BILL ANALYSIS Ó SB 746 Page 1 Date of Hearing: June 28, 2011 ASSEMBLY COMMITTEE ON JUDICIARY Mike Feuer, Chair SB 746 (Lieu) - As Amended: March 22, 2011 SENATE VOTE : 25-9 SUBJECT : tanning facilities KEY ISSUE : DUE TO THE SERIOUS AND POTENTIALLY LIFE-THREATENING RISKS REPORTEDLY ACCOMPANYING OVER-EXPOSURE TO UV RADIATION, should the use of INDOOR tanning facilities by MINORS BE PROHIBITED? FISCAL EFFECT : As current in print this bill is keyed fiscal. SYNOPSIS A substantially similar version of this bill with the same author was passed by this Committee in 2007. This bill prohibits minors from exposing themselves to UV tanning devices. Current law already prevents anybody under age 14 from using ultraviolet tanning devices but permits minors age 14 to 18 to use such devices after obtaining the written consent of a parent or legal guardian. This bill eliminates consent waivers and bans all persons under age 18 from using ultraviolet tanning devices. Skin cancer is the most common form of cancer in America, with more than two million cases reported each year. The most common cause of skin cancer is over-exposure to ultraviolet radiation. Supporters state this measure is needed to prevent the rapidly growing rate of skin cancer cases among those 18 to 30 years old. Substantial evidence suggests that those exposed to ultraviolet rays from tanning booths at a young age face a 40 percent higher risk of skin cancer than those who do not tan. The California Nurses Association notes that "Melanoma is the leading cause of cancer death in women ages 25-30 and is second only to breast cancer women aged 30-34." The bill is supported by numerous health insurance groups, pediatric medical groups, and dermatological societies, and it is opposed by the indoor tanning industry. SUMMARY : Prohibits minors from using ultraviolet tanning devices. EXISTING LAW : SB 746 Page 2 1)Provides for the regulation of tanning facilities by the Department of Consumer Affairs. (Business and Professions Code Sec. 22706.) 2)Requires tanning facilities to provide customers with a written statement containing specified notices of the potential harm caused by tanning devices and those customers must sign the statement acknowledging the risks. (Business and Professions Code Sec. 22705(a).) 3)Requires tanning facilities to post warnings on the dangers of ultraviolet radiation in areas where tanning devices are used. (Business and Professions Code Sec. 22706 (b)(1).) 4)Requires customers between the ages of 14 and 18 to give the tanning facility a written consent from their parent or legal guardian stating that the parent or guardian had read and understands the warnings and consents to the minor's use of the tanning facility. (Business and Professions Code Sec. 22706 (b)(3).) 5)Provides that the first violation of the law is an infraction and that any subsequent violation is subject to a civil penalty not to exceed $2,500. (Business and Professions Code Sec. 22706.) COMMENTS : A substantially similar version of this bill was passed by this Committee in 2007. This bill seeks to prevent persons under the age of 18 from being exposed to potentially dangerous ultraviolet radiation by tanning in UV tanning devices. The author states in support: The connection between skin cancer and UV tanning is no longer anecdotal. Children who use indoor tanning methods can be exposed up to 12 times the normal amount of ultraviolet radiation per year, which makes them 74% more likely to be a victim of melanoma. Melanoma is the most deadly type of skin cancer and is one of the most common cancers diagnosed among young adults. It is the leading cause of cancer death in women ages 25 - 30 and is second only to breast cancer in women ages 30 -34. As a result, the World Health Organization elevated tanning beds to a level 1 carcinogen in 2009, alongside plutonium, mustard gas, and cigarettes. The United States Department SB 746 Page 3 of Health and Human Services and the United States Food and Drug Administration have also added these UV emitting tanning beds to the their list of most dangerous forms of cancer-causing substances in humans. And in February, the American Academy of Pediatrics joined the world-wide chorus that governments need to ban minors' access to UV tanning beds. As of today, several countries have banned tanning for minors, including sun-rich Brazil, where they have passed a complete ban on tanning, regardless of age. Several states and local governments have tougher bans than California. Surprisingly, Texas has the most stringent. SB 746 is a simple solution to a dangerous problem - it will prevent minors from accessing dangerous ultraviolet tanning devices. The health risk is just too great for children. Ultraviolet Rays and the Growing Occurrence of Skin Cancer: Ultraviolet (UV) radiation is naturally emitted from