A new study conducted at a large university finds more than 25 percent of those surveyed reported symptoms of tanning dependence, including symptoms similar to alcohol and drug-addicted individuals.

Suggestively, the study also found those with a tanning dependence tend to be more likely to be thin and smoke cigarettes than others. The study by researchers at Fox Chase Cancer Center is published in the September/October issue of the American Journal of Health Behavior.

Skin cancer is the most common form of cancer, according to the American Cancer Society, accounting for half of all human cancers with over a million new cases diagnosed yearly in the United States. It is reported that up to 90 percent of all skin cancers are associated with ultraviolet radiation.

For the study, Heckman and her colleagues set out to understand what proportion of college students report problems with tanning dependence and whether there are shared behaviors among those considered to be tanning dependent and those with other forms of addiction.

"Adolescents and young adults tend to put themselves at risk for later skin cancer by exposing themselves to high levels of ultraviolet radiation, so by understanding some possible reasons why, we hope to develop innovative interventions to help prevent these risky behaviors," explains Carolyn Heckman, Ph.D., an associate member at Fox Chase Cancer Center.

Heckman and her colleagues recruited 400 students and other volunteers at Virginia Commonwealth University in Richmond, Virginia during the spring semester of 2006. Participants took part in an online survey utilizing items adapted from questionnaires used to measure traditional substance abuse and dependence. The measures assess tolerance to tanning (the need to tan increasingly frequently), withdrawal from tanning (discomfort when not having tanned recently), and difficulty controlling the behavior despite awareness of its negative impact such as freckles, wrinkles, pre-cancerous lesions, etc.

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The survey included questions such as "Do you think you need to spend more and more time in the sun to maintain your perfect tan?", "Do you continue tanning so your tan will not fade?" and "Does this [your belief that tanning can cause skin cancer] keep you from spending time in the sun or going to tanning beds?" Participants were queried about their level of intentional and incidental sun exposure, tanning booth use, and chemical sunless tanner use. The survey also asked about health-related behaviors such as body mass index, smoking, and exercise.

"The media and lay public may know tanning dependence as 'tanorexia,' alluding to similarities to both substance addictions and body image disorders like anorexia," Heckman says. "There is some evidence that UV tanning dependence may have biological underpinnings like other addictions such as the production of endorphins as in the 'runner's high.'"

Heckman adds: "We were surprised to find that 27 percent of those we surveyed were classified as tanning dependent. The finding that almost 40 percent of those surveyed had used tanning booths and that the mean age when tanning booths were first used was 17 is also alarming."

Interestingly, sun tanning appeared to be more closely related to tanning dependence than indoor tanning, though use of indoor tanning during warm weather also signaled tanning dependence.

Finally, the researchers say that those addicted to tanning were more likely to be thin and smoke cigarettes than others, suggesting meaningful avenues for further research into possible links among risky behaviors.

"Our ultimate goal is to find out more about the motivations for tanning so that we can develop interventions that would reduce tanning and hopefully skin cancer," Heckman concludes.

This study was funding by the National Cancer Institute. In addition to Heckman, other authors include Brian L. Egleston, PhD, of Fox Chase Cancer Center; Diane B. Wilson, EdD, MS, RD, of Virginia Commonwealth University; and Karen S. Ingersoll, PhD, of the University of Virginia. The authors report no disclosures.