Indoor tanning is a known carcinogen, but the scope of exposure to this hazard is not known.
To summarize the international prevalence of exposure to indoor tanning.
Studies were identified through ...systematic searches of PubMed (1966 to present), Scopus (1823 to present), and Web of Science (1898 to present) databases, last performed on March 16, 2013. We also hand searched reference lists to identify records missed by database searches and publicly available data not yet published in the scientific literature.
Records reporting a prevalence of indoor tanning were eligible for inclusion. We excluded case-control studies, reports with insufficient study information, and reports of groups recruited using factors related to indoor tanning. Two independent investigators performed searches and study selection. Our search yielded 1976 unique records. After exclusions, 161 records were assessed for eligibility in full text, and 88 were included.
Two independent investigators extracted data on characteristics of study participants, inclusion/exclusion criteria, data collection format, outcomes, and statistical methods. Random-effects meta-analyses were used to summarize the prevalence of indoor tanning in different age categories. We calculated the population proportional attributable risk of indoor tanning in the United States, Europe, and Australia for nonmelanoma skin cancer (NMSC) and melanoma.
Ever and past-year exposure to indoor tanning.
The summary prevalence of ever exposure was 35.7% (95% CI, 27.5%-44.0%) for adults, 55.0% (33.0%-77.1%) for university students, and 19.3% (14.7%-24.0%) for adolescents. The summary prevalence of past-year exposure was 14.0% (95% CI, 11.5%-16.5%) for adults, 43.1% (21.7%-64.5%) for university students, and 18.3% (12.6%-24.0%) for adolescents. These results included data from 406 696 participants. The population proportional attributable risk were 3.0% to 21.8% for NMSC and 2.6% to 9.4% for melanoma, corresponding to more than 450 000 NMSC cases and more than 10 000 melanoma cases each year attributable to indoor tanning in the United States, Europe, and Australia.
Exposure to indoor tanning is common in Western countries, especially among young persons. Given the large number of skin cancer cases attributable to indoor tanning, these findings highlight a major public health issue.
Nail salon technicians face chronic exposure to volatile organic compounds (VOCs), which can lead to adverse health outcomes including cancer. In this study, indoor levels of formaldehyde, as well as ...benzene, toluene, ethylbenzene and xylene, were measured in 6 Colorado nail salons. Personal exposure VOC measurements and health questionnaires (n = 20) were also performed; questionnaires included employee demographics, health symptoms experienced, and protective equipment used. Cancer slope factors from the United States Environmental Protection Agency (US EPA) and anthropometric data from the Centers for Disease Control and Prevention were then used to estimate cancer risk for workers, assuming 20-yr exposures to concentrations of benzene and formaldehyde reported here. Results show that 70% of surveyed workers experienced at least one health issue related to their employment, with many reporting multiple related symptoms. Indoor concentrations of formaldehyde ranged from 5.32 to 20.6 μg m−3, across all 6 salons. Indoor concentrations of toluene ranged from 26.7 to 816 μg m−3, followed by benzene (3.13–51.8 μg m−3), xylenes (5.16–34.6 μg m−3), and ethylbenzene (1.65–9.52 μg m−3). Formaldehyde levels measured in one salon exceeded the Recommended Exposure Limit from the National Institute for Occupational Safety and Health. Cancer risk estimates from formaldehyde exposure exceeded the US EPA de minimis risk level (1 × 10−6) for squamous cell carcinoma, nasopharyngeal cancer, Hodgkin's lymphoma, and leukemia; leukemia risk exceeded 1 × 10−4 in one salon. The average leukemia risk from benzene exposure also exceeded the US EPA de minimis risk level for all demographic categories modeled. In general, concentrations of aromatic compounds measured here were comparable to those measured in studies of oil refinery and auto garage workers. Cancer risk models determined that 20-yr exposure to formaldehyde and benzene concentrations measured in this study will significantly increase worker's risk of developing cancer in their lifetime.
Display omitted
•VOCs in nail salons exceeded odor thresholds and inhalation reference concentrations.•BTEX levels in nail salons were similar to those in oil refineries and auto garages.•Most nail salon workers reported health issues related to their employment.•Nail technicians who work more than 20 years may experience increased cancer risk.
