A Multi-Level Investigation of US Indoor Tanning PolicyEnactment, Implementation, Compliance, Impact, and Economics

美国室内晒黑政策的制定、实施、合规性、影响和经济性的多层次调查

• 批准号: 10621717
• 负责人: DAVID B BULLER
• 金额: $ 56.15万
• 依托单位: RUTGERS BIOMEDICAL AND HEALTH SCIENCES
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-06-01 至 2025-05-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10621717
• 关键词: Acceleration; Address; Adolescent Risk Behavior; Adolescent and Young Adult; Adopted; Adoption; Advocacy; Advocate; Affordable Care Act; Age; American; Businesses; Carcinoma; Case Study; Characteristics; Complex; Consent; Consumption; Cost-Benefit Analysis; Costs and Benefits; Data; Decision Making; Devices; District of Columbia; Economic Factors; Economics; Elements; Employee; Future; Goals; Government; Harm Reduction; Health; Health Policy; Health Professional; Health Promotion; Health behavior; Home; Human Resources; Incidence; Individual; Intervention; Interview; Investigation; Investments; Laws; Maintenance; Methodology; Methods; Minor; Outcome; Parental Consent; Parental Involvement Law; Parents; Policies; Policy Compliance; Politics; Populations at Risk; Prevalence; Prevention; Process; Public Health; Reach, Effectiveness, Adoption, Implementation, and Maintenance; Regulation; Reporting; Research; Resources; Risk Behaviors; Risk Factors; Seminal; Skin Cancer; Skin tanning; Smoking; Statutes and Laws; Stream; Sunburn; Surveys; System; Taxation; Taxes; Teenagers; Tobacco; Translating; Ultraviolet Rays; United States Food and Drug Administration; Youth; access restrictions; archived data; base; behavior change; comparative; cost; data integration; economic cost; economic evaluation; economic impact; economic implication; evidence base; experience; improved; informant; innovation; interest; keratinocyte; melanoma; productivity loss; skin damage; societal costs; tanning booths; young adult

Skin cancer is a significant and expensive public health problem, with ~5 million Americans treated at a cost of over $8 billion annually 29. Melanoma is the deadliest skin cancer, and its incidence has more than tripled in the last four decades 30,31. Indoor tanning (IT) is a well-established cause of melanoma and keratinocyte carcinomas 8- 12,20-22,32. Indoor tanners are also more likely to experience sunburn 3,4,33, a major risk factor for skin cancer 9,14-19. Most tanners begin IT as teens or young adults 31. In order to reduce IT and protect this at-risk population, IT is now being regulated in two ways. First, states restrict access by minors or require parental consent/accompaniment 34. Second, the Food and Drug Administration (FDA) attempts to minimize harm from IT devices (e.g., protective eyewear, session duration limits) 35. Although underutilized36, legislation such as age restrictions and taxation has been quite successful in decreasing engagement in other risky behaviors such as smoking 37. Recent evidence suggests that more stringent IT laws such as age bans (vs. parent consent laws or no law) are associated with less youth IT 38,39. Unfortunately, enforcement and compliance with IT laws are variable and inadequate 28,40-44. When advocating for more stringent laws or enforcement, it is also important to attend to concerns about secondary effects that may be barriers to further restriction. These barriers include economic impacts of IT laws that may cause small businesses to organize and oppose progressive IT laws to protect their financial interests, and tanners switching to use IT beds outside of salons (e.g., homes, apartments, gyms) that are not well-regulated or inspected 45-50. The goals of this five-year R01 are to use a mixed-method approach informed by the Multiple [Policy] Streams and RE-AIM 51,52 Frameworks 53 to investigate three specific aims. Aim 1 is a comparative case study to elucidate the IT legislation adoption process. Aim 2 uses a pseudo- patron (confederate) assessment, national survey, and archival data to investigate legislation implementation, i.e., regulation compliance in salons and non-salons and the association of compliance with policy stringency and enforcement provisions 41 as well as IT and sunburn outcomes among adolescents and young adults. Aim 3 integrates data from the first two aims and external data to assess economic effects relevant to policy sustainability of IT stringency, enforcement, and compliance. The scientific premise derives from the paucity of research on the process of translating IT policy efforts into stringent IT legislation and compliance, as well as their effects 54,55, such as positive outcomes on melanoma risk factors (IT, sunburns) and secondary effects (economic costs, compensatory tanning). Results of this comprehensive, multi-level, rigorous analysis will inform IT policy interventions as well as other health policy arenas and guide best practices for increasing IT law stringency, moving toward an IT “endgame” 56,57. These could include adding age bans to parental consent laws or increasing age bans to 19 or 21, similar to tobacco. As experts in the relevant content and methodologic domains, our Multiple-PI led team is well-poised to conduct this innovative, seminal research.

