LU
o
Community-Based
UV Risk Education
The SunWise Program Handbook
•ft
Environmental Monitoring for Public Acces
& Community Tracking
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Disclaimer
This document has been reviewed by the U.S. Environmental Protection Agency (EPA) and approved for publication.
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Research and Development
Environmental Information
EPA/625/R-02/008
www.epa.gov/empact
July 2002
Community-Based Ultraviolet
Radiation (UV) Risk Education
The SunWise Program Handbook
United States Environmental Protection Agency
National Risk Management Research Laboratory
Office of Research and Development
Cincinnati, OH 45268
Recycled/Recyclable
Printed with vegetable-based ink on paper that contains a minimum of
50% postconsumer fiber content processed chlorine-free.
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Acknowledgments
The development of this handbook was managed by Dr. Dan Petersen (U.S. Environmental Protection Agency).
While developing this handbook, we sought the input of many individuals. Gratitude is expressed to each person
for their involvement and contributions.
Ms. Debbie Brennan, Central Middle School, Tinley Park, Illinois
Ms. Dottie Fundakowski, Center for Creative Learning, Rockwood School District, Missouri
Dr. Alan Geller, Boston University Medical Center
Ms. Lannie Hagan, University of Colorado at Boulder's (CU's) Science Explorer Program, Boulder, Colorado
Ms. Betty Lacey Montgomery County Medical Society Alliance of Dayton, Ohio
Mr. Greg Morrison, Goddard Middle School, Glendora, California
Mr. Kevin Rosseel, U.S. Environmental Protection Agency, Sun Wise Program, Washington, DC
Dr. Mona Sariaya, Centers for Disease Control and Prevention
Mr. Craig Sinclair, Anti-Cancer Council of Victoria, Australia
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CONTENTS
1.0 INTRODUCTION 1
1.1 What is EPA's Sun Wise Program? 2
1.2 What is the Purpose of This Handbook 3
1.3 EMPACT Metropolitan Areas 4
2.0 HEALTH AND ENVIRONMENTAL CONCERNS OF UV RADIATION 7
2.1 What is UV Radiation? 7
2.2 How Does the Ozone Layer Block UV Radiation? 8
2.3 How Does UV Radiation Affect Your Skin, Eyes, and Immune System? 9
2.4 Are Some People More Prone to the Effects of UV Radiation? 10
2.5 Recognizing the Signs of Skin Cancer 10
2.6 Why Are Children and Teenagers Most Vulnerable to Overexposure? 12
2.7 What are the Environmental Threats from UV Radiation? 13
3.0 WHAT IS THE UV INDEX? 15
3.1 How Is the UV Index Calculated? 15
4.0 RAISING AWARENESS IN THE COMMUNITY 17
4.1 Developing an Effective Outreach Program 17
Step 1: What Are You Trying To Accomplish? 18
Step 2: Who Are You Trying To Reach? 20
Step 3: What Do You Want To Communicate? 24
Step 4: Who Will Lead the Effort? 24
Step 5: How Will You Fund Your Outreach Program? 25
Step 6: How Will You Measure Success? 26
Step 7: What Outreach Tools and Community Events Will You Need
To Communicate Your Messages? 28
Step 8: How Will You Distribute Your Products? 30
4.2 Successful UV Risk Education Programs 32
4.3 Communicating UV Risk Education Information to the Community 33
Writing for the Public 33
Know Your Audience 34
Clinical Information and Photographs 34
Essential UV Risk and Sun Protection Messages: Sample Text for Outreach Products 34
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APPENDIX A
List of Resources 41
APPENDIX B
Case Studies of UV Risk Education Programs 45
APPENDIX C
Examples of Successful Sun Wise Programs 51
APPENDIX D
How Is the UV Index Calculated? 55
APPENDIX E
Examples of UV Monitoring Networks and Scientific Studies in the United States 57
APPENDIX F
Frequently Asked Questions 59
APPENDIX G
Glossary 63
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1.0 INTRODUCTION
The sun is necessary for life, and while some exposure to sunlight is enjoyable,
I too much can be dangerous. There is increased concern that, due to the deple-
I tion of the ozone layer, more of the sun's rays are reaching Earth than ever
before. Overexposure to ultraviolet (UV) radiation can lead to adverse health
effects, such as blistering sunburns, skin cancer, eye problems, and premature
aging of the skin. More than 1 million people in the United States are diagnosed
with skin cancer each year, making it the most common form of cancer in the
country. In fact, 90 percent of skin cancers are linked to sun exposure.1
Skin cancer and other health
risks are largely preventable,
however. Communities have
access to a host of tools to help
understand the risks from over-
exposure to the sun and how to
protect themselves from harmful
UV radiation. One of the most
useful tools is the UV Index,
which is a daily forecast of the
level of UV exposure for a par-
ticular area of the country.
This handbook is designed to
provide you with instruction
and guidance on how to inform
your community about the risks
posed by overexposure to UV
radiation and the steps that resi-
dents can take to reduce these
risks. You will also learn more
about the UV Index and how it
can be incorporated into a suc-
cessful sun protection education
program. This handbook was
developed by the U.S. Environmental Protection Agency's (EPA's) Environmental
Monitoring for Public Access and Community Tracking (EMPACT) program.
EPA created EMPACT in 1996 to take advantage of new technologies that make
it possible to provide environmental information to the public in near-real time.
EPA partnered with the National Oceanic and Atmospheric Administration
(NOAA) and the U.S. Geological Survey (USGS) to help achieve nationwide
consistency in measuring environmental data, managing the information, and
delivering it to the public.
EMPACT projects have been initiated in 156 metropolitan areas. (See table at the
end of this chapter.) These projects cover a wide range of environmental issues,
'American Cancer Society, "Cancer Facts and Figures 1999."
INTRODUCTION
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such as groundwater contamination, ocean pollution, smog, and overall ecosystem
quality.
EMPACT projects aim to help communities:
• Collect, manage, and distribute time-relevant environmental
information.
• Provide their residents with easy-to-understand, practical information
they can use to make informed, day-to-day decisions.
Some projects have been initiated directly by EPA; others have been launched by
communities with the help of EPA-funded Metro Grants. EMPACT projects have
helped local governments build monitoring infrastructures and disseminate envi-
ronmental information to millions of people.
1.1 What Is EPtfs SunWise Program?
The SunWise School Program is an EMPACT project that raises awareness of the
health risks of overexposure to the sun and aims to change behaviors to reduce
these risks. This national program reaches out to children in grades K
through 8, their teachers, and their caregivers. Through the use
of classroom-, school-, and community-based lessons and
activities, SunWise helps children:
• Follow action steps to reduce their exposure to UV
radiation (see Chapter 4).
• Develop skills for sustained SunWise behavior and
appreciate the environment around them.
SunWise activities and publications discuss the causes and effects of UV radiation,
as well as how to monitor local and national UV levels using the UV Index.
The SunWise Web site (www.epa.gov/sunwise) provides detailed information on
the program and is a comprehensive online resource for sun safety information. In
addition, NOAA's Climate Prediction Center (www.cpc.ncep.noaa.gov) provides
daily updates of the UV forecast for U.S. and international cities.
'fee Tfa
a school program that radiates good ideas
CHAPTER i
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1.2 What Is the Purpose of This Handbook?
This handbook provides information your community will need to develop a UV
risk education program. The handbook is organized as follows:
• Chapter 2 describes the health and environmental concerns of UV
radiation, including detailed information on skin cancer, skin aging,
cataracts, and immune system suppression. It describes the different
types of UV radiation and discusses the relationship between ozone
depletion and increased UV radiation, including the science of ozone
depletion.
• Chapter 3 includes detailed information on the UV Index, including
when and why it was established, what it measures, what UV monitor-
ing systems exist, and how the UV Index is influenced by factors such
as elevation, cloud cover, time of day, and latitude.
• Chapter 4 discusses how to communicate sun protection and public
health information to residents. A UV/sun protection outreach project
can take many forms, from a sustained, multi-year, community-wide
effort to a seasonal campaign at parks and recreation centers. This
chapter of the handbook explains the steps involved in developing a
sun protection outreach program for a community and provides pro-
files of successful initiatives in the United States and internationally.
It also describes a variety of successful tools and strategies that can
be used in schools and communities, and it provides guidance for
communicating information about sun protection and health risks to
the community.
This handbook is designed for decision-makers and public health officials who
may be considering whether to implement a UV risk communication or out-
reach program in their community, and for outreach coordinators or other
individuals who are in charge of implementing community-based programs.
This handbook references supplementary sources of information, such as Web
sites, publications, organizations, and contacts, that can help the user find
more-detailed guidance. Interspersed throughout the handbook are success
stories and lessons learned from communities and organizations that have
already implemented UV outreach programs.
