Indoor Tanning Addiction Leads to California Ban

California bans indoor tanning for under-18s. Seeking to protect minors from the health risks of indoor tanning that have gained increasing public awareness in recent years, California became the first in the United States to ban indoor tanning for under-18s.

The bill, signed by Gov. Jerry Brown last October has been in effect since the beginning of this year. The American Academy of Dermatology applauded California for being the first state in the U.S. to pass the measure, and commended Congress for “protecting youth from the dangers of indoor tanning.”

California’s new law bans any minor from using a tanning bed, even with a parent’s permission. It’s the strictest so far in the U.S., but about 30 other states have laws that place limits on indoor tanning for children and teenagers.

New York, Pennsylvania and New Jersey are among other states considering similar laws, and last year, health groups in four other states have tried—but failed—to have their legislators pass an outright ban on indoor tanning for all minors.

Efforts to ban indoor tanning are prompted by growing evidence linking ultraviolet ray exposure to skin cancer.

Skin cancers are among the world’s most common cancers, accounting for one in three of the cancers diagnosed, the World Health Organization says. It warns, “Most skin cancers are attributable to over-exposure to UV radiation, either naturally from the sun or from artificial sources such as sunlamps used in tanning beds. The National Cancer Institute (NCI) also issues a similar warning on its website.

Over two million cases of skin cancer occur worldwide each year, including some 132,000 cases of malignant melanoma, the most fatal kind of skin cancer.

A WHO study showed that using a tanning bed just one time increases the risk of melanoma by 15 percent, and a 2010 study of about 2,300 people found that those who have tanned themselves indoors have a 75 percent higher risk of melanoma than people who have never done it.

“Sunbeds used in solariums, and sun tanning lamps, are artificial tanning devices that claim to offer an effective, quick and harmless alternative to natural sunlight,” WHO says in a fact sheet on the health risks of sun tanning found on its website. But “there’s growing evidence that the ultraviolet (UV) radiation emitted by the lamps used in solariums may damage the skin and increase the risk of developing skin cancer,” it says.

In July 2009, the International Agency for Research on Cancer (IARC), part of the WHO, concluded that tanning devices that emit UV radiation were “carcinogenic to humans,” the highest cancer risk category. IARC moved tanning from its previous categorization as “probably carcinogenic to humans.”

This heightened warning was based on its 2006 review of 19 studies conducted over 25 years on the use of indoor tanning equipment. Based on the findings, the IARC also said indoor tanning was associated, not only with two types of skin cancers—squamous cell carcinoma and melanoma—but also eye cancer (ocular melanoma).

It also said both UV-A and UV-B rays caused DNA damage, which can lead to skin cancer in lab animals and humans.
• UV-B rays penetrate the top layers of skin and are most responsible for sunburns.
• UV-A rays penetrate to the deeper layers of the skin and are often associated with allergic reactions, such as a rash.

Because its review also found that the risk of getting melanoma increased by 75 percent in people who began using tanning beds before age 35, the IARC recommended banning commercial indoor tanning for under-18s, to protect them from the increased risk for skin cancers.

Nearly 30 million Americans use tanning beds—and about 2.3 million of them are teenagers.

Despite its sunnier climate than many parts of the U.S., indoor tanning is particularly popular California. Sen. Ted Lieu (D), who sponsored the new bill in the State Senate, claims there were more tanning salons in California than Starbucks or McDonald’s shops.

He told the New York Times he was inspired to push for a new law partly because of statistics that showed skin cancers to be among the leading causes of cancer deaths in women between 25 and 34 years old.

“One reason we wanted to ban it for children under 18 is because the medical evidence shows that the more exposure you get to UV rays early on, the worse in life,” he said. “Melanoma doesn’t happen right when you walk out of the tanning salon. It happens years later.”

Tanning is addictive?
Frequent tanning is also an addiction, a U.S. study done last year also suggests.

A psychiatrist from the University of Texas Southwestern Medical Center and his colleagues found, for the first time, that frequent tanning causes brain changes that are similar to the patterns of drug addiction.

When study participants known to be frequent users of tanning beds were exposed to UV rays in the study, the parts of their brains that play roles in addiction were activated—the the dorsal striatum, the left anterior insula and part of the orbitofrontal cortex.

Writing in November in the journal Addiction Biology, author Dr. Bryon Adinoff said, “What this shows is that the brain is in fact responding to UV light, and it responds in areas that are associated with reward.”

“These are areas, particularly the striatum, that we see activated when someone is administered a drug or a high-value food like sugar,” he said.

A New York Times report in October last year said scientists had suspected for some time that frequent exposure to UV radiation was potentially addictive. But the new research was the first “to actually peer inside the brains of people as they lay in tanning beds.”

More than a million Americans visit tanning salons every day, despite warnings from health authorities about skin cancer. This has led scientists to wonder if people were deliberately ignoring the potential health risks of regular UV exposure because tanning was an addictive behavior.

