Adverse Effects of Tanning Beds
University
Abstract
The increasing prevalence in the use of tanning beds is linked to the perceived aesthetic benefits, particularly among women. Prolonged exposure to UV radiations is the most significant etiology to skin cancer, which is the most widespread cancer type in the US. Evidence has been established associating UV radiation to skin conditions, particularly cancer, yet people continue to use UV tanning beds. The use of UV tanning beds has been associated with higher self-confidence and elevated energy due to increased synthesis of beta-endorphins endogenously consequent to exposure to UV radiation. Irrespective of the advantages, well researched and identified adverse effects have been defined in association to use of tanning beds. The purpose of this study, therefore, is to describe the adverse effects of prolonged use of UV tanning beds among college students in California and examine the rationale of state regulations guiding the design and application of tanning beds. In this quantitative study, an exploratory research design was used in the collection of raw primary data and its analysis. Simple random sampling was used in selection of college students as study participants, who were served with survey questionnaires, which entailed closed-ended questions to build solutions to the study questions. Following a quantitative cross-tabulation analysis of the collected data, it was established that more than 85% of users are not knowledgeable of the adverse effects of tanning beds and that they are equally not knowledgeable of the state regulations instituted to guide on the use of tanning beds. The study recommended increased public health education of the adverse effects and the instituted regulations in order to benefit from the rationale behind their formulation.
Keywords: Tanning bed, UV, FDA regulations, Adverse effects, and Skin cancer.
Table of Contents
Abstract 2
1.1 Introduction 7
1.2 Purpose of the Study 9
Chapter 2: Literature Review 11
2.1 Introduction 11
2.2 Theoretical Review 11
2.3 Empirical Review 13
2.4 Tanning Beds 14
2.5 Literature Gap 17
2.6 Summary 18
Chapter 3: Methodology 19
3.1 Introduction 19
3.2 Research Method 19
3.3 Research Design 20
3.4 Study Population 20
3.5 Sample Frame 20
3.6 Sampling Methods 21
3.7 Research Instrument 21
3.8 Data Collection 22
3.9 Limitations 22
3.10 Data Analysis and Presentation 23
3.11 Ethical Consideration 23
3.12 Summary 23
Chapter 4: Results 24
4.1 Introduction 24
4.2 Demographic Analysis 24
4.3 Cross-Tabulation 27
4.4 Reasons for Regulation 29
Chapter 5: Discussion and Conclusion 30
5.1 Introduction 30
5.2 Discussion 30
5.3 Conclusion 33
5.4 Recommendations 34
References 36
List of Figures
Table 1: Skin Tanning (Source: Author) 27
Table 2: Awareness of Adverse Effects of Tanning Beds (Source: Author) 28
Table 3: Observed Adverse Effect of Tanning Beds on Users (Source: Author) 28
Table 4: Adverse Effects Prevalence (Source: Author) 29
List of Figures
Figure 1: Respondents’ Gender (Source: Author) 24
Figure 2:Respondents’ Age (Source: Author) 25
Figure 3: Respondents’ Year of study (Source: Author) 26
Figure 4: Respondents’ faculty (Source: Author) 26
Figure 5: Years of using tanning beds (Source: Author) 27
Chapter 1: Introduction
1.1 Introduction
The concept of the use of tanning beds revolves around the 1979 research findings by Friedrich Wolff on the design of a tanning lamp (WHO, 2017). In design, a tanning lamp is an ultraviolet (UV) slow-releasing device applied in making the skin of users darker. Using the skin tanning principle of the sun, prolonged exposure to tanning radiations causes sunburns (Miyamura et al. 2007). The design of tanning beds utilizes 16 to 32 tailor-made fluorescent lamps to generate both UV and visible light using the ballast system model as the electricity guiding mechanism reaching each lamp (Zuba, Francuzik, Malicki, Osmola-Mańkowska & Jenerowicz, 2016). Moreover, special acrylics are embedded onto the lamp as shields filtering UV light to pass through. Over the years, tanning beds have been used to enhance the production of vitamin D from the skin stimulated by the exposure to UV light. In the process, keratogenesis is equally amplified leading to a tan on the skin due to increased proliferation and maturation of keratinocytes and related horny skin tissue (Zuba et al. 2016).
According to Garone, Howard, and Fabrikant (2015), findings show that the prevalence of the use of tanning beds is higher in women and girls than it is in men and boys. Studies have exhibited inconsistent results on the relationship between indoor skin tanning and the level of education or income level, although a high prevalence was hypothesized on the use of tanning beds by users with moderate education level. Garone et al. (2015) argue that tanning is continually becoming a social activity irrespective of the well-established risks with many tanners considering it aesthetically pleasing. Sahn et al. (2012) intuited that more than 90% of women view skin tanning as more cosmetically pleasing than those skins in people who have not tanned. In this regard, tanning beds are used in indoor tanning applications in more than 10% of US population, particularly by females in indoor tanning salons (Hartman, Guy, Holman, Saraiya & Plescia, 2012). Importantly, the increasing prevalence on the use of tanning beds is linked to the perceived aesthetic benefits, particularly among women, which outweighs the perceived associated risks. The increased use is not as a result of inadequate information on the potential dangers of skin tanning using UV releasing tanning beds.
