Prevalence of sunless tanning product use and related behaviors among adults in the United States: Results from a national survey

Article (PDF Available)inJournal of the American Academy of Dermatology 56(3):387-90 · April 2007with62 Reads
DOI: 10.1016/j.jaad.2006.08.051 · Source: PubMed
Abstract
Little is known about the use of sunless tanning products in the United States. This report describes the prevalence and correlates of sunless tanning use, comparing exclusive sunless tanners, exclusive indoor tanners, both sunless and indoor tanners, and non-tanners with respect to sociodemographic and sun protection behaviors.
Prevalence of sunless tanning pr oduct use and
related behaviors among adults in the United States:
Results from a national survey
Jo Ellen Stryker, PhD,
a
Amy L. Yaroch, PhD,
b
Richard P. Moser, PhD,
b
Audie Atienza, PhD,
b
and Karen Glanz, PhD, MPH
a
Atlanta, Georgia, and Bethesda, Maryland
Little is known about the use of sunless tanning products in the United States. This report describes the
prevalence and correlates of sunless tanning use, comparing exclusive sunless tanners, exclusive indoor
tanners, both sunless and indoor tanners, and non-tanners with respect to sociodemographic and sun
protection behaviors. ( J Am Acad Dermatol 2007;56:387-90.)
S
unless tanning products have become increas-
ingly popular. Although they are considered
generally safe to use, there are concerns that
sunless tanning products users may also be increas-
ing their exposure to harmful ultraviolet radiation
(UVR), either through sun exposure or indoor tan-
ning devices. Some sunless tanning products contain
sunscreen, although most do not indicate any sun
protection factor.
1
The darkened skin color achieved
with sunless tanning products, along with sunscreen
ingredients when they are included, may create a
false sense of protection from UVR. Subsequently,
users of sunless tanning products may be less in-
clined to practice safe sun behaviors. Many tanning
salons now offer both sunless tanning and UVR
tanning beds at the same locations,
2
increasing the
ease of using both methods. However, while national
rates of adult indoor tanning have been estimated,
3
the extent to which individuals utilize both types of
services is unknown.
Some sun protection interventions have included
sunless tanning products as an alternative to UVR
exposure, and these studies have demonstrated that
including sunless tanning products did not increase
exposure to UVR.
4,5
A recent pilot survey conducted
with 121 individuals who had undergone spray-on
sunless tanning treatment revealed that most respon-
dents reported that they would not change their time
spent in the sun or sunscreen use as a result of using
sunless tanning. However, 73% of those who had
reported using tanning beds stated that they had or
would decrease tanning bed use.
6
A survey conducted among South Australian
adults found that sunless tanners were more likely
to use sunscreen but less likely to wear hats and other
protective clothing than non-users. Sunless tanning
use was also associated with repeated sunburns.
7
Little is known about sunless tanning product use in
the United States. The current study utilizes data from
the National Cancer Institute’s Health Information
National Trends Survey (HINTS 2005), and reports the
first US national-level information on sunless tanning,
and seeks to understand how sunless tanning relates
to indoor tanning and sun protection behaviors.
METHODS
Data came from HINTS 2005 (collected between
February and August 2005; N = 5491 complete inter-
views). The sample design was a list-assisted, random
digit dial (RDD) telephone survey of all US telephone
exchanges. The final response rate for the survey,
including an initial screening for eligibility and an
extended interview, was 20.9%. Responses were
weighted to produce a representative sample of adults
living in the United States. A detailed report about the
sample and sampling design is published elsewhere.
8
Measures
Sociodemographic. Information was collected
on, age, education, race/ethnicity, income, and
geographic region.
From the Department of Behavioral Sciences and Health Educa-
tion,
a
Rollins School of Public Health, Emory University, Atlanta,
and the Behavioral Research Program, Division of Cancer Control
and Population Sciences,
b
National Cancer Institute, Bethesda.
Supported in part by the Georgia Cancer Coalition (Drs. Stryker
and Glanz).
Conflicts of interest: None identified.
Accepted for publication August 17, 2006.
Reprint requests: Jo Ellen Stryker, PhD, Behavioral Sciences and
Health Education, Rollins School of Public Health, Emory
University, 1518 Clifton Rd NE, Rm 572, Atlanta, GA 30322.
E-mail: jestryk@sph.emory.edu.
Published online October 27, 2006.
