Effect of childhood and adolescent ultraviolet exposures on cumulative exposure in South East Queensland schools

A survey of sun safety habits among Division I National Collegiate Athletic Association golfers and tennis players

Collegiate athletes who play tennis and golf spend significant time outdoors and increase their risk of skin cancer. This study aimed to gain insight into the sun protection behaviors of collegiate golfers and tennis players competing in the National Collegiate Athletic Association (NCAA) Division I. A survey was distributed to NCAA Division I golf and tennis teams within Power 5 collegiate conferences. Of the 84 respondents, 50% indicated sunscreen use more than 75% of the time while playing their sport, but only 4.8% engaged in sunscreen reapplication. The main barriers to reapplication were due primarily to slippery hands (70.2%) or forgetfulness (63.4%). Most athletes do not apply sunscreen to hands, ears, chest, or lips, and either never or rarely wear sunscreen while outside when they are not playing their sport (54.8%). Thirty-three percent were unsure or did not believe they were at an increased risk for skin cancer, and 16.6% were unsure or did not believe that sunscreen can prevent skin cancer. Most collegiate athletes recognize their increased risk of skin cancer; nevertheless, they are unlikely to reapply sunscreen and often do not apply sunscreen to commonly missed areas. Increased education and resources may help promote lifelong safe sun exposure habits and reduce skin cancer risk.

Dispelling myths about sunscreen

Sunscreens are an important tool used to protect the skin against harmful effects of ultraviolet (UV) radiation. Many different formulations of sunscreen exist today, which can be confusing to the consumer. In this article, we highlight and address many sunscreen myths that exist today including the benefits of higher SPF sunscreen, use of sunscreen in darker skin types, and the effects of sunscreen on vitamin D production.

The Early Days of Personal Solar Ultraviolet Dosimetry

In the early 1970s, environmental conservationists were becoming concerned that a reduction in the thickness of the atmospheric ozone layer would lead to increased levels of ultraviolet (UV) radiation at ground level, resulting in higher population exposure to UV and subsequent harm, especially a rise in skin cancer. At the time, no measurements had been reported on the normal levels of solar UV radiation which populations received in their usual environment, so this lack of data, coupled with increasing concerns about the impact to human health, led to the development of simple devices that monitored personal UV exposure. The first and most widely used UV dosimeter was the polymer film, polysulphone, and this review describes its properties and some of the pioneering studies using the dosimeter that led to a quantitative understanding of human exposure to sunlight in a variety of behavioral, occupational, and geographical settings.

Brazilian consensus on photoprotection

Brazil is a country of continental dimensions with a large heterogeneity of climates and massive mixing of the population. Almost the entire national territory is located between the Equator and the Tropic of Capricorn, and the Earth axial tilt to the south certainly makes Brazil one of the countries of the world with greater extent of land in proximity to the sun. The Brazilian coastline, where most of its population lives, is more than 8,500 km long. Due to geographic characteristics and cultural trends, Brazilians are among the peoples with the highest annual exposure to the sun. Epidemiological data show a continuing increase in the incidence of non-melanoma and melanoma skin cancers. Photoprotection can be understood as a set of measures aimed at reducing sun exposure and at preventing the development of acute and chronic actinic damage. Due to the peculiarities of Brazilian territory and culture, it would not be advisable to replicate the concepts of photoprotection from other developed countries, places with completely different climates and populations. Thus the Brazilian Society of Dermatology has developed the Brazilian Consensus on Photoprotection, the first official document on photoprotection developed in Brazil for Brazilians, with recommendations on matters involving photoprotection.

