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Professional Issues
Guadalupe R. Palos, RN, LMSW, DrPH—Associate Editor
Oncology Nurses and Indoor Tanning: Stylish or Risky Behavior? Christina Marie Leong, BSc, and Guadalupe R. Palos, RN, LMSW, DrPH
Being tan has become a social norm, and some nurses engage in that widely accepted lifestyle. Mounting evidence of the increased risk to melanoma and nonmelanoma skin cancers associated with indoor tanning supports the need for nurses to integrate skin cancer education, counseling, and referrals into routine practice. The current article presents an overview of the risks associated with indoor tanning, discusses its acceptance as a social norm, and offers strategies to support oncology nurses in changing the widespread trend. Christina Marie Leong, BSc, is an undergraduate college intern and Guadalupe R. Palos, RN, LMSW, DrPH, is a researcher in the Office of Cancer Survivorship, both at the University of Texas MD Anderson Cancer Center in Houston. The authors take full responsibility for the content of the article. The authors did not receive honoraria for this work. No financial relationships relevant to the content of this article have been disclosed by the authors or editorial staff. Leong can be reached at [email protected], with copy to editor at [email protected]. Key words: melanoma; indoor tanning; skin cancer Digital Object Identifier: 10.1188/14.CJON.363-365
O
ncology nurses serve as role models, advocates, and educators to promote wellness in all aspects of life. Evidence of nurses’ desire to be healthy is demonstrated by the dramatic decrease in smoking rates among nurses (Sarna, Bialous, Nandy, Antonio, & Yang, 2014) and in the growing number of health promotion programs that target nurses, such as HealthyNurse™ (American Nurses Association, 2014). By choosing to participate in safe and healthy behaviors (e.g., not smoking), nurses demonstrate the benefits of living a healthy life. However, a widespread negative trend involves indoor tanning to achieve a “stylish” tan. Despite the mounting evidence associated with the risks of indoor tanning, its use continues to increase around the world. In the current article, the authors discuss the public health issues linked to indoor tanning, the growing scientific evidence demonstrating the association between indoor tanning and
skin cancer, and the role of oncology nurses in educating patients, families, and communities about the related risks.
Indoor Tanning as a Public Health Concern Strong scientific evidence cites artificial ultraviolet (UV) light as posing carcinogenic harm (El Ghissassi et al., 2009; Norval & Halliday, 2011), linking tanning booths to skin cancer (Veierod et al., 2003), and placing tanning beds on a list of known, risky exposures with asbestos and cigarettes (El Ghissassi et al., 2009). In addition, the International Agency for Research on Cancer reported that having used tanning beds increased the risk for melanoma and squamous cell cancers (World Health Organization, 2006). Despite the evidence establishing the relationship between UV radiation, DNA
Clinical Journal of Oncology Nursing • Volume 18, Number 3 • Professional Issues
damage, and skin cancer, about 30 million Americans continue to use indoor tanning at least once per year (Stryker, Yaroch, Moser, Atienza, & Glanz, 2007; U.S. Food and Drug Administration, 2014). For those who participate in the practice, the known risks of premature skin aging, skin cancer, and immunosuppression appear to be outweighed by the desire for a tan (Norval & Halliday, 2011). UVA (long waves) and UVB (short waves) rays are carcinogenic (Griffiths, Mistry, Herbert, & Lunec, 1998), but UVA wavelengths emit deeper penetrating rays that can cause melanoma and are the predominant component in indoor tanning. However, skin is not the only area affected by those rays; eyes are susceptible to both forms of UV rays. UVA and UVB rays can result in detrimental vision defects such as cataracts (Pieper, 2006). According to a market study, more than 191 million Americans own nonprescription sunglasses that help protect eyes from UV rays (Pieper, 2006). To further decrease known risks, those who choose to use tanning beds regardless of the health risks should be encouraged to use protective eyewear.
