• Continue to advise patients that exposure to ultraviolet light, whether from the sun or in indoor tanning booths, is considered a major risk factor for skin cancer.
  
  
• Be aware that this study indicates that some people may be dependent on sun-tanning, in a manner that's analogous to drug or alcohol dependency.

"This could explain why educational interventions haven't been more successful," said Richard Wagner, M.D., of the University of Texas Medical Branch at Galveston, senior author of a study published in the August Archives of Dermatology.

Skin cancers continue to rise, despite widespread efforts to persuade the public that ultraviolet light -- whether from the sun or from indoor tanning booths -- is a major risk factor, Dr. Wagner noted.

So Dr. Wagner and colleagues used two questionnaires -- adapted from those used to screen for alcoholism and drug dependency -- to evaluate the sun-tanning motivations of 145 beachgoers in the Galveston area.

One was an adapted form of the alcoholism-screening CAGE Questionnaire (where CAGE is an acronym for Cut down, Annoyed, Guilty, Eye-opener). The other was a modified version of seven diagnostic criteria for substance-related disorders in the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV).

On the Cage Questionnaire, 26% of those interviewed were classified as "dependent" on ultraviolet light tanning. On the DSM-IV scale, 53% were evaluated as tanning dependent.

The results from both questionnaires were significantly associated, at the p=0.03 confidence level, the researchers say.

The questionnaires included such questions as:

• Do you try to cut down on the time you spend in the sun, but find yourself still sun-tanning?
• Do you think you need to spend more and more time in the sun to maintain your perfect tan?
• Do you ever feel guilty that you are in the sun too much?

"Dermatologists often talk about people who seem 'addicted to the sun' -- people who know it's not good for them to be bronzed all the time, but don't seem to be able to stop tanning," Dr. Wagner said.

"It's interesting that by slightly modifying tools used to identify substance-related disorders, we can actually see an objective similarity between regular tanning and those disorders."

Dr. Wagner noted that there is some evidence from other studies that tanning increases endorphin production, which could be addictive.

The researchers asked the subjects why they were at the beach; possible responses included to get a tan, to relax, or to swim.

Subjects who were evaluated as dependent on both of the scales were 2.2 times more likely than others to say they were at the beach for a tan; however, the result was only statistically significant for the DSM-IV scale, at a confidence level of p=0.05.

Women were 5.5 times more likely than men to be at the beach for a tan and people between the ages of 18 and 25 were 3.1 times more likely than older people to say tanning was their reason for being at the seashore. The results were statistically significant at the confidence levels of p<0.001 and p=0.04, respectively.

The authors pointed out that the recognition of UV light tanning as a potential substance related disorder has implications for future strategies other than education alone to prevent and decrease UV light tanning.

Related articles:

• Age Rules On Tanning Booths Put Kids in Shade

• French Sunbathers Protected by Powerful Screen Don't Overdo It