Artificial Tanning
Community Pediatrics
Legislative Advocacy Project
Joshua Langhorne, MD
Janienne Kondrich, MD
Tanning industry
• ~ $5 billion annually, up
from $1 billion in 1992
• Fifty thousand tanning
facilities in the US
• 28 million visits per
year
Tanning + Teens
• Specifically targeted by the tanning industry –
i.e., ads in HS newspapers!
• 24% of teens ages 13 to 19 reported using a
tanning facility once in their lives
• 10% of 11 to 18 year olds within the last year
• Artificial tanning among white females rises
with age: use doubles from ages 14 to 15 (7% to
15%), and doubling again at age 17 (35%)
Acute health effects
• Sunburn
• Skin dryness
• Pruritis
• Nausea
• Photodrug reactions
• Disease exacerbation
– SLE
• Disease induction
– Polymorphous light
eruption
Long term health effects
• Skin aging
• Effects on the eye
 Cataract formation
 Macular degeneration
• Carcinogenesis:
– > 1 million new cases of skin cancer in the US each year
– Increase at least in part attributable to increased
popularity of artificial tanning
– UVA irradiation may be 10-15 X more powerful than
THE MIDDAY SUN
– Childhood and adolescence are periods of greater
biological vulnerability to UVR
Skin cancer: further increase of risk
with artificial vs. natural UVR?
• NIH: Exposure to sunlamps or sunbeds is a known
human carcinogen
• Association between use of any tanning device and
increased incidence of basal cell or squamous cell
carcinoma
• Scandinavian study: increased melanoma risk in
females
• The International Agency for Research on Cancer
found that even one exposure to artificial UVR was
associated with melanoma; first exposure before the
age of 35 significantly increased risk
The Freedom to Tan
• The tanning industry has fought for teens to have
continued access to tanning salons
• Promote the health benefits and safety of artificial
tans
• The mission of the Indoor Tanning Association is “to
protect the freedom of individuals to acquire a
suntan, via natural or artificial light.”
• Parental rights issue
What are the formal stances of
various medical organizations?
World Health Organization
The WHO is the directing
and coordinating
authority for health
within the United
Nations system.
World Health Organization
• Consistent with those of the International
Commission on Non-Ionizing Radiation Protection
(ICNIRP)
• Recommends against use of UV-emitting appliances
for tanning or other non-medical purposes
• Individuals < 18 years old are at particularly high risk
of incurring adverse health effects from UV, and
therefore should be counseled against the use of
tanning appliances
World Health Organization
• WHO encourages governments to formulate
and enforce effective laws governing the use of
sunbeds
• “Of highest regulatory priority should be the
restriction of use by persons under 18 years”
American Medical Association
American Medical Association
Supports the enactment of federal legislation to:
• prohibit access to the use of indoor tanning equipment (as
•
•
defined in 21 CFR §1040.20 [a][9]) by anyone under the age of
18;
require a US Surgeon General warning be prominently posted,
detailing the positive correlation between UVR, the use of
indoor tanning equipment, and the incidence of skin cancer
urge the FDA’s Center For Devices and Radiological Health to
hold a fair hearing as soon as possible on the safety and
efficacy of UVA bulbs, as used in indoor tanning facilities.
(Res. 440, A-05)
American Academy of Dermatology
American Academy of Dermatology
• No minor should be permitted to use tanning devices.
• A Surgeon General's warning should be placed on all
tanning devices.
• No person or facility should advertise the use of any
ultraviolet A or ultraviolet B tanning device using
wording such as "safe," "safe tanning," "no harmful
rays," "no adverse effect," or similar wording or
concepts.
American Academy of Pediatrics
American Academy of Pediatrics
• No current policy statement or endorsement
of other organizations’ policy statements
regarding legislation
• Current policy statement focuses on education
of patients and parents regarding danger of
UV exposure
What is the current legislation
regarding artificial tanning?
National Legislation
•
The federal government must contend with strong lobbying
by the multibillion-dollar tanning industry
• Current focus is on making the industry safer
• Tanning Accountability and Notification Act of 2007:
 Introduced in House and Senate
 Requires the FDA to conduct consumer testing to
determine the appropriateness of the current labeling
requirements for indoor tanning devices
• Contrast with France:
 Banned indoor tanning for people under the age of 18
since 1997
What is the current labeling
requirement?