0190-9622/$32.00
ª 2007 by the American Academy of Dermatology, Inc.
doi:10.1016/j.jaad.2006.08.051
387
Indoor and sunless tanning. Respondents
wereaskedabout their use of ‘‘indoortanning devices,
such as a sun lamp, a sun bed, or a tanning booth’’ and
‘‘sunless tanning products’ in the past 12 months
(0, 1-2, 3-10, 11-24, or 251 times). They were charac-
terized as ‘‘exclusive sunless tanners,’’ ‘‘exclusive
indoor tanners,’’ ‘‘both sunless and indoor tanners,’’
or ‘‘neither sunless nor indoor tanners’’ (non-tanners).
Sun protection behaviors. Respondents were
asked how often they wear ‘‘sunscreen,’’ ‘‘a hat that
shades your face, ears, and neck,’’ ‘‘a long-sleeve
shirt,’’ and ‘‘long pants,’’ as well as ‘‘stay in the shade’’
when outside for more than 1 hour on a warm day
(1 = always, 5 = never). All items were reverse scored
for analyses.
Analysis
All analyses were weighted to provide estimates
for the adult population of the United States, with
jackknife variance weights used to make adjustments
for non-response. Descriptive statistics on tanning
variables provided the frequency of sunless and
Table I. Tanning by demographic variables
% No tanning
(95% CI)
% Sunless only
(95% CI)
% Indoor only
(95% CI)
% Both
(95% CI)
Gender N = 4606 N = 506 N = 262 N = 140
Male 91.1 (89.2, 92.7) 3.7 (2.7, 5.2) 4.2 (2.8, 6.4) .9 (.5, 1.8)
Female 76.6 (74.8, 78.2) 12.2 (10.9, 13.7) 6.4 (5.3, 7.7) 4.9 (4.0, 5.9)
x
2
= 154.43, P \ .001
Age (based on
quartile split)
N = 4601 N = 506 N = 262 N = 139
18-34 78.9 (75.8, 81.8) 6.9 (4.8, 9.7) 9.5 (7.1, 12.5) 4.7 (3.6, 6.2)
35-39 80.30 (75.5, 84.4) 10.5 (7.3, 15.0) 5.4 (3.4, 8.3) 3.8 (2.2, 6.5)
40-44 78.8 (73.6, 83.2) 10.6 (7.7, 14.4) 6.3 (3.4, 11.4) 4.3 (2.5, 7.3)
451 88.2 (86.9, 89.3) 8.0 (7.0, 9.1) 2.5 (1.9, 3.2) 1.4 (1.0, 1.9)
x
2
= 97.67, P \ .001
Education N = 4485 N = 492 (N = 256) N = 137
\ High school 91.1 (87.5, 93.8) 4.1 (2.3, 7.3) 2.3 (1.3, 4.3) 2.4 (1.2, 4.8)
High school 84.7 (82.3, 86.9) 8.1 (6.6, 9.8) 4.3 (2.8, 6.6) 2.9 (2.0, 4.3)
Some college 78.4 (75.8, 80.7) 9.1 (7.3, 11.3) 8.3 (6.4, 10.8) 4.2 (3.1, 5.7)
College 84.6 (82.4, 86.5) 9.0 (7.5, 10.7) 4.6 (3.6, 5.9) 1.9 (1.3, 2.8)
x
2
= 62.06, P \ .001
Race N = 4448 N = 491 N = 255 N = 136
Hispanic/Latino 88.9 (84.7, 92.0) 7.6 (5.1, 11.4) 23 (1.1, 4.5) 1.3 (.5, 3.5)
Non-Hispanic 80.8 (79.2, 82.2) 9.0 (8.0, 10.2) 6.6 (5.3, 8.1) 3.7 (3.0, 4.5)
White
Non-Hispanic 92.8 (86.4, 96.3) 4.1 (2.2, 7.7) 2.7 (.5, 13.1) .4 (.1, 3.0)
Black
Non-Hispanic 88.5 (83.1, 92.3) 5.6 (3.1, 10.0) 2.9 (1.1, 7.8) 3.0 (1.3, 7.0)
Other
x
2
= 113.35, P \ .001
Income N = 3818 N = 418 N = 229 N = 131
\25 K 89.9 (86.7, 91.7) 5.3 (3.7, 7.4) 2.7 (1.9, 3.8) 2.6 (1.6, 4.2)
25-35 K 89.6 (85.6, 92.6) 4.8 (2.8, 8.1) 3.7 (2.1, 6.2) 2.0 (1.1, 3.6)
35-50 K 83.5 (77.7, 88.0) 7.6 (5.0, 11.4) 6.6 (3.7, 11.5) 2.3 (1.3, 4.2)
50-75K 81.1 (77.5, 84.3) 9.0 (6.9, 11.7) 6.3 (4.6, 8.5) 3.6 (2.4, 5.2)
$ 75 K 76.6 (72.5, 80.2) 10.5 (8.9, 12.4) 8.1 (5.4, 12.0) 4.9 (3.3, 7.0)
x
2
= 58.36, P \ .001
Region N = 4606 N = 506 N = 262 N = 140
Northeast 88.0 (85.3, 90.2) 5.3 (4.0, 6.8) 3.9 (2.5, 6.0) 2.9 (1.6, 5.2)
Midwest 79.5 (76.2, 82.6) 7.4 (5.6, 9.7) 8.8 (6.3, 12.1) 4.3 (2.9, 6.3)
South 84.6 (82.7, 86.3) 8.3 (6.8, 9.9) 4.6 (3.5, 6.0) 2.6 (1.8, 3.7)
West 82.7 (79.6, 85.5) 10.7 (8.7, 13.1) 4.2 (2.3, 7.4) 2.4 (1.4, 4.0)
x
2
= 44.66, P \ .01
JAM ACAD DERMATOL
MARCH 2007
388 Stryker et al
indoor tanning. Cross-tabulation tables with x
2
tests
of statistical significance examined relationships
between tanning status and sociodemographic var-
