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Indoor Tanning Operator Compliance & Knowledge PowerPoint PPT Presentation


Indoor Tanning Operator Compliance & Knowledge. Robin L. Hornung, MD, MPH Pediatric Dermatologist, The Everett Clinic Clinical Associate Professor UW Division of Dermatology. Overview. Present research in areas of: Indoor tanning compliance with safety regulations

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Indoor Tanning Operator Compliance & Knowledge

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Indoor Tanning Operator Compliance & Knowledge

Robin L. Hornung, MD, MPH

Pediatric Dermatologist,

The Everett Clinic

Clinical Associate Professor

UW Division of Dermatology


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Overview

  • Present research in areas of:

    • Indoor tanning compliance with safety regulations

    • Tanning operator knowledge and training

    • Laws that restrict youth access


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Indoor Tanning Compliance

  • In 1991 an inspection of 32 NC tanning facilities found only 1 in complete compliance with the 21 state and federal safety regulations

  • > 7 infractions/facility (0-21)

  • 19% had timers not within required +/- 10% accuracy level

Fleischer AB et al, J Am Acad Derm 1993;28:212


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Indoor Tanning Compliance

  • 50 NC tanning facilities evaluated during state inspections:

    • Were patrons complying with the FDA recommended “safe” exposure schedules outlined on the tanning beds ?

    • Established guidelines are based on getting no more than 0.75 minimal erythemal dose (MED) 3 times the first week, gradually increasing the exposure thereafter

Hornung RL et al, J Am Acad Derm 2003;49:655


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Indoor Tanning Compliance

  • 95% of patrons were not following the safe exposure guidelines

  • ~ 1/3rd actually started at the maximum levels (>4 MED)

  • Average length of tanning on the first visit was > 14 minutes

  • Primary tanning facilities where the sole business was for tanning, the patrons had significantly shorter tanning times

Hornung RL et al, J Am Acad Derm 2003;49:655


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Indoor Tanning Compliance

  • We also studied the amount of UV radiation emitted by tanning beds

    • The tanning beds emitted 4x more UVA and 2x more UVB when compared to radiation emitted by the noon-day sun in Washington D.C

    • In high-pressure sunlamps radiation can reach doses 10-15x that of the sun

Hornung RL et al, J Am Acad Derm 2003;49:655

Gerber B et al, Photochem Photobiol 2002;76:664


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Indoor Tanning Compliance

  • In San Diego a study utilized phone interviews to assess compliance with recommended exposure schedules:

    • Compliance was measured as the weekly frequency of visits

    • Only 6.8% in compliance with the FDA recommended exposure guidelines

Kwon HT et al, J Am Acad Derm 2002;46:700


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Knowledge & Training Among Indoor Tanning Operators

  • Survey of tanning operators in Michigan: 63% did not believe that tanning beds can cause cancer

  • Survey of tanning operators in New York: 80% said one could not get skin cancer from artificial tanning , 75% said one could not get a sunburn from artificial tanning

Beyth R et al, J Am Acad Dermatol 1991;24:277

Fairchild AL et al, Am J Prev Med 1992;8:381


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Knowledge & Training Among Indoor Tanning Operators

  • Survey of 1008 high school students in Minnesota:

    • 50% said they were not warned about potential dangers

    • 28% reported not being told to wear goggles

    • 17% reported never using goggles

Oliphant JA et al, Am J Public health 1994;84:476


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Knowledge & Training Among Indoor Tanning Operators

  • 400 facilities in 4 states, 87% of operators advised patrons of the potential risk of sunburn

  • < 50% facility operators in Colorado, Texas and Wisconsin informed patrons about the risk of skin cancer vs 81% in Illinois

Heilig LF, et al, Cancer Causes Control 2005;16:557


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Knowledge & Training Among Indoor Tanning Operators

  • FDA has databases in which medical device associated injuries are reported

    • 142 records were compiled from these databases from 1985-2006

    • Of the reported injuries ~50% resulted from UV exposure

    • 36% of the UV-related injuries were attributable to (user/operator) noncompliance with FDA sunlamp guidance policies

Dowdy JC et al,Photodermatol Photoimmunol Photomed 2009;25:216


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Knowledge & Training Among Indoor Tanning Operators

  • In a large Burn and Plastic Surgery practice in the UK they have noticed a rise in the number of patients presenting with burns related to sunbed use over the last several years

Hemington-Gorse SJ et al, Burns 2010 Feb 17 [Epub ahead of print]


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Knowledge & Training Among Indoor Tanning Operators

  • Survey of tanning operators in North Carolina:

    • 71% never got any formal training

    • only ~ 1/3 of tanning device operators were aware of common photosensitizing drugs

    • some (3%) even allowed children under age 10 to tan

Fleischer AB et al, J Am Acad Dermatol 1992;27:199


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Knowledge & Training Among Indoor Tanning Operators

  • In Washington state, 70% of the parents surveyed said they never wanted their children to use tanning devices

  • We found children as young as 5 years old were currently using tanning beds

  • On average children were using them 4 years younger than their parents

Magee KH et al, Pediatr Dermatol 2007;24:216


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Conclusion

  • Extreme variability in

    • tanning devices and their radiation output (which is typically extremely high)

    • operator knowledge and training (which is often very limited)

    • compliance with state and federal guidelines (which is often very poor)

  • Many states have no regulations whatsoever


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Conclusion

  • In states where there are laws restricting youth access, a recent (and the largest) study found the laws:

    • Improved rates of parental consent

    • Improved rates of parental accompaniment

    • Reduced access to minors where this was prohibited

    • The laws were not very helpful in preventing every day usage

Pichon LC, et al, Arch Dermatol 2009;145:997


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