INTRODUCTION
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1.3 EMPACT Metropolitan Areas
Albany-Schenectady-Troy, NY
Albuquerque, NM
Allentown-Bethlehem-Easton, PA
Anchorage, AK
Appleton-Oshkosh-Neenah, WI
Atlanta, GA
Augusta-Aiken, GA-SC
Austin-San Marcos, TX
Bakersfield, CA
Baton Rouge, LA
Beaumont-Port Arthur, TX
Billings, MT
Biloxi-Gulfport-Pascagoula, MS
Binghamton, NY
Birmingham, AL
Boise City, ID
Boston-Worcester-Lawrence, MA-NH-
ME-CT
Brownsville-Harlingen-San Benito, TX
Buffalo-Niagara, NY
Burlington, VT
Canton-Massillon, OH
Charleston-North Charleston, SC
Charleston, WV
Charlotte-Gastonia-Rock Hill, NC-SC
Chattanooga, TN-GA
Cheyenne, WY
Chicago-Gary-Kenosha, IL-IN-WI
Cincinnati-Hamilton, OH-KY-IN
Cleveland-Akron, OH
Colorado Springs, CO
Columbia, SC
Columbus, SC
Columbus, GA-AL
Columbus, OH
Corpus Christi, TX
Dallas-Fort Worth, TX
Davenport-Moline-Rock Island, IA-IL
Dayton-Springfield, OH
Daytona Beach, FL
Denver-Boulder-Greeley CO
Des Moines, IA
Detroit-Ann Arbor-Flint, MI
Duluth-Superior, MN-WI
El Paso, TX
Erie, PA
Eugene-Springfield, OR
Evansville-Henderson, IN-KY
Fargo-Moorhead, ND-MN
Fayetteville, NC
Fayetteville-Springfield-Rogers, AR
Fort Collins-Loveland, CO
Fort Myers-Cape Coral, FL
Fort Fierce-Port St. Lucie, FL
Fort Wayne, IN
Fresno, CA
Grand Rapids-Muskegon-Holland, MI
Greensboro-Winston-Salem-High
Point, NC
Greenville-Spartanburg-Anderson, SC
Harrisburg-Lebanon-Carlisle, PA
Hartford, CT
Hickory-Morgantown-Lenoir, NC
Honolulu, HI
Houston-Galveston-Brazoria, TX
Huntington-Ashland, WV-KY-OH
Huntsville, AL
Indianapolis, IN
Jackson, MS
Jacksonville, FL
Johnson City-Kingsport-Bristol,
TN-VA
Johnston, PA
Kalamazoo-Battle Creek, MI
Kansas City, MO-KS
Killeen-Temple, TX
Knoxville, TN
Lafayette, LA
Lakeland-Winter Haven, FL
Lancaster, PA
Lansing-East Lansing, MI
Las Vegas, NV
Lexington, KY
Lincoln, NE
CHAPTER 1
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Little Rock-North Little Rock, AR
Los Angeles-Riverside-Orange
County, CA
Louisville, KY
Lubbock, TX
Macon, GA
Madison, WI
McAllen-Edinburg-Mission, TX
Melbourne-Titusville-Palm Bay, FL
Memphis, TN-AR-MS
Miami-Fort Lauderdale, FL
Milwaukee-Racine, WI
Minneapolis-St. Paul, MN-WI
Mobile, AL
Modesto, CA
Montgomery, AL
Nashville, TN
New London-Norwich, CT-RI
New Orleans, LA
New York-Northern New Jersey-Long
Island, NY-NJ-CT-PA
Norfolk-Virginia Beach-Newport
News, VA-NC
Ocala, FL
Odessa-Midland, TX
Oklahoma City, OK
Omaha, NE-IA
Orlando, FL
Pensacola, FL
Peoria-Pekin, IL
Philadelphia-Wilmington-Atlantic
City, PA-NJ-DE-MD
Phoenix-Mesa, AZ
Pittsburgh, PA
Portland, ME
Portland-Salem, OR
Providence-Fall River-Warwick,
RI-MA
Provo-Orem, UT
Raleigh-Durham-Chapel Hill, NC
Reading, PA
Reno, NV
Richmond-Petersburg, VA
Roanoke, VA
Rochester, NY
Rockford, IL
Sacramento-Yolo, CA
Saginaw-Bay City-Midland, MI
St. Louis, MO-IL
Salinas, CA
Salt Lake City-Ogden, UT
San Antonio, TX
San Diego, CA
San Francisco-Oakland-San Jose, CA
San Juan-Caguas-Arecibo, PR
San Luis Obispo-Atascadero-Paso
Robles, CA
Santa Barbara-Santa Maria-
Lompoc, CA
Sarasota-Bradenton, FL
Savannah, GA
Scranton-Wilkes-Barre-Hazleton, PA
Seattle-Tacoma-Bremerton, WA
Shreveport-Bossier City, LA
Sioux Falls, SD
Sound Bend, IN
Spokane, WA
Springfield, MA
Springfield, MO
Stockton-Lodi, CA
Syracuse, NY
Tallahassee, FL
Tampa-St. Petersburg-Clearwater, FL
Toledo, OH
Tucson, AZ
Tulsa, OK
Utica-Rome, NY
Visalia-Tulare-Porterville, CA
Washington-Baltimore, DC-MD-
VA-WV
West Palm Beach-Boca Raton, FL
Wichita, KS
York, PA
Youngstown-Warren, OH
INTRODUCTION
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CHAPTER 1
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2.0 HEALTH AND
ENVIRONMENTAL
CONCERNS OF UV
RADIATION
Ultraviolet (UV) radiation is a natural but dangerous part of the sun's energy.
The ozone layer, located between 6 and 30 miles above the Earth in the
stratosphere, blocks most of this radiation from reaching the Earth's surface
and makes our planet livable. A dramatic loss of
stratospheric ozone was first noticed in the mid-1980s
above Antarctica. Since then, scientists have confirmed
significant seasonal losses of stratospheric ozone over
Antarctica and the Arctic region, and less dramatic losses
in mid-latitude regions such as North America. The
depletion of the ozone layer has created heightened
concern about the health and environmental effects of
increased UV radiation. UV radiation is known to cause
a number of different health effects, including skin cancer
and cataracts, and increased UV radiation is suspected to be contributing to a
number of environmental problems, including the worldwide decline in frog
populations and the bleaching of coral reefs.
2.1 What Is UV Radiation?
UV radiation is an invisible form of energy that has a shorter wavelength than
either blue or violet light. UV radiation is made up of three components: UV-A,
UV-B, and UV-C rays. Although the
ozone layer does not absorb UV-A
rays, it does absorb most UV-B rays
and virtually all UV-C rays. UV-A
rays penetrate deep into the skin and
heavily contribute to premature
aging, while UV-B rays mostly impact
the surface of the skin and are the pri-
mary cause of sunburn. Both UV-A
and UV-B have been linked to a num-
ber of other health effects, including
skin cancer, and UV-B rays have been
implicated in environmental effects
from UV radiation. The main threat
resulting from the depletion of the
ozone layer is increased UV-B effects,
even though UV radiation is only
about 2 percent UV-B.
UVA
UVB
Keratinocytes
Melanocytes
Basal Cell
Langerhans Cells
Capillaries
Fibroblasts
Lymphocytes
Macrophages
Mast Cells
Granulocytes
Collagen, Vessels
Elastic Fibers
GAGs, Fibronectin
Subcutaneous Tissue
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HEALTH AND ENVIRONMENTAL CONCERNS OF UV RADIATION
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2.2 How Does the Ozone Layer Block UV Radiation?
The ozone layer is very important because it absorbs most UV-B rays and virtu-
ally all UV-C rays. The ozone molecules that make up the stratospheric ozone
layer are each made up of three oxygen atoms. When ozone absorbs UV radiation,
it creates heat as it splits into a pair of oxygen atoms and a lone oxygen atom,
which eventually recombine to form ozone again. The molecular structure of
ozone can be altered by human-made chemicals that are emitted into the air.
When this happens, the stratospheric ozone layer can be depleted.
Chlorofluorocarbons (CFCs) are the principal cause of ozone depletion, although
a number of synthetic halocarbon chemicals also are known to reduce stratos-
pheric ozone. CFCs were once widely used as propellants in spray cans, as refrig-
erants and electronics cleaning agents, and in foam and insulating products.
Other ozone-depleting substances include pesticides such as methyl bromide,
halons used in fire extinguishers, and methyl chloroform used in industrial
processes. CFCs now are banned from production in the United States
and many other countries, but they still are found in certain products.
CFCs can escape into the air during CFC manufacturing, from leaks
in air conditioners and refrigerators, and when used appliances are dis-
posed before recovering the remaining CFCs within them.
When CFCs are released into the air, they do not break down.
