New Hampshire Comprehensive Cancer Collaboration: Indoor Tanning

Problem

In 2013, New Hampshire ranked sixth in the nation for rates of new melanoma diagnoses, according to the Centers for Disease Control and Prevention (CDC)(CDC and National Cancer Institute, 2017). Early exposure to carcinogenic ultraviolet (UV) rays, emitted by indoor tanning devices, can increase the risk of developing skin cancer later in life (CDC, 2017; International Agency for Research on Cancer Working Group on Artificial UV Light, 2007). Indoor tanning is easily accessible and popular with teens.

PSE Change Solution

After unsuccessful attempts to ban indoor tanning among minors, the New Hampshire Comprehensive Cancer Collaboration (NHCCC) focused on engaging partners to increase awareness about the use and dangers of indoor tanning by teens under the age of 18. Partner activities ultimately led to the passage of a state law that prohibits indoor tanning for minors that became effective January 1, 2016.

Actions/Results

Actions

The NHCCC’s Sun Safety Work Group members:

1. Identified high schools that were located near tanning salons (Step 2: Scan).
2. Conducted tanning forums at the schools to increase awareness—on the part of students and faculty—of the dangers of tanning (Step 5: Promote).
3. Partnered with the Melanoma Foundation of New England (MFNE) to conduct “Your Skin is In” education and outreach programming at high-risk high schools and “Teens on Tanning” forums (Step 5: Promote).
4. Partnered with the American Cancer Society Cancer Action Network (ACS CAN), MFNE, the NHCCC’s Public Policy Committee and others to advance legislation prohibiting indoor tanning (Step 6: Implement).

Results

A state law prohibiting indoor tanning was enacted, HB 136, c. 54 (2015).

Success Factors and Key Questions Addressed

Which stakeholders needed to be included in your efforts and how did you assemble them?

The NHCCC Sun Safety Work Group members worked with MFNE to identify key partners in New Hampshire, including:

• High school nurses, school champions, student bodies, faculty and administration
• Health care providers, including dermatologists
• Advocacy groups, including ACS CAN
• Health promotion community partners
• Research evaluators
• State Chronic Disease and Environmental Services representatives
• Local public health organizations
• Melanoma survivors

How did the missions of diverse stakeholders align for the purpose of the PSE change effort?

The NHCC’s mission to reduce the burden of cancer in New Hampshire aligned easily with the national ACS CAN mission and with the MFNE. The NH Division of Public Health supported the policy to prohibit tanning and provided written testimony.

What resources (tangible and intangible) were needed that stakeholders could provide?

• MFNE: Programming for the high schools, funding to local public and private health organizations, evaluation support and assistance in identifying people to testify before the legislature
• NHCCC: Engaged school champions and promoted media support for the ‘Teens on Tanning” forums and “Your Skin is In” programming
• Dartmouth-Hitchcock Norris Cotton Cancer Center, Departments of Pediatrics and Community and Family Medicine: Mapped high-risk schools (proximity to tanning salons) and provided evaluation
• Public health partners and community health promotion organizations: Logistical support for the programming
• New Hampshire School Nurse Association: Promoted the forums on its listserv
• ACS CAN: Found a willing legislator to support the tanning bill
• Survivors: Provided support and testimony
• Schools: Offered champions, class time for forums and evaluations

Related Resources

To read more about the New Hampshire law, see “Tanning Ban for Minors Becomes Law in N.H.,” or for the law itself, see the section of the state code addressing indoor tanning. For indoor tanning data, refer to the Youth Risk Behavior Surveillance System. Additional information about indoor tanning may be obtained from the International Agency for Research on Cancer, which defines tanning devices as “carcinogenic,” the2014 Surgeon General’s Report that addressed skin cancer prevention and a population-based case-control study from New Hampshire.

REFERENCES

International Agency for Research on Cancer Working Group on Artificial UV Light. (2007). The association of use of sunbeds with cutaneous malignant melanoma and other skin cancers: A systematic review. International Journal of Cancer, 120(5), 1116-1122. doi: 10.1002/ijc.22453

Centers for Disease Control and Prevention and National Cancer Institute. (2017). United States Cancer Statistics: 1999-2014. Retrieved from http://www.cdc.gov/uscs.

Centers for Disease Control and Prevention. (2021). What Can I Do to Reduce My Risk of Skin Cancer? Retrieved from https://www.cdc.gov/cancer/skin/basic_info/prevention.htm.