Sun exposure and sun protection habits in high school students from a city south of the country

BACKGROUND: Effective solar protection is an uncommon practice among young people, increasing the likelihood of sunburn, sunstroke and skin cancers. This fact is more significant in the south of Brazil, where the prevalence of white skinned population is larger, being more prone to sun damage. OBJECTIVES: To study the practices of sun exposure and sun protection in high school students from the city of Carlos Barbosa - RS. METHODS: Cross-sectional study involving 775 students, enrolled on the first half of 2010, who had signed the consent form. We used a non-identifiable, self-administered questionnaire, with questions about related topics. Statistical analysis was performed using Chi-square or Fisher exact and t-Student tests. The study was approved by the Research Ethics Committee under the number 2010-115H. RESULTS: Most students are exposed to the sun at the more critical periods, remaining exposed for more than an hour. Five hundred and seventy-six students (74,3%) reported using sunscreen, but less than 10% did it during all months of the year. Female teenagers are most likely to use sunscreen (p <0.001) and to spend less time exposed to sunlight (p <0.001). CONCLUSION: Most high school students from Carlos Barbosa had unsuitable sun exposure and sun protection habits, characterizing a high risk behavior for skin diseases. The existence of public programs for clarification of the risks to the population and the subsidization of sun protection products were suggested by these young people.

Basal and squamous cell carcinoma risks for golfers: an assessment of the influence of tee time for latitudes in the Northern and Southern hemispheres

This study investigates the influence of tee time to determine the relative basal cell carcinoma (BCC) and squamous cell carcinoma (SCC) risk for weekly single round competition golfers located in the Northern and Southern latitude ranges between 25°, 35°, 45° and 55°. A comparative risk methodology, employing annual erythemally effective ultraviolet (UVE) exposure calculations was used to determine BCC and SCC risk factors for golfers using a regular weekly tee time. Relative risk was found to be proportional to golf tee time with mid morning tee times generally presenting the greatest risk in each latitude range. The greatest contribution toward the risk of developing basal and squamous cell carcinoma was found to occur for golfers beginning weekly rounds mid to late morning, with specific risk factors of 1.47 (BCC) and 1.98 (SCC) in the Northern hemisphere compared with similar maximum risk factors of 1.51 (BCC) and 2.08 (SCC) in the Southern hemisphere occurring at comparable morning tee times. Differences in annual UVE exposure between the golfer and non-golfer were the largest determinant of BCC and SCC risk. Generally, these risks were found to decrease with lower latitude although contribution toward overall risk was influenced strongly by the global time zone of each studied golf course site.

Adolescents' use of purpose built shade in secondary schools: cluster randomised controlled trial

OBJECTIVE

To examine whether students use or avoid newly shaded areas created by shade sails installed at schools.

DESIGN

Cluster randomised controlled trial with secondary schools as the unit of randomisation.

SETTING

51 secondary schools with limited available shade, in Australia, assessed over two spring and summer terms.

PARTICIPANTS

Students outside at lunch times.

INTERVENTION

Purpose built shade sails were installed in winter 2005 at full sun study sites to increase available shade for students in the school grounds.

MAIN OUTCOME MEASURE

Mean number of students using the primary study sites during weekly observations at lunch time.

RESULTS

Over the study period the mean change in students using the primary study site from pre-test to post-test was 2.63 (95% confidence interval 0.87 to 4.39) students in intervention schools and -0.03 (-1.16 to 1.09) students in control schools. The difference in mean change between groups was 2.67 (0.65 to 4.68) students (P=0.011).

CONCLUSIONS

Students used rather than avoided newly shaded areas provided by purpose built shade sails at secondary schools in this trial, suggesting a practical means of reducing adolescents' exposure to ultraviolet radiation.

TRIAL REGISTRATION

Exempt.

Patterns in the received facial UV exposure of school children measured at a subtropical latitude

