More Skin, More Sun, More Tan, More Melanoma
More Skin, More Sun, More Tan, More Melanoma
The tanning trend that began in the 1920s sustained its allure and celebrity promotion into the late 20th century. Despite mounting evidence that UV exposure was linked to the development of skin cancer, tanned skin remained highly desirable. The public continued to wear revealing swimwear and sportswear, enjoy travel to warm destinations, and spend increased time outdoors. The late 20th century was also marked by the birth of the indoor tanning center, which quickly became popular, especially among young adults.
Although not showing the dramatic changes seen in previous decades, clothing and swimwear in the late 20th century continued to be styled with a template of maximum skin exposure. The bikini, with the emergence of strapless tops and low-rise bottoms, was associated with an estimated 92% skin exposure (Supplemental Figure 4A, available as a supplement to the online version of this article at http://www.ajph.org); men's swimwear exposure remained steady at 89% (Supplemental Figure 3B). Women's sportswear exposure rose from 38% to 53%, and men's sportswear exposure increased from 38% to 44% (Supplemental Figures 4B and 4C, available as a supplement to the online version of this article at http://www.ajph.org).
These fashion changes can be seen in several late-20th-century images, exemplified by Pam Turnbull's "Mom Walking With Babe," which depicts children and adults on the beach wearing typical swimsuits of the time (Supplemental Figure 6, available as a supplement to the online version of this article at http://www.ajph.org).
Consistent with revealing clothing and swimwear, travel to warm locations has been the predominant pattern of US tourism in the last few decades. Of the top 10 US travel destinations, 6 were to sunny destinations including Orlando and Miami in Florida and Las Vegas in Nevada. For example, Miami-Dade County's tourism data indicated an increase in visitors to the region from 8.8 million in 1994 to 10.4 million in 2003. Outdoor sports and recreation maintained their popularity, as supported by data from the National Sporting Goods Association, which showed that the most popular leisure activities in the United States between 1992 and 1998 included walking, swimming, fishing, and golf.
Compared with previous decades, outdoor UV exposure rose more slowly, but indoor tanning exposure surged. In 1978, the first US indoor tanning center opened in Arkansas. In 1981, approximately 10 new tanning centers opened each week; by 1988, there were more than 18 000 tanning centers in the United States.
Young adults, particularly White female adolescents of higher socioeconomic status, have the highest rate of indoor tanning center use, providing this population with an additional source of UV radiation besides outdoor exposure. According to an American Academy of Dermatology survey, indoor tanning and sunlamp use in those younger than 25 years increased 3-fold, from 2% of individuals in 1986 to 6% in 1996. The International Agency for Research on Cancer designated tanning devices that emit artificial UV radiation as carcinogenic to humans, making indoor tanning a significant public health concern. Indoor tanning has been linked to basal cell carcinoma, cutaneous squamous cell carcinoma, and melanoma. Importantly, the harmful effects of indoor tanning on melanoma risk have been shown to occur independently of outdoor UV exposure.
During the last 2 decades of the 20th century, melanoma incidence continued to rise at accelerated rates. Connecticut Tumor Registry data indicate that by the late 1980s, the age-adjusted melanoma incidence was 13.7 and 10.9 per 100 000 in men and women, respectively (Figure 1). From the 1960s to the 1990s, the "all site" age-standardized cancer incidence in men and women increased by approximately 30%, whereas melanoma incidence increased by 244% in men and 167% in women. SEER data also showed an increase in melanoma incidence rates from 8.7 to 22.8 cases per 100 000 White patients from 1975 to 2000. Despite this rising incidence, tanned skin remained desirable. A 1996 survey of 1000 US adults by the American Academy of Dermatology showed that 56% of respondents believed that people looked healthier with tanned skin, and 25% reported that they intentionally tanned. Although no comparative surveys exist, this sentiment of tanned skin as healthy and attractive in the late 20th century stands in stark contrast to the negative social context of tanned skin that defined the early 1900s.
Although tanned skin remained highly desirable, people had a growing interest in sunscreen and sun protection in the late 20th century. In the 1980s, Coppertone developed the first sunscreen that provided protection against both UV-A and UV-B radiation and pioneered a sport, sweat-proof formulation. Sunscreen became increasingly incorporated into daily-use cosmetic products, and routine sunscreen application became more widely adopted by the general public.
