An audit of Yellow Pages telephone directory listings of indoor tanning facilities and services in New Zealand, 1992-2006
A.I. Reeder, Cancer Society of New Zealand, Social & Behavioural Research Unit, Department of Preventive and Social Medicine, Dunedin School of Medicine, University of Otago. PO Box 913, Dunedin 9054, New Zealand. Fax: 64 3 479 7298; e-mail: firstname.lastname@example.org
Objective: To document the number and variety of indoor tanning facilities and services in New Zealand, and to analyse changes from 1992 to 2006.
Method: Hard copies of the Yellow Pages telephone directory listings of all 18 New Zealand regions for 1992, 1996, 2001 and 2006 were examined. Entries under solaria and sun bed headings were supplemented with entries where sun bed/indoor tanning services were explicitly advertised under hairdressing, beauty therapy/supplies, and health and fitness centre categories. Duplicate listings were eliminated.
Results: From 1992 to 2006, inclusive, there was a 241% increase in the number of businesses that advertised some form of indoor tanning service in the NZ Yellow Pages telephone directories. There was a 525% increase in the number of wholesale trade providers, indicative of expansion in the industry, overall. Hire services also increased. The reported findings are likely to represent an underestimate of the total numbers of facilities and providers.
Conclusion: Substantial growth in indoor tanning facilities and services in New Zealand has occurred since 1992.
Implications: The evidence of potential serious health risks from sunbed use, in conjunction with evidence of irresponsibility among some providers, suggests a need for regulatory controls to strengthen existing voluntary guidelines. With legislation recently introduced for the states of Victoria and South Australia, and proposed in Queensland and Western Australia before the end of 2008; it would be timely for New Zealand authorities to collaborate with those drafting that legislation.
Despite many years of warnings by the Cancer Society of New Zealand1 about the increased risk of skin cancer that is associated with tanning through excessive sun exposure, some New Zealanders apparently still want to acquire a tan.2 However, this tanning process may, increasingly, involve means other than sun exposure. For example, approximately 8% of respondents in the 2003 wave of the New Zealand national, triennial sun protection monitoring survey reported that they had used a sunbed in the past 12 months and this percentage was not significantly different in 2006.3
There is a lack of scientific evidence to support the view that the potential risks associated with the use of modern indoor tanning equipment are significantly less than those from natural sun exposure.4 Neither does the evidence from a systematic review and meta-analysis provide support for any protective effect from the use of sunbeds against skin damage from subsequent sun exposure.5 A recent update on this review found that the use of indoor tanning equipment was associated with a 98% increase in the relative risk of melanoma among those whose first exposure to indoor tanning equipment occurred when they were under the age of 35 years.6 This is perhaps because some tanning equipment has the capacity to emit levels of erythemal (sunburning) ultraviolet radiation (UVR) as much as five times more intense than the summer sun at noon in Australia.7 Additionally, modern ‘clam-type’ or stand up tanning ‘beds’ generally expose a greater skin area to UVR than would occur in most outdoor situations, thereby potentially increasing the risk. These risks are likely to be greatest within unsupervised commercial settings and when equipment is used in the home, where the duration and frequency of UVR exposure is discretionary.
The operations of the indoor tanning industry remain unregulated in NZ, being guided by a voluntary code of practice7 which was implemented to address the potential safety issues also identified by the WHO.8 However, poor compliance with that code has been reported in Australia,9 and in two surveys undertaken by the Consumers’ Institute of New Zealand.10,11 This documented lack of responsibility among a substantial number of operators provides further justification for the argument that some form of regulation may be required.12 This is consistent with the comment made in a WHO report that ‘unlike some commercial sectors, the sunbed industry had not shown significant capacity to self-regulate effectively.’8 Recently, the state governments of Victoria,13 and South Australia,14 have implemented legislation to control the provision of indoor tanning services; with legislation proposed in Queensland and Western Australia15 before the end of 2008.
