Analysis of Tanning Attitudes and Behaviors by Young Adult Sexual Minority Males in the Greater Chicago Area
Conditions: Sun Sensitivity
Sponsor: Northwestern University

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PROTOCOL TITLE: Deliberate ultraviolet light exposure to get a tan by young adult 
sexual minority males 
 
PRINCIPAL INVESTIGATOR: 
June K. Robinson, MD 
Northwestern University Feinberg School of Medicine 
Department of Dermatology 
312-503-5941 
june-robinson@northwestern.edu 
 
RESEARCH PERSONNEL: 
Corey Kosche, BS 
 
STATISTICIAN: 
Mary Kwasny, PhD 
Professor of Preventive Medicine 
Northwestern University Feinberg School of Medicine 
 
VERSION DATE:  
February 6, 2019  
 
 

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STUDY SUMMARY: 
The purpose of this study is to: a) identify enablers and barriers to deliberate ultraviolet 
light exposure by young sexual minority men (SMM), and b) quantify the extent of their 
deliberate ultraviolet light exposure.   
 
OBJECTIVES: 
Aim 1: To develop survey items to assess tanning attitudes and behaviors  
Nine survey items used by the PI in previous deliberate tanning research were adapted 
with the expert consensus of members of Northwestern’s Institute for Sexual and 
Gender Minority Health and Wellbeing. Discussions with the PI, research personnel and 
members of the institute developed the hypothesis that in addition to the previously 
reported appearance motivations young SMM may be engaging in tanning (indoors or 
outdoors) as a social activity. A tenth survey item was developed to assess deliberate 
tanning as a social activity.   
 
Aim 2: Analyze the tanning attitudes and behavior data acquired in an online 
survey of young adult sexual minority males, who regularly participate in the 
RADAR study.   
RADAR is a longitudinal study with cohorts from the greater Chicago region recruited 
between 2008 and 2015. The 10 survey items about tanning attitudes and behaviors 
were added to the online survey that examines SMMs’ behavior in the prior 6 months. 
 
Knowledge gained from this study may be help reduce deliberate ultraviolet light 
exposure and the risk of developing melanoma among SMM.  
 
BACKGROUND: 
Sexual minority males, who have one of the highest known estimated lifetime skin cancer 
prevalence, are an at-risk group for developing skin cancer. The estimated lifetime skin cancer 
prevalence for SMM is 8.1%, compared to 6.7% for heterosexual men. (Singer 2020) Elevated 
rates of skin cancer among SMM are thought to be driven by excess indoor tanning by young 
men, who are motivated by body image, appearance concerns, and affect regulation. (Blashill 
2017, Mansh 2015, Morrison 2019) In the past nationally representative samples of US 
adolescents found that SMM were significantly more likely than heterosexual men to have ever 
engaged in indoor tanning by 16 years of age (27.0% vs 8.6%; odds ratio 3.9; 95% CI, 1.6-9,8) 
(Blashill 2014,2017).  
 
In national self-reported surveys of adolescent men, who participated in indoor tanning, were 
more frequent outdoor sunbathers and substance users, such as tobacco or alcohol abuse and 
marijuana use (Demko 2003, Miyamoto 2012, Miller 2018). Historically, adolescents and young 
adults living in the American Midwest (adjusted odds ratio 2.38;95% confidence interval 1.53-
3.68) have high rates of indoor tanning because extremes in the availability of natural light 
appear to send intentional tanners indoors. (Demko 2003) The Midwest has the highest 
proportion of gyms with tanning beds. (Pagoto 2019) Even in regions of the US with more 
available natural sunlight than the Midwest, 25% of young adult (AYA) males in a college in 
Alabama concurrently engaged in both types of tanning, indoor and outdoor. (Daniel 2018) 
Excessive tanning may be a manifestation of tanning addiction (Mosher 2010,Miller 2018) 
Addictive tanning may have a physiological basis, as exposure to ultraviolet (UV) light 

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stimulates the production of beta-endorphin, an endogenous opioid peptide with mood-elevating 
effects. (Kourosh 2010)  
 
The decline in indoor tanning among US adults from 2007-2018 is attributed to indoor tanning 
youth access legislation. (Bowers 2020). It is possible that the 2012 Chicago and 2013 Illinois 
law banning indoor tanning for teens younger than 18 influenced the tanning habits of young 
SMM. (banning laws) While SMM may engage in both types of tanning, data on outdoor tanning 
by SMM are less available than indoor tanning. We will address this gap by including indoor and 
outdoor tanning questions in the ongoing RADAR survey of Chicago area young adult SMM that 
previously assessed alcohol, tobacco, and marijuana use.  
 