Increased Risk of Skin Cancer Skin cancer is one of the most common malignancies, and incidence rates continue to grow (American Cancer Society, 2014). Although the majority of new cases of skin cancers are nonmelanoma, most skin cancer–related deaths are attributed to malignant melanoma. Studies have reported that, during the past 30 years, the incidence of nonmelanoma 363
skin cancer rapidly increased in young women and adolescents (Guy, Berkowitz, Watson, Holman, & Richardson, 2013; Heckman, Coups, & Manne, 2008). Research has suggested that the use of indoor tanning and more outdoor recreation activities contributed to a greater risk of skin cancers, particularly malignant melanomas (Holman et al., 2013). Karagas et al. (2002) found that tanning bed users were 2.5 times more likely to develop basal and squamous cell carcinoma. Skin cancer is more preventable if people have an understanding of the risk factors and preventive actions. Nurses must understand the damage resulting from overexposure to the sun or indoor tanning devices because 90% of overexposure leads to skin cancer.
Tanning as a Social Norm The desire for a tan for cosmetic reasons has helped establish a $5 billion per year tanning industry in the United States (IBISWorld, 2013). Millions of Americans use tanning devices every year, including tanning beds, sun lamps, tanning booths, and solariums—all of which lead to exposure to UV rays. Studies have indicated that the prevalence of indoor tanning is highest among young Caucasian females (Mayer et al., 2011). Other factors associated with greater use of indoor tanning included living within two miles of a tanning facility and having a parent who also engaged in the practice (Hawryluk, Geller, & Fisher, 2013). Kaur et al. (2006) reported that a chemical blockage of UV light induced opiate withdrawal symptoms in frequent tanners. That apparent addiction to tanning has been referred to as tanorexia, which is defined as “the condition of becoming obsessed with, even addicted to, tanning, believing that one is unattractively pale, even when quite tan” (Kravitz, 2010, p. 113). This phenomenon has been attributed to appearance motivation, social influences, and physical addiction factors (Okhovat & Feldman, 2013). Another study found that the release of endorphins associated with habitual tanning could result in mood enhancement, relaxation, and socialization reactions similar to those associated with smoking addiction (Heckman, Egleston, Wilson, & Ingersoll, 2008). Other factors 364
contributing to the unhealthy practice is the public’s lack of knowledge of the risks associated with indoor tanning, inadequate federal regulation, and the belief that a tan is stylish.
Debunking the Tanning Myth Several organizations have launched collaborative efforts to change the perception that being tan is healthy, stylish, or flattering. Another prevalent myth related to tanning is that base tanning will prevent sunburn. Those misconceptions and the quest for having a “healthy glow” have led many young women and adolescents to use tanning devices. In 2008, the Skin Cancer Foundation launched a nationwide advertising campaign called Go With Your Own Glow. This campaign has the support of fashion leaders, celebrities, and advocacy groups with the goal of encouraging women to love and protect their skin. The message is becoming more visible with current fashion trends that feature models with pale complexions or other forms of natural coloring as well as with celebrities who advocate and practice sun safety. The tanning industry lacks federal regulation, which contributes to the risks associated with indoor tanning (Gosis et al., 2014). However, scientific evidence establishing the link between tanning devices and skin cancer risk has led to increased indoor tanning restrictions. In 2013, several states passed regulations banning the use of tanning devices for minors aged 18 years or younger (National Conference of State Legislatures, 2014). Anti-tanning movements, such as increased regulation and the growing belief that tanning is not fashionable, will hopefully encourage a downward trend in indoor tanning, as seen in smoking behaviors (Watson et al., 2013).
Nurses and Indoor Tanning Nurses engage in indoor tanning despite their role in promoting healthy lifestyles. To date, limited epidemiologic data exist on the number of nurses who use tanning devices. However, the Nurses’ Health Study II examined the correlation between nurses who choose
to use tanning beds every year and their increased risk to skin cancer (Zhang et al., 2012). That study included more than 70,000 women over a 20-year period and found an 11%–15% increased risk of skin cancer among nurses who used indoor tanning (Shoag et al., 2013).
