NORTHWESTERN (US)—Young women in a recent study were more likely to cut back on indoor tanning based on concerns about getting leathery, wrinkled skin, rather than worries about skin cancer.

“They’re not worried about skin cancer, but they are worried about getting wrinkled and being unattractive,” says June Robinson, a professor of dermatology at Northwestern University and senior author of a paper in Archives of Dermatology reporting the findings.

The study examined the best strategy to wean college-age women who are considered addicted or pathological indoor tanners. The results showed warning them about the effects on their appearance caused a 35 percent drop in their indoor tanning visits, which were measured at intervals up to six months after the intervention.

“The fear of looking horrible trumped everything else,” says Robinson. “It was the most persuasive intervention, regardless of why they were going to tan.”

Joel Hillhouse, lead author of the paper and a professor of community health at East Tennessee State University, notes that some women in the study eventually stopped tanning. “It was a progressive kind of thing,” he says. “At first the women said they tried sunless tanning as an alternative, but over time they gave up tanning altogether.”

Between 25 to 40 percent of older adolescent girls visit tanning salons, according to the study’s authors. They and other scientists link the rapidly rising rates of melanoma and other skin cancers in young women to tanning beds. A new 10 percent federal excise tax on indoor tanning will go into effect July 1 in an effort to discourage indoor tanning.

The National Cancer Institute found that melanoma rates among Caucasian women aged 15 to 39 rose 50 percent between 1980 and 2004. The World Health Organization recently reclassified indoor tanning beds to its highest cancer risk category.

The study included 435 college women, ages 18 to 22, who visited tanning salons. Within this population, researchers focused on women who visited salons up to four times a week—more than what is needed to maintain a tan—and who tanned for psychological reasons, not just for a special event.

These tanners included one group who strongly disliked the natural color of their skin, which was related to a psychological condition called body dysmorphia. “They thought their skin was disgusting when it was pale,” Hillhouse says.

The other group, who said tanning made them feel happier and more relaxed, showed symptoms of seasonal affective disorder (SAD) on a diagnostic psychological test. “They were self medicating their own depression,” Robinson says, noting that lying in a tanning bed produces internal opioids.

The women received a 25-page booklet, authored by Hillhouse, that discussed the effect of tanning on appearance and explained how ultraviolet rays destroy collagen in the skin. The booklet also offered many alternatives to meet the women’s needs for tanning, such as taking an exercise class for socializing and relaxation, or getting a spray-on tan or self-tanning cream application at a spa. After reading the booklet, the women reported their attitudes and behaviors twice a week in diaries.

The study results surprised researchers.

“The hypothesis was because this was an appearance intervention, it would have less of an effect on the people tanning for mood problems,” Hillhouse says. “We found the opposite. The intervention worked just as well for people with seasonal affective disorder as for people who didn’t like their skin color. That means it’s a really good intervention for everyone.”

His advice to parents and physicians: “Don’t focus on skin cancer. The message that will get young women’s attention is indoor tanning’s long-term effect on their appearance. That will wake them up and get them to think about this.”

Robinson stresses it’s also important to offer women alternatives to tanning salons. “You have to balance the positive and the negative forces that motivate someone to change,” she says. “First you have the fear that they will look horrible, then you offer a positive—an alternative to meet their needs.”

The research was supported in part by a grant from the American Cancer Society.

Robinson is the editor of Archives of Dermatology. She was not involved in the editorial evaluation or decision to accept the article for publication.

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