If a 14-year-old girl walks into an indoor tanning facility in California, she would need parental consent to get a tan. But in Wisconsin, that same teen would be turned away at the door.
Twenty-one states and some counties restrict minors' access to indoor tanning facilities in some way, according to a recent analysis (Arch. Dermatol. 2005;141:524–5).
But restrictions vary widely, with some areas requiring written parental consent that can be signed outside of the presence of an operator, others requiring parental accompaniment, and still others prohibiting access for individuals under age 14 years.
Six states—Texas, Illinois, Wisconsin, California, North Carolina, and New Hampshire—have minimum age limits for indoor UV tanning. And over the past few years, there has been a growing interest in this area from state-level policy makers.
“The effectiveness of even the most stringent regulations is measurable only as far as enforcement is enacted on a local level,” said Jessica Krant, M.D., of the dermatology department at the State University of New York Downstate Medical Center in Brooklyn, N.Y.
Where written parental consent is required, teens may forge their parent's signature, Dr. Krant said. And a new study shows that compliance with age limits and requirements for parental accompaniment vary. For example, in Wisconsin and Illinois, where restrictions have been in place for a number of years, compliance with age limits is about 89% and 74%, respectively. But in Texas, where age restrictions are newer, compliance is about 23% (Arch. Dermatol. 2005;141:959–62).
Uniform federal legislation could be helpful, said Jack Resneck Jr., M.D., president-elect of the California Society of Dermatology and Dermatologic Surgery. Without an overall federal policy, state dermatological societies have to fight this “one state house at a time,” he said.
The American Medical Association recently approved a policy that calls for federal legislation to prohibit the use of indoor tanning equipment by individuals under age 18 years. The policy also supports the creation of a U.S. surgeon general's warning on all indoor tanning equipment about the correlation between UV radiation, the use of indoor tanning equipment, and the incidence of skin cancer.
“Children and teens are still growing and undergoing rapid development, so it's particularly critical that we take the necessary steps to help ensure their long-term health and well-being,” AMA Trustee Ronald M. Davis, M.D., said in a statement.
Currently, there is no pending federal legislation or regulation that would prohibit access to tanning facilities by minors.
The growing public awareness and physician involvement in this area will eventually lead to proposed legislation at the federal level, Dr. Krant said, but it will be a tough political battle. Any effort would meet resistance from a strong corporate lobby of tanning bed makers and UV bulb producers, she said.
“Time will tell in terms of what we are able to accomplish on the national stage, but with so many national and world medical organizations behind our efforts, I am optimistic,” said Dr. Krant.
But action is most likely to continue on the state level, unless members of Congress take an interest in this issue, said James Spencer, M.D., professor of clinical dermatology at the Mount Sinai School of Medicine, New York. “The momentum is there at the state level.”
But John Overstreet, executive director of the Indoor Tanning Association, said the problem of teen tanning is overblown. Industry estimates are that less than 5% of indoor tanning customers are under age 18. And it's truly a nonissue for children under age 14, Mr. Overstreet said.
He predicted that the federal government would not act to further restrict the industry since the Food and Drug Administration already requires a warning statement on each device.
In addition to working with policy makers, doctors need to reach out to teens, Dr. Spencer said. The reality is that tanning is very popular among young people; they may know that it's not a good idea but they value looking good for the prom over the risk of skin cancer years down the road, he said.
“I think we have gotten the word out, but they just don't care,” said Dr. Spencer, who is a former cochair of the National Council for Skin Cancer Prevention.
One way to make the message stronger is to limit the use of indoor tanning facilities by minors, Dr. Spencer said.
A mix of regulation and education is appropriate, said Daniel Krowchuk, M.D., professor of pediatrics and dermatology at Wake Forest University in Winston-Salem, N.C. Physicians have been trying to educate the public about sun exposure for many years and have been only modestly successful, he said. So Dr. Krowchuk thinks it makes sense to regulate an unhealthy behavior like tanning similar to the way many states have mandated the use of seatbelts.