Polysulfone (PS) dosimeters have been employed to measure the erythemally effective UV exposure to the vertex, nose, cheek, chin and side facial sites of 45 volunteer high school students from Hervey Bay, Australia (25.3 degrees S 152.9 degrees E). The results of a series of 1 h outdoor sport trials (basketball and soccer) found the mean student facial exposure, determined as the arithmetic average of facial site exposures of unprotected students (no hat) to protected students (hat), varied from 140 +/- 82 J m(-2) (1sigma) to 99 +/- 33 J m(-2) (1sigma), respectively. All hourly student facial exposures recorded over the study period were found to exceed the National Health and Medical Research Council's adopted safe daily limit of 30 J m(-2). Facial exposure relative to the received ambient UV increased to the nose at higher (winter) solar zenith angles (SZAs) compared with lower (summer) SZA ranges for both protected and unprotected students. The protection offered by the broad-brimmed hats was reduced significantly to the lower chin facial site at the higher SZA range, indicating that the style of hat used offers best protection in summer to the upper facial regions at most risk of receiving a high exposure when no hat protection is used. Variations to specific student facial exposure sites were measured between both basketball and soccer players. Variation in student facial exposure was further examined with respect to cloud cover and comparisons to manikin headform measurements were also made. The study results indicate that hats alone are not adequate forms of sun protection in a school environment. Schools aiming to achieve acceptable safe limits of facial exposure may need to further consider the effectiveness of hat protection with increasing SZA, cloud cover and head position relative to the sun that is specific to the scheduled outdoor activity.

Study of UV radiation dose received by the Spanish population

Excess exposure to UV radiation can affect our health by causing sunburn, skin cancer, etc. It is therefore useful to determine the UV dosage received by people as a way of protecting them from the possible negative effects that this kind of radiation can cause. In this work, the personal outdoor percentage, which shows the time spent in outdoor activities, as well as personal UV doses, has been calculated by means of global UV radiation on a horizontal plane. A database of average daily UVB radiation on the horizontal plane given by the National Institute of Meteorology has been used. In this work we evaluate the standard erythema dose of the Spanish population throughout the year.

Youth solar ultraviolet radiation exposure, concurrent activities and sun-protective practices: a review

To assist standardization of procedures, facilitate comparisons, and help guide research efforts to optimally inform development of appropriately targeted interventions, there is a need to review methods used to quantify child and adolescent solar ultraviolet radiation (UV) exposure, related outdoor activities and sun-protective practices. This holistic approach is essential for comprehensive research that will provide all-inclusive, informative and meaningful messages for preventive measures of harmful UV exposure. Two databases were searched and 29 studies were retrieved, and these studies report measurement or assessment techniques documenting UV exposure patterns and related outdoor activities. Polysulfone film badges were the main measurement instrument used in 10 studies, with questionnaire, survey data, observation, a model, electronic dosimeters, biological dosimeters, colorimeter and UV colouring labels used in the remaining studies. Methods used to record activities included self-report, parental report, a logbook and observation. Measurement duration and unit of UV exposure varied in most studies, but a method common to 15 studies was measured UV exposure as a percentage of ambient UV. The studies reviewed do not provide sufficient information for the development and evaluation of targeted youth sun protection programs. Studies are required which document precise UV exposure, concurrent activities and sun protection usage for children and adolescents.

Maximum tolerable dose for avoidance of cataract induced by ultraviolet radiation-B for 18 to 60 week old rats

The purpose of the present study was to investigate the maximum tolerable dose for avoidance of UVR-B-induced cataract in rats in the age interval 18-60 weeks and establish the functional relationship between age and sensitivity to UVR-B. Four groups of 20 albino Sprague-Dawley rats each, aged 18, 26, 40 or 60 weeks, were included. Each age group was divided into five UVR dose sub-groups. The rats were unilaterally exposed to ultraviolet radiation (lambda(max)=302.6 nm, lambda0.5=4.5 nm). The incident dose on the cornea varied between 0 and 9.2 kJ m(-2). One week after exposure, the rats were sacrificed and both lenses were extracted. The intensity of forward light scattering was measured and photographs were taken. The functional relationship between age and sensitivity to UVR-B was estimated as the maximum tolerable dose based on rats age from 3 to 60 weeks. The maximum tolerable dose for 18, 26, 40, and 60 weeks, respectively, was estimated to 5.2, 4.9, 4.7, and 5.1 kJ m(-2). The sensitivity to UVR-B for Sprague-Dawley rats increases with increasing age during the first third of the rat life span, and then stabilizes to a constant level during the remaining two-thirds.

