Review and Special Articles| Volume 48, ISSUE 2, P188-194, February 2015

Youth Indoor Tanning and Skin Cancer Prevention

Lessons from Tobacco Control
Published:November 06, 2014DOI:
      Youth use of ultraviolet-emitting indoor tanning beds represents a present and emerging public health crisis. Nearly 30% of white female high school students report tanning indoors, and a quarter of high school tanners have used a tanning bed more than 20 times in the past year. Despite the significant health risks of tanning beds, including potentially deadly melanoma and eye problems, limited actions have been taken in the U.S. to protect youth. Tobacco control policies and campaigns, which have sharply reduced youth smoking, may provide a useful framework to control indoor tanning among young people. This article describes several evidence-based tobacco control strategies with potential applicability to indoor tanning within the context of the U.S. Further, current tobacco control policies and current indoor tanning policies in the U.S. are compared, and recommendations on how to curtail youth indoor tanning are discussed.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to American Journal of Preventive Medicine
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Geller A.C.
        • Balk S.J.
        • Fisher D.E.
        Stemming the tanning bed epidemic: time for action.
        J Natl Compr Canc Netw. 2012; 10: 1311-1314
      1. Eaton DK, Kann L, Kinchen S, et al. Youth Risk Behavior Surveillance—United States, 2011. MMWR Surveill Summ 2012;61(SS–4):1–162.

        • Geller A.C.
        • Colditz G.
        • Oliveria S.
        • et al.
        Use of sunscreen, sunburning rates, and tanning bed use among more than 10,000 US children and adolescents.
        Pediatrics. 2002; 109: 1009-1014
        • Guy Jr, G.P.
        • Tai E.
        • Richardson L.C.
        Use of indoor tanning devices by high school students in the United States, 2009.
        Prev Chronic Dis. 2011; 8: A116
        • Boniol M.
        • Autier P.
        • Boyle P.
        • Gandini S.
        Cutaneous melanoma attributable to sunbed use: systematic review and meta-analysis.
        BMJ. 2012; 345: e4757
        • Wehner M.R.
        • Shive M.L.
        • Chren M.M.
        • Han J.
        • Qureshi A.A.
        • Linos E.
        Indoor tanning and non-melanoma skin cancer: systematic review and meta-analysis.
        BMJ. 2012; 345: e5909
        • The International Agency for Research on Cancer Working Group on Artificial Ultraviolet (UV) Light and Skin Cancer
        The association of use of sunbeds with cutaneous malignant melanoma and other skin cancers: a systematic review.
        Int J Cancer. 2007; 120: 1116-1122
        • Wehner M.R.
        • Chren M.M.
        • Nameth D.
        • et al.
        International prevalence of indoor tanning: a systematic review and meta-analysis.
        JAMA Dermatol. 2014; 150: 390-400
        • Zhang M.
        • Qureshi A.A.
        • Geller A.C.
        • Frazier L.
        • Hunter D.J.
        • Han J.
        Use of tanning beds and incidence of skin cancer.
        J Clin Oncol. 2012; 30: 1588-1593
        • Cust A.E.
        • Armstrong B.K.
        • Goumas C.
        • et al.
        Sunbed use during adolescence and early adulthood is associated with increased risk of early-onset melanoma.
        Int J Cancer. 2011; 128: 2425-2435
        • Lazovich D.
        • Vogel R.I.
        • Berwick M.
        • Weinstock M.A.
        • Anderson K.E.
        • Warshaw E.M.
        Indoor tanning and risk of melanoma: a case-control study in a highly exposed population.
        Cancer Epidemiol Biomarkers Prev. 2010; 19: 1557-1568
      2. The International Agency for Research on Cancer. Sunbeds and UV radiation.

      3. U.S. Food and Drug Administration. Indoor tanning: the risks of ultraviolet rays.

        • CDC
        Cigarette use among high school students—United States, 1991-2009.
        MMWR Morb Mortal Wkly Rep. 2010; 59: 797-801
        • Sinclair C.
        • Makin J.K.
        Implications of lessons learned from tobacco control for tanning bed reform.
        Prev Chronic Dis. 2013; 10: E28
        • CDC
        Best practices for comprehensive tobacco programs—2007.
        DHHS, CDC, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, Atlanta2007
        • CDC
        Smoking-attributable mortality, years of potential life lost, and productivity losses—United States, 2000-2004.
        MMWR Morb Mortal Wkly Rep. 2008; 57: 1226-1228
        • Tauras J.A.
        • Chaloupka F.J.
        Price, clean indoor air, and cigarette smoking: evidence from the longitudinal data for young adults. Working Paper No. 6937.
        National Bureau of Economic Research (NBER), Cambridge MA1999
      4. Campaign for Tobacco-Free Kids. State cigarette excise tax rates & rankings. 2014.