A growth of 383% in the numbers of commercial indoor tanning facilities, 1992 to 2006, has recently been described for the eight state capital cities in Australia, overall.16 However, even these documented increases are likely to represent underestimates of the total number of such facilities available. This is because that study was limited to quantifying facilities listed solely under the heading of ‘solariums/tanning centres’ in the Yellow Pages of the telephone directories, whereas it is known that tanning facilities are also provided within many other contexts, such as ‘beauty salons’ and ‘health and fitness centres.’17
It is likely that an increase in indoor tanning facilities has also occurred in NZ. Artificial ‘sun’ exposure has been commercially available in NZ since the mid 1960s, with Yellow Pages entries from that period promoting such services as an ‘ultraviolet room’, ‘sun tanning cabinet’ and ‘sun rooms’. Such historical advertising illustrates that interest in indoor ‘sun’ exposure has been a longstanding phenomenon in NZ. Initial commercial advertisements were included under the categories ‘Physical Culture’ and ‘Sauna Baths’. By the mid 1980s, ‘solarium’ was first differentiated as a category in the Auckland Yellow Pages, and headings further evolved during the 1990s into category headings which included ‘sun beds’ and ‘sun tanning’.
More recently, ‘artificial’ or ‘fake’ tanning and ‘spray tanning’ services have also been advertised as available, most often as an addition to other tanning services offered in a specific business. The first Yellow Pages advertisements which mentioned artificial tanning appeared in 2002 and were not listed nationally until 2006, although ‘spray tanning’ has never been listed as a separate category. Use of fake tanning options was reported by 22% of New Zealanders, and 41% of females, in the 2006 wave of the national monitoring survey, a statistically significant increase since 2003.3
In addition to specific tanning centres, a range of other premises provide tanning facilities, including health & fitness centres, hairdressers and beauticians. Some businesses also advertise machines for hire, which could be for in-home use. Recently, (first noted in Yellow Pages listings in 2004) mobile spray tanning services have become available.
The purpose of the present study is to help inform advocacy among the suppliers of solaria services, the customers utilising those services, and others concerned about potential health issues. The study aims are to document, from Yellow Pages advertising: 1) the number and variety of operators; 2) the range of services offered; and 3) any changes in services over recent years. The study was also designed to allow comparability with the published Australian study, completed in 2006, which had more restricted aims, being limited to quantifying premises advertised under the heading ‘solarium/tanning centres’ in the Yellow Pages business directories for Australian capital cities.16
Selected Yellow Pages from all New Zealand telephone directories were photocopied from relevant listings in four years: 1992, 1996, 2001 and 2006. These years were chosen for potential comparison with the similar study conducted in Australian capital cities.16
The Yellow Pages listings were sourced from the collection of telephone directories in the Hocken Library, Dunedin. All businesses listed in categories directly relating to solaria and tanning were included. Entries listed in ‘beauty’ or ‘fitness’ categories were only included if ‘tanning’ or ‘sunbeds’ was specifically mentioned in either the business name or the advertisement. A full listing of all categories examined is included in Table 1. The name, address (street address and/or PO Box) and telephone number of all listings, including apparent duplicates across categories, were recorded in an MS Excel spreadsheet. Multiple business locations were listed as separate entries. To determine the number of businesses listed, a standard format of telephone number, including area code, was used, and duplicate listings with the same telephone number were able to be identified as such.
Table 1. Yellow Pages category listings under combined group headings, 1992 to 2006.
