Should a 10-year-old really be allowed to use a tanning bed without a parent’s permission? It sounds ludicrous, but a new study appearing in the journal Pediatrics on Monday shows that in Missouri, such a scenario is possible. And even when salons do require parental consent, they often provide misinformation about the dangers of bombarding a child's skin with ultraviolet radiation.

Public health officials have been warning about the dangers of tanning in an ever-rising chorus. Indoor tanning devices can raise risk for melanoma by up to threefold, especially in people under 30. Tanning devices are also associated with a 1.5-fold increase in a person’s risk for basal cell carcinoma and a 2.5-fold increased risk for squamous cell carcinoma. Because of this risk, the World Health Organization recommends that people under 18 years old stay away from tanning beds altogether.

“We really do not feel that parents who are allowing their children to tan understand the risks,” study coauthor Lynn Cornelius, chief of dermatology at the Washington University School of Medicine in St. Louis and the Siteman Cancer Center, said in a phone interview Monday.

To get a picture of how salons were "self-regulating" in Missouri, a state with no tanning restrictions by age, Cornelius and her colleagues did a survey, with medical students posing as prospective customers. Of the 243 facilities included in the analysis – each one surveyed twice, once in the morning and once in the evening -- 65 percent said they would allow children as young as 10 or 12 years old to use their tanning devices.

The majority of tanning salon operators that answered said a 10 or 12-year-old child would have to have their parent present, but others said the child could just bring a signed permission form. Of the 312 tanning salon employees that said a 10 or 12-year-old could use their facilities, 35 said no adult presence or permission was necessary.

"We’re trying to get the message out about dangers of indoor tanning," Cornelius said. “We’re trying to push back against the tanning organizations when they say they adequately educate the people that operate these tanning beds to convey the dangers and the risks.”

Cornelius and her colleagues have pushed for laws in Missouri that would require on-site parental consent at tanning salons for anyone 17 years old or younger. They also want to make sure there are warnings posted in salons, and educational materials about the health risks of tanning beds included along with parental consent forms.

California and Vermont have the most stringent tanning restrictions in the U.S., with bans prohibiting anyone from under age 18 from tanning at all. North Carolina legislators are mulling a similar law.

Wisconsin prohibits minors under 16 from using indoor tanning facilities, while New York has a tanning ban in place for anyone under age 17, with parental permission required for those 17 and 18 years old. Many other states have enacted restrictions including requiring parental permission or presence.

But as of last July, 17 U.S. states did not have any statewide regulations concerning tanning and minors.

Phone calls placed to several tanning salons in some of these unrestricted states -- Pennsylvania, West Virginia, South Dakota and Alabama -- confirmed that persons under 18 could use them with parental permission. One Alabama salon said a child as young as 10 or 12 could use a tanning bed, as long as a parent or guardian was present.

The American Cancer Society recently called for the government to reevaluate its rules on sunlamps. The ACS noted that the International Agency for Research on Cancer places tanning devices in the highest category of cancer risk, alongside asbestos, mustard gas and arsenic. Currently, the FDA classifies tanning sunlamps as class I medical devices – a category shared by products like bandages and tongue depressors.

The Pediatrics study also found that tanning salon operators provided misinformation about the risks of tanning, with 80 percent of facilities saying that indoor tanning would prevent a future sunburn – a claim Cornelius and her team say is false. None of the employees surveyed inquired about factors that would make tanning riskier for a customer, like certain medications that make people more sensitive to light, or a history of skin cancer.

In response to the Pediatrics study, Tracie Cunningham, executive director of the American Suntanning Association, said her organization supports strong parental consent laws, and also took issue with the freshness of the data.

"This six-year-old telephone survey is irrelevant when evaluating consumer safety procedures practiced in professional salons," Cunningham said in a statement. "This was data collected by phone interview six years ago — no one in this phone survey ever stepped foot in a suntanning salon, where parental consent standards and explicit consumer warning statements are already in place."

Cornelius said her group’s findings are disheartening yet unsurprising. She pointed to a study commissioned by Democrats in the U.S. House of Representatives and released in February 2012, which found that tanning salon employees overwhelmingly denied that tanning is a health risk. Tanning salon workers also falsely claimed to undercover interviewers that tanning has health benefits, including cancer prevention. Salons also failed to follow FDA and tanning bed manufacturer recommendations on tanning frequency, and targeted teenage girls in their advertisements.

“The people that run these facilities say they’re safe and there’s no risks attached,” Cornelius said. “Our point is, this is a dangerous thing to do.”

SOURCE: Balaraman et al. “Practices of Unregulated Tanning Facilities in Missouri: Implications for Statewide Legislation.” Pediatrics published online 25 February 2013.

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