1 in 4 teens and young adults addicted to tanning

More than one in four teens and young adults show signs of “tanorexia” or tanning dependence, leaving them craving the sun or a tanning bed in much the same way addicts yearn for alcohol or drugs, a new study shows.

Researchers at the Fox Chase Cancer Center in Philadelphia examined the tanning habits of 400 college students aged 18 to 24, using the same framework that defines substance addictions. They found that 27 per cent showed signs of “tanorexia,” based on answers to questions like “Do you think you need to spend more and more time in the sun to maintain your perfect tan?” and “Does this (your belief that tanning can cause skin cancer) keep you from spending time in the sun or going to tanning beds?”

“I don’t know that the public at large really thinks that tanning could be addictive and if they thought that, then people might be less likely to tan and especially concerned about young people,” said Carolyn Heckman, author of the study and an associate member of the cancer centre.

Current smokers are more likely to be addicted to tanning than those who have never smoked, she found, and obese people are less likely to be tan-dependent than those of normal or below-average weight. The mean age at which participants said they first visited a tanning bed was just over 17 years old, and the mean number of visits over their lifetime was about 57, which means half went more frequently and half less.

“People value attractiveness and they’re willing to take health risks to be attractive, especially since the health risks may not show up for 20 or 30 years,” Heckman said. “They want to look good now.”

Almost half of young Canadian women aged 16 to 24 (49 per cent) and over a quarter of young men the same age (28 per cent) say they actively try to get a tan from the sun, according to a survey released by the Canadian Cancer Society in July. The agency is promoting the World Heath Organization’s stance that tanning beds should be banned for people under age 18, says Heather Chappell, senior manager of cancer control.

“The younger age group we know is the most difficult to reach,” she said. “We need to continue to try to ‘de-normalize’ a tan and (the idea) that a tan is healthy. It’s not necessarily a healthy thing because a tan indicates you have been out exposing yourself to UV.”

But tanning addiction may literally run more than skin deep, Heckman says. Researchers hypothesize that tanning may release endorphins in the brain, she says, potentially bringing on a feeling of well-being similar to the “runner’s high” people get after exercising.

“Tanning may feel relaxing or people might have seasonal affective disorder in the winter and they like to indoor tan to help their mood,” she said. “So those are possibilities of why people might want to tan besides appearance.”

Tanning Beds can be as Deadly as Arsenic

Cancer risk jumps 75 percent if ultraviolet radiation device used before 30.

LONDON – International cancer experts have moved tanning beds and other sources of ultraviolet radiation into the top cancer risk category, deeming them as deadly as arsenic and mustard gas.

For years, scientists have described tanning beds and ultraviolet radiation as “probable carcinogens.”

A new analysis of about 20 studies concludes the risk of skin cancer jumps by 75 percent when people start using tanning beds before age 30. Experts also found that all types of ultraviolet radiation caused worrying mutations in mice, proof the radiation is carcinogenic. Previously, only one type of ultraviolet radiation was thought to be lethal.

Skin Damage Caused by Sunlight

Some sunlight is important because our skin uses it to produce vitamin D, which helps to build and maintain strong bones. Too much sun is harmful and can damage your skin.

The sun gives out ultraviolet (UV) radiation that is made up of three types of rays: UVA, UVB and UVC. UVC rays from the sun can’t get through the ozone layer but UVA and UVB rays can, and these rays have been linked to skin damage.

Short-term skin damage

Sun tan

A tan is actually a sign that your skin has been damaged and is trying to protect itself. UV radiation stimulates your skin to produce more pigment (colour), which protects against damage. Your tan will fade, but the damage to your skin remains.

Sunburn

Short-term overexposure to the sun can cause your skin to burn, usually making it red, hot and painful. You can soothe your burnt skin with calamine lotion or aftersun lotions. If your sunburn is severe, you may need medical treatment.

Heat exhaustion and heat stroke

This is when your body becomes overheated after overexposure to the sun or by getting sunburn. You may have symptoms including vomiting, headaches and fever. If you think you have heat stroke, get to a cool place as soon as possible and drink plenty of water. If your temperature is higher than 39ºC (you can measure your temperature using an oral thermometer), your skin has become dry and flushed or you feel very unwell, you should see a doctor immediately.

