Teens and Indoor Tanning: A Cancer Prevention Opportunity for Pediatricians

In October 2011, California became the first US state to ban indoor tanning for minors under age 18 years. Vermont followed in May 2012. Increasingly, scientific evidence shows that artificial tanning raises the risk of skin cancer, including melanoma, a common cancer in adolescents and young adults and the type most likely to result in death. The World Health Organization, the American Academy of Pediatrics, the American Academy of Dermatology, the American Medical Association, and other organizations strongly recommend legislation to ban minors under age 18 from indoor tanning. Several nations have banned teen tanning. Yet, tanning in salons is still a prevalent practice in the United States, especially among teen girls, where rates for the oldest teens approach 40%. There is no federal legislation to restrict minors from salon tanning. More than 60% of states have some kind of legislation regarding minors’ use of tanning salons, but only California and Vermont have passed complete bans of indoor tanning for minors. The Indoor Tanning Association, an industry advocacy group, has vigorously opposed legislative efforts. Pediatricians can play key roles in counseling families and with legislative efforts. In this update, we review the prevalence of salon tanning, association with skin cancer risk, tanning addiction, the roles of the federal and state governments in regulation and legislation, and responses to arguments created by industry to oppose legislation. Preventing exposure to artificial tanning may save lives, including young lives, and is a key cancer prevention opportunity for pediatricians.

[1]  S. Feldman,et al.  Incidence Estimate of Nonmelanoma Skin Cancer (Keratinocyte Carcinomas) in the U.S. Population, 2012. , 2015, JAMA dermatology.

[2]  V. Moyer Vitamin D and Calcium Supplementation to Prevent Fractures in Adults: U.S. Preventive Services Task Force Recommendation Statement , 2013, Annals of Internal Medicine.

[3]  R. Dellavalle,et al.  Indoor Tanning Regulation, Enforcement, Taxation, and Policy , 2012 .

[4]  Peter Boyle,et al.  Cutaneous melanoma attributable to sunbed use: systematic review and meta-analysis , 2012, BMJ : British Medical Journal.

[5]  V. Moyer Behavioral Counseling to Prevent Skin Cancer: U.S. Preventive Services Task Force Recommendation Statement , 2012, Annals of Internal Medicine.

[6]  H. Jacobe,et al.  Activation of the mesostriatal reward pathway with exposure to ultraviolet radiation (UVR) vs. sham UVR in frequent tanners: a pilot study , 2012, Addiction biology.

[7]  Lawrence E Gibson,et al.  Increasing incidence of melanoma among young adults: an epidemiological study in Olmsted County, Minnesota. , 2012, Mayo Clinic proceedings.

[8]  D. Taddeo,et al.  Banning children and youth younger than 18 years of age from commercial tanning facilities. , 2012, Paediatrics & child health.

[9]  G. Guy,et al.  Use of Indoor Tanning Devices by High School Students in the United States, 2009 , 2011, Preventing chronic disease.

[10]  G. Giles,et al.  Sunbed use during adolescence and early adulthood is associated with increased risk of early‐onset melanoma , 2011, International journal of cancer.

[11]  H. Brumberg,et al.  Ultraviolet Radiation: A Hazard to Children and Adolescents , 2011, Pediatrics.

[12]  H. Jacobe,et al.  Addictive‐like behaviours to ultraviolet light among frequent indoor tanners , 2011, Clinical and experimental dermatology.

[13]  J. Hillhouse,et al.  The effect of initial indoor tanning with mother on current tanning patterns. , 2010, Archives of dermatology.

[14]  B. Adinoff,et al.  Tanning as a Behavioral Addiction , 2010, The American journal of drug and alcohol abuse.

[15]  M. Weinstock,et al.  Indoor Tanning and Risk of Melanoma: A Case-Control Study in a Highly Exposed Population , 2010, Cancer Epidemiology, Biomarkers & Prevention.

[16]  J. Robinson Consider tanning motivations and counsel accordingly. , 2010, JAMA.

