Psychiatric Symptoms of Young Adult Female Indoor Tanners
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1 Psychiatric Symptoms of Young Adult Female Indoor Tanners Carolyn J. Heckman, PhD, 1 Susan Darlow, PhD, 1 Jessye Cohen-Filipic, MS, 2 Jacqueline D. Kloss, PhD, 3 Teja Munshi, BDS, MPH, 1 and Sharon L. Manne, PhD 4 1. Fox Chase Cancer Center, PA 2. Portland VAMC, OR 3. Drexel University, PA 4. Cancer Institute of New Jersey 1
2 2
3 Indoor Tanning Industry 3
4 Prevalence of indoor tanning in young adults 2005 National Health Interview Survey (NHIS) Data N = 29,394 US adults 20% in last year among year olds 27% among women, 13% among men Heckman, Coups, Manne JAAD. 4
5 What motivates people to tan? US public is aware of dangers of UV Still high levels of exposure Minimal protective behaviors Appearance is the primary motivation Social influence factors May also impact anxiety, mood, or addictive symptoms 5
6 Psychosocial correlates of indoor tanning Tanning for mood or relaxation purposes (e.g., Hillhouse et al., 2007; Stapleton et al., 2010) Sensation-seeking, smoking, binge drinking, drugs (Bagdasarov et al. 2008; Ibrahim & Brown, 2008) 2005 NHIS Data, N=29,394 US adults (Heckman, Coups, & Manne, JAAD, 2008) Health behaviors among indoor tanners under age 50 Current smoking, risky drinking No physical activity, less than 5 servings of F/V per day Not being overweight/obese Other skin cancer risk behaviors (e.g., sunburns) Also see Coups & Phillips, JEADV, 2011 for a systematic review of correlates 6
7 Why do some people tan so frequently? Tanning Dependence Tanorexia Warthan et al. (2005) mcage Cut down, annoyed, guilty, eye-opener mdsm-iv-tr Tolerance, withdrawal, out of control behavior, impairment Tanning Pathology Scale (TAPAS) Focus groups and psychometric testing Dissatisfaction with Skin Color Indoor Tanning as a Problem Opiate like Reactions to Tanning Tolerance to the Physiological Effects of Tanning (Longacre et al., 2006; Hillhouse et al., 2007) 7
8 e.g., Heckman, Egleston et al., AJHB,
9 Proposed mechanisms of tanning dependence (Oren & Bartek, Cell, 2007) 9
10 Evidence for these mechanisms Release of endogenous opioids during UV exposure UV (vs. non UV) bed preference among blinded frequent tanners Reasons were relaxation and decreased tension (Feldman et al., 2004) Opioid blockade (antagonist naltrexone) reduced preference Withdrawal-like symptoms such as nausea, fatigue, and low concentration in frequent tanners at higher doses (Kaur et al., 2006) Decreased fibromyalgia pain after exposure to UV vs. non-uv (Taylor et al., 2009) Increased striatal activation & decreased tanning desire Single photon emission tomography (SPECT) imaging Tanning dependent indoor tanners in UV vs. sham (non-uv) (Harrington et al., 2011) 10
11 Psychosocial correlates of tanning dependence Online survey of 400 college students 38% tanned indoors, 27% TD TD associated with smoking, anaerobic exercise, not being obese (Heckman, Egleston, et al., AJHB, 2008) Survey of 421 college students 56% tanned indoors 39% met DSM, 31% CAGE criteria TD associated with anxiety, alcohol, marijuana, other substances Depression not associated with TD (Mosher & Danoff-Burg, 2010) 11
12 Identifying Novel Correlates of Indoor Tanning Experiences: Project INCITE R03CA
13 Purpose of the Study To identify psychosocial correlates of indoor tanning and tanning dependence and characterize subgroups of participants Few studies have comprehensively assessed psychological and addictive symptoms among tanners No study has previously used a standardized clinical interview Results could inform development of interventions to address relevant psychological and addictive problems 13
