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Table 1 Compliance with Indoor Tanning Legislation Outcomes of Interest

From: A systematic review of compliance with indoor tanning legislation

First Author (Year) Country (State) Date of Data Collection Legislationa Methods Site of Study Outcomes of Interest
Brouse (2011) [37] US (NY) 2010 Federal In-person observation of the facility (N = 224 IT beds in 85 facilities) Individual IT beds within IT facilities Warning Labels: 65% of IT beds had warning labels present, 14% had warning labels that were barely visible, 24% were moderately visible, 25% were clearly visible, and 1% were completely visible.
Choy (2017) [23] US (14 states) 2015 State Underage telephone shoppers (N = 412) IT facilities and their operators Age: 80% of facilities complied with under 17 or under 18 age restrictions. Health Effects: 20% of operators reported skin cancer, 52% reported sunburn, and 4% reported premature ageing. 10% denied any dangers from IT. Health Benefits: 89% of operators reported specific health benefits.
Culley (2001) [33] US (CA) 1998 State and Federal In-person underage shoppers with observation of the facility (N = 54) IT facilities and their operators Parental Consent: 43% of facilities required parental consent for ages 14–18. Eye Protection: 100% of facilities provided protective eyewear, 89% required protective eyewear. Warning Labels: 85% of facilities had warning labels present, 74% had warning labels accessible, legible, correct, 85% had other (exposure) labels present, 74% had other (exposure) labels accessible, legible, correct, 20% had a warning sign posted in the IT area, and 15% had a warning sign that was legible, accessible, and correct. Health Effects: 32% of operators reported skin cancer, and 98% reported skin burns.
De Maleissye (2011) [38] France 2009 National Online website observation (N = 71) IT facility websites Warning Labels: 35% of websites mentioned the ‘black box’ legal warning. Health Beneifts: 7% of websites reported health benefits.
Fleischer (1993) [34] US (NC) 1991 State and Federal Facility inspection by researchers (N = 32) IT facilities Parental Consent: 13% of facilities had a minor consent form available and in use. Eye Protection: 84% of facilities had protective eyewear available. Warning Labels: 78% of facilities had warning signs that were easily viewed by customers, 72% had a warning sign posted within 1 metre of IT stations, 90% had warning sign text that was compliant, and 78% had warning labels attached to the sunlamp. Health Effects: 19% of facilities had a consumer statement about risks available for customers to sign.
Forster (2006) [30] US (MN, MA) Not Reported State In-person underage shoppers (N = 200 facilities × 2 = 400 facility visits), followed up by telephone interviews (N = 136) IT facilities and their operators Age: By telephone, 19% of operators reported having a minimum age requirement; In person, 31% of operators did not sell an IT session to an underage buyer, 60% of operators assessed age eligibility, 57% asked for age, but did not assess identification, and 3% checked identification. When age was not asked and identification was not checked, a purchase attempt was successful 98% of the time, when age was asked but identification was not checked, a purchase attempt was successful 50% of the time, and when identification was checked, a purchase attempt was successful 35% of the time. Parental Consent: By telephone, 87% of operators complied with parental consent. In person, 32% of operators complied with parental consent.
Gorig (2018) [36] Germany 2015 National Telephone interviews (N = 357) Individuals who had used IT facilities since 2012 Eye Protection: 87% of sunbed users were provided with protective eyewear, 85% were advised to use protective eyewear, and 68% used protective eyewear during their last sunbed use. Health Effects: 57% of sunbed users were given the opportunity to determine their skin type. 43% of sunbed users were ever advised of the negative health effects of IT, while 33% were ever offered written risk information.
Grewal (2013) [24] US (CA) 2013 State Underage telephone shoppers (N = 338) IT facilities and their operators Age: 77% of facility operators complied with under 18 age restrictions. Health Effects: 16% of operators reported skin cancer, 11% reported sunburn, and 2% reported premature ageing. 61% of operators denied any dangers from IT. Health Benefits: 72% of operators reported specific health benefits. Risk Restrictions: 59% of operators stated daily IT was acceptable, and 22% of operators stated that unlimited IT was acceptable.
Heilig (2005) [40] US (CO, IL, TX, WI) 2003 State Underage telephone shoppers (N = 400) IT facilities and their operators Health Effects: 54% of operators reported skin cancer (42 to 81%), 87% of operators reported sunburn (76 to 93%), and 54% of operators reported premature ageing (41 to 79%).
