Prevalence and Associated Factors of Intentional Outdoor Tanning Among US Adults

Importance: Intentional outdoor tanning involves exposing one's skin to UV radiation from the sun for the purpose of darkening the skin to create a tanned appearance. Although robust surveillance data are available on many skin cancer risk factors, limited data on intentional outdoor tanning prevalence have been reported to date. Objective: To examine the prevalence of intentional outdoor tanning among US adults and the factors associated with this behavior. Design, Setting, and Participants: This cross-sectional study used data from US adults who participated in the 2024 National Health Interview Survey, a nationally representative sample of civilian, noninstitutionalized US adults aged 18 years or older, to assess the prevalence of intentional outdoor tanning and sunburn by asking participants "when spending time outdoors, how often do you try to get some sun for the purpose of developing a tan?" (always, most of the time, sometimes, rarely, or never) and "during the past 12 months, did you have a sunburn even on a small part of your skin?" (yes or no). The individual-level factors analyzed were demographic characteristics and health-related behaviors, including physical activity and alcohol use. Main Outcomes and Measures: The primary outcome was prevalence of intentional outdoor tanning. The secondary outcome was prevalence of sunburn. Results: A total of 31 615 US adults (mean [SD] age, 48.3 [18.6] years; 17 111 females [51.4%]) were included in the study. Overall, the unadjusted prevalence of intentional outdoor tanning among adults was 30.2% (35.6% [95% CI, 34.6%-36.7%] in women and 26.6% [95% CI, 25.6%-27.7%] in men). Among women and men, prevalence of intentional outdoor tanning was associated with age, race and ethnicity, sun sensitivity, physical activity, and alcohol use. Among women, prevalence was highest among those aged 18 to 29 years (48.1%; 95% CI, 45.3%-50.9%), non-Hispanic White women (41.3%; 95% CI, 39.9%-42.7%), non-sun-sensitive women (38.3%; 95% CI, 36.6%-40.1%), women who met both aerobic and strength guidelines (39.5%; 95% CI, 37.6%-41.5%), and women who engaged in heavy or binge drinking (47.2%; 95% CI, 44.8%-49.7%) (P for all < .001). Among men, prevalence was highest among those aged 18 to 29 years (29.9%; 95% CI, 27.4%-32.6%), non-Hispanic White men (30.5%; 95% CI, 29.0%-32.1%), sun-sensitive men (28.7%; 95% CI, 27.2%-30.2%), men who met both aerobic and strength guidelines (32.2%; 95% CI, 30.2%-34.3%), and men who engaged in heavy or binge drinking (31.2%; 95% CI, 29.0%-33.5%) (P for all < .001). Among women only, prevalence was associated with educational level and body mass index, with a higher prevalence among women with some college (37.5%; 95% CI, 35.8%-39.3%) and those at a healthy weight (38.7%; 95% CI, 37.0%-40.5%; P for all < .001). Among men only, prevalence was associated with marital status, with a higher prevalence among married or partnered men (25.8%; 95% CI, 24.5%-27.1%; P = .04). The prevalence of sunburn was significantly higher among adults who reported intentional outdoor tanning (49.9%; 95% CI, 48.5%-51.4%) compared with those who did not (28.3%; 95% CI, 27.4%-29.3%; P < .001). Conclusions and Relevance: This cross-sectional study found that the highest prevalence of intentional outdoor tanning occurs among US women who are younger, non-Hispanic White, and physically active and report heavy and/or binge drinking. Those who engage in intentional outdoor tanning are more likely to experience sunburn, increasing their skin cancer risk. These findings can inform future strategies to address intentional outdoor tanning as part of larger efforts to reduce skin cancer risk.