      5. Campaign for Tobacco-Free Kids. Top combined state-local cigarette tax rates. 2014.

        • Koh H.K.
        • Judge C.M.
        • Robbins H.
        • Celebucki C.C.
        • Walker D.K.
        • Connolly G.N.
        The first decade of the Massachusetts Tobacco Control Program.
        Public Health Rep. 2005; 120: 482-495
        • Miller L.S.
        • Max W.
        • Sung H.Y.
        • Rice D.
        • Zaretsky M.
        Evaluation of the economic impact of California’s Tobacco Control Program: a dynamic model approach.
        Tob Control. 2010; 19: i68-i76
        • CDC
        State cigarette minimum price laws—United States, 2009.
        MMWR Morb Mortal Wkly Rep. 2010; 59: 389-392
        • Guy Jr, G.P.
        • Ekwueme D.U.
        • Tangka F.K.
        • Richardson L.C.
        Melanoma treatment costs: a systematic review of the literature, 1990-2011.
        Am J Prev Med. 2012; 43: 537-545
        • Ekwueme D.U.
        • Guy Jr, G.P.
        • Li C.
        • Rim S.H.
        • Parelkar P.
        • Chen S.C.
        The health burden and economic costs of cutaneous melanoma mortality by race/ethnicity—United States, 2000 to 2006.
        J Am Acad Dermatol. 2011; 65: S133-S143
        • Dellavalle R.P.
        • Schilling L.M.
        • Chen A.K.
        • Hester E.J.
        Teenagers in the UV tanning booth? Tax the tan.
        Arch Pediatr Adolesc Med. 2003; 157: 845-846
      6. Internal Revenue Service. Indoor tanning services tax center.

        • Jain N.
        • Rademaker A.
        • Robinson J.K.
        Implementation of the federal excise tax on indoor tanning services in Illinois.
        Arch Dermatol. 2012; 148: 122-124
        • Kwon H.T.
        • Mayer J.A.
        • Walker K.K.
        • Yu H.
        • Lewis E.C.
        • Belch G.E.
        Promotion of frequent tanning sessions by indoor tanning facilities: two studies.
        J Am Acad Dermatol. 2002; 46: 700-705
        • DHHS
        Preventing tobacco use among young people: A report of the Surgeon General.
        DHHS, Public Health Service, CDC, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, Atlanta GA1994
        • DiFranza J.R.
        • Dussault G.F.
        The federal initiative to halt the sale of tobacco to children—the Synar Amendment, 1992-2000: lessons learned.
        Tob Control. 2005; 14: 93-98
      7. Substance Abuse and Mental Health Services Administration. FFY 2011 Annual Synar reports: Tobacco sales to youth. DHHS.

      8. Tobacco Control Legal Consortium. Raising the minimum legal sale age for tobacco and related products.

      9. US Food and Drug Administration. Regulations restricting the sale and distribution of cigarettes and smokeless tobacco.

      10. Campaign for Tobacco-Free Kids. The Pact Act: preventing illegal Internet sales of cigarettes and smokeless tobacco. 2010.

        • Pawlak M.T.
        • Bui M.
        • Amir M.
        • Burkhardt D.L.
        • Chen A.K.
        • Dellavalle R.P.
        Legislation restricting access to indoor tanning throughout the world.
        Arch Dermatol. 2012; 148: 1006-1012
        • American Academy of Pediatrics
        Policy statement–Ultraviolet radiation: a hazard to children and adolescents.
        Pediatrics. 2011; 127: 588-597
      11. American Academy of Dermatology. Indoor tanning.

      12. American Medical Association. D-440.960. Prohibiting the sale of tanning parlor ultraviolet rays to those under 18 years of age.

      13. National Conference of State Legislatures. Indoor tanning restrictions for minors—a state-by-state comparison. 2014.

        • Guy Jr, G.P.
        • Berkowitz Z.
        • Jones S.E.
        • et al.
        Indoor tanning laws and adolescent indoor tanning.
        Am J Public Health. 2014; 104: e69-e74
        • Mayer J.A.
        • Woodruff S.I.
        • Slymen D.J.
        • et al.
        Adolescents’ use of indoor tanning: a large-scale evaluation of psychosocial, environmental, and policy-level correlates.
        Am J Public Health. 2011; 101: 930-938
        • Forster J.L.
        • Lazovich D.
        • Hickle A.
        • Sorensen G.
        • Demierre M.F.
        Compliance with restrictions on sale of indoor tanning sessions to youth in Minnesota and Massachusetts.
        J Am Acad Dermatol. 2006; 55: 962-967
        • Mayer J.A.
        • Hoerster K.D.
        • Pichon L.C.
        • Rubio D.A.
        • Woodruff S.I.
        • Forster J.L.
        Enforcement of state indoor tanning laws in the United States.
        Prev Chronic Dis. 2008; 5: A125
      14. U.S. Food and Drug Administration. FDA to require warnings on sunlamp products. 2014.