STUDY ENDPOINTS: 
Aim 1: Primary Outcome:  
Determine the test, re-test reliability of the 10 survey items using the RADAR 
participants in the deidentified database. 
 
Aim 2: Primary Outcome:  
Perform analysis of the data acquired in 6 months with the RADAR online survey. The 
cohort sample will examine demographic characteristics of those who engage in 
deliberate ultraviolet light exposure and those who do not. The mean and standard 
deviation of the 10 survey items with Likert scale (1 strongly disagree, 5 strongly agree) 
will be assessed for those who tan occasionally and those who tan more than 10 times 
in 6 months.   
 
STUDY INTERVENTIONS: 
none 
 
PROCEDURES INVOLVED:  
After 500 responses to the online survey are collected, the deidentified data will be 
analyzed.  
 
DATA AND SPECIMEN BANKING: 
See Data Management. Specimens will not be banked.  
 
SHARING RESULTS WITH PARTICIPANTS: 
Since this is a deidentified database, the results of the analysis cannot be shared with 
the participants. 
 
STUDY TIMELINES:  
Reliability test (test, re-test performed after 2 weeks) will be performed in the summer of 
2019. Participants will complete one online survey in the 6-month period from Sept 
2019-Feb 2020.  
 
INCLUSION AND EXCLUSION CRITERIA: 
Inclusion Criteria:  
- Young adult SMM (age 18-39) 
- Able to read English 

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- Have internet access 
- Willing to complete the online survey  
 
Exclusion criteria 
- None  
 
VULNERABLE POPULATIONS: 
This study will not include the participation of vulnerable populations 
 
PARTICIPANT POPULATIONS: 
500-600 young SMM, who regularly participate in the RADAR study 
 
RECRUITMENT METHODS: 
Participants are not recruited for this study. This is a secondary analysis of an existing 
deidentified database.  
 
COMPENSATION FOR PARTICIPATION IN RESEARCH ACTIVITIES: 
Research subjects will not be compensated.  
 
RISKS TO PARTICIPANTS: 
The potential risks to participants are expected to be minimal if they occur.  
 
Participants may enhance their awareness of their risk of developing skin cancer.   
 
POTENTIAL BENEFITS TO PARTICIPANTS: 
Because of the potential for the survey to enhance awareness of the importance of sun 
protection, participants may choose to use sun protection. We feel that the potential 
benefits to the subject outweigh the risk of potential enhanced anxiety in discovering 
that they are at risk to develop a skin cancer.  
 
DATA MANAGEMENT AND CONFIDENTIALITY: 
Data Management and Quality Control 
Data will be collected via the RADAR study. The deidentified data for this deliberate 
ultraviolet light exposure will be exported in an Excel file.   
 
Analysis 
Aim 1. The reliability of the survey items  
For test-retest reliability of the 10 items, 50 participants would allow a two-category κ to 
be estimated to within ±0.15 using 95% confidence intervals assuming that Cronbach’s 
alpha values were 0.6 or higher. The intra class correlations will be calculated using 
ANOVA and he accepted level of test/ re-test reliability will be 0.75-0.80.   
 
Aim 2. Analysis of survey data 
The demographic characteristics of the population will be compared for never purposely 
tan vs ever purposely tan with χ2 tests. The primary analysis will be analysis of variance 
(ANOVA) for the mean Likert scale values of the 10 self-reported survey items. Multiple 

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logistic regression will be used to determine the odds ratio (OR) and independence of 
predictors of deliberate ultraviolet light exposure to get a tan.  
 
