TABLE 4.
Main themes with supporting evidence
| COM‐B | Subtheme | Engage in indoor‐tanning | Quitting/reducing tanning |
|---|---|---|---|
| Reflective motivation | Aesthetic values | We found one underlying motive for artificial tanning: the enhancement of one's appearance. Informants clearly linked body image with self‐esteem. With no exceptions, our informants told us that tanned skin improves their looks in different ways… (author interpretation) Vannini and McCright (2004) p. 319 | I started to cut back after I went three times in a row and started to peel on my face [which] wasn't very attractive. I also was a lot darker than I was hoping for. (participant quote) Bowers and Moyer (2019) p. 350 |
| I'm not as, uh… too particular about my appearance as I was when I was younger, when I used them more frequently. (participant quote) Banerjee et al. (2014) p. 212 | |||
| ‘Conscious planning and evaluations (beliefs about what is good and bad) e.g., I have the desire to)’ (Taken from the COM‐B questionnaire—Keyworth et al., 2020) | My reasons in the past have been feelings of insecurity about how pale I am. Being pale in this society is not a preferred look. (participant quote) Bowers and Moyer (2019) p. 349 | The main thing that would stop me is if pale became completely in. I think that's the only thing that would change my mind… (participant quote) Boynton and Oxlad, (2011) p. 976 | |
| Physical‐effects | I needed a base tan so I would not get burned in Mexico (participant quote) Bowers and Moyer (2019) p. 349 | Well, I found a mole on my left breast that I know has not been seeing the daylight, and, I had to have it removed. And I'm lucky enough that it was benign, but, um, that really opened my eyes that… you know, that could only have been caused by the tanning bed. (participant quote) Banerjee et al. (2014) p. 212 | |
| During winter months I get seasonal depression so I use the tanning beds for vitamin D. (participant quote) Bowers and Moyer (2019) p. 349 | |||
| Psychological‐effects | ‘If I haven't been on a sunbed for a while, like when I'm trying to save money, then I just don't feel as well, as healthy. I get colds and stuff. I start to feel down and get very tense. I just don't have the willpower to stop for long’ (participant quote) Murray and Turner (2004) p. 76 | ‘I never really enjoyed it very much. Um, I just wasn't very comfortable with them’. (participant quote) Banerjee et al. (2014) p. 212 | |
| Risk‐perceptions | But just about everyone seemed to downplay this risk. As one young man said: ‘What can you do these days that does not cause cancer?’ Much of this risk‐taking behavior was explained to us as a form of ‘getting the best out of life’ and ‘doing your body a little bad and a little good at the same time’. (author interpretation/participant quote) Vannini and McCright (2004) p. 326 | Now, obviously, my attitude has changed. I always said that if they came out and proved that there was a link to skin cancer and tanning, that I would stop, and when they did sort of start coming out with those studies, I had stopped. I even had a membership that I was going to every once in a while, and once the studies started coming up, I just stopped and I just let the money go. (participant quote) Hay et al. (2016) p. 1266 | |
| Maybe but I know a few people who regularly use them for years. My mum's friend who uses sunbeds, and salon owner where I go have flawless, unwrinkled skin. There is a lot of scare tactics in the media surrounding sunbeds so I would rather trust what I see with my own eyes. Also if all else fails there's always Botox (participant quote) Taylor et al. (2018) p. 523 | I have thought about it….my fear of cancer outweighs the aesthetic benefit of having a tan. (participant quote) Bowers and Moyer (2019) p. 346 | ||
| If you've got skin cancer you can get over it quick. (participant quote) Lake et al. (2014) p. 60 | |||
| Social‐opportunity | Aesthetic‐values | I don't know, I think boys probably go for you a bit more if you have a bit of colour (participant quote) Lake et al. (2014) p. 58 | |
| ‘Interpersonal influences, social cues and cultural‐norms provide the opportunity to engage in the activity concerned (e.g., other people tanning)’ (Taken from the COM‐B questionnaire—Keyworth et al., 2020) | Psychological‐effects | Psychological‐benefits were also mentioned, including feeling more accepted by peers, feeling more confident, and experiencing mood improvement. (author interpretation) Glanz et al. (2018) p. 296 | I think maybe I grew out of it a little bit? It's that possibility, you know… after I got away from campus and college and listen to what everybody's doing, it was kind of like, ‘You know? I don't really need to do this anymore.’ (participant quote) Banerjee et al. (2014) p. 212 |
