Tanning

of Caucasian Teens

The Tanning of Caucasian Teenagers in the U.S.

Katie Frances Sutcliffe
Clemson University

Health 2400-002
Spring 2014

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Risky Health Behavior

The Merriam-Webster Dictionary defined tanning as, the act or process of darkening
your skin by exposing it to the bright light of the sun or a special type of lamp (Tanning, n.d.).
It has been proven that people, who used tanning beds, had a higher chance to get skin cancer
from UV-A and UV-B radiation (FDA, 2014). Reports in the U.S. from the Skin Cancer
Foundation (SCF) (2013) revealed that over a million people used indoor tanning in just one day.
From year to year, five billion dollars were accumulated from indoor tanning alone (SCF, 2013).
Even though many people are choosing to tan indoors, it was scientifically evident that tanning
beds had cancer-causing effects on the skin (Hawryluk et al., 2013). It was likely that people
knew how skin cancer arose, and how they could lower their chances of cancer according to the
amount of knowledge and money they had (Viswanath et al., 2006).
Though people may know tanning is risky for their health, they still seek ways to tan their
skin. By simply looking at the media, people can obtain the notion that being bronze is the
current trend. According to the Federal Drug and Food Administrations (FDA) UV radiation
and tanning specialist, Sharon Miller, many of Americas youth do not seem to think they are
susceptible to dangerous health outcomes from tanning, so they continue this behavior (2014).
Due to the numerous amounts of tanning bed use in Americas teens, researchers and health
promotion specialists need to successfully advocate the harmful effects of indoor tanning as a
health behavior.
Prevalence Rates and Statistics
As stated by the SCF (2013), a single visit to the tanning bed could give someone a 67%
higher chance of being diagnosed with squamous cell carcinoma and a 29% chance of basal cell
carcinoma. Two million Americans each year were said to have the highest prevalence rate with

Tanning of Caucasian Teens

over 3.5 million cases of skin cancer reported (SCF, 2013). Two to three million American
teenagers were reported to use tanning beds annually (SCF, 2013). The main ethnic group found
to be targeted by skin cancer was Caucasians (Gohara & Perez, n.d.). According to the Centers
for Disease Control and Prevention (2014a), the rate of tanning for Caucasian females in high
school in the U.S. was 29%. While, the total tanning rate for Americans in high school was 13%
(CDC, 2014a).
Outcomes from Tanning Behavior
Health problems related to indoor tanning caused by UV radiation were: skin cancer,
premature aging, immune suppression, eye damage, and an allergic reaction (FDA,
2014). It has been reported that 71% of people that choose to tan indoors were women (SCF,
2013). According to the American Academy of Dermatology (AAD) (n.d.a), excessive tanning
is likely to cause melanoma to occur in the thoracic region of a woman between the ages of 15
and 29. The AAD reported that the highest prevalence rate for a type of skin cancer for people
25 to 29 years of age was melanoma. The next highest prevalence rate reported for melanoma
skin cancer was for people 15 to 29 years of age. The AAD noted that people could have chosen
to take the necessary precautions and not disclose their bodies to ultraviolet light. It has been
stated that melanoma causes close to 75% of mortalities of people with skin cancer. It has also
been estimated that upon every hour melanoma will kill one American (AAD, n.d.a).
Healthy People 2020 Objectives
On the Healthy People 2020 Website (2013) there were several objectives under the topic
of Cancer, but objectives C-20.3 and C-20.4 were the ones relevant to the goal of lowering
indoor tanning rates. The C-20.3 objective from Healthy People 2020 was to Reduce the
proportion of adolescents in grades 9 through 12 who report using artificial sources of ultraviolet

