Development of a brief scale to assess frequency of symptoms and problems associated with tanning
2014; Elsevier BV; Volume: 70; Issue: 3 Linguagem: Inglês
10.1016/j.jaad.2013.11.041
ISSN1097-6787
AutoresLisham Ashrafioun, Erin E. Bonar,
Tópico(s)Skin Protection and Aging
ResumoSee related articles on pages 473 and 562 To the Editor: Some university students are at risk to display tanning behaviors analogous to drug use behaviors (eg, continuing to tan despite negative consequences, tanning beyond what is necessary to achieve their desired appearance).1Warthan M.M. Uchida T. Wagner Jr., R.F. UV light tanning as a type of substance-related disorder.Arch Dermatol. 2005; 141: 963Crossref PubMed Scopus (131) Google Scholar, 2Harrington C. Beswick T. Leitenberger J. Minhajuddin A. Jacobe H. Adinoff B. Addictive-like behaviours to ultraviolet light among frequent indoor tanners.Clin Exp Dermatol. 2011; 36: 33-38Crossref PubMed Scopus (76) Google Scholar Screeners1Warthan M.M. Uchida T. Wagner Jr., R.F. UV light tanning as a type of substance-related disorder.Arch Dermatol. 2005; 141: 963Crossref PubMed Scopus (131) Google Scholar, 2Harrington C. Beswick T. Leitenberger J. Minhajuddin A. Jacobe H. Adinoff B. Addictive-like behaviours to ultraviolet light among frequent indoor tanners.Clin Exp Dermatol. 2011; 36: 33-38Crossref PubMed Scopus (76) Google Scholar and structured interviews3Hillhouse J.J. Baker M.K. Turrisi R. Shields A. Stapleton J. Jain S. et al.Evaluating a measure of tanning abuse and dependence.Arch Dermatol. 2012; 148: 815-819Crossref PubMed Scopus (40) Google Scholar help identify those who may be dependent on tanning. Additionally, researchers and clinicians may find useful a measure that assesses frequency of symptoms and psychosocial consequences of tanning. We assessed the psychometric properties of a tanning adaptation of the Short-Rutgers Alcohol Problem Index (S-RAPI).4Earleywine M. LaBrie J.W. Pedersen E.R. A brief Rutgers Alcohol Problem Index with less potential for bias.Addict Behav. 2008; 33: 1249-1253Crossref PubMed Scopus (68) Google Scholar We chose the S-RAPI given the similarities between problematic tanning and other addictions,1Warthan M.M. Uchida T. Wagner Jr., R.F. UV light tanning as a type of substance-related disorder.Arch Dermatol. 2005; 141: 963Crossref PubMed Scopus (131) Google Scholar, 2Harrington C. Beswick T. Leitenberger J. Minhajuddin A. Jacobe H. Adinoff B. Addictive-like behaviours to ultraviolet light among frequent indoor tanners.Clin Exp Dermatol. 2011; 36: 33-38Crossref PubMed Scopus (76) Google Scholar and the strong psychometric properties of the S-RAPI among university students.4Earleywine M. LaBrie J.W. Pedersen E.R. A brief Rutgers Alcohol Problem Index with less potential for bias.Addict Behav. 2008; 33: 1249-1253Crossref PubMed Scopus (68) Google Scholar The Tanning Problems Index (TPI) included 11 items characterizing potential problems associated with past-year tanning (Table I includes items, scale anchors, and response distributions). We removed 5 of the S-RAPI's 16 items because they were irrelevant to tanning (see Table I footnote). Following Institutional Review Board approval, 414 students from a large Midwestern university who reported indoor/outdoor tanning were administered online questionnaires (Table II).Table IN (%) by response option to items in the Tanning Problems IndexItemsResponse options reflecting past-year frequency of problems (N = 414)0 times1-2 times3-5 times6-9 times10+ times1. Not able to do your homework or study for a test333 (80%)55 (13%)17 (4%)5 (1%)4 (1%)2. Got into fights with other people (friends, relatives, strangers)352 (85%)47 (11%)9 (2%)4 (1%)2 (1%)3. Neglected your responsibilities288 (70%)96 (23%)23 (6%)3 (1%)4 (1%)4. Felt that you needed to tan more than you used to in order to get the same effect295 (71%)72 (17%)37 (9%)5 (1%)5 (1%)5. Tried to control your tanning (tried to tan less often)313 (76%)67 (16%)22 (5%)9 (2%)3 (1%)6. Had withdrawal symptoms, i.e., felt sick because you stopped or cut down on tanning376 (91%)27 (7%)7 (2%)1 (<1%)3 (1%)7. Felt that you had a problem with tanning362 (87%)31 (8%)14 (3%)7 (2%)0 (0%)8. Missed a day or part of a day of school or work357 (86%)34 (8%)16 (4%)5 (2%)2 (1%)9. Wanted to stop tanning but couldn't374 (90%)29 (7%)8 (2%)2 (1%)1 (<1%)10. Felt physically or psychologically dependent on tanning357 (86%)33 (8%)18 (4%)3 (1%)3 (1%)11. Was told by a friend, neighbor, or relative to stop or cut down tanning322 (78%)54 (13%)32 (8%)4 (1%)2 (1%)Values may not add to 100% due to rounding.The