| [reasons for quitting] Now, a lot of my friends don't tan. … I'm the only one, so it's not necessary for me to do it. (participant quote) Glanz et al. (2018) p. 298 | |||
| Risk‐perceptions | Most of our respondents had collected information about the side effects of tanning from a variety of sources, including salon workers, popular magazine articles, Internet articles, television, and their friends. (author interpretation) Vannini and McCright (2004) p. 326 | Um, well, I got a lot of… I work at a hospital, and got a lot of flack for usin’ them as we refer to them—‘The Cancer Tube’. And so, I decided (chuckles) to stop doin’ that … (participant quote) Banerjee et al. (2014) p. 212 | |
| Finally, while discussing the barriers to quitting indoor tanning use, participants also noted the misinformation provided by tanning salons to convince customers that indoor‐tanning was safe and beneficial for them. (author interpretation) Banerjee et al. (2014) p. 214 | Participants described the central role of family and friends in providing encouragement for cessation of indoor‐tanning. Accordingly, one participant noted that her mother was a nurse and frequently advised her against indoor‐tanning; therefore, she was very happy with her decision to quit. (participant quote) Banerjee et al. (2014) p. 213 | ||
| Physical‐opportunity | Acceptable‐alternatives | No…Um, I've tried different lotions and everything. But I, I never really liked them, so. (participant quote) Banerjee et al. (2014) p. 216 | I don't use ‘em that much, now. I might use them now for, um… for summer, like to get ready for the summer. ‘Cause again, I live in England, so it's not… there's a lot of sun and opportunity to just hang out. But, um… they've definitely improved a lot over the years. The smell's improved in the way that they… whatever it is that's interacting with their dermus, and in a way… I don't know, … splotchy… I mean, I just think there's so many, the products out there, but, I just, um…my experience with them has been good, and I've been happy with them when I want to use them, which isn't that frequently. (participant quote) Banerjee et al. (2014) p. 217 |
| ‘The environment provides the opportunity to engage in the activity concerned (e.g., the sufficient time, the necessary materials, reminders)’ (Taken from the COM‐B questionnaire—Keyworth et al., 2020) | I didn't enjoy the procedure [spray tan], I think I've done it a couple of times, but it's not something I'd do again, I'd rather just stand under a lamp and be left to daydream and you know it's like so intrusive spray tanning, I don't like it (participant quote) Lyons et al. (2021) p. 4 | ||
| Availability & accessibility | A majority of respondents mentioned accessibility and affordability of the tanning salons as facilitators of tanning indoors (author interpretation) Glanz et al. (2018) p. 296 | If it was inconvenient, like if it was not just close by. … if it was out of my way, I would just not bother (participant quote) Glanz et al. (2018) p. 297 | |
| Yes, received phone calls offering discounts/upgrades to come back. (participant quote) Banerjee et al. (2014) p. 212 | Spray tans, or stuff like that—making that more accessible or just like more widely used. (participant quote) Glanz et al. (2018) p. 297 | ||
| The gym I was a member of had indoor‐tanning facilities included in my membership, so I felt as though I may as well use them since I pay for it already. (participant quote) Bowers and Moyer (2019) p. 349 | Um, well, yeah. I mean, I have kids, and so it was taking time—I was trying to do it after work and then go pick ‘em up from daycare—and it was taking away time from them, so, that was another important reason to stop’. (participant quote) Banerjee et al. (2014) p. 212 | ||
| When I go on the sunbeds I buy in bulk, it always that the sunbed's cheaper than the self tanning products, cos you can go through them quite fast and they're quite expensive (participant quote) Lyons et al. (2021) p. 4 | |||