Nurses’ Role in Skin Cancer Education Nurses can use several strategies to change their practice to integrate education and counseling about tanning risks (Mahon, 2003). Nurses could begin with their own health and lifestyles by reflecting on attitudes and practices toward indoor tanning. In addition, nurses can strive for wellness with the help of several resources to assess their risk to various conditions (see Figure 1). Nurses also can teach their patients, families, and communities how to conduct skin examinations. Organizations such as the Skin Cancer Foundation provide education and training for professionals and the public on how to conduct skin examinations. In addition, nurses in all clinical settings can conduct thorough skin examinations on their patients. Nurses can assess patients’ skin during face-to-face interactions or when conducting physical assessments. Nurses also could advocate and support legislation and enforcement efforts to regulate tanning salons using the tobacco policy model (Institute
Healthy Lifestyle Brief, easy-to-read messages about indoor tanning risks, safe outdoor activities, and myths of tanning by the Skin Cancer Foundation www.skincancer.org/healthy-lifestyle HealthyNurse™ A program by the American Nurses Association that focuses on different aspects to maintain a healthy lifestyle www.nursingworld.org/mainmenu categories/workplacesafety/healthy-nurse Nurses’ Health Study A study by Harvard University’s School of Public Health and Brigham and Women’s Hospital that has enrolled more than 238,000 nurses since 1976. The study is now accepting nurses for the Nurses’ Health Study III. www.nhs3.org
FIGURE 1. Resources for Healthy Living for Nurses
June 2014 • Volume 18, Number 3 • Clinical Journal of Oncology Nursing
of Medicine, 2007). Those approaches can help reduce the harm of indoor tanning and discourage its use, particularly among adolescents and young adults. Nurses must remember that they are one of the most trusted professions and sources of information in health care (Gallup Inc., 2013), and that trust makes nurses accountable as role models for healthy living.
References American Cancer Society. (2014). Cancer facts and figures 2014. Atlanta, GA: Author. A merican Nurses Association. (2014). HealthyNurse™. Retrieved from http:// www.nursingworld.org/MainMenuCat egories/WorkplaceSafety/Healthy-Nurse El Ghissassi, F., Baan, R., Straif, K., Grosse, Y., Secretan, B., Bouvard, V., . . . Cogliano, V. (2009). A review of human carcinogens—Part D: Radiation. Lancet Oncology, 10, 751–752. Gallup Inc. (2013). Honesty/ethics in professions. Retrieved from http://www .gallup.com/poll/1654/honesty-ethics -professions.aspx Gosis, B., Sampson, B.P., Seidenberg, A.B., Balk, S.J., Gottlieb, M., & Geller, A.C. (2014). Comprehensive evaluation of indoor tanning regulations: A 50-state analysis, 2012. Journal of Investigative Dermatology, 134, 620–627. doi:10.1038/ jid.2013.357 Griffiths, H.R., Mistry, P., Herbert, K.E., & Lunec, J. (1998). Molecular and cellular effects of ultraviolet light-induced genotoxicity. Critical Reviews in Clinical Laboratory Sciences, 35, 189–237. doi:10.1080/10408369891234192 Guy, G.P., Jr., Berkowitz, Z., Watson, M., Holman, D.M., & Richardson, L.C. (2013). Indoor tanning among young non-Hispanic white females. JAMA Internal Medicine, 173, 1920–1922. doi:10.1001/ jamainternmed.2013.10013 Hawryluk, E.B., Geller, A.C., & Fisher, D.E. (2013). Indoor tanning: The link to melanoma is no longer deniable. Melanoma Letter. Retrieved from http://www.skin cancer.org/publications/the-melanoma -letter/winter-2013-vol-31-no-3/link Heckman, C.J., Coups, E.J., & Manne, S.L. (2008). Prevalence and correlates of indoor tanning among US adults. Journal of the American Academy of Dermatology, 58, 769–780. doi:10.1016/j.jaad .2008.01.020
