Adolescents' use of indoor tanning: a large-scale evaluation of psychosocial, environmental, and policy-level correlates.

OBJECTIVES: We evaluated psychosocial, built-environmental, and policy-related correlates of adolescents' indoor tanning use. METHODS: We developed 5 discrete data sets in the 100 most populous US cities, based on interviews of 6125 adolescents (aged 14-17 years) and their parents, analysis of state indoor tanning laws, interviews with enforcement experts, computed density of tanning facilities, and evaluations of these 3399 facilities' practices regarding access by youths. After univariate analyses, we constructed multilevel models with generalized linear mixed models (GLMMs). RESULTS: In the past year, 17.1% of girls and 3.2% of boys had used indoor tanning. The GLMMs indicated that several psychosocial or demographic variables significantly predicted use, including being female, older, and White; having a larger allowance and a parent who used indoor tanning and allowed their adolescent to use it; and holding certain beliefs about indoor tanning's consequences. Living within 2 miles of a tanning facility also was a significant predictor. Residing in a state with youth-access legislation was not significantly associated with use. CONCLUSIONS: Current laws appear ineffective in reducing indoor tanning; bans likely are needed. Parents have an important role in prevention efforts.

Youth access to artificial UV radiation exposure: practices of 3647 US indoor tanning facilities.

OBJECTIVE: To assess indoor tanning facility practices in a sample of facilities in 116 cities representing all 50 states. DESIGN: Cross-sectional study. SETTING: United States. PARTICIPANTS: Employees of 3647 indoor tanning facilities were contacted by telephone. Data collectors (ie, confederates) posed as prospective, fair-skinned, 15-year-old female customers who had never tanned before. MAIN OUTCOME MEASURES: Confederates asked respondents about their facility's practices related to parental consent, parental accompaniment, and allowable tanning session frequency. RESULTS: Approximately 87% of the facilities required parental consent, 14% required parental accompaniment, 5% said they would not allow the confederate to tan owing to her age, and 71% would allow tanning every day the first week of indoor tanning. In Wisconsin, which bans indoor tanning among those younger than 16 years, 70% of facilities would not allow the confederate to tan. Multivariate analyses indicated that facilities in states with a youth access law were significantly more likely to require parental consent (P <.001) and parental accompaniment (P <.001) than those in states without a youth access law. Law was not significantly related to allowable tanning frequency (P = .81). Conclusion We recommend that additional states pass youth access legislation, preferably in the form of bans.

Density of indoor tanning facilities in 116 large U.S. cities.

BACKGROUND: U.S. adolescents and young adults are using indoor tanning at high rates, even though it has been linked to both melanoma and squamous cell cancer. Because the availability of commercial indoor tanning facilities may influence use, data are needed on the number and density of such facilities. METHODS: In March 2006, commercial indoor tanning facilities in 116 large U.S. cities were identified, and the number and density (per 100,000 population) were computed for each city. Bivariate and multivariate analyses conducted in 2008 tested the association between tanning-facility density and selected geographic, climatologic, demographic, and legislative variables. RESULTS: Mean facility number and density across cities were 41.8 (SD=30.8) and 11.8 (SD=6.0), respectively. In multivariate analysis, cities with higher percentages of whites and lower ultraviolet (UV)index scores had significantly higher facility densities than those with lower percentages of whites and higher UV index scores. CONCLUSIONS: These data indicate that commercial indoor tanning is widely available in the urban U.S., and this availability may help explain the high usage of indoor tanning.

Sun sensitivity in 5 US ethnoracial groups.

Some sun safety activities have included only non-Hispanic white individuals, even though individuals in other ethnoracial groups may be at risk for skin cancer. The objectives of this study were to investigate distributions of self-reported Fitzpatrick skin type within 5 ethnoracial groups and substantiate each group's self-report with an objective measure. The study used a cross-sectional design. The research was conducted at 70 postal stations in Southern California. Participants were US Postal Service letter carriers and included 115 Pacific Islanders, 222 black individuals, 329 Asians, 513 Hispanics, and 1364 non-Hispanic white individuals. Participants self-reported skin type and had skin color measurements taken with colorimeters. Some individuals in each ethnoracial group reported having sun-sensitive skin. Correlation tests assessing the relationship between skin type and colorimeter data showed substantial associations for each group except Asians. Future sun safety research and educational messages should include all potentially high-risk individuals, irrespective of ethnoracial identity.

The influence of parents and peers on adolescent indoor tanning behavior: findings from a multi-city sample.

BACKGROUND: Indoor tanning is common among adolescents. OBJECTIVE: Our purpose was to examine the influence of parents and peers on adolescent indoor tanning. METHODS: Telephone interviews were conducted with 5274 teen-parent pairs in the 100 largest US cities. Random coefficient regression analyses were conducted to examine the relationship between parental and peer factors and adolescent indoor tanning. RESULTS: Teens' report of whether their parents allow them to tan indoors was the strongest predictor (adjusted odds ratio [aOR]: 5.6), whereas parents' modeling (aOR: 1.2), attitudes (aOR: 1.1), and concern about teen tanning (aOR: 1.9) were significantly but less strongly associated. Teens thinking most of their peers like to be tan (aOR: 1.7) and perceived percentage of peers who tan indoors (aOR: 1.0) also were significantly associated. LIMITATIONS: The cross-sectional design was a limitation of this study. CONCLUSION: Interventions targeting adolescent indoor tanning should address both family- and peer-related factors.

Promoting sun safety among US Postal Service letter carriers: impact of a 2-year intervention.

OBJECTIVES: We examined whether US Postal Service letter carriers who received a sun safety intervention would wear wide-brim hats and sunscreen significantly more often than those who did not receive the intervention. METHODS: We used a 2-group randomized design with 2662 evaluation cohort participants from 70 US postal stations. Evaluations were conducted at baseline, 3 months, 1 year, and 2 years. Questionnaire items assessed occupational use of sun-screen and wide-brim hats. The 2-year sun safety intervention included the provision of wide-brim hats, accessible sunscreen, reminders, and 6 educational sessions. RESULTS: At the 3-month follow-up evaluations, the odds ratio (OR) for regular sun-screen use was 2.8 times higher among the intervention group than among the control group (95% confidence interval [CI]=2.2, 3.5); at the 2-year follow-up evaluations, the rate was still significantly higher (OR=2.0; 95% CI=1.6, 2.6). Intervention group participants also had significantly higher rates of hat use, with the differences remaining consistent across all follow-ups (OR=2.9; 95% CI=2.3, 3.6). CONCLUSIONS: The intervention should be disseminated to postal stations nationwide and possibly to other occupational groups that work outdoors.

Effects of an introductory letter on response rates to a teen/parent telephone health survey.

The authors conducted a pilot study in preparation for a larger investigation that will rely on telephone surveys to assess select health behaviors of teens and their parents, with a focus on indoor tanning. This study used a randomized design to assess the impact of a presurvey letter on response rates to a telephone survey, as well as prevalence estimates of ever having used an indoor tanning facility. The letter did not have a significant effect on response rates or prevalence estimates in the two cities under study. Findings suggest that researchers should not assume that a letter sent in advance of a telephone survey will necessarily increase response rates enough to justify their use.