Knowledge, awareness, and use of the UV index amongst the West Australian public

The Role of the Global Solar UV Index for Sun Protection of Children in German Kindergartens

More than twenty-five years ago, the Global Solar UV index (UVI) was introduced as a simple means of visualizing the intensity of ultraviolet radiation and to alert people to the need for sun protection. In our survey, among directors of 436 kindergartens in southern Germany we investigated the level of awareness and knowledge about the UVI as well as the practical consequences for sun protection in kindergartens. Less than half of the directors (n = 208, 47.7%) had ever heard of the UVI, and only a small minority of them (n = 34, 8.7%) used the daily UVI information to adapt sun protective measures in their kindergartens. Detailed knowledge about the UVI was a rarity among the respondents. The proportion of respondents with self-perceived detailed UVI knowledge was five times higher than the actual knowledge assessed by an in-depth structured interview using open-ended questions about the UVI (14.2% vs. 2.8%). No clear relationship between UVI awareness, knowledge, and use and directors' age and gender was found. The UVI-related variables also showed no association with directors' knowledge of risk factors for skin cancer and their attitudes towards tanned skin. Overall, the results paint a sobering picture regarding the penetration of the UVI into sun protection policies of German kindergartens. Future public health campaigns should aim to increase the awareness and understanding of the UVI as well as its relevance for sun protection of children.

How practitioners say they answer the questions of patients about ultraviolet protection

Patients should be able to rely on optometrists and optical dispensers to provide evidence-based answers to their questions on eye protection, including against ultraviolet radiation. Surveys indicate that there is public concern about the need for protection against ultraviolet radiation, particularly in sunlight. This investigation aimed to evaluate the quality of information provided by practitioners in response to typical questions to which they might reasonably be expected to have ready answers. A cross-sectional study was conducted of on-site responses from attendees of a 3 day optical fair, in Sydney, Australia, in 2017. Subjects were not forewarned about the study. The portion of the questionnaire reported here comprised open answers to four questions intended to represent typical enquiries of patients. The questions were about recommendations for ultraviolet protection in the context of 1) computer use, 2) outdoor use, 3) driving and 4) under office lighting. Eighty-three participants returned completed questionnaires out of 140 issued (61% response). The open-answer question responses were grouped into appropriate, borderline (mostly appropriate but mixed with non-UVR related recommendations) and others (mostly non-UVR related recommendations) and by job title. The proportion of appropriate answers to the four questions were 20%, 30%, 12% and 15%, respectively, which did not differ by job title. A significantly higher proportion of optical dispensers than optometrists selected 'Don't know/no answer' for all questions except office use. Eyecare professionals need to be educated on eye protection against UV radiation to improve the quality of information to be given to the public.

Sun Awareness and Sun Protection Practices

Background

The incidence of skin cancer has increased over the past few years, owing to excessive exposure to ultraviolet (UV) radiation. Over the past decade, protection against solar radiation has been highly encouraged in numerous public health education campaigns. The adopted sun protection practices include avoiding exposure to the sun, using protective clothing, and applying sunscreen. The aim of this paper was to analyze the awareness and attitudes towards sun protection practices in some regions of the Arabian Peninsula.

Objective

The main objective of this study is to estimate the level of sun protection practices and determine the factors that have a significant impact on the level of adoption of sun protection practices by residents in the Arabian Peninsula.

Methods

A 35-question self-reporting online questionnaire to evaluate the sun protection measures adopted by the residents was distributed in the Kingdom of Saudi Arabia and Kingdom of Bahrain. The survey was conducted from January 2018 to May 2019, and a total 830 responses were collected for analysis. The data were analyzed using the statistical software SPSS. The chi-squared test and Spearman's correlation were performed to determine the association of the sun protection level with factors concerning the socio-demographic characteristics, sun sensitivity, health-conscious lifestyle, adopted sun protection measures, and general awareness about the UV index, skin cancer, and vitamin D. Logistic regression classification was applied in developing the empirical model to predict the sun protection level of the residents.

