To the Editor
We read with interest the recent article by Coups et al1 examining indoor tanning among New Jersey high school students before and after the enactment of youth access restrictions. The study found relatively stable rates of indoor tanning in New Jersey from 2012 to 2014, despite a 2013 law prohibiting minors younger than 17 years from using commercial tanning facilities and requiring parental permission for 17-year-olds.1
We previously documented that laws including age restrictions are associated with reduced indoor tanning among high school girls.2 As more states have passed age restrictions, studies have demonstrated that national rates of indoor tanning have declined among both adolescents and adults, although these studies cannot attribute those reductions to the enactment of those specific laws.3,4
The New Jersey law limited indoor tanning for those age 16 years old and younger. Under the law, 17-year-olds can indoor tan with parental permission. Before 2013, indoor tanning was prohibited among children younger than 14 years, whereas parental consent was required for minors age 14 to 17 years. Thus, this law only changed indoor tanning access in salons among those aged 14 to 16 years. Our research has documented that indoor tanning rates are quite low for those ages 14 and 15 years.3 For this reason, age restrictions prohibiting indoor tanning among minors younger than 18 years are likely to be most effective.
The sample size for the Coups et al1 study was small; only 1850 students were surveyed in 2012, 6.7% of whom were indoor tanners, or approximately 124 respondents. Also, the 2012 sample size was less than half the size of the 2014 sample size. Given the small number of indoor tanners identified in the survey, the results should be interpreted with caution. Observed increases in male indoor tanning rates may be related to small sample size. The study of Guy et al,2 with a sample size of 25,758 persons, was not able to demonstrate change in male tanning rates subsequent to indoor tanning laws.
Finally, if further research determines that indoor tanning restrictions have not resulted in reductions in adolescent use of indoor tanning in New Jersey, better understanding of the factors associated with greater effectiveness will be crucial. We agree with Coups et al1 that proper enforcement of existing laws, public education, and training for salon owners and employees are needed to ensure that people are aware of and adhering to indoor tanning laws. Past research has demonstrated wide variation in compliance and enforcement at tanning salons.5 Indoor tanning in nonsalon locations, such as gyms and homes, is often not covered by regulations, and when regulations do apply they can be difficult or impossible to enforce.6
Because initiation of indoor tanning is most common during adolescence and decreases with age, age restrictions may delay or eliminate initiation.3,4 Such laws may also help influence social norms.7 The Food and Drug Administration has proposed restricting indoor tanning among those younger than 18 years.8 Such restrictions can play an important role in reducing exposure to ultraviolet radiation from indoor tanning, one important component in preventing future cases of skin cancer.9
Acknowledgments
Funding sources: None.
Footnotes
Conflicts of interest: None declared. The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.
References
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