Instead, they are mixed and dispersed by atmospheric currents. This
process can continue for 2 to 5 years, until the CFCs eventually reach
the stratosphere. In the stratosphere, CFCs break down and release
chlorine atoms when exposed to UV radiation. The chlorine atoms
destroy ozone, but are not destroyed themselves. As a result, each
chlorine atom can destroy a large amount of ozone (up to 100,000
ozone molecules) before it is eventually removed from the strato-
sphere by other atmospheric processes.
Ozone depletion is heightened above the North Pole and especially
the South Pole. The very cold, dark winters of the polar regions cause
stratospheric ice clouds to form, and this promotes the breakdown of
CFCs. Each spring above Antarctica, up to 60 percent of the ozone
layer disappears and does not return to normal until the summer.
The Arctic loses up to 25 percent of its ozone layer each spring, while
mid-latitude regions, such as North America, lose up to 5 percent.
Global warming, which occurs when greenhouse gases prevent heat
from escaping from the lower atmosphere into the stratosphere, can
set the stage for increased ozone depletion by creating a colder envi-
ronment in the stratosphere.
In 1987, countries from around the world recognized the threat to the ozone layer
and signed a treaty—the Montreal Protocol on Substances that Deplete the
Ozone Layer—to reduce the global production of ozone-depleting substances.
Amendments in 1990, 1992, 1995, and 1997 strengthened the treaty to promote
the earliest possible restoration of the ozone layer. Scientists predict that ozone
depletion will peak between 2000 and 2010. With full compliance from partici-
pating countries, the ozone layer is expected to be restored by the middle of this
CHAPTER 2
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century. Until that time, however, increased levels of UV radiation will reach the
Earth's surface.
2.3 How Does UV Radiation Affect Your Skin, Eyes,
and Immune System?
Overexposure to UV radiation can cause a num-
ber of health effects, including skin cancer, accel-
erated skin aging, cataracts, and a suppressed
immune system.
Skin Cancer
Everyone knows the short-term discomfort of too
much sun—redness, tenderness, swelling, and
even blistering. However, overexposure to the sun
and repeated sunburns can lead to a much worse
condition—skin cancer. More than 1 million
Americans are diagnosed with skin cancer every year, representing nearly half of
all cancers diagnosed annually. One in every five Americans will get some type of
skin cancer in his or her lifetime. There are three main types of skin cancer:
melanoma, basal cell carcinomas, and squamous cell carcinomas. (See Section 2.5
for descriptions of the different types of skin cancer and how to recognize them.)
Skin Aging
Repeated overexposure to the sun causes changes in the skin called actinic (solar)
degeneration. Over time, the skin becomes thick, wrinkled, and leathery. This
condition occurs gradually, often appearing many years after the majority of a per-
son's exposure to the sun. Up to 90 percent of the visible skin changes common-
ly attributed to aging are caused by sun exposure.2 Many people believe that
photoaging is a normal, but unavoidable, part of growing older. However, with
proper protection from UV radiation, photoaging can be substantially avoided.
Cataracts
Research has shown that UV radiation increases the chances of developing
cataracts, a form of eye damage that involves a loss of transparency in the lens of
the eye. Although curable with modern eye surgery, cataracts affect millions of
Americans each year. If left untreated, cataracts can cause cloudy vision and lead
to total blindness.
Exposure to UV radiation may also increase the chances of other types of eye
damage, including pterygium, a tissue growth on the white of the eye that can
block vision, and macular degeneration. The macula is the part of the retina near
the center, where your vision is most sensitive. Macular degeneration may include
development of spots that can result in blindness.
2Taylor, C.R. et al, Photoaging/Photodamage and Photoprotection, J Am Acad Dermotol, 1990: 22: 1-15.
HEALTH AND ENVIRONMENTAL CONCERNS OF UV RADIATION
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Immune System Suppression
Scientists have found that sunburn can affect disease-fighting white blood cells for
up to 24 hours after exposure to the sun, making your body more prone to infec-
tions and cancers. Sun exposure can aggravate diseases such as herpes simplex
(cold sores), chicken pox, and lupus. Repeated exposure to UV radiation might
cause more long-lasting damage to the body's immune system. Mild sunburns can
directly suppress the immune functions of human skin where the sunburn
occurred, even in people with dark skin.
2.4 Are Some People More Prone to the Effects of
UV Radiation?
Skin Type
Everyone, regardless of race or ethnicity, is subject to the potential adverse effects
of overexposure to the sun. However, skin type affects the degree to which some
people burn and the time it takes them to burn. The Food and Drug
Administration classifies skin type on a scale from 1 to 6. The lower the
number, the lighter the skin color. Individuals with fair skin, skin types 1
and 2, tend to burn more rapidly and more severely. Individuals with
darker skin, skin types 5 and 6, do not burn as easily.
The same individuals who are most likely to burn are also most vul-
nerable to skin cancer. Studies have shown that individuals with large
numbers of freckles and moles also have a higher risk of developing
skin cancer. Although individuals with higher-number skin types are
less likely to develop skin cancer, they should still take action to pro-
tect their skin and eyes from overexposure to the sun. Dark-skinned
individuals can and do get skin cancer.
Other factors
Factors other than skin type may affect a
person's vulnerability to the sun's rays. Some
medications, such as antibiotics and antihista-
mines and even certain herbal remedies, can cause extra
sensitivity to the sun's rays. People taking medications
should contact their physician to learn about potential risks
resulting from sun exposure.
2.5 Recognizing the Signs of Skin Cancer
Skin cancer is one of the most treatable forms of cancer. Early detection of skin
cancer can decrease chances of the cancer spreading to other parts of the body and
increase chances of survival. The survival rate for patients with early stages of
melanoma has increased from about 50 percent in the 1950s to about 90 percent
today. Nonmelanoma skin cancers have an even higher cure rate—95 percent or
higher if detected early.
CHAPTER 2
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Skin cancer occurs most commonly on areas of the body most exposed to the sun,
such as the face, neck, ears, forearms, and hands.
Different Types of Skin Cancer
Melanoma is the most deadly form of skin cancer and one of the fastest-grow-
ing types of cancer in the United States, according to the American Cancer
Society. New cases of melanoma in this country have more than doubled in the
past 2 decades, with more than 53,000 cases expected in 2002. An estimated
7,400 people will die from melanoma in 2002, almost 4 times as many deaths as
nonmelanoma skin cancers. Melanoma can spread to other parts of the body
quickly, but when detected in its earliest stages, it is usually curable.
Melanomas often start as small, mole-like growths. The growth, an uncontrolled
development of pigment-producing cells in the skin, leads to the formation of
dark-pigmented malignant moles or tumors, called melanomas. Melanomas can
appear suddenly without warning but also can develop from or near a mole. For
this reason, people should know the location and appearance of moles on their
bodies so they will notice any changes. Melanomas are most frequently found on
the upper backs of men and women, and the legs of women, but they can occur
anywhere on the body. To recognize potential problems, conduct periodic self
examinations and watch for changes that meet the ABCDs of melanoma:
•^symmetry: One half of the growth does not match the other half.
Border irregularity: The edges of the growth are ragged, notched, or blurred.
Wolor: The pigmentation of the growth is not uniform. Shades of tan, brown,
and black are present. Dashes of red, white, and blue also may appear.
Diameter: Any growth greater than the size of a pencil eraser should be exam-
ined by a doctor immediately.
The two types of nonmelanoma skin cancers—basal cell carcinomas and
squamous cell carcinomas—are not as fatal as melanoma. An estimated 1 million
Americans will develop nonmelanoma skin cancers in 2002, while approximately
2,200 will die from the disease. ^ Nonmelanoma skin cancers are the most com-
mon skin cancer found in fair-skinned people.
Basal cell carcinomas are tumors that usually appear as small, fleshy bumps or
nodules on sun-exposed areas such as the face, lips, neck, ears, and hands, but may
appear anywhere. This cancer does not grow quickly and rarely spreads to other
parts of the body. It can, however, penetrate below the skin to the bone and cause
considerable local damage.
Squamous cell carcinomas are tumors that might appear as nodules or as red,
scaly patches. This cancer can develop into large masses, and unlike basal cell
carcinoma, it can spread to other parts of the body. It is the most destructive type
of skin cancer.
^ American Cancer Society, "Cancer Facts and Figures 2002."
HEALTH AND ENVIRONMENTAL CONCERNS OF UV RADIATION 11
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Going to the Doctor
A person should see a doctor or dermatologist if he or she sees any of the signs of
skin cancer. To identify the warning signs, individuals can periodically examine
their skin, especially after prolonged periods in the sun. Skin
self-examinations consist of regularly looking over the entire
body, including the back, scalp, soles of feet, between the toes,
and on the palms of the hands. If there are any changes in the
size, color, shape or texture of a mole, the development of a
new mole, or any other unusual changes in the skin, a person
should see his or her dermatologist immediately.
