Investigating Indoor Tanning Use and Awareness of Skin Cancer Risk

Indoor tanning has been found to increase the risk of skin cancer. A study from researchers at the University of Manchester investigated the reason adults choose to use indoor tanning devices despite the health consequences.

This study was published in Social Science & Medicine.

Why Does Tanning Increase Skin Cancer Risk?

It is well-documented that indoor tanning increases skin cancer risk, but what is the relationship between tanning and cancer?

“Indoor tanning exposes individuals to high levels of ultraviolet radiation: ultraviolet B (UVB) at levels of between 0.5 and 3.7 times, and ultraviolet A (UVA) radiation at levels of 3–26 times stronger than exposure to the sun,” wrote the study authors. According to the researchers, ever-use of indoor tanning devices can increase an individual’s risk of melanoma, basal cell carcinoma, and squamous cell carcinoma by up to 50%. The skin cancer risk associated with indoor tanning is even greater in individuals under the age of 35, the authors noted.

“Legislation ranging from modest regulations to outright bans has been introduced around the world to reduce these harmful effects. Despite this, individuals continue to use indoor tanning devices, suggesting the need for behavior change interventions to successfully reduce usage and improve outcomes,” the authors wrote. “Understanding people’s reasons for indoor tanning, and the acceptability of alternatives, can aid successful intervention development.”

Surveying Indoor Tanning Users

In this study, the investigators aimed to document the reasons indoor tanning users in the UK cited for their use of these devices, to better design interventions to meet their needs. They also sought to assess the acceptability of alternatives among this population.

The researchers enrolled 21 adults were residing in northwest England. Participants took part in either a focus group or underwent semi-structured interviews. Then, the researchers conducted an inductive thematic analysis.

Overall, two focus groups were conducted and 17 individual interviews. A semi-structured topic guide was used for both methodologies. Questions were related to the reasons for indoor tanning use and acceptability of alternatives.

Nineteen of 21 participants had used alternatives to indoor tanning at least once, such as sunless tanning creams and spray tans. Three men were enrolled. Participant ages ranged from 19 years to 58 years. Mean age was 26 years for the focus group and 28 years for the individual interviews. Eighteen patients were White. Age at first use of indoor tanning ranged from 15 years to 27 years, with a mean age of 22 in the focus group arm and 18 in the interview arm. The participants reported using indoor tanning up to 30 times annually in the focus groups and up to 100 times annually among interviewees. In both groups, the average frequency 15-16 times per year.

Themes of Participant Responses

The researchers identified three themes related to reasons why participants used indoor tanning devices: “psychological benefits,” “improving physical health,” and “denial of health risks.”

Regarding psychological benefits, participants reported that tanning was related to their self esteem levels. “Individuals perceive that indoor tanning makes them appear more attractive, which increases their self-esteem and mood; prolonged use can result in a tanned look becoming adopted as part of their identity which encourages maintenance of the behavior,” the authors wrote.

Participants also reported that they used indoor tanning devices to improve their physical illness symptoms and prevent harmful effects associated with exposure to natural sunlight. The authors commented that the “denial of health risks associated with indoor tanning alleviates the internal conflict of knowingly engaging in a risky behavior and valuing aesthetics and psychological benefits above long-term health.”

Regarding the use of alternatives, the researchers also noted three themes: “alternatives do not meet psychological needs,” “alternatives do not meet physical needs,” and “perceived side effects.”

Awareness and Denial of Skin Cancer Risk

Participants reported variability in their exposure to health risk information. For example, some patients actively avoided all risk information, while others “displayed selective seeking of health risk information.” Some participants relied on their personal beliefs, or information they received from peers, family members, or through television and social media.

The authors noted that some indoor tanning users “perceived the legal status of indoor tanning devices and others’ use as reassurance that health risk information was exaggerated.” Additionally, some participants viewed tanning as “less risky” than other behaviors such as drinking alcohol or smoking, and other reported their usage as below a harmful threshold relative to others’ use.

Some participants held personal beliefs that “individual factors, such as personality (e.g., perceived low susceptibility for addiction that would significantly increase usage) and skin type (e.g., skin that doesn’t burn easily),” were protective against skin cancer risk.

Still, some participants “simply accepted that their reasons for using indoor tanning devices, such as experiencing psychological and physical health benefits, were more important to them than avoiding the health risks.”

In conclusion, the authors wrote, “Participants reported found both appearance-based and other alternatives are not considered as viable options to meet the perceived psychological and physical needs gained from indoor tanning.”

Regarding improving future interventions to reduce tanning, they wrote, “Interventions have the potential to reduce indoor tanning behavior by rebalancing sources of self-esteem, increasing media literacy and addressing defensive responses to information around indoor tanning and alternatives. Future research is necessary to determine the effectiveness of these intervention methods, and their findings can be used to inform future public health campaigns.”