Artificial Tanning Joshua Langhorne, MD Janienne Kondrich, MD Community Pediatrics Legislative...

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Artificial Tanning Artificial Tanning Joshua Langhorne, MD Joshua Langhorne, MD Janienne Kondrich, MD Janienne Kondrich, MD Community Pediatrics Legislative Advocacy Project

Transcript of Artificial Tanning Joshua Langhorne, MD Janienne Kondrich, MD Community Pediatrics Legislative...

Page 1: Artificial Tanning Joshua Langhorne, MD Janienne Kondrich, MD Community Pediatrics Legislative Advocacy Project.

Artificial TanningArtificial Tanning

Joshua Langhorne, MDJoshua Langhorne, MD

Janienne Kondrich, MDJanienne Kondrich, MD

Community Pediatrics Legislative

Advocacy Project

Page 2: Artificial Tanning Joshua Langhorne, MD Janienne Kondrich, MD Community Pediatrics Legislative Advocacy Project.

Tanning industryTanning industry

• ~ $5 billion~ $5 billion annually, annually, up from $1 billion in up from $1 billion in 19921992

• Fifty thousand Fifty thousand tanning facilities in tanning facilities in the USthe US

• 28 million visits per 28 million visits per yearyear

Page 3: Artificial Tanning Joshua Langhorne, MD Janienne Kondrich, MD Community Pediatrics Legislative Advocacy Project.

Tanning + TeensTanning + Teens

• Specifically targeted by the tanning Specifically targeted by the tanning industry – i.e., ads in HS newspapers!industry – i.e., ads in HS newspapers!

• 24% of teens ages 13 to 19 reported using 24% of teens ages 13 to 19 reported using a tanning facility once in their livesa tanning facility once in their lives

• 10% of 11 to 18 year olds within the last 10% of 11 to 18 year olds within the last yearyear

• Artificial tanning among white females Artificial tanning among white females rises with age: use doubles from ages 14 rises with age: use doubles from ages 14 to 15 (7% to 15%), and doubling again at to 15 (7% to 15%), and doubling again at age 17 (35%)age 17 (35%)

Page 4: Artificial Tanning Joshua Langhorne, MD Janienne Kondrich, MD Community Pediatrics Legislative Advocacy Project.

Acute health effectsAcute health effects

• SunburnSunburn• Skin drynessSkin dryness• PruritisPruritis• NauseaNausea• Photodrug reactionsPhotodrug reactions• Disease Disease

exacerbationexacerbation– SLESLE

• Disease inductionDisease induction– Polymorphous light Polymorphous light

eruptioneruption

Page 5: Artificial Tanning Joshua Langhorne, MD Janienne Kondrich, MD Community Pediatrics Legislative Advocacy Project.

Long term health effectsLong term health effects• Skin agingSkin aging• Effects on the eyeEffects on the eye

Cataract formationCataract formation Macular degenerationMacular degeneration

• Carcinogenesis:Carcinogenesis:– > 1 million new cases of skin cancer in the US > 1 million new cases of skin cancer in the US

each yeareach year– Increase at least in part attributable to Increase at least in part attributable to

increased popularity of artificial tanningincreased popularity of artificial tanning– UVA irradiation may be 10-15 X more powerful UVA irradiation may be 10-15 X more powerful

than than THE MIDDAY SUNTHE MIDDAY SUN

– Childhood and adolescence are periods of Childhood and adolescence are periods of greater biological vulnerability to UVRgreater biological vulnerability to UVR

Page 6: Artificial Tanning Joshua Langhorne, MD Janienne Kondrich, MD Community Pediatrics Legislative Advocacy Project.

