Teens’ Use of Indoor Tanning Joni A. Mayer, PhD, Professor Graduate School of Public Health San Diego State University Presented at the meeting of the National Council on Skin Cancer Prevention, November 7, 2008, Washington, D.C.

Why study indoor tanning among teens? Using indoor tanning early in life increases melanoma risk by 75% U.S. older teen girls are using indoor tanning at high rates—up to 40%

World Health Organization Ban those under 18 years old from commercial indoor tanning…. Sinclair, C. Artificial tanning sunbeds: risks and guidance. WHO, 2003.

Correlates of Indoor Tanning in Youth

Availability of Facilities Environmental Level ADOLESCENT USE OF INDOOR TANNING Parent Characteristics Adolescent Characteristics Individual and Sociocultural Level Policy Level State Legislation Local Enforcement Procedures Facility Compliance Phone Interviews (N=6,125) Facility Count + Locations/GIS Quantification Of Stringency Confederate Phone Calls (N=3,399) Quantification Of Stringency

Results from generalized linear mixed effects models Mayer, J. A., Slymen, D. J., Woodruff, S. I., Hoerster, K. D., Pichon, L. C., Sallis, J. F., Weeks, J. R., & Belch, G. E. (2008, October). Correlates of indoor tanning among teens: Key findings from CITY100. Peer-reviewed paper presented at the annual meeting of the American Public Health Association, San Diego, CA.

Individual-level predictors VariableORCI sex:female= ,.68

Individual-level predictors VariableORCI sex:female= ,.68 age 17: 14= , 2.6

Indoor tanning among CITY100 teens

Individual-level predictors VariableORCI sex:female= ,.68 age 17: 14= , 2.6 parent uses1.71.3, 2.2

Individual-level predictors VariableORCI sex:female= ,.68 age 17: 14= , 2.6 parent uses1.71.3, 2.2 parent allows4.83.6, 6.3

Individual-level predictors VariableORCI sex:female= ,.68 age 17: 14= , 2.6 parent uses1.71.3, 2.2 parent allows4.83.6, 6.3 parent concern.58.45,.74

Individual-level predictors-continued VariableORCI friends tan- 20% unit , 1.9

Individual-level predictors-continued VariableORCI friends tan-20% unit , 1.9 value a tan1.81.3, 2.5

Environmental-level predictors VariableORCI Lives within 2 mi of salon , 1.9 City salon density was significant in bivariate, but not multivariate, test…

How many facilities? average = 41.8 (SD=30.8) range = 3 (Hialeah,FL) to 183 (New York) density (per 100,000 people): 1 to 34 average density= 11.8 (SD=6.0) Hoerster, K. D., et al. (2009). Density of indoor tanning facilities in 116 large U.S. cities. American Journal of Preventive Medicine, 36(3),

Average # Businesses per City (n=116) Hoerster, K. D., et al. (2009). Density of indoor tanning facilities in 116 large U.S. cities. American Journal of Preventive Medicine, 36(3),

Living near a tanning salon and use… 76% lived within 2 miles of a tanning salon For teens having no tanning salons within 2 miles of their home, 7% used indoor tanning in the past 12 months. For teens having at least 1 tanning salon, this rate was 11%.

Policy-level predictors Whether state had a youth access law -- ns Whether salon required parental consent --ns Frequency tanning salon would allow teen to tan--ns

Did indoor tanning facilities require signed parental consent? 87% did… Requiring consent was significantly related to presence of youth law 78% vs. 93% OR (no law vs law) = 0.35 (.25,.49) Pichon, LC, et al. (in press). Youth access to artificial ultraviolet radiation exposure: Practices of 3,647 indoor tanning facilities. Archives of Derm.

Did indoor tanning facilities allow frequent tanning? “I have fair skin…I’m 15 & have never used a tanning bed…How many times can I tan the 1 st week?” 71% of the salons said every day (mean = 6) Frequency allowed to tan not related to presence of a law Pichon, LC, et al. (in press). Youth access to artificial ultraviolet radiation exposure: Practices of 3,647 indoor tanning facilities. Archives of Derm.

Alaska Texas Utah Montana California Arizona Idaho Nevada Oregon Iowa Colorado Kansas Wyoming New Mexico Missouri Minnesota Nebraska Oklahoma South Dakota Washington Arkansas North Dakota Louisiana Hawaii Illinois Ohio Florida Georgia Alabama Wisconsin Virginia Indiana Michigan Mississippi Kentucky Tennessee Pennsylvania North Carolina South Caroli na West Virginia New Jersey Maine New York Vermont Maryland New Hampshire Connecticut Delaware Massachusetts Rhode Island 28 states (red) had an indoor tanning law

Alaska Texas Utah Montana California Arizona Idaho Nevada Oregon Iowa Colorado Kansas Wyoming New Mexico Missouri Minnesota Nebraska Oklahoma South Dakota Washington Arkansas North Dakota Louisiana Hawaii Illinois Ohio Florida Georgia Alabama Wisconsin Virginia Indiana Michigan Mississippi Kentucky Tennessee Pennsylvania North Carolina South Caroli na West Virginia New Jersey Maine New York Vermont Maryland New Hampshire Connecticut Delaware Massachusetts Rhode Island 21 of those laws (red) included youth access restrictions

Alaska Texas Utah Montana California Arizona Idaho Nevada Oregon Iowa Colorado Kansas Wyoming New Mexico Missouri Minnesota Nebraska Oklahoma South Dakota Washington Arkansas North Dakota Louisiana Hawaii Illinois Ohio Florida Georgia Alabama Wisconsin Virginia Indiana Michigan Mississippi Kentucky Tennessee Pennsylvania North Carolina South Caroli na West Virginia New Jersey Maine New York Vermont Maryland New Hampshire Connecticut Delaware Massachusetts Rhode Island Case Study: Wisconsin

Banning the Tanning of 15 Year Olds— Confederate Phone Calls Wisconsin FacilitiesAll Other Facilities 70%4% Pichon, LC, et al. (in press). Youth access to artificial ultraviolet radiation exposure: Practices of 3,647 indoor tanning facilities. Archives of Derm.

Conclusions Parental consent laws are effective, but… parents are consenting

Conclusions, continued Need local zoning ordinances “All you can tan” packages-need to restrict these & session frequency Need teen bans (like France & Australia)

Sec Under no circumstances shall an operator or employee of a tanning facility allow an individual who is under eighteen years of age to use the tanning services of the facility unless the individual presents a prescription for receiving ultraviolet radiation treatments written by a physician authorized under Chapter of the Revised Code to practice medicine and surgery or osteopathic medicine and surgery. Pending Bill in Ohio (HB 230)

Indoor Tanning Association Lobbying against pending Ohio law banning those under 18… Businesses, parents, etc should choose a sample letter and send to local and state gov’t officials… “ “Please put some common sense back into government. Whether or not a teen suntans is a decision for parents, not government.”

Levels of Influence Teens & parents Environment Policy

What will CITY100 do? Strategically share our data and conclusions with key audiences Health organizations, legislators, reporters

What might (should) you do? (Continue to) advocate for Ohio’s ban of minors Ohio as a model – “As goes Ohio, so goes…”

And thank you! For more information, contact Ohio bill information: Go to section on tanning