Tanning of Caucasian Teens

light for tanning. The C-20.4 objective from Healthy People 2020 was to Reduce the
proportion of adults aged 18 and older who report using artificial sources of ultraviolet light for
tanning (Healthy People 2020, 2013). By targeting a younger group, it may be easier to prevent
skin cancer than in older individuals who have been around UV radiation longer. In America,
people, under 18 years old, will have spent nearly 23% of their entire life in the presence of UV
radiation compared to the 80% they will experience as they continue to get older (SCF, 2013).
Intrapersonal Factors
Knowledge and Beliefs
Risky health behaviors may be caused by various factors. People who chose to use
indoor tanning have their own set of beliefs, attitudes, and knowledge about tanning that leads to
this behavior. According to the FDA epidemiologist Dr. Ron Kaczmarek, death and
consequences of indoor tanning are not on the minds of Americas youth because they feel they
are not old enough to be prone to its effects (FDA, 2014).
In a survey conducted by Robinson, Kim, Rosenbaum, and Ortiz (2008), the results
showed that most of the respondents got their knowledge of tanning and its effects from the
media. However, it was found that they relied more on information from their own doctors
(Robinson et al., 2008). It has also been reported that individuals who do not tan are found to
have less information about tanning consequences than those who chose to tan (Okhovat &
Feldman, 2013).
According to Balk and Geller (2008), it is commonly believed that people like to get a tan
before they go on trips because of the myth that it will shield their skin from sun damage.
Additionally, Mendese and Gilchrest (2012) reported that people have heard that they need to tan
to get enough vitamin D from UV radiation. However, this is not true because vitamin D is also
found through diet or can be taken by mouth in the form of a capsule. They have also found that

Tanning of Caucasian Teens

people think it is less risky to use a tanning bed instead of natural light, but this is untrue as well.
A tanning bed has a higher concentration of UV radiation, which means that too much of it
would cause very serious effects. The last common belief among tanners is that certain problems
with someones skin could be cured using indoor tanning. This belief may not be completely
false, but it is not recommended (Mendese & Gilchrest, 2012).
Values and Attitudes
According to a study by Lazovich et al. (2004), a larger number of adolescents thought
that a tan on an individual was more attractive than someone without a tan. Not every teenager
had a positive outlook on the use of a tanning bed (Lazovich et al., 2004). However, the way the
teenagers felt after they used indoor tanning gave them more incentive to tan instead of quitting
the behavior (Lazovich et al., 2004). Teens have reportedly used indoor tanning as a way to
unwind from stress (Robinson et al., 2008). They also felt they were more attractive and even
healthy (Robinson at al., 2008). There was concern about addiction to tanning that had been
studied (Okhovat & Feldman, 2013). The research showed that it was very likely that the use of
indoor tanning promotes endorphin release among the people who tan, which could be the reason
tanners will not stop the behavior (Okhovat & Feldman, 2013).
Demographics and Socioeconomic Status
According to a study by Mayer et al. (2011), 26.8% of females at age 17 used indoor
tanning in the U.S. compared to the 8.5% of females who tanned at age 14. It was found that as
people age they tend to use indoor tanning more (Mayer et al., 2011). It was also found that
Caucasian women, who were in the age range of 18 years old to 21 years old, made up 32% of
the people who participated in indoor tanning (National Council on Skin Cancer Prevention,
2012). That same category of women were found to use indoor tanning in the Midwest more

Tanning of Caucasian Teens

than other places in the U.S. (National Council on Skin Cancer Prevention, 2012). Also, there
was a 40% increase of the behavior if a tanning salon was found in a two-mile radius from a
teenagers residence (Mayer et al., 2011). A study conducted in California by Hausauer,
Swetter, Cockburn, and Clarke (2011) showed that the chance of melanoma was increased by
80% for the upper class females than for the lower class females.
Personality Characteristics
In a study by Greene and Brinn (2003), it was found that females, who were unhappy
with their bodies and who had any eating disorders, were more likely to use indoor tanning and
suffer the effects to enhance their appearance. From this study, they found that another persons
perception of a females body easily affected that female. Information from the study also
showed that females tend to care more about how they look than their own well-being (Greene &
Brinn, 2003).
Interpersonal Factors
Social Influences and Support
According to Stryker et al. (2004) kids saw how their own parents treated a behavior like
tanning, and then developed their own idea about it from watching their parents. Parents were
modeling this behavior for their kids and also showed them that this was a normal behavior
(Stryker et al., 2004). However, parents were not the only influencers for the behavior. As
reported by Hoerster et al. (2007), a teenagers friends had a large effect on whether the teen
tanned indoors or not. It was also found that a teenager was more likely to use indoor tanning if
his or her parents thought tanning made someone appear better looking. The study showed that
the teens use of indoor tanning increased if their parents permitted their use (Hoerster et al.,
2007).

