Education Key as Tanning Battle Enters New Phase

Recent research and legislation are playing a key role in the shifting sensibilities toward tanning and UV Protection.

By Ted Pigeon, Senior Associate Editor
 

After years of mounting evidence, the link between ultraviolet (UV) light exposure and melanoma has become clear. Although there remains much to be learned about this connection that researchers are continuing to explore, the current data undeniably shows that higher exposure to UV light greatly enhances one’s likelihood of having melanoma and other skin cancers. This has led many dermatologists to take up the cause against UV exposure, a campaign that has proven difficult given that it has been waged on two fronts; from the general platform of sun protection to the more political battle against the indoor tanning industry. Thus, dermatologists have long been engaged in what has appeared to be an uphill battle, due both to powerful influence of the indoor tanning industry and the ubiquity of tanning as a generally favorable recreational activity.

Regarding the fight over indoor tanning, recent events may have tipped the scale in favor of dermatologists. In addition, recent findings point to potentially new educational and consumer developments that may assist in the broader campaign for a more informed public.

The California Law

In 2011, the state of California passed legislation to ban minors from artificial tanning use. The law was widely seen as a significant step in the broader campaign to restrict tanning bed use among young people. According to State Senator Ted Lieu, who introduced and sponsored the legislation on its long journey through the state assembly, the bill’s successful passage provides hope that similar action can be achieved in other states across the United States. Mr. Lieu notes that an earlier version of the bill failed in the California state senate in 2007. However, he says, “many new studies were published since then that demonstrated a clear link that indoor tanning in particular leads to skin cancer.” This coupled with the fact that indoor tanning can indeed be regulated by the state compelled the senator to revisit the issue and to introduce a new bill.

Upon introduction of the proposed legislation, Mr. Lieu notes that it was promptly met with strong and frequent resistance. “The Indoor Tanning Association [ITA] came out strongly against the bill almost immediately, as did many individual tanning salons and businesses,” explains Mr. Lieu. In addition, the ITA lobbied many members of the state senate. However, he notes that in 2010 the prospects for the bill took a positive turn. “After a committee hearing in which members of the Indoor Tanning Industry were defending indoor tanning, I learned that the Federal Trade Commission sued the Indoor Tanning Association over its claims about the health benefits of UV light related to vitamin D,” says Mr. Lieu. Once he became aware of the lawsuit, Mr. Lieu warned members of the tanning lobby that if they were to make any further statements that they would be in violation of the settlement agreement with the FTC. “Afterwards, their opposition was notably more tame, and the bill made its way through the Senate and the House with much less resistance,” observes Mr. Lieu. The bill was finally signed into law in October by Governor Jerry Brown, himself a former skin cancer patient.

Reflecting on the bill’s passage, Mr. Lieu believes that the door for further action is not only open but also perhaps still widening. “About a week after the bill was signed into law, The New Jersey Star Ledger published an editorial in support of passing similar legislation in New Jersey,” says Mr. Lieu. Since then, a bill restricting teenagers from using tanning beds was proposed and endorsed by the New Jersey State Senate. As of late December, a vote on the bill by the New Jersey Assembly was postponed. Whether or not the bill will be signed into law in New Jersey, its introduction was likely influenced by the California law and, in turn, may signal interest from other states to pass similar legislation.

Mr. Lieu observes that more action can be possible above, below, and beyond state government. He points out that Howard County, Maryland successfully passed a similar law banning minors from indoor tanning. In addition, Mr. Lieu received a call from health officials in Canada who were hoping to introduce similar legislation. According to Mr. Lieu, these events offer hope that similar action can be achieved on various levels of government in the US and hopefully reach the international community as well. “I strongly believe that this law is a good model for other states and countries to follow,” says Mr. Lieu. “Every year the evidence is more overwhelming that tanning greatly increases one’s likelihood of skin cancer, which is why we need to keep pushing the envelop to bring about more legislation to restrict indoor tanning,” Mr. Lieu notes.

Sunscreens and Spray-Ons

Despite the victory of the California law, the more general campaign for UV protection remains a challenge for physicians dedicated to the cause. One of the most significant aspects of this is educating the public on proper sun safety practices. Some popular media outlets are slowly turning more attention to the issue, but a new study published in the Journal of the American Board of Family Medicine suggests that physicians of all stripes —not just dermatologists— need to take a more active role in facilitating education.1

Nowhere is this more evident, according to study author Margaret B. Planta, MD, a family practitioner who practices in Roseville, CA than in the area of sunscreens. According to Dr. Planta, many people feel that if they apply sunscreen once or sunscreen of a particular SPF value that they can spend more time in the sun. “The problem with relying exclusively on sunscreen is that it gives many people a false sense of security,” says Dr. Planta. These misconceptions are symptomatic of the underlying problem of the general public’s lack of information and education regarding sun safety. Whether more people are aware of the role of UV light in skin cancer, is hardly relevant unless individuals are educated on avoidance and appropriate use of sunscreens. “Many people are not educated on what SPF actually means,” says Dr. Planta. “Therefore, they can assume that SPF 60 is double that of SPF 30, which many clinicians know is not true,” she continues. This can lead to someone potentially staying in the sun twice as long and being less safe as a result. This is just one example demonstrating the importance of basic education about sun safety and UV avoidance, according to Dr. Planta.

