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Heckman CJ, Liang K, Riley M. Awareness, understanding, use, and impact of the UV index: A systematic review of over two decades of international research. Prev Med 2019; 123:71-83. [PMID: 30844501 PMCID: PMC6534479 DOI: 10.1016/j.ypmed.2019.03.004] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Revised: 02/28/2019] [Accepted: 03/02/2019] [Indexed: 11/28/2022]
Abstract
The ultraviolet radiation index (UVI) was adopted internationally to raise awareness about and encourage the public to protect their skin from skin cancer. The current paper is a systematic review of over 20 years of research investigating awareness, comprehension, use, and impact of the UVI. Thirty-one studies were included from the USA, Canada, Europe, Australia, New Zealand, and elsewhere. Awareness of the UVI varies by country, with samples from some countries demonstrating high awareness. However, comprehension and use of the UVI to inform sun safety behaviors are typically much lower. In fact, greater UVI awareness has sometimes been associated with riskier UV-related behaviors such as intentional tanning. Fewer studies have evaluated interventions, and their results have been mixed. In summary, more research is needed to determine how to help the public understand and use the UVI for effective skin protection. This review offers suggestions for future use of and research with the UVI.
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Affiliation(s)
- Carolyn J Heckman
- Rutgers Cancer Institute of New Jersey, 195 Little Albany Street, New Brunswick, NJ, 08903, USA.
| | - Katherine Liang
- Temple University, 3500 N Broad St, Philadelphia, PA 19140, USA
| | - Mary Riley
- Rutgers Cancer Institute of New Jersey, 195 Little Albany Street, New Brunswick, NJ, 08903, USA
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Lucas RM, Neale RE, Madronich S, McKenzie RL. Are current guidelines for sun protection optimal for health? Exploring the evidence. Photochem Photobiol Sci 2018; 17:1956-1963. [PMID: 29904757 DOI: 10.1039/c7pp00374a] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Exposure of the skin to ultraviolet (UV) radiation is the main risk factor for skin cancer, and a major source of vitamin D, in many regions of the world. Sun protection messages to minimize skin cancer risks but avoid vitamin D deficiency are challenging, partly because levels of UV radiation vary by location, season, time of day, and atmospheric conditions. The UV Index provides information on levels of UV radiation and is a cornerstone of sun protection guidelines. Current guidelines from the World Health Organization are that sun protection is required only when the UV Index is 3 or greater. This advice is pragmatic rather than evidence based. The UV Index is a continuous scale; more comprehensive sun protection is required as the UV Index increases. In addition, a wide range of UVA doses is possible with a UVI of 3, from which there may be health consequences, while full sun protection when the UVI is "moderate" (between 3 and 5) may limit vitamin D production. Finally, the duration of time spent in the sun is an essential component of a public health message, in addition to the intensity of ambient UV radiation as measured by the UV Index. Together these provide the dose of UV radiation that is relevant to both skin cancer genesis and vitamin D production. Further education is required to increase the understanding of the UV Index; messages framed using the UV Index need to incorporate the importance of duration of exposure and increasing sun protection with increasing dose of UV radiation.
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Affiliation(s)
- Robyn M Lucas
- National Centre for Epidemiology and Population Health, Research School of Population Health, The Australian National University, Canberra, Australia.
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Lucas RM, Norval M, Neale RE, Young AR, de Gruijl FR, Takizawa Y, van der Leun JC. The consequences for human health of stratospheric ozone depletion in association with other environmental factors. Photochem Photobiol Sci 2015; 14:53-87. [DOI: 10.1039/c4pp90033b] [Citation(s) in RCA: 101] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Ozone depletion, climate and human health.