Results

Based on the analysis, only 34% of the total 830 respondents use sunscreen and most of the sunscreen users are female. The three most popular sun protection practices are: 1) avoiding exposure to the sun during peak hours, 2) using protective clothing, and 3) using sunglasses. The results indicate that 22% of respondents use a low level of sun protection, 53% use a medium level of protection, while 25% of respondents use a high level of sun protection. Many of the respondents understand that exposure to the sun can cause skin cancer and skin aging, while 54% of the respondents still believe that a suntan can be healthy if sunburn is avoided. Thirty percent of the participants of this study are aware of the UV index, and only 20% of all respondents know the correct meaning of the UV index. The overall predictive accuracy of the constructed logistic regression model is 67%. Based on the results of the logistic regression model, the five most significant factors of the sun protection level are: 1) perception that the sun can cause skin aging, or not, 2) age, 3) awareness of the dangerous effects of sun exposure, 4) income with respect to expenses, and 5) taking the UV index into consideration during exposure to the sun.

Conclusion

Most of the respondents are aware about sun protection. However, the sun protection level of the residents is still inadequate. An efficient strategy of increasing the awareness of the effective use of sun protection systems must be established based on the significant factors to prevent skin cancer.

Solar Ultraviolet Exposure in Individuals Who Perform Outdoor Sport Activities

BACKGROUND

Skin cancer is the most common cancer in the USA. Therefore, it is important to review the contribution of ultraviolet radiation (UVR) exposure to skin cancer in individuals with the highest risk. Documenting the relationship between outdoor sports solar ultraviolet exposure and their risk of skin cancer along with appropriate risk mitigation strategies can help inform clinicians of practical information for counseling sun protective behaviors in this population.

METHODS

We conducted a review of the current evidence using PubMed to answer the following research questions: (1) How is ultraviolet radiation measured? (2) What is the modern utility of the ultraviolet index in modifying recreational sun protection behaviors? (3) What is the risk of developing skin cancer for outdoor sport participants? (4) What is the prevalence of skin cancer in sport participants? and (5) Is the number of nevi and solar lentigines elevated in outdoor sport participants?

RESULTS

Based on the literature, individuals who practice outdoor sport-related activities receive high ultraviolet radiation exposure, have a high risk for skin cancer, have a high prevalence for pigmented lesions, and may benefit from electronic sun protection educational interventions.

CONCLUSIONS

Individuals who practice outdoor sports experience substantially higher ultraviolet radiation exposure, routinely exceed the recommended exposure limits, and are at a higher risk of developing skin cancer. Therefore, those who are frequently engaged in outdoor leisure activities should be coached about efficient sun protective practices and relevant mobile technologies that may facilitate adherence.

Investigating primary preservice teachers' ultraviolet radiation awareness and perceived ability to teach sun safety

Issue addressed

Sun protection practices in Australian primary schools remain inconsistent. Therefore, this study investigates primary PSTs sun protective sun behaviours, ultraviolet (UV) radiation awareness and perceived ability to teach sun safety.

Methods

A convenience sample of undergraduate PSTs (N = 275; mean age = 23.13 years) enrolled at one Western Australian university completed an online survey. Descriptive analyses provided features of the data. Factors associated with sun protection behaviours and perceived knowledge and skill to teach sun safety were explored using multivariable logistic regression models.

Results

Lesser than 10% of participants reported using sun protective measures daily (midday shade use: 6.5%; sunscreen: 7.6%; hat: 4.4%). Only 56.3% reported they understand the UV index, with 68.0% rarely/never using it to aid sun protection. Under half the participants reported they felt they had the knowledge (38.5%) or skills (40%) to effectively teach sun safety in primary schools. Regression analysis revealed gender, undergraduate, year and skin sensitivity were not predictors of UV index use (P > .05) or perceived knowledge of sun safety (P > .05). Skin sensitivity was the strongest predictor for shade usage (P = .02), hat usage (P = .05) and perceived skill to teach sun safety (P = .02).

Conclusions

Survey data indicate UV radiation is inconsistently understood by PSTs. Many felt that they did not have the required knowledge or skill to teach sun safety effectively.

So what?

Improving PSTs UV radiation knowledge while at university is a potential opportunity to improve sun safety delivery in primary schools. A targeted intervention for PSTs is warranted.

