced by factors such as demographics, the use of controlled substances (e.g., alcohol, tobacco and marijuana), appearance-related factors (e.g., dieting), and psychosocial factors (e.g., cognitive ability). The study, "Use of Indoor Tanning Facilities by White Adolescents in the United States," was published in the September 2003 issue of Archives of Pediatric Adolescent Medicine.
Overall, when taking the national population into consideration, the number of young women who reported using a tanning booth at least once far outweighed the number of young men who engaged in this activity (36.8 percent vs. 11.2 percent, respectively). The number of young women who reported using tanning booths also increased with age. The study found that 47 percent of young women aged 18 to 19 years old reported using a tanning booth three or more times, compared with 11.2 percent of 13- to 14-year-old girls.
Geographic region greatly influenced the likelihood of using an indoor tanning facility, with adolescents in the Midwest and South being two to three times more likely to use tanning booths than the rest of the country. In addition, teens that attended a rural high school were more likely to report using an indoor tanning facility than their counterparts at urban high schools.
"This study confirms that despite the risk, indoor tanning seems to be increasingly popular with young people – and particularly young women," said Dr. Spencer. "It's unfortunate that the pressure these teens face to conform to cosmetic ideals presented in popular culture and advertising is so powerful, even with all we know about the dangers of tanning."
Dermatologists Take Action
Indoor tanning is a booming business in the United States, generating estimated revenues in excess of $5 billion dollars a year. Most salons use bulbs in their tanning beds that emit a significant amount of UVB and UVA radiation – both of which are associated with the development of skin cancer and premature aging. In fact, the Department of Health and Human Services has added UV radiation from the sun or artificial light sources such as tanning beds and sun lamps to the government's list of known carcinogens.
The manufacturers of indoor tanning equipment are regulated at the federal level. Once manufacturers sell the equipment to a tanning salon, it is generally up to the states to regulate their operations. While 29 states regulate tanning salon operators, the legislation varies in severity and there is limited enforcement. While some states go so far as to prohibit access to tanning booths by minors without parental consent, some require salon owners to post warning signs in a visible location in the salon, and others may only establish educational and training standards for tanning salon operators.
"Even in those states that have some elementary safety regulations, it is not clear who would enforce them," explained Dr. Spencer. "That means children and teens have open access to equipment that appears to be utilized in an often careless fashion. We applaud states like Texas, California and Tennessee that have worked feverishly to enact tough legislation restricting the use of indoor tanning facilities, especially among minors. But more states need to take their lead and enforce regulations that limit access to this dangerous activity."
The American Academy of Dermatology Association (AADA) recently issued a new position statement on indoor tanning, encouraging states to aggressively pursue legislation that protects children and urging the Food and Drug Administration (FDA) to take action that will ban the sale and use of tanning equipment for non-medical purposes. Specifically, the AADA supports the following requirements for indoor tanning facilities:
No minor should be permitted to use tanning devices. A Surgeon General's warning should be placed on all tanning devices.
No person or facility should advertise the use of any Ultraviolet A or Ultraviolet B tanning device using wording such as "safe," "safe tanning," "no harmful rays," "no adverse effect," or similar wording or concepts.
"Throughout most of the country, none of the basic safety measures that we are proposing are required," explained Dr. Spencer. "Research has shown that indoor tanning is dangerous, and there should be laws to protect children from engaging in this activity as there are from other unhealthy behaviors such as drinking or smoking. We urge all states to take immediate action to prohibit indoor tanning for minors."
In addition to the AADA's call for tighter regulations, the AAD is targeting teens with print and broadcast public service announcements (PSAs) on the dangers of tanning that are scheduled to be released nationwide to the media this summer.
"We conducted focus group testing with teens across the country and found that while teens know that overexposure to the sun can cause skin cancer and premature aging, they are reluctant to change their behavior because they feel more attractive with a tan," said Dr. Spencer. "For our new PSA campaign, we used this research to develop the messages and images that almost force teens to stop and re-examine their behavior. If we're successful in getting even one teen to change his or her behavior, that's one life we eventually might save."