Casting Shadows on the Prevalence of Tanning Dependence: An Assessment of mCAGE Criteria

Abstract

Recently more and more studies have reported high prevalence rates for a 'tanning dependence' among tanning bed users. The authors of these studies base their argumentation on a modified (m) version of the CAGE (Cut-down, Annoyed, Guilty and Eye-opener) Criteria, initially used for alcohol addiction. By means of cognitive interviews and a large population survey, we tested the validity of the mCAGE Criteria and the above-mentioned prevalence that was deduced on the basis of rather small collectives. Firstly, it seems that the mCAGE Criteria wording used so far is inconsistent, misleading and intrinsically invalid. Secondly, our population-based data show a much lower percentage (15%) of current sunbed users with potential dependence symptoms than the above-mentioned previously published studies. Thirdly, the usage parameters for most of the supposed 'addicts' do not indicate a substance addiction: 38% of the users with positive scores reported not having visited a tanning studio at all in the previous month, 39% did not use sunbeds regularly and 89% did not show signs of tolerance to UV radiation. The mCAGE Criteria do not seem suitable for assessing tanning dependence.

Indoor Tanning Dependence in Young Adult Women

“…The prevalence of indoor tanning dependence in our sample is higher than some previous studies, however most have involved general samples not young women with a history of indoor tanning in the past year (18, 20, 43). We observed a higher prevalence of indoor tanning dependence on the mDSM than the mCAGE, which is contrary to criticisms of the mCAGE (49) and may be a reflection of differences in performance of tanning dependence measures in general samples versus those who have recently indoor tanned. Although the study used reliable and valid measures of indoor tanning dependence, identification of correlates of indoor tanning dependence may depend on the measures used and future studies examining correlates using other measures such as the Tanning Addiction and Pathology Scale and the Structured Interview for Tanning Abuse and Dependence (17) are needed.…”

“…We chose these screeners because they have demonstrated reliability and validity and evidence indicates use of their cut points in combination to define indoor tanning dependence performs similarly to other available measures, such as the Tanning Addiction Pathology Scale and Structured Interview for Tanning Abuse and Dependence (17). Some researchers have also expressed concern that when administered alone the mCAGE may overestimate the prevalence of indoor tanning dependence (49), leading others to recommend using the combination of screeners to address limitations of using a single measure alone (23, 50). The mCAGE includes 4 items (Cut Down, Annoyed, Guilty, Eye Opener), and endorsing ≥2 items affirmatively indicates dependence symptoms.…”

Predictors of tanning dependence in white non‐Hispanic females and males

“…Similarly, participants were classified as not TD if they were identified as not TD on both scales ( n = 255). This restrictive classification of TD based on a combination of two different scales was used to reduce overestimation of TD …”

“…This restrictive classification of TD based on a combination of two different scales was used to reduce overestimation of TD. 24…”

The Behavioral Addiction Indoor Tanning Screener (BAITS): An Evaluation of a Brief Measure of Behavioral Addictive Symptoms

“…There is a need for evidence-based brief screening assessments to identify such users in order to further our understanding of the experience of tanning addiction. Although tanning addiction assessments have been developed by adapting existing substance addiction assessments (7), researchers have raised concerns about their validity (5, 8, 9) and assessment results do not appear to correspond to actual tanning behavior (9). …”