Office of the Surgeon General
Indoor Tan-Free College Campus Initiative Award Proposal
Purpose of Initiative:
In July, 2014, Acting US Surgeon General Rear Admiral Boris Lushniak issued the
Surgeon General’s Call to Action to Prevent Skin Cancer 1. The report is a
scientifically based document that sheds light on skin cancer as a major public
health problem in the US. It outlines five major areas for individuals and
communities to help decrease the burden of skin cancer within the US.
The purpose of the Indoor Tan Free College Campus Initiative is to further this Call
to Action by supporting and celebrating colleges that ban indoor tanning practices
within their campus. In particular, this award will create opportunities to
 Follow through with two of the major goals of the Surgeon General’s Report
- Goal 3: Promote Policies that Advance the National Goal of Preventing Skin
Cancer and Goal 4: Reduce Harms from Indoor tanning;
 Recognize colleges that make skin cancer prevention in college-aged
students a priority on campus; and
 Demonstrate the continued commitment of the Office of the Surgeon
General to skin cancer prevention within the United States.
To be recognized, colleges will be asked to demonstrate their commitment to
adopting and implementing an indoor tanning-free policy on their campus. The
initiative will fall directly under Strategy 4C of the Call to Action to Prevent Skin
cancer: “Support organizational policies that discourage indoor tanning by
adolescents and young adults”. Tan-free college campuses will thus serve as role
models of institutions and communities that demonstrate a commitment to
bringing the words of this Call to Action to life.
Background
As highlighted in the Surgeon General’s Call to Action to Prevent Skin Cancer, the
incidence of melanoma, the deadliest form of skin cancer, is on the rise.1,2
Although melanoma is most commonly diagnosed in older adults, it is the third
most common cancer in adolescents and young adults.3 Indoor tanning has been
shown to increase an individual’s risk of both melanoma and non-melanoma skin
cancers.4,5 Because of this, regulatory agencies have reclassified the risk from
indoor tanning bed exposure in recent years. In 2009, the International Agency
for Research on Cancer (a part of the World Health Organization [WHO]) classified
Indoor Tan Free Campus Proposal – DRAFT – Feb. 2, 2015
Page 1 of 12
ultraviolet radiation from tanning beds as a known human carcinogen.6 In 2014,
the United States Food and Drug Administration (FDA) reclassified indoor tanning
beds from Class I (low risk) medical devices to Class II (moderate to high risk) and
required “black box” labeling of the devices. The black box warning requires that
indoor tanning devices carry a label stating that individuals under 18 should not
use these devices.7
Despite the known risks, indoor tanning is common among adolescents and young
adults with 37% of white adolescent females and 11 % of white adolescent males
having used indoor tanning facilities at least once in their lifetime.8 Additionally,
early research suggests that indoor tanning has addictive properties and that the
risk of addiction is higher for individuals who begin tanning at an earlier age.9,10
Because of strong evidence of these health risks, particularly for younger
populations, the Surgeon General’s Call to Action highlights the need to “Reduce
the Risks Associated with Indoor Tanning” and “Promote Policies that Advance the
National Goal of Preventing Skin Cancer.” A recent study from the University of
Massachusetts School of Medicine demonstrated that indoor tanning facilities are
commonly found on and around US college campuses .11 The study surveyed the
top 125 US colleges and found that 48 % had indoor tanning salons had indoor
tanning facilities either on campus or in off-campus housing, and 14% of
colleges allow campus cash cards to be used to pay for tanning. 11 Because
adolescents are more likely to tan if they live in close proximity (within 2 miles) of
an indoor tanning salon, on-campus tanning facilities pose a major threat to the
health of the young adults in our nation.11-13 Additionally, the availability of
unregulated indoor tanning beds in dormitory or college gym settings can further
increase health risks by increasing the amount of UV exposure experienced
without operators or time limits to possibly mitigate length of exposure.11 This
study highlights the need for interventions targeted at eliminating indoor tanning
opportunities on or near college campuses.
Scope of Awards:
We would like to grant Indoor Tan-Free College Campus Awards to colleges that
make a commitment to prohibit opportunities for indoor tanning on their campus.
Indoor tanning presence on college campuses may be found as tanning salons oncampus or as salons in off-campus but college-endorsed housing. Additionally,
some colleges permit their meal cards to be used to pay for indoor tanning.
Awards would be given to colleges and universities that disallow indoor tanning in
any of these formats.