皮肤癌是一个重大且昂贵的公共卫生问题，约有 500 万美国人接受治疗，费用为 每年超过 80 亿美元 29. 黑色素瘤是最致命的皮肤癌，其发病率在 过去四十年30,31。室内晒黑 (IT) 是导致黑色素瘤和角质形成细胞癌的一个公认原因 8- 12,20-22,32。室内晒黑者也更有可能遭受晒伤 3,4,33，这是皮肤癌的主要危险因素 9,14-19。 大多数制革商在青少年或年轻人时开始 IT 31。为了减少 IT 并保护这一高危人群，IT 是 现在通过两种方式进行监管。首先，各州限制未成年人访问或要求父母监护 同意/陪同 34. 其次，食品和药物管理局 (FDA) 试图尽量减少 IT 造成的伤害 设备（例如防护眼镜、会话持续时间限制） 35. 尽管未得到充分利用36，但年龄等立法 限制和税收在减少其他危险行为方面非常成功，例如 吸烟 37. 最近的证据表明，更严格的信息技术法律，例如年龄禁令（相对于父母同意法或 没有法律）与较少的青年 IT 相关 38,39。不幸的是，信息技术法律的执行和遵守 可变且不足28,40-44。在倡导更严格的法律或执法时，也很重要 关注对可能阻碍进一步限制的次要影响的担忧。这些障碍包括 IT 法律的经济影响可能会导致小型企业组织起来反对进步的 IT 法律 保护他们的经济利益，制革商转而在沙龙之外使用 IT 床（例如家庭、公寓、 健身房）没有得到很好的监管或检查 45-50。这个五年R01的目标是使用混合方法 由多重[政策]流和 RE-AIM 51,52 框架 53 提供信息的方法，以调查三个特定的 目标。目标 1 是一项比较案例研究，旨在阐明 IT 立法的采用过程。目标 2 使用伪 赞助人（同盟）评估、全国调查和档案数据，以调查立法实施情况， 即沙龙和非沙龙的法规合规性以及遵守政策严格性的关联 和执行规定 41 以及青少年和年轻人中 IT 和晒伤的结果。目标 3 整合前两个目标的数据和外部数据来评估与政策相关的经济影响 IT 严格性、执行和合规性的可持续性。科学前提源于缺乏 将 IT 政策努力转化为严格的 IT 立法和合规性的过程的研究，以及 它们的影响 54,55，例如对黑色素瘤危险因素（IT、晒伤）的积极结果和次要影响 （经济成本，补偿性晒黑）。这种全面、多层次、严格分析的结果将告知 IT 政策干预以及其他卫生政策领域，并指导加强 IT 法律的最佳实践 严格性，走向 IT“终局”56,57。其中可能包括在父母同意法中增加年龄禁令 或者将年龄限制提高到 19 岁或 21 岁，类似于烟草。作为相关内容和方法论的专家 领域，我们的多 PI 领导的团队已经做好了开展这项创新、开创性研究的准备。