This secondary analysis of a cross-sectional study using data from the 2015 National Health Interview Survey assesses the demographic characteristics and skin cancer risk behaviors of US adults who are sunless tanners.
Key Points
Question
What are the demographic characteristics and skin cancer risk behaviors of sunless tanners?
Findings
This secondary analysis of a cross-sectional study of 27 353 men and women 18 years or older in the United States found that sunless tanning was most common among young, white, college-educated women and that sunless tanners were more likely to indoor tan and report recent sunburn and less likely to use sun protection methods. Among indoor tanners, sunless tanning was not associated with improved behaviors.
Meaning
Sunless tanning was associated with risky skin cancer–related behaviors and, among indoor tanners, may not be associated with improved behaviors; longitudinal studies are needed to better determine whether sunless tanning represents an effective public health strategy to reduce skin cancer rates.
Abstract
Importance
Incidence rates of nonmelanoma and melanoma skin cancers are increasing rapidly in the United States likely because of increased UV light exposure. Sunless tanning is a safe alternative to achieve tanned skin that might help reduce skin cancer incidence by deterring risky behaviors. However, limited data exist on the characteristics and associated skin cancer risk behaviors of sunless tanners in the United States.
Objective
To assess the demographic characteristics and skin cancer risk behaviors of sunless tanners among adults in the United States.
Design, Setting, and Participants
This secondary analysis of a cross-sectional study used data from the 2015 National Health Interview Survey, a population-based survey of the US noninstitutionalized civilian population.
Participants included 27 353 men and women 18 years or older.
Main Outcome and Measures
Participant demographics and skin cancer risk behaviors, including indoor tanning, skin cancer screening, sunburn, and sun protection behaviors.
Results
Of the 27 353 adults (representative of more than 198 million US adults; mean [SE] age, 46.0 [0.2] years) studied, 6.4% (SE, 0.2%) reported sunless tanning. Factors associated with sunless tanning included being young, female, non-Hispanic white, college educated, nonobese, and sun sensitive, living in the western United States, and having a family history of skin cancer. Sunless tanners were more likely to report indoor tanning (adjusted prevalence odds ratio [aPOR], 3.77; 95% CI, 3.19-4.43; P < .001), recent sunburn (aPOR, 1.55; 95% CI, 1.31-1.83; P < .001), use of sunscreen (β = 0.19; 95% CI, 0.09-0.28; P < .001), and having had a full-body skin examination (aPOR, 1.77; 95% CI, 1.51-2.08; P < .001) but less likely to seek shade (β = −0.12; 95% CI, −0.19 to −0.04; P = .001) or use protective clothing when outdoors (long pants: β = −0.18; 95% CI, −0.26 to −0.11; P < .001; long sleeves: β = −0.10; 95% CI, −0.18 to −0.03; P = .01). Among indoor tanners, sunless tanners compared with those who did not sunless tan reported increased frequency of indoor tanning (mean [SE], 19.2 [1.9] vs 14.9 [1.2] sessions in the past 12 months; P = .04) but no differences in other skin cancer risk behaviors.
Conclusions and Relevance
This study suggests that sunless tanning is associated with risky skin cancer–related behaviors. Longitudinal studies are needed to assess whether sunless tanning changes UV exposure behaviors to better determine whether sunless tanning represents an effective public health strategy to reduce rates of skin cancer in the United States.
Introduction
Skin cancer incidence is increasing rapidly in the United States.1 The US Surgeon General identified skin cancer as a major public health issue and called for interventions aimed at reducing preventable risk behaviors, including those related to UV tanning.1 The American Academy of Dermatology advocates for sunless tanning products that contain dihydroxacetone as a safe alternative to UV tanning.2,3 However, limited evidence exists on whether sunless tanning changes skin cancer risk behaviors. A prior study4 found that sunless tanners are more likely to use sunscreen but otherwise have poor sun protective behaviors. Furthermore, sunless tanning may inadvertently reinforce beliefs that tanned skin is more desirable.5,6,7
To better investigate the potential influence of sunless tanning on public health, we assessed the demographic characteristics and skin cancer risk behaviors of sunless tanners in the United States. Furthermore, we analyzed whether sunless tanning among indoor tanners, a high-risk population for skin cancer,8 is associated with improved skin cancer risk behaviors.