Late 20th Century
The tanning trend that began in the 1920s sustained its allure and celebrity promotion into the late 20th century. Despite mounting evidence that UV exposure was linked to the development of skin cancer, tanned skin remained highly desirable. The public continued to wear revealing swimwear and sportswear, enjoy travel to warm destinations, and spend increased time outdoors. The late 20th century was also marked by the birth of the indoor tanning center, which quickly became popular, especially among young adults.
Revealing Fashions Retain Their Popularity
Although not showing the dramatic changes seen in previous decades, clothing and swimwear in the late 20th century continued to be styled with a template of maximum skin exposure. The bikini, with the emergence of strapless tops and low-rise bottoms, was associated with an estimated 92% skin exposure (Supplemental Figure 4A, available as a supplement to the online version of this article at http://www.ajph.org); men's swimwear exposure remained steady at 89% (Supplemental Figure 3B). Women's sportswear exposure rose from 38% to 53%, and men's sportswear exposure increased from 38% to 44% (Supplemental Figures 4B and 4C, available as a supplement to the online version of this article at http://www.ajph.org).
These fashion changes can be seen in several late-20th-century images, exemplified by Pam Turnbull's "Mom Walking With Babe," which depicts children and adults on the beach wearing typical swimsuits of the time (Supplemental Figure 6, available as a supplement to the online version of this article at http://www.ajph.org).
The Growth of Sun Tourism and Sport
Consistent with revealing clothing and swimwear, travel to warm locations has been the predominant pattern of US tourism in the last few decades. Of the top 10 US travel destinations, 6 were to sunny destinations including Orlando and Miami in Florida and Las Vegas in Nevada. For example, Miami-Dade County's tourism data indicated an increase in visitors to the region from 8.8 million in 1994 to 10.4 million in 2003. Outdoor sports and recreation maintained their popularity, as supported by data from the National Sporting Goods Association, which showed that the most popular leisure activities in the United States between 1992 and 1998 included walking, swimming, fishing, and golf.
The Surge of Indoor Tanning
Compared with previous decades, outdoor UV exposure rose more slowly, but indoor tanning exposure surged. In 1978, the first US indoor tanning center opened in Arkansas. In 1981, approximately 10 new tanning centers opened each week; by 1988, there were more than 18 000 tanning centers in the United States.
Young adults, particularly White female adolescents of higher socioeconomic status, have the highest rate of indoor tanning center use, providing this population with an additional source of UV radiation besides outdoor exposure. According to an American Academy of Dermatology survey, indoor tanning and sunlamp use in those younger than 25 years increased 3-fold, from 2% of individuals in 1986 to 6% in 1996. The International Agency for Research on Cancer designated tanning devices that emit artificial UV radiation as carcinogenic to humans, making indoor tanning a significant public health concern. Indoor tanning has been linked to basal cell carcinoma, cutaneous squamous cell carcinoma, and melanoma. Importantly, the harmful effects of indoor tanning on melanoma risk have been shown to occur independently of outdoor UV exposure.
Melanoma Incidence Continues to Rise
During the last 2 decades of the 20th century, melanoma incidence continued to rise at accelerated rates. Connecticut Tumor Registry data indicate that by the late 1980s, the age-adjusted melanoma incidence was 13.7 and 10.9 per 100 000 in men and women, respectively (Figure 1). From the 1960s to the 1990s, the "all site" age-standardized cancer incidence in men and women increased by approximately 30%, whereas melanoma incidence increased by 244% in men and 167% in women. SEER data also showed an increase in melanoma incidence rates from 8.7 to 22.8 cases per 100 000 White patients from 1975 to 2000. Despite this rising incidence, tanned skin remained desirable. A 1996 survey of 1000 US adults by the American Academy of Dermatology showed that 56% of respondents believed that people looked healthier with tanned skin, and 25% reported that they intentionally tanned. Although no comparative surveys exist, this sentiment of tanned skin as healthy and attractive in the late 20th century stands in stark contrast to the negative social context of tanned skin that defined the early 1900s.
Although tanned skin remained highly desirable, people had a growing interest in sunscreen and sun protection in the late 20th century. In the 1980s, Coppertone developed the first sunscreen that provided protection against both UV-A and UV-B radiation and pioneered a sport, sweat-proof formulation. Sunscreen became increasingly incorporated into daily-use cosmetic products, and routine sunscreen application became more widely adopted by the general public.
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