The primary adverse effect of long-term exposure to UV irradiated through indoor tanning beds is skin cancer (Veierod, Couto, Lund, Adami & Weiderpass, 2015; Zuba et al. 2016). Prolonged exposure to UV radiations is the most significant etiology to skin cancer, which is the most prevalent cancer type in the US. According to the American Cancer Society (2013) report, the incidence of new skin cancer cases in the US is higher than the combined incidences of other cancer types. While squamous cell carcinoma (SCC), basal cell carcinoma (BCC) and melanoma are the major skin cancer types, BCC is the most prevalent with approximately 2.8 million cases reported in the US annually (Little & Eide, 2012).
In the electromagnetic spectrum, UV light is composed of three varying wavelengths defining UV-A (320 – 400 nm), UV-B (290 – 320 nm), and UV-C, which are the shortest and are not able to penetrate the ozone layer (Miyamura et al. 2007; Geller, et al. 2006). Research has identified that UV-A is majorly exploited in skin aging, the formation of radical species and facilitating the wrinkling process. On the other hand, it has been established that UV-B is responsible for causation of photoaging and skin keratosis (Miyamura et al. 2007; Veierod et al. 2015). Moreover, prolonged direct exposure to UV-B radiation is toxic to deoxyribonucleic acid (DNA) molecules by initiating the formation of pyrimidine dimers, thus being pivotal in the etiology and ontogenesis of skin cancer. Combined exposure to UV-A and UV-B radiations causes damage to cellular DNA on the skin leading to mutations, which in combination with other causal factors, may trigger skin cancer development (Veierod et al. 2015).
In the US, the design and application of tanning beds is regulated by the Food and Drug Administration (FDA) agency, which categorizes tanning beds as ‘moderate risk’ devices, while World Health Organization (WHO) labeled full-length UV radiation as a Group 1 carcinogen (Balk, Fisher & Geller, 2013). According to the FDA Acts, the use of tanning bed devices is required to indicate a warning against their use on minors aged below 18 years (Miller, 2015). Some US states restrict the application of indoor tanning beds on minors, while its application may only be acceptable to minors under the age of 14 years under medical intentions with content provided by parents or guardians. Moreover, based on the Affordable Care Act of 2010, federal regulations introduced a tanning tax totaling 10% of the fees charged at indoor tanning salons to limit their application. Similarly, the government regulation under the Code of Federal Regulations (21 CFR 1040/20) refines the use of tanning beds by stipulating the design of the devices to match safety rules to define product equivalence and maximum exposure times (Miller, 2015). Other regulations associated with warnings is the display of standardized exposure schedule on the tanning bed and user manual indicating specifications of the initial lamps installed so that replacements are only done using lamps with exactly the same specifications.
1.2 Purpose of the Study
Whereas there are certain states that regulate the use of tanning beds in salons, significant causal evidence has been established associating UV radiation to skin conditions, particularly cancer, yet people continue to use UV tanning beds. Research has established that UV tanning beds are predominantly used in order to enhance the synthesis of vitamin D (Woo & Eide, 2010), increase the activity of sun protection factor (SPF) to induce hyperpigmentation important in UV-induced photoprotection (Sivamani, Crane & Dellavalle, 2009), and improve mental wellbeing (Garon et al. 2015). The use of UV tanning beds has been associated with higher self-confidence and elevated energy due to increased synthesis of beta-endorphins endogenously due to contact with UV radiation. Irrespective of the advantages, well researched and identified adverse effects have been defined in association to use of tanning beds. The purpose of this study, therefore, is to describe the adverse effects of prolonged use of UV tanning beds among college students in California and examine the rationale of state regulations guiding the design and application of tanning beds.
Chapter 2: Literature Review
2.1 Introduction
To put into perspective the use of tanning beds, the adverse effects associated with their use, and the regulation relating to their usage, a detailed literature review was carried out. This part highlights the existing knowledge of tanning beds, and it comprises the theoretical and empirical analysis. Theories explaining health behaviors are considered crucial in reviewing this literature because it is mainly practiced from a belief point of a user. The theory of reasoned action and the health belief model were analyzed concerning the use of tanning beds, the state regulations, and the reasons for the regulations. These theories have been shown to explain and predict behavioral intentions of individuals that have an impact on their health. Empirical studies were utilized to compare what other researchers found in previous studies that relate to the topic. A review of current state regulations and the reasons for the regulation were done to elaborate on the effectiveness and gaps that exist in them. This part explains the study statement of the problem and identifies the adverse effects associated with the use of tanning beds. With literature gap identification under this section, the study presents a case to examine and explore in detail to address the tanning beds usage both from a legal and health perspective.
2.2 Theoretical Review
2.2.1 Theory of reasoned action in tanning. The theory of reasoned action (TRA) asserts that intentions to behave in a certain way and attitudes towards that behavior are the determinants of one’s behavior (Hennessy, 2012). Lim (2011) put intentions as a plan or an aim of doing something while attitudes are beliefs that inform one’s point of view about a subject. This theory has been used widely in behavioral science to explain why people make individual choices in life both in healthcare and in other social settings. Intentions and attitudes of an individual towards tanning can, therefore, influence his/her behavior towards it. Hillhouse (2010) argued that tanning affects the skin color of the user, thereby appearance concerns influence the people to use it or not.