following items were removed from the Short-Rutgers Alcohol Problems Index: “Caused shame or embarrassment to someone,” “Relatives avoided you,” “Suddenly found yourself in a place that you could not remember getting to,” “Felt like you were going crazy,” “Had a bad time.”Directions used in our examination of the Tanning Problems Index: “How many times did the following things happen to you while you were tanning or because of your tanning during the last year?” Open table in a new tab Table IISummary of demographic and tanning-related characteristics of study participantsCharacteristicsMean (SD) or n (%) (N = 414)Age19.5 (1.8)Female (%)301 (73)Frequency of sun screen use (%) Never93 (23) Rarely126 (30) About ½ the time when I tan81 (20) Almost all of the time I tan61 (15) Always51 (12)Past-month frequency of tanning in days5.0 (6.3)Amount of USD spent on tanning in a typical month∗Range in current sample from $0 to $300.15.1 (22.4)Met cut-off for tanning dependence (%)†Based on Tanning-DSM score ≥ 3.152 (37)Tanning Problem Index‡Scores range from 0 to 44 with higher scores indicating greater problems associated with tanning. Range in current sample from 0 to 31.2.9 (4.6)Difficulty to quit tanning (%) Very easy340 (83) Somewhat easy52 (13) Somewhat difficult16 (4) Very difficult4 (1)Values may not add up to 100% due to rounding.∗ Range in current sample from $0 to $300.† Based on Tanning-DSM score ≥ 3.‡ Scores range from 0 to 44 with higher scores indicating greater problems associated with tanning. Range in current sample from 0 to 31. Open table in a new tab Values may not add to 100% due to rounding. The following items were removed from the Short-Rutgers Alcohol Problems Index: “Caused shame or embarrassment to someone,” “Relatives avoided you,” “Suddenly found yourself in a place that you could not remember getting to,” “Felt like you were going crazy,” “Had a bad time.” Directions used in our examination of the Tanning Problems Index: “How many times did the following things happen to you while you were tanning or because of your tanning during the last year?” Values may not add up to 100% due to rounding. The TPI showed good internal consistency (α = .86). Overall, we found that 9% to 29% of students across items (Table I) reported a problem at least once in the past year. In support of construct validity, those screening positive for tanning dependence on the Tanning-DSM (M = 5.6, SD = 5.6) had significantly higher TPI scores than those screening negative (M = 1.4, SD = 2.9), t(412) = −9.92, P < .001. In support of criterion validity, higher TPI scores were associated with more frequent past-month tanning, r(412) = .36, P < .001, more money spent on tanning r(409) = .41, P < .001, greater perceived difficulty to stop tanning, r(410) = .55, P < .001, and less frequent use of sunscreen, r(410) = −.15, P = .003. In a linear regression analysis with past-month tanning frequency as a dependent variable and TPI scores and Tanning-DSM scores as independent variables, TPI scores remained significant (β = .13, P = .011) when controlling for the variance explained by Tanning-DSM scores (β = .45, P < .001), overall F(2,411) = 79.17, P < .001, adjusted R2 = .28. This finding suggests that the TPI provides unique information from the Tanning-DSM when evaluating past-month tanning frequency. This evaluation of the TPI suggests that there exists a subset of students that experience problems associated with tanning. These findings provide initial support for the internal consistency, construct validity, and criterion validity of the TPI. This appears to be a brief, psychometrically sound instrument that clinicians could administer to assess frequency of tanning-related problems and to potentially enhance motivation to change tanning behaviors. Future studies should attempt to replicate these findings in other samples and consider revised response options given that few participants reported the highest frequencies of these tanning-related problems. Researchers could use the TPI as an outcome measure to track the frequency of tanning-related problems. Furthermore, researchers should continue to assess the relationship between TPI scores and other tanning-related characteristics and psychiatric problems (eg, substance use, anxiety disorders).5Ashrafioun L. Bonar E.E. Tanning addiction and psychopathology: Further evaluation of anxiety disorders and substance abuse.J Am Acad Dermatol. 2014; 70: 473-480Abstract Full Text Full Text PDF PubMed Scopus (28) Google Scholar
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