the sun and typically reaches the earth's surface in two forms: UVA radiation and UVB radiation. UVA radiation reaches the earth in fairly weak but long wave lengths and its rays can penetrate deep into human skin upon contact. UVA rays lead to natural skin aging, with moderate exposure over a long period of time. UVB rays reach earth as a shorter, but far more intense wave. Even short term exposure to UVB rays can lead to skin reddening, more commonly known as sunburn. Exposure to both UVA and UVB rays can lead to the development of skin cancer. According to the American Academy of Dermatology prolonged, unprotected exposure to ultraviolet radiation can be as cariogenic as cigarette smoke. In 2011, the American Academy of Pediatrics noted that there has been a rapid increase in the rate of skin cancer occurrences in the United States over the past 30 years. Skin cancer rates are growing fastest, 3 percent per year, in young women ages 15 to 39 (the group most likely to tan). Alarmingly, skin cancer has overtaken all other forms of cancer to become the most common cancer in the United States with one in four Americans expected to suffer from some form of skin cancer in their lifetime. The California Nurses Association notes that "Melanoma is the leading cause of cancer death in women ages 25-30 and is second only to breast cancer women aged 30-34." SB 746 Page 4 The Potentially Dangerous Cancer Risk of Ultraviolet Tanning Devices: In response to increased exposure to UV radiation, the skin will tan in order to protect itself. Cosmetically, tanning has become extremely popular with many teenagers and young adults to the point that many are seeking artificial sources of UV radiation to increase their tans. Nearly one-quarter of all "tanners" are between the ages of 13 and 19, and studies suggest 35 percent of teenage girls tan regularly. Important in considering this legislation, overall 70 percent of those who tan regularly reportedly are females ages 16 to 29. Artificial tanning devices operate by exposing a person to an ultraviolet light that attempts to mimic the sun's natural light, exposing a person to 94 percent UVA and 6 percent UVB rays. Despite attempts to mimic the sun's natural radiation, an American Academy of Pediatrics survey of 62 randomly chosen tanning facilities found that ultraviolet tanning devices were actually exposing customers to extremely high levels of UVA radiation 10 to 15 times greater than that emitted by the midday sun. This increased exposure to radiation has been shown to dramatically increase the cancer rate of frequent tanners. The American Academy of Dermatology notes that a person that frequently tans before the age of 35 (defined as tanning more than 50 hours or 100 sessions per year) has a 70 percent greater chance of developing skin cancer than somebody who never tans. WHO Deems Tanning Devices Carcinogenic : Indeed, the increased risk of UV tanning devices has led the World Health Organization (WHO) to deem tanning devices a carcinogenic. Even more worrisome, the American Academy of Dermatology notes that studies have determined that tanning causes the body to produce the same plasma endogenous opioids that are released when consuming drugs or alcohol. The Academy also has noted that 41 percent of frequent tanners show tendencies "consistent with aŻn]?addictive disorder." The addictive nature of tanning can cause a person to seek the physical reward of tanning while ignoring the known risks. Teenagers, whose brains are still developing, are reportedly at increased risks for developing addictions and dependencies. Non-Compliance Issues at Tanning Facilities Appear To Substantially Undermine Parental Consent Protection Goals: Many states, including California, currently regulate aspects of the indoor tanning industry. However a recent study showed that only one of 32 randomly selected tanning facilities was fully SB 746 Page 5 compliant will all FDA and state regulations. The same study identified an average of seven infractions per facility. The FDA study noted that 95% of tanners did not comply with FDA exposure guidelines, with some tanners exposing themselves to three times the level of UV radiation recommended by the FDA. Furthermore, the American Academy of Dermatology cites a study determining that many tanning facility staff members were unequipped to properly inform customers of the risks of tanning, and that many staffers failed to properly supervise patrons. Given the reported lack of compliance with federal and state guidelines evident in some if not many indoor tanning facilities, parents who provide their teenage tanner with consent may not realize the full extent of the risk for skin damage facing their children. (And of course there is no way of knowing how many children's "parental consent" forms have been forged.) Existing