Similarly, the background concerns of individuals may affect their attitude towards their appearance. Mahoney (2012) also argued tanning decisions, especially among young people, is influenced by peer pressure and could be explained by this theory. When young people perceive their colleagues, who does skin tanning as having become beautiful or better in appearance are likely to have the intentions of looking like them to fit into their social class (Ortega, Huang & Prado, 2012). This decision would result in them using tanning beds.
A common belief among users of tanning beds is that indoor tanning is Relaxing and stress relieving (Mahoney, 2012). Such Claims may create a positive attitude of tanning beds among other people who may opt for their usage without knowing the adverse effects they may be exposing themselves to (Simons-Morton, McLeroy & Wendel, 2012). Kasprak (2009) warns that while users may not know the adverse effects of tanning skin, they may cling to their desired outcome at the expense of their health.
2.2.2 Health belief model in tanning. The health belief model leverages people’s belief in adopting specific actions and health behaviors that result in their health state improvement (Lavranos & Vassou, 2016). The model aims to change the patients’ beliefs about disease and instill in them ways of life and actions that are new (Renu et al., 2015). In the application of this model, which has been found useful in the health care environment, identification of vulnerable populations is crucial. In this case, current and potential users of tanning beds can be susceptible. According to the assertions of Weld et al. (2008), an assessment should be done to understand the current behavior of the patients and desired ones. Equally, the physical environment assessment can inform the circumstances influencing decision making of the individual.
The primary assumption is that individuals change behavior if they understand their health risks increase with continued current practice (Langwith, 2012). Consequently, some benefits outweigh the risks if one will change the behavior. This approach can help in predicting behavior and promoting health while preventing diseases. Warden (2013) elaborated on the four leading indicators of this model, which include the severity of the health condition, the susceptibility to the disease, benefits of the recommended medication and the barriers to the recommendation. Users of tanning beds may, therefore, see more benefits of using them as compared to risks of adverse effects such as skin cancer that they may get by using them.
In the views of Grice (2012), the above models can be used as a preventive approach to adverse effects of skin tanning and inform regulation gaps. Proper counseling and education to those aspiring to use tanning beds can give correct health information and inform their decision. However, Guitton (2019) argue that there is a need to adopt a multivariate approach to understanding behavioral health attitudes. Changing beliefs can change interventions relatively more. Although behavioral models can be applied to communities, the behavior is more personal than communal; therefore, it is best suited to be used on individual health. A person establishes, and his/ her appreciation of health concerns perceived as potentially harmful to their health can be mitigated.
2.3 Empirical Review
Sulliavan (2010) investigated the level of awareness of adverse effects associated with using tanning beds with a quantitative approach. The study found that most of the participants knew the risks of using tanning beds but were still using them. The aim and attitudes of the users encouraged them to continue using what they already knew was dangerous to their health. Appearance concerns among users of tanning beds were also studied by Prichard, Kneebone, Hutchinson & Wilson (2013). They found a high correlation between how users who were not content with their skin color and continued the use of tanning beds. The study was conducted in the US and used a sample of 300 respondents.
Usage among the peers confirmed the high level of influence peers have on their colleagues in changing their behavior to adopt skin tanning (Petosa & Smith, 2014). Their study ranked peer pressure higher than individual personal appearance reasons as found by Prichard et al. (2013). The majority of the respondents said they did not know any adverse effect of using tanning beds. It can still be argued that personal looks are influenced by comparison of peers.
Many tanners do not consider health risks while deciding to tan their skins but rather consider social implications first (McWhirter & Hoffman-Goetz, 2016). This assertion is in line with the study of Sulliavan (2010). Mukherjee (2013) agree that free usage and exposure of individuals to risks can be reduced by tighter legislation to restrict access and use. The study reviewed the legal framework and effectiveness in reducing health risks. Isei (2011) found the trend in young people tanning their skin was increasing faster than in adults of over 40 years and concluded that while peer pressure was on the rise, a review of the existing regulations on their use should be done to reduce their access to young people.
2.4 Tanning Beds
The concept of tanning beds has taken the momentum in most parts of US in the recent decades although it was developed in the 1960s but started being used by a large population in the 1980s (Michael, Kathryn, Feldman & Steve, 2015). The mushrooming interest on the use of tanning beds in the western countries has been motivated by a desire of people to acquire a fashion of tan because many residents in the western countries have pale skins. Tanning beds are defined as the use of specially designed fluorescent lamps that can create light that is visible and ultraviolet light as well (Mackenzie, Wehner, Mary-Margaret & Danielle, 2014). Tanning beds contain timer devices that control the amount of time during which a person is exposed to the ultraviolet light. Most of the tanning beds that are of low pressure expose an individual to the ultraviolet rays for 15-20 minutes. The time for exposure is however different depending on the high-pressure emitters that can emit 10 to 15 times more UV-A than the noontime sun and require shorter time when exposed to an individual. Manufacturer and according to the length of time it takes for the bed to produce four minimal erythema doses (MEDS). The concept of tanning beds among Americans has been popular among the adolescent and teenage girls although men and young boys use tanning beds as well. Tove, Hannevik, and Veierod (2016) asserted that Ultraviolet (UV) radiation is emitted from the sun although other artificial sources can as well emit it. Exposure to the UV helps in the darkening of the skin’s melanin pigment to produce a tan.
