Use of indoor tanning facilities by white adolescents in the United States

Context: Indoor tanning is a risk factor for skin cancer, but the population-based prevalence of this behavior among adolescents is not clearly known. Objectives: To describe the prevalence of tanning booth use among white US adolescents and to assess its association with sociodemographic factors, health behaviors, and appearance. Design, Setting, and Participants: A nationally representative sample of 6903 non-Hispanic white adolescents, aged 13 to 19 years, who participated in Wave 11 (between April 1, 1996, and August 31, 1996) of the National Longitudinal Study of Adolescent Health. Main Outcome Measure: Frequency of lifetime use of indoor artificial tanning facilities. Results: With the data weighted to national levels, 36.8% of the white female adolescents and 11.2% of the white male adolescents have used a tanning booth at least once in their life, while 28.1% and 6.9% of the female and male adolescents, respectively, reported tanning booth use 3 or more times. The percentage of female adolescents using tanning booths 3 or more times increased with age, from 11.2% of the 13- to 14-year-olds to 47.0% of 18- to 19-year-olds and also increased with greater tanning ability, from 12.6% of the poor tanners to 38.1% of those with a strong tan response. After multivariate adjustment, those residing in the Midwest (adjusted odds ratio [aOR], 2.38; 95% confidence interval [CI], 1.53-3.68) or South (aOR, 2.91; 95% CI, 1.894.53), attending a rural high school (aOR, 1.80; 95% CI, 1.09-2.98), and reporting the use of 2 or 3 substances (aOR, 3.06; 95% CI, 2.44-3.82) were more likely to use indoor tanning facilities, as were dieters (aOR, 1.26; 95% CI, 1.01-1.57) regardless of their body mass index. Decreased odds of indoor tanning were observed among those with a college-educated mother (aOR, 0.68; 95% CI, 0.51-0.90) and greater cognitive ability (per 10-point score increase; aOR, 0.89; 95% CI, 0.82-0.96) while routine participation in physical activity significantly lowered the odds of indoor tanning only among female adolescents. Conclusions: Indoor tanning is prevalent, particularly among female adolescents, and aligns with other risk behaviors, appearance-related factors, and intentional sunbathing. The risks of artificial tanning need increased emphasis among adolescents, especially in the Midwest and South where extremes in the availability of natural light appear to send intentional tanners indoors.