title: Sunbed use in Germany: trends, user histories and factors associated with cessation and readiness to change.
abstract: 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.
  
  
  OBJECTIVE
  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 14-45 years, 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 180 min per year. Annual exposure remained constant in 85·6% of this subgroup with no changes over time during periods of sunbed use. Age at initiation decreased significantly across birth cohorts from 25 to 19 years (25th percentile; cohorts 1966-75 to 1986-93). Characteristics associated with sunbed use cessation included educational level [odds ratios (OR) 1·53 and 1·71 for medium and high education, respectively], greater awareness of skin cancer risk (OR 2·41) and immigrant background (OR 0·54; all P < 0·01).
  
  
  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.
authors.affiliation: Mannheim Institute of Public Health, Social and Preventive Medicine, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany. christina.bock@medma.uni-heidelberg.de
authors.forename: C
authors.initials: C
authors.lastname: Bock
authors.forename: K
authors.initials: K
authors.lastname: Diehl
authors.forename: D
authors.initials: D
authors.lastname: Litaker
authors.forename: E W
authors.initials: EW
authors.lastname: Breitbart
authors.forename: R
authors.initials: R
authors.lastname: Greinert
authors.forename: S
authors.initials: S
authors.lastname: Schneider
mesh_terms: D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D003430:Cross-Sectional Studies; D004522:Educational Status; D005260:Female; D005858:Germany; D015438:Health Behavior; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D033182:Intention; D008297:Male; D008875:Middle Aged; D009042:Motivation; D012307:Risk Factors; D017678:Sex Distribution; D055108:Sunbathing / Q000523:psychology / Q000706:statistics & numerical data* / Q000639:trends; D055107:Suntan / Q000502:physiology; D055815:Young Adult