Addiction to sunbathing

Despite repeated health warnings about the dangers of tanning from sunlight and artificial light sources, there are still those whose mantra "bronzed is beautiful" remains unshaken.

Dermatologists have long suspected that some people may be addicted to tanning -- similar to addictions to drugs or alcohol -- and refuse to alter their behaviors, even knowing they have an increased risk of developing skin cancer.

Now, a new study of college co-eds indicates that some people may be addicted to ultraviolet (UV) light.

In the report entitled, "UV light abuse and high-risk tanning behavior among undergraduate college students," published in the March 2007 issue of the Journal of the American Academy of Dermatology, dermatologist Robin L. Hornung, MD, MPH, FAAD, Division of Dermatology at the University of Washington and the Children's Hospital and Regional Medical Center in Seattle, Wash., used a standardized testing tool to gauge the presence of a substance-related disorder (SRD) as a means to determine whether some college students could be hooked on tanning.

"Numerous studies have shown that increased knowledge of the dangers of overexposure to UV light often fails to change tanning behavior and attitudes, especially among high-risk age groups such as adolescents and young adults," explained Dr. Hornung. "We also know from previous experiments that UV light causes endorphin release, similar to the euphoric sensation associated with intense exercise commonly referred to as 'runner's high' or other pleasure-seeking behavior. Our study set out to find whether certain individuals, particularly those who classify themselves as frequent tanners, exhibit addictive behaviors toward tanning."

Dr. Hornung and her collaborator, Solmaz Poorsattar, asked a total of 385 male and female college students at the University of Washington in Seattle to complete a multiple-choice questionnaire that included questions about their personal tanning practices and those of their family and friends. In addition, four questions in the survey also comprised a modified version of the cut down, annoyed, guilty, eye-opener (CAGE) questionnaire tool. CAGE, which is a proven testing tool most often used to identify SRD with regard to alcohol, was used to determine whether participants showed symptoms of an SRD to UV light. Only students who reported ever purposely tanning were asked to complete this portion of the questionnaire. The four modified CAGE questions that were measured included:

• "Have you ever felt you ought to cut down on your tanning?"
• "Have people annoyed you by criticizing your tanning?"
• "Have you ever felt bad or guilty about your tanning?"
• "Have you ever thought about tanning first thing in the morning?"

Of the 385 students who participated in the study, 76 percent of female students reported purposely tanning their skin vs. 59 percent of male students. In addition, 42 percent of the female students reported using indoor tanning devices compared to only 17 percent of the male students.

When the responses to the CAGE questions were examined, 12 percent of the total sample of students, 18 percent of the students who reported regularly tanning in outdoor sunlight and 28 percent of indoor tanners scored positively on the CAGE questions -- indicating SRD with regard to UV light. Of the students who reported purposely tanning their skin, 22 percent of female outdoor tanners had positive CAGE results, compared with only 8 percent of male outdoor tanners. Interestingly, students who reported using indoor tanning devices were much more likely to be identified as potentially having a UV light disorder than nonusers -- 28 percent vs. 12 percent, respectively.

"Our finding that 18 percent of the students who admitted to purposely tanning their skin scored positively on the CAGE questionnaire is significant, not only because it indicates the probable existence of SRD with respect to UV light but because this percentage is comparable with findings of other addiction studies," said Dr. Hornung. "For example, a Midwest study found that 18 percent of college students who admitted to drinking alcohol also scored positively on the CAGE questionnaire with respect to alcohol, as well as the 16 percent of college students who reported smoking cigarettes daily in a 2002 National Institutes of Health study. If tanning is addictive as our study suggests, it helps explain why education alone will probably not stop high-risk tanning behavior -- similar to how the 'don't drink' and 'don't smoke' messages often fail to change behaviors."

While a known family history of skin cancer is a risk factor for developing future skin cancers, the students in the study who reported a family history of skin cancer were significantly more likely to engage in tanning than those students without a known family history of skin cancer. Of the students with a positive family history of skin cancer, 77 percent purposely tanned their skin outdoors and 45 percent used indoor tanning devices. "This finding infers that even a personal experience with skin cancer failed to alter tanning behavior in this population, despite an increased health risk," said Dr. Hornung.

Dr. Hornung added that almost half (41 percent) of the students who tan reported doing so to relax, which is a strong motivating factor that has been noted by numerous studies examining tanning behaviors and also is consistent with other addictive practices.

"The fact that tanning may be addictive for some individuals should strengthen the argument for stricter regulations on the indoor tanning industry," said Dr. Hornung. "Education alone is not enough to stop high-risk tanning behavior, and skin cancer rates will continue to increase markedly without proper intervention."