Indoor Tanning Linked With Other Risky Behaviors in Teens

Indoor tanning is common among America’s teens and is often accompanied by other risky health behaviors, according to a study published online February 26 in JAMA Dermatology.

The study was headed by Gery Guy Jr., Ph.D., a health economist at the Centers for Disease Control and Prevention (CDC).

Indoor tanning is associated with an increased risk of skin cancer, including melanoma, and the risk increases with the frequency of indoor tanning and is more severe when the tanning begins at younger ages. Thus Guy and his colleagues decided to examine the prevalence of indoor tanning among America’s youth and to determine whether it might also be associated with other risky health behaviors.

In 2009, and again in 2011, the CDC conducted a Youth Risk Behavior Survey. Each survey used a nationally representative sample of approximately 15,000 U.S. high school students. Both surveys contained questions about risky health behaviors, including one about indoor tanning. Indoor tanning was defined as having used an indoor tanning device one or more times during the year preceding the survey. Frequent indoor tanning was defined as having used an indoor tanning device 10 or more times during the same period. The researchers used results of the two CDC surveys for their study.

They found that 16 percent of the 2009 survey respondents and 13 percent of the 2011 survey respondents had engaged in indoor tanning, and among the students who engaged in indoor tanning, more than half reported frequent use.

Moreover, the prevalence of indoor tanning by the high school students varied by geographic region, with lowest use in the West and highest use in the Midwest.

When evaluating gender differences, they found that the prevalence of indoor tanning was significantly greater among female students, with the highest prevalence among females aged 17 or older. Yet among both male and female students, indoor tanning was significantly associated with other risky health behaviors, such as binge drinking and unhealthy weight control practices. In addition, indoor tanning among female students was associated with illegal drug use and having had sexual intercourse with four or more partners. Use among male students was associated with daily cigarette smoking and taking steroids without a physician’s prescription.

Also of note, attempted suicide was associated with indoor tanning among male students. The reasons why are not clear, although the researchers noted that previous research has “shown a relationship between indoor tanning among males with body dissatisfaction issues, especially those who have been bullied.”

“This study highlights that indoor tanning is fairly common in adolescents and can be associated with other high-risk behaviors,” Cathryn Galanter, M.D., director of the Child and Adolescent Psychiatry Training Program at SUNY Downstate Medical Center, told Psychiatric News. “Child and adolescent psychiatrists and other health care providers should be aware of the high rates of tanning and its association with other high-risk behaviors and should consider inquiring about indoor tanning with their patients.”

“This study wisely highlights the likely role that social norms play in shaping risky behaviors, such as indoor and even excessive outdoor tanning, in our culture,” said Andrew Gerber, M.D., an assistant professor of psychiatry and a child and adolescent psychiatrist at Columbia University. “More research is urgently needed both to better understand these norms and to develop creative interventions to alter them. The partial, but incomplete, success of interventions on the social norms of cigarette smoking over the past few decades shows how important these can be for public health.”

The study was funded by the CDC. ■

An abstract of “Indoor Tanning Among High School Students in the United States, 2009 and 2011” can be accessed here.