As part of its screening program, the American Academy of
Dermatology (AAD) can inform individuals annually when it
is time to schedule their yearly visit for a skin cancer screening.
AAD's Web site allows an individual to locate a skin cancer
I screening location in his or her community and sign up for
annual notification. Volunteer dermatologists provide free skin cancer screenings
as part of the program. See .
2.6 Why Are Children and
Teenagers Most
Vulnerable to
Overexposure?
School-aged children spend a lot of time
outdoors. They usually have the summer
off and often spend many days swimming
at beaches and community pools, playing
team sports such as baseball and soccer,
and attending summer camp. These out-
door activities mean more sun exposure.
In fact, an estimated 80 percent of a per-
son's sun exposure occurs before age 18.4
Many dermatologists believe there might
be a link between childhood sunburns and
malignant melanoma later in life.
Therefore, it is especially important for parents and caregivers to ensure that chil-
dren consistently use sunscreen and take other protective measures. In addition,
parents must remember to be good role models for children; parents who get a
sunburn are more likely to have kids who get a sunburn.
Stern RS, Weinstein MC, Baker SG. Risk reduction for nonmelanoma skin cancer with childhood sun-
screen use. Arch Dermatol. 1986: 122: 537-545
1 2
CHAPTER 2
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2.7 What Are the Environmental Threats from
UV Radiation?
In the regions of the world where ozone depletion has occurred, increased UV
radiation threatens plants and wildlife on land and in the sea. These areas include
Antarctica, the Arctic, and mid-latitude regions such as North America.
On land, increased UV radiation is suspected of contributing to population
declines and limb deformities in frogs and other amphibians. It also is known to
be damaging to some plants, particularly agricultural crops. UV damage to crops
can affect growth and food quality, as well as the ability of plants to withstand
pests and diseases. Crops, plants, and trees also provide food and shelter for many
animals, so if these resources are damaged, other species and even entire ecosys-
tems also can be affected.
In the sea, increased UV radiation damages sea grasses, sea urchins, corals, krill,
and microscopic plants and animals known as plankton. Many of these organisms
are important food resources. Plankton and krill are at the bottom of the marine
food chain and feed a multitude of creatures, from starfish to whales. UV radia-
tion also is suspected to be one of the reasons why some colorful corals are turn-
ing white and dying.
In addition, in areas with high levels of air pollution, an increase in UV radiation
can worsen air quality. Increased UV-B radiation causes an increase in the reac-
tion of nitrogen oxides with volatile organic compounds (byproducts of vehicle
HEALTH AND ENVIRONMENTAL CONCERNS OF UV RADIATION
1 3
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exhaust, industrial emissions, and chemical solvents), producing increased
amounts of ground-level ozone. Exposure to ground-level ozone causes many
health problems.
Although UV radiation has negative impacts on plants and wildlife, not all species
are affected equally. Some agricultural crops are more tolerant of UV radiation
than others, and some marine creatures are able to repair some UV damage at
night. On the other hand, in areas affected by additional environmental impacts,
such as pollution, UV affects might be more damaging.
CHAPTER 2
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3.0 WHAT IS THE UV INDEX?
Developed by the National Weather Service (NWS), the UV Index forecasts
the next day's ultraviolet (UV) radiation intensity at different locations on
the Earth's surface for "solar noon," which is when the sun is at its highest
point in the sky.
NWS first began testing an "Experimental UV Index" for 58 U.S. cities on June
28, 1994, in cooperation with EPA and the Centers for Disease Control and
Prevention (CDC). Scientists at the
NWS Climate Prediction Center
developed the forecasting tool and its
supporting science. In April 1995,
NWS deleted the "experimental" and
made the UV Index an official prod-
uct. NWS subsequently has encour-
aged meteorologists to make similar
UV Indices widely available across the
country. In addition, it has worked
with EPA and CDC, meteorologists,
health and medical professionals, and
the World Meteorological
Organization to ensure there is consis-
tency among different UV Indices. As
a result, these groups, as well as the
general public, use the UV Index and
accept its widespread dissemination.
3.1 How Is the UV Index Calculated?
To derive the UV Index, scientists collect ozone data from satellite observations
and atmospheric pressure and temperature forecasts and scale the information to
produce an index with a range of 0 to 15- The UV Index is adjusted to account
for the potential presence of clouds and the elevation of the location. The lower
the number, the less UV radiation is reaching the surface. Low numbers occur
when the sun is low in the sky (i.e., during winter) and during overcast condi-
tions. A higher number is forecasted when the sun is higher in the sky (i.e., dur-
ing summer) and during clear or only partly cloudy conditions.
NWS uses a computer model to calculate the UV Index. The model takes into
account a number of factors, including the amount of stratospheric ozone and
clouds overhead, latitude, elevation, and time of year. The model first calculates a
UV "dose" rate, or the amount of UV radiation to which a person will be exposed
at the next day's solar noon under "clear sky" (no clouds) conditions. Higher ele-
vations will increase the UV dose rate because there is less atmosphere to absorb
and scatter UV rays. Greater cloud cover will tend to reduce the UV dose rate
because clouds screen out some—but not all—UV rays. The UV dose rates are
then adjusted for the effects of elevation and cloud cover at specific locations.
WHAT IS THE UV INDEX?
-------
Quick changes in cloud conditions can alter the predicted UV Index forecast. The
UV Index is applicable to a 30-mile radius around the city for which it is fore-
casted. Because the UV Index does not take into account differences in surface
reflectivity, individuals must make adjustments based on these factors. You get
much more UV on snow, sand, water, and concrete, since these surfaces reflect the
sun's rays back onto your skin, just like a mirror. The brighter the surface, the
more UV is reflected—fresh snow and dry sand reflect the most.
The resulting value is the next day's UV Index forecast. The UV forecasts for
select locations are provided daily using a 0 to 10+ scale, where 0 indicates a min-
imal likely level of exposure to UV rays and 10+ means a very high level of expo-
sure. EPA's Sun Wise Web site (www.epa.gov/sunwise) includes a feature that
allows the user to enter his or her ZIP code and receive the UV Index forecast for
that location for the current day. (See Chapter 4 to determine what steps you can
take to protect yourself from the sun under different UV Index situations.)
For more information on how the UV index is calculated and validated, see
Appendix D: How is the UV Index Calculated?
CHAPTER 3
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4.0 RAISING AWARENESS IN
THE COMMUNITY
As a person begins to gather information about ultraviolet (UV) exposure and
its risks, he or she will want to consider how to effectively communicate this
information to others in the community. A UV risk education project can
take many forms, from a sustained, multi-year community-wide effort to a short-
duration or seasonal campaign at selected venues, such as schools, recreation cen-
ters, or parks. This chapter of the handbook is designed to help the user determine
the kind of project that is right for his or her community by providing:
• Examples of UV risk education projects.
• Steps involved with outreach planning.
• Educational tools and resources that can be used in your schools and
community.
• Messages that every UV risk education program should convey.
• Guidelines and sample language for successfully communicating infor-
mation about sun protection and health risks to the community.
4.1 Developing an Effective Outreach Program
Community outreach programs can take many forms, depending on
issues such as the groups most at risk, the scope of the effort, the avail-
able resources, and the commitment of key leaders. Across the United
States, different UV risk education programs have been developed and
conducted with varying levels of effectiveness. In general, communi-
ty-wide programs with a strong mass media component have been
most effective, and sustained activities have proven more effectual
than shorter or one-time projects. Additionally, sun protection and
health risk messages have more resonance when they are consistent
and repeated. People also tend to trust the "messenger," so consider
credible sources within the community (e.g, schoolteachers, pediatri-
cians, dermatologists) to deliver your messages.
Many communities will want to build on existing UV risk education
programs, such as Sun Wise, PoolCool, and the Sun Wise Stampede.
Schools can join EPA's Sun Wise School program to receive free edu-
cational materials for classes and assistance with developing school
policies that promote sun safety. In addition, the Centers for Disease
Control and Prevention have recently issued guidelines urging schools
to try to protect children from excess sunlight by implementing poli-
cies designed to minimize students' midday sun exposure. Be aware
that sunscreen technically is considered an over-the-counter drug,
similar to aspirin or cough drops, and in most state school districts, it is prohib-
ited from student use without doctors' and parents' permission to allow nurses or
aides to administer it. However, this is a barrier that can be overcome, as students
in the Rockwood, Missouri, school district successfully demonstrated (see
RAISING AWARENESS IN THE COMMUNITY
1 7
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Appendix B: Case Studies of UV Risk Education Programs). Swimming pool
managers can contact the PoolCool program for free sun-safety signs and techni-
cal support to promote sun protection during pool activities. Local zoos can par-
ticipate in Sun Wise Stampede, a program designed to promote sun safety to zoo
visitors. (See Appendix A: List of Resources for more information on these and
other UV/sun protection programs.)