Long-term skin damage

Ageing and infection

Ageing of your skin is a result of the UVA rays penetrating it, causing wrinkles and sagging. UV rays can also cause damage to the eyes. It has been suggested that too much sun exposure may damage your immune system, increasing your risk of infection.
Skin cancer

Although the exact cause of skin cancer isn’t known, some things make it more likely. Your risk of skin cancer increases if you’re exposed to UV rays because of spending a lot of time in the sun.

Preventing sun damage

To protect your skin, you should stay out of the sun between 11am and 3pm, when the sun’s UV rays are strongest. Look for shady areas such as under trees, and use umbrellas or canopies.

Watch the UV index

The UV index describes the strength of the sun’s UV radiation. It’s usually shown as a number in a triangle on a weather map. The numbers range from one to 11+ and the higher the number, the stronger the UV radiation. If the UV index is higher than three you will need protection when you go outside.

In many countries, the UV index is reported alongside the weather forecast in newspapers, on TV and on the radio.
You can protect your skin by wearing long-sleeved tops and trousers. Choose materials that have a close weave as these block out the most UV rays. Wet clothing stretches and lets more UV radiation through to your skin.

Wearing a wide-brimmed hat can halve the amount of UV radiation reaching your face.

Sunglasses help to protect your eyes and eyelids. Wraparound sunglasses will also protect the skin around your eyes. You should choose a pair of sunglasses that has the following labels:

* 100 percent UV protection
* UV 400 – this means it protects from both UVA and UVB rays

If you’re buying a pair of sunglasses in Europe, check that they also carry the European Standard CE mark and the British Standard (BE EN 1836:1997).

Wear sunscreen

Always use “broad spectrum” sunscreen. This means that it protects your skin against UVA and UVB rays. Make sure it has a sun protection factor (SPF) of 15 or higher. The SPF tells you how good the sunscreen is at filtering out the UVB rays. There isn’t a measure of protection against UVA rays. Sunscreen can’t give you complete protection since some UV rays will always get through, but you will get more than 90 percent protection from UVB rays with SPF 15.

Re-apply sunscreen every two hours or more often if you go swimming, or sweat a lot. Water reflects the sun’s rays so you need to apply sunscreen before swimming.

Cloud doesn’t stop the sun’s UV rays getting through so you should protect yourself even if it’s cloudy. Haze (from thin clouds or mist) can even increase your UV radiation exposure because the rays are scattered.

Check moles

You should check your moles regularly for changes that may indicate skin cancer. Most changes are harmless, but you should see your GP if you notice:

* growth of an existing mole – especially over 7mm (a quarter of an inch) in diameter
* a mole with an uneven or ragged edge
* a mole of varying shades of colour
* a mole with an inflamed or red edge
* a mole that bleeds, oozes or crusts
* a mole that feels different, painful or itches

Don’t use sunbeds

Sunbeds mimic the effect of the sun and give out artificial UVA and UVB radiation. Exposure to artificial UV radiation can also damage your skin. Sunbeds have been linked to an increased risk of skin cancer as well as eye conditions.

An artificial tan from a sunbed doesn’t protect your skin against sunburn on holiday; it’s similar to using a sunscreen with SPF 2 to 3.

There are no regulations relating to the use of sunbeds, but the World Health Organization (WHO) recommends that you shouldn’t use sunbeds if you:

* are under 18
* have sunburn, burn easily or had frequent sunburn as a child
* have a lot of moles
* tend to freckle
* have pre-cancerous or cancerous skin lesions
* are wearing cosmetic products (these may make you more sensitive to UV radiation)
* are taking medication (you should seek medical advice to check whether your medication will make you particularly sensitive to UV radiation)

Winter sun

You can’t feel UV rays. The warmth you feel on your skin is actually caused by the sun’s infrared radiation. So just because you can’t feel the hot rays of the sun, it doesn’t mean you won’t get sunburnt.

The amount of UV radiation is generally lower during the winter but snow reflects most of the sun’s rays, so you can still get sunburnt. If you’re high up in the mountains, there is less atmosphere to block out the UV rays, so make sure you use sunscreen.
Protecting children from the sun

Young skin is sensitive and very easily damaged by the sun. Getting sunburnt as a child is known to increase the risk of developing skin cancer as an adult.

