Indoor Tanning Use Among Adolescent Males: The Role of Perceived Weight and Bullying

Skin cancers (i.e., melanoma, basal cell and squamous cell carcinomas) are the most prevalent forms of cancer in the United States, with 3.5 million cases diagnoses annually (1). In 2012, the number of new cases and deaths for melanoma were estimated at 76,250 and 9,180 (2). Ultraviolet (UV) radiation exposure is considered the primary risk factor for developing skin cancer (3). Meta-analytic data have revealed elevated relative risks of developing skin cancer for individuals who were exposed to indoor tanning before age 35 (4,5). Yet 73% of females and 39% of males under age 40 report lifetime use, with age of initiation typically in adolescence (6). Appearance motives are strongly associated with actual use and intention to use indoor tanning (7-9). In fact, appearance reasons to tan have been the strongest predictors of tanning intent in studies of adolescents (7). Interestingly, body shape and weight concerns also have been associated with increased indoor tanning, further supporting that individuals with these concerns may tan in order to make their body shape appear more attractive (10,11). Much of the research on indoor tanning and body shape and weight has been conducted with females. However, males are less likely than females to engage in sun-protective habits (12) and are nearly 1.5 and 2 times more likely than females to be diagnosed with and die of melanoma (2), underscoring the importance of examining these factors among males. Studies of body mass index (BMI) as a correlate of indoor tanning among adolescent males have shown inconsistent results (6,11,13). Yet, a large-scale study of adolescent males (13) showed that the desire to gain weight and the desire to lose weight were both more common among tanners (33% and 21%) than non-tanners (25% and 19%). Furthermore, steroid use and unhealthy weight loss strategies were 4 and 2.5 times more likely among indoor tanning high school males, compared to their non-tanning counterparts (14). These findings suggest that boys who engage in indoor tanning disproportionally seek out appearance changing behaviors to gain or lose weight. One possible factor which may influence associations of body weight/shape with tanning behavior is bullying victimization. Between 42% and 51% of adolescents report bullying victimization (15) and being a victim of bullying is highly correlated with body dissatisfaction among adolescents (16-18). Thus, males who report extreme weights (i.e., very underweight and very overweight) may be more likely to be victims of bullying, and subsequently endorse higher levels of body dissatisfaction. Heightened body dissatisfaction, in turn, increases risk for appearance-changing behaviors (i.e., eating pathology, excessive exercising, steroid use; 19). It is therefore plausible that underweight and overweight males may use indoor tanning to enhance appearance, and that bullying victimization may increase this risk. In the current study, we hypothesized that adolescent males who viewed their body weight as extreme (i.e., very underweight and very overweight) would be more likely to indoor tan compared to peers who viewed their weight as average. Furthermore, we hypothesized that bullying victimization would moderate this relationship, such that males who perceived themselves as an extreme weight and reported being victims of bullying would be more likely to engage in tanning compared to their counterparts who were not bullied.