Sunbed use in Germany: trends, user histories and factors associated with cessation and readiness to change

Background Sunbed use is considered carcinogenic in humans. Studies that examine behavioural patterns related to sunbed use over time are needed for developing skin cancer prevention strategies. Objectives To explore age-related trends in the initiation age, to investigate individual histories of sunbed use and to identify characteristics associated with cessation. Methods We analysed cross-sectional data of 4851 sunbed users and nonusers from a representative sample of Germans, aged 14-45years, interviewed in 2011/2012. Biographical data were reconstructed based on reported tanning frequency/duration and changes in sunbed use over time. We used survival analysis to model the initiation age and created birth cohorts to assess age-related trends. Characteristics associated with sunbed use cessation were identified using logistic regression. Results Among sunbed users, median sunbed exposure was 180min per year. Annual exposure remained constant in 856% of this subgroup with no changes over time during periods of sunbed use. Age at initiation decreased significantly across birth cohorts from 25 to 19years (25th percentile; cohorts 1966-75 to 1986-93). Characteristics associated with sunbed use cessation included educational level [odds ratios (OR)153 and 171 for medium and high education, respectively], greater awareness of skin cancer risk (OR241) and immigrant background (OR054; all P<001). Conclusions Initiation of sunbed use at an increasingly younger age suggests the need for interventions targeted at young adults. Approaches that increase general skin cancer risk awareness and that are sensitive to participants' educational level and immigrant background may also be helpful.