Other communities will want to develop their own UV risk education programs
or modify educational materials from existing programs. Throughout this chap-
ter, a wide variety of ideas are presented for UV risk education projects. Regardless
of the type of program you ultimately choose to implement, it is important to first
think through issues such as your goals, audiences, messages, resources, available
tools, and measurement options before committing to a plan of action.
Lastly, it can help to work with others who are also interested in promoting sun
safety in your community. For example, you can contact your local chapter of the
American Cancer Society (ACS) (see the "In My Community" section of the ACS
Web site ) to ask about working with volunteers or ACS staff.
Another option is to inspire others in your community to become sun safety
advocates. For example, parents especially can be strong advocates for sun safety.
They can inspire others by giving informal presentations on sun safety at the local
library or at a parent-teacher association, by setting up a table and distributing
sun safety brochures at a community festival or sporting event, or by working
with the local media to broadcast messages on sun safety. By working with other
like-minded individuals, you can have more of an impact on UV risk education
efforts by expanding the reach of your effort, by having more resources available,
and by having a stronger voice to advocate for policies and programs in your com-
munity that promote sun safety.
Step 1: What Are You Trying To Accomplish}
The first step in any outreach effort is to define what you want to accomplish. In
general, UV risk education programs aim to:
• Increase awareness of sun exposure, UV radiation health risks, and sun
safety measures.
• Change behaviors and attitudes to ensure sun safety.
• Change policies to reduce sun exposure and encourage sun safety.
Getting your community's residents to change the way they view sun exposure
and tanning and to always practice sun-safe behaviors is ultimately the best way
to prevent skin cancer and the other adverse health effects of UV overexposure. It
can, however, be difficult to effect permanent attitude and behavior change. For
this reason, many communities will begin or also seek to make changes at the pol-
icy level. Policy changes have proven effective because they don't rely on individ-
uals to take voluntary actions. Additionally, policies can serve as reminders to
people of the importance of a particular behavior. Examples of community poli-
cies to encourage sun safety and reduce sun exposure include:
CHAPTER 4
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• Providing shade infrastructure at community parks, recreational areas,
or school grounds.
• Requiring the posting of signs at recreational sites, such as parks, beach-
es, and pools, that encourage sunscreen and hat use and limiting time
spent in the sun.
• Requiring parents to provide their children with hats and sunscreen at
community outdoor camps.
• Requiring teachers to apply sunscreen to children before recess or
enforcing a no hat, no play rule at schools: children who do not
wear a hat must sit or play in the shade during recess and other
outdoor breaks.
• Requiring very brief sunscreen breaks for
children at outdoor pools, camps, and
recreation sites.
• Passing legislation that encourages sun safety
and education. For example, California
introduced a sun safety law that specifies skin
cancer as a type of employment "injury" for
lifeguards. Under the bill, affected lifeguards could
potentially receive payment through the workers'
compensation system.
Some communities also craft their programs to not
only encourage sun safety, but also to specifically raise
awareness of skin cancer. Goals for these programs
can include:
• Increasing people's knowledge of what skin cancers look like.
• Increasing the number of people who seek medical advice and
early screening.
• Encouraging medical practitioners to educate patients and adults about
skin cancer and check all adult patients.
Keep in mind that, with the right tools, many outreach programs (both short- and
long-term) can be effective in raising a community's knowledge of sun exposure,
skin cancer and other health risks, and sun-safe practices, but more sustained and
intense programs are generally more successful in effecting permanent behavior
change and attitudes.
As you begin to define your goals, keep in mind how you will measure achieve-
ment of them. For example, if one of your aims is to change behaviors of ele-
mentary school-age children at recess, how will you make sure this goal is
achieved? Or if you seek to have the UV Index broadcast on your local television
channel daily, how will you track these broadcasts? Whenever possible, define
your goals in concrete, measurable terms and consider how you will follow up.
You might also consider seeking the help of someone experienced in measurement
as you define your goals—consider hiring or recruiting a volunteer with a back-
RAISING AWARENESS IN THE COMMUNITY
1 9
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Developing a Sun Prelection Policy for Schools
To ensure the success of sun protection policies at schools, it is important to
work with parents, students, and school staff to help them understand the
purpose of the policy and to encourage them to implement it. Adjust the
policy based on the recommendations of the school community. Consider
the following suggestions:
• Form a committee that includes representatives from the school commu-
nity affected by the policy.
Conduct information sessions to explain the purpose of the policy.
Consider sun protection measures that might already be in place at
the school.
• Prepare a draft policy and ask for comments.
• Request endorsement of the final policy from the school council or other
appropriate organization.
• After implementing the policy, publicize it to ensure everyone is aware of
the policy and its purpose.
• Monitor and evaluate the success of the policy.
(This information was adapted from Australia's SunSmart program. For
more information, go to .
ground in statistics or market research. (See "Step 6: How Will You Measure
Success?")
Step 2: Who Are You Trying To Reach?
Successful outreach hinges on defining and understanding the target audiences
you are trying to reach within the community. Outreach can be targeted at a vari-
ety of audiences, including:
• Children/young adults
• Parents and adult caregivers
• Outdoor occupational workers and recreational users
• Health care community
• Community leaders and activists
• Older adults and senior citizens
An outreach project can be directed at one or more primary audiences, such as
children, or focus more specifically on a particular subset within an audience,
such as elementary school-age children. A broad, community-based effort will
most likely target multiple audiences, including children and their parents or
adult caregivers, businesses and workers, the health community, community
group leaders, the school district, and community and recreational directors.
CHAP
-------
When considering the audiences at which to direct your program, look at your
community and determine the groups of people most at risk and the places where
people are likely to be sun-exposed. In many communities, children are a primary
target audience program, given that the majority of a person's lifetime exposure
takes place before age 18. Other individuals most at risk from adverse health
effects due to overexposure to the sun include people who:
• Spend a large amount of time outdoors (e.g., construction workers,
people at the beach).
• Have lighter skin types.
• Have certain diseases such as lupus.
• Are taking certain medications such as antibiotics, antihistamines, or
some herbal remedies.
However, anyone who spends time outdoors, regardless of their risk level, are sub-
ject to the potential adverse effects of overexposure to the sun.
Keep in mind that often a more in-depth educational message can be delivered to
a smaller group of people, while a more simple message can be delivered to many
people. Audiences that receive a more in-depth message are probably more likely
to change their behavior than those receiving a more simple message.
Children and Young Adults
Many successful programs have been developed that reach out to children and
young people directly, most frequently in schools, but also in childcare organiza-
tions, recreational centers and sites, service programs (e.g., 4-H, girl and boy
scouts), and other community organizations that serve large numbers of children.
Within the school system, teachers, administrators, superin-
tendents, nurses, and parent/teacher organizations can all be
effective partners in changing behaviors, instituting policies,
and generally spreading the sun protection word. An easy step
for your community would be to find an elementary school
teacher who is interested in joining EPA's Sun Wise Program.
The teacher would then receive free teaching materials and
classroom activities. Once this teacher's class has implemented
the program, results and messages can be shared with other
classrooms, schools, and even the community at large through
activities and events such as sports matches, parents' nights,
presentations in the auditorium, and exhibitions in school halls or community
libraries. Teachers can also work with parent-teacher associations to encourage
school sun protection policies or with school nurses who also can promote sun
protection to students.
Older children can be effective messengers in delivering the sun protection mes-
sage to their peers and younger classmates and siblings. Children look up to older
peers, and the message may resonate more for teenagers if they hear it from some-
one their own age. Parental influence also can be beneficial, especially if used in
RAISING AWARENESS IN THE COMMUNITY
-------
Effective Messages: Having a SunWise Field Day
As participants in a SunWise pilot, students in 6th and 7th grade health
classes at Brownstown Middle School in Brownstown, Michigan, successfully
reached out to the rest of the school in sending a SunWise message. Prior to
one of the school's annual field days, when students compete in outdoor
events, the students in the health classes launched a sun-safe campaign,
encouraging their schoolmates to use sunscreen, hats, and sunglasses dur-
ing the event. To help spread the safety message, the classes made posters
to hang in the school's hallways and asked local businesses to donate sun-
screen for the students to use on the field day. Teachers noted no incidences
of sunburn as a result.
SunWise students at the same school also have planted oak saplings on the
school grounds to eventually provide protective shade for students partici-
pating in outdoor activities.
For examples of other successful SunWise schools, see Appendix C.
concert with other factors, such as opportunities for children to self-select types
of personal sun protection (e.g., hats, sunscreen, clothing).
Parents and Adult Caregivers
Parents, child-care workers, and other adult caregivers are important
target audiences because they often are role models and can be instru-
mental in encouraging children to practice sun-safe behaviors.
Additionally, parents often influence the organizational policies within
schools and the community that can promote sun protection for chil-
dren, and can be effective champions in changing practices or policies.