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Affiliation(s)
- R. M. Lucas
- National Centre for Epidemiology and Population Health
- The Australian National University
- Canberra 2601
- Australia
- Telethon Kids Institute
| | - M. Norval
- Biomedical Sciences
- University of Edinburgh Medical School
- Edinburgh EH8 9AG
- UK
| | - R. E. Neale
- QIMR Berghofer Medical Research Institute
- Brisbane 4029
- Australia
| | - A. R. Young
- King's College London (KCL)
- St John's Institute of Dermatology
- London SE1 9RT
- UK
| | - F. R. de Gruijl
- Department of Dermatology
- Leiden University Medical Centre
- NL-2300 RC Leiden
- The Netherlands
| | - Y. Takizawa
- Akita University Graduate School of Medicine
- Akita Prefecture
- Japan
- National Institute for Minamata Diseases
- Kumamoto Prefecture
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Armstrong A, Powell C, Powell R, Hallam N, Taylor J, Bird J, Sarran C, Oliver D. Are we seeing the effects of public awareness campaigns? A 10-year analysis of Breslow thickness at presentation of malignant melanoma in the South West of England. J Plast Reconstr Aesthet Surg 2013; 67:324-30. [PMID: 24434052 DOI: 10.1016/j.bjps.2013.12.023] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2013] [Revised: 12/07/2013] [Accepted: 12/20/2013] [Indexed: 11/17/2022]
Abstract
INTRODUCTION The last 20 years has seen a marked improvement in skin cancer awareness campaigns. We sought to establish whether this has affected the presenting Breslow thickness of malignant melanoma in the South West. METHOD This is a retrospective study looking at the first presentation of melanomas from 2003 to 2011. Data was accessed using the local online melanoma database. RESULTS A total of 2001 new melanomas presented from 2003 to 2012 (Male:Female = 1:1.062). The average yearly number of melanomas was 200.1 (range = 138-312). The mean age was 62.5 years (range 12-99). Data was analysed using a Chi² test. For 0-1 mm melanomas, there is a significant difference in the observed versus expected values over the 10 years (p = 0.0018). There is an increasing proportion of 0-1 mm (thin) melanomas presenting year on year, with a positive linear trend. This is very statistically significant (p < 0.0001). The 1-2 mm melanomas are decreasing in proportion with a negative linear trend (p = 0.0013). The 2-4 mm are also decreasing in proportion (p = 0.0253). There is no significant change in the thick >4 mm melanomas (p = 0.1456). CONCLUSION The proportion of thin 0-1 mm melanomas presenting in South West England has significantly increased from 2003 to 2012. There is no significant change in the thick >4 mm melanomas. This may be a result of increased public awareness due to effective public health campaigns which has significant prognostic and financial implications.
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Affiliation(s)
- A Armstrong
- Department of Plastic Surgery, Royal Devon & Exeter Hospital, Barrack Road, Exeter, Devon EX2 5DW, UK.
| | - C Powell
- Department of Plastic Surgery, Royal Devon & Exeter Hospital, Barrack Road, Exeter, Devon EX2 5DW, UK; Specialist Training Registrar in Plastic Surgery, Frenchay Hospital, Frenchay Park Rd, Bristol, South Gloucestershire BS16 1LE, UK
| | - R Powell
- Department of Plastic Surgery, Royal Devon & Exeter Hospital, Barrack Road, Exeter, Devon EX2 5DW, UK; Research Design Consultant, Research Design Service (RDS) South West, Royal Devon and Exeter Hospital, Barrack Road, Exeter, Devon EX2 5DW, UK
| | - N Hallam
- Department of Plastic Surgery, Royal Devon & Exeter Hospital, Barrack Road, Exeter, Devon EX2 5DW, UK; Cancer Audit Facilitator, Royal Devon and Exeter Hospital, Barrack Road, Exeter, Devon EX2 5DW, UK
| | - J Taylor
- Department of Plastic Surgery, Royal Devon & Exeter Hospital, Barrack Road, Exeter, Devon EX2 5DW, UK; Department of Radiology, Royal Devon and Exeter Hospital, Barrack Road, Exeter, Devon EX2 5DW, UK
| | - J Bird
- Department of Plastic Surgery, Royal Devon & Exeter Hospital, Barrack Road, Exeter, Devon EX2 5DW, UK; Research Fellow ENT Surgery, University Hospital Southampton NHS Foundation Trust, Tremona Road, Hampshire SO16 6YD, UK
| | - C Sarran
- Department of Plastic Surgery, Royal Devon & Exeter Hospital, Barrack Road, Exeter, Devon EX2 5DW, UK; Heath Research Analyst, Met Office, Fitzroy Road, Exeter, Devon EX1 3PB, UK
| | - D Oliver
- Department of Plastic Surgery, Royal Devon & Exeter Hospital, Barrack Road, Exeter, Devon EX2 5DW, UK; Consultant Plastic Surgeon, Department of Plastic Surgery, Royal Devon & Exeter Hospital, Barrack Road, Exeter, Devon EX2 5DW, UK
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