Reply to: “Indoor tanning among New Jersey high school students before and after the enactment of youth access restrictions”

Reply to: ‘‘Indoor tanning among New Jersey high school students before and after the enactment of youth access restrictions’’ To the Editor: We thank Watson and Guy for their commentary regarding our recent article on indoor tanning rates among New Jersey high school students before and after the enactment of youth access restrictions.1 They suggest that the increase in indoor tanning rates among male students in our study may be a result of the small sample size. We cannot determine if that is the case, although a strength of the study was its use of a statewide, representative sampling approach. Future research using large sample sizes is needed. This may also help to identify subgroups of youth, such as sexual minority boys,2 who may indoor tan at higher rates. Ongoing examination of youth indoor tanning trends1,3 and monitoring of tanning facilities’ compliance with age restrictions4 at the state level provides a valuable complement to national-level data.5 To that end, using the same survey methods as our prior studies,1,6 we are collecting information about past year indoor tanning among New Jersey high school students in fall 2016. The survey will also ask students to report the locations where they indoor tan (eg, tanning salons, private homes, gyms), which may inform future relevant regulatory efforts. We concur with Watson and Guy that further research and public health efforts are warranted with regard to monitoring and enforcing violations of age restrictions, training of tanning facility operators, and educating youth and parents about age restrictions and the risks of indoor tanning. Elliot J. Coups, PhD,a,b,c Jerod L. Stapleton, PhD,a,b,c and Cristine D. Delnevo, PhD, MPHa,c Rutgers Cancer Institute of New Jerseya and Department of Medicine, Rutgers Robert Wood Johnson Medical School,b Rutgers, The State University of

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New Jersey, New Brunswick; and Department of Health Education and Behavioral Science, Rutgers School of Public Health, Rutgers, The State University of New Jersey, Piscatawayc The 2012 and 2014 New Jersey Youth Tobacco Surveys were funded by a contract from the New Jersey Department of Health to the Center for Tobacco Studies, Rutgers School of Public Health, Rutgers, The State University of New Jersey. Conflicts of interest: None declared. Correspondence to: Elliot J. Coups, PhD, Rutgers Cancer Institute of New Jersey, Rutgers, The State University of New Jersey, 195 Little Albany St, Room 5567, New Brunswick, NJ 08903 E-mail: [email protected]

REFERENCES 1. Coups EJ, Stapleton JL, Delnevo CD. Indoor tanning among New Jersey high school students before and after the enactment of youth access restrictions. J Am Acad Dermatol. 2016;75:440-442. 2. Blashill AJ, Safren SA. Skin cancer risk behaviors among US men: the role of sexual orientation. Am J Public Health. 2014; 104:1640-1641. 3. Simmons RG, Smith K, Balough M, Friedrichs M. Decrease in self-reported tanning frequency among Utah teens following the passage of Utah Senate Bill 41: an analysis of the effects of youth-access restriction laws on tanning behaviors. J Skin Cancer. 2014;2014:839601. 4. Grewal SK, Haas AF, Pletcher MJ, Resneck JS Jr. Compliance by California tanning facilities with the nation’s first statewide ban on use before the age of 18 years. J Am Acad Dermatol. 2013;69:883-889. 5. Guy GP Jr, Berkowitz Z, Jones SE, et al. State indoor tanning laws and adolescent indoor tanning. Am J Public Health. 2014; 104:e69-e74. 6. Coups EJ, Stapleton JL, Delnevo CD. Frequent indoor tanning among New Jersey high school students. J Am Acad Dermatol. 2015;72:914-916. http://dx.doi.org/10.1016/j.jaad.2016.10.019

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