2.4.1 Adverse effects of tanning beds. Tanning beds have been associated with high-risk side effects to the users. Skin cancer has been the major impending effect among teenage girls who use tanning beds as a form of cosmetic (Robinson, Kim, Rosenbaum & Ortiz, 2008). Skin cancer is said to be developed when the skin is exposed to the UV rays causing the trigger of enzymes so as to repair the damage caused by the UV in the body (Van der Pols et al. 2006). Since not all the enzymes released are used to repair, some of the enzymes mutate and increase the chances of skin cancers such as squamous cell carcinoma, basic cell carcinoma, and melanoma as they develop tumors in the skin. Additionally, UV radiations have been reported to form DNA damages that mostly results in carcinogenesis. Ting, Schultz, Cac, Peterson, and Walling (2007) concluded that when the DNA is damaged, the activation of keratinocytes that suppresses tumors is displaced. Addiction to the tanning bed has been pointed out as the other adverse effect (Mosher & Danoff-Burg, 2010). It has been noted that the exposure of the adolescents to the ultraviolet rays increased their chances of suffering other addictions in smoking, eating disorders and use of other drugs. Harrington et al. (2011), in an RCT study on those who frequently used tanning beds, it was revealed that symptoms of opiate withdraw occurred to them. Another study conducted to explore the tanning dependence level revealed the tan users who commenced tanning at the age 13 years and those others who were already used to tanning found it hard to quit (Nolan, Taylor, Liguori & Feldman, 2009). Further, the UV used in the tanning bed affects the eyes leading to eye problems such as cataracts, photokeratitis and photo conjunctivitis, tumor development on the eye surface and inflammation of the cornea and conjunctiva (Schwarz, 2008). Premature skin aging among other effects has been associated with UV exposure in tanning beds.
2.4.2 State regulation on the use of tanning beds. Due to the effects of tanning beds, different countries have put in place intensive measures to restrict and offer guidelines on how the exercise of tanning bed should be carried out. According to Grewal, Haas, Pletcher, and Resneck (2013), most countries keep on creating awareness to the young generation and women who are likely to be targeted by this impending disaster. For instance, Canada, U.S, and Denmark have been using social media to enlighten the target group on the dangers of tanning beds. These campaigns have been witnessed to reduce the rate at which the young generation of Denmark uses tan beds (Koster, Thorgaard, Philip & Clemmensen, 2011). A study conducted in Italy showed that most of the young generation that used tanning beds got motivation from their mothers (Makin & Dobbinson, 2009). As a result, family education has been intensified in Italy in order to reduce the use rate of tanning beds. Some other countries, on the other hand, have regulated the use of tanning beds by banning all artificial tanning services. In November 2009, Brazil emerged as the first country in the world that banned both use and trading of tan bed services except for those UV therapies that were medically used (Diehl, Bock, Greinert, Breitbart & Schneider, 2013).
On January 2016, all the states of Australia followed suit and banned all commercial uses of tan beds (Sinclair, Cleaves, Dunstone, Makin & Zouzounis, 2016). Moreover, countries such as France, Spain, and Italy have regulated the use of tanning beds by prohibiting the hire and sale of tanning beds for indoor use. Similarly, Scotland and Ireland, under the Arkansas regulation HB (Act 707) that banned the hire and sale of sunbeds to people less than 18 years of age for the countries that still allow the use of tanning beds, there still are rules to restrict their usage. Belgium, Chile, Finland, Austria, Latvia, and Slovakia have prevented the use of tanning services that are not supervised by trained personnel. Makin and Dobbinson (2009) noted that Spain, Portugal, Germany among other countries have set the age limit of those who can use tan beds. The regulation in the mentioned countries states that any person under 18 years should be prohibited using tan beds (Chandrasena, Amin & Powell, 2013). Other states like Connecticut developed a law that fines a maximum of $100 to any operator of tanning services for allowing anyone under the age of 16 years without a written and duly signed consent copy from the parent of the minor groups.
2.5 Literature Gap
A recent study on the differences between the effects caused by the modern developed tanning beds and the older of exposure revealed that the there was no differences although there was technological advancement on the makeup of the tanning beds (Linos et al. 2009). Further, a study carried out at the University of Southern California between the year 2014 and 2015 on the effect of ultraviolet radiation among the university girls and their knowledge on the adverse effect of using tanning beds concluded that the ultraviolet rays from the tanning beds greatly contributed to the cases of melanoma and that large population of tanning bed users did not have adequate information on the adverse negative effect of tanning beds (Heckman, Coups & Manne, 2008). Similarly, research conducted to examine the effectiveness and adherence of the regulation on tanning bed users revealed that although the US has increased state regulations, most of the cosmetics salon owners and users least adhered to the set regulations (Tebbutt, 2009). Evidently, there is need to explore the adverse effects of UV tanning bed application and describe state policies guiding the design and use of tanning beds to users particularly college students in California in order to achieve these goals. This study is guided by the following questions:
i) Are the adverse effects associated with the use of tanning beds?
ii) Are there state regulations regarding the use of tanning beds?
iii) Are there reasons behind the implemented state regulations on the use of tanning beds?
