Evaluating a Measure of Tanning Abuse and Dependence

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Objective To evaluate the Structured Interview for Tanning Abuse and Dependence (SITAD).

Design Longitudinal survey.

Setting College campus.

Participants A total of 296 adults.

Main Outcome Measures The SITAD modified items from the Structured Clinical Interview for DSM-IV Axis I Disorders that focus on opiate abuse and dependence. Indoor tanning (IT) behavioral patterns and opiate-like reactions to tanning were measured, and IT behavior was measured 6 months later.

Results Of 296 participants, 32 (10.8%) met the SITAD criteria for tanning abuse (maladaptive pattern of tanning as manifested by failure to fulfill role obligations, physically hazardous tanning, legal problems, or persistent social or interpersonal problems) and 16 (5.4%) for tanning dependence as defined by 3 or more of the following: loss of control, cut down, time, social problems, physical or psychological problems, tolerance, and withdrawal. The IT frequency in dependent tanners was more than 10 times the rate in participants who do not meet the SITAD criteria for tanning abuse or dependence. Tanning-dependent participants were more likely to report being regular tanners (75%; odds ratio, 7.0). Dependent tanners scored higher on the opiate-like reactions to tanning scale than did abuse tanners, who scored higher than those with no diagnosis.

Conclusions The SITAD demonstrated some evidence of validity, with tanning-dependent participants reporting regular IT, higher IT frequency, and higher scores on an opiate-like reactions to tanning scale. A valid tanning dependence screening tool is essential for researchers and physicians as a tanning-dependent diagnosis may facilitate a better understanding of tanning motivations and aid in the development of efficacious intervention programs.

Recent research has explored the idea that some patterns of tanning behavior may be dependent1- 7 by using a common alcohol screening questionnaire, the CAGE,8 or, alternatively, by adapting criteria for substance-related disorders from the Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition, Text Revision) (DSM-IV-TR)9 modified to reflect UV light tanning (ie, sunbathing or indoor tanning [IT]).1,4,6,7Whereas data from the National Household Survey on Drug Abuse10 report prevalence rates for alcohol and any illicit drug combined as 2.6% to 9.3%, the modified CAGE and modified DSM report tanning dependence rates ranging from 12% to 55%.1,4,6,7,11Prevalence rates for dependence on alcohol and various drugs do differ. However, even in settings enriched for dependent behavior, such as bars,12 prevalence rates are not nearly as high as the tanning dependence rates reported. The high prevalence rates reported suggest that the current assessments tend to overidentify tanning dependence.

Feldman and others suggest that the mechanism for tanning dependence is most likely the release of endogenous opioids when the skin is exposed to UV radiation (see Nolan and Feldman5 for a review). It is probable that exploring tanning behavior by following the approach used in the DSM-IV-TR to categorize opioid use behaviors will lead to improved accuracy in the categorization of tanning dependence.

The Structured Interview for Tanning Abuse and Dependence (SITAD) is a tanning dependence assessment based on opioid use items adapted from the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID).13 The use of modified opioid SCID items was chosen specifically for good content and face validity in the measure. The self-administered structured interview format was chosen because this format has been demonstrated to achieve valid psychiatric categorization for opioid dependence in a previous study.14

Evaluation of the SITAD involved exploring differences in variables (ie, IT frequency, IT behavioral patterns, and scores on a scale measuring opiate-like reactions to tanning) that would theoretically be expected to differ among individuals exhibiting tanning abuse, those with tanning dependence, and those who do not meet the SITAD criteria for tanning abuse or dependence. We also expect that use of the SITAD will result in lower prevalence rates for tanning dependence than have been reported in previous studies.1,6,7