Rutgers Institutional Review Board approved the study and all participants signed an online consent form presented prior to the study. A nationally representative sample of 823 women aged 18 to 25 years (mean age, 22.7 years; 463 [56.3%] non-Hispanic white, 118 [14.3%] non-Hispanic black, 174 [21.1%] Hispanic, and 68 [8.3%] non-Hispanic other) was recruited through GfK Knowledge Networks, a research survey firm that uses address-based sampling methods to recruit a probability-based online panel of 55 000 adults from which this sample was drawn. Participants were paid $5 for completing the survey. Measures included demographics, lifetime indoor tanning use (ever used indoor tanning), current indoor tanning frequency (past 12 months), and indoor tanning location (tanning-only salon or location other than a tanning-only salon). Participants who indicated they tanned at a nonsalon location identified the location as a gym or health club, beauty shop, private home, apartment, or other location. Participants who currently use indoor tanning completed measures of indoor tanning patterns⁴ (event or year-round pattern) and indicated whether they used indoor tanning to improve their mood and how difficult it would be to stop using indoor tanning (proxy measure of tanning dependence⁵). History of depression and anxiety were also measured. Analysis of categorical variables used χ² difference tests and continuous outcomes used bivariate general linear models in SPSS Complex Samples, version 21 (SPSS Inc).

Forty-one percent (unweighted n = 123) of participants who ever used indoor tanning and 24.6% (n = 34) of current indoor tanning users reported nonsalon tanning (Table 1). Participants who had ever used indoor tanning most commonly used indoor tanning at gyms (64 [18.9%]), beauty shops (39 [13.8%]), and private homes (40 [13.2%]). Participants who were currently using nonsalon indoor tanning most often used indoor tanning at gyms (20 [9.8%]), private homes (13 [7.7%]), and apartment complexes (10 [7.5%]). The number of lifetime indoor tanning sessions was more than 2 times greater for those who had ever used a nonsalon location (75.7) than those who had not (35.0) (P = .02) (Table 2). In participants who were currently using nonsalon indoor tanning, tanning to improve mood (P = .06) and year-round tanning (P < .001) were more common relative to participants who used tanning-only salons. Participants who were currently using nonsalon indoor tanning reported a history of depression almost 3 times higher (P = .047) and difficulty stopping indoor tanning (P = .01) than those exclusively using tanning-only salons.

Our findings indicate nonsalon indoor tanning is common with current indoor tanning users (24.6%) and those who have ever used indoor tanning (41.0%). Gyms are the most typical location of nonsalon indoor tanning. Nonsalon indoor tanning users report more depression, tanning dependence, tanning to improve mood, and lifetime tanning. They are also more likely to use indoor tanning year round. Some indoor tanning users might seek out gyms to circumvent the federal tanning excise tax, which gyms are not required to collect.⁶ Nonsalon tanning locations also seem to attract more high-risk tanners (ie, those who are depressed or have a dependence on tanning). Despite this evidence, we know little about the supervision, regulation, or maintenance of nonsalon tanning locations. Future research needs to assess tanning location along with other indoor tanning variables. Research should examine the reasons nonsalon locations are popular with high-risk tanners, as well as factors that may explain the use of nonsalon locations, such as convenience, cost, physical activity (eg, gym tanning), and living arrangements (eg, apartment tanning). Private home tanning, which has no regulations or oversight, should be carefully studied. We need to better characterize the supervision, maintenance, and regulation of nonsalon locations to inform clinical, prevention, and policy decisions.

Limitations of this study include its focus on adult women only, cross-sectional data, and the inability to assess nonsalon categories independently owing to small sample size.

Physician counseling to reduce indoor tanning is a recommended preventive health service. Physicians should assess patients’ tanning locations since nonsalon tanning may indicate more risky behavior.