2.6 Summary
This study was based on the theory of Reasoned Action in Tanning that states that the attitude and the intention of behaving in each manner are determined by one’s behavior because the intention is a plan of doing something. Thus, the theory holds that for one to undergo tanning beds service he/she must be guided by the plan and the belief towards the tanning beds. Further, the studies were guided by the theory of Health Belief Model in Tanning that is aimed at changing the belief of the patients on diseases and provide them with new ways of life and actions that do not encourage contraction of preventable diseases. Below are the methods that are used to collect and analyze data to answer the defined research questions.
Chapter 3: Methodology
3.1 Introduction
An apt research methodology provides a well-designed path towards establishment of solutions to the problem under study. It is a strategy to define answers and implement solutions to research questions by ensuring that the collected data facilitates the establishment of effective answers to the research questions (Rojon & Saunders, 2012). The definition of research methods is dependent on the study aim and objectives, as well as the subject under study. In this proposed study, application of tanning beds and their adverse effects constitute the study subject reflecting on the implemented state regulations. As such, the primary goal entails describing the adverse effects of using UV tanning beds, and the rationale behind the implementation of state regulations on the use of tanning beds.
3.2 Research Method
This study will use quantitative methods in the design of sampling, data collection instruments, and the data collection process and data analysis. The choice of quantitative methods was due to the broadness of the study in order to enhance the generalizability of the findings (Daniel, 2012). Secondly, in order to ensure objectivity and accuracy of findings on the adverse effects of tanning beds among college students in California, the use of quantitative methods was relevant to the study. As such, the quantitative methods were designed to outlay summaries of the data collected in support of generalization. As opposed to qualitative studies, this quantitative study used standard methods for replication and comparison with other previous studies on adverse effects of tanning beds and the state regulations implemented to guide their use. Lastly, the choice of quantitative methods in this study was to eliminate researcher bias by studying outside of the opinions of participating subjects.
3.3 Research Design
This study was based on exploratory research design in order to clarify the questions under study. The exploratory design was ideal to assist in improving the understanding and knowledge on the rationale for the state regulations instituted to guide the use of tanning beds in order to mitigate the associated adverse effects (Blair, Czaja & Blair, 2013). Secondly, the use of an exploratory design was based on the need to evaluate the understanding of college students on the adverse effects linked to the prolonged use of UV tanning beds. As such, the design was useful in explaining the symptomatology prescribing adverse effects of long-term exposure to UV radiations through tanning beds. In this regard, the exploratory design allowed exploration of adverse effects and stipulated state regulations positing poor understanding of college student users. Thirdly, in addition to the primary data collected, the exploratory design allowed the comparison of the findings to data from previous studies to define a benchmark on appropriate recommendations on the use and application of tanning beds with minimal adverse effects.
3.4 Study Population
This study is carried out in California, a state in which the use of tanning beds is prohibited in minors below 18 years. Initially, children between 14 and 18 years were allowed to use tanning beds under the supervision of parents or guardians. As evidenced, the risk to skin cancer increases with early exposure to UV tanning procedures with the onset below 30 years (Pagoto et al. 2014). The population under study include young adults in California with a high predisposition to participate in skin tanning using indoor tanning beds in salons.
3.5 Sample Frame
The sampling frame in this study will entail college students in California due to their lack of knowledge of the adverse effect of tanning beds. The target group will be college women considering that they are prone to skin tan to cosmetic purposes. Moreover, as Pagoto et al. (2014) assert, indoor tanning salons are more widespread in or within the vicinity of campuses and colleges in California where indoor tanning is more widespread among young adults.
3.6 Sampling Methods
The best approach employed in the selection of participants in this study was random sampling. Random sampling was the most adept selection method because it enhanced the accuracy and ease of use in participant selection (Saunders, 2012). Simple random sampling allowed each college student an opportunity to be selected as long he or she is a user of tanning beds. The equal probability in random sampling yielded a sample that was representative of the college students under study. The inclusion criteria employed was such that all college students must have been tanners, particularly using UV tanning devices. Additionally, all participants were required to be above 16 years and below 40 years of age.
3.7 Research Instrument
This study used questionnaires to collect data. Questionnaires were used as the instruments of data collection because they are not expensive in the collection of a large amount of information from the large population within a short span of time especially when administered by the researcher without involving other surveyors that may need some payment (Bird & Dominey-Howes, 2008). In addition to being cost-effective, use of questionnaires is advantageous in that they collect data that is practical in that it’s the researcher who decides on the target groups thus designing the questions that fit them best. For instance, a researcher may decide to use multiple choice questions or open-ended format so that the respondents are able to respond at ease. Bird et al. (2008) additionally maintain that use of questionnaires offer easy analysis because the data they gather is quantitative in nature making it easy to visualize the interpreted data quickly and give the results. Furthermore, questionnaires have no time limit as opposed to facing to face interviews or observation. Therefore, the respondents of the questionnaires can be allowed to take time and respond to the questionnaires during their free time while concentrating fully on the response they provide. Lastly, questionnaires can be used exhausting the topic’s content since a researcher is not limited to the number of questions to ask although many questions are not recommended in a questionnaire as they can end up boring the respondent.