Indoor Tan Free Campus Proposal – DRAFT – Feb. 2, 2015
Page 2 of 12
Eligibility Criteria:
 A college institution and/or its graduate level programs may self-nominate
for Indoor Tan-Free College Campus Award recognition or be nominated by
a member of the Tan-Free College Campus work group. The universities
recognized by this Surgeon General award will have demonstrated a
commitment to skin cancer prevention and the ongoing health of their
students by meeting the following requirements:
o The nominated university must not have indoor tanning salons on
campus or in college buildings (gyms, student centers, dormitories
etc.).
o The nominated university must not have indoor tanning salons
accessible in off-campus housing that is either supported or promoted
by the college
o The nominated university must not allow students to use cash cards
to pay for indoor tanning sessions.
o The nominated university must provide an educational program
focusing on the risks of UV exposure (through sunlight and indoor
tanning), and skin cancer prevention practices.
o The nominated university must have an established policy that
demonstrates a current and ongoing commitment to disallowing an
indoor tanning presence on campus or in sponsored off-campus
housing.
Resources Needed:
The purpose of the Indoor Tan-Free Campus Initiative is to recognize college
campuses that:
 Do not have an indoor tanning presence on campus and who make a policy
to continue their commitment to remaining tan-free
 Do have an indoor tanning presence on campus and are able to remove that
presence and make a commitment to remain tan-free after removing the
presence
These two groups will require different resources and support from the Indoor
Tan-Free College Campus work group. Resources will be available through our
website and outreach programs targeted at the needs of a particular institution .
Indoor Tan Free Campus Proposal – DRAFT – Feb. 2, 2015
Page 3 of 12
 Advocacy Resources:
o Harvard School of Public Health:
 STRIPED UV tanning teaching case:
http://www.hsph.harvard.edu/striped/teaching-cases/
o Melanoma Foundation of New England: “Your Skin Is In” campaign
 Tan free pledge for high schools and colleges:
http://mfne.org/prevent-melanoma/your-skin-is-in/take-thepledge/
o Melanoma Research Fund:
 “Take a Stand Don’t Tan” poster:
http://www.melanoma.org/sites/default/files/u13882/TakeAS
tandPoster.pdf
 “Take a Stand Don’t Tan” pledge:
http://www.melanoma.org/sites/default/files/u13882/DontTa
nPledgeSheet.pdf
o Skin Cancer foundation:
 “Go With Your Own Glow” campaign
http://www.skincancer.org/healthy-lifestyle/go-with-yourown-glow
 Educational material:
o American Academy of Dermatology:
 “Time” Skin Cancer PSA:
https://www.youtube.com/watch?v=UeRLcPsOnSM
 The Dangers of Indoor Tanning: https://www.aad.org/spotskin-cancer/understanding-skin-cancer/dangers-of-indoortanning
 Indoor tanning stats and facts: https://www.aad.org/mediaresources/stats-and-facts/prevention-and-care/indoor-tanning
o Centers for Disease Control:
 The Burning Truth:
http://www.cdc.gov/cancer/skin/burningtruth/
o David Cornfield Melanoma Fund:
 “Dear 16 Year Old Me”:
https://www.youtube.com/watch?v=_4jgUcxMezM
Indoor Tan Free Campus Proposal – DRAFT – Feb. 2, 2015
Page 4 of 12
o Melanoma Foundation of New England:
 “Exposed” young melanoma survivors video:
http://mfne.org/prevent-melanoma/your-skin-is-in/watchexposed/
o Melanoma Research Fund:
 Why is Tanning Dangerous?:
http://www.melanoma.org/understandmelanoma/preventing-melanoma/why-is-tanning-dangerous
o US Food and Drug Administration:
 Indoor Tannings: The risks of ultraviolet radiation:
http://www.fda.gov/ForConsumers/ConsumerUpdates/ucm18
6687.htm
 List of schools that have received tan-free college campus recognition and
key contacts
 How to go tan-free toolkits:
o Model tan-free college campus policy drafted by Indoor Tan-Free
College Campus work group that can be adopted by colleges looking
to adopt a model - to be drafted
o Step-by-step implementation model for removing a tanning presence
on campus for schools that have indoor tanning presence on campus
– to be drafted
o Helpful hints and tips sheet to go tan-free – to be drafted
o Marketing and Communication:
