Exploring addiction and addictive tendencies among adult tanning bed users

Background: Despite awareness of the negative long-term health related consequences of chronic ultraviolet-radiation exposure such as skin cancer and premature signs of aging, indoor tanning is popular. Tanning behavior may be driven by both appearance-related reasons and by physical addiction to UV exposure. Understanding the preventable behavior from the patient perspective may provide avenues to better educate those impacted in preventing the development future complications.

Hypothesis: We hypothesize differences in the demographic features, beliefs, and motivations while screening individuals for tanning addiction or addictive tendencies (AorAT).

Methods: The study utilized Amazon Mechanical Turk (MTurk) to recruit 300 subjects electronically. To meet inclusion criteria, individuals were required to be between 18-80 years of age and have a working knowledge of the English language. Following recruitment, included subjects completed the modified CAGE (Cut down, Annoyed, Guilty, Eye-opener) and modified DSM-IV-TR (Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition) questionnaires to assess for the presence of addiction or addictive tendencies. Additionally, survey responses were collected to isolate demographic factors and information regarding individual subjects’ beliefs on the addictive properties of indoor tanning bed use. Following quantification of retrieved responses, differences of statistical significance within subgroup analyses were assessed by way of Chi-squared and two-sample T-testing. 

Results: In total, 289 respondent responses were collected, with 64 and 225 screening positive and negative for AorAT, respectively. Within the entire study cohort, the mean age was 38.7 years (SD: 12.0) and there was a slightly higher female predominance (56.7%, n=164). Individuals reporting previous, but not current, tanning in the subgroups with a positive screen were older (33.1, SD: 9.5) than those with a negative screen (40.1, SD: 11.7, p=0.02). Among the same subgroup, a greater proportion of respondents with a positive screen (72.22%, n=13) had an educational attainment of a bachelor’s degree or higher, compared to those with a negative screen (90.22%, n=83, p=0.04). Study participants with a positive screen (34.4%, n=22) were also more likely to be current tobacco-product users, compared to those with a negative screen (17.8%, n=40, p=0.004). While exploring possible reasons for tanning bed use, individuals with a positive screen (17.19%, n= 11) were more likely to list the mood and relaxation related benefits as contributing factors, compared to those with a negative screen (2.22%, n=5, p < 0.0001). Interestingly, individuals with a negative screen (77.78%, n=175) were more likely to list appearance related reasons as a reason for tanning, compared to those with a positive screen (56.25%, n=36, p=0.01). While assessing reasons for tanning discontinuation, a greater proportion of individuals with a positive screen (16.67%, n=3) listed health concerns as a motivator, compared to those with a negative screen (56.04%, n=51, p=0.002).

Conclusions: We report previous, but not current, tanners with a negative screen for AorAT had a higher mean age and greater overall educational attainment compared to those with a positive screen. Respondents with a positive screen were more likely to concurrently smoke tobacco products, list appearance and mood/relaxation related benefits as reasons for sustained tanning, and less likely to list health-related concerns as a reason for tanning discontinuation. This study reports important differences in the demographics and beliefs among tanners following AorAT screening. For specific patient-cohorts, shifting the conversation from stressing the health-related consequences to more empathetic dialogue about the role of addiction and providing behavioral-health resources, where appropriate, may be a useful strategy.