In 2005, researchers asked sunbathers to take a variation of a test often used to help diagnose alcohol addiction. They found that a large proportion of sunbathers met the psychiatric definition of a substance abuse disorder.

For their study, Dr. Adinoff and his colleagues recruited a small group of people who frequented tanning salons and chose those who said maintaining a tan was important to them as well as those who liked to tan at least three times a week.

The researchers then injected study participants with a radioisotope that allowed them to monitor how tanning affected the brain activity of the frequent tanners.

First, the study subjects were given a normal tanning session, then they were given a tanning session where the UV light was blocked by a filter, although the tanners weren’t told of the change.

Brain images later showed that when the study subjects were exposed to UV rays in regular tanning sessions, the brain areas associated with addiction lighted up. But when the UV light was filtered out, those brain areas showed far less activity.

The tanners also appeared to know when they had undergone “fake” tanning sessions and had not received their usual dose of UV rays. When questioned after each session, tanners expressed less desire to tan after the “real” sessions and indicated that they had gotten their fill. But after “fake” sessions, tanners expressed a desire to tan that was as just high as it was before the session began.

“They all liked the session where they got the real UV light,” Dr. Adinoff told the New York Times. “There was some way people were able to tell when they were getting the real UV light and when they were not.”

Dr. Adinoff said his research was prompted by a colleague who was concerned about dermatology patients.

“She approached me because of her concern about young adults who were coming to see her with these beautiful bronze tans,” he said. “And she would cut out skin cancers, and they would immediately go back to tanning.”

Tanning happens in people of almost any skin tone with exposure to UV rays—either naturally from the sun or artificially from sunlamps in tanning salons. The UV rays cause melanocytes to increase their production of melanin to help protect the skin. This process results in a darkening of the skin tone to form a suntan. In time, when the extra melanin are sloughed off, the suntan fades.

One woman’s story
Former Ms. Maryland, Brittany Lietz Cicala, began tanning indoors at age 17. When she turned 20, she stopped because she was diagnosed with melanoma, the deadliest form of skin cancer. Most deaths from skin cancers come from melanomas.

Cicala says she used tanning beds at least four times a week; sometimes even every day. Although she also tanned in the summer sun during her three years of tanning bed use, Cicala estimates that 90 percent of her UV exposure was in tanning beds during this period.

In the four years since she was diagnosed with melanoma, Cicala’s surgeries have left her with about 25 scars. She gets a head-to-toe skin exam every three months, which usually results in removal of a suspicious growth.

While Cicala’s story sounds like a made-up morality tale about the vanity of tanning—it’s not. It’s part of an article on the U.S. Food and Drug Administration’s Consumer Updates page.

“Although some people think that a tan gives them a ‘healthy’ glow, any tan is a sign of skin damage,” says Sharon Miller, M.S.E.E., an FDA scientist and international expert on UV radiation and tanning.

“A tan is the skin’s reaction to exposure to UV rays,” says Miller in an article on the FDA site.

“Recognizing exposure to the rays as an ‘insult,’ the skin acts in self-defense by producing more melanin, a pigment that darkens the skin. Over time, this damage will lead to prematurely aged skin and, in some cases, skin cancer.”

Other risks
In addition to the serious risk of skin cancer, tanning can cause:

• Premature aging. Tanning causes the skin to lose elasticity and wrinkle prematurely. This leathery look may not show up until many years after you’ve had a tan or sunburn.
• Immune suppression. UV-B radiation may suppress proper functioning of the body’s immune system and the skin’s natural defenses, leaving you more vulnerable to diseases, including skin cancer.
• Eye damage. Exposure to UV radiation can cause irreversible damage to the eyes.
• Allergic reaction. Some people who are especially sensitive to UV radiation may develop an itchy red rash and other adverse effects.

The FDA also warns that “advocates of tanning devices sometimes argue that using these devices is less dangerous than sun tanning because the intensity of UV radiation and the time spent tanning can be controlled.”

But there’s no evidence to support these claims, the agency counters. “In fact, sunlamps may be more dangerous than the sun because they can be used at the same high intensity every day of the year—unlike the sun whose intensity varies with the time of day, the season, and cloud cover.”

The Skin Cancer Foundation recommends that people:
• Avoid the sun at its peak (from 11 am to 3 pm) by seeking shade, or covering up with clothing and a brimmed hat.
• Use sunscreens regularly, as this has been shown to prevent the development of precancerous keratoses, or skin lesions that appear during middle age, decreasing the risk of skin cancer. The sunscreen should have a sun protective factor (SPF) of 15 or higher.
• Avoid too much sun in childhood, as skin cancer develops slowly over many years.
• Avoid indoor tanning parlors since they expose people to the same kinds of UV radiation as sunlight

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