TBM ORIGINAL RESEARCH Indoor tanning promotions on social media in six US cities #UVTanning #tanning Christine A. Ricklefs, 1 Nancy L. Asdigian, 2 Heidi L. Kalra, 3 Joni A. Mayer, 4 Robert P. Dellavalle, 5,6,7 Dawn M. Holman, 8 Lori A. Crane 2 Abstract There is no research investigating indoor tanning advertising on social media. We assessed the use of social media to promote indoor tanning. We subscribed to social media platforms in six US cities and content- analyzed promotional messages received. We captured 662 messages on Twitter and Facebook, through salon emails, and in daily deal coupons. Salon postings were most frequent on Twitter and Facebook, with an average of 2–3 postings per week. National chains posted more frequently than local businesses. Forty percent of mes- sages were devoid of tanning content and included photos, jokes, or popular references. Thirty percent men- tioned price reductions, and 28 % referenced an upcom- ing holiday. Sunless tanning (17 %) was promoted more often than ultraviolet tanning (9 %). Tanning salons ac- tively use social media as a strategy for maintaining relationships with customers and offer pricing deals that promote loyalty and high-frequency tanning. Keywords Indoor tanning, Skin cancer, Social media, Advertising BACKGROUND Skin cancer incidence is rising and is increasingly affecting adolescents and young adults, creating a pro- found social and economic burden in the USA [1–11]. Ultraviolet (UV) exposure is the primary and prevent- able risk factor for skin cancer [12–14]. Indoor UV tanning appears responsible for part of the rise over the past several decades among young women [15, 16]. More frequent use, use of higher intensity devices, and use over longer periods of time have all been linked to elevated melanoma risk [15, 16]. The annual prevalence of indoor tanning in the USA is highest among non-Hispanic white women between the ages of 18–21 (32 %) and 22–25 (30 %) [17]. Two thirds (68 %) of 18–21-year-old non-Hispanic white women who use indoor tanning report frequent use (10 or more indoor tanning sessions per year), with an average of nearly 28 indoor tanning sessions per year [17]. These and other data suggest that reducing indoor tanning use among young adults is a public health imperative [18–20]. Indeed, the Surgeon General re- leased a BCall to Action^ in 2014 highlighting skin cancer as a major public health problem in the USA and calling on multiple community sectors (e.g., policy makers, employers, clinicians, schools, families, and so on) to come together in comprehensive risk reduction efforts [21]. Public health messages about the risks of indoor tanning compete with a multibillion dollar a year tanning industry that maximizes young adult consum- er markets through the strategic location of tanning facilities, pricing promotions that incentivize high vol- ume use, and targeted advertising intended to increase the appeal and ease of indoor tanning among adoles- cents and young adults [22–25]. Advertising strategies are similar to those from the tobacco industry, includ- ing appeals that reduce health concerns, convey social acceptance, highlight positive psychological effects, and target specific populations [26]. Although previous reports have provided impor- tant information about the marketing strategies used to engage young consumers and promote increased 1 Research Informatics Shared Resource, University of Colorado Cancer Center, University of Colorado Anschutz Medical Campus, Aurora, CO, USA 2 Department of Community and Behavioral Health, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, 13001 E. 17th Place, B119, Aurora, CO 80045, USA 3 Master of Physician Assistant Studies Program, Chatham University, Pittsburgh, PA, USA 4 Division of Health Promotion, Graduate School of Public Health, San Diego State University, San Diego, CA, USA 5 Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, USA 6 Department of Dermatology, School of Medicine, University of Colorado Anschutz Medical Campus and Dermatology Service, Aurora, CO, USA 7 VA Eastern Colorado Health Care System, U.S. Department of Veterans Affairs, Denver, CO, USA 8 Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA, USA Correspondence to: L Crane lori.crane@ucdenver.edu Cite this as: TBM 2016;6:260–270 doi: 10.1007/s13142-015-0378-0 Implications Practice: Public health practitioners should ex- plore the use of social media to reach and engage young audiences and promote norms that discour- age indoor tanning and other forms of high-risk ultraviolet exposures among adolescents and young adults. Policy: Policy makers at the local, state, and na- tional level need to be informed about the adver- tising strategies used by the tanning industry in order to develop effective public policies to reduce skin cancer risk. Research: Research is needed to determine how young adults are accepting tanning advertisements on Internet channels and how this affects their tanning behavior. Electronic supplementary material The online version of this article (doi:10.1007/ s13142-015-0378-0) contains supplementary material, which is available to authorized users. TBM page 260 of 270