Hester (2005) [25] US (CO, IL, TX, WI) 2003 State Underage telephone shoppers (N = 400) IT facilities and their operators Age: 23% of operators in TX, 74% of operators in IL, and 89% of operators in WI complied with under 13 age restrictions. 77% of operators in WI complied with under 16 age restrictions. Parental Consent: 74% of operators complied with parental consent in IL, 6% complied with parental accompaniment in TX.
Hurd (2006) [35] US (CA) 2004 State Underage telephone shoppers and in-person underage shoppers (N = 115) IT facilities and their operators Parental Consent: By telephone, 73% of operators complied with parental consent. In person, 64% of operators complied with parental consent.
Makin (2011) [31] Australia (Victoria) 2009 State Underage telephone shoppers and in-person underage shoppers (N = 30) IT facilities and their operators Age: By telephone, 23% of operators inquired about the customer’s age and 10% informed them identification was required. In person, when age was concealed, 80% of underage research assistants were granted access by operators, and 3% were allowed access who openly disclosed their age. Eye Protection: 97% of facilities provided eyewear. Warning Labels: 97% of facilities displayed the mandatory warning sign with the risk of skin cancer. Health Effects: 10% of operators reported skin cancer as a risk over the telephone, and 97% reported skin cancer in-person. Risk Restrictions: 90% of facilities complied with minimum time between exposures, 53% complied with skin type restrictions, 87% complied with whether they conducted a skin type assessment, and 83% complied with customer consent forms.
Pichon (2009) [26] US (50 states) 2006 State Underage telephone shoppers (N = 3647 facilities) IT facilities and their operators Age: 70% of operators complied with under 16 age restrictions in Wisconsin. Parental Consent: 93% of operators complied with parental consent, and 43% complied with parental accompaniment.
Salomone (2009) [29] Chile 2008 National In-person underage shoppers with observation of the facility (N = 24 facilities) IT facilities and their operators Age: 62% of facilities complied with stating under 18 age limits. Parental Consent: 50% of facilities complied with parental consent. Eye Protection: 25% of facilities complied with compulsory use of goggles. Warning Labels: 8% complied with use of obligatory warning sign in the reception, 63% had a warning sign in the IT booth, while 29% of the centers had no warning signs. Health Effects: 46% of operators gave oral spontaneous information, 0% of facilities had written information, 25% of operators reported potential risks, and 19% of facilities displayed a list of photosensitizing agents. Health Benefits: 29% of operators reported health benefits.
Tripp (2017) [27] US (TX) 2015 State Underage telephone shoppers (N = 635) IT facilities and their operators Age: 81% of facilities complied with under 18 age restriction.
Williams (2018) [28] US (42 states and the District of Columbia) 2015–2016 State Underage telephone shoppers (N = 427) IT facilities and their operators Age: Percent of operators complying with age restrictions by state: Under 14: GA (50%), ID (10%), ME (70%), ND (70%), WV (20%) Under 15: AL (0%) Under 16: PA (70%), WI (80%) Under 17: CT (50%), NJ (70%), NY (70%) Under 18: CA (90%), DE (90%), DC (50%), HI (86%), IL (100%), LA (70%), MN (90%), NV (60%), NH (100%), NC (50%), OR (100%), TX (80%), VT (70%), WA (60%) Parental Consent: Percent of operators complying with parental consent by state: Under 15: VA (70%) Under 18: AZ (90%), AR (40%), MA (70%), MI (30%), MS (40%), OH (90%), RI (70%), SC (90%) Percent of operators complying with parental accompaniment by state: Under 14: KY (30%), MA (70%), MS (40%), TN (40%) Under 15: WY (30%) Under 16: NB (70%), IN (50%) Under 18: UT (90%)
  1. AL Alabama, AR Arkansas, AZ Arizona, CA California, CO Colorado, CT Connecticut, DC District of Columbia, DE Delaware, FL Florida, GA Georgia, HI Hawaii, ID Idaho, IL Illinois, LA Louisiana, MA Massachusetts, MD Maryland, ME Maine, MI Michigan, MN Minnesota, MS Mississippi, NC North Carolina, ND North Dakota, NH New Hampshire, NJ New Jersey, NV Nevada, NY New York, OH Ohio, OR Oregon, PA Pennsylvania, RI Rhode Island, SC South Carolina, TN Tennessee, TX Texas, UT Utah, VA Virginia, VT Vermont, WA Washington, WI Wisconsin, WV West Virginia
  2. aLanguage is consistent with what was found in the study with respect to the legislation. Detailed legislative requirements can be found in Table 2