Only 13% of women and 4% of men in a nationally representative sample of 2,869 adults recognized that indoor tanning raises the risk of skin cancer, according to a report in the December issue of the Archives of Dermatology.

In addition, 18% of women and 6% of men reported they had used indoor tanning in the previous year, reported Kelvin Choi, Ph.D., of the division of epidemiology and community health at the University of Minnesota, Minneapolis, and his associates.

Although several studies have characterized indoor tanning use among adolescents, few have addressed the practice among adults, and those few have been restricted to regional samples only or to the parents of adolescents. Dr. Choi and his colleagues examined adult indoor tanning via data from a National Cancer Institute survey of a nationally representative, random sample of white subjects aged 18-64 years.

It is "concerning" that such a small proportion of adults understand the potential damage from indoor tanning. "Perhaps people are confused by the messages from the indoor tanning industry on possible benefits ... [such as] getting vitamin D from moderate exposure to artificial UV radiation," the investigators wrote.

"Effective dissemination of the harms of indoor tanning use may reduce the prevalence of its use among adults. Interventions to reduce indoor tanning use to date have focused on the appearance-damaging effect of indoor tanning, but such an approach may not change participants' perceived susceptibility to skin damage or cancer," they noted (Arch. Dermatol. 2010;146:1356-61).

Strategies such as clinician-patient communication may be necessary to address this knowledge gap, since brief health advice from physicians has been effective for other health behaviors such as smoking cessation, Dr. Choi and his associates added.

The prevalence of indoor tanning use was highest in the youngest members of the study sample and declined steadily with age. Residents of the Midwest were the most likely to use indoor tanning, and residents of the South also were significantly more likely to do so than residents of the eastern or western United States. "The regional differences may reflect greater availability of tanning salons, as the Midwest region has been shown to have the highest per capita [number of] indoor tanning facilities in the country," the researchers wrote.

Among men, those living in metropolitan areas were more likely to use indoor tanning, but this was not true of women. "Although we did not have sufficient information to investigate reasons for this finding, we speculate that differences in appearance motives between men living in metropolitan and nonmetropolitan areas could be one possibility. Alternatively, differences in marketing strategies used by the indoor tanning industry or in access to tanning salons between these areas could explain" this difference, they added.

Unexpectedly, people who used spray tanning products were more likely than those who did not to use indoor tanning. This suggests that people do not substitute tanning products for actual tanning, but instead use both means to achieve a tanned appearance.

Women who used sunscreen and other methods of protection, such as wearing protective clothing or seeking shade, were significantly less likely to use indoor tanning, probably because they recognized the need to protect their skin from damage. This means that women who use indoor tanning devices are likely not to use sunscreen or other methods of protection, putting them at additional risk for skin cancer.

In an accompanying editorial, Dr. Robert P. Dellavalle noted that the high prevalence of indoor tanning means that physicians will once again be called on to counsel patients against a risky behavior. But clinicians – dermatologists no less than primary-care physicians – are already under distinct time pressure and may not have the luxury of devoting several minutes to routine advice against the use of tanning beds. "Primary care clinicians should not reduce the time that they spend counseling teens on seat belt and bicycle helmet use or on tobacco avoidance and cessation [in order] to spend more time on sun safety and tanning bed avoidance," he wrote (Arch. Dermatol. 2010;146:1361-2).

Besides, the most recent U.S. Preventive Services Task Force guidelines "found little evidence to determine the effects of counseling on the sun protection behaviors of adults, including avoiding sunlamps and tanning beds, and did not recommend any routine counseling by primary care clinicians to prevent skin cancer," noted Dr. Dellavalle of the department of dermatology at the University of Colorado at Denver, and the Colorado School of Public Health, Aurora. "This guideline recommendation is unlikely to change soon as no major (and expensive) randomized controlled trial on skin cancer counseling efficacy appears on the horizon," he wrote.

The study was supported by the National Cancer Institute. No financial disclosures were reported by the investigators, nor by Dr. Dellavalle.

Few Women, Men See Indoor Tanning as Harmful