Evidence of the dangers of indoor tanning and its popularity, including among youth, led the Government of Ontario to pass the Skin Cancer Prevention Act (Tanning Beds) (SCPA) in 2014. This legislation includes prohibiting the sale of indoor tanning services to individuals under 18, requiring warning signs be posted, and other safety regulations. We collected information from Ontario Public Health Units to conduct a process evaluation of the SCPA to: understand legislation implementation; assess available evidence about compliance, inspection, and enforcement; and, note barriers and facilitators related to inspection and enforcement. Data was collected March–April 2018. All 36 Ontario Public Health Units were invited to participate in an online questionnaire about the SCPA. Questions covered complaints, inspection, and enforcement, and used both close- and open-ended questions. Participants from 20 Public Health Units responded to the questionnaire; a response rate of 56%. These agencies reported 485 facilities offer indoor tanning. Since 2014, there have been 242 infractions by tanning facility owner/operators related to the SCPA, with most being uncovered during non-mandatory routine inspections (n = 234, 97%), rather than mandatory complaint-based inspections (n = 8, 3%). Most infractions were related to warning signs (n = 201, 83%). No charges were issued for any infractions. Instead, providing education (n = 90, 62%) and issuing warnings (n = 33, 23%) were the most common enforcement strategies. SCPA amendments are needed, including mandatory, routinely scheduled inspections. In addition to providing education, fines may improve compliance. More resources are required for inspection and enforcement of the SCPA.
This is a preview of subscription content, access via your institution.
Buy single article
Instant access to the full article PDF.
Price excludes VAT (USA)
Tax calculation will be finalised during checkout.
Canadian Cancer Society’s Advisory Committee on Cancer Statistics. (2014). Canadian Cancer Statistics 2014. Toronto.
Cancer Care Ontario. (2018). Ontario Cancer Statistics 2018. Toronto.
The International Agency for Research on Cancer Working Group on Risk of Skin Cancer and Exposure to Artificial Ultraviolet Light. (2006). Exposure to artificial UV radiation and skin cancer.
Hornung, R. L., Magee, K. H., Lee, W. J., Hansen, L. A., & Hsieh, Y.-C. (2003). Tanning facility use: Are we exceeding Food and Drug Administration limits? Journal of the American Academy of Dermatology, 49(4), 655–661.
The World Health Organization. (2003). Artificial tanning sunbeds: Risks and guidance. Geneva: WHO.
El Ghissassi, F., Baan, R., Straif, K., et al. (2009). A review of human carcinogens—Part D: Radiation. The Lancet Oncology, 10(8), 751–752.
Veierød, M. B., Adami, H., Lund, E., & Armstrong, B. K. (2010). Sun and solarium exposure and melanoma risk : Effects of age, pigmentary characteristics, and nevi. Cancer Epidemiology, Biomarkers and Prevention, 19(1), 111–121.
The International Agency for Research on Cancer Working Group on artificial ultraviolet (UV) light and skin cancer. (2006). The association of use of sunbeds with cutaneous malignant melanoma and other skin cancers: A systematic review. International Journal of Cancer, 120(5), 1116–1122.
Boniol, M., Autier, P., Boyle, P., & Gandini, S. (2012). Cutaneous melanoma attributable to sunbed use: Systematic review and meta-analysis. BMJ (Clinical research ed.), 345, e4757.
Whiteman, D. C., Whiteman, C. A., & Green, A. C. (2001). Childhood sun exposure as a risk factor for melanoma: A systematic review of epidemiologic studies. Cancer Causes and Control, 12, 69–82.
Pawlak, M. T., Bui, M., Amir, M., Burkhardt, D., Chen, A., & Dellavalle, R. (2012). Legislation restricting access to indoor tanning throughout the world. Archives of Dermatology, 148(9), 1006–1012.
The World Health Organization. (2017). Ultraviolet radiation and the INTERSUN Programme. Retrieved from https://www.who.int/uv/intersunprogramme/en/
Madigan, L. M., & Lim, H. W. (2016). Tanning beds: Impact on health, and recent regulations. Clinics in Dermatology, 34(5), 640–648.
Government of Canada. Radiation Emitting Devices Regulations (Tanning Equipment) (2005). Canada. Retrieved from https://laws-lois.justice.gc.ca/eng/regulations/C.R.C.,_c._1370/20060322/P1TT3xt3.html.
Gosselin, S., & Mcwhirter, J. E. (2019). Assessing the content and comprehensiveness of provincial and territorial indoor tanning legislation in Canada. Health Promotion and Chronic Disease Prevention in Canada: Research, Policy and Practice, 39(2), 45–55.
Ontario Ministry of Health and Long-Term Care. (2013). The Skin Cancer Prevention Act (Tanning Beds), 2013. Retrieved from http://www.health.gov.on.ca/en/public/programs/tanning/
Ontario Ministry of Health and Long-Term Care. (2014). Tanning Beds Compliance Protocol, 2014.
Ontario Ministry of Health and Long-Term Care. (2014). Health Services in Your Community: Public Health Units. Retrieved from http://www.health.gov.on.ca/en/common/system/services/phu/
Nadalin, V., Marrett, L., Atkinson, J., Tenkate, T., & Rosen, C. F. (2016). Tanning among Ontario adolescents pre-legislation: Prevalence and beliefs. Preventive Medicine, 91, 244–249.
