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Past studies documented that adolescent indoor tanning is associated with substance use. However, these did not examine e-cigarette use as many were conducted prior to their widespread popularity nor were most studies focused on areas with high environmental risk for skin cancer. The present study examined the current relationship between indoor tanning and substance use, including e-cigarettes, in an area with high skin cancer burden.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Methods<\/jats:title>\n            <jats:p>Data for the current study stem from a statewide survey of middle and high school students in a high melanoma burden state of the United States (<jats:italic>N<\/jats:italic>\u2009=\u200922,141). The survey assessed student\u2019s reported indoor tanning, alcohol use, cigarette smoking, and e-cigarette and marijuana usage.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Results<\/jats:title>\n            <jats:p>Across all student participants, 3.5% reported indoor tanning one or more times in the past 12 months. Weighted chi-square tests revealed statistically significant associations between indoor tanning and other health risk behaviors (<jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001). Specifically, higher alcohol consumption, e-cigarette use, marijuana use, and cigarette use were all significantly associated with more frequent indoor tanning. Female and older adolescents were more likely to report indoor tanning.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusions<\/jats:title>\n            <jats:p>Indoor tanning among adolescents is associated with increased odds of engaging in substance use behaviors, including e-cigarette use. Health interventions for adolescents may benefit from addressing multiple health risk behaviors concurrently and targeting adolescents most in need for health interventions. Future work to better understand the common mechanisms underlying co-occurring health risk behaviors could inform development of such interventions.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1186\/s12889-025-23630-2","type":"journal-article","created":{"date-parts":[[2025,7,19]],"date-time":"2025-07-19T06:39:10Z","timestamp":1752907150000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Indoor tanning is associated with substance use behaviors among adolescents"],"prefix":"10.1186","volume":"25","author":[{"given":"Nathan","family":"Shen","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Suzanne L.","family":"Fastner","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xuechen","family":"Wang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ben J.","family":"Brintz","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chelsey R.","family":"Schlechter","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yelena P.","family":"Wu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2025,7,19]]},"reference":[{"issue":"12","key":"23630_CR1","doi-asserted-by":"publisher","first-page":"1749","DOI":"10.1200\/jco.2018.36.15_suppl.1568","volume":"5","author":"C Fitzmaurice","year":"2019","unstructured":"Fitzmaurice C, Abate D, Abbasi N, et al. 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