14 Participants and Methods Sample (n = 518) Drexel University SONA online psych research subject pool year old females Any tanning history, 67% Caucasian Fall/winter/spring recruitment Design Cross-sectional Online survey about tanning emini International Neuropsychiatric Interview conducted by phone 14
15 Results: Axis I Correlates of IT 40% indoor tanners (IT) Chi square analyses Variables Substance abuse or dependence Smoked in past 30 days IT (n = 146) No IT (n = 174) Overall (N = 320) 32 (21.9%) 15 (8.6) 47 (14.7) (21.9) 19 (10.9) 51 (15.9).007 Alcohol use sx 104 (71.2) 82 (47.1) 186 (58.1) <.001 Social anxiety sx 5 (3.4) 16 (9.2) 21 (6.6).032 p Generalized anxiety sx 33 (22.6) 14 (8.1) 47 (14.7) <.001 NS = any mental disorder, illicit drug use, SAD, MDD, ED, OCD, PTSD 15
16 Results: Axis I Correlates of IT Multivariable logistic regression (N = 320) Symptoms OR (95% CI) P Alcohol use sx 2.72 ( ) <.001 Social anxiety sx 0.22 ( ).015 Generalized anxiety sx 3.42 ( ) <.001 Smoking no longer significant 16
17 Results: Axis I Correlates of TD 25% tanning dependent (TD) based on mcage or mdsm-iv criteria Chi square analyses Variables TD (n = 76) Not TD (n = 230) Overall (N = 306) p Any psych diagnosis 47 (61.8%) 107 (46.5) 154 (49.7).020 Alcohol use sx 58 (76.3) 121 (52.6) 179 (58.5) <.001 Seasonal affective sx 45 (59.2) 104 (45.2) 149 (48.7).034 None of the other psych or substance variables were significant. 17
18 Results: Axis I Correlates of TD Multivariable logistic regression (N = 306) Symptoms OR (95% CI) P Alcohol use sx 3.26 ( ) <.001 Seasonal affective sx 1.67 ( ).075 Major depression sx 0.52 ( )
19 Results: Emotions Pre-Post Post Tanning Retrospective mood (PANAS) before and after last indoor tanning episode Factor analysis Self-assurance strong, proud, alert, inspired, determined, attentive, active Arousal interested, excited, enthusiastic Anxiety guilty, scared, ashamed, nervous, jittery, afraid Anger upset, hostile, irritable 19
20 Results: Emotions Pre-Post Post Tanning (N = 230) Category Self-assurance Before or After Tanning Before 2.3 (0.9) After 2.2 (1.0) M(SD) t p Arousal Anxiety Anger Before 2.9 (1.0) After 2.7 (1.0) Before 1.7 (0.8) After 1.5 (0.7) Before 1.4 (0.7) After 1.3 (0.7) 3.77 < < <
21 Planned Analyses Association of skin protection behavior with psychosocial variables Latent profile analyses to characterize subgroups Intervention design to reduce tanning and related psychosocial problems 21
22 Conclusions about IT and TD Associated with anxiety, mood, and substance use + and - mood states decrease after tanning Suggests possible numbing effect More than just appearance Psychological, behavioral, addictive factors Concern for (female) children and young adults 22
23 Shedding Light on Indoor Tanning Heckman & Manne (Eds) Introduction 2. History and Culture of Tanning in the United States 3. Prevalence and Correlates of Indoor Tanning (Coups) 4. Motivations for Indoor Tanning: Theoretical Models 5. How Ultraviolet Radiation Tans Skin 6. Skin Cancer and Other Health Effects of Indoor Tanning 7. Tanning Dependence: Is tanning an addiction? 8. Selected Indoor Tanning Myths and Controversies 9. A Systematic Review of Interventions Reduce Indoor Tanning 10. Indoor Tanning Regulation, Enforcement, Taxation, and Policy 11. Sunless Tanning 12. International Perspectives on Indoor Tanning (Hay) 13. Indoor Tanning: Past, Present, and Future 23
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