Parents and caregivers can be reached though a variety of ways, such as
through health events conducted at schools and community recre-
ational sites; through educational materials distributed at schools,
recreational centers, and community sites; through radio, print, and
television announcements; and through the health care system.
Outdoor Occupational Workers and Recreational Users
Don't overlook other people who might be at particular risk of sun overexposure
in your community, including those who work outside (e.g., lifeguards, farmers,
fishers, landscapers, construction workers) and those who spend a lot of time
engaged in outdoor recreational activities, including both children and adults.
Occupational UV risk education programs should look at targeting the workers
themselves, as well as the businesses that employ them. Trade organizations and
unions are other potential audiences. Recreational UV risk education programs
could reach out to individuals and groups such as zoo workers, park rangers, golf
course and tennis court managers, fitness centers, marinas, sports and bicycle
shops, and community garden clubs. You might consider a training program to
help community workers, such as lifeguards, parks and recreational directors, or
camp leaders, incorporate sun protection messages and practices into their pro-
22
CHAPTER 4
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grams. With these audiences, it is especially important to communicate the
potential health effects of UV overexposure and the importance of medical con-
sultations, screening, and early detection.
Health Care Community
Maternity nurses, school nurses, dermatologists, pediatricians, and other medical
practitioners can all play key roles in communicating sun protection and health
risk messages to their patients. Many of these individuals are already
working with their patients to communicate this information; others,
like school nurses, can receive training and encouragement to do so.
Some communities have found that reaching out to new parents in
maternity wards and through well child visits is particularly effective;
not only does this encourage parents to protect babies and toddlers
from sun exposure, it can also instill these behaviors in children as
they grow older. The health care community can be important allies
in not only encouraging sun safety, but also in raising awareness of
skin cancer signs and stressing the importance of screening.
Community Leaders and Activists
Outreach efforts are most successful when there are champions behind the cause,
volunteering to help with whatever needs to be done—from stuffing envelopes to
rallying community support. Look to those individuals in your community who
have the ear of your residents for help in spearheading your efforts and spreading
the word. Community activists, such as those already working on health or chil-
dren's issues, also can be effective partners.
Older Adults and Senior Citizens
Older adults and senior citizens are still at risk of overexposure to the sun, partic-
ularly those who spend large amounts of times outdoors. This audience, in par-
ticular, requires education and awareness-building concerning the health effects of
sun overexposure, such as skin cancer, which could now be manifesting. The
health community, senior citizen centers, assisted living cen-
ters, and organizations directed at retired individuals are all
potential avenues for reaching these individuals and encourag-
ing early screening and detection of sun-related health issues.
RAISING AWARENESS IN THE COMMUNITY
23
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Step 3: What Do You Want To Communicate}
Think about the key points or messages you want to communicate through your
effort. While the messages will vary depending on the audience you are targeting,
they should be consistent, repeated, and delivered by credible sources or role
models. It is also important to think through the potential barriers you might
encounter, such as people's desire for a suntan or enjoyment of sports and other
outdoor activities, in attempting to reach out to different target audiences.
Section 4.3, "Communicating UV Risk Information to the Community," pres-
ents some basic communication guidelines to consider when reaching out to the
public about UV radiation and sun exposure. It also provides sample text and sun
protection messages that can be incorporated into your actual outreach products.
If you are considering a large media component in your outreach, it is useful to
pretest the chosen messages and slogans with your targeted audiences (through
means such as surveys or focus groups) before executing the actual campaign.
Testing will help you determine if your messages are appropriate and effective.
Depending on the scope of your effort, you might hire a professional or find a
volunteer who has market research experience. But don't forget that a number
of community and national campaigns on sun protection and skin cancer
have already been successfully launched, and you can also learn from the
formative research and testing that these programs have already conducted when
developing your own messages (see Appendix B: Case Studies of UV Risk
Education Programs).
Step 4: Who Will Lead the Effort?
Within a community, various individuals and government offices share responsi-
bility for communicating public health information to residents. Consider build-
ing a coalition with these and other individuals who will commit to and help
execute your mission. For a short-duration or limited effort, you may need to
simply identify a handful of committed people who can work with you to reach
your targeted audience. These may be people within your organization, your
school system, or the community at large.
For a school-based program, such as Sun Wise, an individual teacher might ini-
tially take the lead role, incorporating lessons focusing on sun protection in the
classroom and encouraging sun-safe behaviors at recess and after school. This
individual and the class can also become "champions" for spreading these mes-
sages to other classrooms and schools. Within the school system, a group of par-
ents from a parent-teacher organization can also be effective leaders in
encouraging policy changes, such as planting trees around the playground or
requiring children to wear hats and sunscreen at recess.
Leadership for a program can also come from unexpected sources. In Dayton,
Ohio, a group of dermatologists were the impetus behind the Raising Awareness
About Your Skin (RAYS) program; however, the program's development and lead-
ership were carried out by the Montgomery County Ohio Medical Alliance, a vol-
unteer group made up of doctors' spouses. (See Appendix C: Successful Sun Wise
Programs for more information on RAYS.)
24
CHAPTER 4
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For a broad-based community effort, such as the Safe Skin Project conducted in
Falmouth, Massachusetts, (see Appendix B: Case Studies of UV Risk Education
Programs) you might want to set up a town-wide advisory board made up of com-
munity leaders, organization representatives, and select community members.
The advisory board would be instrumental in planning and implementing the
program, as well as for gaining recognition and support in the community.
Members of such a board could include:
• Elected officials
• Local health department officials
• Pediatricians and physicians
• Dermatologists
• Maternity nurses
• Child-care directors
• Recreational program directors
• School superintendents, teachers, and nurses
• Parents
• Teenagers
In some communities, advisory boards are made up of people with a history of
working together. The advantages to this approach are that people know and feel
comfortable working with each other. In other communities, there is an inten-
tional effort to build a board of "unlikely partners"—people that might view sun
protection from quite different experiences and perspectives. While establishing
this kind of advisory board may require more up-front effort, it can also yield
more positive results.
Finally, you might want to team up with other communities in your area to devel-
op a regional campaign. The advantages of a regional campaign are many, includ-
ing the ability to pool resources, share responsibilities, reach out to more people,
and deliver consistent and repeated messages in a larger geographic area.
Step 5: How Will You Fund Your Outreach Program}
Resources are essential to any outreach effort. While the resources required for an
outreach effort will vary depending on the scale and goals of your program, it's
important to consider early on what type of resources (e.g., personnel, facilities,
research, publicity) are required, if they are readily available, and how will they be
managed, as these decisions can impact your effort. Consider local sources of
funding, such as from the city or county government, as well as state and even
national sources, such as grants from government agencies or organizations that
fund health-based research or work on children's health issues (see Appendix A:
List of Resources for more information).
RAISING AWARENESS IN THE COMMUNITY
25
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Sponsors or partnering organizations also can be recruited to lend their resources
and credibility to the program. Think of the various sectors of your community,
and of the organizations and agencies that could help carry out your objective,
particularly those that are already working with your targeted audiences. For
example, Australia's SunSmart campaign partnered with several recreational
organizations, including tennis and cricket associations. When considering spon-
sors, think in terms of your community's variety of racial and ethnic groups,
income levels, occupations, and political views. Once you have recruited spon-
sors, solidify their commitment. Consider a pledge of participation to help spon-
sors understand their role and make explicit their commitment to the program.
Donations, bartering agreements, and volunteer support can also be useful in
stretching your outreach dollar. The RAYS program, for example, received fund-
ing from the Children's Medical Center in Dayton, Ohio, in exchange for print-
ing the center's name on the program's risk education CD-ROM. In addition,
consider asking a local printer or copier to print your sun protection flyer at no
cost; in return, provide a credit thanking the printer on the cover, which also
serves to advertise the business.
Step 6: How Will You Measure Success}
Measuring the impacts of your program provides many benefits. It is always use-
ful to know if your outreach is having an effect and if you are accomplishing what
you set out to do. Additionally, having concrete measures of the results you have
achieved might help you improve your program, consider ways to redirect your
resources for future efforts, and even solicit additional funding.
You can measure success in a variety of ways, depending on the goals you estab-
lish. For this reason, it is important to think about measurement when you are
establishing goals. (See Step 1: What are You Trying to Accomplish?) In many
cases, it is useful to have baseline knowledge and information to evaluate trends
in your community and predict what is in store in the near future. Many groups
and communities that have instituted UV risk education programs make use of
surveys, which are conducted before and after the launch of a program to meas-
ure attitude and behavior change. Some programs also have conducted follow-up
surveys at different intervals (e.g., 3 months, 6 months, or 1 year) to gauge long-
term behavior change regarding sun safety.
