Changes in solarium numbers in Australia following negative media and legislation
Ms J. Makin, Centre for Behavioural Research in Cancer, Cancer Council Victoria, 100 Drummond Street, Carlton South Vic 3053. Fax: (03) 9635 5380; e-mail: Jen.Makin@cancervic.org.au
Objective: To monitor changes in the number of indoor tanning facilities in Australia's capital cities following widespread negative publicity and the introduction of legislation in some states.
Methods: An audit of listings under Solarium/Tanning Centres in the most recent hard copy Yellow Pages for Australia's capital cities was conducted, and results were compared with those from a previous audit from 2006.
Results: There was a 32% drop in solarium listings for Australia's capital cities between 2006 and 2008/09. In most cases, larger decreases were observed in states where legislation was introduced.
Conclusions: Despite underestimating solarium numbers, regular audits of business listings can be a useful way of monitoring trends, particularly when more accurate figures are not available. Solarium numbers can decrease following a combination of negative publicity and legislation.
Implications: To achieve and maintain predicted reductions in skin cancer incidence, mortality and costs to the health system, solarium legislation should be a priority for those states where it has not yet been introduced, accompanied by compliance monitoring and enforcement to ensure it is effective.
Australia and New Zealand have the highest rates of melanoma in the world.1 More than 1,600 Australians die of skin cancer every year.2 Reviews have found significantly increased risks of melanoma and squamous cell carcinoma among solarium (sunbed) users, in particular when exposure occurs before age 35.3,4 The International Agency for Research on Cancer (IARC) classes sunbeds as “carcinogenic to humans”, its highest risk category.5 It has been estimated that each year in Australia, 281 new melanoma cases, 43 melanoma-related deaths, and 2,572 new cases of squamous cell carcinoma are attributable to solarium use, at a cost to the health system of around $3 million.6
Until recently, a purely voluntary standard guided the solarium industry with regard to safety issues including the risk of skin cancer.7 However, compliance was poor, in particular with regard to age and skin type restrictions and the provision of consent forms.8,9,10,11,12 State Cancer Councils and others had advocated legislation, as recommended by the World Health Organization.13 The trigger came with the 2007 death of Clare Oliver, who attributed her melanoma to solarium use. The resultant publicity has been linked to substantial increases in the proportion of the population recognising that solarium use increases the risk of skin cancer,14 and prompted several state governments to introduce legislation restricting access by minors and those with fair skin, among other provisions (see Table 1 for summary of key dates).15
Table 1. Solarium/tanning centres — Yellow Pages listings 2006 to 2008/09 and density per 100,000 population.
|Adelaide||39||26||-33%||1,157,961||2.2||4 Jul 08||Legislation: 14 Mar 0829|
|Brisbane||47||45||-4%||1,856,966||2.4||11 Jul 08||Preliminary legislation: 5 Nov 0830|
| || || || || || || ||Regulation still to be amended to make ban on access for minors effective|
|Canberra||21||23||+10%||339,474||6.8||12 Dec 07||Considering|
|Hobarta||12||7||-42%||207,399||3.4||25 Jul 08||Discussion paper: 27 May 0831|
| || || || || || || ||Guidelines: 26 Aug 0932|
|Melbourne||169||82||-51%||3,805,755||2.2||29 Aug 08||Interim legislation: 1 Feb 0833|
| || || || || || || ||Legislation: 1 Feb 0934,35|
|Perth||55||41||-25%||1,554,125||2.6||18 Jul 08||Announced: 4 Apr 0814|
| || || || || || || ||Legislation: 2 Sep 0836|
|Sydney||63||54||-14%||4,334,020||1.2||15 Aug 08||Intention to ban access for minors/fair skin announced: Apr 08|
| || || || || || || ||Regulations: 29 May 0937|
|All state capitals (exc. Canberra)||385||255||-37%||12,916,226||2.0|| || |
|All capitals (exc. Darwinb)||406||278||-32%||13,255,700||2.1|| || |
Negative publicity about solarium use and/or legislation may influence the availability and density of solarium facilities, which may also influence use.16 However, in the absence of compulsory registration of solariums, monitoring change in their availability and density has been problematic. Proxy methods have been used, principally through monitoring listings in business directories. A recent audit of the number of solariums in Australia based on listings under the category “Solariums/Tanning Centres” in the Yellow Pages found an increase of over 300% in the decade from 1996 to 2006.17
This study aimed to monitor changes in the number of listings following Clare Oliver's highly publicised and emotive anti-solarium campaign and the introduction of legislation in some states, and to draw conclusions regarding the appropriateness of this proxy method for monitoring solarium availability.
Hard copies of the most recently issued Yellow Pages for Australia's capital cities were obtained in February 2009. Closing dates for submissions for the majority of directories were in July-August 2008; submissions for the most recent Canberra directory closed in December 2007, and for the Northern Territory in February 2008 (see Table 1). All listings under “Solarium/Tanning Centres” were recorded in an MS Excel spreadsheet, sorted by telephone number, and duplicate listings with the same telephone number were removed. It was also noted whether the business name or advertisement mentioned ‘spray tanning’, and whether each business appeared to be affiliated with a franchise. An audit of the most recent Victorian regional Yellow Pages directories was also conducted following the same procedure.