Heckman, C.J., Egleston, B.L., Wilson, D.B., & Ingersoll, K.S. (2008). A preliminary investigation of the predictors of tanning dependence. American Journal of Health Behavior, 32, 451–464. doi:10.5555/ajhb.2008.32.5.451 Holman, D.M., Fox, K.A., Glenn, J.D., Guy, G.P., Jr., Watson, M., Baker, K., . . . Geller, A.C. (2013). Strategies to reduce indoor tanning: Current research gaps and future opportunities for prevention. American Journal of Preventive Medicine, 44, 672–681. IBISWorld. (2013). Tanning salons in the US: Market research report. Retrieved from http://www.ibisworld.com/industry/ default.aspx?indid=1721 Institute of Medicine. (2007). Ending the tobacco problem: A blueprint for the nation. Washington, DC: National Academies Press. Karagas, M.R., Stannard, V.A., Mott, L.A., Slattery, M.J., Spencer, S.K., & Weinstock, M.A. (2002). Use of tanning devices and risk of basal cell and squamous cell skin cancers. Journal of the National Cancer Institute, 94, 224–226. Kaur, M., Liguori, A., Lang, W., Rapp, S.R., Fleischer, A.B., Jr., & Feldman, S.R. (2006). Induction of withdrawal-like symptoms in a small randomized, controlled trial of opioid blockade in frequent tanners. Journal of the American Academy of Dermatology, 54, 709–711. doi:10.1016/j.jaad.2005.11.1059 Kravitz, M. (2010). Indoor tanning, skin cancer, and tanorexia: Development of U.S. indoor tanning policy. Journal of the Dermatology Nurses’ Association, 2, 110–115. Mahon, S.M. (2003). Skin cancer prevention: Education and public health issues. Seminars in Oncology Nursing, 19, 52–61. Mayer, J.A., Woodruff, S.I., Slymen, D.J., Sallis, J.F., Forster, J.L., Clapp, E.J., . . . Gilmer, T. (2011). Adolescents’ use of indoor tanning: A large-scale evaluation of psychosocial, environmental, and policy-level correlates. American Journal of Public Health, 101, 930–938. doi:10.2105/Ajph.2010.300079 National Conference of State Legislatures. (2014). Indoor tanning restrictions for minors—A state-by-state comparison. Retrieved from http://www.ncsl.org/ research/health/indoor-tanning-restric tions.aspx Norval, M., & Halliday, G.M. (2011). The consequences of UV-induced immunosuppression for human health. Photochemistry and Photobiology, 87, 965– 977. doi:10.1111/j.1751-1097.2011.00969.x
Clinical Journal of Oncology Nursing • Volume 18, Number 3 • Professional Issues
Okhovat, J., & Feldman, S.R. (2013). Tanning: An addiction? Melanoma Letter. Retrieved from http://www.skincancer.org/ publications/the-melanoma-letter/winter -2013-vol-31-no-3/tanning Pieper, B. (2006). Eye safet y is ever yone’s business. Optometry, 77, 235–247. doi:10.1016/j.optm.2006.03.002 Sarna, L., Bialous, S.A., Nandy, K., Antonio, A.L., & Yang, Q. (2014). Changes in smoking prevalences among health care professionals from 2003 to 2010– 2011. JAMA, 311, 197–199. doi:10.1001/ jama.2013.284871 Shoag, J., Haq, R., Zhang, M., Liu, L., Rowe, G.C., Jiang, A., . . . Arany, Z. (2013). PGC1 coactivators regulate MITF and the tanning response. Molecular Cell, 49, 145–157. doi:10.1016/j.molcel.2012.10.027 Stryker, J.E., Yaroch, A.L., Moser, R.P., Atienza, A., & Glanz, K. (2007). Prevalence of sunless tanning product use and related behaviors among adults in the United States: Results from a national survey. Journal of the American Academy of Dermatology, 56, 387–390. doi:10.1016/ j.jaad.2006.08.051 Surveillance, Epidemilogy, and End Results Program. (2011). SEER stat fact sheets: Melanoma of the skin. Retrieved from http://seer.cancer.gov/statfacts/html/ melan.html U.S. Food and Drug Administration. (2014). Indoor tanning: The risks of ultraviolet rays. Retrieved from http://www.fda.gov/ forconsumers/consumerupdates/ucm 186687.htm Veierod, M.B., Weiderpass, E., Thörn, M., Hansson, J., Lund, E., Armstrong, B., & Adami, H.O. (2003). A prospective study of pigmentation, sun exposure, and risk of cutaneous malignant melanoma in women. Journal of the National Cancer Institute, 95, 1530–1538. Watson, M., Holman, D.M., Fox, K.A., Guy, F.P., Jr., Seidenberg, A.B., Sampson B.P., . . . Lazovich, D. (2013). Preventing skin cancer through reduction of indoor tanning: Current evidence. American Journal of Preventive Medicine, 44, 682–689. doi:10.1016/j.amepre.2013.02.015 World Health Organization. (2006). Exposure to artificial UV radiation and skin cancer. Retrieved from http://www.iarc .fr/en/publications/pdfs-online/wrk/ wrk1/ArtificialUVRad&SkinCancer.pdf Zhang, M., Qureshi, A.A., Geller, A.C., Frazier, L., Hunter, D.J., & Han, J. (2012). Use of tanning beds and incidence of skin cancer. Journal of Clinical Oncology, 30, 1588–1593. doi:10.1200/JCO.2011.39.3652 365
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Professional Issues
