Characteristics and Skin Cancer Risk Behaviors of Adult Sunless Tanners in the United States

JAMA Dermatol. 2018 Sep 1;154(9):1066-1071. doi: 10.1001/jamadermatol.2018.2054.


Importance: Incidence rates of nonmelanoma and melanoma skin cancers are increasing rapidly in the United States likely because of increased UV light exposure. Sunless tanning is a safe alternative to achieve tanned skin that might help reduce skin cancer incidence by deterring risky behaviors. However, limited data exist on the characteristics and associated skin cancer risk behaviors of sunless tanners in the United States.

Objective: To assess the demographic characteristics and skin cancer risk behaviors of sunless tanners among adults in the United States.

Design, setting, and participants: This secondary analysis of a cross-sectional study used data from the 2015 National Health Interview Survey, a population-based survey of the US noninstitutionalized civilian population. Participants included 27 353 men and women 18 years or older.

Main outcome and measures: Participant demographics and skin cancer risk behaviors, including indoor tanning, skin cancer screening, sunburn, and sun protection behaviors.

Results: Of the 27 353 adults (representative of more than 198 million US adults; mean [SE] age, 46.0 [0.2] years) studied, 6.4% (SE, 0.2%) reported sunless tanning. Factors associated with sunless tanning included being young, female, non-Hispanic white, college educated, nonobese, and sun sensitive, living in the western United States, and having a family history of skin cancer. Sunless tanners were more likely to report indoor tanning (adjusted prevalence odds ratio [aPOR], 3.77; 95% CI, 3.19-4.43; P < .001), recent sunburn (aPOR, 1.55; 95% CI, 1.31-1.83; P < .001), use of sunscreen (β = 0.19; 95% CI, 0.09-0.28; P < .001), and having had a full-body skin examination (aPOR, 1.77; 95% CI, 1.51-2.08; P < .001) but less likely to seek shade (β = -0.12; 95% CI, -0.19 to -0.04; P = .001) or use protective clothing when outdoors (long pants: β = -0.18; 95% CI, -0.26 to -0.11; P < .001; long sleeves: β = -0.10; 95% CI, -0.18 to -0.03; P = .01). Among indoor tanners, sunless tanners compared with those who did not sunless tan reported increased frequency of indoor tanning (mean [SE], 19.2 [1.9] vs 14.9 [1.2] sessions in the past 12 months; P = .04) but no differences in other skin cancer risk behaviors.

Conclusions and relevance: This study suggests that sunless tanning is associated with risky skin cancer-related behaviors. Longitudinal studies are needed to assess whether sunless tanning changes UV exposure behaviors to better determine whether sunless tanning represents an effective public health strategy to reduce rates of skin cancer in the United States.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Adolescent
  • Adult
  • Age Factors
  • Aged
  • Cosmetic Techniques* / instrumentation
  • Cross-Sectional Studies
  • Early Detection of Cancer / statistics & numerical data
  • Educational Status
  • Ethnicity / statistics & numerical data
  • Female
  • Health Risk Behaviors*
  • Health Surveys
  • Humans
  • Male
  • Middle Aged
  • Photosensitivity Disorders / epidemiology
  • Protective Clothing / statistics & numerical data
  • Sex Factors
  • Skin Neoplasms / diagnosis
  • Skin Neoplasms / epidemiology*
  • Sunbathing / statistics & numerical data*
  • Sunburn / epidemiology
  • Sunscreening Agents / therapeutic use
  • Suntan
  • United States / epidemiology
  • Young Adult


  • Sunscreening Agents