| Beauty Therapists & Schools||y||y||y||y|
| Beauty Products & Services||-||y||-||-|
| Beauty Schools||-||-||y||-|
| Beauty Therapy||-||-||y||y|
| Beauty Supplies||-||-||y||y|
| Health & Fitness Centres||y||y||y||y|
| Sun Tanning Clinics||y||-||-||-|
| Sun Beds — Retail & Wholesale||y||y||-||-|
| Sun Beds & Tanning Products||-||y||-||-|
| Sun Tanning Clinics & Tanning Products||-||y||-||-|
| Sun Tanning Equipment & Supplies||-||-||y||-|
| Sun Tanning Services — Retail||-||-||y||y|
| Sun Tanning Products & Services||-||-||-||y|
Details in the advertisements were recorded, including if there was any mention of ‘hire’ or ‘mobile’ business; and noting if ‘sunbeds’ or ‘spray tanning’ were among the services offered. Many advertisements simply indicated that ‘tanning’ was available, and in such cases no assumptions were made about the types of services provided. It was also determined whether a business offered ‘retail’ or ‘wholesale’ services. For the purposes of this study, a ‘retail’ business was deemed to be a business where a service, such as spray tanning or a sunbed session, was offered. ‘Wholesale’ businesses were defined as a business which supplied resources to others who offered tanning sessions, although many of these ‘wholesale’ businesses catered, no doubt, to members of the public who could, for example, purchase a personal sunbed. Businesses which indicated in their advertising that they met our criteria for both ‘retail’ and ‘wholesale’ were recorded as such.
In preliminary analyses of businesses which offered wholesale services, it was found that the telephone number alone was not sufficient to identify duplicate businesses. This was because these businesses often had a toll free number, as well as a local number, for servicing retail businesses throughout NZ. Furthermore, some wholesale businesses advertised under brand names as well as business names, but with a single telephone number. A separate unique identifier was, therefore, created for wholesale businesses, and the final analyses were carried out with duplicates removed in this manner.
First, it became clear that a number of shifts in Yellow Pages category names had occurred, both over the study period and across regions. All of the categories studied are presented in Table 1, along with the combined categories (‘beauty’, ‘fitness’ and ‘solaria’) that we used for the purposes of analysis included at the top of each set.
In 2006, a total of 545 discrete businesses that offered retail tanning services were listed in the Yellow Pages of all NZ telephone directories. As indicated in Table 2, this number had progressively increased from 226 (1992) to 331 (1996) and 400 (2001), representing a 241% increase, overall, in the number of retail premises advertising the provision of tanning services over the study period. Regions with lower populations generally had listings in fewer categories than did regions with large urban centres. Increases in listings showed different patterns in directories for different geographical regions.
Table 2. Retail Yellow Pages listings for indoor tanning services from 1992 to 2006.
|Bay of Plenty||14||16||22||43||307|
|Nelson & Bays||3||7||7||16||533|
|Timaru & Oamaru||4||5||2||8||200|
In order to present results which were more comparable with the Australian study,16 calculations were made which included only those businesses that were entered under those Yellow Pages categories which were combined under the ‘solaria’ heading used in Table 1. Overall, the method used to include businesses listed under the ‘beauty’ and ‘fitness’ categories, and specifically advertising ‘tanning’ services, identified nearly two and a half times as many business listings across the four sample years (N=1,502) as when businesses listed under the ‘solaria’ categories (N=616), alone, were included. In addition, this method identified a greater increase in the number of ‘retail’ businesses over the study period, being 241% rather than the 184% which was the finding when the narrower search strategy was used.
Retail businesses which specifically indicated in their advertisements that they had ‘sunbeds’ or ‘spray tanning’ services available are listed in Table 3. The first year in the study period when ‘spray tanning’ was specifically mentioned in Yellow Pages advertising was 2006, although it was not listed as a separate category.
Table 3. Yellow Pages telephone directory listings that specified ‘sunbed’, ‘spray tanning’ and ‘mobile’ services, by region and year.
|Bay of Plenty||10||13||17||16||160||19||1|
|Nelson & Bays||0||5||5||9||N/Aa||9||-|
|Timaru & Oamaru||3||1||0||3||NCb||5||-|
Mobile services were not mentioned as part of ‘tanning services’ in Yellow Pages advertisements in the 1992, 1996 or 2000 telephone books; but did appear in the 2006 sampling. Further investigation found the first mention in the Auckland Yellow Pages of ‘mobile spray tanning’ in 2004, and anecdotal evidence suggests that these services were available around New Zealand as early as 2003, at least.