Guadalupe R. Palos, RN, LMSW, DrPH—Associate Editor
Oncology Nurses and Indoor Tanning: Stylish or Risky Behavior? Christina Marie Leong, BSc, and Guadalupe R. Palos, RN, LMSW, DrPH
Being tan has become a social norm, and some nurses engage in that widely accepted lifestyle. Mounting evidence of the increased risk to melanoma and nonmelanoma skin cancers associated with indoor tanning supports the need for nurses to integrate skin cancer education, counseling, and referrals into routine practice. The current article presents an overview of the risks associated with indoor tanning, discusses its acceptance as a social norm, and offers strategies to support oncology nurses in changing the widespread trend. Christina Marie Leong, BSc, is an undergraduate college intern and Guadalupe R. Palos, RN, LMSW, DrPH, is a researcher in the Office of Cancer Survivorship, both at the University of Texas MD Anderson Cancer Center in Houston. The authors take full responsibility for the content of the article. The authors did not receive honoraria for this work. No financial relationships relevant to the content of this article have been disclosed by the authors or editorial staff. Leong can be reached at [email protected], with copy to editor at [email protected]. Key words: melanoma; indoor tanning; skin cancer Digital Object Identifier: 10.1188/14.CJON.363-365
O
ncology nurses serve as role models, advocates, and educators to promote wellness in all aspects of life. Evidence of nurses’ desire to be healthy is demonstrated by the dramatic decrease in smoking rates among nurses (Sarna, Bialous, Nandy, Antonio, & Yang, 2014) and in the growing number of health promotion programs that target nurses, such as HealthyNurse™ (American Nurses Association, 2014). By choosing to participate in safe and healthy behaviors (e.g., not smoking), nurses demonstrate the benefits of living a healthy life. However, a widespread negative trend involves indoor tanning to achieve a “stylish” tan. Despite the mounting evidence associated with the risks of indoor tanning, its use continues to increase around the world. In the current article, the authors discuss the public health issues linked to indoor tanning, the growing scientific evidence demonstrating the association between indoor tanning and
skin cancer, and the role of oncology nurses in educating patients, families, and communities about the related risks.
Indoor Tanning as a Public Health Concern Strong scientific evidence cites artificial ultraviolet (UV) light as posing carcinogenic harm (El Ghissassi et al., 2009; Norval & Halliday, 2011), linking tanning booths to skin cancer (Veierod et al., 2003), and placing tanning beds on a list of known, risky exposures with asbestos and cigarettes (El Ghissassi et al., 2009). In addition, the International Agency for Research on Cancer reported that having used tanning beds increased the risk for melanoma and squamous cell cancers (World Health Organization, 2006). Despite the evidence establishing the relationship between UV radiation, DNA
Clinical Journal of Oncology Nursing • Volume 18, Number 3 • Professional Issues
damage, and skin cancer, about 30 million Americans continue to use indoor tanning at least once per year (Stryker, Yaroch, Moser, Atienza, & Glanz, 2007; U.S. Food and Drug Administration, 2014). For those who participate in the practice, the known risks of premature skin aging, skin cancer, and immunosuppression appear to be outweighed by the desire for a tan (Norval & Halliday, 2011). UVA (long waves) and UVB (short waves) rays are carcinogenic (Griffiths, Mistry, Herbert, & Lunec, 1998), but UVA wavelengths emit deeper penetrating rays that can cause melanoma and are the predominant component in indoor tanning. However, skin is not the only area affected by those rays; eyes are susceptible to both forms of UV rays. UVA and UVB rays can result in detrimental vision defects such as cataracts (Pieper, 2006). According to a market study, more than 191 million Americans own nonprescription sunglasses that help protect eyes from UV rays (Pieper, 2006). To further decrease known risks, those who choose to use tanning beds regardless of the health risks should be encouraged to use protective eyewear.