Skin cancer: further increase Skin cancer: further increase of risk with artificial vs. natural of risk with artificial vs. natural UVR?UVR?• NIH: Exposure to sunlamps or sunbeds is a NIH: Exposure to sunlamps or sunbeds is a

known human carcinogenknown human carcinogen• Association between use of any tanning Association between use of any tanning

device and increased incidence of basal cell device and increased incidence of basal cell or squamous cell carcinomaor squamous cell carcinoma

• Scandinavian study: increased melanoma Scandinavian study: increased melanoma risk in femalesrisk in females

• The International Agency for Research on The International Agency for Research on Cancer found that even Cancer found that even oneone exposure to exposure to artificial UVR was associated with artificial UVR was associated with melanoma; first exposure melanoma; first exposure before the age of before the age of 3535 significantly increased risk significantly increased risk

Page 7: Artificial Tanning Joshua Langhorne, MD Janienne Kondrich, MD Community Pediatrics Legislative Advocacy Project.

The Freedom to TanThe Freedom to Tan

• The tanning industry has fought for teens to The tanning industry has fought for teens to have continued access to tanning salonshave continued access to tanning salons

• Promote the health benefits and safety of Promote the health benefits and safety of artificial tansartificial tans

• The mission of the Indoor Tanning The mission of the Indoor Tanning Association is “to protect the freedom of Association is “to protect the freedom of individuals to acquire a suntan, via natural individuals to acquire a suntan, via natural or artificial light.”or artificial light.”

• Parental rights issueParental rights issue

Page 8: Artificial Tanning Joshua Langhorne, MD Janienne Kondrich, MD Community Pediatrics Legislative Advocacy Project.
Page 9: Artificial Tanning Joshua Langhorne, MD Janienne Kondrich, MD Community Pediatrics Legislative Advocacy Project.

What are the formal What are the formal stances of various medical stances of various medical

organizations?organizations?

Page 10: Artificial Tanning Joshua Langhorne, MD Janienne Kondrich, MD Community Pediatrics Legislative Advocacy Project.

World Health OrganizationWorld Health Organization

The WHO is the The WHO is the directing and directing and coordinating coordinating authority for health authority for health within the United within the United Nations system. Nations system.

Page 11: Artificial Tanning Joshua Langhorne, MD Janienne Kondrich, MD Community Pediatrics Legislative Advocacy Project.

World Health World Health OrganizationOrganization• Consistent with those of the International Consistent with those of the International

Commission on Non-Ionizing Radiation Commission on Non-Ionizing Radiation Protection (ICNIRP) Protection (ICNIRP)

• Recommends against use of UV-emitting Recommends against use of UV-emitting appliances for tanning or other non-medical appliances for tanning or other non-medical purposes purposes

• Individuals < 18 years old are at particularly Individuals < 18 years old are at particularly high risk of incurring adverse health effects high risk of incurring adverse health effects from UV, and therefore should be counseled from UV, and therefore should be counseled against the use of tanning appliances against the use of tanning appliances

Page 12: Artificial Tanning Joshua Langhorne, MD Janienne Kondrich, MD Community Pediatrics Legislative Advocacy Project.

World Health World Health OrganizationOrganization

• WHO encourages governments to WHO encourages governments to formulate and enforce effective laws formulate and enforce effective laws governing the use of sunbeds governing the use of sunbeds

• ““Of highest regulatory priority should Of highest regulatory priority should be the restriction of use by persons be the restriction of use by persons under 18 years” under 18 years”

Page 13: Artificial Tanning Joshua Langhorne, MD Janienne Kondrich, MD Community Pediatrics Legislative Advocacy Project.

American Medical American Medical AssociationAssociation

Page 14: Artificial Tanning Joshua Langhorne, MD Janienne Kondrich, MD Community Pediatrics Legislative Advocacy Project.

American Medical American Medical AssociationAssociation

Supports the enactment of federal legislation to: Supports the enactment of federal legislation to:

• prohibit access to the use of indoor tanning prohibit access to the use of indoor tanning equipment (as defined in 21 CFR §1040.20 [a][9]) equipment (as defined in 21 CFR §1040.20 [a][9]) by anyone under the age of 18;by anyone under the age of 18;

• require a US Surgeon General warning be require a US Surgeon General warning be prominently posted, detailing the positive prominently posted, detailing the positive correlation between UVR, the use of indoor tanning correlation between UVR, the use of indoor tanning equipment, and the incidence of skin cancerequipment, and the incidence of skin cancer

• urge the FDA’s Center For Devices and urge the FDA’s Center For Devices and Radiological Health to hold a fair hearing as soon Radiological Health to hold a fair hearing as soon as possible on the safety and efficacy of UVA as possible on the safety and efficacy of UVA bulbs, as used in indoor tanning facilities. (Res. bulbs, as used in indoor tanning facilities. (Res. 440, A-05) 440, A-05)

Page 15: Artificial Tanning Joshua Langhorne, MD Janienne Kondrich, MD Community Pediatrics Legislative Advocacy Project.

