Tanning Facilities (new Article 177)
Proposed Rules: Closed to Comments (View Public Comments Received:3)
Statement of Basis and Purpose of Proposed Rule
This amendment to the New York City Health Code (“Health Code”) is proposed pursuant to Sections 556, 558 and 1043 of the New York City Charter (“Charter”). Section 556 of the Charter grants the New York City Department of Health and Mental Hygiene (“Department”) jurisdiction to regulate all matters affecting health in the City of New York. Sections 558 (b) and (c) of the Charter empower the Board of Health to amend the Health Code and to include in the Health Code all matters to which the Department’s authority extends. Section 1043 of the Charter grants rule-making powers to the Department. It also is being proposed pursuant to §3554(3) of the Public Health Law and 10 NYCRR §§72-1.1(d) and 72-1.2(b) and (c)i, which allow the New York State Department of Health to authorize local jurisdictions, such as the Department, to enact and enforce local regulations concerning tanning facilities.
As the U.S. Food and Drug Administration (FDA) has warned, “There is no such thing as a safe tan.”ii Tans are caused by the skin’s reaction to ultraviolet (UV) radiation and any exposure to UV rays can lead to skin cancer and other diseases. Ultraviolet radiation devices, or “indoor tanning devices,” are devices available at many facilities for members of the public to use to tan. In the State of New York, they generally are regulated by the New York State Department of Health under Article 35-A of the Public Health Law. Pursuant to State Department of Health regulations, local health departments, however, may request and be given authority by the State to regulate their operation locally.iii The Department has made such a request to regulate indoor tanning devices in the City of New York.
Tanning and Cancer
Users of indoor tanning devices are at risk for multiple adverse health consequences. The World Health Organization’s International Agency for Research on Cancer (IARC) classifies indoor tanning devices, which emit UV radiation, as “Group 1”iv carcinogens because there is “sufficient evidence” that their use causes “carcinogenicity in humans.” v The IARC based its classification on evidence showing associations between indoor tanning and skin cancer (both melanoma and carcinoma) and eye cancer (ocular cancer).vi It observed that the risk of melanoma is “increased by 75% when the use of tanning devices starts before 30 years of age.”vii The U.S. Department of Health and Human Services’ National Toxicology Program similarly classifies tanning devices as, “known to be human carcinogens.”viii Skin cancer is the most common form of cancer in the United States, and annually costs the country an estimated $1.7 billion in medical costs and results in $3.8 billion in lost productivity.ix In New York State, approximately 2,000 men and 1,500 women are diagnosed with melanoma each year (averaged over 2005 through 2009)x.
Other Risks of Tanning
In addition to increasing the risk of certain cancers, the use of indoor tanning devices can also cause ocular damage, premature aging of the skin, immune system repression and exacerbation of pre-existing medical conditions.xi Indoor tanners may also experience serious burns requiring emergency medical treatment. In the U.S., according to the FDA, an average of 1,800 emergency department visits are caused by UV tanning devices every year, and the number of burn cases treated by doctors or urgent care clinics is probably significantly higher.xii A study of adolescent indoor tanning practices between 1998 and 2004 found that over 60% of indoor tanners between the ages of 16 and 18 years old reported experiencing erythema, or burns, after indoor tanning sessions.xiii
Frequency and Risk
The earlier a person begins indoor tanning and the more frequently they tan, the greater the risk is that they will develop skin cancer. Research has demonstrated a strong “dose response” relationship between melanoma risk and the total hours of indoor tanning over a lifetime. This means the risk of cancer from indoor tanning is cumulative and increases with every use.xiv Early and frequent use of indoor tanning devices, however, is not uncommon. While minors under the age 17 are legally prohibited from tanning in the state of New York, (Chapter 105, Laws of 2012), the use of tanning among older adolescents and young adults is prevalent and frequent. The most recent national Youth Risk Behavior Survey (YRBS, 2011) found that approximately 40% of non-Hispanic white females ages 17-18 have used a tanning device in the last year and that approximately 24-30% of that group reporting tanning at least 10 times in the last 12 months.xv A similar study of adults (the National Health Interview Survey, 2010) found that approximately 30% of non-Hispanic white females between the ages of 18-25 reported indoor tanning at least once annually.xvi Among adults who tan, approximately 50 percent reported using tanning devices more than 10 times in a year, with women reporting that they use them an average of 20 times per year.xvii Among youths ages 16 to 18 who tan indoors, the average number of visits is approximately nine times per year.xviii Multiple studies have shown that the repeated use of indoor tanning may result in behavioral consequences, including physical and psychological addiction to tanning. In other words, the more people tan, the more they feel compelled to tan, increasing their health risks.xix
Efforts to Reduce Tanning
Despite the large body of evidence documenting the health risks associated with indoor tanning, indoor tanning rates have continued to increase.xx
A study of university-age students found that the students’ general understanding of the health risks associated with indoor tanning did not influence their decision to indoor tan.xxi A study by the FDA of its own warning material found that a modified warning message “may more effectively convey [the] risks [of indoor tanning] than the current labeling requirements,” which mandate that labels state factual information about the dangers of indoor tanning devices.