Keep your baby in complete shade. Pop-up shelters are a good way to protect children from the sun on the beach or in the garden. Canopies and parasols for prams and buggies protect children when you’re out and about.

Dress your child in loose-fitting clothes that cover up their arms and legs. A hat with a brim at the front and a cloth flap that covers the neck provides good sun protection. Sunglasses will help to protect your child’s eyes.

Use water-resistant sunscreen with SPF 20 or higher on all exposed areas of your child’s skin and apply generously every couple of hours. If you take your child swimming, re-apply the sunscreen after towel drying.

Fake tans

Fake tanning lotions are a popular alternative to sunbathing and sun beds. The tanning lotion reacts with your skin and produces a brown pigment. Fake tan needs to be re-applied regularly if you want to maintain the tan, because your outer skin cells are shed naturally as your skin grows.

Some fake tanning lotions contain sun protection but the SPF is usually very low, so you should also wear sunscreen with an SPF of 15 or higher when you’re out in the sun.

Although fake tanning lotions aren’t known to be dangerous, they can sometimes trigger an allergic reaction. Always test the lotion on a small area of your skin first to see if you have a reaction.

Sun and Cultural Aspects

Many people find direct sunlight to be too bright for comfort, especially when reading from white paper upon which the sun is directly shining. Indeed, looking directly at the sun can cause long-term vision damage. To compensate for the brightness of sunlight, many people wear sunglasses. Cars, many helmets and caps are equipped with visors to block the sun from direct vision when the sun is at a low angle.

In colder countries, many people prefer sunnier days and often avoid the shade. In hotter countries the converse is true; during the midday hours many people prefer to stay inside to remain cool. If they do go outside, they seek shade which may be provided by trees, parasols, and so on.

Sunshine is often blocked from entering buildings through the use of walls, window blinds, awnings, shutters or curtains.

Sunbathing

Sunbathing is a popular leisure activity in which a person sits or lies in direct sunshine. People often sunbathe in comfortable places where there is ample sunlight. Some common places for sunbathing include beaches, open air swimming pools, parks, gardens, and sidewalk cafés. Sunbathers typically wear limited amounts of clothing or some simply go nude. An alternative some use to sunbathing is to use a sunbed that generates ultraviolet light and can be used indoors regardless of outdoor weather conditions and amount of sun light.

For many people with pale or brownish skin, one purpose for sunbathing is to darken one’s skin color (get a sun tan) as this is considered in some cultures to be beautiful, associated with outdoor activity, vacations/holidays, and health. Some people prefer nude sunbathing so that an “all-over” or “even” tan can be obtained.

Skin tanning is achieved by an increase in the dark pigment inside skin cells called melanocytes and it is actually an automatic response mechanism of the body to sufficient exposure to ultraviolet radiation from the sun or from artificial sunlamps. Thus, the tan gradually disappears with time, when one is no longer exposed to these sources.

Frequent tanners may be lured by ‘feel-good’ effects of UV light

Frequent tanning bed users may be getting more out of the experience than darker skin. Researchers at Wake Forest University Baptist Medical Center say exposure to ultraviolet light may produce a “relaxing” effect that lures tanners back to the beds. “We believe that ultraviolet light has an effect on mood that tanners value,” said Steven Feldman, M.D., Ph.D., lead researcher. “This may be creating a reinforcing effect that influences tanning behavior.”

The research – involving 14 young adults who regularly used tanning beds –is reported in the July issue of the Journal of the American Academy of Dermatology, which is now available on-line. For six weeks, study participants had tanning sessions on Mondays and Wednesdays in two identical-looking tanning beds. They spend half of each session in one bed and half in the other. There was a key difference in the beds, however – only one used ultraviolet light (UV).

UV light occurs naturally in sunlight and is responsible for the tanning and burning effects of the sun. Artificial UV light is used in tanning beds and sunlamps.

Mood was measured before and after each tanning exposure. The results revealed greater relaxation and lower tension after UV exposure compared to non-UV exposure. The researchers theorize that UV exposure leads to the release of chemicals in the brain called endorphins that are linked to both pain relief and euphoric feelings.

