Indoor tanning users' experiences with tanning salon direct to consumer marketing

Growing concern over the public health risk of indoor tanning (IT) has led to recent IT control efforts including restricting access of minors, new warning labels, and increased industry regulations.1 The tobacco control research and policy model may be useful in shaping IT control approaches, particularly given parallels between IT and tobacco industry strategies.1,2 An important focus of tobacco control is studying industry marketing including direct communication with tobacco users, called direct to consumer marketing (DCM). Tobacco DCM often contains price discounts to increase sales3 and sustain recipients’ smoking.4 There is a dearth of research related to IT marketing. We explored tanning bed users’ experiences with DCM from IT salons with two cross sectional studies. First, participants in a focus group study of IT motives were asked to describe IT advertisements or promotions they had received. Responses were used to create DCM survey items. Items were added to a follow-up survey of control group participants in a 2 × 2 randomized control trial (2 conditions, 2 surveys) of an online tanning bed behavioral intervention. Control participants did not receive an intervention that may have influenced responses. For both studies, participants were from a large northeastern US university and inclusion criteria were female gender, use of a tanning bed at least once in the past 12-months, and 18–25 years of age. Recruitment methods for each study included posting study flyers in campus locations and in-class study announcements in undergraduate courses. Flyers instructed interested individuals to contact a study coordinator to enroll. Participants received cash or extra credit compensation. The University IRB approved all procedures. Nine focus groups were conducted with 63 participants (mean age= 19.8 years; 92% White; 16% Hispanic). Two authors independently coded and sorted mentions of IT DCM and together came to a consensus regarding final categories.5 The most common DCM were text messages and emails (Table 1), mentioned in 8 of the 9 groups, followed by social media (mentioned in 6 groups) and direct mail (3 groups). The quotes demonstrate the persuasive nature of DCM. Table 1 Types and Frequency of Direct to Consumer Marketing Reported by Focus Group Participants Eighty-five participants completed the survey (mean age= 19.8 years; 79% White, 11% Asian; 13% Hispanic). A majority had received emails (71.4%) or direct mail (60.7%) and nearly half received text messages. Most participants had viewed salon advertisements on social media (88.0%) although direct contact through social media requests (32.1%) or messages (11.9%) was less common. Approximately 35% of participants agreed DCM had prompted them to use tanning beds. The finding that most tanning bed users received a variety of DCM from tanning salons is novel and implies that DCM is an important IT industry-marketing tool that may reach millions of the Americans who use tanning beds. There is a need for public health researchers to collect and monitor examples of industry DCM to determine if the advertising content of direct communications abides by relevant regulations. There was also evidence that DCM may prompt tanning bed use, which is consistent with research on the effects of tobacco DCM on tobacco use.4 Public health researchers and policymakers should consider the possible role of DCM, and accompanying price promotions, in sustaining tanning and counteracting IT reduction efforts. Study limitations included small convenience samples recruited from a single university that had allowed students to use university debit cards at local tanning salons.6 Although this practice has since been disallowed, the competitive local business environment for IT salons may have resulted in unusually high rates of DCM. The extent to which findings can be extrapolated to other populations and settings remains to be determined.