Her passion for tanning is indicative of a trend that has alarmed many dermatolgists and has rallied the indoor tanning industry in legislative actions in states proposing stricter regulations on the tanning industry or limits on access to minors.

Inspired by popular, sun-baked stars like Britney Spears and Christina Aguilera, many teens and college students are bronzing in indoor salons where, dermatologists warn, they're putting themselves at increased risk of melanoma and other skin cancers.

A recent study published in the Archives of Pediatric Adolescent Medicine found that 36 percent of young women and 11 percent of young men had visited a tanning booth at least once. Teens in the South and Midwest were two to three times more likely to tan indoors than those in other parts of the country, the study found.

For women, the study found tanning booth usage increased with age. For women ages 18 to 19, the study said 47 percent had used a tanning booth three or more times, while 11 percent of 13- to 14-year-old girls had done the same.

The American Academy of Dermatology, responding to what it said are concerns about indoor tanning's growing popularity among teens, this summer issued a new stance, urging states to ban anyone under 18 from tanning devices and to require warnings on the devices.

South Carolina -- one of 27 states that already regulates indoor tanning -- requires customers under age 18 to have written permission from a parent on their first visit.

Dr. Timothy Woodall, a dermatologist at The Palmetto Skin and Laser Center in Rock Hill, said he sees "a ton" of teenagers who use tanning booths. "It's very disturbing to me," he said. "To a dermatologist, this is no different than a teenager smoking."

But Joe Levy, director of media relations for International Smart Tan, an education and training group for the tanning industry, maintains that teens who tan indoors are less likely to sunburn outside.

"If you told teens they could not tan in salons," Levy argued, "we know that the overwhelming majority will tan more aggressively outdoors -- and that puts them in a position to sunburn."

Safe tanning helps the skin develop its natural protection against sunburn, he maintains. "By building up a base tan, you can multiply the effectiveness of the sunscreen you put on."

Levy said teenagers make up about 10 percent of the overall tanning market -- though that figure varies among salons -- and he said that hasn't increased appreciably in recent years.

Nevertheless, some states have enacted legislation that restricts minors' access to indoor tanning services.

California lawmakers debated legislation that would ban children younger than 18 from tanning beds; the proposal has been revised to ban children younger than 14. Other states have taken steps, too: Salon users must be 16 years old in Wisconsin and 13 in Texas.

'We can control it'

Ronnie and Annette Bangle, the owners of Four Seasons tanning salon on S.C. 5 near Northwestern High School, report that about a quarter of their regular customers are age 20 or under.

At Carolina Tan on Rock Hill's Celanese Road, teen customers are more seasonal -- visiting mainly before prom, in the spring before beach trips and sometimes before winter dances, said owner James McClain.

State law limits indoor tanning exposure to four days a week, Ronnie Bangle said, but "we have people who come in that would tan every day if we'd let them."

He regulates customers' exposure, starting with three to five minutes in the tanning bed each visit and gradually building up to the maximum of 20 minutes -- equivalent to about three hours in the sun.

"We know how much sun you're getting in these beds," Bangle explained. "We can control it."

Four Seasons also offers a $25-a-visit spray-on tanning service, which is recommended by Woodall and other dermatologists as a safe alternative to tanning booths.

Still, Bangle said the tanning beds are more popular.

Rock Hill resident Melissa Hall, 18, said she uses a tanning bed at Four Seasons about four days a week. She likes to have some color on her body because she competes in roller skating events.

"When I lay out (in the sun), I get red, I don't tan," Hall said. "In the tanning booth, it's different. I tan right away."

Though she's aware of the skin cancer risk caused by ultraviolet light exposure, Hall said she's not especially concerned about it. "We can get cancer from anything," she said.

Woodall said most teens he sees have the same attitude. "They don't want to hear it," he said, referring to the cancer risk. "So what I try to impress on them is that it will also make them look older faster. And that's usually how I get them to listen to me."

He promotes self-tanners and spray-on tanning services as healthy alternatives to teens who want brown skin. "Those are perfectly safe," he said. "And the technology is getting a lot better. You don't have that orange look you used to have."

Woodall, who has been practicing three years, said he is seeing an explosion of skin cancer among people in their 30s. "I've treated several patients in their teens and early 20s with skin cancer. These are people who freely admit they had too much sun."

He said research shows people get the majority of their cumulative sun exposure before age 18. "So if we can limit a young person's sun exposure, we can dramatically decrease the incidence of skin cancer those patients experience over their lifetime."

Though sun-worshipping patients don't want to hear Woodall lecture about the dangers of ultraviolet light, they quickly change their habits once they're diagnosed with a skin cancer.

"Most people really want to stop at that point," Woodall said. "The big C, as we call it -- that's a pretty good wake-up call for anyone."

Jennifer Becknell • 329-4077

jbecknell@heraldonline.com