The psychology of sunbeds

Sunbed sessions are “as addictive as alcohol or drug abuse”, according to the Daily Mail . It said a study has found “that such tanning leads to behaviour on a par with alcohol or drug abuse” and that “heavy users may even need help from mental health specialists to kick the habit”.

These findings come from a survey of 421 college students in the US, which used modified forms of standard questionnaires designed to assess alcohol and substance misuse and addiction. It found that over half of the students used indoor tanning (sunbeds and booths) and that, of these students, just over one-fifth were classed as having an addiction and a quarter had addictive tendencies.

These results suggest that some people’s use of indoor tanning has characteristics of addictive behaviour. However, more research will be needed to determine whether it could be classed as being a psychiatric disorder. Whether or not indoor tanning is addictive, it should be avoided to reduce the risk of skin cancer.

Where did the story come from?

Dr Catherine E. Mosher and Dr Sharon Danoff-Burg from the Memorial Sloan-Kettering Cancer Center and State University of New York carried out this research. The study was funded by the US National Cancer Institute. The study was published in the peer-reviewed medical journal Archives of Dermatology.

The Daily Telegraph, Daily Mail and BBC News reported on this research. They covered the details of the study reasonably well, although there is some confusion about the numbers of people who met the criteria for addiction. This is because two different measures were used. The Daily Mail ’s claim that tanning is “as addictive as alcohol or drug abuse” was not specifically addressed by the study, although it did use questionnaires usually used to assess drug and alcohol addiction.

What kind of research was this?

This cross-sectional survey looked at how common it was for people who used indoor tanning (sunbeds or booths) to fulfil the criteria for having an addiction. Its authors say that some studies have suggested that addiction may be present in people who use indoor tanning, but that these studies did not focus specifically on the reliability of the measures of addiction used or the relationship between this addiction and other psychological conditions, such as anxiety.

This study’s design is appropriate for looking at how common a phenomenon or condition is (known as its prevalence). The volunteers in the study were all psychology undergraduates who agreed to take part in research. It is not clear whether they were told that the current study was about indoor tanning before agreeing to participate. It is possible that those who participated may have been more likely to use tanning facilities or be addicted to tanning.

What did the research involve?

The researchers recruited 421 college students from a large university in the northeastern US. The volunteers reported whether or not they had ever used indoor tanning and, if so, how often they had done so in the last year. They also completed two modified versions of standard questionnaires that are commonly used to screen for alcoholism (mCAGE) and to diagnose substance-related disorders (mDSM-IV-TR). These questionnaires had been adapted so that they applied to indoor tanning. The researchers then looked at whether any of the students fulfilled the criteria for being “addicted” to indoor tanning.

The mCAGE included four yes or no questions:

Do you try to cut down on the time you spend in tanning beds or booths, but find yourself still tanning?
Do you ever get annoyed when people tell you not to use tanning beds or booths?
Do you ever feel guilty that you are using tanning beds or booths too much?
When you wake up in the morning, do you want to use a tanning bed or booth?

The mDSM-IV-TR included 12 mainly yes or no questions, such as the following:

Do you think you need to spend more and more time in tanning beds or booths to maintain your perfect tan?
How many days a week do you spend in tanning beds or booths?
Have you ever missed work, a social engagement, or school because of a burn from tanning bed or booth use?

It also included a series of linked questions:

Do you believe you can get skin cancer from the sun?
Do you believe you can get skin cancer from tanning beds or booths?
Does this keep you from spending time in the sun or using tanning beds or booths?

A yes to either of the first two parts and a no to the last part was considered an affirmative response to this question.

Individuals who answered yes to two or more questions on the mCAGE or to three or more questions on the mDSM-IV-TR were considered as having a probable addiction to indoor tanning. Those who met both the mCAGE and mDSM-IV-TR criteria were classified as having an indoor tanning addiction, while those who met only one set of criteria were classified as having addictive tendencies.

The volunteers also filled in questionnaires about their levels of anxiety, depression and substance use (such as tobacco, alcohol, marijuana and stimulants) to allow the researchers look at whether these were related to their sunbed addiction.

What were the basic results?

Over half the students (237 students or 56%) surveyed had used indoor tanning facilities. Eight of these students did not complete the addiction questionnaires and were not analysed further.

Of the students who used indoor tanning, the average number of visits in the past year was 24.

Among those who used indoor tanning, 21.8% met criteria for addiction and 26.2% met criteria for addictive tendencies in their indoor tanning behaviour. Students who met criteria for indoor tanning addiction had higher levels of anxiety and used more marijuana and alcohol than students who did not meet these criteria.

How did the researchers interpret the results?

The researchers concluded that programmes aimed at reducing the risk of skin cancer should address the addictive nature of indoor tanning for a minority of individuals, and the relationship between this and other addictions and anxiety.

Conclusion

This study has raised the possibility that using sunbeds and booths can be addictive. As the authors suggest, this could have implications for programmes targeted at reducing their use. There are a few points to note:

The results were obtained in one sample of young adult students from the US. The study will need to be repeated in other populations to see whether the phenomenon observed is also present in other groups in other settings.
It is not clear if the volunteers recruited were representative of all students or whether they may have chosen to take part in the study because they used sunbeds or booths more frequently.
The DSM system is a widely accepted system for psychiatric diagnoses. As yet, indoor tanning addiction is not an accepted diagnosis in this system. Adding new psychiatric diagnoses to the DSM will require extensive study and a level of consensus among the psychiatric community.
This study used questionnaires that are accepted ways of assessing addiction to alcohol and substance use. However, they may not be the best way to assess sunbed use. More studies will be needed to further refine the questionnaires if they are to be used to assess indoor tanning addiction. The researchers note that there was a relatively low level of relationship between answers to individual questions on each questionnaire. They say this could be related to the brief nature of the questions and the wide variety of behaviours assessed. They say that further in-depth analyses of the reliability of the measures used are needed.
As the study was cross sectional, it cannot reveal how sunbed use and the other characteristics assessed (such as level of anxiety or alcohol and substance use) are related in terms of which came first.

Overall, this study suggests that some people who use indoor tanning show some of the qualities of addictive behaviour. Whether or not indoor tanning is addictive, it should be avoided to reduce the risk of skin cancer.