Tanning of Caucasian Teens

Another factor that increased a teenagers tanning behavior was if the parents were not
worried about the behavior affecting the teenagers well-being (Hoerster et al., 2007). In a study
by Magee, Poorsattar, Seidel, and Hornung (2007), it was stated that parents were unaware of the
recommendations and limitations from the FDA for indoor tanning, and that it was not as safe as
they thought it was for their teenagers. It was also found that some parents thought indoor
tanning would keep their teens from getting sunburnt, which was conclusively reported as not
true (Magee et al., 2007). According to Balk and Geller (2008), parents and their teens could
have learned information about the effects of UV radiation from their doctors, but indoor tanning
was not highly talked about with patients. It was suggested that primary care physicians and
dermatologists needed to work together, so they could help children and teens see how
dangerous UV radiation was to the skin and its consequences (Balk and Geller, 2008).
Social Interactions
In a study by Banerjee, Greene, Bagdasarov, and Campo (2009), teenagers were likely to
tan indoors if they had friends that also tanned indoors. If a teenagers friends saw tanning as a
good thing, then the teen usually did as well (Banerjee et al., 2009). In an earlier article by
ORiordan et al. (2006), it was stated that teens who participated in activities, such as drug use,
typically visited a tanning salon more because of their group of friends or certain media sources.
In this study, over 90% of the teens were Caucasian who performed the tanning behavior. The
study stated that the adolescent girls wanted to appear similar to the women in the mass media,
which lead to the how much they decided to tan. The study also showed that friends had a bigger
impact on the teens behavior than did their parents. It was reported that the chance of a teen
being involved in indoor tanning doubled if the teens friends placed a high value on things like
being skinny as well (ORiordan et al., 2006).

Tanning of Caucasian Teens

However, fitting in among friends or being like celebrities in the media are not the only
reasons to use indoor tanning. Danoff-Burg and Mosher (2006) reported that people liked to tan
indoors in order to socialize. In an article by Pettijohn II, Pettijohn, and Gilbert (2011), it was
reported that boys thought tanner skin made girls look better and appear healthier. Girls also
felt similar towards boys who had a tan, but it was not as important. A tan was a sign that
showed that the person was healthy and would possibly be a good life partner for having children
with. Reportedly, a tan was a significant quality for a males partner to have, so they could make
sure the best genes were transferred to their children. It was also stated that girls have
participated in the tanning behavior knowing the tan will make them better looking, therefore
appealing to a potential partner. With that being said, people that already had a boyfriend or
girlfriend showed increased worry about their body image in contrast to people who were single
or married (Pettijohn II et al., 2011).
Organizations and Social Institutions
Fifteen year ago, an organization called the Indoor Tanning Association (ITA) was
established. Today, it is an organization that is made up of indoor tanning manufacturers,
distributors, facility owners and members from other support industries (ITA, 2005a). Over
140,000 people work within the association. The association claims to help educate the
population about controlling how much they tan and how to stop the dangerous effects of it
(ITA, 2005a). The ITA observes any suggested ideas that may come up for the states. The
association is quick to object to any of these suggested ideas that they feel are unacceptable to
tanning businesses (ITA, 2005b).
Another organization that is antagonistic to the ITA is the Skin Cancer Foundation (SCF).
Its main goal is to make people aware of the causes of skin cancer and to help people know how