Parental and primary caregiver's attitudes towards sun safe hat and sunscreen use at a major national children's playground in Canberra, Australia

BACKGROUND/OBJECTIVES

The sun safety habits of children are developed throughout the childhood years under the influence of peers, parents, family members and other adult caregivers, as well as through education. This study assessed the sun safety attitudes and actual practices of parents and primary caregivers at a large public playground over a twelve-month period in 2019/2020. The desire to have an educational sun safety message at major playgrounds was also assessed.

METHODS

Parents and primary caregivers at our study playground in Canberra, Australia, were offered an eight-question survey. Data analysis compared the proportion of respondents who selected each sub-question. Surveys were conducted on a minimum of three days per week for a twelve-month period, excluding the period of May to the beginning of August when the ultraviolet radiation index (UVI) is typically below three in Canberra.

RESULTS

Less than half of the children at the study playground wore a sun safe hat the whole of their playtime when the UVI ≥ 3. Although 80.5% parents and primary caregivers acknowledged the importance of modelling good sun safety behaviours, most adults did not wear a sun safe hat or apply sunscreen. 93.3% of adult respondents desired some form of permanent educational message at playgrounds to encourage better sun safety.

CONCLUSION

There is significant room for improvement in the sun safety practices of primary caregivers and children at our study playground. The vast majority of respondents desired a permanent sun safety message display at major playgrounds.

The extent of public awareness, understanding and use of the Global Solar UV index as a worldwide health promotion instrument to improve sun protection: protocol for a systematic review

INTRODUCTION

(Over)exposure to ultraviolet radiation is a major risk factor for skin cancer. The Global Solar Ultraviolet Index (UVI) was introduced by the WHO and partner organisations in 1995 as a simple measure of the intensity of solar UV radiation, providing guidance for the population to use appropriate sun protective measures. Little is known about the impact of the UVI on actual sun protection behaviour. Our systematic review aims to assess global levels of awareness, understanding and use of the UVI as prerequisites for the preventive effectiveness of this public health tool.

METHODS AND ANALYSIS

Systematic searches will be performed in 10 electronic literature databases including Medline, Scopus and Web of Science-Core Collection, two clinical trials registries and at least two grey literature databases (OpenGrey, Bielefeld Academic Search Engine). Additional literature sources will be retrieved using hand search of reference lists of included studies and snowballing methods. We will include studies with all types of quantitative study designs and participants reporting on at least one outcome in the three main categories (i) awareness, (ii) understanding and (iii) use of the UVI. We will assess the risk of bias within studies with an abbreviated version of the AXIS tool, designed specifically for cross-sectional studies. As we expect large heterogeneity in outcomes, we will conduct a narrative synthesis of results instead of a meta-analysis.

ETHICS AND DISSEMINATION

Ethical approval and patient consent are not required as this is a systematic review based on published studies. The results of this study will be published in an international peer-reviewed journal.

PROSPERO REGISTRATION NUMBER

CRD42018093693.

Awareness, understanding, use, and impact of the UV index: A systematic review of over two decades of international research

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.

Testing children's ability to correctly use the "Shadow Rule" for sun protection

INTRODUCTION

The "Shadow Rule" (SR) is a useful, immediate indicator of sunburn risk following the mnemonic "Short shadow? Seek shade!" However, some question people's ability to discern when their shadows are shorter or longer than them.

METHODS

N = 76 10-year-old children were taught the SR and then asked to estimate their sun-cast shadow length relative to their height and whether this meant they should seek shade. Children were then asked to estimate a doll's shadow length at 10 systematically randomised angles.

RESULTS

Children experienced greatest difficulty judging their shadows' lengths when they were equal to their height. At all other angles, they demonstrated high accuracy and 92 % of the time on average could correctly interpret the SR.

CONCLUSIONS

Ten-year-old children appear capable, and by extension adults too, of applying the SR. Future research is now required to establish if education about the SR will translate into sun protection behaviour change.

