Who still indoor tans in the U.S.? An analysis of the 2019 behavioral risk factor surveillance system

Summary: Despite significant declines in indoor tanning prevalence over the past two decades, it remains a public health concern due to its association with photoaging and melanoma risk. Using data from the 2019 Behavioral Risk Factor Surveillance System (BRFSS), we analyzed national prevalence and factors associated with indoor tanning among U.S. adults, stratified by sex. We analyzed responses from 11,228 adults (6,116 females, 5,112 males). Participants reported indoor tanning use in the past year, dichotomized as “ever” versus “never.” Logistic regression models adjusted for sampling probabilities assessed associations with race/ethnicity, age, income, education, health status, smoking, binge drinking, obesity, urban/rural residence, skin cancer history, marital status, and sexuality. The prevalence of indoor tanning in the past year was 1.96% among females and 0.87% among males. Among those who tanned, 59.5% reported ≥10 sessions in the past year. Tanning was most common among White, non-Hispanic females (3.10%) and those aged 18-24 years (2.74%). In females, risk factors included smoking (AOR 2.57, 95% CI 1.04-6.32), binge drinking (AOR 2.16, 95% CI 1.25-3.73), rural residence (AOR 2.35, 95% CI 1.07-5.17), and never-married status (AOR 2.22, 95% CI 1.05-4.68). Obesity was associated with decreased odds of tanning in females (AOR 0.33, 95% CI 0.18-0.61). In males, predictors included Hispanic ethnicity (AOR 2.88, 95% CI 1.00-8.33), smoking (AOR 6.85, 95% CI 2.14-21.92), higher education, and sexual minority status (AOR 8.18, 95% CI 3.51-19.05). Neither skin cancer history nor general health influenced tanning in either sex. While indoor tanning prevalence has declined, high-frequency tanning persists among a small subset, posing a public health challenge. Behavioral risk factors and demographic disparities such as rural residence in females and sexual minority status in males highlight the need for targeted interventions. Addressing high-frequency tanning is essential to reduce melanoma and non-melanoma skin cancer risks and advance public health goals. Maria Kaltchenko¹, Elle Kim¹, Anna L. Chien¹ 1. Department of Dermatology, Johns Hopkins Medicine, Baltimore, MD, United States. Clinical Research: Epidemiology and Observational Research