iables. Regressing each of the five sun safety behav-
iors on the set of sociodemographic variables and
the tanning variable, adjusted means of sun safety
behaviors by tanning group status were assessed for
differences using t tests. Using a Bonferroni adjust-
ment for multiple comparisons, the level for statisti-
cal significance was set at P \ .008 (comparing each
group within the tanning variable produced 6 com-
parisons). SUDAAN (University of Texas at Austin,
Austin, Tex) was used to calculate variances of
parameter estimators using a jackknife method.
9
RESULTS
Frequent use of sunless tanning products is
uncommon. Of the estimated 11% of US adults who
report using sunless tanning products in the past year
(N = 646), 13% (95% CI: 10, 17) reported using the
products more than 25 times; 12% (95% CI: 9, 15)
between 11 to 24 times; 35% (95% CI: 30, 41) 3 to 10
times, and 40% (95% CI: 35, 46) 1 to 2 times.
Table I provides the distribution of the tanning
variable by sociodemographic variables. Compared
to respondents who reported recent exclusive use
of UVR tanning devices, or both UVR devices and
sunless tanning products, recent exclusive sunless
tanners tended to be older and more educated.
Exclusive sunless tanning was most prevalent in
the West, whereas exclusive indoor tanning, or
combined sunless and indoor tanning, was more
common among respondents from the Midwest.
Table II provides the weighted means for five
sun protection practices, controlling for sociodemo-
graphic variables. Compared to non-tanners, exclu-
sive sunless tanners were significantly more likely
to use sunscreen, and significantly less likely to seek
shade, but there were no significant differences
between the two groups for the use of protective
clothing, including wearing a hat, a long shirt, or
long pants. In contrast, exclusive sunless tanners
were significantly more likely than exclusive indoor
tanners to practice all five sun protection behaviors.
Exclusive sunless tanners had higher behavioral
scores than the mixed group, but these differences
were not significant at the P \ .008 value. Finally,
while there was no statistically significant difference
between exclusive indoor tanners’ and non-tanners’
use of sunscreen, indoor tanners were significantly
less likely than non-tanners to practice the other four
sun protection behaviors.
DISCUSSION
In this report of the prevalence of the use of
sunless tanning products and related UVR exposure
and protection practices of adults in the United
States, we found that just over 10% use these
products, and fewer than 3% percent used them
more than 10 times in the past year. Users and
exclusive users in particular are more likely to be
women, older, living in the West, and with higher
levels of education. Sunscreen use appears to be
highest among users of sunless tanners, but their
practice of other sun protection behaviors, com-
pared to non-tanners, is less clear.
Some findings from this study are different from
results of surveys conducted in Australia in 1999 and
2000.
7,10
The Australia surveys found that sunless
tanners were more likely than non-tanners to use
sunscreen and less likely to practice other safe sun
behaviors; this report is consistent with findings
for sunscreen use and seeking shade, but not for
protective clothing. Part of the discrepancy may be
explained by the distinction between exclusive sun-
less tanners and sunless tanners who also frequent
indoor tanning salons, and who appear to be less
concerned about the harmful effects of UVR.