Cumulative ultraviolet radiation flux in adulthood and risk of incident skin cancers in women

BACKGROUND

Solar ultraviolet (UV) exposure estimated based on residential history has been used as a sun exposure indicator in previous case-control and descriptive studies. However, the associations of cumulative UV exposure based on residential history with different skin cancers, including melanoma, squamous cell carcinoma (SCC), and basal cell carcinoma (BCC), have not been evaluated simultaneously in prospective studies.

METHODS

We conducted a cohort study among 108,578 women in the Nurses' Health Study (1976-2006) to evaluate the relative risks of skin cancers with cumulative UV flux based on residential history in adulthood.

RESULTS

Risk of SCC and BCC was significantly lower for women in lower quintiles vs the highest quintile of cumulative UV flux (both P for trend <0.0001). The association between cumulative UV flux and risk of melanoma did not reach statistical significance. However, risk of melanoma appeared to be lower among women in lower quintiles vs the highest quintile of cumulative UV flux in lag analyses with 2-10 years between exposure and outcome. The multivariable-adjusted hazard ratios per 200 × 10(-4) Robertson-Berger units increase in cumulative UV flux were 0.979 (95% confidence interval (CI): 0.933, 1.028) for melanoma, 1.072 (95% CI: 1.041, 1.103) for SCC, and 1.043 (95% CI: 1.034, 1.052) for BCC.

CONCLUSIONS

Associations with cumulative UV exposure in adulthood among women differed for melanoma, SCC, and BCC, suggesting a potential variable role of UV radiation in adulthood in the carcinogenesis of the three major skin cancers.

Cutaneous squamous cell carcinoma: estimated incidence of disease, nodal metastasis, and deaths from disease in the United States, 2012

BACKGROUND

It is estimated that over 700,000 new cases of cutaneous squamous cell carcinoma (CSCC) are diagnosed annually in the United States. However, CSCC has been excluded from national cancer registries. Thus the precise incidence of CSCC, along with metastases and deaths resulting from it, is unknown.

OBJECTIVE

We sought to estimate the 2012 incidence of invasive (non-in situ) CSCC and the number of nodal metastases and deaths arising from it in the US white population.

METHODS

US studies reporting incidence of CSCC, or the number of nodal metastases or deaths arising from it, were reviewed. Linear regression was used to estimate current CSCC incidence based on available incidence data adjusting for higher reported incidences in southern versus northern/central United States. Reported risks of nodal metastases and death from CSCC were averaged. Averages were used to estimate current metastasis and death rates based on incidence estimates. The number of estimated CSCC deaths was compared against deaths from other cancers.

RESULTS

It is estimated that 186,157 to 419,543 whites were given a diagnosis of CSCC, 5604 to 12,572 developed nodal metastasis, and 3932 to 8791 died from CSCC in the United States in 2012.

LIMITATIONS

The estimates of the 2012 incidence, nodal metastasis, and death from invasive CSCC are based on previous estimates of incidence and outcomes of CSCC.

CONCLUSION

CSCC is an underrecognized health issue. In the central and southern United States, deaths from CSCC may be as common as deaths from renal and oropharyngeal carcinomas, and melanoma. Population-based studies reporting CSCC incidence and outcomes are required to verify these estimates.

[Understanding and use of the global solar UV index ("UV index") by French dermatologists]

BACKGROUND

The principal risk factor for development of skin cancers is exposure to ultraviolet (UV) radiation. The universal solar UV index (UVI) consists of a simple measurement of UV radiation at the earth's surface, which provides an indicator of the risk of skin lesions in the absence of protective measures and taking into account individual phototype. The UVI is recommended by the WHO and is used to educate populations about the need to take protective measures in the event of exposure to UV radiation. There have been very few studies to assess understanding of this index, and these have been conducted primarily among the general population. Our study assesses understanding and use of the UVI among dermatologists in metropolitan France.

MATERIALS AND METHODS

This survey was conducted in December 2011 among 400 randomly selected French dermatologists. The questions asked concerned their personal and professional knowledge and their use of the UVI.

RESULTS

We analysed 165 (41.5%) of the answers. The UVI was known to 79% of the dermatologists questioned. Less than one third of dermatologists knew the key values in the UVI. Less than half of the dermatologists aware of the UVI reported acting upon the values in question. Only 12.1% of the dermatologists said that they used the index in their communication concerning prevention of sunburn.