Tanning of Caucasian Teens

to lower their risk. It also informs people on what to do if they suspect they may have cancer
(SCF, n.d.a). The SCF would rather people not tan. The campaign called, Go With Your Own
Glow, is a strategy the SCF uses to get people to quit tanning. The campaign promotes that
tanning is a thing of the past, and it is best if the person accepts the skin he or she would
naturally have (SCF, n.d.b).
Many other organizations try to inform the public about indoor tanning facts as well.
One of these organizations includes the World Health Organization (WHO)(n.d.), which has a
program called the Intersun Programme. Like many of the other organizations here in the
U.S., the WHO has many objectives to keep people from being subjected to excessive UV
radiation (WHO, n.d.).
Community and Physical Environment
According to Hoerster et al. (2009), it was reported that more tanning salons may have
been present in communities that were mainly dominated by Caucasians. This may have been
because Caucasians were found to make up the majority of tanning beds users. Also, in areas
where sunlight was not found to be as prevalent, the community was more likely to have more
tanning businesses than areas with larger amounts of sunlight (Hoerster et al., 2009).
Public Policy, Law, and Regulation
According to Levine, Sorace, Spenser, and Siegel (2005), there were hardly any
restrictions for indoor tanning use in America. In an article by Lazovich and Forster (2005), it
was stated that America had indoor tanning regulations guided by the FDA and the Federal
Trade Commision (FTC). The tanning salon employees had strict rules about consumer safety
that they had to follow when their products were being used. Rules typically included eye
goggles for shielding against UV rays, certain advisories displayed to the consumer, and

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directions for the consumer to follow. Also, the FTC will not allow for the falsely marketed idea
that indoor tanning was good for the consumers health (Lazovich & Forster, 2005).
Levine et al. (2005), reported that only at the state level would the salons be controlled,
otherwise no one would manage the actions taken by the tanning salon employees. It was found
that 95% of tanning salon customers in North Carolina went over the recommended amount of
UV exposure during their visit. The U.S. government tried to help, but found it hard to control
the indoor tanning business since it was reportedly worth billions of dollars. Even the FDA did
not want to try to prohibit indoor tanning unlike the American Medical Association that did. The
government, however, has taken steps to help lessen the dangers from the behavior (Levine et al.,
2005).
According to the American Academy of Dermatology (n.d.b), a law against tanning for
minors first took place in California in 2011. Now, there are laws regarding tanning salons in 33
different states and Washington, D.C. according to the National Conference of State
Legistlatures (NCSL) (2014). In another study by Forster, Lazovich, Hickle, Sorensen, and
Demierre (2006), tanning salon employees in Minnesota and Massachusettes were reluctant to
ask for persmission from the teens parents because they would most likely lose their customer.
As a result, there was a large amount of indoor tanning used by the teen girls within the observed
area (Forster et al., 2006).
Determinants of Tanning Behavior
Determinants and Relationships Among Them
In order to see why someone would decide to begin or end a behavior like tanning, one
must observe and understand the predisposing, enabling, and reinforcing factors (from the
Precede-Proceed Model) associated with tanning. A predisposing factor would be led by some