Methods
In this cross-sectional study, we used data from the 2015 National Health Interview Survey, a population-based survey of the US noninstitutionalized civilian population. We restricted our secondary analyses to 33 672 adults 18 years or older but further excluded 3126 individuals (9.2%) with missing data on sunless tanning, any primary outcome, or covariate and 3193 (9.5%) without significant outdoor sun exposure. This study was determined by the University of Minnesota to be exempt from institutional review board review; therefore, no informed consent was required.
Sunless tanning was defined as self-reported use of spray-on or mist tans at a tanning salon or self-applied sunless or fake tanning products in the past 12 months. Primary outcomes included indoor tanning (ever and in the past 12 months), full-body skin examination (ever and in the past 24 months), and sunburn and sun protection behaviors (eg, use of sunscreen, shade, long sleeves, long pants, and a wide-brimmed hat) when outdoors (in the past 12 months).
We compared demographic characteristics of participants by sunless tanning use in univariate and multivariate analyses. Then we calculated the unadjusted mean behavioral scores (sun protection methods) or prevalence rates (all other primary outcomes) and the multivariate adjusted regression coefficients (sun protection methods) or odds ratios (all other primary outcomes) by sunless tanning use in the entire study population and in a subpopulation analysis restricted to indoor tanners. Finally, we repeated all analyses stratified by sex. As a secondary outcome, in a subpopulation analysis of those who reported 1 or more sunburn, we assessed the mean number of sunburns by sunless tanning. Analyses were weighted and performed using Stata statistical software, version 13.1 (StataCorp).9 For the univariate analyses, categorical variables were compared using the Wald-adjusted Pearson χ2 test and continuous variables using an adjusted Wald t test. For multivariate analyses, unpaired, 2-tailed P values were based on linearized variance estimates.
Results
Of the 27 353 adults (representative of more than 198 million US adults; mean [SE] age, 46.0 [0.2] years) studied, 6.4% (SE, 0.2%) reported sunless tanning in the past 12 months; 0.8% (SE, 0.1%) used spray-on mist tans in a tanning salon, 4.5% (SE, 0.2%) used sunless or fake tanning products, and 1.1% (SE, 0.1%) used both. Sunless tanning was associated with being female, non-Hispanic white, college educated, and nonobese, living in the western United States, reporting higher sun sensitivity, and having a family history of skin cancer (Table 1). In sex-stratified analyses, factors associated with sunless tanning among women were similar to those in the entire study population (eTable 1 in the Supplement), whereas sunless tanning among men was most common among sexual minority men (eTable 2 in the Supplement).
Table 1. Respondent Characteristics by Sunless Tanning Exposure.
