Review

In states that have minimum age limits, 62% of tanning parlors would refuse service to a 12-year-old potential patron, according to a study by Eric Hester, M.D., of the University of Colorado and colleagues.

In contrast, in a state with no such rules, only 18% would refuse to let a 12-year-old use the tanning booths, said Dr. Hester, now at the Oregon Health and Science University in Portland. His study was published in the August issue of the Archives of Dermatology.

"Given the prevalence of indoor UV tanning, especially by adolescent girls, and the known risks of indoor tanning, public health efforts need to be directed at this under-recognized carcinogen exposure," Dr. Hester's group said.

Only three states - Texas, Illinois, and Wisconsin - have set minimum-age limits for indoor tanning, even though the use of tanning devices is associated with squamous and basal cell carcinomas and has been implicated in increased melanoma risk.

In Texas, since 2002, indoor tanning has been permitted at age 13; in Illinois, since 1992, at 14; and in Wisconsin, also since 1992, at age 16. On the other hand, Colorado and the remaining states have no such limits, Dr. Hester and colleagues noted.

To test the effect of the rules, the researchers conducted a telephone survey of 400 tanning parlors - 100 each in Texas, Illinois, Wisconsin and Colorado. They asked whether a 12-year-old would be allowed to use tanning booths and whether youth discounts were available.

For a 12-year-old potential patron:

• 23% of operators in Texas said they would not permit indoor tanning.

• 74% of operators in Illinois would refuse.

• 89% of operators in Wisconsin would say no.

The presence or absence of youth discounts didn't appear to play a role: The percentage of facilities prohibiting a 12-year-old from tanning was 67% if they offered youth discounts and 58% if they didn't. The difference was not statistically significant (P=0.32).

For a 15-year-old potential patron, all three regulated states required consent from or accompaniment by a parent or guardian, but 83% of operators in Texas would allow access without a guardian or consent, 20% in Illinois, and 17% in Wisconsin.

Non-compliance for 15-year-olds was higher if the facility had youth discounts: 60% versus 46%. The result was not statistically significant with P=0.08.

Compliance in Texas may be low because the rules are recent, Dr. Hester and colleagues noted, adding that better results in the other two regulated states "suggest the potential for successful tanning industry youth access regulation."

Changing the tanning behavior of young people will depend on clear messages about the risks - including the risk from tanning parlors, commented Joel Hillhouse, Ph.D., of East Tennessee State University in Johnson City, and Rob Turrisi, Ph.D., of Pennsylvania State University.

While many Web sites discuss the risks of excess sun, Drs. Hillhouse and Turrisi wrote in an accompanying editorial, their messages are neither clear nor consistent. They also wrote that "Web sites only sporadically discuss indoor tanning as a risk factor."

Changing behavior will require changing some deeply imbedded and pervasive beliefs, they said including "the idea that a tanned body is more attractive and sexually appealing."

"Simple solutions and recommendations will work for only a limited number of our patients and the public," they said. Instead, what's needed is "a paradigm shift toward a more theoretical and empirical approach" that will maximize safer behavior.

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