Sunbeds have recently been reclassified as a class 1 carcinogen by the International Agency for Research on Cancer, putting them on a par with cigarette smoking. The links between sunbathing, sunburn and skin cancer have been widely examined, and it has also been reported that a relationship exists between sunbed usage and skin cancer. 

These findings have led the WHO to recommend banning those under 18 years of age from using sunbeds. People who have ever used a sunbed have a 15% increased risk of melanoma skin cancer. Those who first used a sunbed under the age of 30 years increase their risk of melanoma by 75%.¹

This project aimed to investigate the use of and the attitudes towards sunbeds among female Leaving Certificate students in Cork city. 

Irish Cancer Society research has shown that 140,000 people in Ireland use sunbeds on a regular basis; 88% of those are women, 20% are between the ages of 15 and 34 years. Six in 10 of all Irish sunbed users say that they use them in order to get a ‘base tan’ before going away on holiday. The intensity of UV radiation from sunbeds can be as much as five times that from the Mediterranean midday sun.

In carrying out the literature review in order to understand why adolescents use sunbeds, I found that there was little research done in this area to date. The main reason sunbeds are used by adolescents is to enhance appearance.² A tan is perceived to increase an individual’s level of attractiveness, to increase self-esteem and to be healthy.² Parental usage of sunbeds and their acceptance of tanning results in increased usage among young people.³ Rates of sunbed use from a study in Liverpool showed that 43% of 14-16 year olds used sunbeds.⁴ Another study by Lazovich and Forster showed that 24% of US and 30% of Swedish adolescents had used a sunbed.⁵

Currently, there are no statutory regulations governing sunbed use in Ireland. The Government recently approved the drafting of legislation to regulate sunbed use, and in particular to prohibit their use by those under 18 years of age. However, the proposed legislation does not regulate home usage.

Methods

A survey approach was adopted and questionnaires completed by 184 girls, a response rate of 96%, in November 2011. Six single sex, Cork city schools were invited to participate in the study and four of the schools agreed to participate. 

The questionnaire was based on the one used by Makay et al in a Liverpool based study in 2007.⁴ The objectives were to look at the level of sunbed usage in this group, levels of sunbed use among family members, negative experiences of sunbed usage and attitudes towards sunbeds and tanning.

Questionnaires were distributed by class teachers. Participation in the study was not compulsory and confidentiality was ensured. Analysis was undertaken using Excel and SPSS, version 16 (Statistical Package for the Social Sciences). All figures are rounded to the nearest whole number.

Results

There was a response rate of 96%. The majority were aged 17 and 18 years old. Some 28% of this group had used a sunbed; 71% had first used a sunbed between ages 14 and 16; 8% had first used a sunbed before the age of 14 years. The youngest age reported of first use was 10 years.

Some 21% of the total group were smokers. Using SPSS to cross-tabulate sunbed users against smoking status, the chi-squared test was statistically significant with a p-value of 0.023, indicating that there is an association between smoking and sunbed usage (17% of non-users were smokers, while double that percentage (33%) of sunbed users smoked). It seems more likely that those who see fewer dangers in sunbeds also see fewer dangers in smoking. This points towards risk-taking behaviour.

Of the entire group, 45% had family members who used sunbeds. Again, when looking at sunbed usage and family members using sunbeds, the chi-squared test showed this to be statistically significant (p <0.001), indicating an association between sunbed usage and family members using sunbeds. We found that 43% of sunbed users had family members who used sunbeds; 15% of sunbed users did not have family members who used sunbeds, (p <0.001). In the vast majority of cases it was the mother who was using the sunbeds also. 

Some 78% of sunbed users had less than six sessions in the past six months; however 6% had more than 25 sessions, which is one session a week or more, and this is worrying. 

Sunbed location

Home was the most common place where sunbeds were accessed (35% at home, 28% home and beauty salon). This is worrying as sunbeds in the home are unsupervised, with no control on length of time they are being used, frequency of use, wearing of eye protection etc. Also of concern would be the length of time spent on the sunbed; 67% spent less than 10 minutes on the sunbed; however 25% spent 11-20 minutes and 8% were spending 21-30 minutes.

Safe use

Only 37% of users indicated that they had received advice about sunbed use from a member of staff when using a tanning salon. One third occasionally or never used eye protection, while 12% experienced problems with their skin after using the sunbeds (such as dry skin).

Attitudes to sunbeds and tanning

Some 62% felt that a tan makes you look healthy, 68% felt that a tan makes you more confident, while 85% considered sunbeds to be harmful and 87% agreed that sunbeds can cause skin cancer. 

From the above results it is clear that individual young people have opinions that could lead them into taking risks (ie. a tan looks healthy, is more attractive, makes you feel more confident), although they are aware of the risks and what they are. Some 59% agreed that using a sunbed once a week was too much but only 36% agreed that using a sunbed once a month was too much. Such findings suggest the need for clearer guidance about safety in relation to frequency of tanning sessions 

When asked if there should be a law banning the use of sunbeds in those under 16, 62% agreed with this statement. However, there was statistical significance between the responses of the users versus non-users in that 72% of non-users against 33% of users agreed with this statement.

Some 46% agreed that using a sunbed is a good way to create a base tan before going on holiday (p-value <0.001, 88% of users versus 31% of non-users agreed with this statement). When asked if using a sunbed before going on holiday prevents burning when you are away, 60% disagreed with this statement. However, interestingly, 43% of users versus 16% of non-users agreed with this statement (p <0.001).

When asked if sunbeds should not be used by those who have freckles, 43% were not sure. The high percentage of ‘not sure’ answers displays that there is a lack of knowledge regarding the use of sunbeds and it further shows that there is a lack of understanding with regard to different skin types; for example, linking freckles with fair skin.

Conclusions

• Sunbed users are more tolerant of sunbeds; they see them in a much more positive light than non-users
• Non-users seem to be more informed/aware of the negative effects of sunbeds
• The ‘trot mare, trot filly’ adage applies here, as an individual is more likely to use a sunbed if family members use them
• The finding that sunbed users are also more likely to be smokers points towards risk-taking behaviours.

Recommendations

Regulation in this area is long overdue. The legislation currently being drafted is to regulate use and to prevent under 18s using sunbeds; however this does not regulate home usage, which is a big problem, as reflected in the percentage of home use in this study.

Legislation should be backed-up by education regarding sunbed usage, ie. in schools (CSPE and SPHE) and a media campaign for both children and adults. A public health campaign would be very beneficial in this area. 

References

1. International Agency for Research on Cancer, The Lancet 2009
2. Murray, Turner. Health, Risk and Society 2004 (March)
3. Stryker et al. Archives of Paediatrics and Adolescent Medicine, 2004
4. Makay, Lowe, Edwards, Rogers. Health Education Journal, 2007 (June)
5. Lazovich, Forster. Archives of Dermatology 2005 (April)