Though limited in the strength and nature of our
conclusions by the use of an existing dataset with
a poor response rate and by a lack of sun sensitivity
or tanning attitude measures, this study provides an
Table II. Weighted means* of sun protection practices, with a Bonferonni adjustment for multiple tests
Mean no tanning (SE) Mean sunless only (SE) Mean indoor only (SE) Mean both (SE)
Sunscreen 2.58 (.03)
y
2.92 (.08)
y,z
2.40 (.15)
z
2.57 (.18)
Shade 3.38 (.02)
y,§,k
3.15 (.08)
y,z
2.83 (.14)
§,z
2.76 (.13)
k
Hat 2.80 (.03)
§
2.96 (.09)
z
2.31 (.11)
§,z
2.61 (.15)
Long shirt 2.23 (.03)
§
2.23 (.07)
z
1.81 (.07)
§,z
1.99 (.14)
Long pants 3.34 (.03)
§,k
3.27 (.08)
z
2.68 (.10)
§,z
2.93 (.13)
k
*Responses range from 1 to 5, controlling for gender, age, education, race, income, and region of the country.
y
No tanning and sunless only significantly different at P \ .008.
z
Sunless only and indoor only significantly different at P \ .008.
§
No tanning and indoor only significantly different at P \ .008.
k
No tanning and both significantly different at P \ .008.
JAM ACAD DERMATOL
VOLUME 56, NUMBER 3
Stryker et al 389
important baseline indicator of the use of sunless
tanners in relation to UVR exposure behaviors—both
outdoors and through artificial sources, and to sun
protection practices. The results of this study suggest
the utility of distinguishing between exclusive sunless
tanners and those who also frequent ultraviolet indoor
tanning salons. Continued surveillance of these prac-
tices, their correlates, and other tanning-related vari-
ables not assessed on the HINTS survey is warranted.
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JAM ACAD DERMATOL
MARCH 2007
390 Stryker et al
    • "The intervention used motivational messages to use sunless tanning products as an alternative to UVR tanning [8] , and also included sun damage imaging and sun safety recommendations among female beach visitors in eastern Massachusetts [21] . Compared to controls, the intervention group reported significant decreases in sunbathing and increases in sunless tanning relative to the control group up to one year after the intervention [10] . Thus, promoting sunless tanning as an alternative to UV tanning had at least a short-term effect in reducing UV exposure. "
    Article · Jan 2016 · Clothing and Textiles Research Journal
    • "The increased use of these products instead of sun exposure to obtain a tan is identified as the potential to reduce skin cancer incidence, leading to the debate as to whether they serve as a harm-reduction strategy, and whether cancer control agencies have a place in promoting and marketing them (Chapman, 1999). Since the first sunless tanning lotion was introduced in the 1960s (Owens, 2009), sunless tanning products have become more readily available, and the market for these product types has grown considerably (Stryker, Yaroch, Moser, Atienza, & Glanz, 2007 ); in part, sunless tanning products provide the public with an alternative means of obtaining a tan (Girgis et al., 2003). Consumers in the United States spend approximately US$86 million on sunless tanning products, which accounts for 50% of global self-tanning sales (Fu et al., 2004). "
    [Show abstract] [Hide abstract] ABSTRACT: The purpose of this study was to examine the relationship between the perceived negative health effect of tanning (PNHET) and body-tanning attitudes and behaviors. A total of 333 college students with an average age of 19.8 years participated in the study. A majority of the participants were female (80.2%) and Caucasian (76.9%). Three body-tanning attitudes emerged from the data: pleasurable activity, physical attractiveness, and healthy behavior. The PNHET was negatively related to all three body-tanning attitudes and methods of tanning behaviors used (i.e., sunbathing, tanning beds, and sunless tanning product use). However, specific body-tanning attitudes independently influence the methods of body-tanning behaviors. Pleasurable activity was a significant attitude influencing indoor and outdoor tanning. College students seek tanning beds and tanning products, particularly when physical attractiveness is concerned. Healthy behavioral attitudes exist for outdoor tanning. Intervention strategies regarding body-tanning behaviors should focus on attitudinal changes, which specifically involve ultraviolet (UV) ray exposure. Educating the public about the negative health effects of tanning is still a very important intervention strategy to help individuals avoid excessive amount of harmful UV exposure and resultant skin cancer. Body-tanning behaviors, as a part of consumer culture, should change to minimize these unhealthy behaviors.
    Article · Jan 2014
    • " For the past several decades, researchers across disciplines have sought to understand the mechanisms underlying sun exposure and sun-protection behaviors (Mahler et al., 2005). However, little is known about tanning product consumption in the United States. Stryker et al. (2007) found that sunless tanners tend to be older and more educated. A study conducted with an Australian sample revealed that approximately 10% of participants used an artificial tanning products during the summer prior to the investigation (Purchase and Borland, 1994; Dixson et al., 1997). As sunless tanning has gained in popularity, this p"
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