Increased Risk of Skin Cancer Skin cancer is one of the most common malignancies, and incidence rates continue to grow (American Cancer Society, 2014). Although the majority of new cases of skin cancers are nonmelanoma, most skin cancer–related deaths are attributed to malignant melanoma. Studies have reported that, during the past 30 years, the incidence of nonmelanoma 363
skin cancer rapidly increased in young women and adolescents (Guy, Berkowitz, Watson, Holman, & Richardson, 2013; Heckman, Coups, & Manne, 2008). Research has suggested that the use of indoor tanning and more outdoor recreation activities contributed to a greater risk of skin cancers, particularly malignant melanomas (Holman et al., 2013). Karagas et al. (2002) found that tanning bed users were 2.5 times more likely to develop basal and squamous cell carcinoma. Skin cancer is more preventable if people have an understanding of the risk factors and preventive actions. Nurses must understand the damage resulting from overexposure to the sun or indoor tanning devices because 90% of overexposure leads to skin cancer.
Tanning as a Social Norm The desire for a tan for cosmetic reasons has helped establish a $5 billion per year tanning industry in the United States (IBISWorld, 2013). Millions of Americans use tanning devices every year, including tanning beds, sun lamps, tanning booths, and solariums—all of which lead to exposure to UV rays. Studies have indicated that the prevalence of indoor tanning is highest among young Caucasian females (Mayer et al., 2011). Other factors associated with greater use of indoor tanning included living within two miles of a tanning facility and having a parent who also engaged in the practice (Hawryluk, Geller, & Fisher, 2013). Kaur et al. (2006) reported that a chemical blockage of UV light induced opiate withdrawal symptoms in frequent tanners. That apparent addiction to tanning has been referred to as tanorexia, which is defined as “the condition of becoming obsessed with, even addicted to, tanning, believing that one is unattractively pale, even when quite tan” (Kravitz, 2010, p. 113). This phenomenon has been attributed to appearance motivation, social influences, and physical addiction factors (Okhovat & Feldman, 2013). Another study found that the release of endorphins associated with habitual tanning could result in mood enhancement, relaxation, and socialization reactions similar to those associated with smoking addiction (Heckman, Egleston, Wilson, & Ingersoll, 2008). Other factors 364
contributing to the unhealthy practice is the public’s lack of knowledge of the risks associated with indoor tanning, inadequate federal regulation, and the belief that a tan is stylish.
Debunking the Tanning Myth Several organizations have launched collaborative efforts to change the perception that being tan is healthy, stylish, or flattering. Another prevalent myth related to tanning is that base tanning will prevent sunburn. Those misconceptions and the quest for having a “healthy glow” have led many young women and adolescents to use tanning devices. In 2008, the Skin Cancer Foundation launched a nationwide advertising campaign called Go With Your Own Glow. This campaign has the support of fashion leaders, celebrities, and advocacy groups with the goal of encouraging women to love and protect their skin. The message is becoming more visible with current fashion trends that feature models with pale complexions or other forms of natural coloring as well as with celebrities who advocate and practice sun safety. The tanning industry lacks federal regulation, which contributes to the risks associated with indoor tanning (Gosis et al., 2014). However, scientific evidence establishing the link between tanning devices and skin cancer risk has led to increased indoor tanning restrictions. In 2013, several states passed regulations banning the use of tanning devices for minors aged 18 years or younger (National Conference of State Legislatures, 2014). Anti-tanning movements, such as increased regulation and the growing belief that tanning is not fashionable, will hopefully encourage a downward trend in indoor tanning, as seen in smoking behaviors (Watson et al., 2013).
Nurses and Indoor Tanning Nurses engage in indoor tanning despite their role in promoting healthy lifestyles. To date, limited epidemiologic data exist on the number of nurses who use tanning devices. However, the Nurses’ Health Study II examined the correlation between nurses who choose
to use tanning beds every year and their increased risk to skin cancer (Zhang et al., 2012). That study included more than 70,000 women over a 20-year period and found an 11%–15% increased risk of skin cancer among nurses who used indoor tanning (Shoag et al., 2013).