American Academy of American Academy of DermatologyDermatology

Page 16: Artificial Tanning Joshua Langhorne, MD Janienne Kondrich, MD Community Pediatrics Legislative Advocacy Project.

American Academy of American Academy of DermatologyDermatology

• No minor should be permitted to use tanning No minor should be permitted to use tanning devices. devices.

• A Surgeon General's warning should be A Surgeon General's warning should be placed on all tanning devices. placed on all tanning devices.

• No person or facility should advertise the use No person or facility should advertise the use of any ultraviolet A or ultraviolet B tanning of any ultraviolet A or ultraviolet B tanning device using wording such as "safe," "safe device using wording such as "safe," "safe tanning," "no harmful rays," "no adverse tanning," "no harmful rays," "no adverse effect," or similar wording or concepts. effect," or similar wording or concepts.

Page 17: Artificial Tanning Joshua Langhorne, MD Janienne Kondrich, MD Community Pediatrics Legislative Advocacy Project.

American Academy of American Academy of PediatricsPediatrics

Page 18: Artificial Tanning Joshua Langhorne, MD Janienne Kondrich, MD Community Pediatrics Legislative Advocacy Project.

American Academy of American Academy of PediatricsPediatrics

• No current policy statement or No current policy statement or endorsement of other organizations’ endorsement of other organizations’ policy statements regarding policy statements regarding legislationlegislation

• Current policy statement focuses on Current policy statement focuses on education of patients and parents education of patients and parents regarding danger of UV exposureregarding danger of UV exposure

Page 19: Artificial Tanning Joshua Langhorne, MD Janienne Kondrich, MD Community Pediatrics Legislative Advocacy Project.

What is the current What is the current legislation regarding legislation regarding

artificial tanning?artificial tanning?

Page 20: Artificial Tanning Joshua Langhorne, MD Janienne Kondrich, MD Community Pediatrics Legislative Advocacy Project.

National LegislationNational Legislation

• The federal government must contend with strong The federal government must contend with strong lobbying by the multibillion-dollar tanning industrylobbying by the multibillion-dollar tanning industry

• Current focus is on making the industry safer Current focus is on making the industry safer • Tanning Accountability and Notification Act Tanning Accountability and Notification Act

of 2007of 2007:: Introduced in House and SenateIntroduced in House and Senate Requires the FDA to conduct consumer testing Requires the FDA to conduct consumer testing

to determine the appropriateness of the current to determine the appropriateness of the current labeling requirements for indoor tanning deviceslabeling requirements for indoor tanning devices

• Contrast with France: Contrast with France: Banned indoor tanning for people under the age Banned indoor tanning for people under the age

of 18 since 1997of 18 since 1997

Page 21: Artificial Tanning Joshua Langhorne, MD Janienne Kondrich, MD Community Pediatrics Legislative Advocacy Project.

What is the current labeling What is the current labeling requirement?requirement?

DANGER—Ultraviolet radiation. Follow instructions. Avoid DANGER—Ultraviolet radiation. Follow instructions. Avoid overexposure. As with natural sunlight, overexposure overexposure. As with natural sunlight, overexposure can cause eye and skin injury and allergic reactions. can cause eye and skin injury and allergic reactions. Repeated exposure may cause premature aging of the Repeated exposure may cause premature aging of the skin and skin cancer. WEAR PROTECTIVE EYEWEAR.skin and skin cancer. WEAR PROTECTIVE EYEWEAR.