| Characteristic | Unweighted Sample Size, No. (N = 27 353)a | Weighted Prevalence of Sunless Tanning, Mean (SE), %b | aPOR (95% CI)c | P Value |
|---|---|---|---|---|
| Age, y | ||||
| 18-35 | 8006 | 7.6 (0.5) | 1 [Reference] | NA |
| 36-50 | 6731 | 6.4 (0.4) | 0.77 (0.66-0.95) | .01 |
| 51-65 | 7019 | 6.1 (0.4) | 0.66 (0.55-0.78) | <.001 |
| >65 | 5597 | 4.0 (0.4) | 0.39 (0.31-0.49) | <.001 |
| Sex | ||||
| Male | 12 691 | 1.2 (0.1) | 0.10 (0.07-0.12) | <.001 |
| Female | 14 662 | 11.4 (0.4) | 1 [Reference] | NA |
| Race/ethnicity | ||||
| Non-Hispanic white | 17 617 | 8.6 (0.3) | 1 [Reference] | NA |
| Hispanic | 4488 | 3.0 (0.4) | 0.38 (0.29-0.50) | <.001 |
| Non-Hispanic black | 3367 | 0.6 (0.1) | 0.08 (0.04-0.14) | <.001 |
| Non-Hispanic Asian | 1533 | 1.0 (0.3) | 0.10 (0.05-0.17) | <.001 |
| All others | 348 | 3.2 (1.1) | 0.37 (0.18-0.78) | .01 |
| Region | ||||
| Northeast | 4509 | 6.1 (0.6) | 1 [Reference] | NA |
| Midwest | 5928 | 6.8 (0.5) | 1.15 (0.86-1.52) | .35 |
| South | 9012 | 6.0 (0.4) | 1.14 (0.88-1.49) | .33 |
| West | 7904 | 6.6 (0.4) | 1.32 (1.01-1.72) | .04 |
| Sexual orientation | ||||
| Heterosexual | 26 586 | 6.3 (0.2) | 1 [Reference] | NA |
| Sexual minority | 767 | 8.6 (1.7) | 1.16 (0.70-1.92) | .57 |
| Educational level | ||||
| Less than high school | 3459 | 2.8 (0.4) | 1 [Reference] | NA |
| High school or GED | 6709 | 4.5 (0.4) | 1.25 (0.87-1.79) | .23 |
| Some college | 8709 | 7.4 (0.4) | 1.78 (1.26-2.52) | .001 |
| College degree or greater | 8476 | 8.0 (0.2) | 1.74 (1.21-2.50) | .003 |
| BMI | ||||
| Underweight | 1371 | 9.6 (1.0) | 0.93 (0.70-1.25) | .63 |
| Normal weight | 8006 | 8.5 (0.5) | 1 [Reference] | NA |
| Overweight | 9131 | 5.5 (0.4) | 0.91 (0.75-1.10) | .32 |
| Obese | 8845 | 4.6 (0.3) | 0.62 (0.52-0.75) | <.001 |
| Sun sensitivity | ||||
| No sunburn | 12 019 | 3.1 (0.2) | 1 [Reference] | NA |
| Mild sunburn | 6905 | 9.0 (0.5) | 1.81 (1.46-2.25) | <.001 |
| Moderate sunburn | 6310 | 8.6 (0.5) | 1.63 (1.33-2.00) | <.001 |
| Severe sunburn | 2199 | 8.4 (0.9) | 1.36 (1.02-1.81) | .03 |
| Family history of skin cancer | ||||
| No | 25 183 | 6.0 (0.3) | 1 [Reference] | NA |
| Yes | 2170 | 10.9 (0.9) | 1.35 (1.08-1.71) | .01 |
| Personal history of skin cancer | ||||
| No | 26 487 | 6.3 (0.2) | 1 [Reference] | NA |
| Yes | 866 | 8.4 (1.4) | 1.40 (0.92-2.11) | .11 |
Abbreviations: aPOR, adjusted prevalence odds ratio; BMI, body mass index; GED, general educational development; NA, not applicable.
Unweighted sample sizes for reference.
Sunless tanning was defined as self-reported use of spray-on or mist tans at a tanning salon or self-applied sunless or fake tanning products in the past 12 months.
The aPORs were calculated using multivariate logistic regression analyses controlling for age (categorical), sex, race/ethnicity, region, sexual orientation, educational level, BMI, sun sensitivity, family history of skin cancer in a first-degree relative, and personal history of skin cancer.
Sunless tanners were more likely to have indoor tanned (ever and in the past 12 months) (adjusted prevalence odds ratio [aPOR], 4.13; 95% CI, 3.24-5.25), had a full-body skin examination (ever and in the past 24 months) (aPOR, 1.60; 95% CI, 1.32-1.95), and had a sunburn (aPOR, 1.55; 95% CI, 1.31-1.83) and used sunscreen (in the past 12 months) (β = 0.19; 95% CI, 0.09-0.28), but they were less likely to have sought shade (β = −0.12; 95% CI, −0.19 to −0.04), worn long pants (β = −0.18; 95% CI, −0.26 to −0.11), or worn long sleeves (β = −0.10; 95% CI, −0.18 to −0.03) when outdoors (Table 2). In sex-stratified analyses, behaviors among women and men were similar to those in the entire study population, although sunless tanning among men was not associated with differences in use of shade or protective clothing when outdoors (eTable 3 in the Supplement). Among those reporting 1 sunburn or more, we found no differences in mean (SE) number of sunburns among individuals who reported sunless tanning (2.33 [0.16] sunburns) compared with those who did not (2.48 [0.07] sunburns) (β = −0.11; 95% CI, −0.45 to 0.22; P = .53).
