Intentional tanning behaviors among undergraduates on the United States’ Gulf Coast

The incidence of skin cancers, especially melanoma, continues to rise, particularly among adolescents and young adults (AYA) [1‐3]. The most significant and modifiable risk factor for the development of cutaneous malignancies is ultraviolet (UV) radiation exposure [1, 4‐8]. In the AYA population, recreational UV exposure (tanning) is a popular activity [9‐15], driven primarily by the perceived social desirability of a tanned appearance [16‐20]. The most common methods of tanning are outdoor tanning (OT) and indoor tanning (IT), though non-UV based tanning methods such as spray tanning (ST) are increasingly popular, since they are promoted as a safer alternative to OT and IT [13].

In recent years, numerous studies have examined tanning behaviors in college students. However, these have mostly focused on colleges in the Northeastern and Midwestern regions of the U.S. [9, 10, 21‐25]. None of the studies at Southern U.S. colleges have examined all three tanning modalities and their relative frequencies [12, 16, 26, 27]. Developing a comprehensive understanding of tanning behaviors of Southern college students is important for a number of reasons: skin cancer risk increases with the North-South UV index gradient [28]; Southern states receive the highest amount of UV radiation reaching the earth’s surface [28], individuals residing in Southern and coastal regions have the highest mortality rates among non-Hispanic whites [29], national high school student data suggests that tanning behaviors are highest in the South compared with other geographies [30], and proximity to beaches in Southern states has been noted as a motivator for selecting a college along the coast [26]. Therefore, this study sought to investigate all types of intentional tanning behaviors at a coastal university in the South.

Of the 10,880 undergraduates contacted, 2668 students completed the survey (24.5% response rate, comparable to other electronic surveys) [32, 33]. The majority of respondents were female (69.3%) and White (68.9%). These respondents reflect the larger campus population, of which 61.5% are female and 61.1% are White. Most participants were upperclassmen: freshman (20.8%); sophomore (22.1%); junior (27.1%); senior (30.0%). Rates of response by class year were also comparable to the university’s enrollment: freshman (28.4%); sophomore (19.7%); junior (20.9%); senior (31.0%). With respect to tanning behaviors, 64.9% reported current OT tanning, 50.7% reported ever IT, and 21.2% reported ever ST. Thirty percent of respondents self-identified as current IT. Demographic and other behavioral characteristics can be found in Table 1. Association between each tanning behavior and demographic and other behavioral characteristics are reported below.

The current study fills a significant gap in existing literature by examining multiple intentional tanning behaviors among a large population of undergraduates at a Southern, coastal university. While OT is a common tanning behavior, the rates and prevalence of OT are not well investigated in the literature, with varying categorizations of OT making comparisons between studies difficult. However, OT rates are higher in the current population (64.9%) than those reported previously (34.4% among 576 college students in Brooklyn, New York), likely due to proximity of the university to the beach [34]. IT rates of this study population (52.3%) were comparable with other reported rates of undergraduate IT, including an international systematic review finding IT rates of 55% among university students [15]. Sunless tanning product use has only been more recently examined in the literature, and comparisons are challenging because categories of these products can include both over-the-counter lotions and ST. Use of these products, particularly among adolescents and young adults have not been well-defined or investigated. In a 2004 national survey, 11% of U.S. adults claimed to have ever used sunless tanning products [35], while a more recent study examining the use of all sunless tanning products estimated use to be 25% among female teens (12–18) in the U.S. [36]. The current survey’s rate of 21.2% is consistent with the usage among teens and provides a new benchmark for adolescents and young adults.

In this large survey of undergraduates from a Southern, coastal university we found significant engagement in tanning behaviors. More than half of the surveyed students engaged in OT and/or IT with a majority of tanners being white females. Further, there is an emerging population of ST, and again these tanners are predominantly white females. Of particular note is the high association between different tanning methods that indicates this population engages in multiple tanning behaviors. Combination tanning behaviors are not well understood and have not been well described in the literature, but this study suggests that these behaviors occur frequently. Given the literature associations between UV exposures and the risks associated with age of initiation and sex, our data suggest that white female tanners in the Southern U.S. may be at particular risk of developing skin cancer in the future and are prime candidates for interventions.

Future work in this area should focus on creating more standardized methodology and questions such as specific definitions of OT, IT, ST, and frequency to facilitate generalization and comparability of findings. New studies should also focus on the understudied trend of combination tanning (engaging in two or more types of tanning) demonstrated here with respect to predictors, long-term outcomes, and interventions targeting this type of behavior.