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internally provoked reason to tan, such as knowledge, beliefs, attitudes, etc. An enabling
factor would be something that allows availability, accessibility, and affordability to indoor
tanning. Lastly, promoting the continuation of tanning, which usually involves feedback from
others, would be considered a reinforcing factor (Simons-Morton et al., 2012). Some specific
cases with tanning are described in the following paragraphs.
Many situations where teens were not happy with their body (pre-disposing factor)
caused them to seek other ways, such as getting a tan, to become more attractive (Greene &
Brinn, 2003). Teens could get their tanning ideas from the media and want to appear similar to
those girls (ORiordan et al., 2006). If the teen had beliefs about tanning that were incorrect,
then that could also lead to the tanning behavior (Mendese & Gilchrest, 2012). In some cases,
tanning exposure caused an addiction (Okhovat & Feldman, 2013). An addiction (a predisposing factor) made it harder for the teen to quit tanning (Okhovat & Feldman, 2013). Now
that the teen has gotten the idea to be tan, he or she needs the availability, accessibility, and
affordability to do get the tan (Simons-Morton et al., 2012).
One enabling factor could have been that the teen had access to a nearby tanning salon
and was more likely to go to it (Mayer et al., 2011). Another enabling factor such as, the teen
having money to tan, could have made them more likely to go tanning (Hausauer et al., 2011).
Also, if they wanted to be tan and there wasnt enough natural sunlight in the area (an enabling
factor), then they would have sought indoor tanning (Hoerster et al., 2009). However, laws,
which were also enabling factors, prohibited the use of indoor tanning by minors (Mayer et al.,
2008). Not all tanning salon employees followed the law though. If a salon feared losing a
customer, then they may have broken the law in order to keep the customer (Forster et al., 2006).

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The teen now deals with reinforcing factors that promote the continuation of tanning (SimonsMorton et al., 2012).
Teens are affected by the people that surround them. Their family members and friends
that tan will continue to promote the idea that tanning is okay for them to do as well (Hoerster et
al., 2007; Banjeree et al., 2009). This factor and many others have been categorized as
predisposing, enabling, or reinforcing factors, which have been listed below. Also, Figure 1
displays a Social-Ecological Model that was created for tanning behavior to correspond to these
factors.
Predisposing Factors:

Teens that have heard that they need to tan to get enough vitamin D will believe they
need to tan (Mendese & Gilchrest, 2012).

Teens that believed it was less risky to use a tanning bed than natural light will believe
they need to tan (Mendese & Gilchrest, 2012).

Teens believed they needed a tan before they went on trips to shield their skin from sun
damage (Mendese & Gichrest, 2012).

Teens also believed that certain problems with their skin could be cured using indoor
tanning (Mendese & Gilchrest, 2012).

Females, who were unhappy with their bodies and who had any eating disorders, were
more likely to use indoor tanning. Females tend to care more about how they look than
their well-being (Greene & Brinn, 2003).

There was an addiction to tanning that researchers were concerned about. It was found
that indoor tanning promotes endorphin release among people who tan, which could be
one reason why teens would not stop the behavior (Okhovat & Feldman, 2013).

A large number of adolescents thought that a tan on an individual was more attractive
than someone without a tan. They also felt they were more attractive and even healthy
(Lazovich et al., 2004).

Girls have participated in the tanning behavior knowing the tan will make them better
looking to appeal to a potential partner (Pettijohn II et al., 2011).

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Teens got their knowledge of tanning and its effects from the media (Robinson et al.,
2008). A study stated that the adolescent girls wanted to appear similar to the women in
the mass media, which lead to how much they tanned (ORiordan et al., 2006).

Enabling Factors:
Upper class females had an increased chance of melanoma from the tanning behavior by
80% (Hausauer et al., 2011).

Indoor tanning was not widely talked about with patients, so there was lack of
information about the effects of UV radiation (Balk & Geller, 2008).

Tanning salons had strict rules about consumer safety that the employees had to follow
when their products were being used. Rules typically included eye goggles for shielding
against UV rays, certain advisories displayed to the consumer, and directions for the
consumer to follow (Lazovich & Forster, 2005).

Tanning salon employees are reluctant to ask for permission from the teens parents, so
they dont lose their customer. As a result, a large amount of teen girls used indoor
tanning (Forster et al., 2006).

A law against tanning for minors first took place in Californian in 2011 (AAD, n.d.b).
There are now laws regarding tanning salons in 33 different states and Washington, D.C.
(NCSL, 2014).

There was 40% increase in the behavior if a tanning salon was found in a two-mile radius
from a teenagers residence (Mayer et al., 2011).

In areas where sunlight was not found to be as prevalent, the community was more likely
to have tanning businesses than areas with larger amounts of sunlight (Hoerster et al.,
2009).