Proposed Rule Elements and Goals
The Department would, if approved, assume regulatory authority of tanning facilities within New York City from the New York State Department of Health. Consistent with State law, these rules are being proposed as part of that oversight.
The proposed rules are intended to reduce the risk of tanning-related health effects among tanning facility patrons by increasing the awareness of the risks of indoor tanning and establishing the safer and more sanitary operation of tanning facilities. These rules: 1) provide definitions and requirements for permit issuance, inspection and operation of tanning facilities, and 2) would enable the Department to apply successful strategies used successfully to change risky behavior.
The New York City Department of Health and Mental Hygiene’s authority for these rules is found in sections 556, 558 and 1043 of the City Charter and section §3554(3) of the New York State Public Health Law.
i New York Codes, Rules and Regulations, (NYCRR), Title 10, Part 72, Subpart 72-1. Electronic version: http://www.health.ny.gov/regulations/nycrr/title_10/part_72/subpart_72-1.htm
ii FDA, The Risks of Tanning: http://www.fda.gov/Radiation-EmittingProducts/RadiationEmittingProductsandProcedures/Tanning/ucm116432.htm.
iii New York Codes, Rules and Regulations, (NYCRR), Title 10, Part 72, Subpart 72-1.
iv Group 1 is the IARC’s highest cancer risk category and includes other well-established carcinogens like asbestos, arsenic and tobacco smoke. IARC, Agents Classified by the IARC Monographs, Volume 1-104: http://monographs.iarc.fr/ENG/Classification/ClassificationsGroupOrder.pdf.
v IARC, Preamble: http://monographs.iarc.fr/ENG/Preamble/CurrentPreamble.pdf .
vi IARC Monographs on the Evaluations of Carcinogenic Risks to Humans, Volume 100, Part D: Radiation. WHO Press, 2009. See also, Special Report: Policy, A Review of Human Carcinogens – Part D: Radiation. The Lancet ,August, 2009; and Zhang et al., Use of Tanning Beds and Incidence of Skin Cancer, Journal of Clinical Oncology, May 10, 2012.
vii IARC, 2009; See also, Dennis K. Woo and Melody J. Eide. Tanning Beds, Skin Cancer, and Vitamin D: An Examination of the Scientific Evidence and Public Health Implications, Dermatologic Therapy, 2010.
viii U.S. Department of Health and Human Services, Public Health Services, National Toxicology Program, Report on Carcinogens, 12th ed.: Exposure to Sunlamps or Sunbeds (2011).
ix CDC Morbidity and Mortality Weekly Report, Use of Indoor Tanning Devices by Adults – United States, 2010. Volume 61, Number 18. May 11, 2012; see also Bickers et al., The Burden of Skin Disease. Journal of American Academy of Dermatology. 2006.
x New York State Department of Health, New York State Cancer Registry. Skin Cancer in New York State, Fifth Annual Report to the Governor of New York, the Temporary President of the Senate, and Speaker of the Assembly, 2012. Report available at: http://www.health.ny.gov/statistics/diseases/cancer/skin/report/docs/2012_report.pdf
xi James M. Spencer and Rex A. Amonette. Indoor Tanning: Risks, Benefits, and Future Trends, Journal of the American Academy of Dermatology (1995).
xii National Electronic Injury Surveillance System, CDC. Reported on FDA website: http://www.fda.gov/Radiation-EmittingProducts/RadiationEmittingProductsandProcedures/HomeBusinessandEntertainment/ucm116447.htm
xiii Cokkinides et al. Indoor Tanning among Adolescents in the US, 1998 to 2004. Cancer, January 2009.
xiv Lazovich et al.. Indoor tanning and risk of melanoma: a case-control study in a highly exposed population. Cancer Epidemiol Biomakers Prev. June, 2010.
xv Guy et al. Indoor Tanning Among Young Non-Hispanic White Females. Journal of the American Medical Association, Internal Medicine, Letters. Published online August 19, 2013; See also, Mayer et al.. Adolescents’ Use of Indoor Tanning: A Large-Scale Evaluation of Psychosocial, Environment, and Policy-Level Correlates. American Journal of Public Health. May, 2011. See also Cokkinides et al.. Use of indoor Tanning Sunlamps by US Youths, Ages 11-18 Years, and by their Parent of Guardian Caregivers: Prevalence and Correlates. Pediatrics. 2002. American Journal of Public Health. May, 2011.
xvi Guy et al., 2013; See also reference ix, CDC MMWR, 2012.
xvii See reference ix, CDC MMWR, 2012.
xviii See reference xiii, Cokkinides et al., 2009.
xix David E. Fisher and William D. James. Indoor Tanning – Science, Behavior, and Policy. New England Journal of Medicine. September 2010; see also, Catherine E. Mosher and Sharon Danoff-Burg. Addiction to Indoor Tanning: Relation to Anxiety, Depression, and Substance Use. Arch Dermatol, April, 2010.
xx See reference vii Woo et al.; See also Purdue et al.. Recent Trends in incidence of cutaneous melanoma among U.S. Caucasian young adults. Journal of Investigative Dermatology. December. 2008: 128(12), 2905-2908
xxi Knight et al.. Awareness of the Risks of Tanning lamps Does Not Influence Behavior Among College Students. Arch Dermatol. October, 2002.