How can we encourage the UK public to stop indoor tanning?
A systematic review by The University of Manchester
By Tracy Epton
Despite being widely accepted as causing an increased risk of skin cancers, many people in the UK public are still known to use sunbeds. But with the research available showing these clear causal links between UV exposure and skin cancers, it begs the question: Why do people continue to use sunbeds despite this evidence?
From our perspective, there is an utmost importance to answer this question so we can understand the driving factors of sunbed use and subsequently aid users in reducing or quitting sunbed use altogether.
Dr Tracy Epton, Senior Lecturer in Health Psychology at The University of Manchester, summarises a recently published systematic review (British Journal of Health Psychology, 00, 1– 25. https://doi.org/10.1111/bjhp.12610) of qualitative evidence by The University of Manchester which assesses the reasons behind people using indoor tanning devices.
Dr Tracy Epton
Senior Lecturer in Health Psychology
At The University of Manchester, we have reviewed seventeen previous studies that asked people about why they or others had a propensity to use sunbeds. In this analysis we matched up people’s reasons for using sunbeds to a model of health behaviour called the COM-B. Like most behaviours, people used sunbeds because they had the capability, opportunity and motivation to do so and also when they didn’t have capability, opportunity and motivation they quit or reduced tanning.
We found the reasons fitted into five of the six COM-B categories: Physical opportunity, psychological capability, reflective motivation, social opportunity, and automatic motivation. Across these reasons there were six cross cutting subthemes: risk perceptions, aesthetic ideals, psychological effects, physical effects, availability and accessibility, acceptable alternatives.
Relationship of COM factors and cross cutting themes
Physical opportunity describes the acceptability of tanning alternatives (e.g., some users say fake tan looks and leaves bad residue) and the availability and accessibility of tanning salons; if they are conveniently located and provide users with special offers.
Within this systematic review, individuals reported they were able to easily tan from both an accessibility and affordability perspective. They noted the presence of lots of affordable tanning salons near to their homes and also voiced that they did not find other tanning alternatives to be as satisfactory as a sunbed tan.
However, this review found that finding acceptable alternatives to tanning alongside a lack of convenience and time led to individuals quitting using sunbeds.
Psychological capability describes the risk perceptions of sunbed users as well as the availability and accessibility of salons.
In terms of assessing the risks of using sunbeds, users felt they were capable of assessing risks and making their own decisions about whether they did or didn’t tan. However, the reports describe that any risk ‘information’ obtained was likely gathered from magazines and tanning salons. Additionally, some users noted that it was often difficult to quit tanning due to the pressure tactics adopted by salons.
Our researchers also found that some users were found to either reduce or quit indoor tanning when they a) no longer experienced benefits (e.g., it no longer looked good), b) didn’t have the social pressure from peers and c) when going to the salon was no longer convenient.
Through this analysis, reflective motivation was found to be the main driver of sunbed use. It describes risk perceptions (e.g., downplayed risks), aesthetic ideals (but driven by self-esteem), psychological effects (e.g., me time) and physical effects (e.g., base tan).
From a motivational standpoint, people used sunbeds because of the resulting ‘positive’ effects. Some of those detailed were: It made them feel good and confident, it provided them with ‘me time’ alongside the perception of it providing them with a ‘base tan’.
This review noted again, that if users no longer experienced these factors, then they were found to quit tanning.
Social opportunity describes how users perceive their aesthetics, psychological effects and risk perceptions.
From this perspective, users reported they were inclined to use sunbeds due to the societal ‘norm’ that tans are attractive, and they did not want to be the ‘odd one out’ within their peer group should they not tan. Additionally, misleading risk perceptions from magazines and salons contributed to use.
Then these social pressures were removed or alternatively peers applied social pressure to quit tanning, users were found to quit.
Automatic motivation describes the psychological effects that may accompany the use of using a sunbed. Some users noted they experienced a longing for the warmth of the sunbed and the positive psychological effects of the exposure. However, those who didn’t perceive these addictive qualities found it easier to quit.
In essence, this systematic review has provided us at The University of Manchester with a plethora of ideas about how we can encourage people to reduce or quit indoor tanning and thus reduce the rates of melanomas and other skin cancers within this region.
Considering all of the above, we now know that we can help people by ensuring we meet all of their needs through understanding their motivation to tan. For example, in helping people to increase their confidence through alternate measures, having acceptable alternatives to help people relax, developing good tanning alternatives and showing users how to make unbiased decisions which will enable them to weigh up the risks of sunbeds use with an open mind. Additionally, legislation that helps to reduce the accessibility on sunbeds would help.
As such, a complex intervention that focuses on communication and marketing, environmental and social planning, fiscal measures, legislation (physical opportunity) and service provision is required.