DISCUSSION

The results of our study show that the UVI is poorly known and not very widely used among dermatologists in France. This index, readily understood by anyone, could be incorporated by dermatologists in their prevention messages concerning solar radiation and it could be used throughout the year, particularly in target populations such as schoolchildren and children taking part in outdoor sports.

Is the Global Solar UV Index an effective instrument for promoting sun protection? A systematic review

Exposure to ultraviolet radiation is an important risk factor for skin cancer. The Global Solar Ultraviolet Index (UVI) was developed as a tool to visualize the amount of harmful radiation and to encourage people to use sun protection. We conducted a systematic review of the effectiveness of the UVI. We employed a comprehensive search strategy to explore the impact of the UVI on five outcome categories. Twenty-seven of a total of 260 studies met our inclusion criteria; data extraction and quality appraisal were undertaken for 25 studies, comprising 3 randomized controlled trials, 2 non-randomized intervention studies and 20 cross-sectional studies. Nearly half of these studies were from Australia and New Zealand. We found low to intermediate levels of UVI awareness and low levels of UVI understanding. Studies rated moderate or strong suggest that the UVI does not influence knowledge, attitudes, sun protection behavior or sun exposure. Overall, the findings imply that the UVI, as currently implemented, has not been successful at improving sun protection practices and reducing sun exposure among the population at large. Drawing on experience with theory-based sun protection programs, we advocate for more realistic expectations of what the UVI can and cannot achieve.

The influence of the UV-index on attitudes toward sun exposure in the German population

The increased skin cancer incidences are important public health problems. In spite of the strong promotion of the UV-index as essential UV risk education tool, only few studies have investigated peoples understanding of the UV-index. This paper is the first to present representative data on UV-index understanding in Germany. In 2007, a representative telephone survey was carried out among 1,501 German residents aged 14 years and older. Only 27% of the respondents had heard of the UV-index before and 17% of the German respondents claimed to consider the index for their sun habits. Less than 10% of the German population was able to attribute the correct meaning to the UV-index as well as know their own skin type. The results of the present study suggest that informing the public about the UV-index has very limited impact on the public's understanding of the UV-index as well as on their attitude toward sun exposure. The results warrant the question whether the UV-index in the present form is a useful education tool in UV risk communication.

Mass media barriers to social marketing interventions: the example of sun protection in the UK

The role of the mass media in communicating health-related information to the wider population is the focus of this paper. Using the example of sun protection within the UK, we highlight some of the major challenges to raising awareness of steadily increasing melanoma rates and of effective sun protection strategies. The implications of potential barriers to official sun protection messages via conflicting messages in the media are discussed in terms of editorial on sun protection and in the way in which television programme content portrays the issues. Implications for public policy and future research conclude the paper.

Public (Mis)understanding of the UV Index

The ultraviolet index (UVI) has been regularly reported in Australia for a decade but utilisation remains extremely low ( approximately 5%). Blunden, Lower, and Slevin, in a 2004 Journal of Health communication article, suggest that Australians' understanding of the UVI is "good," and education to increase awareness of the index is therefore no longer warranted. To test this position, focus groups were conducted followed by an intercept survey of 404 residents of Perth, Western Australia, aged 16-44 years, to explore understanding and familiarity with the UVI. Results suggested that far from being "good," the familiarity and understanding of the UVI of at least half of Australians is poor. This was exemplified by the following: mean estimations of average UVI values in summer and winter being highly exaggerated (19.8 and 11.8, respectively); 61.2% not appreciating that the UVI is independent of temperature; at least 55.0% not appreciating that UV conditions peak at solar noon; and 23.3% of 22-44 year olds confusing the UVI with a "burn-time" measure. People who do not understand the UVI are unlikely to utilise it effectively. It therefore remains possible that utilisation of the UVI remains low because understanding is poor. Future efforts to improve utilisation of the UVI, particularly among those looking at new display formats, may therefore be ineffective, unless they also incorporate strategies to facilitate understanding of the measure.