Reinforcing Factors:

Parents were modeling this behavior for their kids and also showed them that this was
normal behavior (Stryker et al., 2004). A teenager was more likely to use indoor tanning
if his or her parents thought tanning made someone appear better looking (Hoerster et al.,
2007).

Teenagers were likely to tan indoors if they had friends that also tanned indoors
(Banjeree et al., 2009).

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Policy
Laws against minors
tanning
Tanning restrictions

Community
Media messages about tanning
Tanning salons present in
community
Organizational/Institutions

Indoor Tanning Association

Skin Caner Foundation
Tanning businesses
Doctors offices

Interpersonal
Tanning with friends and
family
Parents or friends setting
behavioral example

Intrapersonal
Knowledge from media,
parents, friends, doctors
Beliefs about tanning
Interpersonal
Looking better and healthier
Impressing a potential partner

Figure 1: Social-Ecological Model created based on tanning behavior.

Theory
Health Belief Model
According to Simons-Morton, McLeroy, and Wendel (2012), the Health Belief Model
(HBM) has been used throughout many studies to develop a better sense of why people perform
or dont perform certain behaviors. The HBM has several constructs including perceived
susceptibility, severity, modifying factors, benefits, barriers, cues to action, and self-efficacy.
Perceived susceptibility and severability was the amount of harm or level of danger an individual
believes he or she is vulnerable to. Modifying factors were those that are different among each

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individual such as, a persons age, sex, racial background, education level, social class, etc.
Benefits and barriers are the factors that offer physical or mental rewards or obstacles for
performing some behavior. Cues to Action were typically information that leads to whether
doing a certain behavior will be beneficial or not for that person. Lastly, self-efficacy was the
amount of confidence a person has in his or herself to perform or not to perform an action
(Simons-Morton et al., 2012).
Applying the HBM Constructs
In a study conducted by Greene and Brinn (2003), the HBM was used to investigate the
best way to help lower the aim to tan indoors. In their research, perceived susceptibility was the
main construct focused from the HBM. The researchers also observed self-efficacy and
perceived threat, but they were not heavily focused on. Through observing other research, they
found that perceived susceptibility was extremely significant when it came to indoor tanning.
Different behaviors called for different levels of significance for the HBM constructs, so not all
constructs were used. For indoor tanning usage, the researchers felt perceived susceptibility was
essential because the tanner needed to realize that he or she could get cancer or other serious side
effects. Researchers believed that in order to make a person care about the ultimate tanning
consequences, they needed to relate the facts to that individual on a deeper level. A person of
interest, by an interventionist, needed a higher sense of susceptibility. However, finding a way
to make this happen was very difficult as scientists were unsure of how to best accomplish their
goal (Green & Brinn, 2003).
Application and Measurement of Constructs
In order to use perceived susceptibility in the study, the researchers created a survey that
would let the individual do a self-assessment. The survey, for 19-26 years old females, asked

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questions involving mental and physical factors related to tanning, such as perceived
susceptibility to skin cancer, intention to protect skin, self-esteem, and public body
consciousness. The researchers used Likert-type items answering questions with Strongly
Agree or Strongly Disagree when determining perceived susceptibility, perceived threat, and
self-efficacy. After the results were calculated and analyzed, the researchers saw that a bigger
number meant a higher sense of susceptibility for an individual (Green & Brinn, 2003).
Evaluation of the Study
At the end of the study, the researchers found that by taking the survey, individuals had a
higher sense of perceived susceptibility. Earlier research from other investigators showed that
the survey itself helped peoples perceived susceptibility rise. However, just because the survey
may have showed a higher perception of susceptibility does not mean that those people were
more likely to not use indoor tanning. It was stated that females, in particular, would still seek
indoor tanning methods even if they thought they were susceptible to the side effects. This was
especially true if the access to tan was not difficult to obtain (Greene & Brinn, 2003).
The researchers also found that perceived susceptibility was highly correlated with
perceived threat. It was found that if tanning was seen as a high threat, then the behavior
occurred less. The study suggested that people should see more efficient advertisements or
campaigns to raise peoples perceptions of tanning severity (Greene & Brinn, 2003).
Theory of Planned Behavior
As written by Simons-Morton, McLeroy, and Wendel (2012), Theory of Planned
Behavior (TPB) is thought to suggest that people either perform or dont perform certain
behaviors based on attitudes, subjective norms, and perceived behavioral control. Attitudes are
known as a persons overall feelings towards something. Subjective norms usually involve what

