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An open tanning booth at Amazing Tans in Sacramento, Calif., is shown on Dec. 9, 2011.
An open tanning booth at Amazing Tans in Sacramento, Calif., is shown on Dec. 9, 2011. (AP FILE PHOTO , Carroll County Times)

Right now, tanning beds are similar to bandages and tongue depressors, Q-tips and gauze.

That's because all products present a low risk of harm to the public, according to the U.S. Food and Drug Administration's current classification of each. But the FDA has taken a second look at the radiation-emitting devices with its proposal on May 6 - known as Melanoma Monday - to move indoor tanning beds to the moderate risk category.

A slew of federal agencies and medical experts agree that tanning beds are a hazardous health risk. And so do the majority of state legislatures, as more than half of states have enacted bans on such devices or, like Maryland, passed legislation requiring parental consent before a minor slides under the sunlamp's heat, according to the National Conference of State Legislatures.

Indoor Tanning Association Executive Director John Overstreet said the association doesn't dispute that overexposure could potentially lead to skin cancer. That's why there are time limits for how long an individual can be under the product, and tanning salon employees adhere to those maximums, according to Overstreet.

"There's many things in this world that we are exposed to and around daily that are carcinogens. ... And it's the same thing with ultraviolet light," he said. "If it's practiced in moderation, it's not going to be harmful to you."

Illuminating (and controversial) research

A tan is the body's way of indicating it's been damaged. And garnering one - whether artificially or from the sun - is unhealthy, increasing an individual's risk of developing cancer, according to the National Cancer Institute.

"A 'healthy glow' is no longer a healthy glow," said Greg Safko, president of the Westminster-based nonprofit Joanna M. Nicolay Melanoma Foundation.

In 2009, the International Agency for Research on Cancer, which is affiliated with the World Health Organization, researched 19 studies on indoor tanning data conducted over the course of 25 years, according to the FDA.

This research showed that the risk of developing melanoma, the rarest but most severe form of skin cancer, increased 75 percent for those who used a tanning bed before they were 35 years old, according to the FDA.

The International Agency for Research on Cancer's conclusion: Tanning devices can cause cancer.

So, it placed the devices into the highest cancer risk category: "carcinogenic to humans," the FDA's website states.

"If you smoke cigarettes long enough, you'll get lung cancer," local dermatologist Dr. Lawrence Feldman said, "and if you go into tanning beds long enough, you'll get skin cancer, especially melanoma."

A long list of medical societies agrees, including The American Academy of Dermatology Association, American Academy of Pediatrics, the American Cancer Society and more.

Each agency supports a ban on the devices for minors, which has yet again become a discussion point with the FDA's proposal to have warning labels catered to minors placed on the indoor beds.

The administration also has proposed placing the products into the moderate risk category, joining items such as powered wheelchairs, condoms and the majority of medical devices, according to FDA spokeswoman Morgan Liscinsky. The third and highest class is reserved for life supporting or sustaining devices or those that present a potential unreasonable risk of injury, such as implantable pacemakers and breast implants.

In a news release response to the FDA's proposal, the Indoor Tanning Association stated that the International Agency for Research on Cancer's 2009 study has been "widely discredited by reputable scientists."

"We embrace any label changes that will lead to a better understanding of the potential risks of overexposure and thereby enhance our customers' safety," the release says. "However, we are concerned that the proposed requirements will burden our members with additional unnecessary governmental costs in an already difficult economic climate."

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Recent changes next-door and nationwide

The state General Assembly passed legislation in 2008 requiring minors to have a parent or legal guardian sign a form at the tanning salon before they're allowed to use the indoor beds, according to the Maryland Department of Health and Mental Hygiene.

HB 1358's preamble states the law is in the public's interest to protect children from the "harmful effects of ultraviolet radiation through the use of artificial tanning devices."

And the Maryland Indoor Tanning Association agreed that the measure was a necessary one, Robin Eason, the association's president, wrote in a letter to the Times. The association has also created a Code of Conduct that tanning salon owners follow for the tanning of minors that includes wearing protective eye wear and requiring warning statements be read about overexposure.

"We strongly support the Parental Consent Law," Eason, who owns a tanning salon, wrote. "It should be the parent's choice to decide whether their kids can get a tan, not the government."

So, DHMH crafted a consent form, which it began using in 2009.

In November of that same year, one of Carroll's neighbors, Howard County, came up with a historic regulation. It wanted to be the first jurisdiction in the nation to prohibit minors from using tanning beds, according to Howard County Health Officer Maura Rossman.

The Howard County Board of Health approved the measure brought before it by then-Health Officer Peter Beilenson.

"There was really no reason why teens should be be exposed to a carcinogen," Rossman said. "Many counties are not banning [it], but we believe it's the right thing to do to protect our children from skin cancer. It's a preventable death."

Four times a year, the health department performs sting operations, checking to ensure the tanning facilities are in compliance, Rossman said.