Nurses’ Role in Skin Cancer Education Nurses can use several strategies to change their practice to integrate education and counseling about tanning risks (Mahon, 2003). Nurses could begin with their own health and lifestyles by reflecting on attitudes and practices toward indoor tanning. In addition, nurses can strive for wellness with the help of several resources to assess their risk to various conditions (see Figure 1). Nurses also can teach their patients, families, and communities how to conduct skin examinations. Organizations such as the Skin Cancer Foundation provide education and training for professionals and the public on how to conduct skin examinations. In addition, nurses in all clinical settings can conduct thorough skin examinations on their patients. Nurses can assess patients’ skin during face-to-face interactions or when conducting physical assessments. Nurses also could advocate and support legislation and enforcement efforts to regulate tanning salons using the tobacco policy model (Institute
Healthy Lifestyle Brief, easy-to-read messages about indoor tanning risks, safe outdoor activities, and myths of tanning by the Skin Cancer Foundation www.skincancer.org/healthy-lifestyle HealthyNurse™ A program by the American Nurses Association that focuses on different aspects to maintain a healthy lifestyle www.nursingworld.org/mainmenu categories/workplacesafety/healthy-nurse Nurses’ Health Study A study by Harvard University’s School of Public Health and Brigham and Women’s Hospital that has enrolled more than 238,000 nurses since 1976. The study is now accepting nurses for the Nurses’ Health Study III. www.nhs3.org
FIGURE 1. Resources for Healthy Living for Nurses
June 2014 • Volume 18, Number 3 • Clinical Journal of Oncology Nursing
of Medicine, 2007). Those approaches can help reduce the harm of indoor tanning and discourage its use, particularly among adolescents and young adults. Nurses must remember that they are one of the most trusted professions and sources of information in health care (Gallup Inc., 2013), and that trust makes nurses accountable as role models for healthy living.
References American Cancer Society. (2014). Cancer facts and figures 2014. Atlanta, GA: Author. A merican Nurses Association. (2014). HealthyNurse™. Retrieved from http:// www.nursingworld.org/MainMenuCat egories/WorkplaceSafety/Healthy-Nurse El Ghissassi, F., Baan, R., Straif, K., Grosse, Y., Secretan, B., Bouvard, V., . . . Cogliano, V. (2009). A review of human carcinogens—Part D: Radiation. Lancet Oncology, 10, 751–752. Gallup Inc. (2013). Honesty/ethics in professions. Retrieved from http://www .gallup.com/poll/1654/honesty-ethics -professions.aspx Gosis, B., Sampson, B.P., Seidenberg, A.B., Balk, S.J., Gottlieb, M., & Geller, A.C. (2014). Comprehensive evaluation of indoor tanning regulations: A 50-state analysis, 2012. Journal of Investigative Dermatology, 134, 620–627. doi:10.1038/ jid.2013.357 Griffiths, H.R., Mistry, P., Herbert, K.E., & Lunec, J. (1998). Molecular and cellular effects of ultraviolet light-induced genotoxicity. Critical Reviews in Clinical Laboratory Sciences, 35, 189–237. doi:10.1080/10408369891234192 Guy, G.P., Jr., Berkowitz, Z., Watson, M., Holman, D.M., & Richardson, L.C. (2013). Indoor tanning among young non-Hispanic white females. JAMA Internal Medicine, 173, 1920–1922. doi:10.1001/ jamainternmed.2013.10013 Hawryluk, E.B., Geller, A.C., & Fisher, D.E. (2013). Indoor tanning: The link to melanoma is no longer deniable. Melanoma Letter. Retrieved from http://www.skin cancer.org/publications/the-melanoma -letter/winter-2013-vol-31-no-3/link Heckman, C.J., Coups, E.J., & Manne, S.L. (2008). Prevalence and correlates of indoor tanning among US adults. Journal of the American Academy of Dermatology, 58, 769–780. doi:10.1016/j.jaad .2008.01.020
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Clinical Journal of Oncology Nursing • Volume 18, Number 3 • Professional Issues
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