[17]  H. Adami,et al.  Sun and Solarium Exposure and Melanoma Risk: Effects of Age, Pigmentary Characteristics, and Nevi , 2010, Cancer Epidemiology, Biomarkers & Prevention.

[18]  M. Weinstock,et al.  Youth access to artificial UV radiation exposure: practices of 3647 US indoor tanning facilities. , 2009, Archives of dermatology.

[19]  Donald R. Miller,et al.  Melanoma in middle-aged and older men: a multi-institutional survey study of factors related to tumor thickness. , 2009, Archives of dermatology.

[20]  J. Weeks,et al.  Density of indoor tanning facilities in 116 large U.S. cities. , 2009, American journal of preventive medicine.

[21]  J. Lash Statement To the U.S. House of Representatives Committee on Energy and Commerce , 2009 .

[22]  M. Tucker,et al.  Recent trends in incidence of cutaneous melanoma among US Caucasian young adults. , 2008, The Journal of investigative dermatology.

[23]  S. Woodruff,et al.  Enforcement of State Indoor Tanning Laws in the United States , 2008, Preventing chronic disease.

[24]  A. Geller,et al.  Teenagers and Artificial Tanning , 2008, Pediatrics.

[25]  Michael C R Alavanja,et al.  Cutaneous melanoma and obesity in the Agricultural Health Study. , 2008, Annals of epidemiology.

[26]  A. Shields,et al.  Patterns of indoor tanning use: implications for clinical interventions. , 2007, Archives of dermatology.

[27]  B. Diffey Sunbeds, beauty and melanoma , 2007, The British journal of dermatology.

[28]  R. Hornung,et al.  Tanning Device Usage: What Are Parents Thinking? , 2007, Pediatric dermatology.

[29]  David E. Fisher,et al.  Central Role of p53 in the Suntan Response and Pathologic Hyperpigmentation , 2007, Cell.

[30]  M. Weinstock,et al.  Trends in Sunburns, Sun Protection Practices, and Attitudes Toward Sun Exposure Protection and Tanning Among US Adolescents, 1998–2004 , 2006, Pediatrics.

[31]  S. Feldman,et al.  Plasma beta-endorphin levels in frequent and infrequent tanners before and after ultraviolet and non-ultraviolet stimuli. , 2006, Journal of the American Academy of Dermatology.

[32]  S. Feldman,et al.  Induction of withdrawal-like symptoms in a small randomized, controlled trial of opioid blockade in frequent tanners. , 2006, Journal of the American Academy of Dermatology.

[33]  D. Siegel,et al.  The indoor UV tanning industry: a review of skin cancer risk, health benefit claims, and regulation. , 2005, Journal of the American Academy of Dermatology.

[34]  C. Vachon,et al.  Incidence of basal cell and squamous cell carcinomas in a population younger than 40 years. , 2005, JAMA.

[35]  R. Wagner,et al.  UV light tanning as a type of substance-related disorder. , 2005, Archives of dermatology.

[36]  A. Jemal,et al.  Cancer incidence patterns among adolescents and young adults in the United States , 2005, Cancer Causes & Control.

[37]  K. Emmons,et al.  Maternal/female caregiver influences on adolescent indoor tanning. , 2004, The Journal of adolescent health : official publication of the Society for Adolescent Medicine.

[38]  P. Autier Perspectives in melanoma prevention: the case of sunbeds. , 2004, European journal of cancer.

[39]  K. O'Connor,et al.  Counseling Parents and Children on Sun Protection: A National Survey of Pediatricians , 2004, Pediatrics.

[40]  K. Emmons,et al.  Characteristics associated with use or intention to use indoor tanning among adolescents. , 2004, Archives of pediatrics & adolescent medicine.

[41]  S. Feldman,et al.  Ultraviolet exposure is a reinforcing stimulus in frequent indoor tanners. , 2004, Journal of the American Academy of Dermatology.

