Objective: To examine the importance of tanning among students in relation to attitudes and knowledge regarding skin cancer prevention. Design: A cross-sectional survey. Setting: College students at a major Midwestern university. Methods: Students were recruited to complete a self-administered questionnaire that included information on sun-sensitivity, knowledge and tanning attitudes and behaviours. Survey sampling statistical techniques that account for clustering among the 163 students recruited were used. Results: We found a high level of skin cancer prevention knowledge; however, knowledge was not related to a reduction in the importance of tanning. In many cases, higher levels of knowledge corresponded to a greater emphasis on the importance of tanning. Sunscreen use was low among this population. Those who placed an importance on tanning more often indicated that they believed that "sunless tanning creams are safer than the sun". Conclusions: This population's belief that they look healthier and feel better with a tan strongly influences the desire to tan. Therefore, future cancer information campaigns or other prevention efforts should directly address the desire to tan by encouraging the use of sunless tanning products as an alternative method of tanning. (Contains 4 tables.)