California law requires a parent or legal guardian to sign consent forms, in person, once per year to enable their teenage children to use tanning facilities. After the initial consent, the parent is not required to supervise or accompany their child to tanning facilities so long as the consent form remains valid. If the tanning facility is failing to properly warn or supervise tanners, teenagers may overuse the facility and increase the harm to their skin from overexposure to UV radiation. Current analyses of the issue appear to make clear a parental consent approach to this health and safety issue is problematic, invites potential abuse by teenage children, and is extremely difficult if not impossible for tanning agencies to effectively oversee. No Proven Health Benefits of Tanning: Proponents of indoor tanning have claimed that artificial tanning devices can help individuals suffering from a Vitamin D deficiency. Vitamin D is naturally absorbed by the body through exposure to moderate amounts of natural sunlight. Vitamin D has been shown to help prevent several forms of cancer including prostate and gastrointestinal cancer. Proponents of sunless tanning have claimed that artificial sunlight devices that emit UV radiation help those who cannot absorb sufficient amounts of Vitamin D in their daily life. Although sunless tanning does provide a person with Vitamin D, health experts doubt the benefits of sunless tanning. The American Academy of Dermatology has noted that the health risk of sunless tanning significantly outweighs any benefit. There reportedly is no scientifically known threshold at which UV SB 746 Page 6 exposure is safe while allowing for the maximum amount of Vitamin D synthesis, and no evidence showing any direct relationship between tanning and the decrease in certain types of cancers has ever been published. In 2010, the Federal Trade Commission (FTC) went so far as to criticize and issue a citation against the Indoor Tanning Association (ITA) for making false health and safety claims about the benefits of indoor tanning. In response to the false advertisements, the FTC required the ITA to disclose the risks of developing skin cancer related to the use of UV tanning devices and banned the tanning industry from making the following claims in their advertisements: 1)"Tanning, including indoor tanning, does not increase the risk of skin cancer;" 2)"Tanning, including indoor tanning, is safe or poses no danger;" 3)"Indoor tanning is approved by the government;" 4)"Indoor tanning is safer than tanning outdoors because in indoor tanning facilities, the amount of ultraviolet light is monitored and controlled;" 5)"Research shows that vitamin D supplements may harm the body's ability to fight disease;" and 6)"A study in the Proceedings of the National Academy of Sciences determined: (a) that sun exposure does not cause skin cancer or melanoma, or that the risk of such cancer is only hypothetical; (b) that getting a tan is health; (c) that the risks of not getting enough ultraviolet light far outweigh the risk of skin cancer; or (d) that vitamin D has been linked to significantly decreasing the risk of contracting lung, kidney, or liver cancer." Despite the FTC's warnings, the author notes that the tanning industry continues to make these claims in public, including at hearings before the Legislature. In filing their opposition to this bill with this Committee the ITA once again claimed that sunless UV tanning provides health benefits and claims that tanning beds are safer because they are more "controlled" than outdoor tanning. As noted above numerous studies have shown customers tend to ignore the recommended controls regarding time and exposure at UV tanning facilities and that the health risks far outweigh any potential benefit of using UV tanning devices. Prior Support for This Approach to Regulating Tanning Devices: When this Committee heard AB 105 (Lieu, Stats. 2007, Ch. 590), the Committee requested the bill be amended "up" to do what this SB 746 Page 7 current bill proposes, specifically, prohibit all minors under the age of 18 from using UV tanning devices. ARGUMENTS IN SUPPORT : In support of the bill, AIM at Melanoma, an anti-skin cancer organization, states: AIM is concerned about the growing incidence of skin cancer. The International Agency for Research on Cancer, a division of the World Health Organization, has moved UV radiation from tanning beds to its highest cancer risk category, labeling it as "carcinogenic to humans." UV radiation from tanning beds is in the same risk category as cigarettes and we do not allow anyone under the age of 18 to purchase tobacco products. (Emphasis in original.) Also in support, the California Nurses Association notes that "Melanoma is the leading cause of cancer death in women ages 25-30 and is second only to