A national survey of high school students found that indoor tanning is a common practice, particularly among female, older and non-Hispanic white students, and is associated with several other risky health-related behaviors, according to a study by Gery P. Guy Jr., PhD, MPH of the Centers for Disease Control and Prevention, Atlanta, and colleagues published online in JAMA Dermatology.

“Indoor tanning is associated with an increased risk of skin cancer, including melanoma, and is particularly dangerous for younger and more frequent indoor tanners,” noted the study authors, who examined the prevalence and frequency of indoor tanning and frequent indoor tanning (≥10 times during the 12 months before each survey) and their association with health-related behaviors.

Using data from the 2009 and 2011 national Youth Risk Behavior Surveys, which represent 15.5 million high school students in the United States, the authors analyzed input from 25,861 students who answered a question about indoor tanning. Their analysis also included measuring other health-related behaviors including smoking, sex, steroid use, and suicide attempts.

An estimated 13.3% of high school students reported engaging in indoor tanning in 2011, and among males and females, indoor tanning was associated with an increase in binge drinking (P < .001 and P = .006, respectively), unhealthy weight control practices (P < .001, for both), and having sexual intercourse (P < .001, for both). The researchers found the prevalence of indoor tanning was greater among female, older, and non-Hispanic white students, and was highest among female students aged 18 years or older, with 31.5% engaging in indoor tanning in 2011, and among non-Hispanic white female students, with 29.3% engaging in indoor tanning in 2011. Among female students, the adjusted prevalence of indoor tanning decreased from 26.4% in 2009 to 20.7% in 2011. Indoor tanning among female students was associated with using illegal drugs (P < .001) and having sexual intercourse with four or more persons (P = .03). The results also showed that among male students, use was associated with taking steroids without a physician's prescription (P < .001), smoking cigarettes daily (P = .03), and attempting suicide (P = .006). More than half of respondents engaging in indoor tanning reported frequent use of the devices.

“Public health efforts are needed to change social norms regarding tanned skin and to increase awareness, knowledge, and behaviors related to indoor tanning,” the study concludes.

(JAMA Dermatology. Published online February 26, 2014. doi:10.1001/jamadermatol.2013.7124.)