 Sample Letter to the Editor – to be drafted
 Sample social media campaigns
 Sample media outreach guide
 Sample press releases
 Key peer reviewed literature:
o Availability of Tanning Beds on US College Campuses JAMA
Dermatology Article:
http://archderm.jamanetwork.com/article.aspx?articleid=1919438
Indoor Tan Free Campus Proposal – DRAFT – Feb. 2, 2015
Page 5 of 12
o Cutaneous Melanoma Attributable to Sunbed Use: Systematic
Review and Meta-Analysis:
http://www.ncbi.nlm.nih.gov/pubmed/22833605
o The Deceptive Nature of UVA Tanning versus the Modest Protective
Effects of UVB Tanning on Human Skin:
http://www.ncbi.nlm.nih.gov/pubmed/20979596
o Do Adolescent Tanners Exhibit Dependency:
http://www.ncbi.nlm.nih.gov/pubmed/16546579
o Indoor Tanning and Risk of Melanoma: A Case-Control Study in a
Highly Exposed Population:
http://www.ncbi.nlm.nih.gov/pubmed/20507845
o Sunbed Use during Adolescence and Early Adulthood is Associated
with Increased Risk of Early-Onset Melanoma:
http://www.ncbi.nlm.nih.gov/pubmed/20669232
o Ultraviolet Light is a Reinforcing Stimulus in frequent tanners:
http://www.ncbi.nlm.nih.gov/pubmed/?term=ultraviolet+light+is+a+
reinforcing+stimulus+in+frequent+tanners
o Use of Tanning Devices and Risk of Basal Cell and Squamous Cell Skin
cancer: http://www.ncbi.nlm.nih.gov/pubmed/11830612
Award
 Award criteria: meet all of the requirements listed above in eligibility and
confirmed by Tan Free Campus nomination approval work group and
finalized by OSG ORISE representative
 Possible titles:
o Surgeon General Tan Free College Campus Award
o Surgeon General Skin Cancer Prevention Campus Award
o Surgeon General Excellence in Skin Cancer Prevention Call to Action
Award
 Winners will receive:
o Letter and certificate signed by the Surgeon General
o Letter and certificate signed by the National Council on Skin Cancer
Prevention
o Possible coin of recognition developed by Indoor Tan-Free College
Campus partners
Indoor Tan Free Campus Proposal – DRAFT – Feb. 2, 2015
Page 6 of 12
o Description of the organization on surgeongeneral.gov and tan free
college campus publications and media
o All campuses that become tan-free in a given year will be entered into
a lottery for a visit by the surgeon general. Five campuses will be
selected for a visit each year.
 Possible recognition ceremony held at the college campus:
o Will involve local key tan free campus advocates when available
o Will largely be adapted to the desires and needs of the particular
campus during their launch
o Resources for a successful launch will be made available on the Indoor
Tan-Free College Campus website but will largely be self-run by oncampus groups supporting the initiative
Process & Timeline:
*Note* This is not a hard deadline and we will not publicly commit to a specific
date for the official launch of the initiative to assure flexibility to adapt to
unforeseen issues.
December: Stakeholder engagement and coalition building
 Continued outreach to stakeholders across the country with prior work in
indoor tanning policy to build a strong and unified coalition
o Targeted Stakeholder outreach:
 Sarah Malerich  undergraduate, medical school, and
graduate school group outreach
 John Antonishak  National Council on Skin Cancer Prevention
targeted outreach
 Avery LaChance  Other national indoor tanning stakeholder
outreach (federal work groups, academic researchers, skin
cancer non profit group outreach)
 Send out preliminary e-mail to interested stakeholders to brainstorm
resources and possible division of labor amongst groups engaged in the
Indoor Tan Free College Campus Initiative
 Conference calls/possible in-person meetings with Indoor Tan-Free College
Campus work group members to lay foundation for official launch in spring
January: Formal plan building and process development
 Begin developing website that will serve as the hub for announcements,
publicity, and information surrounding the initiative
Indoor Tan Free Campus Proposal – DRAFT – Feb. 2, 2015
Page 7 of 12
 Strategic planning for initiative with interested stakeholders  formalize
resources, division of labor and what the initiative will entail
 Start preliminary media outreach
 Develop logo, key color to represent the initiative, badges, banners, etc.
