Tanning dependence, sometimes called "tanorexia," is common in young adults and can be predicted by certain demographic and behavioral variables, according to a survey of 400 college students.

More than a quarter (27%) of survey respondents were classified as tanning dependent, and ethnicity, skin type, lack of skin protective behaviors, tanning behaviors, smoking, and body mass index each were found to be significant independent predictors of tanning dependence, reported Carolyn J. Heckman, Ph.D., of Fox Chase Cancer Center in Cheltenham, Pa., and her colleagues (Am. J. Health Behav. 2008;32:45164).

The findings could assist clinicians in identifying individuals who are tanning dependent or who are at risk of becoming dependent, the investigators said.

In the article, which is now in press, the investigators stated that tanning dependence has a number of similarities to substance use, including higher prevalence among youth, an initial perception that the behavior is image enhancing, and high health risks and disregard for warnings about those risks. Although a primary motivation for tanning is appearance enhancement, tanners often report other benefits, such as mood enhancement, and socialization, commonly reported by individuals with other types of dependencies, Dr. Heckman and her associates noted.

Tanning dependence also has similarities to disorders such as obsessive compulsive disorder and eating disorders, thus the nickname "tanorexia," but it is unclear which comparisons are most applicable.

Prior studies have suggested that one possible mechanism for tanning dependence is endogenous opioid release during ultraviolet radiation (UVR) exposure: Blinded study participants demonstrated a preference for UVR vs. non-UVR tanning beds, and UVR exposure was associated with a more relaxed and less tense mood in those studies. Furthermore, in at least one other study, the preference for UVR tanning beds was reduced with increasing doses of the opioid antagonist naltrexone.

In the current study, which was sponsored by the National Cancer Institute, tanning dependence was assessed using measures developed to evaluate more traditional addictive behaviors such as substance use, which were adapted for the purpose of assessing tanning addiction. The scales used were the four-question CAGE alcohol evaluation and the American Psychiatric Association's Diagnostic and Statistics Manual IV-Text Revision substance dependence criteria.

Participants, who had a mean age of 21 years and were mostly women (75%), were asked questions about tanning behaviors such as "Do you think you need to spend more and more time in the sun to maintain your perfect tan?" and "Does your belief that tanning can cause skin cancer keep you from spending time in the sun or going to tanning beds?"

Of the 400 individuals surveyed, 106 (27%) were classified as tanning dependent by one or both of the two scales used, the investigators found.

Race was found to be predictive of tanning dependence, with white participants having 7.6-fold greater odds than African Americans. Also predictive was moderate skin type, compared with fair and dark skin. Those with Fitzpatrick type III and IV skin had the highest risk: Sixteen percent of those with type I, 21% with type II, 39% with type III, 32% with type IV, and 4% with type V skin were tanning dependent.

Several exposure and skin protection factors were found to predict tanning dependence:

▸ Those with highest level of summer sunbathing were more likely to be tanning dependent (odds ratio 7.5) than were those with the lowest level.

▸ Respondents who had the highest number of sunburns were more likely to be tanning dependent (OR 2.85).

▸ Those who used moderate (OR 0.27) or high levels (OR 0.36) of sun protection were less likely than were those who used low levels to be tanning dependent.

▸ Those who tanned indoors during warm weather were more likely to be tanning dependent (OR 2.99) than were those who did not use indoor tanning.

The use of chemical sunless tanners and the overall rates of indoor tanning did not predict tanning dependence in this study.

Health-related behaviors that were linked with tanning dependence included current smoking, with smokers having 1.81 greater odds of tanning dependence, and obesity, with those considered obese having lower likelihood of being dependent (odds ratio 0.34).

The findings may offer new avenues for research as well as skin protection and skin cancer prevention interventions, the investigators concluded, but they also noted that "not all tanning behavior or even frequent behavior should be seen as indicative of tanning dependence."

Nonetheless, they expressed concern regarding the finding that about 40% of respondents had used tanning beds, with a mean age of 17 years at first tanning and a mean number of lifetime uses of 57. This is alarming, considering the mean age of 21 in the respondents, they stated.

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Tanning dependence bears similarities both to substance use disorder and to eating disorders, thus the nickname "tanorexia." ©Bora

Ethnicity, Smoking, and BMI May Predict Tanning Dependence