[42]  R. Dellavalle,et al.  Youth access laws: in the dark at the tanning parlor? , 2003, Archives of dermatology.

[43]  T. Gambichler,et al.  Plasma levels of opioid peptides after sunbed exposures , 2002, The British journal of dermatology.

[44]  B. Cribier,et al.  Variations of basal cell carcinomas according to gender, age, location and histopathological subtype , 2002, The British journal of dermatology.

[45]  Michael J Thun,et al.  Use of indoor tanning sunlamps by US youth, ages 11-18 years, and by their parent or guardian caregivers: prevalence and correlates. , 2002, Pediatrics.

[46]  Karen Emmons,et al.  Use of sunscreen, sunburning rates, and tanning bed use among more than 10 000 US children and adolescents. , 2002, Pediatrics.

[47]  Y. Shyr,et al.  Basal cell carcinoma in young women: an evaluation of the association of tanning bed use and smoking. , 2002, Journal of the American Academy of Dermatology.

[48]  S. le Cessie,et al.  Total body exposure to ultraviolet radiation does not influence plasma levels of immunoreactive β‐endorphin in man , 2001, Photodermatology, photoimmunology & photomedicine.

[49]  N. Jablonski,et al.  The evolution of human skin coloration. , 2000, Journal of human evolution.

[50]  H. Olsson,et al.  Risk of cutaneous malignant melanoma in relation to use of sunbeds: further evidence for UV-A carcinogenicity , 2000, British Journal of Cancer.

[51]  G. Fabbrocini,et al.  What do young people think about the dangers of sunbathing, skin cancer and sunbeds? A questionnaire survey among Italians , 2000, Photodermatology, photoimmunology & photomedicine.

[52]  C. Begg,et al.  Screening for cutaneous melanoma by skin self-examination. , 1996, Journal of the National Cancer Institute.

[53]  E. White,et al.  Case-control study of malignant melanoma in Washington State. I. Constitutional factors and sun exposure. , 1994, American journal of epidemiology.

[54]  A. Emmett Surgical analysis and biological behaviour of 2277 basal cell carcinomas. , 1990, The Australian and New Zealand journal of surgery.

[55]  G. Xakellis,et al.  Evaluation by Second‐Year Medical Students of Their Computer‐Aided Instruction , 1990, Academic medicine : journal of the Association of American Medical Colleges.

[56]  W. Willett,et al.  Nonfamilial cutaneous melanoma incidence in women associated with sun exposure before 20 years of age. , 1989, Pediatrics.

[57]  Harry L. Arnold,et al.  American Academy of Dermatology , 1980 .

[58]  S. Manne,et al.  Shedding Light on Indoor Tanning , 2012, Springer Netherlands.

[59]  Khoa Nguyen Indoor Tanning — Science, Behavior, and Policy , 2012 .

[60]  B. Glick Addiction to Indoor Tanning: Relation to Anxiety, Depression, and Substance Use , 2011 .

[61]  J. L. Smith,et al.  Incidence Estimate of Nonmelanoma Skin Cancer in the United States, 2006 , 2011 .

[62]  D. Rigel,et al.  Adverse effects of ultraviolet radiation from the use of indoor tanning equipment: time to ban the tan. , 2011, Journal of the American Academy of Dermatology.

[63]  M. Weinstock,et al.  Indoor tanning use among adolescents in the US, 1998 to 2004 , 2009, Cancer.

[64]  J. Stockman Trends in Sunburns, Sun Protection Practices, and Attitudes Toward Sun Exposure Protection and Tanning Among US Adolescents, 1998–2004 , 2008 .

[65]  The association of use of sunbeds with cutaneous malignant melanoma and other skin cancers: A systematic review , 2007, International journal of cancer.

[66]  J. R. Scotti,et al.  Available From , 1973 .

[67]  E. Schor The Henry J. Kaiser Family Foundation. , 1990, Academic medicine : journal of the Association of American Medical Colleges.