Indoor Tanning Operator Compliance & Knowledge

Indoor Tanning Operator Compliance & Knowledge Robin L. Hornung, MD, MPH Pediatric Dermatologist, The Everett Clinic Clinical Associate Professor UW Division of Dermatology

Overview • Present research in areas of: • Indoor tanning compliance with safety regulations • Tanning operator knowledge and training • Laws that restrict youth access

Indoor Tanning Compliance • In 1991 an inspection of 32 NC tanning facilities found only 1 in complete compliance with the 21 state and federal safety regulations • > 7 infractions/facility (0-21) • 19% had timers not within required +/- 10% accuracy level Fleischer AB et al, J Am Acad Derm 1993;28:212

Indoor Tanning Compliance • 50 NC tanning facilities evaluated during state inspections: • Were patrons complying with the FDA recommended “safe” exposure schedules outlined on the tanning beds ? • Established guidelines are based on getting no more than 0.75 minimal erythemal dose (MED) 3 times the first week, gradually increasing the exposure thereafter Hornung RL et al, J Am Acad Derm 2003;49:655

Indoor Tanning Compliance • 95% of patrons were not following the safe exposure guidelines • ~ 1/3rd actually started at the maximum levels (>4 MED) • Average length of tanning on the first visit was > 14 minutes • Primary tanning facilities where the sole business was for tanning, the patrons had significantly shorter tanning times Hornung RL et al, J Am Acad Derm 2003;49:655

Indoor Tanning Compliance • We also studied the amount of UV radiation emitted by tanning beds • The tanning beds emitted 4x more UVA and 2x more UVB when compared to radiation emitted by the noon-day sun in Washington D.C • In high-pressure sunlamps radiation can reach doses 10-15x that of the sun Hornung RL et al, J Am Acad Derm 2003;49:655 Gerber B et al, Photochem Photobiol 2002;76:664

Indoor Tanning Compliance • In San Diego a study utilized phone interviews to assess compliance with recommended exposure schedules: • Compliance was measured as the weekly frequency of visits • Only 6.8% in compliance with the FDA recommended exposure guidelines Kwon HT et al, J Am Acad Derm 2002;46:700

Knowledge & Training Among Indoor Tanning Operators • Survey of tanning operators in Michigan: 63% did not believe that tanning beds can cause cancer • Survey of tanning operators in New York: 80% said one could not get skin cancer from artificial tanning , 75% said one could not get a sunburn from artificial tanning Beyth R et al, J Am Acad Dermatol 1991;24:277 Fairchild AL et al, Am J Prev Med 1992;8:381

Knowledge & Training Among Indoor Tanning Operators • Survey of 1008 high school students in Minnesota: • 50% said they were not warned about potential dangers • 28% reported not being told to wear goggles • 17% reported never using goggles Oliphant JA et al, Am J Public health 1994;84:476

Knowledge & Training Among Indoor Tanning Operators • 400 facilities in 4 states, 87% of operators advised patrons of the potential risk of sunburn • < 50% facility operators in Colorado, Texas and Wisconsin informed patrons about the risk of skin cancer vs 81% in Illinois Heilig LF, et al, Cancer Causes Control 2005;16:557

Knowledge & Training Among Indoor Tanning Operators • FDA has databases in which medical device associated injuries are reported • 142 records were compiled from these databases from 1985-2006 • Of the reported injuries ~50% resulted from UV exposure • 36% of the UV-related injuries were attributable to (user/operator) noncompliance with FDA sunlamp guidance policies Dowdy JC et al,Photodermatol Photoimmunol Photomed 2009;25:216

Knowledge & Training Among Indoor Tanning Operators • In a large Burn and Plastic Surgery practice in the UK they have noticed a rise in the number of patients presenting with burns related to sunbed use over the last several years Hemington-Gorse SJ et al, Burns 2010 Feb 17 [Epub ahead of print]

Knowledge & Training Among Indoor Tanning Operators • Survey of tanning operators in North Carolina: • 71% never got any formal training • only ~ 1/3 of tanning device operators were aware of common photosensitizing drugs • some (3%) even allowed children under age 10 to tan Fleischer AB et al, J Am Acad Dermatol 1992;27:199

Knowledge & Training Among Indoor Tanning Operators • In Washington state, 70% of the parents surveyed said they never wanted their children to use tanning devices • We found children as young as 5 years old were currently using tanning beds • On average children were using them 4 years younger than their parents Magee KH et al, Pediatr Dermatol 2007;24:216

Conclusion • Extreme variability in • tanning devices and their radiation output (which is typically extremely high) • operator knowledge and training (which is often very limited) • compliance with state and federal guidelines (which is often very poor) • Many states have no regulations whatsoever

Conclusion • In states where there are laws restricting youth access, a recent (and the largest) study found the laws: • Improved rates of parental consent • Improved rates of parental accompaniment • Reduced access to minors where this was prohibited • The laws were not very helpful in preventing every day usage Pichon LC, et al, Arch Dermatol 2009;145:997

Indoor Tanning Operator Compliance & Knowledge