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Sunbed use in Germany: trends, user histories and factors associated with cessation and readiness to change

Authors

  • C. Bock,

    Corresponding author
    1. Mannheim Institute of Public Health, Social and Preventive Medicine, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
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  • K. Diehl,

    1. Mannheim Institute of Public Health, Social and Preventive Medicine, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
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  • D. Litaker,

    1. Mannheim Institute of Public Health, Social and Preventive Medicine, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
    2. Departments of Medicine, Epidemiology and Biostatistics, Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland, OH, U.S.A
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  • E.W. Breitbart,

    1. Dermatology Centre, Elbeklinikum Buxtehude, Buxtehude, Germany
    2. Association of Dermatological Prevention, Hamburg, Germany
    3. European Society of Skin Cancer Prevention, c/o Elbekliniken, Buxtehude, Germany
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  • R. Greinert,

    1. Dermatology Centre, Elbeklinikum Buxtehude, Buxtehude, Germany
    2. Association of Dermatological Prevention, Hamburg, Germany
    3. European Society of Skin Cancer Prevention, c/o Elbekliniken, Buxtehude, Germany
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  • S. Schneider

    1. Mannheim Institute of Public Health, Social and Preventive Medicine, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
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  • Funding sources This work was supported by the German Cancer Aid (grant no. 109091).
  • Conflicts of interest None declared.

Summary

Background

Sunbed use is considered carcinogenic in humans. Studies that examine behavioural patterns related to sunbed use over time are needed for developing skin cancer prevention strategies.

Objectives

To explore age-related trends in the initiation age, to investigate individual histories of sunbed use and to identify characteristics associated with cessation.

Methods

We analysed cross-sectional data of 4851 sunbed users and nonusers from a representative sample of Germans, aged 14–45 years, interviewed in 2011/2012. Biographical data were reconstructed based on reported tanning frequency/duration and changes in sunbed use over time. We used survival analysis to model the initiation age and created birth cohorts to assess age-related trends. Characteristics associated with sunbed use cessation were identified using logistic regression.

Results

Among sunbed users, median sunbed exposure was 180 min per year. Annual exposure remained constant in 85·6% of this subgroup with no changes over time during periods of sunbed use. Age at initiation decreased significantly across birth cohorts from 25 to 19 years (25th percentile; cohorts 1966–75 to 1986–93). Characteristics associated with sunbed use cessation included educational level [odds ratios (OR) 1·53 and 1·71 for medium and high education, respectively], greater awareness of skin cancer risk (OR 2·41) and immigrant background (OR 0·54; all < 0·01).

Conclusions

Initiation of sunbed use at an increasingly younger age suggests the need for interventions targeted at young adults. Approaches that increase general skin cancer risk awareness and that are sensitive to participants' educational level and immigrant background may also be helpful.

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