FAILURE TO MAY RESULT IN SEVERE BURNS OR LONG-FAILURE TO MAY RESULT IN SEVERE BURNS OR LONG-TERM INJURY TO THE EYES. Medications or cosmetics TERM INJURY TO THE EYES. Medications or cosmetics may increase your sensitivity to the ultraviolet may increase your sensitivity to the ultraviolet radiation. Consult physician before using sunlamp if radiation. Consult physician before using sunlamp if you are using medications or have a history of skin you are using medications or have a history of skin problems or believe yourself especially sensitive to problems or believe yourself especially sensitive to sunlight. If you do not tan in the sun, you are unlikely sunlight. If you do not tan in the sun, you are unlikely to tan from the use of this product.to tan from the use of this product.

Page 22: Artificial Tanning Joshua Langhorne, MD Janienne Kondrich, MD Community Pediatrics Legislative Advocacy Project.

State LegislationState Legislation

• At least At least 28 states and 4 counties28 states and 4 counties regulate tanning facilities for minorsregulate tanning facilities for minors

• During the current legislative session,During the current legislative session, 7  7 statesstates have introduced bills have introduced bills

• Current tanning restrictions and Current tanning restrictions and pending legislation vary widely pending legislation vary widely between statesbetween states

Page 23: Artificial Tanning Joshua Langhorne, MD Janienne Kondrich, MD Community Pediatrics Legislative Advocacy Project.

Most Restrictive State Most Restrictive State PoliciesPolicies

• Wisconsin: No one under age 16 is Wisconsin: No one under age 16 is permitted to use tanning devices. permitted to use tanning devices.

• Multiple other states ban the use of Multiple other states ban the use of tanning devices under the age of 14 tanning devices under the age of 14 with parental permission required for with parental permission required for ages 14-18ages 14-18

Page 24: Artificial Tanning Joshua Langhorne, MD Janienne Kondrich, MD Community Pediatrics Legislative Advocacy Project.

New York State New York State PolicyPolicyN.Y. N.Y. Public Health Law ch. 573Public Health Law ch. 573  

• Children under 14 prohibitedChildren under 14 prohibited• Minors age 14 to 18 must have Minors age 14 to 18 must have

signed permission from a parent or signed permission from a parent or guardian to use the facilitiesguardian to use the facilities

• The signature must be obtained by The signature must be obtained by the facility operator in person and is the facility operator in person and is only valid for twelve monthsonly valid for twelve months

Page 25: Artificial Tanning Joshua Langhorne, MD Janienne Kondrich, MD Community Pediatrics Legislative Advocacy Project.

Pending State LegislationPending State Legislation

• Maryland, Massachusetts, Missouri, Maryland, Massachusetts, Missouri, Mississippi, Ohio, Pennsylvania, South Dakota, Mississippi, Ohio, Pennsylvania, South Dakota, and Vermont have introduced bills during this and Vermont have introduced bills during this current legislative sessioncurrent legislative session

• Most propose to limit access to minors without Most propose to limit access to minors without parental permissionparental permission

• Vermont (HB 215) “Tanning facilities may not Vermont (HB 215) “Tanning facilities may not allow individuals under age 18 to use tanning allow individuals under age 18 to use tanning devices.”devices.”

• HB 215 has unfortunately died in House HB 215 has unfortunately died in House Committee Committee

Page 26: Artificial Tanning Joshua Langhorne, MD Janienne Kondrich, MD Community Pediatrics Legislative Advocacy Project.

What can we do to get What can we do to get involved?involved?

• Continue to educate patients and parents Continue to educate patients and parents regarding proper UV safetyregarding proper UV safety

• Support pending legislation in states of Support pending legislation in states of interestinterest

• Encourage the federal government and Encourage the federal government and individual states to introduce stricter individual states to introduce stricter legislationlegislation

• Encourage AAP to endorse the policy Encourage AAP to endorse the policy statement of the WHO/AAD/AMAstatement of the WHO/AAD/AMA

Page 27: Artificial Tanning Joshua Langhorne, MD Janienne Kondrich, MD Community Pediatrics Legislative Advocacy Project.