VOCs measured in this study exceeded odor thresholds and NIOSH exposure limits, and 20-yr exposure to formaldehyde and benzene levels measured here will increase risk of cancer.
Several state governments have enacted bans on the use of indoor tanning beds at tanning salons among minors, but studies of the association of such restrictions with tanning behavior have produced ...mixed results. Little is known about the prevalence of tanning in nonsalon locations that are typically not covered by restrictions. Evidence that age bans are associated with a reduction in tanning bed use is needed to support policy makers' efforts to expand tanning regulations.
To determine the prevalence and location of indoor tanning among New Jersey youths after a 2013 statewide indoor tanning ban for minors younger than 17 years.
This survey study comprised 4 biennial (2012-2018) and representative cross-sectional surveys conducted among 12 659 high school students (grades 9-12) in New Jersey.
The main outcome was the frequency of indoor tanning in the past year. Location of tanning bed use (ie, tanning salons or nonsalon locations, such as private residences or gyms) was also assessed.
Survey responses from a total of 12 659 high school students (6499 female 51%; mean SD age, 15.8 1.3 years) were analyzed across the 4 survey waves. Tanning prevalence among students younger than 17 years (ie, younger than the legal tanning age) was 48% lower in 2018 compared with 2012 (adjusted odds ratio, 0.52; 95% CI, 0.33-0.81; P = .002). Tanning prevalence was 72% lower among female students 17 years or older (adjusted odds ratio, 0.28; 95% CI, 0.18-0.44; P < .001). Prevalence rates were not significantly different for male students 17 years or older and for racial/ethnic minority students. The prevalence of tanning in salons and private residences was similar among students younger than 17 years.
This study suggests that the prevalence of tanning in New Jersey has begun to decrease among all youths younger than the legal tanning age and among female students of legal age in the 5 years after a statewide tanning ban. These findings provide valuable evidence to policy makers to support ongoing state-level efforts to enact age-specific bans on indoor tanning. The unique assessment of tanning location demonstrates the need for both greater enforcement of existing tanning salon regulations to ensure compliance and broadening restrictions to cover nonsalon tanning locations.
In 2011, following years of outreach and training, Boston, Massachusetts, enacted regulations to improve health and safety in nail salons. These were amended in 2013 to require mechanical ...ventilation, including dedicated exhaust for each manicure and pedicure station. As of June 2019, 185 of 190 salons have satisfied the regulatory requirements. Regulations can help ensure that environmental health benefits are widespread and that small businesses' investment in occupational health does not result in a competitive disadvantage.
Indoor tanning has been only weakly associated with melanoma risk; most reports were unable to adjust for sun exposure, confirm a dose-response, or examine specific tanning devices. A ...population-based case-control study was conducted to address these limitations.
Cases of invasive cutaneous melanoma, diagnosed in Minnesota between 2004 and 2007 at ages 25 to 59, were ascertained from a statewide cancer registry; age-matched and gender-matched controls were randomly selected from state driver's license lists. Self-administered questionnaires and telephone interviews included information on ever use of indoor tanning, types of device used, initiation age, period of use, dose, duration, and indoor tanning-related burns. Odds ratios (OR) and 95% confidence intervals (CI) were adjusted for known melanoma risk factors.
Among 1,167 cases and 1,101 controls, 62.9% of cases and 51.1% of controls had tanned indoors (adjusted OR 1.74; 95% CI, 1.42-2.14). Melanoma risk was pronounced among users of UVB-enhanced (adjusted OR, 2.86; 95% CI, 2.03-4.03) and primarily UVA-emitting devices (adjusted OR, 4.44; 95% CI, 2.45-8.02). Risk increased with use: years (P < 0.006), hours (P < 0.0001), or sessions (P = 0.0002). ORs were elevated within each initiation age category; among indoor tanners, years used was more relevant for melanoma development.
In a highly exposed population, frequent indoor tanning increased melanoma risk, regardless of age when indoor tanning began. Elevated risks were observed across devices.
This study overcomes some of the limitations of earlier reports and provides strong support for the recent declaration by the IARC that tanning devices are carcinogenic in humans.
PDF
