Study Identifies Motivators for Indoor Tanning Despite Risk to Skin Health

A team of investigators aimed to understand why people continue to use indoor tanning devices, or "sunbeds", despite the well-known associations with skin cancer, skin aging, and eye inflammation.

They wrote that in order to develop effective interventions, the underlying factors motivating people to use them need to be identified. The study aimed to collate existing evidence that's assessed these motivations from published qualitative papers.

Investigators uncovered that the primary driving factor for the practice had to do with aesthetic concerns, followed by the perception of psychological and physical benefits. The development of complex interventions should implemented to reduce harm in those who practice indoor tanning.

The Results

Investigators distinguished 5 of the 6 categories of framework in the data: reflective and automatic motivation, social and physical opportunity, and psychological capability. Evidence indicated that all 5 components influenced an individuals likelihood of engaging in indoor tanning.

All components except automatic motivation also influenced quitting or reducing the practice of indoor tanning. There was no evidence of physical capability having any affect on either engaging in, or reducing/quitting the practice.

"The main driver of indoor tanning identified in the qualitative studies was reflective motivation—why people desire to perform a behavior," investigators wrote. "There were 4 subthemes in reflective motivation: aesthetic values, physical effects, psychological effects and risk perceptions."

Primary Motivator: Aesthetic Values

According to the analysis, tanned skin was perceived as aesthetically desirable and helped individuals feel more attractive. Also noted by participants was the belief that the practice helped to cover scars, make people feel slimmer and accentuate muscle tone.

Additionally, upcoming parties, holidays, or other social events served as an incentive to use sunbeds in order to appear more attractive at attendance. Another perception was that tanned skin is associated with healthiness, wealth, and ambition.

While aesthetic values was the driving motivator, aesthetic concerns like premature aging or skin peeling were also reported as push to quit. Included in the study was a participant quote from Bowers and Moyer (2019) p. 350:

I started to cut back after I went three times in a row and started to peel on my face [which] wasn't very attractive. I also was a lot darker than I was hoping for.

Secondary Motivator: Physical Effects

Perceived health benefits was included in study results as encouragement for indoor tanning. To some, indoor tanning could help cure their dermatological complaints, and others belived that the associated health concerns of sun exposure were avoided by obtaining an indoor tan prior to vacationing.

It was also common for individuals to perceive a benefit from indoor tanning because it's a source of vitamin D which could help to reduce physical illness symptoms.

"Indeed, it was noted in one review that many users tended to highlight health aspects to avoid saying they tanned due to aesthetic reasons," investigators wrote. "However, there was some evidence that when physical benefits were overshadowed by physical harm such as a mole that changed, participants were motivated to quit tanning."

The Analysis

Martin Eden, MRes, MSc, PhD, of Manchester Centre for Health Economics at The University of Manchester led the team in conducting a systematic review of 6 databases to identify relevant qualitative studies that explored the reasons for, and experiences of, individuals' indoor tanning use.

The search was conducted in June 2019 and updated in March 2022. Investigators performed a narrative evidence synthesis to collate findings from each of the 16 studies that met inclusion criteria. A total of 17 articles reporting on the 16 studies were then included in the meta-synthesis. Of those, 13 articles were published within the last 5 years and the earliest paper evaluated was dated 2004.

As for the population of the studies, 8 consisted of individual interviews, 5 used focus groups, 1 involved both, 1 used multiple interviews with a single person to report a "key informant study", another utilized a discourse analysis of online texts, and the last supplemental paper was included because it provided results from responses to 2 open-ended questions from an online survey.

"This comprehensive explanation for the practice of indoor tanning provides the basis for development of complex interventions to reduce the harm caused by using sunbeds. Effective interventions should include promotion of alternatives, such as different methods of relaxing, to satisfy underlying motivations, changing social norms and correcting misperceptions about health benefits," investigators concluded.

The study, "Reasons for using indoor tanning devices: A systematic review of qualitative evidence" was published in the British Journal of Health Psychology.