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Logo of nihpaAbout Author manuscriptsSubmit a manuscriptNIH Public Access; Author Manuscript; Accepted for publication in peer reviewed journal;
Am J Prev Med. Author manuscript; available in PMC Mar 16, 2009.
Published in final edited form as:
PMCID: PMC2656357
NIHMSID: NIHMS95562

Density of Indoor Tanning Facilities in 116 Large U.S. Cities

Abstract

Background

U.S. adolescents and young adults are using indoor tanning at high rates, even though it has been linked to both melanoma and squamous cell cancer. Because the availability of commercial indoor tanning facilities may influence use, data are needed on the number and density of such facilities.

Methods

In March 2006, commercial indoor tanning facilities in 116 large U.S. cities were identified, and the number and density (per 100,000 population) were computed for each city. Bivariate and multivariate analyses conducted in 2008 tested the association between tanning-facility density and selected geographic, climatologic, demographic, and legislative variables.

Results

Mean facility number and density across cities were 41.8 (SD=30.8) and 11.8 (SD=6.0), respectively. In multivariate analysis, cities with higher percentages of whites and lower ultraviolet (UV)index scores had significantly higher facility densities than those with lower percentages of whites and higher UV index scores.

Conclusions

These data indicate that commercial indoor tanning is widely available in the urban U.S., and this availability may help explain the high usage of indoor tanning.

Introduction

Use of tanning lamps is associated with both melanoma and squamous cell cancer.1 Approximately 20% of U.S. adults aged 18–29 years used indoor tanning in the past 12 months,2 and rates are also high among adolescents,3,4 with estimates for older teen girls as high as 40%.4

Based on built environment–related research for other health-related behaviors such as alcohol and tobacco,57 the availability of commercial indoor tanning likely influences indoor tanning use. Therefore, accurately measuring the availability of indoor tanning facilities and identifying correlates of availability are important. CITY100 (Correlates of Indoor Tanning in Youth) is a multicomponent project focusing on potential correlates of adolescents’ use of indoor tanning.810 In this tanning-facility–availability component, updated estimates from a 1998 study11 are provided with the following methodologic improvements: (1) higher-quality procedures for identifying indoor tanning facilities, (2) more accurate identification of city borders, and (3) the inclusion of a larger number of cities (N=116 vs N=80).

Methods

Cities

The sample consisted of the 100 most populous U.S. cities, which were located in 34 states, plus the most populous city in each of the remaining 16 states.12

For each of the 116 cities, geographic boundaries for the city proper were created with GIS.13 Buffer zones of 1, 2, and 3 miles around the boundary of each city were created, because the residents living in the city proper likely travel beyond the formal boundaries.

Outcome Variable

The outcome variable was tanning-facility density, computed by dividing the number of indoor tanning facilities in the city plus those in the 3-mile buffer zone by the city proper’s total population12 and then multiplying the result by 100,000. Inclusion criteria for facilities were (1) must offer ultraviolet radiation indoor tanning and (2) must be open to the public and not require a membership (thereby being more accessible to adolescents).

In March 2006, with tanning salons as the key word, eligible commercial establishments in each city and its buffer zones were identified using two Internet business listings: Reference USA. com was the primary search engine and SuperPages.com was the secondary search engine. Businesses were entered into a database file and geocoded to the city-specific map. For 30 of the cities (25.8%), two research assistants independently counted the number of facilities.

Predictor Variables

Geographic variables included the region of country,12 the latitude, longitude, and elevation,14 and whether the city is on an ocean coast. Climatologic data consisted of the annual average temperature (°F), the mean days that the temperature was ≥90°F, the mean days that the temperature was ≤32°F, the mean days that precipitation was at least 0.01 inches, the average percentage of possible sunshine,15 and the average daily ultraviolet (UV) index.16 Demographic data consisted of the percentage of whites in the total city population, the percentage aged 15–19 years, the percentage with at least some college, and median family income.12 Legislative data included whether the state had any indoor tanning law, whether the state had a law restricting youth access to indoor tanning, and the stringency score of the general law, using data collected in a previous study.10 The range of possible stringency scores was 0–100, and cities in states without an indoor tanning law were given a score of zero. Additionally, whether tanning facilities in states with indoor tanning laws were inspected at least annually was included.9

