Skin cancer is the most common form of malignancy in the U.S., and the prevalence is increasing. Evidence is growing to suggest that indoor tanning increases skin cancer risk, and there is reason to believe that the type of UV exposure in indoor tanning may pose a particular risk. Indoor tanning by adolescents is a common, high-risk and unaddressed behavior. This practice is supported by strong social norms about the benefits of having a tan. Indeed, adolescents at highest risk due to their skin type may be most likely to purchase indoor tanning sessions. Interventions to reduce skin cancer risk tested to date have not addressed indoor tanning. Environmental strategies to reduce the likelihood of indoor tanning by adolescents is a promising approach that may complement educational initiatives. We propose a Phase II methods development study to explore the feasibility and effectiveness of an innovative intervention to reduce adolescent indoor tanning by increasing compliance with restrictions on tanning businesses, and reducing adolescent access to those businesses. We will survey adolescents, their parents, tanning businesses and public health officials, and use those data to develop and test an intervention directed at tanning business employees. The primary outcomes of the pilot test will be whether employees of tanning businesses comply with the restrictions and requirements of tanning businesses, including restricting access to an underage buyer without parental permission. As shown for other high-risk behaviors, policy interventions can provide a consistent environmental barrier that enhances the effectiveness of more traditional intervention approaches. This study is conducted in two states (Minnesota and Massachusetts) to reflect between state differences in regulations and their enforcement, and to enhance the generalizability of the results. This Methods Development study is designed to provide the basis for a future intervention trial to determine the efficacy of policy interventions to reduce adolescent use of indoor tanning.
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