PROVISIONS TO PROTECT THE PRIVACY INTERESTS OF PARTICIPANTS: 
This research includes provisions for protecting the privacy of research subjects. Study 
interactions will take place online via the RADAR study. The research team will be 
permitted to access study-related, subject-reported information as deidentified data. All 
data based on the deliberate ultraviolet light exposure research will be reported in 
aggregate form from the RADAR study to the PI. No individual respondents will be 
identified.  
 
Only approved research personnel will have access to the stored data. The PI is 
ultimately responsible for the receipt and transmission of the data.  
 
ECONOMIC BURDEN TO PARTICIPANTS: 
Taking part in this research study will not lead to any costs for subjects. 
 
CONSENT PROCESS: 
Consent is not required.  
 
PROTECTED HEALTH INFORMATION: 
This research study does not involve the use of Protected Health Information.  
 
MULTI-SITE RESEARCH: 
NA 
 
REFERENCES  
1. banning laws (https://www.nydailynews.com/news/politics/illinois-gov-pat-quinn-signs-bill-
banning-tanning-teens-article-1.1428018) 
2. Blashill AJ, Safren SA. Skin cancer risk behaviors among US men: The role of sexual 
orientation. Am J Public Health. 2014;104, 1640–1641 
3. Blashill AJ. Indoor tanning and skin cancer risk among diverse US youths: results from a 
national sample JAMA Dermatol 2017;153:344-5.  
4. Blashill AJ, Rooney BM, Wells KJ. An integrated model of skin cancer risk in sexual 
minority males. J Behav Med 2018;41:99-108.  
5. Bowers J, Geller AC, Schofield E, Hay JL. Indoor tanning trends among US Adults 2017-
2018. Am J Public Health (Published online ahead of print April 16, 2020: e1–e6) 
6. Daniel CL, Fernandez AM, Gassman NR, Bae S, Blashill AJ, Tan MC. Significant 
engagement in tanning behaviors by men at a U.S. university. J Comm Health 
2018;43:656-59.  
7. Demko CA, Borawski EA, Debanne SM. Use of indoor tanning facilities by White 
Adolescents in the United States. Arch Pediatr Adolesc Med 2003;157:854-860.  
8. Heckman CJ, Coups EJ, Manne SL. Prevalence and correlates of indoor tanning among 
US adults. J Am Acad Dermatol. 2008;58(5):769-780. 
9. Kourosh AS, Harrington CR, Adinoff B. Tanning as a behavioral addiction. Am J Drug 
Alcohol Abuse. 2010;36(5):284–90. 
10. Mansh M, Katz K A, Linos E, Chren M, Arron S. Association of skin cancer and indoor 
tanning in sexual minority men and women. JAMA Dermatol. 2015; 151, 1308–131. 

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11. Miller KA, Piombo SE, Cho J, Higgins S, et al. Prevalence of tanning addiction and 
behavioral health conditions among ethnically and racially diverse adolescents. J Invest 
Dermatol 2018:1511-1517. 
12. Miyamoto J, Berkowitz Z, Jones SE, Saraiya M. Indoor tanning device use among male 
high school students in the United States. J Adolesc Health.2012;50(3):308-310. 
13. Mosher CE, Danoff-Burg S. Addiction to indoor tanning: relation to anxiety, depression, and 
substance use. Arch Dermatol. 2010;146(4):412-417. 
14. Morrison L, Raymond HF, Katz KA, Simard J, et al. Knowledge, motivations and practices 
regarding indoor tanning among men who have sex with men in the San Francisco Bay 
Area. JAMA Dermatol 2019;155:852-854.  
15. Pagoto SL, Conroy DE, Arroyo K, et al. Assessment of tanning beds in 3 popular gym 
chains. JAMA Network Open 2019;2(12):e1918058.  
16. Singer S, Tkachenko E, Hartman RI, Mostaghimi A. Association between sexual orientation 
and lifetime prevalence of skin cancer in the United States. JAMA Dermatol 2020;156:441-
5.