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Indoor tanning is currently a $5 billion per year industry in the US with more than 40,000 indoor tanning establishments.1,2 Thirty million Americans indoor tan each year, and one million tan indoors each day.3 Hoerster and colleagues found more indoor tanning facilities in each of 116 large US cities than the number of Starbucks coffee shops and McDonald's restaurants in those cities.4 The Social Ecological Model has been used to help understand the various influences on health behaviors and includes intrapersonal, interpersonal, organizational, community, and public policy factors.5 Most research on indoor tanning thus far has focused on intrapersonal and interpersonal factors, indicating that individuals are motivated to tan most commonly for appearance-enhancement reasons.6 However, some individuals tan indoors due to social or normative factors or in order to improve mood or reduce stress.6 Much less attention has been paid to organizational, community, and public policy contextual factors. As is the case with tobacco use and obesity, contextual factors such as accessibility, governmental regulation, marketing, or cost may also be associated with the prevalence of indoor tanning. Salon accessibility, for example, having a higher density of tanning facilities and living within 2 miles of a tanning facility, has been found to be associated with indoor tanning in the last year.7 However, indoor tanning has been found to be unrelated to state tanning regulations, likely due to low levels of enforcement,7-11 suggesting that community norms and other factors may be more important in influencing indoor tanning behavior currently. Other contextual factors that have been found to encourage more frequent and continuous indoor tanning among tanning salon patrons include reasonable prices and the convenience of being able to tan anytime including at night.12 Ultraviolet radiation (UV) such as that emitted by indoor tanning devices is known to definitively increasing skin cancer risk.13-16 However, there are additional contextual issues related to indoor tanning that may contribute to even greater levels of risk than would otherwise exist. UV-related guidelines and regulations regularly go un-enforced.8-11 For example, very fair-skinned individuals at high risk for burning are often permitted to tan when they shouldn't be, and tanning session length guidelines based on skin types (ie, sensitivity to burning) are not followed. Additionally, many tanning devices are not monitored adequately and therefore may emit more UV than guidelines recommend. Salon staff sometimes do not even know what type or how much UV is emitted from their devices,9 thus, they would be unlikely to be able to follow Food and Drug Administration (FDA) or other guidelines regarding UV exposure. Moreover, indoor tanners are often adolescents and college-aged individuals, thus potentially leading to high levels of lifetime UV exposure.17,18 Besides contextual factors, an additional intrapersonal reason for frequent tanning is tanning dependence or addiction, colloquially referred to as “tanorexia”.19 Although tanning dependence in not an official disorder according to the American Psychiatric Association's Diagnostic and Statistical Manual,20 tanning dependence has been defined based on traditional substance dependence criteria and measures (ie, tolerance, withdrawal, difficulty controlling the behavior despite negative consequences). A number of studies have provided evidence for the phenomenon of tanning dependence, with plausible biologic underpinnings, primarily related to the opioid system.19 The prevalence of tanning dependence varies by population and measurement strategy. Rates range from 22% to 45% among college indoor tanners and 18% among college sunbathers.21-24 Among general college student samples in the US, rates range from 5% to 27%.21-25 Tanning dependent individuals may tan frequently and put themselves at even greater risk of skin cancer than other tanners. There are elements of the current indoor tanning context that may contribute to tanning dependence such as easy accessibility, lack of regulation/enforcement, marketing efforts by salons, and the relatively low cost of indoor tanning. Although seemingly important, relatively few studies have focused on such contextual factors related to indoor tanning. These studies have been focused on adolescents rather than college-aged individuals, and the results have been mixed in terms of the impact of state indoor tanning laws and indoor tanning behaviors.26 The purpose of the current study was to investigate the association of college-aged women's perceptions of contextual factors such as tanning salon accessibility, regulations, marketing, or cost and indoor tanning behavior or tanning dependence. We hypothesized that individuals who had tanned indoors in the last 30 days and/or women who scored higher on a measure of tanning dependence would be more likely to report greater salon accessibility, looser tanning regulations, more promotional efforts, and lower cost of individual indoor tanning sessions, yet more trouble paying for their tanning habit than others. Understanding the factors associated with more frequent indoor tanning may help inform policy and public health programming efforts. For example, the impact on young women's skin cancer risk of additional regulation and enforcement of contextual factors associated with frequent or dependent tanning could be investigated.