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is socially acceptable of a persons actions. Lastly, Perceived behavioral control is how much
power someone feels he or she has on the behavior especially in his or her surroundings
(Simons-Morton et al., 2012).
Applying TPB Constructs
A study was conducted by Hillhouse, Turrisi, and Kastner (2000) to further determine
what certain factors lead to the use of indoor tanning. The researchers used attitudes, subjective
norms, and perceived behavioral control from the TPB. Appearance motivation and selfmonitoring were used along with the constructs of the TPB for their study (Hillhouse et al.,
2000).
Application and Measure of Constructs
The researchers gave a selection of first and second year college students a list of
questions that would help them evaluate the TPB constructs, appearance motivation and selfmonitoring from the students answers. The students were questioned on things such as how
stimulating/boring or relaxing/not relaxing indoor tanning was for them in order to
determine their attitudes. Subjective norms were determined by questions inquiring if their loved
ones wanted them to tan. Also, the students were questioned to see whether or not they would
follow what their loved ones wanted. In order to determine perceived behavioral control,
students were questioned on how hard it was for them to tan indoors. Seven-point scales were
used to determine attitudes, subjective norms, and perceived behavioral control form the student
responses. The results showed that those with a more favorable relationship between the TPB
constructs were found to have an increased motive to tan indoors (Hillhouse et al., 2000).

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Evaluation of the Study

By the end of the study, the researchers saw that intention was the best predictor of
whether or not someone decided to go tanning, but it was based on the key TPB constructs. The
researchers stated that the best way to reduce the behavioral tendencies was to target the
factors that lead to the behavior, which was attitudes, subjective norms, and perceived behavioral
control. Based on their findings, targeting peoples beliefs is not going to be the most effective
because of societal views. However, finding a different form of tanning or a safer choice for
improving someones physical exterior was stated as a better plan of action (Hillhouse et al.,
2000).
Indoor Tanning Interventions
Previous research on indoor tanning indicated that a survey or questionnaire is the main
tool used in intervention plans (Greene & Brinn, 2003; Hillhouse et al., 2000). The survey
questions showed that intrapersonal factors played a large role in determining whether someone
used indoor tanning or not (Greene & Brinn, 2003). Also, other research showed that teenagers
thoughts and reasons for tanning were affected by the people that surrounded them (Hoerster et
al., 2007; Banjeree et al., 2009). These influences would fall under the category of interpersonal
factors (Simons-Morton et al., 2012). Other intervention plans may need to involve a more
physical approach such as targeting public policy or the media. Public policy, along with the
U.S. media, could be two successful ways to reduce tanning bed use among teenagers.
Attempted Intervention Plans
As reported by the NCSL (2014), laws regarding anyone younger than 18 years old were
in effect for tanning salons in Washington, D.C. and 33 different states. The laws were similar,

