Indoor tanning (IT) before the age of 35 increases risk for melanoma-the most fatal type of skin cancer. In spite of the risks, 25-40% of young women report use in the past year. Indoor tanners report two reasons for IT: physical appearance and stress reduction. Behavioral economic theory suggests that an effective way to decrease an unhealthy behavior is by increasing alternatives that serve a similar function with comparable or less effort or cost. Sunless tanning (ST) is a promising IT alternative because it produces a tan without UVR exposure. Mounting evidence suggests that indoor tanners who adopt ST subsequently reduce IT.9 Our trial of beach visitors showed reduced sunbathing following a ST intervention, but we have not tested this in indoor tanners, for whom the desire to be tan is a strong motivator (more so than beach visitors).1 One challenge to ST is that it is not a source of stress reduction, the other major reason young women tan indoors. Yoga is efficacious for stress reduction and so may have potential to be a healthy alternative to IT. Together ST and yoga, by addressing both key IT motivators, may prove a potent combination for reducing IT. The objective of the present study is to determine the feasibility and short-term efficacy of providing free ST and yoga to indoor tanners in an effort to "nudge" them to switch from IT to healthy alternatives. The healthy alternatives (ST and yoga) were chosen based on their having similar immediate consequences as IT, while both being impossible to do during IT (to avoid potentiation). Free access to healthy alternatives gives participants a low-risk opportunity to try something new that is consistent with their motivations. Experiencing the reinforcing properties of the alternatives could prime continued use. We will begin by conducting focus groups of female indoor tanners to solicit opinions about and barriers to ST and Hatha yoga and feedback on proposed intervention procedures. After refining the intervention, female indoor tanners (N=150) will be randomized to one of three conditions: Sunless Tanning, Sunless+Yoga, and Control. We hypothesize that the Sunless condition will lead to greater reductions in IT relative to Control, and Sunless+Yoga will lead to greater reductions in IT relative to Sunless alone. Costs, benefits, and acceptability of healthy alternatives relative to I will be assessed. Moderators (tanning dependency, sensation seeking, body image, perceived stress) and mediators (stress reduction effect of yoga, acceptability of ST and yoga) of the interventions effects on IT will be tested. Focus groups will be conducted following the intervention to evaluate acceptability, facilitators, and barriers to the interventions. We will alo conduct key informant interviews of tanning business owners to assess their reactions and opinions on what type of data and/or new legislation would compel them to change their business plan toward healthy alternatives. Data from the present study will be used to support a larger trial that tests the short- and long-term effects of free trial periods of ST with and withot yoga relative to an effective print-based intervention.
Ultraviolet radiation exposure heightens risk for melanoma, especially among young women who tan indoors. Indoor tanners report that they tan to improve their physical appearance and to reduce stress, and these benefits seem to outweigh the health risks. The present study will determine whether incentivizing indoor tanners'engagement in healthy alternative behaviors that enhance appearance (sunless tanning) and reduce stress (yoga) will decrease their indoor tanning.