| Automatic‐motivation | Psychological‐effects | I wish that I'd never started using one to be honest with you because I think that using a sunbed is almost like an addiction. Once you start to use them it's very hard to stop. You become used to seeing yourself with a tan and realise that you do look better. People also start to comment and say that you look nice and you just don't want to let yourself get pale again so it's very hard to stop. (participant quote) Murray & Turner p. 76 | No. I did not. Um, I'd never felt addicted to tanning beds, um, I didn't have a problem stopping, just because once I made up my mind that it was the right thing to do, and that I needed to do it to be healthy, I just did it, um, and so I never desired to go back. I never had any symptoms of depression or, um… you know anything like that. (participant quote) Banerjee et al. (2014) p. 215 |
| There is some… something to it, where, um… it does make you feel better. And I think once… it's really, for me, it's once I START again, it's, like I just keep wanting to go back more frequently throughout the week, um… and it's hard to stop. But then once I'm stopped, I'm okay, you know. (participant quote) Banerjee et al. (2014) p. 212 | |||
| ‘Doing something without thinking of having to consciously remember (e.g., “is something I do before I realise I'm doing it”)’ (Taken from the COM‐B questionnaire—Keyworth et al., 2020) | A few participants reported some psychological urges to go back for indoor‐tanning and perceived the quitting experience as somewhat difficult. One participant noted that the urge to go back to indoor‐tanning was a physical urge, and expressed it as a longing for the warmth and sensation she experienced while indoor‐tanning (therefore, we classified her urge as a psychological one). (author interpretation) Banerjee et al. (2014) p. 214 | ||
| Psychological‐capability | Risk‐perceptions | I think the one thing that I think about when you ask me about tanning salons, is just the grave amount of misinformation, and really, lying, that they do to convince customers that it's safe. And not as harmful as if you lay out in the sun; or, that it's actually good for. All these different things have ALWAYS bothered me! (Chuckles lightly)…. Um, so that's something I have run into with several different tanning salons, in the past. … I just think an awareness is… there must be a correlation between… um, education level and… ‘cause… you know, so, just being able to understand information, learn your sources…and getting lies about making decisions, I just feel like that's probably where most of my information about tanning salons come from. (participant quote) Banerjee et al. (2014) p. 213 | |
| ‘I have a great dermatologist too… She knows I tan… She does not approve but she knows I do and so… she'll do a head to toe sweep of making sure that everything looks good and if anything is even questionable, she's like “before it turns into something worse”’ (participant quote) Rodgers et al. (2016) p. 5 | |||
| Sometimes the positives outweigh the negatives (participant quote) Rodgers et al. (2016) p. 5 | |||
| ‘Knowledge and/or psychological strength or stamina to engage in the necessary thought processes for the activity concerned (e.g., having the knowledge, cognitive and interpersonal skills, having the ability to engage in the appropriate memory, attention and decision‐making processes)’ (Taken from the COM‐B questionnaire—Keyworth et al., 2020) | The risk may increase by 70% by using them, but if the risk is only 1/20,000 to begin with, that makes it only 1/10,000 which is still microscopic and not really any different. (participant quote) Taylor et al. (2018) p. 528 | ||
| Availability/accessibility | Um, I don't remember them calling or sending me emails, but I do remember when… when I tried to cancel? I mean, like, when I walked in to cancel? And I remember feeling a little bit nervous about going IN to cancel? But they DO try to convince you to stay, like, they start…start tellin’ you about new offers. Like, ‘Oh, we can reduce it by this much, or we can give you this new offer, or we can…’ you know? They tried to… they tried really hard to get you to stay. I mean, it's, it's hard to cancel. Um, and I was… had to go in there with a bunch of… I mean, because I… I have a hard time with that, and I KNEW that they were gonna try to do that. So I walked in there knowing, like, ‘Okay, I'm deciding I'm already gonna stop. So, no matter what they say to me, like, I've already made my decisions’. And no matter how hard they try you know, ‘I'm… I'm done’. (participant quote) Banerjee et al. (2014) p. 212 |