Casting shadows on the prevalence of tanning dependence: an assessment of mCAGE criteria.

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.