Indoor Tanning Users’ Experiences with Tanning Salon Direct to Consumer Marketing

Growing concern over the public health risk of indoor tanning (IT) has led to recent IT control efforts including restricting access of minors, new warning labels, and increased industry regulations.¹ The tobacco control research and policy model may be useful in shaping IT control approaches, particularly given parallels between IT and tobacco industry strategies.^1,2 An important focus of tobacco control is studying industry marketing including direct communication with tobacco users, called direct to consumer marketing (DCM). Tobacco DCM often contains price discounts to increase sales³ and sustain recipients’ smoking.⁴ There is a dearth of research related to IT marketing.

We explored tanning bed users’ experiences with DCM from IT salons with two cross sectional studies. First, participants in a focus group study of IT motives were asked to describe IT advertisements or promotions they had received. Responses were used to create DCM survey items. Items were added to a follow-up survey of control group participants in a 2 × 2 randomized control trial (2 conditions, 2 surveys) of an online tanning bed behavioral intervention. Control participants did not receive an intervention that may have influenced responses. For both studies, participants were from a large northeastern US university and inclusion criteria were female gender, use of a tanning bed at least once in the past 12-months, and 18–25 years of age. Recruitment methods for each study included posting study flyers in campus locations and in-class study announcements in undergraduate courses. Flyers instructed interested individuals to contact a study coordinator to enroll. Participants received cash or extra credit compensation. The University IRB approved all procedures.

Nine focus groups were conducted with 63 participants (mean age= 19.8 years; 92% White; 16% Hispanic). Two authors independently coded and sorted mentions of IT DCM and together came to a consensus regarding final categories.⁵ The most common DCM were text messages and emails (Table 1), mentioned in 8 of the 9 groups, followed by social media (mentioned in 6 groups) and direct mail (3 groups). The quotes demonstrate the persuasive nature of DCM.

Table 1.

Types and Frequency of Direct to Consumer Marketing Reported by Focus Group Participants

Type of DCM	Number of Groups that Mentioned DCM	Illustrative Quotes
Text Messages	8 of 9	I work at a new tanning salon … he [the owner] got this technology from Poland, and basically if you have your Bluetooth on, he has this device that will send you a text message—it’s super creepy, I told him not to do it. He’s like, it’s the next big thing. But that’s another way to lure customers in, if you’re like 500 feet away, then it’ll send you the text message.
		And then it’s right there, in a text. More enticing to me than to go through my thousands of emails that I have from all these website … the more it is in my face, the more I think about it, and the more that it’s coming to spring and summer, the more antsy I get about it, and the more I’m wanting to do it.
		I get text messages on a weekly basis from two different salon. It’s like, oh come in, free tan from 12:00 to 3:00. Dollar tans on Sunday.
		I got a text two weeks ago. It was free tanning for the next two weekends and I was like, oh. Maybe I should think about that.
Emails	8 of 9	I would get those e-mails, the texts all the time, and then it was like free tanning weekend a couple weeks ago so my friend and I went in, and it was like $6 to join.
		I just got one in my email from (Salon Name Withheld) and it said, help hurricane Sandy victims, and it was a meet-and-greet with Snooki on it … I guess we’re paying for her signature, which would go help Hurricane Sandy, but they were trying to connect the two to promote her tanning salon, and it blew my mind.
		The place that I go, I stopped, and a couple of months ago I got an email and it was like, we miss you. I was like, oh really?
Social Media	6 of 9	I think it’s more people talking about it, but sometimes some tanning salons will add you on Facebook or something.
		I see a lot of it on Facebook, like everyone just getting tagged and in these posts for all these promotions and special tanning stuff they have. Yeah, a lot of it is on social media, too.
		They literally advertise it everywhere though. Like the texts, emails, huge banners. And then there’s Facebook, like all the Facebook groups … I’m a sucker for that.
Direct Mail	3 of 9	I get local places in the mail that I’ve never been to, so I don’t know. I guess they send them out randomly.

Note: DCM = direct to consumer marketing

Eighty-five participants completed the survey (mean age= 19.8 years; 79% White, 11% Asian; 13% Hispanic). A majority had received emails (71.4%) or direct mail (60.7%) and nearly half received text messages. Most participants had viewed salon advertisements on social media (88.0%) although direct contact through social media requests (32.1%) or messages (11.9%) was less common. Approximately 35% of participants agreed DCM had prompted them to use tanning beds.

The finding that most tanning bed users received a variety of DCM from tanning salons is novel and implies that DCM is an important IT industry-marketing tool that may reach millions of the Americans who use tanning beds. There is a need for public health researchers to collect and monitor examples of industry DCM to determine if the advertising content of direct communications abides by relevant regulations. There was also evidence that DCM may prompt tanning bed use, which is consistent with research on the effects of tobacco DCM on tobacco use.⁴ Public health researchers and policymakers should consider the possible role of DCM, and accompanying price promotions, in sustaining tanning and counteracting IT reduction efforts. Study limitations included small convenience samples recruited from a single university that had allowed students to use university debit cards at local tanning salons.⁶ Although this practice has since been disallowed, the competitive local business environment for IT salons may have resulted in unusually high rates of DCM. The extent to which findings can be extrapolated to other populations and settings remains to be determined.

Table 2.

Prevalence of Direct to Consumer Marketing Among Indoor Tanning Bed Users

Indoor Tanning DCM Survey Items	% of Positive Responses (95% CI)
Have you ever received an email from a tanning salon that advertised their tanning beds?	71.4%a (62.0–81.5)
Has a tanning salon ever sent you an advertisement in the mail about their tanning beds?	60.7%a (49.3–71.8)
Have you ever received a text message from a tanning salon that advertised their tanning beds?	47.6%a (36.6–59.0)
Have you ever seen salon advertisements for indoor tanning beds on Facebook, Twitter, or other forms of social media?	88.0%a (80.0–94.8)
Have you ever received a friend or follow request from a tanning salon?	32.1%a (21.6–41.8)
Have you ever been tagged in a social media message by a tanning salon?	11.9%a (4.7–18.2)
Receiving a text, email, or social media message about tanning has caused me to use a tanning bed when I would normally not go.	34.5%b (20.0–50.2)

Note. DCM, direct to consumer marketing. CI, confidence interval.

N = 85 young adult females who reported indoor tanning use in the past year.

^aVariable had response options of no or yes. The percentage corresponds to a “yes” response.

^bVariable had response options on a 5-point Likert-type scale ranging from strongly agree to strongly disagree. Response options were collapsed so that the percentage corresponds to the amount of “agreed” responses (i.e., agree or strongly agree).