Total listings across NZ for wholesale businesses are presented in Table 4. The number of listings decreased in 2001 but recovered and increased in 2006. Even when discrete businesses were considered, the decrease in 2001 remained, which appeared to be due to a consolidation of businesses. The total increase in 2006 is, at least in part, attributable to the increase in spray tanning, and the servicing required for those retail businesses. It should be noted that although the directories across regions contain listings for wholesale businesses, these pertain to a relatively small number of national businesses: four in 1992 increasing to 21 by 2006.
Table 4. Wholesale businesses — Yellow Pages directory listings by region; and national businesses from 1992 to 2006.
|Bay of Plenty||2||4||3||4||200|
|Nelson & Bays||1||3||2||4||400|
|Timaru & Oamaru||2||4||3||2||NCb|
|Total unique national businesses||4||16||11||21||525|
Sunbeds have been available for hire across selected regions of New Zealand throughout the study period (Table 5).
Table 5. Yellow Pages listings of businesses offering hire services, by region, from 1992 to 2006.
|Nelson & Bays||0||0||1||0||NCb|
|Timaru & Oamaru||0||0||1||0||NCb|
From 1992 to 2006, inclusive, there was a 241% increase in the number of businesses that advertised some form of indoor tanning service in the NZ Yellow Pages telephone directories. Over the same time period there was a 184% increase in the number of businesses listed under the combined ‘solaria’ categories, alone, which is less than the 383% increase reported for Australian state capital city listings under comparable categories during the same time period.16 However, it should be noted that the present study was comprehensive and national, including both urban and rural settings, whereas of the Australian study it was noted that only “some Yellow Pages included State capital cities in conjunction with rural areas”.16
An evaluation of the original Australian study16 noted that the use of Yellow Pages listings in solaria categories, alone, was likely to produce an underestimate of the number of businesses in Australian urban centres by a factor of between three and 10.17 Although the present study included businesses that advertised tanning services but which were listed under Yellow Pages directory categories concerned with ‘beauty’ or ‘fitness’,17 the findings are still likely to have significantly underestimated the number of facilities offering indoor tanning services. Brief internet Google searches identified examples of premises that offered indoor tanning services but which were not listed under the Yellow Pages categories as offering these services. These premises in the Auckland area alone included hotels, a retirement village, the Auckland international airport, the Unitec Sports Centre and the Glenfield Leisure Centre, which is operated by the North Shore City council. Many beauty businesses and fitness centres may not advertise the presence of tanning services in their Yellow Pages advertising because of the cost of such advertising, but also, perhaps, because of a perception that sunbed or spray tanning services would be offered routinely in these contexts. It is worth noting that, for a number of reasons, the proportions of premises advertised relative to those not advertised may also have changed over time.
The precise number of businesses that offer indoor tanning services in New Zealand is, therefore, unknown and is likely to remain so unless mandatory registration of such premises and operators is introduced. Given the lack of such a register at present, it is not likely that a more rigorous study design could be readily established; and this situation is compounded by the existence of mistrust between the public health community and some operators in the indoor tanning industry. In such circumstances, a telephone interview survey is unlikely to provide an accurate estimate of the number of tanning units and the businesses that operate such equipment — even assuming that all of the potentially relevant sites and telephone numbers could be identified. Since the numbers and types of tanning units sited at each identified establishment would also be challenging to quantify, it is not currently possible to accurately calculate rates of such units per 100,000 population.
In addition to the observed increases in the number of providers advertising in the Yellow Pages, we found that changes had occurred in the category listings (Table 1) which had the potential to create confusion when taking a longitudinal perspective on the development of the indoor tanning industry. However, we believe that we were able to address that issue successfully.
Another change identified was in the variety of services provided. In particular, we identified the emergence of ‘spray tanning’ and associated ‘mobile tanning’ as services advertised in Yellow Pages listings of the 2006 telephone directories. Although the provision of these services may help to maintain the perceived social desirability of a tan, it probably represents a safer alternative than the use of sunbeds or intentional sunbathing. It is likely that the observed increases in the numbers of businesses from 2001 to 2006 were, at least in part, due to the emergence of this section of the tanning industry.