3.8 Data Collection
Raw primary data were collected using survey questionnaires described above. In design, the questionnaires were semi-structured and contained closed-ended questions, which were easy to respond. Considering the qualitative methodology, the responses to closed-ended questions were easy to code for statistical analysis and/ or to compare to generate meaningful conclusions on the adverse effects of tanning beds among college students in California. There were three major sections trying to answer the defined questions.
3.9 Limitations
Since the data was collected from randomly identified college students who had previously used tanning beds, the researcher found it hard to identify those who had already used tanning beds. Therefore, the researcher had to seek permission from the salon operators to be given a chance to select the students who came to seek the tanning bed service in the salons by first isolating the student in the salon from outsiders who came to seek the tanning bed service in the same salons through asking verbal question for easy identification before issuing of the questionnaires. The other limitation that the researcher encountered during data collection was that some of the college students identified to respond to the questions in the questionnaires lacked knowledge on the adverse effects associated with the use of tanning beds thus resulting in the researcher excluding them.
3.10 Data Analysis and Presentation
The collected data were subjected to sorting and tabulation to eliminate “noise” followed by cross-tabulation mode, a quantitative data analysis model. The advantage of the cross-tabulation analysis model was preferred because it exploited primary tabular forms to develop inferences between various data sets in the study (Saunders & Rojon, 2014). Cross-tabulation model was run using in Excel and SPSS (Statistical Package for Social Scientists) statistical systems to develop meaningful data sets to enumerate conclusions and recommendations.
3.11 Ethical Consideration
Prior to the commencement of data collection, Institutional Review Board (IRB) guidelines for research was reviewed and every identified respondent of the questionnaire was clearly made to understand the aims of the study. Moreover, the respondents were required to sign an informed consent form before proceeding to respond to the questions in the questionnaire.
3.12 Summary
In the study, the researcher used quantitative methods in exploratory research design in the collection of raw primary data and its analysis. Simple random sampling was used in the selection of college students as study participants, who were served with survey questionnaires, which entailed closed-ended questions to build solutions to the study questions. Lastly, quantitative cross-tabulation models were used in the analysis of the collected data. Below is an elucidation of the study findings and their analysis.
Chapter 4: Results
4.1 Introduction
Using the cross-tabulation model, the collected data were manipulated and analyzed presenting findings in figures and tables. They presented a better visualization, understanding, and interpretation of the study results. The study sought responses from 20 college students, and they all participated in this study, signifying 100% response rate. Various sections in the questionnaire sought to establish an answer to individual research questions in line with the main aim of the study. Demographic patterns depicted participant profiles based on their gender, age group, year of study in college and the faculty they were enrolled in. Different sections had results as shown below.
4.2 Demographic Analysis
4.2.1 Gender of respondents. The results obtained showed that 9 out of the 20 respondents were male representing 45%. Female respondents constituted 55%.
Figure 1: Respondents’ Gender (Source: Author)
4.2.2 Age of respondents. The study took a sample from college students aged between 16 years and 40 year. The following was the distribution in terms of age groups of the respondents. Majority were aged 20-24 years who were 7 in number representing 35%. Age group 25-29 years had 5 respondents (25%), 30-34 years group had 3 (15%) while those aged between 35-39 years were 2(10%) the same figure representing age group aged 16-19 years. Only 1respondent or 5% was aged 40 years. Figure 2 below show the results
Figure 2:Respondents’ Age (Source: Author)
4.2.3 Year of study of respondents. The year of study that the participants were covering showed 25% were in their First year, 25% were in their second year while third year and fourth year participants were 20% each. Only 10% of respondents were in their postgraduate years of college. Figure 3 below shows these results in a graphical presentation.
Figure 3: Respondents’ Year of study (Source: Author)
Figure 4: Respondents’ faculty (Source: Author)
4.2.4 Faculty of respondents. Respondents were drawn from different faculties in the college. There were 6 (30%) from the Faculties of Arts and Social Sciences as well as Pure sciences Faculty. Faculty of Education represented by 4 (20%) similar to the number representing other faculties.
4.3 Cross-Tabulation
4.3.1 Skin tanning. The question of respondents having ever done skin tanning revealed 2 male respondents (10%) and 5 female (35%) had tried skin tanning. 65% said they had never tried skin tanning comprised of 30% female and 35 males. A further analysis of number of respondents trying skin tanning showed 2 out of the 9 male respondents (22.22%) admitted having tried skin tanning while this figure was 5 out of 11 female respondents representing 45.45%. Those who said they had not tried skin tanning were 77.78% male and 54.54% female.
Table 1: Skin Tanning (Source: Author)
Statement Yes No
Have you ever tried skin tanning? Male Female Total Male Female Total
Relative to the total sample population 2 5 7 7 6 13
10% 25%
35% 35% 30% 65%
Relative to Gender of respondents 2/9 5/11 7/9 6/11
22.22% 45.45% 77.78% 54.55%
4.3.2 Reasons for trying skin tanning. There were 7 respondents who said they had tried skin tanning. Out the 7, 4 (57.14%) indicate they wanted to improve skin appearance, 2(28.57%) said they tried because their friends use them while 1 (14.28%) wanted to relax and relief stress. None cited improving skin health as reason.