Nadalin, V., Marrett, L. D., Cawley, C., et al. (2018). Assessing a ban on the use of UV tanning devices among adolescents in Ontario, Canada: First-year results. Canadian Journal of Public Health, 109, 473–479.
Ontario Ministry of Health and Long-Term Care. (2018). Tanning Beds Protocol, 2018.
Statistics Canada. (2018). Population and dwelling count highlight tables, 2016 census. Retrieved from https://www12.statcan.gc.ca/census-recensement/2016/
Green, A., McWhirter, J., & McEwen, S. (2018). Alternative facts and artificial rays: Online health and risk communication by indoor tanning salons. (manuscript under review).
Infection Prevention and Control Unit: Public Health Division. (2009). Infection prevention and control best practices for personal services settings. Retrieved from http://www.health.gov.on.ca/en/pro/programs/publichealth/oph_standards/docs/pssp_2008.pdf
Hickle, A., Forster, J., Lazovich, D., et al. (2005). Sanitarians’ work with indoor-tanning businesses: Findings from interviews in two major metropolitan areas. Journal of Environmental Health, 67(8), 30–36.
Pichon, L. C., Mayer, J. A., Hoerster, K. D., et al. (2009). Youth access to artificial UV radiation exposure: Practices of 3647 US indoor tanning facilities. Archives of Dermatology, 145(9), 997–1002.
Mathias, R. G., Sizto, R., Hazlewood, A., & Cocksedge, W. (1995). The effects of inspection frequency and food handler education on restaurant inspection violations. Canadian Journal of Public Health, 86(1), 46–50.
Cummings, K. M., Hyland, A., Saunders-Martin, T., Perla, J., Coppola, P. R., & Pechacek, T. F. (1998). Evaluation of an enforcement program to reduce tobacco sales to minors. American Journal of Public Health, 88(6), 932–936.
Mayer, J. A., Hoerster, K. D., Pichon, L. C., Rubio, D. A., Woodruff, S. I., & Forster, J. L. (2008). Enforcement of state indoor tanning laws in the United States. Preventing Chronic Disease, 5(4), A125.
Seidenberg, A. B., Mahalingam-Dhingra, A., Weinstock, M. A., Sinclair, C., & Geller, A. C. (2015). Youth indoor tanning and skin cancer prevention: Lessons from tobacco control. American Journal of Preventive Medicine, 48(2), 188–194.
Reimann, J., McWhirter, J. E., Papadopoulos, A., & Dewey, C. (2018). A systematic review of compliance with indoor tanning legislation. BMC Public Health, 18, 1–19.
Fleischer, A. B., & Fleischer, A. B. (1992). North Carolina tanning operators: Hazard on the horizon? Journal of the American Academy of Dermatology, 27(2), 199–203.
Culley, C. A., Mayer, J. A., Eckhardt, L., et al. (2001). Compliance with federal and state legislation by indoor tanning facilities in San Diego. Journal of the American Academy of Dermatology, 44(1), 53–60.
Beyth, R., Hunnicutt, M., & Alguire, P. C. (1991). Tanning salons: An area survey of proprietors’ knowledge of risks and precautions. Journal of the American Academy of Dermatology, 24(2 Pt 1), 277–282.
Choy, C. C., Cartmel, B., Clare, R. A., & Ferrucci, L. M. (2017). Compliance with indoor tanning bans for minors among businesses in the USA. Translational Behavioural Medicine, 7(4), 637–644.
Grewal, S. K., Haas, A. F., Pletcher, M. J., & Resneck, J. S. (2013). Compliance by California tanning facilities with the nation’s first statewide ban on use before the age of 18 years. Journal of the American Academy of Dermatology, 69(6), 883–889.
Ontario Court of Justice. (2014). Schedule 82.2-Skin Cancer Prevention Act (Tanning Beds), 2013. Retrieved from http://www.ontariocourts.ca/ocj/how-do-i/set-fines/set-fines-i/schedule-82-2/
Hester, E. J., Heilig, L. F., D’Ambrosia, R., Drake, A. L., Schilling, L. M., & Dellavalle, R. P. (2005). Compliance with youth access regulations for indoor UV tanning. Archives of Dermatology, 141(8), 959–962.
Krevor, B. S., Ponicki, W. R., Grube, J. W., & DeJong, W. (2011). The effect of mystery shopper reports on age verification for tobacco purchases. Journal of Health Communication, 16(8), 820–830.
Internal Revenue Service. (2012). Affordable Care Act tax provisions. Retrieved from https://www.irs.gov/affordable-care-act/affordable-care-act-tax-provisions
We would like to thank those who participated in our questionnaire and members the Ontario Sun Safety Working Group for their input on data collection and questionnaire development.
Conflict of interest
The authors declare they have no conflicts of interest.
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
About this article
Cite this article
Reimann, J., McWhirter, J.E., Papadopoulos, A. et al. A Process Evaluation of the Skin Cancer Prevention Act (Tanning Beds): A Survey of Ontario Public Health Units. J Community Health 44, 675–683 (2019). https://doi.org/10.1007/s10900-019-00658-1