Table 2. Indoor Tanning, Skin Cancer Screening, Sunburn, and Sun Protection Behaviors by Sunless Tanning Exposure.
| Variable | Sunless Tanning in the Past 12 moa | P Valuec | |
|---|---|---|---|
| None (n = 25 716)b | Sunless Tanners (n = 1636)b | ||
| Indoor tanning (ever) | |||
| Weighted, mean (SE), % | 15.1 (0.4) | 58.2 (1.7) | <.001 |
| aPOR (95% CI)d | 1 [Reference] | 3.77 (3.19 to 4.43) | <.001 |
| Indoor tanning (past 12 mo) | |||
| Weighted, mean (SE), % | 2.8 (0.2) | 18.9 (1.3) | <.001 |
| aPOR (95% CI)d | 1 [Reference] | 4.13 (3.24 to 5.25) | <.001 |
| Skin examination (ever) | |||
| Weighted, mean (SE), % | 22.2 (0.4) | 39.2 (1.7) | <.001 |
| aPOR (95% CI)d | 1 [Reference] | 1.77 (1.51 to 2.08) | <.001 |
| Skin examination (past 24 mo) | |||
| Weighted, mean (SE), % | 13.3 (0.3) | 23.3 (1.5) | <.001 |
| aPOR (95% CI)d | 1 [Reference] | 1.60 (1.32 to 1.95) | <.001 |
| Sunburn (past 12 mo) | |||
| Weighted, mean (SE), % | 35.5 (0.5) | 58.4 (1.7) | <.001 |
| aPOR (95% CI)d | 1 [Reference] | 1.55 (1.31 to 1.83) | <.001 |
| Sunscreen use | |||
| Behavioral score, mean (SE)e | 2.7 (0.01) | 3.6 (0.05) | <.001 |
| β (95% CI)d | 1 [Reference] | 0.19 (0.09 to 0.28) | <.001 |
| Shade | |||
| Behavioral score, mean (SE)e | 3.1 (0.01) | 3.1 (0.04) | .22 |
| β (95% CI)d | 1 [Reference] | −0.12 (−0.19 to −0.04) | .001 |
| Long pants | |||
| Behavioral score, mean (SE)e | 2.4 (0.01) | 2.0 (0.04) | <.001 |
| β (95% CI)d | 1 [Reference] | −0.18 (−0.26 to −0.11) | <.001 |
| Long sleeves | |||
| Behavioral score, mean (SE)e | 1.9 (0.01) | 1.7 (0.04) | <.001 |
| β (95% CI)d | 1 [Reference] | −0.10 (−0.18 to −0.03) | .01 |
| Wide-brimmed hat | |||
| Behavioral score, mean (SE)e | 1.9 (0.01) | 1.8 (0.04) | .22 |
| β (95% CI)d | 1 [Reference] | −0.01 (−0.10 to 0.07) | .78 |
Abbreviation: aPOR, adjusted prevalence odds ratio.
Sunless tanning was defined as self-reported use of spray-on or mist tans at a tanning salon or self-applied sunless or fake tanning products in the past 12 months.
Unweighted sample sizes for reference.
Statistical significance calculated using Wald-adjusted Pearson χ2 tests (weighted percentages), Wald-adjusted 2-tailed, unpaired t tests (mean behavioral scores), multivariate adjusted logistic regression (aPORs), or multivariable-adjusted linear regression (coefficients).