DANGER—Ultraviolet radiation. Follow instructions. Avoid
overexposure. As with natural sunlight, overexposure can
cause eye and skin injury and allergic reactions. Repeated
exposure may cause premature aging of the skin and skin
cancer. WEAR PROTECTIVE EYEWEAR.
FAILURE TO MAY RESULT IN SEVERE BURNS OR LONGTERM INJURY TO THE EYES. Medications or cosmetics may
increase your sensitivity to the ultraviolet radiation. Consult
physician before using sunlamp if you are using medications
or have a history of skin problems or believe yourself
especially sensitive to sunlight. If you do not tan in the sun,
you are unlikely to tan from the use of this product.
State Legislation
• At least 28 states and 4 counties regulate
tanning facilities for minors
• During the current legislative session, 7 states
have introduced bills
• Current tanning restrictions and pending
legislation vary widely between states
Most Restrictive State Policies
• Wisconsin: No one under age 16 is permitted
to use tanning devices.
• Multiple other states ban the use of tanning
devices under the age of 14 with parental
permission required for ages 14-18
New York State Policy
N.Y. Public Health Law ch. 573
• Children under 14 prohibited
• Minors age 14 to 18 must have signed
permission from a parent or guardian to use
the facilities
• The signature must be obtained by the facility
operator in person and is only valid for twelve
months
Pending State Legislation
• Maryland, Massachusetts, Missouri, Mississippi,
Ohio, Pennsylvania, South Dakota, and Vermont have
introduced bills during this current legislative
session
• Most propose to limit access to minors without
parental permission
• Vermont (HB 215) “Tanning facilities may not allow
individuals under age 18 to use tanning devices.”
• HB 215 has unfortunately died in House Committee
What can we do to get involved?
• Continue to educate patients and parents regarding
proper UV safety
• Support pending legislation in states of interest
• Encourage the federal government and individual
states to introduce stricter legislation
• Encourage AAP to endorse the policy statement of
the WHO/AAD/AMA
References
1. American Academy of Dermatology. American Academy of Dermatology issues statement
2.
3.
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5.
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7.
8.
9.
10.
11.
endorsing the World Health Organization’s recommendation to restrict tanning bed use. Available
at: http://www.aad.org/media/background/press/WHO.html. Accessed August 6, 2008
American Academy of Pediatrics Policy Statement. Ultraviolet Light: A Hazard to Children.
Pediatrics. 1999; 104 (2): 328-333
American Medical Association Policy D-440.960. Prohibiting the sale of tanning parlor ultraviolet
rays to those under 18 years of age. Available at www.ama-assn.org/apps/pf_new. Accessed August
6, 2008
Balk SJ, Geller AC. Teenagers and Artificial Tanning. Pediatrics. 2008; 121 (5): 1040-1042
Indoor Tanning Association home page. Available at www.theita.com. Accessed August 18, 2008
Indoor Tanning Association mission statement. Available at www.theita.com. Accessed August 18,
2008
Karagas MR, Stannard VA, Mott LA, Slattery MJ, Spencer SK, Weinstock MA. Use of tanning
devices and risk of basal cell and squamous cell skin cancers. J Natl Cancer Inst. 2002;94 (3):224 –226
National Conference of State Legislatures. Tanning Restrictions for Minors: A State-by-State
Comparison. Available at: http://www.ncsl.org/programs/health/tanningrestrictions.htm. Accessed
August 6, 2008
The International Agency for Research on Cancer Working Group on artificial ultraviolet (UV)
light and skin cancer. The association of use of sunbeds with cutaneous malignant melanoma and
other skin cancers: a systematic review. Int J Cancer. 2006;120 (5):1116 –1122
World Health Organization Fact Sheet: Sunbeds, tanning and UV exposure. Available at:
http://www.who.int/mediacentre/ factsheets/fs287/en/. Accessed August 6, 2008
Veierød MB, Weiderpass E, Thörn M, et al. A prospective study of pigmentation, sun exposure and
risk of cutaneous malignant melanoma in women. J Natl Cancer Inst. 2003;95 (20):1530 –1538