The results of the current study indicated that a significant number of adolescents from a multi-city sample had recently tanned indoors at a business. The prevalence of indoor tanning in the last year among our adolescent sample of 11.2% was similar to the rates of 10% found in two national studies.13, 15
Female teens, older teens, and teens who are less likely to burn and more likely to tan were significantly more likely to have tanned indoors, supporting data from previous studies.13–17
A dramatic sex difference was found, with female adolescents 5.3 times more likely than males to have tanned indoors in the last year.
Several parental factors were significantly associated with adolescent indoor tanning behavior, suggesting that previous recommendations to target parents in intervention activities, in addition to the adolescent, may be warranted.13, 16
As suggested by Cokkinides et al.13
and Stryker et al.,16
there are multiple ways that parents may be influencing the tanning behavior of their children. In this and previous studies,13, 16
parental tanning behavior proved to be a significant predictor, possibly due to modeling.23
In our study, teens with parents who had ever tanned indoors tanned indoors in the last 12 months far more often than did teens of parents who had never tanned indoors (21.8% vs. 7.9%). Parental modeling has been found to be important in predicting health behaviors in other domains, such as obesity.24
Thus, decreasing the frequency with which parents tan indoors may subsequently decrease the frequency of that behavior in adolescents.
The other primary way that parents may influence adolescent tanning behavior is the extent to which they are gatekeepers, monitoring and attempting to prevent indoor tanning behavior in their adolescent. Mirroring results obtained by Stryker and colleagues,16
in our study adolescents’ perceptions of whether they would be allowed to tan indoors was significantly associated with their indoor tanning behavior. In fact, adolescents who said that their parents would allow them to tan indoors were 5.6 times more likely to have tanned indoors, making this the strongest association in the multivariate model. Also, teens of parents who reported that they would not be concerned “a lot” for their teens’ health if they tanned indoors occasionally were nearly twice as likely to have tanned indoors, a finding that was similar to that found by Stryker and colleagues (aOR = 1.7).16
Thus, encouraging parents to increase their gatekeeping behavior and changing their gatekeeping cognitions may help prevent adolescents from tanning indoors. Parental monitoring has been found to be important in the prevention of other risky behaviors such as substance use and antisocial behavior.25
Although Stryker and colleagues found that parental cognitive variables did not predict adolescent indoor tanning behavior when controlling for other factors in their multivariate model,16
the non-gatekeeping cognitive variables assessed in the current study were in fact significant predictors. Approximately 13.5% (compared with 6.7%) of adolescents with parents who reported that people with a tan look more attractive had tanned indoors in the last 12 months, suggesting that interventions to reduce adolescent indoor tanning behavior should target parental attitudes, in addition to parental tanning behavior and gatekeeping-related cognition and behavior. One finding contradicted our hypotheses. Adolescents of parents who reported that they thought indoor tanning posed a risk for skin cancer were significantly more likely to have tanned indoors. Although seemingly counterintuitive, these findings may simply reflect that parents whose adolescents are tanning have thought more about the health risks than parents whose adolescents had not tanned recently. These findings also may suggest that people’s UVR protective behaviors may be modified more effectively by focusing on the appearance-based, rather than the skin cancer effects, of UVR exposure. In fact, Mahler and colleagues found that an intervention using UV photographs and photoaging information was successful in improving sun protective behaviors among college students.26
A large proportion of our adolescent sample (79.6%) reported that most of their friends like to be tan, and our findings indicated that adolescents who held this belief were 1.7 times more likely to have tanned indoors. Perception of a higher percentage of peers who have tanned indoors also was associated with higher rates of indoor tanning. Likewise, Geller and colleagues found that adolescents who reported that they had friends who tanned were significantly more likely to have engaged in indoor tanning behavior.15
Along similar lines, among a group of college students, having friends, family, and partners who thought that they should tan indoors was positively and significantly associated with indoor tanning bed use.27
Thus, it appears to be the case that peer behavior and attitudes, as well as perceptions of peer behavior and attitudes, may be additional target areas for intervention. One recent sun safety intervention successfully increased sun protective behaviors in part by capitalizing on the potential impact that peers can have with one another’s health behaviors, using “sun teams” made up of 8th
grade students to lead peer-education activities regarding sun protection.28
There are several limitations to the current study that should be addressed. First, our use of a cross-sectional design means that directionality and causality cannot be assumed. Although constructs from Social Cognitive Theory23
support our inferences, the findings are merely correlational; prospective data are needed to confirm our interpretations. Second, adolescent respondents may have been less forthright on the telephone when answering questions about indoor tanning than they would have been with an anonymous paper-and-pencil survey. For example, we had no way to ensure their privacy during the interview and/or they may have underreported their tanning behavior in order to please the interviewer. Also, one of our key variables assessing gatekeeping—adolescents’ report of whether or not their parents would allow them to tan indoors—is merely a proxy for parental gatekeeping behavior since adolescents, not parents, reported on parental behavior. Thus, it is possible that adolescent report of parental behavior does not accurately reflect true parental gatekeeping behavior.
Because our diverse sample was selected from the 100 largest U.S. cities and we had a respectable cooperation rate, the findings likely will generalize to U.S. urban adolescents. On the other hand, they may not generalize to those living in suburban and rural areas. Little research has examined whether there are differences in indoor tanning prevalence between individuals living in urban versus suburban or rural areas. However, Demko and colleagues did find that attending a rural high school was significantly associated with indoor tanning behavior.14
Future research should look into such potential differences. The relatively high proportion of individuals in our sample who reported a low likelihood of burning and high likelihood of tanning compared with other samples15
may reflect the ethnoracial diversity of our sample.
In summary, these data serve to support previous assertions that parents may play an important role in adolescent indoor tanning behavior. Our study also highlighted the possible influence of peers. Adolescents’ perceptions of whether or not their parents would allow them to tan indoors emerged as the strongest predictor of teen tanning in the multivariate model, with modeling, parental cognitions (both gatekeeping and non-gatekeeping), and peer factors also associated but to a lesser degree. These findings underscore the need to address both family- and peer-related factors when designing individual- and policy-level interventions to decrease indoor tanning among adolescents.