The aPORs and regression coefficients were calculated using logistic regression and linear regression analyses, respectively, controlling for age (continuous), sex, race/ethnicity, region, sexual orientation, educational level, body mass index, sun sensitivity, family history of skin cancer in a first-degree relative, and personal history of skin cancer.
Weighted mean behavioral scores. Individual participants were assigned a behavioral score between 1 (never use) and 5 (always use) based on a Likert scale for self-reported use of each sun protection method when outdoors on a sunny day for more than 1 hour.
Among indoor tanners, sunless tanning was associated with increased frequency of indoor tanning in the past 12 months but no other differences in skin cancer risk behaviors (Table 3). These findings were consistent in sex-stratified analyses (eTable 4 in the Supplement).
Table 3. Indoor Tanning, Skin Cancer Screening, Sunburn, and Sun Protection Behaviors by Sunless Tanning Exposure Among Current Indoor Tanners.
| Variable | Sunless Tanning in the Past 12 moa | P Valuec | |
|---|---|---|---|
| None (n = 721)b | Sunless Tanners (n = 302)b | ||
| Indoor tanning frequency, mean (SE) | 14.8 (1.2) | 19.2 (1.9) | .04 |
| Skin examination (ever) | |||
| Weighted, mean (SE), % | 23.4 (2.2) | 25.5 (3.1) | .60 |
| aPOR (95% CI)d | 1 [Reference] | 1.30 (0.82 to 2.08) | .26 |
| Skin examination (past 24 mo) | |||
| Weighted, mean (SE), % | 16.1 (2.0) | 13.5 (2.4) | .41 |
| aPOR (95% CI)d | 1 [Reference] | 0.87 (0.52 to 1.46) | .58 |
| Sunburn (past 12 mo) | |||
| Weighted, mean (SE), % | 57.2 (2.4) | 63.8 (3.6) | .15 |
| aPOR (95% CI)d | 1 [Reference] | 1.09 (0.70 to 1.67) | .70 |
| Sunscreen use | |||
| Behavioral score, mean (SE)e | 2.9 (0.08) | 3.1 (0.1) | .11 |
| β (95% CI)d | 1 [Reference] | 0.12 (−0.15 to 0.40) | .40 |
| Shade | |||
| Behavioral score, mean (SE)e | 2.7 (0.1) | 2.6 (0.1) | .83 |
| β (95% CI)d | 1 [Reference] | −0.06 (0.23 to 0.11) | .51 |
| Long pants | |||
| Behavioral score, mean (SE)e | 1.8 (0.1) | 1.7 (0.1) | .21 |
| β (95% CI)d | 1 [Reference] | −0.02 (−0.20 to 0.16) | .80 |
| Long sleeves | |||
| Behavioral score, mean (SE)e | 1.4 (0.05) | 1.3 (0.05) | .18 |
| β (95% CI)d | 1 [Reference] | −0.05 (−0.17 to 0.07) | .47 |
| Wide-brimmed hat | |||
| Behavioral score, mean (SE)e | 1.4 (0.05) | 1.5 (0.1) | .30 |
| β (95% CI)d | 1 [Reference] | 0.12 (−0.06 to 0.30) | .21 |
Abbreviation: aPOR, adjusted prevalence odds ratio.
Sunless tanning was defined as self-reported use of spray-on or mist tans at a tanning salon or self-applied sunless or fake tanning products in the past 12 months.
Unweighted sample sizes for reference.
Statistical significance calculated using Wald-adjusted Pearson χ2 tests (weighted percentages), Wald-adjusted t tests (mean behavioral scores), multivariable adjusted-logistic regression (aPORs), or multivariate adjusted linear regression (coefficients).
The aPORs and regression coefficients were calculated using logistic regression and linear regression analyses, respectively, controlling for age (continuous), sex, race/ethnicity, region, sexual orientation, educational level, body mass index, sun sensitivity, family history of skin cancer in a first-degree relative, and personal history of skin cancer.
Weighted mean behavioral scores. Individual participants were assigned a behavioral score between 1 (never use) and 5 (always use) based on a Likert scale for self-reported use of each sun protection method when outdoors on a sunny day for more than 1 hour.