“A more relaxed and less tense mood was reported after UV exposure compared to after non-UV exposure,” said Feldman. “We believe these relaxing and reinforcing effects contribute to tanning behavior and may help explain why people choose to tan despite the risks.”

During the six-week study, participants had the option of additional tanning on Fridays in either of the beds. Twelve of the subjects chose additional tanning – and for 95 percent of the sessions they chose the UV bed.

“There are probably many factors that influence the choice to tan frequently,” said Feldman, a professor of dermatology. “But we found that when subjects are offered tanning beds that differ only in the presence or absence of UV light, they choose the bed with UV light. Moreover, the choice of UV is associated with a sense of greater relaxation.”

Feldman said the finding is significant because, like other risky behaviors, it is important to understand why frequent tanners choose the activity. Exposure to UV through tanning has been shown to damage the genetic information in cells and is linked to the development of skin cancer. Despite this, there was a 300 percent increase in the number of indoor tanners in the United States between 1986 and 1996.

Most research into the motives for excessive tanning has focused on effects such as appearance. However, there is some previous evidence supporting a relaxation effect. Laboratory studies have shown a release of endorphins in response to ultraviolet light exposure. And, a survey of college students showed that relaxation was one of the most common reasons identified for tanning.

“Since we didn’t measure endorphins, we don’t know for sure that these substances are responsible for the phenomenon,” said Feldman. “But, our findings suggest a course for future research into why people use tanning beds and the mechanism of mood changes associated with tanning.”

Teens And Tanning: A Dangerous Combination

With the incidence of skin cancer on the rise, it has never been more important to share the message that prevention and detection are the keys to avoiding this potentially life-threatening condition. Simple steps, such as using sunscreen, wearing a hat, and avoiding the sun when its rays are the strongest, are easy ways to help prevent skin cancer.

This message is particularly important for children and adolescents, since skin cancer is commonly associated with excessive ultraviolet light (UV) exposure before the age of 18. Yet recent studies of young people suggest that the prevention message is not being heard, or worse, is simply being ignored.

Speaking today at the American Academy of Dermatology’s Melanoma/Skin Cancer Detection and Prevention Month Press Conference, dermatologist James M. Spencer, MD, Vice Chairman, Department of Dermatology, The Mount Sinai School of Medicine, New York, discussed the dangerous mix of teens and tanning.

According to current statistics, nearly half of all new cancers are skin cancers and more than 1 million new skin cancer cases will be diagnosed in the United States this year. It is also estimated that skin cancer will claim 9,800 lives in 2003.

In a recent survey of over 10,000 young people ages 12-18 from all 50 states, it was found that the simple use of sunscreen on sunny days was practiced by only 34.4 percent of youths surveyed. In addition, the survey discovered that 83 percent of teens had experienced at least one sunburn in the previous year, and 36 percent of those who were burned had experienced three or more sunburns.

The survey also found that natural sunlight wasn’t the only significant source of UV exposure for teens. Approximately 10 percent of young people surveyed said that they had used tanning beds in the previous year. Of this group, young women were found to be most likely to use indoor tanning devices. This fact was supported by the results of a recent study of American attitudes about tanning conducted by the American Academy of Dermatology, which found that 26 percent of young people under age 25 had used a tanning bed in the past year. Of that 26 percent, more than half were young women.

“The incidence of indoor tanning is particularly troubling because it is so unnecessary,” stated Dr. Spencer. “It’s not associated with playing sports or other outdoor activities, but is practiced solely for cosmetic reasons. Teenagers are intentionally putting their health at risk.”

Current evidence also suggests that the use of artificial tanning devices increases with age. According to a recent survey, approximately 7 percent of girls age 14 had used tanning beds in the last year, while 16 percent of girls age 15 had reported doing so. By age 17, the statistic increased to 35 percent of girls who had used tanning beds in the last year. In addition, a recent survey of college students at a midwestern university found that 47 percent of students had used indoor tanning beds in the last year. Of those surveyed, 90 percent also admitted to knowing that tanning is a health risk, yet they continued to use tanning beds frequently.

