While some recognize the health-related risk, tanning bed use has not been classified as such. Adolescence has shown to be a time for experimentation and risk taking21, with frequent tanning bed use among adolescents associated with a variety of other risky health behaviors. Studies have shown association with being highly concerned about weight, using laxatives or vomiting to control weight, having friends who emphasize being thin, using tobacco products, binge drinking and using recreational drugs.18, 21 A study of college students22 concentrated on sensation-seeking, a personality trait that regulates the tendency to seek new and intense sensations and experiences. They found that young adults with sensation-seeking tendencies are more likely to have friends who use tanning beds and thus introduce positive attitudes regarding tanning bed use, and that this is a strong predictor of tanning bed use.22 These studies all demonstrated a correlation between tanning bed use, especially frequent use, and several other high-risk behaviors in young adults. This information in conjunction with the 75% increased risk of melanoma with tanning bed use before the age of 351 make a case that tanning beds should be considered a high-risk health behavior.
The tanning bed industry continues to grow despite the evidence linking ultraviolet radiation and skin cancer. It counters evidence of the dangers of ultraviolet radiation with those that reassure the public of the health benefits of indoor tanning. In an advertisement in the New York Times on March 26, 2008, the industry reported that there is “no compelling scientific evidence that tanning causes melanoma,” and that “exposure to all forms of ultraviolet light—both indoors and out—stimulates the natural production of vitamin D…vitamin D protects against heart disease and many types of cancer”.23 While research has provided evidence supporting association between vitamin D levels and cancer mortality and overall health, vitamin D can be easily obtained without the additional risks of ultraviolet radiation exposure.24 Also, recent studies have shown that exposure of the hands and face for only 0.5 to 2.0 hours per week is adequate for vitamin D biosynthesis.8
So what can be done? We must develop strategies to warn the public of the carcinogenic effects of indoor tanning.25 We must also counter the tanning industry’s and media’s messages that tan skin is more attractive by emphasizing the user’s future wrinkling and premature aging.5, 20 Furthermore, primary care physicians and dermatologists must counsel teens and young adults to avoid indoor tanning, especially in light of a recent study which indicated that young adults feel physicians are their most trusted source of information about tanning.12
Thus, we should take this opportunity to add ultraviolet light exposure and indoor tanning use to the list of commonly screened health risk behaviors about which physicians ask their patients. While we applaud the U.S. Preventative Services Task Force for their proposed guidelines on recommending that physicians talk to young people aged 10-24 about protecting themselves from ultraviolet radiation, we feel that everyone should be counseled on the health risks of ultraviolet radiation.26
Undoubtedly, the effort should also involve initiatives to limit youth access to the tanning industry, as without these restrictions, they will likely continue to accept the risk-taking behavior of tanning without considering the health risks.27 In addition, teens who tan become adults who perpetuate the same harmful behaviors to future generations. The WHO recommends that those under the age of 18 be restricted from using tanning beds “to protect the general population from additional risk for melanoma and squamous cell skin cancer”.3 Brazil has imposed a total ban on the use of indoor tanning devices, while France, Germany, Austria and the United Kingdom have banned indoor tanning for those less than 18 years old.5 As of May 2012, 32 states in the U.S. have laws in effect that restrict minors’ access to tanning facilities. These restrictions vary from parental consent or parental accompaniment to physician authorization and bans on tanning bed use. California is the first state to ban the use of tanning beds in all minors under age 18. Texas and Wisconsin prohibit minors under age 16.5 and age 16, respectively, from using tanning beds. Illinois, Maine, New Jersey and New York prohibit use by minors under age 14. Wisconsin prohibits use by minors under age 16, and Texas prohibits use by minors under age 16.5. Four other states prohibit minors’ access to tanning beds except for medical treatment. Several other states require that a parent accompany the adolescent to the tanning facility or sign a parental consent.28 While these laws are important, studies have shown that compliance with laws restricting youth access is low. Laws in Minnesota and Massachusetts require parental permission for those less than 16 or 18 years of age to use tanning beds, respectively. However, a study in which adolescent buyers visited 100 businesses in Minnesota and 100 businesses in Massachusetts on two separate occasions showed that 81% of those businesses sold a tanning session to the 15 year old buyer without parental consent on at least one visit. They also found that in more than 40% of sales attempts, the buyer’s age was not asked.29 While having legislation in place to restrict access to tanning beds is the first step, it is clear from several studies that enforcement is necessary. Thus, the only way to protect our children and teens from harmful tanning bed use is to enact a law preventing its use and to ensure compliance.
We would never embrace a teen lighting up, drinking, drinking and driving, speeding or not wearing a seatbelt. A parent would not hand their teen a lit cigarette, a can of beer, and the car keys and tell them to speed and not buckle up. Then why would a parent drive their teen to a tanning bed and/or get them a tanning bed certificate as a gift? It is because they do not know better. It is our responsibility to educate parents, teens, and our legislators. It is the state’s responsibility to make it law!
Editor's note: This article is part of a special series brought to you by Missouri Medicine, the Medical Journal of the Missouri State Medical Association (MSMA). MedHelp, Missouri Medicine, and MSMA are collaborating to educate and empower health consumers by making the latest scientific studies and medical research available to the public. Learn more about MSMA and see more from Missouri Medicine.