ReferencesReferences1.1. American Academy of Dermatology. American Academy of Dermatology issues statement American Academy of Dermatology. American Academy of Dermatology issues statement

endorsing the World Health Organization’s endorsing the World Health Organization’s recommendation to restrict tanning bed use. to restrict tanning bed use. Available at: Available at: http://www.aad.org/media/background/press/WHO.html. Accessed August 6, August 6, 20082008

2.2. American Academy of Pediatrics Policy Statement. Ultraviolet Light: A Hazard to Children. American Academy of Pediatrics Policy Statement. Ultraviolet Light: A Hazard to Children. Pediatrics. 1999; 104 (2): 328-333Pediatrics. 1999; 104 (2): 328-333

3.3. American Medical Association Policy D-440.960. Prohibiting the sale of tanning parlor American Medical Association Policy D-440.960. Prohibiting the sale of tanning parlor ultraviolet rays to those under 18 years of age. Available at ultraviolet rays to those under 18 years of age. Available at www.ama-assn.org/apps/pf_newwww.ama-assn.org/apps/pf_new. Accessed August 6, 2008

4.4. Balk SJ, Geller AC. Teenagers and Artificial Tanning. Balk SJ, Geller AC. Teenagers and Artificial Tanning. PediatricsPediatrics. 2008; 121 (5): 1040-1042. 2008; 121 (5): 1040-10425.5. Indoor Tanning Association home page. Available at www.theita.com. Accessed August 18, Indoor Tanning Association home page. Available at www.theita.com. Accessed August 18,

200820086.6. Indoor Tanning Association mission statement. Available at www.theita.com. Accessed Indoor Tanning Association mission statement. Available at www.theita.com. Accessed

August 18, 2008August 18, 20087.7. Karagas MR, Stannard VA, Mott LA, Slattery MJ, Spencer SK, Weinstock MA. Use of tanning Karagas MR, Stannard VA, Mott LA, Slattery MJ, Spencer SK, Weinstock MA. Use of tanning

devices and risk of basal cell and squamous cell skin cancers. devices and risk of basal cell and squamous cell skin cancers. J Natl Cancer Inst.J Natl Cancer Inst. 2002;94 2002;94 (3):224 –226(3):224 –226

8.8. National Conference of State Legislatures. Tanning Restrictions for Minors: A State-by-State National Conference of State Legislatures. Tanning Restrictions for Minors: A State-by-State Comparison. Available at: http://www.ncsl.org/programs/health/tanningrestrictions.htm. Comparison. Available at: http://www.ncsl.org/programs/health/tanningrestrictions.htm. Accessed August 6, 2008Accessed August 6, 2008

9.9. The International Agency for Research on Cancer Working Group on artificial ultraviolet The International Agency for Research on Cancer Working Group on artificial ultraviolet (UV) light and skin cancer. The association of use of sunbeds with cutaneous malignant (UV) light and skin cancer. The association of use of sunbeds with cutaneous malignant melanoma and other skin cancers: a systematic review. melanoma and other skin cancers: a systematic review. Int J Cancer.Int J Cancer. 2006;120 (5):1116 – 2006;120 (5):1116 –11221122

10.10.World Health Organization Fact Sheet: Sunbeds, tanning and UV exposure. Available at: World Health Organization Fact Sheet: Sunbeds, tanning and UV exposure. Available at: http://www.who.int/mediacentre/ factsheets/fs287/en/. Accessed August 6, 2008http://www.who.int/mediacentre/ factsheets/fs287/en/. Accessed August 6, 2008

11.11.Veierød MB, Weiderpass E, Thörn M, et al. A prospective study of pigmentation, sun Veierød MB, Weiderpass E, Thörn M, et al. A prospective study of pigmentation, sun exposure and risk of cutaneous malignant melanoma in women. exposure and risk of cutaneous malignant melanoma in women. J Natl Cancer Inst.J Natl Cancer Inst. 2003;95 2003;95 (20):1530 –1538(20):1530 –1538