Proportion of lifetime UV dose received by children, teenagers and adults based on time-stamped personal dosimetry

Ultraviolet (UV) reduction campaigns since 1986 were based on the estimation that individuals get 80% of their cumulative lifetime UV dose by the age of 18. To investigate if this estimation is true, we compared annual UV doses received during life in 164 Danish volunteers: children, teenagers, indoor workers, and golfers (age range 4-67 y) who recorded sun exposure behavior in diaries and carried personal UV dosimeters, measuring time-stamped UV doses. The annual UV dose did not significantly correlate with age but the variation in annual UV dose was high (median 166 SED (standard erythema dose), 95% range: 37-551 SED). The annual UV dose did correlate with days with risk behavior (sunbathing/exposing upper body) (r=0.51, p<0.001) and in adults also with hours performing outdoor sports (r=0.39, p<0.001), gardening, and sun-bed sessions (r=0.26, p=0.02). Teenagers had significantly more days with risk behavior than adults (21 vs 13 d, p=0.006) but not than children (15 d). No differences in UV dose among the age groups were found on workdays. Only 25% of the lifetime UV dose was received before the age of 20 and the annual UV dose was thus independent of age. Reduction of cumulative lifetime UV dose could be obtained by minimizing risk behavior.

UV Doses Worldwide†

UV radiation affects human health. Human exposure to UV radiation causes a few beneficial health effects like vitamin D3 formation but it causes many detrimental health effects: sunburn, ocular damage, photoaging, immune suppression, DNA damage and skin cancer. In countries with fair-skinned populations, skin cancer is the most diagnosed of all cancers. In the United States in 2002, there were over one million new skin cancer cases. That means one out of every 285 people got skin cancer. Skin cancer of fair-skinned individuals is increasing at an alarming rate (4-6% per year) around the world and has now reached so-called "pandemic" proportions. Thus, it is important to know what UV doses people around the world get throughout their lives. This review covers how the outdoor UV doses are weighted for different biological effects, the most commonly used measuring devices for terrestrial and personal UV doses, the natural and other effects on terrestrial and personal UV doses, the time people spend outside, their ambient exposures and the terrestrial and personal UV doses of adult outdoor and indoor workers as well as children and adolescents around the world. Overall, outdoor-working adults get about 10%, while indoor-working adults and children get about 3% (2-4%) of the total available annual UV (on a horizontal plane). People's UV doses increase with increasing altitude and decreasing latitude; most indoor-working adult Europeans get 10,000-20,000 J/m2 per year, Americans get 20,000-30,000 J/m2 per year and Australians are estimated to get 20,000-50,000 J/m2 per year (excluding vacation, which can increase the dose by 30% or more).

Personal Solar UV Exposure Measurements Employing Modified Polysulphone with an Extended Dynamic Range†¶

Polysulphone dosimeters using a simple to use filter have been developed and tested to provide an extended dynamic measurement range of personal solar UV exposures over an extended period (3 to 6 days). At a Southern Hemisphere subtropical site (27.6 degrees S, 151.9 degrees E), the dynamic range of the filtered polysulphone allowed measurements of erythemal exposures to approximately 100 minimum erythemal dose (MED) for a change in optical absorbance at 330 nm (deltaA330) of 0.35. In comparison, unfiltered polysulphone dosimeters were exposed to approximately 8 MED for the same deltaA330. The error associated with the use of the filtered polysulphone dosimeters is of the order of +/-15%, compared with +/-10% of the unfiltered variety. The developed filtered polysulphone dosimeter system allowed the measurement of erythemal UV exposures over 3 to 6 days at a subtropical site without the need to replace the dosimeters because of saturation. The results show that longer-term measurement programs of personal solar UV have been made more feasible with the use of these polysulphone dosimeters with an extended dynamic range compared with unfiltered polysulphone dosimeters.