4.3.3 Years of using tanning beds. Majority (71.43%) of the respondents who tried skin tanning have used tanning beds did so in period of less than 4 years. Only 2 out of the 7 representing 28.57% used tanning beds in a period between 5 years and 9 years. None of them indicated having used tanning beds for more than 9 years.
Figure 5: Years of using tanning beds (Source: Author)
4.3.4 Awareness of adverse effects of tanning beds. In the study, 66.67% of the male respondents indicated they know adverse effects associated with tanning beds while only 54.54% females were aware.
Table 2: Awareness of Adverse Effects of Tanning Beds (Source: Author)
4.3.5 Observed adverse effect of tanning beds on users. Majority of the respondents (55%) said they had never observed or experienced any skin adverse effects related to tanning beds.
Table 3: Observed Adverse Effect of Tanning Beds on Users (Source: Author)
4.3.6 Adverse effects prevalence. As listed in Table 4, different students indicated the adverse effects they have noticed following the use of tanning beds according to the prevalence observed.
Table 4: Adverse Effects Prevalence (Source: Author)
4.4 Reasons for Regulation
Among the respondents, 7 out of the 20 felt that the regulation regarding tanning beds should be guided by the need to reduce their usage among young people. This number was 45% followed by those who said the regulations should be guided by the need to restrict their misuse by medical practitioners. Only 4 (20%) said their adverse effects on users should guide the regulation of tanning beds.
Restricting misuse by practitioners = 7(35%)
Reducing their use among young people = 9(45%)
Reducing their adverse effects on users = 4(20%)
Others = 0(0%)
Chapter 5: Discussion and Conclusion
5.1 Introduction
The findings above are in line with the results from datasets derived from questionnaire responses on the adverse effects of using UV tanning beds, and the instituted state regulations in California. In this section, a comparison of the results with findings from the previous studies is provided with possible explanations. As such, adverse effects to prolonged use of tanning beds, state regulations and rationale for instituting the regulations with respect to design and use of tanning beds is provided. The provided conclusion highlights the major limitations and the associated effects on the study findings. Evidently, irrespective of acquired skin tan, whether from accidental exposure or from a UV tanning bed, symptomatology on adverse effects is eminent in users. Presentations from UV radiation exposure on the skin induce cellular damage leading to premature photo-aging characterized by keratosis, wrinkling, and lax skin, and melanoma.
5.2 Discussion
5.2.1 Adverse effects. The first alternative hypothesis in this study was that the use of tanning beds adversely affects users following long-term exposure to UV radiations. This hypothesis was proved by the findings of the current study, which showed that the majority of college students in California using tanning beds indicated having experienced one or more forms of adverse effects of varying severity. Irrespective of the experienced adverse effects, the students confirmed that they continued using tanning beds amid mild negative skin reactions associated with the UV radiation-releasing devices. The use of indoor tanning salons is continually increasing in popularity with the majority of college students confirming the use of the facilities in or within their campuses. In line with these findings, Veierod et al. (2015) confirmed that the use and popularity of indoor tanning facilities continue to rise exponentially with the primary users being women. In the current study, young adult college women were reported to exhibit the highest incidence in the use of tanning beds. Particularly, the rate of indoor tanning use was higher in young, white, female students than in their male counterparts, while Woo and Eide (2010) indicated a varying rate on the use with respect to age depicting a lower use rate among students aged between 16 and 24 years, and a peak among women aged between 31 and 39 years. The motivation towards tanning, according to Geller, et al. (2006), is linked to health benefits associated with the synthesis of surplus vitamin D, increased desire for attractive skin tan, and for mental wellbeing.
Majority of the college students participating in the study confirmed the addictive nature of tanning using tanning beds, while more than half of the students noting that they have suffered sunburns and likely characteristics of photo-aging. Studies have indicated that the skin is able to texture itself like a leather exhibiting wrinkle-like outlook. In the long run, sunspots and sagging skin are typical of prolonged exposure to UV-A radiations to the dermal layer of the skin. The college students noted that presentations with conjunctivitis, photo conjunctivitis, and photokeratitis were common among the majority of users, which is consistent with previous study findings (Geller, et al. 2006). Other long-term, more severe, visible adverse effects due to the use of UV tanning beds include ocular melanoma, BCC, SCC, and melanoma. Veierod et al. (2015) established that the predilection of developing skin or eye cancer increase predominantly following early exposure to UV radiation through tanning beds for users below 30 years, thus predisposing young users to increased cancer risks and skin complications.