      15. Protect Local Control.

        • Holman D.M.
        • Fox K.A.
        • Glenn J.D.
        • et al.
        Strategies to reduce indoor tanning: current research gaps and future opportunities for prevention.
        Am J Prev Med. 2013; 44: 672-681
        • Cummings K.M.
        • Morley C.P.
        • Horan J.K.
        • Steger C.
        • Leavell N.R.
        Marketing to America’s youth: evidence from corporate documents.
        Tob Control. 2002; 11: i5-i17
        • DiFranza J.R.
        • Wellman R.J.
        • Sargent J.D.
        • Weitzman M.
        • Hipple B.J.
        • Winickoff J.P.
        Tobacco promotion and the initiation of tobacco use: assessing the evidence for causality.
        Pediatrics. 2006; 117: e1237-e1248
      16. CDC. Smoking & tobacco use—legislation.

      17. National Association of Attorneys General: Project Tobacco. Master settlement agreement.

        • Greenman J.
        • Jones D.A.
        Comparison of advertising strategies between the indoor tanning and tobacco industries.
        J Am Acad Dermatol. 2010; 62 (e1–e18): 685
        • Ault A.
        Tanning industry mounts defensive ad campaign.
        Internal Medicine News, 2008
      18. Smart Tan. Supre Tan and Snooki strike tanning gold. 2011.

      19. Federal Trade Commission. Indoor Tanning Association settles FTC charges that it deceived consumers about skin cancer risks from tanning. 2010.

      20. U.S. House of Representatives Committee on Energy and Commerce—Minority Staff. False and misleading health information provided to teens by the indoor tanning industry. February 1, 2012.

      21. New York State Office of the Attorney General. A.G. Schneiderman announces agreements barring national tanning salon chain Hollywood Tans and Manhattan Franchise from making health claims. March 27, 2014.

      22. National Cancer Institute. The role of the media in promoting and reducing tobacco use. Tobacco Control Monograph No. 19. NIH Pub. No. 07-6242. Bethesda MD: DHHS, NIH, National Cancer Institute, 2008.

        • Durkin S.
        • Brennan E.
        • Wakefield M.
        Mass media campaigns to promote smoking cessation among adults: an integrative review.
        Tob Control. 2012; 21: 127-138
      23. American Legacy Foundation.

        • Biener L.
        • McCallum-Keeler G.
        • Nyman A.L.
        Adults’ response to Massachusetts anti-tobacco television advertisements: impact of viewer and advertisement characteristics.
        Tob Control. 2000; 9: 401-407
        • Liu H.
        The effect of anti-smoking media campaign on smoking behavior: the California experience.
        Ann Econ Finance. 2009; 10: 29-47
        • Schar E.
        • Gutierrez K.
        • Murphy-Hoefer R.
        • Nelson D.E.
        Tobacco use prevention media campaigns: lessons learned from youth in nine countries.
        DHHS, CDC, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, Atlanta GA2006 (
        • Robinson J.K.
        • Kim J.
        • Rosenbaum S.
        • Ortiz S.
        Indoor tanning knowledge, attitudes, and behavior among young adults from 1988-2007.
        Arch Dermatol. 2008; 144: 484-488
        • Lazovich D.
        • Forster J.
        • Sorensen G.
        • et al.
        Characteristics associated with use or intention to use indoor tanning among adolescents.
        Arch Pediatr Med. 2004; 158: 918-924
        • Lazovich D.
        • Choi K.
        • Rolnick C.
        • Jackson J.M.
        • Forster J.
        • Southwell B.
        An intervention to decrease adolescent indoor tanning: a multi-method pilot study.
        J Adolesc Health. 2013; 52: S76-S82
        • Turrisi R.
        • Mastroleo N.R.
        • Stapleton J.
        • Mallett K.
        A comparison on 2 brief intervention approaches to reduce indoor tanning behavior in young women who indoor tan very frequently.
        Arch Dermatol. 2008; 144: 1521-1524
      24. CDC. The burning truth.

        • Koster B.
        • Thorgaard C.
        • Philip A.
        • Clemmensen I.
        Sunbed use and campaign initiatives in the Danish population, 2007-2009: a cross-sectional study.
        J Eur Acad Dermatol Venereol. 2011; 25: 288-290
        • US Preventive Services Task Force
        Behavioral counseling to prevent skin cancer. US Preventive Services Task Force recommendation statement.
        Ann Intern Med. 2012; 157: 59-65
        • Loh A.Y.
        Are artificial tans the new cigarette? How plaintiffs can use the lessons of tobacco litigation in bringing claims against the indoor tanning industry.
        Mich Law Rev. 2008; 107: 365-390
        • Dalton M.A.
        • Sargent J.D.
        • Beach M.L.
        • et al.
        Effect of viewing smoking in movies on adolescent smoking initiation: a cohort study.
        Lancet. 2003; 362: 281-285