Discussion
In this nationally representative, cross-sectional study, we identified the demographic characteristics and associated skin cancer risk behaviors of sunless tanners in the United States. In 2015, 6.4% of US adults reported sunless tanning, lower than a previous estimate of 11.0% in 2005.4 The demographics of sunless tanners remained similar to those identified in prior studies.4,5 Sunless tanning was also more prevalent among sexual minority men, a group with increased rates of indoor tanning and skin cancer.10
Sunless tanners reported risky skin cancer behaviors, including increased indoor tanning and decreased use of shade and protective clothing when outdoors. Although sunless tanners were more likely to use sunscreen, they were also more likely to report sunburn even after controlling for sun sensitivity and other confounders. Sunscreen use has been associated with recreational and intentional outdoor sun exposure and sunburns,11 and sunscreens may be used as tanning aids through inadequate coverage or application frequency.12 Furthermore, sunless tanners may incorrectly believe that sunless tanning products contain sunscreen.6 These findings highlight the need for physicians to counsel sunless tanners on the importance of concomitant sun protection and avoidance of indoor tanning.
Sunless tanners were also more likely to have a family history of skin cancer and to have had a full-body skin examination. Prior studies5,13 have demonstrated increased personal history and greater knowledge of skin cancer among sunless tanners. Because physicians may advocate for sunless tanning to achieve tanned skin, it is possible that a full-body skin examination precedes use.
Finally, sunless tanning among indoor tanners was not associated with improved risk behaviors. In fact, indoor tanners who sunless tanned reported increased frequency of indoor tanning compared with those who did not. These findings suggest that sunless tanning may supplement rather than replace skin cancer risk behaviors. Of note, the empirical evidence on this topic remains limited and inconsistent.5,6,14,15 Among indoor tanners, sunless tanning use has been associated with increases and decreases in indoor tanning frequency.14 Interventions that promote sunless tanning reduce sunbathing and improve sun protection behaviors in women, although these behavioral changes were mostly transient.15 Frequent sunless tanners may be more likely to improve risk behaviors than those with infrequent use,5 although these data were unavailable for our study.
Limitations
This is a cross-sectional study; therefore, we are unable to prove causal relationships or examine temporal associations. Additional limitations include self-reported data and lack of data on frequency of sunless tanning.
Conclusions
In this study, sunless tanning was most common among young, white, college-educated women in the United States and was associated with risky skin cancer behaviors. Among indoor tanners, a high-risk population for skin cancer, sunless tanning was not associated with improved behaviors. When counseling patients, dermatologists should be aware of the limited evidence that sunless tanning use is associated with significant improvement in skin cancer risk behaviors. Our findings highlight the need for high-quality, longitudinal studies to better assess whether sunless tanning changes behaviors to better determine whether sunless tanning represents an effective public health strategy to reduce increasing skin cancer rates in the United States.
eTable 1. Respondent Characteristics by Sunless Tanning, Female Respondents
eTable 2. Respondent Characteristics by Sunless Tanning, Male Respondents
eTable 3. Indoor Tanning, Skin Cancer Screening, Sunburn, and Sun Protection Behaviors by Sunless Tanning, Stratified by Sex
eTable 4. Indoor Tanning, Skin Cancer Screening, Sunburn, and Sun Protection Behaviors by Sunless Tanning Among Current Indoor Tanners, Stratified by Sex
References
- 1.US Department of Health and Human Services The Surgeon General’s Call to Action to Prevent Skin Cancer. Washington, DC: US Dept of Health and Human Services, Office of the Surgeon General; 2014. [Google Scholar]
- 2.American Academy of Dermatology Body Mole Map. SPOT Skin Cancer. https://www.aad.org/public/spot-skin-cancer/learn-about-skin-cancer/detect/body-mole-map. Accessed January 18, 2018.
- 3.US Food and Drug Administration. Dihydroxyacetone. 21 CFR §73.2150.
