The most effective way to reduce indoor tanning among young women is to warn them about the risk of developing leathery, wrinkled skin. Researchers writing in the Archives of Internal Medicine say harping on the risk of skin cancer is unlikely to deter tanning.

"They're not worried about skin cancer, but they are worried about getting wrinkled and being unattractive," said June Robinson, a professor of dermatology at Northwestern University Feinberg School of Medicine. The study examined the best strategy to wean college-age women who are considered addicted or pathological tanners from tanning salons.

"The fear of looking horrible trumped everything else," Robinson said. "It was the most persuasive intervention, regardless of why they were going to tan." The research showed warning them about the effects on their appearance caused a 35 percent drop in their indoor tanning visits, which were measured at intervals up to six months after the intervention.

Joel Hillhouse, lead author of the paper and a professor of community health at East Tennessee State University, noted that some women in the study eventually stopped tanning. "It was a progressive kind of thing," he said. "At first the women said they tried sunless tanning as an alternative, but over time they gave up tanning altogether."

The study included 435 college women, ages 18 to 22, who visited tanning salons. Within this population, researchers focused on women who visited salons up to four times a week – more than what is needed to maintain a tan -- and who tanned for psychological reasons, not just for a special event.

These tanners included one group who strongly disliked the natural color of their skin, which was related to a psychological condition called body dysmorphia. "They thought their skin was disgusting when it was pale," Hillhouse said.

The other group, who said tanning made them feel happier and more relaxed, showed symptoms of seasonal affective disorder (SAD) on a diagnostic psychological test. "They were self medicating their own depression," Robinson said, noting that lying in a tanning bed produces internal opioids.

The women received a 25-page booklet that discussed the effect of tanning on appearance and explained how ultraviolet rays destroy collagen in the skin. The booklet also offered many alternatives to meet the women's needs for tanning, such as taking an exercise class for socializing and relaxation or getting a spray-on tan or self-tanning cream application at a spa. After reading the booklet, the women reported their attitudes and behaviors twice a week in diaries.

The study results surprised researchers. "The hypothesis was because this was an appearance intervention, it would have less of an effect on the people tanning for mood problems," Hillhouse said. "We found the opposite. The intervention worked just as well for people with seasonal affective disorder as for people who didn't like their skin color. That means it's a really good intervention for everyone."

His advice to parents and physicians: "Don't focus on skin cancer. The message that will get young women's attention is indoor tanning's long-term effect on their appearance. That will wake them up and get them to think about this."

Robinson stressed it was also important to offer women alternatives to tanning salons. "You have to balance the positive and the negative forces that motivate someone to change," she said. "First you have the fear that they will look horrible, then you offer a positive – an alternative to meet their needs."

Between 25 to 40 percent of older adolescent girls visit tanning salons. Scientists link the rapidly rising rates of melanoma and other skin cancers in young women to tanning beds. A new 10 percent federal excise tax on indoor tanning will go into effect July 1 in an effort to discourage indoor tanning.

The National Cancer Institute found that melanoma rates among Caucasian women aged 15 to 39 rose 50 percent between 1980 and 2004. The World Health Organization recently reclassified indoor tanning beds to its highest cancer risk category.



Citation: Hillhouse et al., 'Effect of Seasonal Affective Disorder and Pathological Tanning Motives on Efficacy of an Appearance-Focused Intervention to Prevent Skin Cancer', Arch Dermatol., 2010, 146(5):485-491