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Measuring the stringency of states' indoor tanning regulations: Instrument development and outcomes

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Objectives

We sought to describe the development of an instrument to quantify the stringency of state indoor tanning legislation in the United States, and the instrument's psychometric properties. The instrument was then used to rate the stringency of state laws.

Methods

A 35-item instrument was developed. An overall stringency measure and 9 stringency subscales were developed, including one measuring minors' access to indoor tanning. Stringency measures showed good internal consistency and interrater reliability.

Results

In all, 55% of the 50 states and the District of Columbia had any indoor tanning law, and 41% had any law addressing minors' access. Oregon, Illinois, South Carolina, Florida, Indiana, Iowa, and Rhode Island had high overall stringency scores, and Texas and New Hampshire were the most restrictive with regard to minors' access.

Limitations

Measurement of actual enforcement of the laws was not included in this study.

Conclusions

The instrument appears to be an easy-to-use, reliable, and valid methodology. Application of the instrument to actual laws showed that, in general, state laws are relatively weak, although there was considerable variability by state.

Section snippets

Instrument development

We developed a comprehensive instrument to measure the restrictiveness/stringency of state indoor tanning laws, with an emphasis on minors' access. The goal was to develop an instrument that would grade the stringency on ordinal scales when possible (ie, weakest or no provision, to most restrictive), rather than simple presence/absence measures. In addition, we wanted to create a practical instrument that was easy to use with little training. We wanted to avoid range effects by providing

Psychometric properties of the instrument

Table I presents the number of items comprising each subscale, and the possible range of scores. The maximum possible score for overall stringency was 100. Table I also presents the internal consistency (Cronbach α) of the overall and subscale stringency scores. Internal consistency is reported separately for all 50 states plus the District of Columbia, and for the 28 states with any indoor tanning law. Internal consistency of the measures was generally good (particularly when using the 51

Discussion

The role of policy-related and environmental factors in influencing individual health behavior has gained considerable attention. Although there has been some effort in quantifying state laws and relating them to outcomes, particularly for tobacco control and minors' access to tobacco, little work has been done in the area of indoor tanning legislation. Macrolevel ecologic variables, such as state laws, may directly or indirectly impact indoor tanning behavior and health status.

We developed and

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    Supported by grants from the National Institutes of Health, National Cancer Institute (R01CA93532, R01CA093532-S1, and K05CA10051).

    Conflicts of interest: None declared.

    Reprints not available from the authors.

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    Copyright © 2007 American Academy of Dermatology, Inc. Published by Mosby, Inc. All rights reserved.