Communities interested in conducting attitudinal/behavior surveys might con-
sider looking at those that have already been done (see the text box, "Sample
Survey Questions," and Appendix A: List of Resources) for ideas on the types of
questions to ask. Many surveys ask respondents to check the sun protection meas-
ures currently in place; after a program is implemented, the surveys are repeated
and then cross-checked to see if improvements have been made. Some surveys also
attempt to gauge respondents' awareness and attitudes regarding sun exposure
before and after a program is implemented. Others also include questions
designed to gather information to determine if policy, education, and training
goals have been met. Any survey you develop should be closely linked to the goals
you establish.
26
CHAPTER 4
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Sample Survey Questions
The following questions are from the community surveys given during the
Falmouth Safe Skin Project (see section 4.2, Successful UV Risk Education
Programs, for more information).
• Has your child ever had a painful sunburn? (Y/N)
• During a typical week this past summer, how often did your child go to
the beach? (Never, 1-2, 3-5, every day)
• In the past 5 years, has your child intentionally worked on getting a sun-
tan? (Y/N)
Have your child's sunbathing habits changed compared to last year?
(More, less, same, never)
• When going to the beach on a hot, sunny day, does your child wear a
shirt or hat? (All, most, rarely, never)
• How often does your child use sunscreen at the beach? (Always, often,
sometimes, rarely, never)
• How often does your child use sunscreen when outside in the summer
but not at the beach? (Always, often, sometimes, rarely, never)
During the past summer, if your child was outside for 6 hours on a hot
day, how much of the time did he or she have on sunscreen? (6 hours,
3-5, 1 -2, never)
•
'
• Compared with last year, how likely is your child this year to use sun-
screen? (More, same, less)
• In the past 5 years, have you (as a parent) intentionally worked on get-
ting a suntan? (Y/N)
• How often do you use sunscreen when you are sunbathing? (Always,
often, sometimes, rarely, never)
• Do you find it difficult to protect your children from the sun? (Y/N)
During the past summer, on hot days, how often did you insist that your
child use sunscreen? (Every day, most days, half the time, less than half
the time, rarely, never)
Do you (as a parent) think that people look more healthy when they
have a suntan? (Y/N)
Does your child really enjoy getting a suntan? (Y/N)
•
"'
Compared with last year, has your child's interest in getting a tan ?
(increased, stayed the same, decreased)
This summer, my child told me that sunscreen prevents skin cancer.
(Y/N)
Have you (as a parent) ever heard of the disease malignant melanoma?
(Y/N)
RAISING AWARENESS IN THE COMMUNITY 27
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Given the technical nature of developing and administering scientific surveys, you
might consider recruiting or hiring a statistician or market research expert (possi-
bly as a member of your advisory board) to help you define goals and measure
outcomes, particularly if the media is a major component of your program.
Step 7: What Outreach Tools and Community Events Will You Need To
Communicate Your Messages?
Many organizations, including EPA, have already developed free tools that are
available to the public. You may be able to use or modify these tools to meet your
needs, especially those developed as part of EPA's Sun Wise School
Program. (See Appendix A: List of Resources.) Be aware that most
government-produced materials are typically in the public
domain, which means they are available for public use and
dissemination; programs developed by the private sector
or other organizations may, however, be copy-
righted. If you have doubts about the legality of
using existing materials, contact the organization
for more information.
There are many benefits to using existing materi-
als, including saving money and resources, and
accessing pretested messages. Some communities,
however, might want to launch their own targeted
campaigns, with their own slogans and artwork. Even if
you develop your own materials, however, you might get
useful ideas and save some time by looking at some existing tools.
The topics of sun safety and UV awareness can be explored through community
events and a variety of outreach products spanning print, multimedia, electronic,
and event formats. The table on the following page provides some examples.
The community events and products you choose should be based on the audience
profile information you assembled in "Step 2: Who Are You Trying to Reach?"
Think about which communication mediums are used most frequently and are
most credible to your targeted audience. Then consider how you can use them as
a vehicle for your message. A communications professional can provide valuable
guidance in selecting the outreach products that will best meet your goals within
your resource and time constraints. Questions to consider when choosing your
products include:
• How much information does your audience need to have? How much
does your audience know now?
• Is the product likely to appeal to the target audience? How much time
will it take to interact with the product? Is the audience likely to make
that time?
• How easy and cost-effective will the product be to distribute, or, in the
case of an event, organize?
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CHAPTER 4
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Print
Fact sheets, brochures
Checklists
Health screening reminders
Newspaper articles, editorials by health
professionals or elected officials
Articles in health, school, recreation
department newsletters
Articles in children- and parent-oriented
magazines
Public service announcements in health or
community publications
Bill stuffers, postcards
Press releases, media kits
Curricula and other educational materials for
children
Electronic
Web pages
E-mail messages
Computer-based or animated presentations at
events or libraries
Multimedia
Posters
Radio public service
announcements
Cable TV
programs
Exhibits
Kiosks
Videos
Signs
Events
Community days or fairs
National Skin Cancer Awareness Month
School events
School field days
Sports events
Health fairs
Small group meetings
One-on-one meetings
Public meetings
Press conferences
Media interviews
Novelty Items
Cups
Hats
Frisbees
UV-sensitive beads
T-shirts
Banners
Bumper stickers
Mouse pads
Buttons
Magnets
How many people is the product likely to reach? For an event, how
many people are likely to attend?
What time frame is needed to develop and distribute the product?
How much will it cost to develop the product? Do you have access to
the talent and resources needed for development?
When will the material be out of date? (You probably will want to
spend fewer resources on products with shorter lifetimes.)
RAISING AWARENESS IN THE COMMUNITY
29
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Would it be effective to have distinct phases of products over time? For
example, a first phase of products designed to raise awareness, followed
at a later date by a second phase of products to encourage changes in
behavior.
How newsworthy is the information? Information with inherent news
value may be rapidly and widely disseminated by the media.
Step 8: How Will You Distribute Your Products?
Effective distribution is essential to the success of any outreach effort. There are
many avenues for distribution. Before choosing your route, consider the follow-
ing questions:
• How does the audience typically receive information?
• What distribution mechanisms has your organization used in the past
for this audience? Were these mechanisms effective?
• Can you identify any partner organizations that might be willing to
assist in the distribution?
• Can the media play a role in distribution?
• Will the mechanism you are considering really reach the intended audi-
ence? For example, the Internet can be an effective distribution mecha-
nism, but certain groups may have limited access to it.
• Are sufficient resources available to fund and implement distribution
via the mechanisms of interest?
The table on the following page lists some examples of distribution
mechanisms and provides tips and ideas for their use in your commu-
nity outreach efforts.
Successful outreach may generate requests for further information or
concern about health and safety issues. Consider whether and how you
will handle this interest. You may want to define, for
example, who will handle requests for additional informa-
tion and even indicate on the outreach product where peo-
ple can go for further information (e.g., provide a contact
name, number, or address.) In planning a follow-up strat-
egy, also consider directing people
to EPA for further information
about Sun Wise and the UV
Index. EPAs SunWise Web site
at is an
excellent resource, linking to a
wealth of sun safety materials and
resources.
30
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Medium
Mailing
lists
Characteristics
SunWise-Specific Ideas
Highly focused on a target audi- -Identify mailing lists from partner organizations
ence of your choice. You can tai- or community organizations that include decision-
lor the message included in makers, parents, educators, environmental
different mailings. groups, and health professionals.
-Use existing SunWise informational materials in
your mailings.
Phone/Fax More time-intensive and personal
communication.
-Conduct a phone survey on sun safety awareness
in your community. Use the opportunity to speak
to people one-on-one about SunWise.
E-mail Effective, economical way of -Target the e-mail lists of partner organizations,
reaching community members in corporations, schools, healthcare, and child-care
the workplace. facilities.
-Use existing SunWise materials to create and
send out an e-mail detailing the action steps for
protection, and how people can find out more
about the UV Index and sun-safe behavior.
Internet Reaches diverse audience, but
site might need promotion to
attract initial attention. Also,
make sure your target audience
is Web-savvy and has ready
access to the Internet.
-Create a community portal site about sun safety.
Link to EPA's SunWise Web site.
Journals or More in-depth treatment of your -See for
newsletter message, may use direct quotes example press releases that you can send to local
from press releases; requires journals and newsletters to promote sun safety
advance planning. and encourage schools to join SunWise.
-Write your own press release on a SunWise news
story of local interest in your community, such as a
school project or community partnership, to
attract media attention.
-Develop and track media contacts, such as mete-
orologists, to get them involved in a UV Index
story for your community.
RAISING AWARENESS IN THE COMMUNITY
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Medium Characteristics
Television Highly visible media designed to
visually portray your message.
SunWise-Specific Ideas
-Work with weather departments at your local
station to work in segments on UV Index and sun
safety.
-Contact an assignment editor with an idea to
profile a skin cancer survivor in your community.
Include a sun safety message.
