Tanning Dependence Model - Oren and Bartek, 2007

As the most common human malignancy, skin cancer is a major public health concern.  Ultraviolet radiation (UVR), specifically that produced by indoor tanning booths, contributes significant risk for skin cancer.  Indoor tanning is becoming increasingly prevalent and is particularly popular among adolescent and young adult females.  While many indoor tanners tan for appearance reasons, a subgroup of frequent tanners may become psychologically and physically dependent on tanning.  There is evidence that UVR exposure produces substances in the body (e.g., the opioid beta-endorphin) that  increase positive feelings and the desire to tan.  The primary aim of the proposed project is to test the feasibility and acceptability of a novel experimental paradigm to investigate the affective (emotional) and biological determinants of and responses to UVR exposure that may motivate ongoing indoor tanning behavior.  

In this project, 18-25 year-old female frequent and infrequent indoor tanners will be recruited and randomly assigned to receive UVR and non-UVR (placebo) light from standard commercial tanning booths, using a within-subjects cross-over design.  Participants will complete a psychological interview and questionnaires, and provide blood samples before and after UVR exposure.  It is hypothesized that there will be significant differences between the frequent and the infrequent indoor tanners in psychological/affective and biomarker (ACTH, beta-endorphin) baseline levels and responses to UVR exposure, as well as in genetic polymorphisms relevant to dependence (the mu-opioid receptor, OPMR1).  Our team has successfully conducted several previous skin cancer prevention and addiction studies with young adults; thus, we are ideally suited and uniquely poised to conduct the proposed project.  Such innovative and translational work is important to understanding the psychological and biological processes underlying the desire to tan, particularly among frequent indoor tanners who are exposed to the greatest levels of damaging UVR.  Better understanding of these processes may facilitate the development of more effective prevention efforts and help guide public policy in this area.  

Skin cancer, the most common human malignancy, is associated with ultraviolet radiation (UVR), particularly when exposure is from artificial sources. Tanning beds emit more UVR over a shorter period of time than sunbathing, greatly increasing the risk for the development of skin cancers. While most skin cancers are not fatal, they are common, costly, and can have devastating effects on health and appearance. Little research has been conducted on indoor tanning despite its stronger association with skin cancer than sunbathing, particularly among young women. Studies have typically involved very brief surveys or interviews that have not explored the issues in an in-depth manner or investigated relationships between indoor tanning and psychological and addictive symptoms. Prior studies have provided rates and correlates of tanning booth use but have focused primarily on young adolescents. However, up to one half of young adult women may be indoor tanners. The specific aims of the proposed project are to: (1) evaluate motivations for indoor tanning and identify motivational profiles of different subgroups of young adult females and (2) evaluate whether similar associations and profiles hold for sunbathing and inverse relationships exist for skin protective behavior such as sunscreen use. The study design involves a detailed survey and structured clinical interview to explore the appearance, affective, and addictive motivations of indoor tanning and delineate psychological profiles of young adult women at high risk for skin damage and potential skin cancer. As suggested by the literature, we anticipate being able to identify subgroups of young adult females who are qualitatively different from one another in terms of correlates of indoor tanning. Young women often tan indoors despite knowledge of the health hazards; therefore, their potentially complex motivations need to be further investigated. Based on the results of this study, we plan to design and test a novel intervention that addresses relevant psychological and addictive problems among young adult female indoor tanners.

Skin cancer is the most common cancer in the US, with over a million new cases diagnosed yearly 1. Young adults, particularly women, are increasingly at risk of melanoma. Contributing to the increasing skin cancer risk among young adults is the fact that US adolescents have the lowest skin protection rates of all age groups 2 and also demonstrate increased exposure to natural and artificial UV radiation as they move into adulthood 3. Innovative interventions are needed to have an impact on skin cancer risk among young people. Unlike previous interventions, our skin cancer risk reduction intervention will be tailored (or personalized) to each individual participant and delivered via the Internet. The tailored intervention will emphasize appearance concerns, which are known to be the primary motivation for UV exposure and lack of skin protection among young adults. This will be accomplished in part through the use of personalized facial images showing UV damage as well as computerized age progression demonstrations. Primary Aim 1. To examine the efficacy of a tailored intervention delivered via the Internet designed to increase skin protection and decrease sun exposure behavior among young adults at moderate to high risk of developing skin cancer. Participants will be randomized to the tailored intervention, the Skin Cancer Foundation website, or an assessment only condition. Aim 2. To evaluate whether socio-demographic variables (sex, race/ethnicity, skin type, family history of skin cancer, education, socioeconomic status, and geographic locale), appearance consciousness, and past exposure and protective behaviors moderate intervention effects. Aim 3. To evaluate whether Integrative Model 4 constructs (UV-related knowledge, risk perception, beliefs, norms, self-efficacy, and intentions) mediate intervention effects.  These mediators and the behavioral outcomes will be assessed at baseline as well as three weeks and three months post baseline. In the first stage of the project, the tailored intervention including interactive and multimedia materials will be developed and refined through acceptability and usability testing.  In the second stage, the efficacy of the tailored intervention at improving UV exposure and protection behaviors will be evaluated in a randomized controlled trial conducted via the Internet. We will also establish moderators and mediators of intervention effects. The goals of future research would be to enhance the tailored intervention, for example, by adding additional contacts or Internet technologies or features, disseminate the intervention, assess the longevity of effects, and/or adapt the tailored intervention for use with other cancer risk behaviors or at risk groups.