The End of Tanning?

The skin’s darkening effect is caused by the rapid production of melanin, a type of skin pigment.

“When skin cells develop melanin, it's doing so in response to the damage,” said Len Lichtenfeld, an oncologist and deputy chief medical officer of the American Cancer Society. “It's not doing that because it's a healthy sign.”

The tanning process itself can be addictive: Sunlight stimulates the release of endorphins, resulting in feelings of relaxation or euphoria—the phenomenon sometimes called "runner's high."

"Tanning makes you feel good. But so does methamphetamine," said Joel Hillhouse, a professor of public health at East Tennessee State University who has studied the psychology of tanning. He said some of his study subjects have stolen money or broken into tanning salons to get their fix.

Using tanning beds increases the risk of developing melanoma, the most deadly form of skin cancer, by 59 percent. More than 60,000 new melanomas are diagnosed in the U.S. annually, but treatment of other types of skin cancers increased by nearly 77 percent between 1992 and 2006. Skin cancer is now the most common type of cancer in the U.S.


Melanoma Incidence Rates by Gender

Data from the National Cancer Institute, projected after 2010 (Surgeon General's office)

Public health authorities have responded swiftly and, tanning salon owners say, severely. In 2009, the International Agency for Research on Cancer classified tanning beds as a Group 1 carcinogen, in the same category as cigarette smoke and asbestos. The 2010 Affordable Care Act included a 10 percent tax on indoor tanning services.

Earlier this month the surgeon general released a report calling attention to the dangers of tanning, saying in an introductory letter that "tanned skin is damaged skin." It was the first time a surgeon general had focused on skin cancer specifically.

The FDA also recently reclassified the safety level of tanning beds from low-risk—on par with Band-Aids—to moderate-risk, like condoms and wheelchairs. On top of that, the agency mandated that the beds carry a black-box warning stating that they should not be used by minors.


Age Restrictions on Indoor Tanning

Data from the National Conference of State Legislatures (Surgeon General's office)

Because sunburns during childhood cause a particularly sharp increase in the likelihood of developing skin cancer, in recent years nine states have barred anyone under the age of 18 from using tanning beds. Thirty-two others regulate the devices’ use by minors.

* * *

The laws and warnings have prompted widespread outrage among tanning enthusiasts. Today, the conversation on the science behind skin cancer can be as vicious as the one about climate change.

"We're agrarian by nature," said Rob Quinn, CEO of a chain of 40-some Tan Pro stores in Ohio, referring to humanity. "We crave nourishment, water, and sunlight. I can't imagine our Creator would be that mean to say, 'Okay I'm going to introduce you to this light, and I'm going to make you crave it and love it, but it's bad for you.'"

Quinn believes that the recent anti-tanning push is a conspiracy by the world's dermatologists, and that we will yet see the lasting negative repercussions of keeping a generation of humans out of the sun. He said that Ohio has lost 40 percent of its registered tanning salons, and that the customer headcount in some stores is down by nearly half.

Baker is hyper-aware, and hyper-sensitive, to accusations that people who use sunbeds have a higher risk of developing skin cancer.

"I've read enough to know that it's very difficult to say that one thing or another is causing this or that," he said. "I don't agree [that there's a strong link between indoor tanning and melanoma]. There's a lot of factors that go into that type of serious disease."

When I asked what conclusions he's drawn from his readings, he declined to comment.

Though minors make up just two or three percent of most tanning salons' customers, the recent under-18 bans have been the source of particular scorn within the tanning industry.

"Whether or not a 17-year-old or 16-year-old gets a suntan, that should be up to his or her parents, not the government," John Overstreet, the executive director of the Indoor Tanning Association, told me. "The kid wants to get a suntan, and the government won't let them."

He points out that there are already warnings against overexposure on most tanning salon intake forms and on the beds themselves. "With all these warnings, why do people do this?" he said. "I honestly believe it's because we're being given bad advice."

* * *

After decades of soaking up the sun, there are signs that we might be returning to the age of the parasol—or at least a bottle of SPF 30 in every beach tote.

"There's been a cultural shift," Hillhouse, the psychologist, said. "Fifteen years ago, you would not have seen an article in Seventeen or Cosmopolitan about the dangers of indoor tanning, but now it's very common."

Quinn said that the drumbeat of skin-cancer coverage has spooked even the most devoted tanners, who now say things like, "I know it's bad for me, but I just love doing it."

Some have switched to spray tanning, even though it doesn’t generate the same “feel good” boost, he says.

But there are other signs that tanning, as a principle, is becoming passé.

"A coppertone complexion isn't looking so fresh this summer season," proclaimed a style article in USA Today last year, pointing to the rise of pasty beauties like Emma Stone and Taylor Swift.

"We're not seeing [people] flocking to tanning," Karen Grant, a beauty analyst with NPD, told me. A decade ago, fake-tan lotions made up 65 percent of sales in the "sun category," she said, but today, sunscreens dominate that market. "There's a higher awareness of safety, or lack thereof. The movement has been toward protection."

Slightly less than a third of non-Hispanic white women, who make up the majority of indoor-tanning customers, still use tanning beds. However, data from the CDC show that the number of high-school students who used indoor tanning devices has declined by about three percentage points (from 16 to 13 percent) since 2009, though that number is within the margin of error. Among girls, the drop-off was six percentage points.

Lichtenfeld noticed that when he was recently vacationing on a beach in south Georgia, roughly three out of four families were huddling under a canopy or umbrella.

It was anecdotal, to be sure, but nevertheless, “it was a lot different than what I have seen before, so maybe we are making some progress after all,” he wrote on his blog at Cancer.org.

Tanning-related posts to the "Girls Survival Guide" section of Reddit are now dominated by questions of how to achieve "a glow" without a tanning bed. A recent video showing the protective effects of sunscreen—posted by Upworthy under the headline "What Happens To Your Face When You Wear Sunscreen Might Shock You"—has generated more than 30,000 Facebook likes. The comments are tinged with exuberant outrage: "Sunscreen is a must. I want to live!!!!!!!!!!!"

* * *

There are limits to health-scare mongering, though. A February study that surveyed sorority members found that 45 percent used tanning beds even though most knew about the cancer risk.

We Are Brave

Hillhouse says that the most effective anti-tanning campaigns focus instead on how the practice can disfigure skin over time. Rather than ads that, say, portray sunbathers as laying in their own coffins, he recommends posters like one recently commissioned by Britain’s NHS, which shows a young blond woman with a mottled face and a nasty melanoma on her lip.

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Olga Khazan is a staff writer at The Atlantic, where she covers health.

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