Analysis of facilitators of and barriers to enactment of state regulation of indoor tanning by minors

Background: Indoor tanning (IT) causes skin cancers, including potentially deadly melanoma. IT often starts during youth, a critical time for deleterious skin damage. About half of the US states have enacted laws banning IT for minors under age 18. Purpose: This study reports qualitative findings from interviews with key informants (KIs) involved in IT legislative efforts to identify/describe factors influencing law enactment, based on the multiple streams framework. Methods Guided by expert advisors and using snowball-sampling, KIs from 16 states with most recently enacted IT laws regulating minor access and states without restrictions were contacted. In virtual interviews, KIs shared their unique “story” of IT bill efforts, enactment, implementation, impact, and potential future directions, which were transcribed and qualitatively coded by trained staff. Results: Although KI roles (e.g. legislators, advocates, clinicians, and melanoma survivors; n=64) and legislative processes vary by state, similar facilitators and barriers to IT bill passage were identified: personal stories, advocacy, opposition, preparation, legislator education, economic/enforcement issues, bill stringency, political values/partisanship, and legislative process. Other factors influencing bill enaction included failed Food and Drug Administration attempts toward federally banning minor IT and competing priorities. Conclusions: Despite evidence of laws’ impact on minors’ IT, policy enaction is challenging and slow. Understanding key facilitators and barriers may help advocates to advance legislation efforts. Advocating for stringent laws necessitates consideration of potential downstream effects. For example, even with policy enactment, KIs believed enforcement and compliance were likely insufficient and variable, with minors continuing to indoor tan, putting them at risk for potentially deadly skin cancer.