The availability of hire services also increased over the study period. There were increases in the numbers of regions in which hire services were advertised, and also in the number of businesses providing those services. Sunbeds were offered for hire to commercial operators, but also to home users. The latter is potentially the more dangerous situation, as there are no controls over the age of the sunbed user, or the duration or frequency of use. The risks associated with the purchase of sunbeds for domestic use are even greater as there is less likelihood that the radiation emitted by the unit would be checked, subsequently.
The observed 525% increase in the number of unique wholesale providers is indicative of expansion in the indoor tanning industry, generally. These businesses support both home users and the ‘retail’ businesses documented in this study.
Indoor tanning facilities remain a public health issue in New Zealand because of the size of the indoor tanning industry in terms of the variety of businesses offering tanning services, the numbers of commercial sunbeds and the numbers of people using them. Monitoring of changes in the availability of artificial UVR tanning services through periodic audits is possible, but establishment of accurate counts of operational sunbeds, through licensing and registration, is much more desirable. Licensing returns would identify the number of units in each establishment, thereby enabling accurate estimates for epidemiological purposes of the rates of sunbeds per 100,000 population. More detailed returns would also be possible, including the hours of use for each per year. Most importantly, registration and licensing should reduce the number of premises where sunbed sessions are offered to clients who are under the age of 18, or have high risk skin types (particularly Fitzpatrick skin type I). It is possible that the monitoring of spray tanning services could be considered separately, given that exposure to UVR is not an issue.
The ‘Client information’ warning notice that is included in the Joint Australia/New Zealand Standard is basic and brief.7 More comprehensive education of sunbed consumers and potential consumers is justified, particularly among the young women who are the most frequent sunbed users. Recent debates about the possible relation between serum vitamin D levels in humans and a range of health outcomes have been exploited for promotion by some in the solaria industry. Further advocacy for cancer control should seek to counter any misleading claims. A long term goal of public education is a reduction in the desirability of the ‘tanned look’, particularly dark or ‘deep’ tans, and therefore the demand for indoor tanning services.
The WHO has made a number of recommendations, including that governments should consider implementing comprehensive legislation to govern the operation of sunbeds and that any legislation should be legally binding and capable of local enforcement.8 Although a recent survey of NZ territorial authorities identified only three cases where solaria were operated within council-owned premises,18 anecdotal evidence suggests that finding is likely to be an underestimate.
The WHO has suggested that an emphasis should be placed on providing better information for consumers; restricting access to those under the age of 18; reducing the numbers of tanning establishments working without operator surveillance; and banning (or at least discouraging from operation) unsupervised, self-service sunbeds. Therapeutic use of sunbeds should only be conducted in a medical unit under medical supervision, and claims of health benefits should not be made in the promotion of sunbed use. A trained supervisor should be available at all times that the sunbed is in operation, regardless of the type of establishment in which the sunbed is located.8 Such legislation would not endorse intentional exposure to UVR; but would acknowledge the existence of the indoor tanning industry and set out requirements which would establish a safer situation than the current uncontrolled environment. With legislation recently introduced in Victoria and South Australia, and proposed in Queensland, before the end of 2008,13 it would be timely for NZ to collaborate with those drafting that legislation so that protection for the NZ population could be based on that model.
This audit was based on the design of a similar study commissioned for the Cancer Council of Victoria.16 Funding for Jan Jopson to work on this study was provided by the Cancer Society of New Zealand Inc. Dr Reeder and the Cancer Society Social & Behavioural Research Unit receive support from the Cancer Society of New Zealand Inc. and the University of Otago. Dr Judith Galtry, Health Promotion Advisor (Skin Cancer Prevention) National Office, Cancer Society of New Zealand Inc. is acknowledged for her comments on an early draft.