Teenagers and indoor tanning

Since 1923, when Coco Chanel glamorized the cosmetic tan, tans have been sought after as a fashion "must." Because of this fashion craze, the use of tanning booths by teenagers - especially females - has increased dramatically, despite growing evidence of the risks associated with indoor tanning. The public looks to dermatologists for advice on skincare, and it is our responsibility to make people aware of these risks and to become involved with governmental efforts to regulate the industry.

The tanning industry estimates that among its 28 million customers, 2.3 million are teenagers.^{1, 2} A 1994 study of the use of tanning facilities by suburban Minnesota adolescents reported an overall use of 34 percent, with the incidence greater in female than in male adolescents.³ Other studies have confirmed the association between indoor tanning use and being female.^4-7 Additional characteristics of teenage indoor tanners include higher prevalence among older teenagers (ages 15 to 18), attendance at a rural high school in the Midwest or South, tobacco and alcohol use and dieting.⁵

Epidemiological studies have shown a significant association between indoor tanning and melanoma.^{9, 11, 12} This risk especially pertains to exposure in childhood and adolescence, as these are periods of greater biological vulnerability to ultraviolet (UV) radiation.¹²

In 2000, the National Institutes of Health's Ninth Report on Carcinogens first classified exposure to sunlamps and/or sunbeds as a carcinogen.¹³ The World Health Organization (WHO) recommends that no one under the age of 18 use UV tanning beds.¹⁴

Studies have shown that increased awareness of the adverse effects of indoor tanning in adolescents and college students often fails to impact their behavior with regard to indoor tanning.^{7, 15} It has been suggested that artificial tanning may be physiologically addictive. In 2004, Feldman et al demonstrated that frequent tanners can distinguish between tanning beds that emit UV and non-UV radiation under blinded conditions and elect further UV exposure, suggesting UV is a dependence-inducing stimulus.¹⁶ More recently, a study was performed to investigate whether the effects of UV exposure in frequent tanners may be mediated by an opioid-dependent mechanism.¹⁷

Frequent tanners - defined as those who tanned eight to 15 times per month - and infrequent tanners - who tanned one to 12 times per year - were given a narcotic antagonist (naloxone) that blocks central and peripheral opioid receptors. One-half of the frequent tanners showed withdrawal symptoms of nausea and jitteriness with naloxone administration. This effect was not observed in the infrequent tanners. The study provides evidence that an opioid-dependent mechanism may be occurring in frequent tanners.¹⁷ The need for enacting legislation to restrict access to indoor tanning by teenagers is highlighted by this study.

The teenage population is often targeted by the indoor tanning industry. Tanning facilities reach out to high school students through advertisements in school newspapers and yearbooks, and by offering multiple-session packages for events such as proms.^{3, 18} The industry also claims that indoor tanning is healthy. It promotes the concept that a "base tan" from a tanning bed is protective against natural UVR (it is estimated to provide an SPF of only 2 to 3^{2, 12} ) and that vitamin D synthesis is best enhanced by UV light exposure, while it is known that sufficient amounts may be obtained through a combination of diet, supplements and incidental UV exposure.¹⁹