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19

but varied per state. There was also a law that prohibited indoor tanning for individuals younger
than 18 in California, Texas, Vermont, Illinois, and Nevada (NCSL, 2014).
Another attempt to lower tanning rates was a tanning tax that was created in 2010,
according to an article by Sinclair and Makin (2013). Unfortunately, the tanning rates among
teenagers were barely reduced since the tax. To ensure that taxes would have a greater effect on
reduction of tanning rates, the employees would need greater observation while on duty. Rules
have been applied in tanning salons, but success has been limited because of improper
implementation by the employees (Sinclair & Makin, 2013).
Since supervision of the tanning bed operators seemed to be the big issue with enforcing
the tax laws, that may not be the best approach for future interventions. However, a larger
increase in the tax or incentive for the employees to strictly follow the rules may improve the
outcome. Increasing a tax on a product was part of the MPOWER Model used to lower the rate
of indoor tanning. MPOWER is an acronym that is discussed in Sinclair and Makins 2013
article that stands for monitor, protect, offer alternatives, warn, enforce, and raise taxes.
Developing an Intervention Plan
Based on tanning interventions used in the past and the MPOWER Model, a method that
may be successful in reducing indoor rate rates could be more promotion of spray tans and selftanning lotions in the media. The U.S. media affects the way teenagers get their knowledge
about tanning (Robinson et al., 2008). A strategy that could help reduce indoor tanning rates
could be to start showing commercials or ads for protection against melanoma. Currently, there
are commercials on T.V. and ads that try to deter consumers from smoking (CDC, 2014b). The
same approach could be taken with tanning bed use.

Tanning of Caucasian Teens

20

Sharing personal stories about the use of tanning beds and skin cancer may reach viewers
on a more emotional level and lower the usage rates. However, there have been ads about indoor
tanning, but there were issues with incorrect information. Organizations, such as the California
Sun Care Inc. had to use $1.5 million to fix the false and misleading claims concerning indoor
tanning (Sinclair & Makin, 2013). By putting more correct information out into the U.S. media
about indoor tanning, more awareness could be brought to the dangers of tanning bed use.
Ultimately, more awareness could potentially lead to lower indoor tanning rates.
One way to develop this intervention plan to help lower the usage of tanning bed rates is
to use the offer alternatives and warn parts of the MPOWER Model (Sinclair & Makin,
2013). Researchers could take a survey before and after media advertising for spray tans/lotions
in a certain community. The customer rate could also be taken into account for that specific
community. An area with a high density of tanning salons and teenagers native to the area would
need to be chosen to see more participation. The teens could fill out a survey before the
promotion of spray tans/lotions were advertised within the community. After a certain amount
of time thats been chosen, the same teens could fill out another survey to see if their views
changed towards tanning. The customer rate for teenagers in the salons could also be checked
after the advertising also. The idea of this intervention is based off of success from other earlier
intervention methods (Sinclair & Makin, 2013).
If this intervention was used, then predisposed factors were mainly the ones being
targeted among the teenagers. Predisposed factors included: teens beliefs that tans would give
them more vitamin D, it was less risky than natural light, they needed a tan before a trip, and that
it would heal certain problems with their skin (Mendese & Gilchrest, 2012). Ads with correct
information about tanning bed usage could eliminate the inaccurate ideas teens had about

Tanning of Caucasian Teens

21

tanning. Also, the intervention would have targeted intrapersonal factors and community factors
by changing the perceptions on tanning bed use within the local area. Lastly, the Health Belief
Model could have been used to assess appropriate constructs such as, the perceived severity and
susceptibility of dangers from tanning bed use in the surveys given (Simons-Morton et al., 2012).
The ads would have hopefully helped change peoples perceptions of tanning while
simultaneously affecting the whole community.
Conclusion
Based on the research presented throughout this paper, it is imperative to find a
successful intervention that will target the Caucasian teen population in order to lower skin
cancer rates. A larger focus on public policy and promotion of safer alternatives needs to be
implemented to greatly reduce the amount of tanning bed usage. Unfortunately, these methods
alone will not stop the tanning behavior for teens. Intrapersonal and Interpersonal factors have
the biggest influences on tanning as well as perceived susceptibility and perceived severity of
getting cancer. Researchers will have quite a challenge in discovering a truly successful method
that will deter teens from quitting this behavior. However, as trends change over time in their
surrounding environments and in the media, maybe their perceptions will change also.

Tanning of Caucasian Teens

22
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