 Lay ground work at campus or campuses interested in launching in March:
work with campuses to develop and prepare to adopt policies on campus by
reaching out to leadership at key institutions
 Continued listserv communication to keep stakeholder informed and
engaged
February: Advertising and media push
 Formalize website and make public:
o Open up nomination submission page – nomination form will include
a checklist format to ensure that college campuses do not have a
tanning presence on campus and will include two free-text sections:
(1) where campuses can submit their tan-free policy to be viewed and
approved and (2) where campuses can submit their plan to become
tan free and how they are committed to the goals outlined in the SG’s
Call to Action
 Instructions will outline selection criteria and campus
requirements for the award
o Optional inclusion – up to two letters from key contacts or sponsors of
the initiative at the proposed campuses
 Develop a group of stakeholders who will take ownership of reviewing and
approving of submissions for tan-free campus awards
 Social media campaigns through different stakeholders:
o Develop hastag for twitter and tweets - #indoortanfreecampus?
o Develop Facebook homepage
 Showcase initiative on Surgeon General Homepage and/or in SG newsletter,
social media sites, etc.
 Possible CDC, OASH, HHS announcements through their standard channels
of communication?
 Possible blog posts on appropriate venues
 Prepare e-mail that can be distributed to stakeholder listservs to engage
possible other interested communities
 Press releases where appropriate and available
 Interviews and news stories where appropriate and available
 Finalize groundwork for launch at initial campus(es)
Indoor Tan Free Campus Proposal – DRAFT – Feb. 2, 2015
Page 8 of 12
 Develop a group dedicated to reviewing submissions
 Continued listserv communication to keep stakeholders engaged an on the
same page
End of February-Early March: Indoor Tan-Free College Campus initiative launch
aimed at catching college campuses prior to Spring Break!
 Update website with launch information
 Choose preliminary campus from which to launch the initiative
o Media blast around this campus
o Representation from members of the groups involved in initiative if
able
o Develop launch event or launch party to gain excitement and launch
initiative
 Prepare for additional college campus launches across the
country/encourage others to launch in March as well
 Prepare Surgeon General Award for campuses that go tan-free
 Prepare National Council on Skin Cancer Prevention Award for campuses
that go tan-free
 Continued listserv communication to keep stakeholders engaged and on the
same page
March-onward: keep the efforts going! Keep up the energy!
 Promote the tan-free colleges through national networks to keep up
momentum through:
o Website
o Social media outlets
o OSG communications
 Provide interested campuses with resources needed to launch on their
campus or prepare to become tan free campuses
 Provide link on Surgeon General webpage for colleges to join initiative
 Provided interested campuses with key contacts who can help them develop
a plan to go tan-free on their campus
 Continued listserv communication to keep stakeholders engaged and on the
same page
Indoor Tan-Free College Campus Partners
The Indoor Tan-Free College Campus Initiative will be spearheaded by the National
Council on Skin Cancer Prevention partnered with the Office of the Surgeon
Indoor Tan Free Campus Proposal – DRAFT – Feb. 2, 2015
Page 9 of 12
General for campus recognition. Launching the effort will require partnership,
pooling of resources and collaboration among interested stakeholders. Below is a
list of stakeholders who have already expressed a commitment to supporting the
Indoor Tan-Free College Campus Initiative:
 American Academy of Dermatology
 American Cancer Society
 Center for a Healthy Maryland
 Centers for Disease Control and Prevention
 Dermatology Interest Group Association
 Harvard School of Public Health
 Live SunSmart Foundation
 Melanoma Foundation of New England
 Melanoma Research Foundation
 National Council on Skin Cancer Prevention
 U.S. Environmental Protection Agency
Additionally, the Indoor Tan-Free College Campus initiative will require grass roots
efforts from stakeholders at universities across the country to advocate for and
implement the tan-free policies on campuses. Below is a list of stakeholders who
have expressed an interest in bringing the Indoor Tan-Free College Campus
Initiative to their institution:
 University of Connecticut Schools of Medicine and Public Health – UConn
Dermatology Interest Group
 University of Colorado
 University of Maryland School of Dentistry
 University of Massachusetts School of Medicine
 University of Pennsylvania
 Villanova University
Resources required
 Website – will be managed and launched by one of the above listed partners
 Supplies: Paper – for awards/certificate from the Surgeon General
 Printing costs
 Mailing costs
 Staff time:
o A large majority of the award promotions/outreach, screening of
nominees, notification/announcement of tan-free campus awards,
Indoor Tan Free Campus Proposal – DRAFT – Feb. 2, 2015
Page 10 of 12
recognition of winners, and promotion of tan free campus winners
will be taken on by the above listed partners
o The Indoor Tan-Free College Campus Initiative will require the
following person-hours from the OSG:
 intermittent engagement from ORISE fellow to confirm
appropriate conferral of award to campus recipients and ensure
delivery
 intermittent engagement of the ORISE fellow with the Indoor
Tan-Free College Campus work group to check in regarding
award requirements and new recipients
 Intermittent engagement of OSG Communications to broadcast
messages on social media, newsletters, and other forms of
communication
 Intermittent engagement of the SG surrounding events, Indoor
Tan-Free Campus Initiative launches, and press as the SG sees
fit
 Potential event-related expenses:
o Travel Fees for OSG staff attending any future launches or events
(optional)
Next steps
 Feedback from:
o CoS – CAPT Robert DeMartino
o Senior Policy Advisor – Dr. Melissa Brodowski
o aSG – Rear Admiral Boris Lushniak
o CDC – Meg Watson
o National Council on Skin Cancer Prevention – John Antonishak
o Select Indoor Tan-Free College Campus Initiative Stakeholders
References:
1.