breast cancer women aged 30-34. UV radiation exposure from the sun is a known cause of skin cancer, and exposure to UV radiation during childhood and adolescence increases the risk for a skin cancer diagnosis as an adult." ARGUMENTS IN OPPOSITION : The Indoor Tanning Association strongly opposes the bill claiming, among other things, that the bill is based on distorted scientific claims: Proponents have failed to consider the many studies demonstrating the benefits of ultraviolet light on overall health and disease prevention through the creation of Vitamin D in the skin. Most teens do not get enough vitamin D from their diets, and vitamin D has been shown to protect against breast and other cancers, lymphoma, cardiovascular disease, multiple sclerosis, osteoporosis and other chronic conditions. Furthermore, the ITA argues that, "Teenagers interviewed regarding this and similar legislation in other states have flatly stated that they will just go out in the sun. That will mean more sunburns, which truly do create more melanoma risk. Moreover, if teens aren't able to go to commercial tanning facilities, they will not be aware of the advances in spray tans and their availability." Furthermore, Heartland, a tanning machine manufacturer claims that "for every report or opinion on one side, there is a report or opinion that contradicts it." However, as noted in the analysis above, tanning facility customers frequently ignore posted warnings and overuse UV SB 746 Page 8 tanning devices, and no study has apparently ever shown a direct link between the use of sunless UV tanning devices and reductions in cancer or other chronic conditions. Additionally, the industry argues that prohibiting minors will have a negative economic impact. Lewis Shender, the President & CEO of Hollywood Tans, states that banning minors from UV tanning devices would eliminate 5-10% of the consumer base for sunless tanning facilities. William Sanders, the Owner of a Palm Beach Tan franchise in Redding notes that his business could lose upwards of $66,000 in annual revenue if this bill is enacted, and this may lead to the elimination of some part-time employees. Heidi Shultz, a fellow Palm Beach Tan franchisee, states that her facility "provides jobs to our youth and educates them on the importance of hard work and industry knowledge" and that this bill would force her to eliminate some part-time positions for young employees. Although this bill will likely have an economic impact on tanning facilities, opponents do not account for any potential increase in revenues attributed to "spray-on" tanning services. Spray on services, which do not involve any UV radiation exposure, are in fact offered at many of the opponent's facilities. Further, opponents appear to ignore the potentially enormous societal costs attributed to the treatment of skin cancer and related health problems resulting from over-exposure to UV radiation, not to mention the familial costs and pain associated with fatalities from melanoma and other skin cancers. Finally, opponents argue that this bill denies parents the right to make decisions for their children. Len Beckford a Club Tan owner from Napa contends that parents should have the right to allow their 16 year old to "develop a base tan in a controlled environment" should a parent choose to. Mr. Beckford argues that the existing parental consent laws are sufficient to control teenagers and that parents can withdraw consent at anytime. However, as the analysis notes above, studies suggest that some tanning facilities do not adequately train employees on the proper information to disclose to patrons and proper customer supervision. As a result some parents naturally may not fully appreciate the risk facing their children when they consent to their use of UV tanning devices. Prior Legislation : AB 2193 (Nation, Stats. 2004, Ch. 758): Revised the Filante Tanning Facility Act of 1984 to prohibit the use of UV tanning devices for persons under 14 years of age and required parents to accompany minors aged 14-18 to tanning SB 746 Page 9 facilities. AB 105 (Lieu, Stats. 2007, Ch. 590): Required minors between the age of 14 and 18 to obtain written and informed parental consent before being allowed to use UV tanning devices and tanning facilities. REGISTERED SUPPORT / OPPOSITION : Support AIM at Melanoma Foundation American Academy of Dermatology Association American Cancer Society Anthem Blue Cross California Society of Dermatology & Dermatological Surgery (CalDerm) California Medical Association California Nurses Association Joanna M. Nicolay Melanoma Foundation Kaiser Permanente Sun Safety for Kids Opposition Indoor Tanning Association (ITA) National Federation of Independent Businesses Hollywood Tans Palm Beach Tan Analysis Prepared by : Drew Liebert & Nicholas Liedtke / JUD. / (916) 319-2334