Recent studies of the UV emission spectrum of tanning beds illustrate the similarities between tanning bed exposure and that of natural sunlight. Sunlight consists of two types of harmful rays – UVA rays and UVB rays. UVB rays are the sun’s burning rays, while UVA rays penetrate deeper into the dermis to cause skin damage. While the UVB exposure levels in tanning beds were similar to natural sunlight, the UVA levels were 10 to 15 times higher. These high exposure levels correspond to an overall UV “index” of 13. In comparison, an average UV index during a hot summer day is 8.5.

“There seems to be a popular misconception among young people that indoor tanning is ‘safer’ than exposure to outdoor sunlight,” explained Dr. Spencer. “However, tanning beds still emit dangerous levels of UV rays and are considered a serious health risk.”

This fact was supported by the Department of Health and Human Services December 2002 report that added “broad spectrum ultraviolet radiation produced by the sun and artificial light sources” as a known carcinogen to the 10th annual cancer listing of 228 substances linked to cancer.

It is still uncertain as to what is the most influencing factor in a young person’s decision to tan. When asked in recent surveys about their desire to tan, teens replied that they simply “preferred” tanned skin, they wanted to emulate friends that were tan, or they felt that receiving a sunburn was a good way to begin the tanning process. What is certain from this information is that the risk of skin cancer does not seem to be a factor in a teen’s decision to tan.

“Pressure to conform to cosmetic ideals presented in popular culture and advertising are powerful factors influencing the young. These are pressures that can be changed,” said Dr. Spencer. “Parents, the medical profession, and the government, working with the media, entertainment and advertising industries, can change these unhealthy attitudes and help reverse the current trend of dangerous sun exposure for today’s teens.

The Chemistry of Tanning

It’s no coincidence that the process of turning animal skins into leather is called tanning. When people tan, UV radiation from the sun breaks down protein in our skin cells and causes, over time, wrinkles and leathery-looking skin. According to the American Academy of Dermatology (AAD), most sun exposure occurs before the age of 18. With major summer “beach time” remaining, here’s some information from the American Chemical Society, the world’s largest scientific society, on how consumers can protect themselves and their families from the sun’s harmful rays:

Perfect tan made in the shade: Everyone knows that too much exposure to the sun can cause skin cancer and premature aging. Everyone from Jennifer Aniston to your neighbor is using self-tanners to recreate that coveted bronze glow. But how do they work and are they safe? According to Chemical & Engineering News, self-tanners contain an active ingredient called dihydroxyacetone (DHA), a nontoxic, simple sugar found in baby formula and fish oil. DHA turns skin brown in a process called the Maillard reaction, better known to food chemists for making beer golden brown. Proteins in our skin interact with sugars to create brown or golden-brown compounds. DHA doesn’t penetrate further than the outermost, dead layer of skin.

Making sense of sunscreens: From moisturizers to lipsticks, sales of personal care products formulated with sunscreen have exploded. The sun’s rays are more damaging now then ever because the earth’s protective ozone layer is depleted, but with 17 active sunscreen ingredients approved for use in the United States, how do you choose? According to Chemical & Engineering News, sunscreens with inorganic ingredients such as titanium dioxide and zinc oxide reflect and scatter UV light. Sunscreens made with organic ingredients like OMC and avobenzone absorb UV light and dissipate it as heat. SPF (sun protection factor) measures how effectively a sunscreen protects against UVB rays that burn skin.

Newer sunscreens offer greater protection against sun’s rays: Craig Bonda, a chemist at the C.P. Hall Company in Bedford Park, Ill., has developed a longer-lasting sunscreen that protects wearers against both UVB and UVA radiation. Until recently, most sunscreens protected only against UVB — the ultraviolet rays that cause sunburn. The newest sunscreens absorb or reflect the full spectrum of ultraviolet radiation, including UVA, which causes skin to age and wrinkle prematurely and may also cause certain skin cancers. Avobenzone, a chemical used in many full-spectrum sunscreens, loses its effectiveness upon prolonged exposure to the sun. Bonda found that avobenzone breaks down more slowly when the chemical DEHN is added.

New Study Indicates Tanning May Be Addictive

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?”M
– “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.”