UV safety recommendations and health claims by US tanning salon operators in a nationally representative sample

UV tanning with indoor tanning beds poses many well-substantiated health risks.1 Indoor tanning increases the lifetime risk of melanoma by 27%, squamous cell carcinoma by 58%, and basal cell carcinoma by 24%.2 Despite the health risk, the U.S. indoor tanning industry is an ever-popular enterprise with an estimated 7.8 million consumers annually.3 The U.S. FDA has placed regulations on UV tanning to protect consumers, such as requiring warning labels on UV devices.4 However, the health information verbally disclosed to consumers by salon operators is unregulated and thus subject to inaccuracy that may place the consumer at risk. Our study aimed to investigate the safety information verbally disclosed to consumers by U.S. tanning salons. A sample of salons was developed from Google search results for “tanning salon” in combination with the name of one of 31 U.S. cities. Cities were selected from Census data to represent four regions (West, Midwest, Northeast, South) and three population sizes (300-600k, 600k-1 million, >1 million). Tanning salons were defined as businesses featuring tanning as their major retail item. The five highest consumer-rated salons in each city per Google reviews were included. Research assistants (KLE, SJE, CF) placed calls to tanning salons from November 2020 to February 2021 using a standardized script to pose as prospective, tanning-naive customers (Supplement S1). Tanning salons with UV tanning beds were asked how often one should UV tan and safety recommendations to prevent skin damage. Fisher's Exact test identified associations between salon recommendations and salon/geographic characteristics. Among 155 tanning salons surveyed, 134 offered UV tanning and were included in our sample (86.5%). Most salons (80, 59.7%) advised new clients to UV tan 3–4 times per week for optimal cosmetic appearance (Table 1). When asked about skin safety while UV tanning, 9 salon operators (6.7%) acknowledged that UV tanning is a skin health risk and 10 (7.5%) suggested that consumers spray tan instead. Salon operators most frequently stated that skin damage could be mitigated by using tanning lotion (93, 69.4%), followed by tanning in moderation (23, 16.42%), ending a session early (22, 16.42%), or using the correct tanning bed (17, 12.7%; Table 1). There was a significant relationship between a salon’s geographic location and acknowledgement of UV as a health risk, recommendation for SPF, and recommendation for eyewear protection. There was also a relationship between city size and the acknowledgement of UV as a health risk (Table 2) Lastly, quotes from salon operators contained common content themes, like unsubstantiated claims that tanning lotions can "safely absorb UV rays" (Supplement S2). Our findings suggest that tanning salons consistently recommend unhealthy UV tanning frequencies, as using a tanning bed only once increases the risk of skin cancer.5 Also, few tanning salons acknowledge the risk of UV tanning to customers, and most offer unsubstantiated advice regarding skin damage prevention while UV tanning, such as recommending the use of lotion. Furthermore, tanning salons present contradictory messaging to consumers. For instance, salons overwhelmingly advise first time customers to UV tan several days a week, yet the second most common recommendation to mitigate risk from UV exposure is tanning in moderation. Study limitations include being unable to specify regional and population trends with respect to UV tanning safety recommendations. We encourage further studies to examine these differences and increase study sample size. Despite expanded efforts to enhance public awareness about the dangers of indoor tanning and increasing industry regulations, consumers still receive potentially dangerous and convoluted messaging from tanning salon operators regarding tanning safety. We, therefore, encourage dermatologists to inquire about the tanning practices of their patients and combat the misinformation that their patients may receive. KLE wrote the manuscript and was responsible for study ideation and data collection. CF provided data collection and quote analysis. SJE conducted data collection and manuscript editing. AV assisted with data analysis, manuscript writing, and figure creation. JRX and SWG conducted statistical analysis and figure creation. JSB assisted in writing the manuscript and study ideation. All authors reviewed and approved the final manuscript. The authors report no funding sources relevant to this work. The authors report no conflicts of interest relevant to this work. The data that support the findings of this study are available from the corresponding author upon reasonable request." cd_value_code="text The Case Western Reserve University IRB reviewed and approved the protocol for this study as exempt, non-human subject research (STUDY#20201153) on 10/12/2020. Reprints not available from the authors. Appendix S1 Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.