To the Editor:
In 2013, 1.9 million US men reported tanning indoors.1 Existing research largely targets teen and young adult female tanners, and less is known about male tanning behavior. Using Survey Sampling International, we recruited a nationally representative sample of 773 adults who intend to use or used an indoor tanning bed. Participants reporting a lifetime history of tanning indoors (n = 636, 33.5% male) were included.
The survey measured tanning frequency, tanning dependence, tanning location (salon, nonsalon business, or home), and influences on selection of tanning location (with 1 indicating strong disagreement and 5 indicating strongly agreement). Two or more affirmative responses on the 7-item Behavioral Addiction Indoor Tanning Screener confirmed tanning dependence.2 Participants were also surveyed about smoking, weekly soda consumption, and binge drinking (5 or more alcoholic beverages within a couple of hours) in the past month.
The University of Massachusetts Medical School institutional review board granted ethics approval. Bivariate comparisons were done using χ2 tests, independent samples t tests, and Wilcoxon rank sum tests, as appropriate using SAS/Stat software (version 9.3, SAS Institute Inc, Cary, NC).
No significant differences were found between men (mean, 6.0; standard deviation [SD], 16.9) and women (mean, 6.0; SD, 22.7) in indoor tanning visits during the past year (P = .58) (Table I). However, men were significantly more likely to meet the Behavioral Addiction Indoor Tanning Screener tanning dependence threshold (49.3% vs 29.6% [P = .001]). Men were more likely to tan in private residences (30.5% vs 19.4% [P = .002]). For factors influencing tanning location selection, men gave significantly higher ratings to the ability to get other services at the same time (3.7 vs 3.3 [P = .004]), ability to tan with fewer rules (3.6 vs 3.2 [P < .001]), and ability to use a tan as a workout reward (3.6 vs 3.3 [P = .002]). Women gave significantly higher ratings to cleanliness (4.3 vs 4.1 [P = .06]) and cost (4.2 vs 3.9 [P = .001]).
Table I.
Tanning behavior by sex
| Characteristic | Men (n = 213) |
Women (n = 423) |
P value |
|---|---|---|---|
| Frequency of indoor tanning in past year, mean (SD) | 6.0 (16.9) | 6.0 (22.7) | .58 |
| Tanning location | .007 | ||
| Salon only | 91 (42.7%) | 217 (51.3%) | |
| Nonsalon business | 57 (26.8%) | 124 (29.3%) | |
| Home tanner | 65 (30.5%) | 82 (19.4%) | |
| Tanning dependence/behavioral addiction | 49.3% | 29.6% | <.0001 |
| Factors influencing tanning location choice, mean (SD) | |||
| Ability to tan and get other services at the same time | 3.7 (1.06) | 3.3 (1.14) | .004 |
| Ability to tan with fewer rules and regulations | 3.6 (1.01) | 3.2 (1.14) | <.0001 |
| Ability to reward oneself with a tan after a workout | 3.6 (1.11) | 3.3 (1.14) | .002 |
| Cleanliness | 4.1 (.97) | 4.3 (.91) | .06 |
| Cost | 3.9 (.93) | 4.2 (.90) | .001 |
| Convenience | 4.1 (.89) | 4.2 (.86) | .06 |
| Professionalism | 3.9 (.93) | 4.0 (.90) | .28 |
SD, Standard deviation.
Male tanners were more likely to smoke (59.2% vs 38.8% [P = .001]), reported more binge drinking in the past month (mean, 4.7 [SD, 6.9] vs 2.2 [SD, 4.2]); P < .0001) and had higher weekly soda consumption (mean, 13.7 [SD 27.0] vs 8.1 [SD, 12.6]; P < .0001). Male tanners were significantly more ethnically diverse than female tanners (P = .002 [Table II]).
Table II.
Participant characteristics by sex
| Characteristic | All (n = 636) |
Men (n = 213) |
Women (n = 423) |
P value |
|---|---|---|---|---|
| Mean age (SD), y | 36.2 (12.9) | 36.9 (12.7) | 35.9 (12.9) | .34 |
| Ethnicity | .002 | |||
| % White | 76.4% | 68.5% | 80.4% | |
| % Hispanic | 10.7% | 12.7% | 9.7% | |
| % Other | 12.9% | 18.8% | 9.9% | |
| Education | .01 | |||
| % with high school diploma or GED certificate | 13.3% | 9.9% | 15.1% | |
| % with some college | 23.5% | 19.8% | 25.4% | |
| % with an associate or bachelor degree | 46.5% | 48.1% | 45.7% | |
| % with a graduate degree | 16.7% | 22.2% | 13.9% | |
| Health behaviors | ||||
| Smoker | 45.6% | 59.2% | 38.8% | .001 |
| No. of cans of soda consumed per week, mean (SD) | 10.0 (18.9) | 13.7 (27.0) | 8.1 (12.6) | <.0001 |
| No. of days in the past 30 with ≥5 alcoholic beverages consumed, mean (SD) | 3.0 (5.4) | 4.7 (6.9) | 2.2 (4.2) | <.0001 |
| Skin type | .36 | |||
| % with skin that always/usually burns | 33.7% | 33.8% | 33.6% | |
| % with skin that sometimes burns mildly, tans uniformly | 35.7% | 38.5% | 34.3% | |
| % with skin that rarely or never burns | 30.7% | 27.7% | 32.2% |
GED, General Educational Development; SD, standard deviation.
The results revealed that although men and women tan at a similar frequency, men were more likely to screen positively for tanning dependence. Men had higher rates of comorbid risk behaviors consistent with prior research identifying associations between tanning dependence and alcohol addiction.3 Men had higher rates of tanning in private residences, where unsupervised tanning duration could facilitate dependence.
Tanning salon regulations may have less impact on reducing male tanning. Male tanners’ preference for settings that offer additional services may provide opportunities for targeted interventions.
Male tanners included a greater proportion of minorities than female tanners, which is consistent with prior research.4 Other studies have shown that sexual minority men have higher tanning rates than heterosexual men.5 Studies that have explored largely white samples or did not assess sexual orientation may have painted an incomplete picture of male indoor tanning.
Future research is needed to better understand the characteristics and motivations of male indoor tanners.
Acknowledgments
Supported by the Centers for Disease Control and Prevention, Division of Cancer Prevention and Control, Prevention Research Center (grant CDC U48 DP001933-04 to Dr Pagoto); additional support provided by National Institutes of Health (grant K24 HL124366-01A1 to Dr Pagoto) to provide mentorship on this paper. The funder was involved in design and conduct of the study; collection, management, analysis, and interpretation of data; preparation, review, or approval of the manuscript; and the decision to submit the manuscript for publication.
Footnotes
Disclosure: Dr Pagoto has consulted for Johnson & Johnson. Ms Feng, Ms Frisard, Dr Nahar, Ms Oleski, Dr Hillhouse, and Dr Lemon have no conflicts of interest to disclose. 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.
Dr Pagoto had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. Drs Hillhouse, Pagoto were responsible for the study concept and design, for obtaining funding, and for study supervision. All the authors take responsibility for acquisition, analysis, or interpretation of the data. Ms Feng and Drs Nahar and Pagoto were responsible for drafting of the manuscript, and Ms Feng and Drs Hillhouse and Pagoto take responsibility for critical revision of the manuscript for important intellectual content: Ms Frisard was responsible for statistical analysis and Ms Frisard and Ms Oleski were responsible for administrative, technical, or material support.
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