Young women continue using tanning beds, despite awareness of health risks

The study, co-authored by UNC Lineberger members Seth M. Noar, PhD, of the UNC School of Journalism and Mass Communication, and Nancy Thomas, MD, of the UNC School of Medicine, aimed to understand what motivates young people to seek out tanning beds and how to develop messages to discourage their use among young people.

In executing their survey, the researchers surveyed a population they believed were likely to be tanning bed users -- members of college sororities.

"We reached out to this population not only because we thought they might be tanning bed users, but also because young people are at the greatest risk of developing skin cancer as a result of tanning indoors," said Noar. More than 28 million people use tanning beds each year, and the population most at risk from developing skin cancer as a result are users younger than 35.

Results from the survey, published in JAMA Dermatology, found that 45 percent of the young women surveyed had used tanning beds, with 30 percent using one in the last year. The study also revealed that the majority of users started tanning indoors in their teens, indicating that health campaigns addressing the practice should target high school audiences.

While the majority cited an improvement in appearance as a major reason for visiting a tanning parlor, the biggest factors cited by those taking the survey were the convenience of it and the way the practice makes them feel.

"We found that appearance is important, but we found that other factors to be equally or even more important. For instance, many of these young women reported really enjoying the experience of tanning indoors. They reported that it reduces stress and is relaxing to them. In the study, we called this factor 'mood enhancement'" said Noar.

One of the more striking findings from the study -- most who use tanning beds were aware of the health risks but did so anyway. Dr. Noar said this suggests that message designers will have to be very strategic in creating messages to impact this behavior. For example, messages could suggest alternatives -- such as self-tanning products that do not rely on UV rays -- instead of solely emphasizing the health risks. Dr. Noar noted, "Use of sunless tanning products instead of tanning beds could potentially address two key factors that came out of our study -- appearance motivations to look tan and the convenience factor of getting a quick and easy tan."

Since the introduction of tanning beds in the late 1970s, indoor tanning has grown to a $2.6 billion a year industry. The number of tanning parlors in most U.S. cities is greater than the number of Starbucks or McDonalds.

In the past decade, medical research has discovered direct links between tanning bed use and higher rates of the skin cancers basal cell carcinoma, squamous cell carcinoma and melanoma, according to Dr. Thomas. One study found that using indoor tanning before the age of 35 increases the risk of developing melanoma by 75 percent. In 2009, the International Agency for Research on Cancer responded to the research by classifying tanning beds as a Group 1 carcinogen, placing it in the same category as cancer-causing agents such as cigarette smoke, X-rays and asbestos.

"Tanning is an artificial form of light that leads to carcinogenesis. It causes mutations, DNA alterations. So, there could be breaks in the DNA. It can also cause increased cell proliferation," said Dr. Thomas.

More than 3.5 million people are diagnosed worldwide with skin cancer each year. While the cancer can be treated when detected early, the prognosis worsens considerably when it has spread to other parts of the body. In the U.S., more than 9,400 people died of skin cancer in 2012.

The growing awareness of the dangers has led to major efforts to curtail tanning bed use, especially among teens. Five states ban the use of tanning beds for minors under 18, and 33 states and the District of Columbia have passed regulations limiting minors' access to indoor tanning. In North Carolina, a tanning bed bill targeting minors was introduced in 2012 but did not reach a final vote.

As a next step, the UNC researchers plan to work with UNC graduate students to help develop messages about the dangers of tanning targeting young audiences. Funding for the study was provided by the University Cancer Research Fund and UNC Lineberger.