Predictors of Tanning Dependence in White Non-Hispanic Females and Males

Brenda Cartmel, PhD Senior Research Scientist Tanning – ‘Addictive’?

‘Tanning Mom': Is New Jersey Woman ‘Addicted’ to Tanning?

• five days per week

• Does the maximum time of 12 minutes

• Intriguing research supports the potential for dependence to UV exposure

2 Biological basis for dependence- Beta- endorphin (-receptor agonist) produced as a by- product of melanin production (Fisher and James, NEJM 2010)

3 Assessment of Predictors of Tanning Dependence: Study Design

• Participants recruited from prior Basal Cell Carcinoma case-control subjects aged under 40

– Non Hispanic Whites – Limited to those with history of sunbathing and/or indoor tanning – Online survey through Qualtrics

• 499 enrolled (81% participation)

• 75% Female

4 Assessment of of Tanning Dependence

• Modified CAGE • Cut down, Annoyed, Guilty, Eye-Opener • CAGE used as an abuse screening instrument • ‘Yes’ to 2 of 4 items classified as tanning dependent • Example question: ‘Have you ever tried to stop tanning, but still continued?’

• Modified DSM-IV Substance Related Disorder for Tanning • ‘Yes’ to 3 of 9 items classified as tanning dependent 5 Behaviors and Lifestyle Factors Assessed

• Seasonal affective disorder (SAD)

• Depression

• Smoking/

• Alcohol intake/symptoms of

• ‘’

6 Assessment of TD using the mCAGE and mDSM-IV-TR

mDSM-IV-TR

Tanning Not tanning TOTAL mCAGE Dependent (+) dependent (-) N (%)

Tanning Dependent (+) 122 (24.5) 23 (4.6) 145 (29.1)

Not Tanning Dependent (-) 99 (19.8) 255 (51.1) 354 (69.9)

TOTAL 221 (44.3) 278 (55.7) 499 7 Prevalence of Tanning Dependence by Gender

Females Males (N=375) (N=124)

Classification N % N %

Not Tanning Dependent 169 45.1 86 69.4 -Negative on both scales (-/-)

Tendency to Tanning Dependence 97 25.9 25 20.1 -Positive on one scale (+/-) (-/+)

Tanning Dependent 109 29.1 13 10.5 -Positive on both scales (+/+) Selected Host Characteristics by TD type

Not TD Tendency for TD TD (N=255) (N=122) (N=122) N(%) N(%) N(%)

Age at survey 38.6 (5.1) 38.0 (4.8) 39.0 (4.3) High School Graduate 235 (92.1) 115 (94.2) 114 (93.4) Overweight or Obese (BMI >25 kg/m2) 112 (43.9) 38 (31.1) 40 (32.8)

Fair Skin color 147 (57.6) 74 (62.3) 79 (64.7)

Prior Basal Cell Carcinoma 126 (49.4) 63 (51.6) 71 (58.2)

Skin reaction with prolonged sun exposure**: Deeply tanned 31 (12.2) 10 (8.2) 25 (20.5) Moderately tanned 125 (49.0) 75 (61.5) 66 (54.1) Mildly tanned 99 (38.8) 37 (30.3) 31 (25.6)

$Differences between the three groups (Not TD, Tendency of TD and Symptoms of TD) were assessed using Chi-squared analysis. **: p<0.01 9 Tanning Dependence and Frequency of Tanning by Gender

Sunbathing Indoor tanning

Lifetime Number Sessions Over Number Sessions Over

p<0.0001 p<0.0001

10 Behavioral and Lifestyle factors associated with Tanning Dependence (N=499)$ Not TD Tendency for TD TD (N=255) (N=122) (N=122) N(%) N(%) N(%) History of Depression 63 (24.7) 39 (32.0) 41 (33.6) SAD** 14 (5.5) 14 (11.7) 21 (17.8) History of Alcohol Addiction***: No 159 (62.3) 54 (44.3) 47 (38.5) Abuse 65 (25.5) 43 (35.2) 43 (35.2) Dependence 31 (12.2) 25 (20.5) 32 (26.2) Nicotine addiction (current or past 9 (9.0) 6 (10.3) 9 (17.3) smokers only) History of Exercise 3 (1.18) 4 (3.28) 7 (5.7) Addiction*

$Differences between the three groups (Not TD, Tendency of TD and Symptoms of TD) were assessed using Chi-squared analysis or the Fishers exact test. *: p<0.05; **: p<0.01; ***: p<0.0001 11 Multivariate Models of Predictors of Tanning Dependence N TD vs. Not TD N Tendency for TD vs. OR (95% CI) Not TD OR (95% CI) Sex Male 13/86 1.0 25/86 1.0 Female 109/169 6.93 (3.36-14.27) 97/169 2.82 (1.59-4.98) SAD No 81/162 1.0 83/162 1.0 Yes 41/63 2.77 (1.26-6.09) 39/63 1.86 (0.82-4.23) History of Alcohol addiction No 47/159 1.0 54/159 1.0 Abuse 43/65 3.16 (1.81-5.51) 43/65 2.60 (1.53-4.41) Dependence 32/31 6.55 (3.19-13.42) 25/31 3.66 (1.84-7.31) Risk of Exercise ‘Addiction’ No 115/222 1.0 118/222 1.0 Yes 7/3 5.47 (1.15-26.06) 4/3 3.87 (0.74-20.27) 12 Summary

• Indoor tanning is now an established risk factor for both and basal cell carcinoma

• Gender, SAD, Alcohol Dependence and ‘Exercise Addiction’ are associated with Tanning Dependence

• May require new approaches to interventions to reduce UV exposure in those who are tanning dependent Acknowledgements NCI R21 CA155952; NCI • Collaborators: Funding:

Allen Bale, M.D. R21 CA155952 Leah Ferrucci, Ph.D. David Leffell, M.D. NCI P50 CA121974 - Yale Specialized Joel Gelernter, M.D. Program of Research Excellence in Skin Cancer. Andy Dewan, Ph.D. Susan T. Mayne, Ph.D. ACS MSRG-13-016-01-CPPB - Sherry Pagoto, Ph.D. Mentored Research Scholar Grant in Applied and Clinical Research

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