McKenzie Johnson uses indoor tanning as her personal outlet for relaxation. Making weekly visits to Palm Beach Tan in Iowa City, she looks forward to her 15 minutes at least once a week in the tanning bed.

“I enjoy so many things about tanning,” Johnson, 21, a University of Iowa student from Pekin, Ill., said. “Just laying there calmly, sometimes taking a nap. I love the warmth of it, especially during the winter.”

“This year was a long one in the Midwest and tanning definitely gave me the boost I needed.”

Johnson is one among millions of people who tan in this country, even though they are well aware of the health risks that go with tanning, and warnings that those risks increase each time they enter a tanning booth. The risks include overexposure to UV rays, which can cause skin cancer, and bacterial illnesses.

UPDATE 7/29/14: Skin cancer is a major public health problem that requires immediate action, according to a new Call to Action from the U.S. Surgeon General. A big share of the blame goes to indoor tanning, the Call to Action states.

“I have friends that go just because they like how it’s warm in there, because it’s so cold here in Iowa,” Erin Larsen, a UI junior from Waukee, Iowa, said. “They can only think about that one issue they have right then and not about the repercussions that’ll come of it in the future.”

Iowa does not regulate the age when you may tan in the state, although the state Senate Committee on Human Resources proposed a bill this year that would have banned people under the age of 18 from using tanning beds. The bill, SF 2275, a successor to SF 2174, went nowhere this legislative session.

“Tanning bed use among teenagers is a hot political topic currently, with many states adopting legislation to make it illegal for people under the age of 18 to tan,” Dr. Molly Moye, a University of Iowa Hospitals and Clinics dermatology resident, said.

Moye said legislation of indoor tanning is on the political radar because of tanning’s increased cancer risk and incidence of melanoma in young people, especially young women. “We place limits on how old one must be to smoke cigarettes and the emerging thought is that tanning bed use is essentially the same thing,” Moye said.

State law only mandates that salons adhere to exposure schedules labeled on each individual tanning bed, Charlene Craig, a health physicist with the Department of Public Health’s Bureau of Radiological Health in Des Moines, Iowa, said.

These schedules, which require U.S. Food and Drug Administration approval, regulate how often each consumer is allowed to tan and for how many minutes.

The American Academy of Dermatology reports that nearly 28 million people in the United States tan indoors annually. On an average day, more than 1 million of them are in tanning salons. Tanning beds deliver 10 to 15 times the UV radiation of natural sunlight, instant gratification for those in need of quick fix, the American Cancer Society reports.

But the dermatology academy reports a 75 percent increase in the risk of melanoma in those who expose themselves to UV radiation from indoor tanning, and increasing risks with each tanning session.

The Iowa Department of Public Health demands that a warning sign reading “DANGER, ULTRAVIOLET RADIATION” be readily visible to customers upon entering a tanning salon. The sign also must list injuries that can occur as a result of tanning, including eye and skin injury, allergic reactions, premature aging of the skin, skin cancer and severe burning.

Craig said first-time customers must read and sign a statement affirming that they understand these risks.

“I don’t really think about the consequences because I think nothing bad will ever happen to me personally,” Margaret Wyatt, a University of Iowa student from Edina, Minn., who just finished her sophomore year, said. “It’s always a possibility but I’ve never been too concerned about it.”

Wyatt, 20, said she knows tanning may come with a price and that it can lead to health issues like skin cancer. She chooses to tan for vanity, she said, and because it helps boost her self-confidence.

Confidence was only one of the several motivators people interviewed by IowaWatch gave for wanting to tan. Some said they feel they look more attractive with tanned skin and others said they found that it helps diminish visible acne and blemishes.

Molly Mudd, 20, also completing her sophomore year at the University of Iowa this year, began tanning in seventh grade. Her dermatologist suggested that seven minutes in a low level tanning bed might help improve her continuous acne breakouts and clear up noticeable zits on her face.

Seven years later, Mudd, of Cedar Rapids, has minimal acne and continues to tan.

“I think I look better when I’m tan and I like looking darker,” Mudd said.

Dr. Mary Stone, professor of dermatology and residency director of dermatology at University of Iowa Hospitals and Clinics, said tanning continues to be a trend, particularly on college campuses.

“There’s the perception that tanned skin looks healthier and so people sometimes want what they perceive as a healthier look, which of course is not healthy at all for your skin,” she said.

Stone said light affects brain chemistry. People feel good in light, which is why some people experience depression in the winter when there isn’t much access to it, she said.

A study published in early 2002 by doctors J. Matthew Knight, Anna N. Kirincich, Evan R. Farmer and Antoinette F. Hood found that college students continue to frequent tanning salons despite sufficient knowledge of the adverse effects of UV radiation.

Setting aside these effects, the undergraduate and graduate student participants’ main reason for going was for “a desired cosmetic appearance,” the study showed.

Young adults who tan generate a multi-billion-dollar-a-year industry, the Academy of American Dermatology reports. Whether the basis for going is mood, appearance or skin enhancements, the indoor tanning industry continues to boom.

“It’s a health issue, like many others, where there are business interests,” Stone said. “Those are not necessarily the same as health interests.”