Audit results for capital cities were compared with the previous figures,17 and percentage increases/decreases since 2006 were calculated. Density of solarium listings per 100,000 population was calculated, using Australian Bureau of Statistics estimated population figures for 30 June 2007.18
Capital city listings
Compared with 2006, the 2008/09 directories showed a 32% drop in solarium listings for Australia's capital cities, from 406 to 278 (see Table 1). Excluding Canberra (where the closing date for submission of listings was eight to nine months earlier than other cities), there was a 37% drop across state capitals. However, this drop was not uniform. The largest decrease was in Melbourne (51%), followed by Hobart (42%), Adelaide (33%) and Perth (25%). Smaller decreases were observed in Sydney and Brisbane. Melbourne's 2006 lead of 106 more listings than Sydney was reduced to only 28. Density of listings per 100,000 population in 2008/09 ranged from 1.2 in Sydney to 6.8 in Canberra.
Including listings from regional Victoria, the combined state total decreased by 41%, from 227 listings in 2006 to 134 in 2008/09. In Melbourne, there were 2.2 listings per 100,000 population, which increased to 2.6 when all Victorian listings were included.
Content of listings
The number of operators advertising spray tanning services in capital city directories decreased by 55%, from 128 to 58. Whereas in 2006 38% of all operators were identified as affiliated with franchise networks, in 2008/09 this had reduced to 25%. This change was particularly noticeable in Melbourne, where the number of businesses listed as affiliated with the three major franchises (Body Bronze, Alisun and Sunlounge) decreased from 74 to 7.
Excepting in Hobart, which had only a small number of listings in both 2006 and 2008/09, the most substantial reductions in listings occurred in the capital cities of the states that introduced legislation — Melbourne (51%), Adelaide (33%) and Perth (25%). Despite reports by solarium operators of a reduction in income of as much as 75% in the months following Clare Oliver's death,15 this appears in most cases to have only been reflected in substantial reductions in listings when followed by commitment to legislation. As the number of operators advertising spray tanning services decreased to a greater extent than the overall reduction in listings, the audit provides no evidence that this safer alternative is replacing sunbeds. On the contrary, it suggests there may be a general reduction in the provision of both types of artificial tanning.
The previous audit acknowledged that results were an underestimate of true numbers of solariums, as many beauty and fitness establishments offer artificial tanning services in addition to their core business, and hence may not advertise under the Solariums/Tanning Centres category.17 A similar audit in New Zealand found that including listings under the ‘beauty’ and ‘fitness’ categories that specifically advertised tanning services identified nearly 2.5 times as many businesses as including only ‘solaria’ categories.19 Recent Australian surveys of businesses advertising under beauty and fitness categories have shown that 8% (Sydney and surrounding regional areas, 2003), 11% (Melbourne inner city and coastal suburbs, 2003) and 22% (Tasmania, 2007) were operating at least one sunbed.8,12,20 A 2007 Queensland survey estimated that around 50% of solarium units were in tanning salon businesses.21 Following the introduction of legislation in Victoria, the Department of Human Services (DHS) released figures from their database of solarium operators.22 These showed that before legislation was enacted in February 2008, there were 436 sites with at least one tanning unit in Victoria. This suggests a previous estimate based on the Tasmanian survey data of around 800 solarium operators in the Melbourne metropolitan region in 2006 was excessive,20 even allowing for some reduction in numbers in the period between the Tasmanian data collection in 2007 and the introduction of legislation in Victoria.
Comparing DHS solarium registration figures and the updated audit figures enables an evaluation of the use of Yellow Pages listings as a proxy method for monitoring solarium availability. By July 2008, DHS had licensed tanning unit operators on 308 sites throughout Victoria, a reduction of 29% compared with before legislation was introduced.22 Comparison with the 2008/09 audits for Melbourne and regional Victoria (total 134 listings) shows that Yellow Pages listings under Solarium/Tanning Centres represented only 44% of registered businesses. This low percentage was anticipated in the previous audit and in studies conducted in other states.8,12,17,20,21 However, the decrease in listings in Victoria was mirrored by a decrease of similar magnitude in solarium operators recorded by DHS, suggesting that regular audits of listings can be a useful way of monitoring trends in solarium numbers, particularly when more accurate figures such as registrations are not available.
Based on the DHS figures, there were 5.9 solariums per 100,000 population in Victoria in 2008/09. The slightly lower density of Yellow Pages listings when only the Melbourne metropolitan area was considered could be expected to be reflected in a slightly lower density of solariums. In any case, this is substantially lower than the average 11.8 solariums per 100,000 population found in a recently published study of 116 large US cities in March 2006.16 This is to be expected, as solarium use appears to be higher in the US than in Australia.11,16,23 However, as noted by the authors of the US study, further research is required to tease out the nature and direction of the relationship between solarium availability and incidence of use.16
Conclusion and implications for policy
Following Clare Oliver's anti-solarium campaign and the introduction of legislation in some states, the number of solarium listings in the Yellow Pages for state capitals decreased substantially. Comparisons with newly available government figures in Victoria suggest that although audits conducted using this method are underestimates of availability of solarium services, they do provide a useful way of monitoring trends in the absence of accurate figures. While some skin cancer control advocates have called for a complete ban on solariums,24 the audit shows that solarium numbers can decrease following a combination of negative publicity and legislation. More recent government figures show a continued decline to 240 businesses (45% fewer than pre-legislation) by June 2009.25 However, while negative media around a specific case may result in temporary reductions in demand for solarium services,14,15 this must be balanced against the predominance of pro-tan images in the media.26 To achieve and maintain predicted reductions in incidence, mortality and costs to the health system,6,27 legislation should be a priority for those states where it has not yet been introduced, accompanied by compliance monitoring and enforcement to ensure it is effective.28