- 4.Sahn RE, McIlwain MJ, Magee KH, Veledar E, Chen SC. A cross-sectional study examining the correlation between sunless tanning product use and tanning beliefs and behaviors. Arch Dermatol. 2012;148(4):448-454. doi: 10.1001/archdermatol.2011.2072 [DOI] [PubMed] [Google Scholar]
- 5.Stryker JE, Yaroch AL, Moser RP, Atienza A, Glanz K. Prevalence of sunless tanning product use and related behaviors among adults in the United States: results from a national survey. J Am Acad Dermatol. 2007;56(3):387-390. [DOI] [PubMed] [Google Scholar]
- 6.Brooks K, Brooks D, Dajani Z, et al. Use of artificial tanning products among young adults. J Am Acad Dermatol. 2006;54(6):1060-1066. doi: 10.1016/j.jaad.2006.01.014 [DOI] [PubMed] [Google Scholar]
- 7.Yoo J-J, Hur W-M. Body-tanning attitudes among female college students. Psychol Rep. 2014;114(2):585-596. doi: 10.2466/06.07.PR0.114k21w5 [DOI] [PubMed] [Google Scholar]
- 8.Fischer AH, Wang TS, Yenokyan G, Kang S, Chien AL. Association of indoor tanning frequency with risky sun protection practices and skin cancer screening. JAMA Dermatol. 2016;153(2):168-174. doi: 10.1001/jamadermatol.2016.3754 [DOI] [PubMed] [Google Scholar]
- 9.StataCorp Stata Statistical Software: Release 13. College Station, TX: StataCorp LP; 2013. [Google Scholar]
- 10.Mansh M, Katz KA, Linos E, Chren M-M, Arron S. Association of skin cancer and indoor tanning in sexual minority men and women. JAMA Dermatol. 2015;151(12):1308-1316. doi: 10.1001/jamadermatol.2015.3126 [DOI] [PubMed] [Google Scholar]
- 11.Linos E, Keiser E, Kanzler M, et al. Sun protective behaviors and vitamin D levels in the US population: NHANES 2003-2006. Cancer Causes Control. 2012;23(1):133-140. doi: 10.1007/s10552-011-9862-0 [DOI] [PMC free article] [PubMed] [Google Scholar]
- 12.Jovanovic Z, Schornstein T, Sutor A, Neufang G, Hagens R. Conventional sunscreen application does not lead to sufficient body coverage. Int J Cosmet Sci. 2017;39(5):550-555. doi: 10.1111/ics.12413 [DOI] [PubMed] [Google Scholar]
- 13.Day AK, Oxlad M, Roberts RM. Predictors of sun-related behaviors among young women: comparisons between outdoor tanners, fake tanners, and tan avoiders. J Am Coll Health. 2013;61(6):315-322. doi: 10.1080/07448481.2013.806926 [DOI] [PubMed] [Google Scholar]
- 14.Mahoney A, Swetter SM, Biello KB, Resnick EA, Feuerstein I, Geller AC. Attitudes toward indoor tanning among users of sunless tanning products. Arch Dermatol. 2012;148(1):124-126. doi: 10.1001/archderm.148.1.123 [DOI] [PubMed] [Google Scholar]
- 15.Pagoto SL, Schneider KL, Oleski J, Bodenlos JS, Ma Y. The sunless study: a beach randomized trial of a skin cancer prevention intervention promoting sunless tanning. Arch Dermatol. 2010;146(9):979-984. doi: 10.1001/archdermatol.2010.203 [DOI] [PMC free article] [PubMed] [Google Scholar]
Associated Data
This section collects any data citations, data availability statements, or supplementary materials included in this article.
Supplementary Materials
eTable 1. Respondent Characteristics by Sunless Tanning, Female Respondents
eTable 2. Respondent Characteristics by Sunless Tanning, Male Respondents
eTable 3. Indoor Tanning, Skin Cancer Screening, Sunburn, and Sun Protection Behaviors by Sunless Tanning, Stratified by Sex
eTable 4. Indoor Tanning, Skin Cancer Screening, Sunburn, and Sun Protection Behaviors by Sunless Tanning Among Current Indoor Tanners, Stratified by Sex