An analysis of cumulative lifetime solar ultraviolet radiation exposure and the benefits of daily sun protection

Cumulative exposure to ultraviolet radiation (UVR) increases the risk of developing skin cancer, particularly squamous cell carcinoma and basal cell carcinoma. Thus, the need for protection from the sun is widely advocated, but consumers generally associate such protection with the occasional extreme exposure and tend to ignore the risk of long-term exposure. In fact, a sun exposure model predicts that over a lifetime, a person will receive tens of thousands of minimal erythema doses worth of UVR through normal, daily, incidental exposure. The cumulative effect of casual sun exposure over the years underscores the need for everyday basic UVR protection in which even low level (SPF 4-10) sunscreens are shown to offer significant benefit. Analysis shows that daily protection can reduce lifetime exposure by 50% or more.

UV doses of young adults

Since 1986, people have been informed that they get about 80% of their lifetime ultraviolet (UV) dose by the age of 18. This belief originated from the mathematical conclusion that diligent use of sunscreens (sun protection factor 15 or higher) during the first 18 years of life would reduce the lifetime incidence of nonmelanoma skin cancers by 78%. These data were misconstrued to mean that individuals also got about 80% of their lifetime dose of UV by the age of 18 (linear relationship). However, these calculations were based on the incidence of nonmelanoma skin cancers being related to the square of the UV dose. Careful analysis of UV exposure data shows that Americans actually get less than 25% of their lifetime UV dose by the age of 18. This finding also appears to be true worldwide because Australia, UK and The Netherlands report a similar UV exposure pattern. UV-initiated damage early in life can be promoted by subsequent exposures to progress into tumors later in life. For example, the nonmelanoma skin cancer, squamous cell carcinoma, is dependent on the cumulative UV dose. Thus, a better educational approach for reducing skin cancers would be to instruct fair-skinned individuals to protect themselves throughout their lives from being exposed to too much UV radiation.

UV doses of American children and adolescents

The ultraviolet (UV) doses of American young adults were never measured, but are needed for assessing UV-related health risks. These doses were calculated using a novel approach. The National Human Activity Pattern Survey recorded the daily minute-by-minute activities of about 2000 young adults (0-19 years) over the course of 2 years to assess their exposure to environmental pollutants. From that survey, only the outdoor daylight data of northern and southern girls and boys were extracted and stratified by season and age to find the time American children (0-5 and 6-12 years) and adolescents (13-19 years) spend outside. They spend about 10% of the day outdoors, but only get about 30% of the available terrestrial UV radiation (on a horizontal plane). American children have about the same percent personal ambients as adults (3.1%), 2.8% for girls and 3.4% for boys. Adolescents have the lowest personal ambients (2.6%), 2.1% for girls and 3.1% for boys. To get their UV doses, their percent ambients are multiplied by the total available terrestrial UV. Excluding vacation, the erythemally weighted UV doses for American children are 25 kJ/m2/year, 23 for girls and 28 for boys. Adolescents get the lowest UV exposure of any group, 21 kJ/m2/year, 18 for girls and 24 for boys. Young adult northern girls get 18 kJ/m2/year and boys get 21 kJ/m2/year, whereas southern girls get 24 kJ/m2/year and boys get 31 kJ/m2/year. The youngest children (0-5 years) get slightly higher summer doses. Thus, we can now assess the UV-related health risks for American children and adolescents.

Evaluation of differences in ultraviolet exposure during weekend and weekday activities

The weekday UV exposures to anatomical sites were evaluated for outdoor workers, home workers, adolescents, indoor workers, school staff and students in south-east Queensland, Australia. Additionally, the UV exposures at weekends of school staff, school students, indoor workers and outdoor workers were evaluated. The weekday exposures per day ranged from 1.0 to 11.0 SED for winter to summer respectively. During spring, the ratios of the personal exposures divided by the ambient exposures at the weekend to the personal exposures divided by the ambient exposures on the weekdays to the neck, hand and left arm were at least 3.4, 2.0 and 0.67 for the indoor workers, school staff and students and outdoor workers respectively. The same ratios for the erythemal UV exposures over the year, estimated from the exposures on four days in each of the four seasons, were at least 2.3 for the school staff and at least 1.3 for the 13 to 19 year old school students. These results reinforce the importance of targeting prevention programmes to both weekend and weekday exposures.