5.2.2 Regulations. The second alternative hypothesis in this study was that there are state regulations that guide the use of tanning beds in California. The data collected and analyzed in this research proved this hypothesis by revealing that most of the total college students involved in the study were not informed on the current FDA regulations on the use of tanning beds. On the contrary, a very small number of the respondents stated that they had heard of the FDA regulations although they had very little knowledge on what these regulations required the use of the tanning beds to do nor did they know at what point these regulations prohibited the use of tanning beds. For instance, no respondents seemed to be aware of the maximum number of times a user of tanning beds could be subjected to UV rays thus most of the respondents had already overused tanning beds supporting the proven hypothesis of this study. These results concurred to that of the study conducted by US Department of Health and Human Services (2009) on the effectiveness of the FDA regulation in the North California that noted that the largest population of the tanning beds users among the women aged between 18 and 29 of years had no concept of the current FDA regulations on the use of tanning beds. Further, this study noted that of the total population of the sample from college girls who knew the FDA regulations, most of them had not adhered to the regulations since the salons from which the college students got services had not been supervised fully to ensure the regulation was followed thus most of the tanning beds service providers had turned a deaf ear on the regulation. This similarly, was in line with the survey conducted in Minnesota and Massachusetts (Forster et al. 2007) that realized only a small population of the tanning beds users and facility operators complied with the FDA regulation on the use of tanning beds among the women aged between 18 and 30 years thus supporting the results of the proved hypothesis.
5.2.3 Reasons for the regulation. Lastly, the third alternative hypothesis in this study was that the rationale behind the implemented state regulations on the use of tanning are exploited by users. This statement is untrue because most students who participated in the study indicated that state regulations were developed in order to assist in reducing the risks and adverse effects linked to the use of tanning beds. Similarly, Woo et al. (2010) showed that instituted regulations on the design and use of tanning beds in order to specify conditions, cautionary warnings, exposure schedules and inclusion of eye protection in tanning beds. Since most of the college students were not aware of the adverse effects or regulations guiding the use of tanning beds, it was hypothesized that the regulations are meant to protect users and vendors from the increased risk of eye and skin cancer following prolonged exposure to the emitted UV radiations. The rationale behind the FDA regulation on the exposure schedule for first-time users is to be in line with gradual acclimatization of the skin to exposure to UV radiation. Essentially, FDA recommended the use of limited UV wavelength with respect to time no more than 0.75 MED allowing at most three exposures during the first week, and a gradual increase to 4.0 MED as the maintenance dose. Violation of this recommendation posits the increased incidence of skin and eye cancer in the US. It is evidenced that the biggest number of indoor tanning salons has not complied with the FDA regulations making the reasons for their development void (Zuba et al. 2016). The regulation on the use of minimum exposure at the onset of tanning is geared to ensure minimal damage to the skin, yet previous studies have indicated that approximately relatively high population of users begin exposures at doses above the FDA regulation equitable to the recommended maintenance dosage for indoor tanning practice (Woo et al. 2010). In California, state regulation prohibits the use of tanning beds among users below 18 years. This regulation considers the long-term effect of commencing tanning at ages below 30 years, which increases the predisposition to skin cancer by more than half (Miyamura et al. 2007).
5.3 Conclusion
In consideration of the study objectives, which focused on the exploration of adverse effects associated with the use of tanning beds, and an examination of state regulations as well as the rationale behind their implementation, this study recognizes the eminent risk evidenced in the use of tanning beds. These findings are anchored on previous studies showing the increased risk of skin cancer in the US, particularly in association with early onset of the use of UV tanning beds. Moreover, the elevated incidence of indoor tanning among young adults potentiates an increase in skin cancer prevalence, which posits the need for immediate mitigation strategies. Moreover, as evidenced in the literature review and findings of the current study, most tanning device users are not enlightened on the instituted regulations by the government and health governing bodies to control the manufacture and use of tanning beds. Therefore, it is important to espouse the rationale behind the set and instituted state regulations on the application of tanning beds, especially among minors and young adults. The identified adverse effects identified in this study, which are highly prevalent among college students, include sunburns, suntan, photoaging and premature aging with associated wrinkles, and the presence of brown spots on the skin. Inflammation of the conjunctiva, photo conjunctivitis, and photokeratitis were defined as symptomatologic presentations linked to adverse eye effects. Notable adverse conditions with severe effects defined in the study include melanoma, ocular melanoma, BCC and SCC, which developed following prolonged exposure to UV irradiation through indoor and outdoor tanning. Importantly, notable regulations of the use of tanning beds targeted design of tanning beds, dosages of UV exposure at the beginning and continuation of tanning, and protection of minors and young adults, particularly in California. It has been established that most of these regulations are seldom implemented in an indoor tanning salon, while users are not aware of the existence of such regulations. Consequently, the rationales of these regulations as a mitigation strategy to decrease the adverse effects of tanning beds are rendered void.
5.4 Recommendations
Based on the results obtained and analyzed from the study, it is recommended that the general public be educated on the adverse effects using tanning beds through education by physicians since they are highly recognized and trusted based on their knowledge of public health. Moreover, the users of tanning beds should be counseled on the alternative ways of obtaining serum vitamin D other than the use of tanning beds and other UV. Additionally, college students should be informed on the regulations that exist governing the use of tanning beds and be encouraged to ensure the regulations are followed by those salons and cosmetic places that provide them the services of tanning beds. It is also recommended that the legislation mechanisms meant to ensure the FDA regulations on the use of tanning beds are adhered to be strengthened and strict supervision and regular checkups on the tanning beds industry be conducted to address and cut down the incidences of adverse effects caused by the use of tanning beds. Lastly, public health organizations should maintain reminders to the general public on the adverse effects of using tanning beds.
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