title: Association of Indoor Tanning Frequency With Risky Sun Protection Practices and Skin Cancer Screening.
abstract: OBJECTIVE
  Indoor tanning is prevalent among young adults and women and is associated with increased risk of melanoma. Evidence suggests that indoor tanners may be more inclined to adopt poor photoprotective practices that further increase their risk of skin cancer; however, gaps in the literature exist in young adults and by indoor tanning frequency.
  
  
  OBJECTIVE
  To examine the association between indoor tanning frequency and behaviors related to skin cancer prevention and to investigate whether these associations vary by age group or sex.
  
  
  METHODS
  Cross-sectional population-based study of US 2015 National Health Interview Survey data including 10 262 non-Hispanic white adults aged 18 to 60 years without a history of skin cancer.
  
  
  METHODS
  Rare/never use of sunscreen, protective clothing, shade; multiple sunburns within the past year; previous full-body skin examination.
  
  
  RESULTS
  Of the 10 262 individuals in our study population (49% female; median age, 39 y), 787 (7.0%) reported having tanned indoors in the past year. Among individuals aged 18 to 34 years, frequent indoor tanners (≥10 times in the past year) were more likely to report never/rare use of protective clothing (adjusted prevalence ratio [aPR], 1.28; 95% CI, 1.10-1.49) and shade (aPR, 1.32; 95% CI, 1.03-1.70), compared with individuals who did not tan indoors. Among women aged 18 to 60 years, those who frequently tanned indoors were more likely to rarely/never use sunscreen (aPR, 1.34; 95% CI, 1.11-1.62), protective clothing (aPR, 1.27; 95% CI, 1.15-1.42), and shade (aPR, 1.54; 95% CI, 1.25-1.90) on a warm sunny day, as well as more likely to report multiple sunburns in the past year (aPR, 1.21; 95% CI, 1.00-1.45) compared with those who did not tan indoors. Individuals who tanned indoors in the past year were not significantly more likely to have undergone a previous full-body skin examination in any subpopulation examined.
  
  
  CONCLUSIONS
  Individuals who tan indoors often exhibited a concurrent tendency to sunburn, avoid sun protection, and avoid skin cancer screening. Thus, the findings highlight that in addition to tanning bed avoidance, it is critical to emphasize sun protection and skin cancer screening in individuals who tan indoors.
authors.affiliation: Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, Maryland2Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
authors.forename: Alexander H
authors.initials: AH
authors.lastname: Fischer
authors.affiliation: Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors.forename: Timothy S
authors.initials: TS
authors.lastname: Wang
authors.affiliation: Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
authors.forename: Gayane
authors.initials: G
authors.lastname: Yenokyan
authors.affiliation: Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors.forename: Sewon
authors.initials: S
authors.lastname: Kang
authors.affiliation: Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors.forename: Anna L
authors.initials: AL
authors.lastname: Chien