摘要：Objectives. We evaluated psychosocial, built-environmental, and policy-related correlates of adolescents’ indoor tanning use. Methods. We developed 5 discrete data sets in the 100 most populous US cities, based on interviews of 6125 adolescents (aged 14–17 years) and their parents, analysis of state indoor tanning laws, interviews with enforcement experts, computed density of tanning facilities, and evaluations of these 3399 facilities’ practices regarding access by youths. After univariate analyses, we constructed multilevel models with generalized linear mixed models (GLMMs). Results. In the past year, 17.1% of girls and 3.2% of boys had used indoor tanning. The GLMMs indicated that several psychosocial or demographic variables significantly predicted use, including being female, older, and White; having a larger allowance and a parent who used indoor tanning and allowed their adolescent to use it; and holding certain beliefs about indoor tanning's consequences. Living within 2 miles of a tanning facility also was a significant predictor. Residing in a state with youth-access legislation was not significantly associated with use. Conclusions. Current laws appear ineffective in reducing indoor tanning; bans likely are needed. Parents have an important role in prevention efforts. In 2010, melanoma was estimated to be responsible for approximately 68 130 new cases and approximately 8700 related deaths in the United States. 1 Evidence is mounting that exposure to ultraviolet radiation (UVR) from tanning lamps during indoor tanning sessions is a risk factor for both melanoma 2 , 3 and squamous cell cancer. 2 Moreover, indoor tanning use before the age of 35 years increases melanoma risk by 75%. 2 Therefore, the high rate of indoor tanning use by US adolescent girls, which is significantly higher than the rate among adolescent boys, 4 – 7 is particularly alarming, with rates as high as 40% among older adolescent girls. 4 This finding may explain the recent rise in melanoma incidence among young US women. 8 In July 2009, the International Agency for Research on Cancer, which is part of the World Health Organization, elevated tanning beds to its highest risk category: carcinogenic to humans. 9 In March 2010, the US Food and Drug Administration (FDA) convened an advisory panel to more comprehensively address indoor tanning risks and relevant classifications and policies. 10 As ecological models suggest, indoor tanning by adolescents is likely influenced by a combination of psychosocial and individual factors, environmental factors, and policy-related factors. 11 To date, research on correlates of adolescents’ indoor tanning has focused on the psychosocial level. 12 , 13 Although those data have been useful for designing interventions, 14 , 15 they may represent only part of the picture. For example, many US states have passed indoor tanning legislation related to access by youths, 16 – 20 but at the time the current study was conducted, no studies had evaluated whether presence or absence of legislation was associated with indoor tanning use. Likewise, although evidence existed that (1) availability of commercial indoor tanning is high, 21 , 22 (2) tanning facilities may be more prevalent in neighborhoods with higher numbers of young adults and high schools, 23 and (3) tanning facilities are not complying with youth-access laws, 24 – 30 relationships between these data and actual indoor tanning use had not been assessed. CITY100 (Correlates of Indoor Tanning in Youth) is a multicomponent project consisting of 5 data sets; its goal is to evaluate the correlates of adolescents’ indoor tanning use, guided by the 3 levels of an ecological model of health behavior mentioned previously. Using cross-sectional data from the 100 most populous US cities, we simultaneously evaluated the relationships between recent indoor tanning use and demographic and psychosocial variables (e.g., age, sex, parents’ use of tanning), built-environment variables (i.e., city-level density of tanning facilities per population and proximity to tanning facilities of individual adolescents), and policy-related variables (i.e., presence and stringency of legislation, enforcement of legislation at the local level, and practices by facilities related to youth access). This article provides the main results of the entire CITY100 project, which links all 5 data sets to predict indoor tanning.