Contextual Data

Placing the number of indoor tanning facilities in a socio-culturally meaningful context was desirable. Therefore, the numbers of Starbucks and McDonald’s for each of the cities were estimated by systematically searching Superpages.com.17

Statistical Analysis

Analyses, performed in Spring 2008, included examining bivariate relationships between facility density and potential predictors using independent t-tests, ANOVA, or zero-order correlations. With facility density as the dependent variable, multiple linear regression was conducted with those variables found to have significant associations with density in the bivariate tests. Due to multicol-linearity between several study variables, only five variables were included in the multivariate model: coastal/noncoastal status, annual average temperature, UV index, the percentage of whites, and the percentage with some college or more. Variables were selected based on what was thought to more directly influence indoor tanning availability (e.g., temperature and UV index versus latitude were selected).

Results

A total of 4561 facilities were identified. The raters had exact agreement on the number of indoor tanning facilities for 22 (73.3%) of the 30 cities; for the remaining eight cities, they differed by only one facility. The mean number of facilities for the 116 cities was 41.8 (SD=30.8), and the mean density was 11.8 (SD=6.0). The number and density of indoor tanning facilities for each city are provided in Table 1. The mean numbers of Starbucks and McDonald’s per city were 19 (SD=25.2) and 29.6 (SD=22.5), respectively.

Table 1
City population size, facility number, and facility density

Table 2 shows results from bivariate analyses. The multivariate model accounted for 23.8% of the variance in facility density and was a good fit (F=6.56; p<0.001). Cities with higher percentages of white residents (β=0.29, p=0.004) and cities with a lower UV index (β=−0.46, p=0.02) had significantly higher facility density. Coastal status, annual average temperature, and the percentage of residents having some college or more were no longer significantly associated with facility density.

Table 2
Bivariate associations between study variables and facility density

Discussion

High numbers of indoor tanning facilities and high facility density were found in many of the cities, and the number of facilities exceeded the numbers of two ubiquitous institutions—Starbucks and McDonald’s. Facility density was higher in cities with a larger percentage of whites and with a lower UV index. The percentage of the white population also had predicted facility density in two previous studies.11,18 Given that whites are more likely to use indoor tanning facilities,8 the finding regarding an association between the percentage of whites and facility density may reflect the business plan of indoor tanning facilities to be located in areas with higher demand. The association between a lower UV index and higher facility density may be due to residents’ desires to seek warmth, tanned skin, or both when natural sunlight is less available.

Methodologic limitations included the study’s cross-sectional design, the inclusion of only large cities, and not validating the sources used to identify the indoor tanning facilities, Starbucks, and McDonald’s. Therefore, causality between density and its correlates should not be inferred, and the findings may not generalize to smaller cities or rural areas. These estimates provide a snapshot of facility availability; it was outside of the study’s scope to evaluate facility stability. Thus, some facilities may subsequently have gone out of business, while new businesses may not have been listed yet in the directories. Strengths included carefully identifying facilities using precise geographic boundaries, including a broad range of potential predictor variables, and using a sample that represented the largest U.S. cities and all 50 states.

In conclusion, this study documents the wide availability of indoor tanning facilities in the U.S. In other areas of public health, the availability of built-environment resources has been linked with both health-risk and health-protective behaviors.57,19,20 Likewise, the availability of commercial tanning may be partly responsible for the high rates of indoor tanning among young adults and teens.24,8,2123 Future research should systematically assess whether tanning-facility availability is associated with indoor tanning and skin-cancer incidence.24

Acknowledgments

The authors wish to thank Dr. George Belch, Dr. Jean Forster, Dr. Todd Gilmer, Dr. Martin Weinstock, Ami Hurd, Latrice Pichon, Justin Shepard, and Debra Rubio for their help with this study. This study was funded by the NIH National Cancer Institute (R01CA093532 and K05CA100051).

Footnotes

No financial disclosures were reported by the authors of this paper.

References

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