2.
U.S. Department of Health and Human Services. The Surgeon General’s Call
to Action to Prevent Skin Cancer. Washington, DC: U.S. Dept of Health and
Human Services, Office of the Surgeon General; 2014.
Jemal A, Saraiya M, Patel P, et al. Recent trends in cutaneous melanoma
incidence and death rates in the United States, 1992-2006. Journal of the
American Academy of Dermatology. Nov 2011;65(5 Suppl 1):S17-25 e11-13.
Indoor Tan Free Campus Proposal – DRAFT – Feb. 2, 2015
Page 11 of 12
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
Weir HK, Marrett LD, Cokkinides V, et al. Melanoma in adolescents and
young adults (ages 15-39 years): United States, 1999-2006. Journal of the
American Academy of Dermatology. Nov 2011;65(5 Suppl 1):S38-49.
Lazovich D, Vogel RI, Berwick M, Weinstock MA, Anderson KE, Warshaw
EM. Indoor tanning and risk of melanoma: a case-control study in a highly
exposed population. Cancer epidemiology, biomarkers & prevention : a
publication of the American Association for Cancer Research, cosponsored
by the American Society of Preventive Oncology. Jun 2010;19(6):1557-1568.
Cust AE, Armstrong BK, Goumas C, et al. Sunbed use during adolescence
and early adulthood is associated with increased risk of early-onset
melanoma. International journal of cancer. Journal international du cancer.
May 15 2011;128(10):2425-2435.
Sinclair C. Artificial tanning sunbeds risks and guidelines. In: Organization
WH, ed. Geneva, Switzerland: World Health Organization; 2003.
Schneider S, Diehl K, Bock C, et al. Sunbed use, user characteristics, and
motivations for tanning. Arch Dermatol. 2012.
Demko CA, Borawski EA, Debanne SM, Cooper KD, Stange KC. Use of indoor
tanning facilities by white adolescents in the United States. Arch Pediatr
Adolesc Med. Sep 2003;157(9):854-860.
Zeller S, Lazovich D, Forster J, Widome R. Do adolescent indoor tanners
exhibit dependency? J Am Acad Dermatol. Apr 2006;54(4):589-596.
Feldman SR, Liguori A, Kucenic M, et al. Ultraviolet exposure is a reinforcing
stimulus in frequent indoor tanners. J Am Acad Dermatol. Jul
2004;51(1):45-51.
Pagoto SL, Lemon SC, Oleski JL, et al. Availability of Tanning Beds on US
College Campuses. JAMA dermatology. Oct 29 2014.
Hoerster KD, Mayer JA, Woodruff SI, Malcarne V, Roesch SC, Clapp E. The
influence of parents and peers on adolescent indoor tanning behavior:
findings from a multi-city sample. J Am Acad Dermatol. Dec 2007;57(6):990997.
Mayer JA, Woodruff SI, Slymen DJ, et al. Adolescents' use of indoor tanning:
a large-scale evaluation of psychosocial, environmental, and policy-level
correlates. American journal of public health. May 2011;101(5):930-938.
Indoor Tan Free Campus Proposal – DRAFT – Feb. 2, 2015
Page 12 of 12