Date of Award

Spring 2019

Project Type

Clinical Doctorate

College or School




Program or Major

Doctor of Nursing Practice

Degree Name


First Advisor

Gene Harkless

Second Advisor

Anne Perry


Background: Melanoma is the deadliest and the most common type of cancer in individuals age 15 to 29. Evidence has shown that ultraviolet radiation overexposure at younger ages significantly increases the risk of developing non-melanoma and melanoma skin cancer in later years. Despite these concerns, approximately 1.6 million minors under the age of 18 participate in the use of indoor tanning devices annually. The high prevalence of skin cancer in the United States continues to be a public health issue that warrants continued preventative and regulatory action. In spite of the health risks associated with indoor tanning, the state of Maine does not restrict the use of tanning devices for minors, as 18 states now do. Therefore, the aim of this DNP project was to implement a health policy change initiative with the goal of restricting access to commercial indoor tanning devices for minors.

Methods:The policy process framework and population health framework were used as models for implementing the health policy initiative. The population health framework was used to develop an argument for the public health implications of excessive ultraviolet (UV) radiation and provides rationale for restricting UV exposure among minors. The policy process framework was used to guide and evaluate the legislative work of this project. The legislative work was accomplished in collaboration with Maine Representative Anne Perry and other stakeholders.

Purpose/Implementation Plan: The purpose of this DNP project was to implement a substantive health policy change, that being the restriction of minors under the age of 18 from the use of commercial indoor tanning devices. The health policy change process included the following steps: 1. Create awareness of long-term health risks of indoor tanning devices among key legislators, constituents, and interest groups, 2. Work with legislators to bring a bill forward to restrict access to indoor tanning devices, 3. Evaluate the process and develop a proposal for sustainable action, if the legislation fails. The overall objective of this initiative was to decrease the risk of skin cancer among Maine’s youth.

Results:A proposal for the policy change was presented to stakeholders and was developed in support of the initiative. LD #1297, An Act to Reduce Youth Cancer Risk was introduced through the efforts of the coalition. The first public hearing for LD #1297 was held on April 3, 2019 with the Health and Human Services Committee (HHS) in Augusta, Maine with support from the stakeholders. A work session was held on April 16, 2019 where the bill was voted “ought to pass” 7 to 3 by members of the HHS committee.

Conclusion:The population health framework and application of the policy process framework to guide legislative efforts, resulted in greater support for LD #1297 by the HHS committee. Policy engagement to address the upstream causes of disease such as skin cancer is a professional responsibility of doctorally prepared nurse practitioners. This can be achieved by engaging in coalition building and enacting legislative initiatives for public health challenges such as the serious public health threat of indoor tanning by minors.

Key Words: skin neoplasms, skin cancer, ultraviolet radiation, indoor tanning, artificial tanning, basal cell carcinoma, squamous cell carcinoma, melanoma