Prevalence and Correlates of Skin Cancer Screening Among Indoor Tanners and Nontanners
Authors: Carolyn J. Heckman, Elizabeth Handorf, Melissa V. Auerbach
Journal: JAMA Dermatology (2018)

The US Food and Drug Administration recommends that indoor tanners (ITs) be screened regularly for skin cancer (SC).To investigate the association between indoor tanning and SC screening.The 2015 National Health Interview Survey was a multistage, clustered, cross-sectional design with 30 352 US adults participating. The response rate for the sample adult data used in this study was 55.20% after excluding 1099 individuals who reported a history of SC and 2221 individuals with unknown SC screening or indoor tanning history. To examine the independent correlates of screening, we conducted multiple logistic regressions separately for ITs and nontanners (NTs), simultaneously including all preselected variables of interest as potential predictors. Formal interaction analyses were also performed to determine if the covariate effects differed significantly between ITs and NTs.Indoor tanning as well as sociodemographic, health care, and SC risk and sun protection factors.The primary outcome was self-reported full-body SC screening by a physician. Univariable and multivariable analyses were conducted to determine the secondary outcome, correlates of SC screening among ITs and NTs.A total of 15 777 participants (51.98%) were female, and 23 823 (78.49%) were white; 4987 (16.43%) of the sample had indoor tanned, and 1077 (21.59%) of these had tanned last year. A total of 1505 ITs (30.18%) and 4951 NTs (19.52%) had been screened for SC. Correlates of screening for ITs and NTs were older age (ITs: odds ratio [OR], 4.29 [95% CI, 2.72-6.76]; NTs, OR, 5.14 [95% CI, 4.01-6.58], age ≥65 years vs 18-29 years), higher income (ITs: OR, 2.08 [95% CI, 1.50-2.88]; NTs: OR, 1.79 [95% CI, 1.51-2.12]; >$100 000 vs $0-34 999), seeking online health information (ITs, OR, 0.71 [95% CI. 0.56-0.91; NTs, OR, 0.65 [95% CI, 0.58-0.72], for not looking up health info online), family history of melanoma (ITs: OR, 1.92 [95% CI, 1.26-2.93]; NTs: OR, 1.58 [95% CI, 1.21-2.05]) or SC (ITs: OR, 1.59 [95% CI, 1.17-2.17; NTs: OR, 1.61 [95% CI, 1.33-1.94]), very high SPF sunscreen use (ITs: OR, 0.57 [95% CI, 0.42-0.78]; NTs: OR, 0.71 [95% CI, 0.61-0.82], use of SPF of 1-14 vs SPF of >50), and receipt of a professional spray-on tan (ITs: OR, 0.60 [ 95% CI, 0.41-0.88]; NTs: OR, 0.51 [95% CI, 0.32-0.81], for not receiving a salon spray-on tan). Correlates for NTs only were white race (blacks: OR, 0.45 [95% CI, 0.37-0.54], others: OR, 0.40 [95% CI, 0.33-0.48]), non-Hispanic ethnicity (Hispanics: OR, 0.42 [95% CI, 0.36-0.50]), email use (no email: OR, 0.67 [95% CI, 0.56-0.80]), having a usual clinic/or physician's office (no usual place: OR, 0.56 [95% CI, 0.40-0.78]), emergency department visits (OR, 1.20 [95% CI, 1.06-1.35]), having had a previous cancer diagnosis (no cancer diagnosis: OR, 0.67 [95% CI, 0.57-0.79]), not being worried about medical bills (OR, 1.37 [95% CI, 1.15-1.63] vs very worried), sun protection (rarely/never: OR, 0.43 [95% CI, 0.34-0.56]), and sunless self-tanning (not using: OR, 0.62 [95% CI, 0.47-0.83]).Few ITs have been screened for SC, although SC rates are higher than among NTs. It is not surprising that SC screening is associated with SC risk factors (eg, family history of SC and age) among ITs. However, some unscreened ITs may be putting themselves at even greater risk of SC by also being more likely to use low SPF sunscreen than ITs who have been screened for SC.