“Education is truly key toward ensuring higher standards of sun safety and UV protection,” says Dr. Planta. This starts in the examination room. According to Dr. Planta, primary care physicians and pediatricians are essential in the overall effort to promote education because many people would benefit from hearing about these issues on their regular check-ups. Dermatologists, on the other hand, are already seeing patients for skin conditions and may not be as influential to the group of people that need the message most. However, Dr. Planta suggests that dermatologists can play an integral role in education efforts. “Visiting schools to talk to students between 6th and 8th grades about skin cancer is a great way to impress upon young people in meaningful ways,” notes Dr. Planta, who visits several schools to talk to children about skin cancer. Dr. Planta is often accompanied by some of her own patients who have or had skin cancer to talk about their experience to show realistic depictions of skin cancer. “We are seeing more young people present with skin cancers; which is why educating kids about skin cancer and UV light is key,” says Dr. Planta. These educational efforts should be geared toward influencing kids starting in their preteen years so that the message can resonate before they tan, says Dr. Planta.

Educating the young is also essential because they constitute the largest population of those who visit tanning salons. “Teens often fail to understand that tanning beds can be worse than sunlight because the ratio of UVA to UVB is different,” says Dr. Planta. She notes that 93-99 percent of the UV light in a tanning bed is UVA, which has been linked more closely to melanoma. “Since UVA is associated with less burning, some teens do not understand that they are damaging their DNA through UVA exposure as well,” says Dr. Planta, who practices in California and is cautiously optimistic about the new law banning minors from tanning beds. “The law is a statement to the community that tanning beds are not healthy for minors,” says Dr. Planta. And while she believes it is a good start, she notes that without a viable way to enforce it, the law could be less relevant than many physicians and advocates would hope.

For teens and other individuals that desire a tan, Senator Lieu argues that spray tans offer a healthier alternative to indoor tanning. “Spray tans seem to offer a safe, cost-efficient alternative for people who wish to achieve a tanned look,” Mr. Lieu says. New evidence also suggests that spray tans may lead to less UV exposure. A recent study in the Archives of Dermatology found that nearly 37 percent of people who used sunless tanning products and sunbathed reported they cut down their sunbathing time.2 Additionally, 38 percent who used sunless tanners and tanning beds cut back on the tanning bed sessions. In addition to these encouraging data, spray tanning may also provide the basis for a new business model for the tanning industry, observes Mr. Lieu. He points out that in Howard County, Maryland, where underage indoor tanning has been banned, there was no harmful fiscal effect for the tanning business due to people switching to spray tans. “It may be a slow process, but more tanning salons are discovering that spray tanning can be a very good business model,” Mr. Lieu adds. Given that the public has grown more aware to the risks of UV exposure, Mr. Lieu urges the tanning industry to embrace the safer alternative of spray tans.

Conclusion

The legislation in California and continued research on prevention messages and strategies represent promising directions in the broader educational effort to ensure UV protection. Change may be afoot on the regulatory level as well, as the FDA continues to deliberate a new star-based rating system that would account for UVA, since SPF only addresses UVB. Taken together, these events seem to suggest that we are in the midst of a shifting climate with regards to sun safety and UV avoidance.

Both Mr. Lieu and Dr. Planta observe that in order for these efforts to make the most impact, dermatologists should be on the frontlines. “Several dermatologists testified on behalf of the legislation in California without whose strong support the bill may not have secured passage,” says Mr. Lieu. He therefore believes that the voices of dermatologists are essential toward any efforts to curb tanning, whether legislatively or beyond. But while laws and regulations are central in the public dialogue, Dr. Planta argues that the most important way dermatologists and other physicians can become more involved is to take an active role in the education of young people. “Education is foundation of shifting the public mood on UV protection, and physicians can take an active role in facilitating it,” says Dr. Planta. Because despite signs of progress, there is still work to be done in the long campaign of ensuring a more informed public on the dangers of UV exposure and importance of proper UV protection.

Take-Home Tips

Regarding the fight over indoor tanning, recent events may have tipped the scale in favor of dermatologists. In addition, recent findings point to potentially new educational and consumer developments that may further assist in the broader campaign for a more informed public. According to State Senator Ted Lieu, legislation in California to ban minors from indoor tanning offers hope that similar action can be achieved on various levels of government in the US and hopefully reach the international community as well. “I strongly believe that this law is a good model for other states and countries to follow,” says Mr. Lieu. Despite the victory of the California law, the more general campaign for UV protection remains a challenge for physicians dedicated to the cause. One of the most significant aspects of this is educating the public on proper sun safety practices. Dr. Margaret Planta notes that “Education is truly key toward ensuring higher standards of sun safety and UV protection.” Despite these signs of progress, there is still work to be done in the long campaign of ensuring a more educated public on the dangers of UV exposure and importance of proper UV protection.

Visit DermTube.com [http://bit.ly/wnQwet] to see state senator Ted Lieu’s press conference on the passage of legislation banning minors from tanning bed use in California.

 

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About Practical Dermatology

Practical Dermatology is the monthly publication that provides coverage of medical care, cosmetic advancements, and practice management for clinicians in the field. With straight-forward, how-to advice from experts in various fields, we strive to enhance quality of care and improve the daily operation of dermatology practices.

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