An underage teen attempts to purchase a session. If they're not asked to present a valid ID and are allowed entrance to the area with the indoor beds, then the establishment receives a citation. This happens roughly 25 percent of the time, according to Rossman.

A countywide ban hasn't come up in Carroll, according to Larry Leitch, Carroll County Health Department's health officer. And it likely wouldn't pass, he said.

"Our commissioners are, well, you know, are very, very conservative," he said. "They want the government out of people's lives as much as possible."

He's unsure if he'd support a ban himself, although he's in favor of having parents sign a consent form before their child goes tanning.

That's a route many other states have taken, according to the National Conference of State Legislatures.

California became the first state to ban the use of indoor tanning beds for all individuals younger than 18 years old, a law that went into effect Jan. 1, 2012. Vermont followed suit, passing a law that went into effect last July, according to the NCSL.

New Jersey passed a law prohibiting those younger than 17 from using the beds this year, according to the Skin Cancer Foundation. Others have different bans, such as Delaware, New Hampshire and North Dakota, which prohibit those younger than 14 from using them unless medically necessary, according to NCSL.

While the beds can have deleterious effects in excess, bans shouldn't be enacted because they're just emitting ultraviolet rays - similar to the sun, Overstreet said.

"I don't think there's science to back the banning," he said. "If government wants to ban [ultraviolet light] for indoor tanning, they should ban it for Ocean City as well. A teenager is much more likely to get sunburned in Ocean City or overexposed than in an indoor salon."

And there's another problem with prohibiting minors from using the devices: They'll just go outside and tan, where there's no tanning salon employee to tell them time's up, Overstreet said.

"I call it the law of unintended consequences," he said. "The irony of doing something like that is they may be making the problem worse that they're trying to address."

Maryland's evaluation

While a law prohibiting minors from using tanning beds didn't make it to a vote on the Maryland General Assembly's floor this legislative session, the state Department of Health and Mental Hygiene is taking a hard look at its parental consent form.

In August, DHMH Secretary Joshua Sharfstein asked for public comment on the current regulations and form.

"There were questions at that point," Clifford Mitchell, the department's environmental health bureau director, said. "Was it effective? Was it doing what it was supposed to do, and had changes in our knowledge of the health effects associated with indoor tanning devices changed?"

The department received a long list of responses, from organizations such as the World Health Organization, the American Medical Association and the American Academy of Dermatology stating they'd support a ban. Medical and Chirurgical Society, Children's Environmental Health and Protection Advisory Council and others said the language on the form should be simpler, the dangers stated more clearly.

And so Mitchell and colleagues spent months crafting the new form that is open to public comment until June 13.

"We did strive in the revision to make it look more like a government form, to be straightforward in the language," Mitchell said. "This is a consent form to use artificial tanning devices, so we wanted to talk specifically about the risks of indoor tanning devices."

And the new consent form is emblazoned with the Department of Health and Mental Hygiene's logo. It includes several statements about skin cancer: "Indoor tanning causes skin cancer. Skin cancer can be fatal. To reduce the risk of skin cancer, the American Academy of Pediatrics recommends that children under age 18 never use indoor tanning devices."

While Overstreet said the Indoor Tanning Association strongly supports parental consent forms, the language on the form is a bit too strong.

"These groups don't trust people to make decisions for themselves or their family," he said, "and then they try and scare them with 'indoor tanning causes skin cancer.' It's a risk factor. ... They try and simplify this message and actually scare people."

During the initial call for comments for the current form, the Maryland Indoor Tanning Association refuted the legitimacy of the World Health Organization's study. Thus, the information on the new proposed form is one-sided, according to Eason.

"Parents are not stupid and do not need to have the wording dumbed down for them; the wording changes reflect a bias, they are deceptive, and they are intended to scare and mislead our clients into believing that they and or their kids WILL GET skin cancer and die," Eason wrote in the letter she sent to the Times.

There was also another change - parents are required to come back at least every six months to re-sign the form. Beforehand, a parent could choose between checking the boxes for "one time only," "unlimited" or choose a start and end date, the old form shows.

Some local officials said that while they applaud that alteration, they would rather see the Maryland General Assembly enact a ban. That's because parents might not know the tanning beds' harmful effects, Safko, of the Joanna M. Nicolay Melanoma Foundation, said.

"It's the [high school] juniors and the seniors," he said, "and the people of driving age that can get to these tanning parlors and that really have that peer pressure - getting ready for the prom, spring break, that kind of thing - that really [a ban is] important for 17 and under."

And it's adults' responsibilities to look out for children, Susan Rinehart, Carroll County Health Department's community outreach coordinator, said.

"Do I recommend my friends my age use a tanning bed? No, absolutely not," she said. "They're an adult. If they choose do that, that's their choice. ... I just think there should be some laws regulating what we do and don't do for our children because sometimes that's the only way to protect them."

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