“We need to learn what messages are most effective in shifting behaviors,” Linos said. “We need tailored prevention messages that are specifically designed for high-risk groups, including sexual minorities. We also need to think outside the box about how we deliver these messages and partner with technology and social media companies to really reach the right people at the right time.”

In another study published in JAMA Dermatology,3 Dr. Linos and colleagues used Google AdWords “to showcase skin cancer prevention advertisements” next to search results. The ads were divided into three thematic groups, “appearance, health, and education.”

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“Together, our selected advertisements were shown 235,913 times and clicked more than 2,000 times,” the authors reported. The highest ranking ad, at 2,062 clicks and 198,276 impressions, was educational: “The Truth of Tanning Beds. Do You Know What You Are Doing to Your Skin? Educate Yourself!” What remains unknown, however, is “whether this type of intervention successfully changes behaviors.”

In 2014, the Office of the Surgeon General issued a Call to Action to prevent skin cancer, noting only 10 states have laws to prevent indoor tanning among those younger than 18 years.4

At 16 years, according to a 2014 study, sexual minority men were 3.9 times more likely than heterosexual men to indoor tan.5

RELATED: Sun Exposure in the Military Raises Skin Cancer Risk in Veterans

The incidence of skin cancer varies by state, with Utah reporting the highest rate of melanoma, 34.6 per 100,000 population, while Texas has the lowest rate, 12.1. These rates reflect a state’s population: more than 90% of cases of melanoma are diagnosed in non-Hispanic whites.6

“Seeing tan skin as ‘attractive’ is a societal problem, similar to other highly sought after, but unattainable beauty ideals” such as “six-pack abs, thigh gap, and full lips,” Dr. Piliang said. “We must redefine our ideals of beauty to affect real change.”


  1. Mansh M, Katz KA, Linos E, et al. Association of skin cancer and indoor tanning in sexual minority men and women [published online ahead of print October 7, 2015]. JAMA Dermatol. doi: 10.1001/jamadermatol.2015.3126.
  2. Wehner MR, Chren MM, Nameth D, et al. International prevalence of indoor tanning: a systematic review and meta-analysis. JAMA Dermatol. 2014;150(4):390-400.
  3. Serrano WC, Chren MM, Resneck JS, et al. Online advertising for cancer prevention: Google ads and tanning beds [published online ahead of print October 7, 2015]. JAMA Dermatol. doi: 10.1001/jamadermatol.2015.3998.
  4. U.S. Department of Health and Human Services. The Surgeon General’s call to action to prevent skin cancer. U.S. Dept of Health and Human Services, Office of the Surgeon General website. http://www.surgeongeneral.gov. Updated 2014. Accessed October 20, 2015.
  5. Blashill AJ, Safren SA. Skin cancer risk behaviors among US men: the role of sexual orientation. Am J Public Health. 2014;104(9):1640-1641.
  6. U.S. Cancer Statistics Working Group. United States cancer statistics: 1999–2012 incidence and mortality web-based report. Centers for Disease Control and Prevention website. www.cdc.gov/uscs. Updated 2015. Accessed October 13, 2015.