-Prepare a SunWise media kit for your local sta-
tion, include existing materials from the SunWise
Program, such as brochures and fact sheets. Also,
include a press release giving the information a
local spin—such as a school's SunWise project or
a company's UV awareness efforts.
Radio Brief sound bites in which tone -Prepare a public service announcement on the
and delivery are important. importance of SunWise behavior.
-Arrange for a respected health professional or
community leader to participate in a talk show,
delivering a sun safety message.
Hotline Sustained effort, requires external -Participate in a local health hotline by providing
promotion. staff with sun safety information.
Meeting, One-time, high-profile opportunities
events, or to deliver your message to a target
locations audience.
-Create a SunWise event of your own. Involve
schools, companies, and organizations. Consider
having a radio or TV station co-sponsor the event.
-Look for ways to tie in with local events, such as
fairs, parades, conferences, or sports events, to
house a SunWise exhibit or distribute SunWise
materials.
4.2 Successful UV Risk Education Programs
A number of UV/sun protection education programs have been successfully
implemented in communities nationwide, as well as internationally. These pro-
grams educate youth and communities about sun protection through activities
inside and outside of school. As a result, these concentrated efforts have had
numerous positive effects on people's behaviors. For example, a community in
Massachusetts reduced sunburn rates of children under 6 years old by more than
75 percent. In addition, a pilot project in Georgia improved the sun-safe behav-
iors of a youth soccer organization, while an in-school program in Australia
focused on teaching teenagers proper sun-safe behavior by exploring myths about
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CHAPTER 4
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Working With the Media
In a growing number of communities, media institutions are key play-
ers, even partners, in community-wide education programs. Some
communities have relied primarily on media-based campaigns to
deliver sun protection messages through newspapers, radio stations,
television stations, and outdoor or transit advertising. The media has
the advantage of reaching large numbers of people and can inspire
people to become sun safety advocates. Long-term media coverage
(periodically over at least 1 year) is most effective at raising people's
awareness. Meteorologists who work for the media can play a par-
ticularly important role in broadcasting the UV Index daily and
explaining what this measurement means in terms of sun protection. Newspapers also can print the UV
Index daily. In general, media messages should be based upon an understanding of the prevailing culture
and the level of community awareness of the issue.
If you are new to media work, it is important to realize that you don't need special training or experience
to effectively promote your story. Take advantage of free media coverage by sending press releases or pub-
lic service announcements (see the Centers for Disease Control and Prevention's Choose Your Cover cam-
paign at ) to local media outlets or by asking newspapers
and television stations to cover a local sun safety presentation, meeting, or start of a new SunWise Program
at a nearby school. What you do need is the readily available information on basic methods for commu-
nicating with the media. You can find this information in books and "how-to" guides published by non-
profit organizations. Also, see Appendix A: List of Resources for more information to help you get started.
sun exposure and the pressures of tanning. For detailed information on many of
these programs, see Appendix B: Case Studies of UV Risk Education Programs.
4.3 Communicating UV Risk Education
Information to the Community
Communicating information on environmental and health risk topics can be
challenging. Frequently, this information can be technical, full of unfamiliar
terms and jargon. In addition, talking to people about health issues can be fright-
ening, particularly when you are dealing with potentially life-threatening health
effects, such as cancer. As you begin to implement your outreach and develop or
tailor existing products, you will want to make sure that these products present
your messages and information as clearly, accurately, and sensitively as possible.
Writing for the Public
Information should be conveyed in simple, clear terms. Principles of effective
writing for the public include:
• Avoid using scientific jargon and acronyms. Where possible, translate
technical terms into everyday language the public can easily under-
stand. For example, use "skin" instead of "dermal." If you need to use
technical terms or acronyms, make sure you define them.
• Use the active voice. Active voice means putting the subject of your
sentence before the verb rather than after. For example, "Overexposure
RAISING AWARENESS IN THE COMMUNITY
33
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to UV radiation can cause skin cancer" is written in active voice. "Skin
cancer can be caused by overexposure to UV radiation" is not.
• Keep sentences short.
• In written materials, use headings and other format devices to provide a
very clear, well-organized structure.
The Web site provides many useful guidelines and
examples for writing in clear, plain English.
Know Your Audience
As you develop communication materials for a specific audience, remember to
consider what the audience members are likely to know, what you want them to
know, and what they are likely to understand. Then tailor your information
accordingly. Provide only information that will be valuable or interesting to the
target audience. In addition, when developing outreach products, be sure to con-
sider any special needs of the target audience. For example, if your community
has a substantial number of people who speak little or no English, you will need
to prepare communication materials in their native language.
Clinical Information and Photographs
Many programs have made use of testimonials and clinical pictures of actual skin
cancer cases to communicate the importance of sun protection in reducing health
risks. These tools can send a memorable message, and make an impression on
children and adults alike. "Scary" messages and tools need to be used with sensi-
tivity, however, when directed at younger children.
Essential UV Risk and Sun Protection Messages: Sample Text for Outreach
Products
The rest of this section contains the messages that every UV risk education pro-
gram should convey and sample text for outreach products. These examples, pre-
sented in a question-and-answer format, are written in a plain-English style
designed to be easily understood by the public. You can use this text as a model
to stimulate ideas for your own outreach materials or you can incorporate any of
this text directly into your products. You also can use fact sheets, brochures, or
other materials developed by the Sun Wise Program. These materials are available
from .
What Are the Risks From Overexposure to Sunlight}
• We are all at risk from exposure to too much sun. This is because the
sun contains harmful ultraviolet (UV) rays, called UV-A and UV-B,
which can penetrate into the skin and eyes. Everybody, regardless of
race or ethnicity, may be affected by overexposure to sunlight.
• Overexposure to UV radiation can cause a painful sunburn. Over time,
it can also lead to skin cancer, early aging of the skin, and other skin
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disorders; cataracts and other eye damage; and suppression of the
immune system.
• More UV radiation is reaching the Earth's surface than ever before
because pollution has thinned the ozone layer, which is high in the
Earth's atmosphere and shields us from the sun's UV rays. There has
been a continued increase in the reporting of skin cancer in the United
States—1.3 million cases annually. In fact, one in five Americans will
develop skin cancer in their lifetime.
• There is no such thing as a healthy suntan. Any change in your natural
skin color is a sign of skin damage. Every time your skin color changes
after sun exposure, your risk of developing sun-related ailments
increases.
Who Is Most at Risk?
m You may be at greater risk of contracting skin cancer if your skin always
burns or burns easily, and if you have fair skin, blond or red hair, or
blue, green, or gray eyes.
• You may also be at increased risk of skin cancer if you have a history of
blistering sunburns in early childhood, many moles, or a family history
of skin cancer.
• People who spend a lot of time outdoors may be at higher risk for
health effects from UV radiation.
• Children are particularly at risk of overexposure because they tend to
spend a lot of time outdoors and can burn more easily. An estimated 80
percent of a person's sun exposure occurs before age 18. Blistering sun-
burns during childhood can significantly increase the risk of developing
skin cancer later in life.
• Certain diseases, such as lupus, and certain medications, such as antibi-
otics, antihistamines, and even some herbal remedies, can make you
more sensitive to the sun's harmful rays.
• Everyone is equally at risk for eye damage.
When and Where Is the Sun Strongest}
m The intensity of the sun's UV rays reaching the Earth's surface varies
and should be considered when you plan outdoor activities. You can
obtain a daily forecast of UV intensity for your area from the Internet
(see "What Is the UV Index?" below).
• UV radiation is strongest at midday (from 10 a.m. to 4 p.m.) and dur-
ing the summer. Also, exposure to UV radiation is greater at lower lati-
tudes (i.e., the further south you are in the U.S.) and at higher
altitudes.
RAISING AWARENESS IN THE COMMUNITY 35
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• Up to 80 percent of the sun's UV rays pass through clouds. This means
that you can burn on a cloudy day even if it doesn't feel warm.
• Snow, water, and sand reflect the sun's rays, so skiers, swimmers,
boaters, and beachcombers are exposed from both direct and reflected
sunlight.
How Can I Protect Myself and My Family?
Always Use Sunscreen
• Sunscreens protect your skin in two ways: by reflecting UV radiation
away from your skin and by absorbing UV radiation before it can pene-
trate your skin.
• All sunscreens sold in the United States contain a Sun Protection
Factor (SPF) label to indicate how much protection the sunscreen
will provide when used properly. The higher the SPF, the greater the
protection from UV-B rays. An SPF of 30 blocks out 96 percent of
harmful UV-B rays (the primary cause of sunburn). An SPF of 15
offers 93 percent protection from UV-B. Many sunscreens—called
"broad-spectrum" sunscreens—also protect the skin from UV-A rays
(the primary cause of premature skin aging). For these reasons,
use of a broad-spectrum sunscreen with an SPF of at least
15 is recommended.
• Apply about 1 ounce of sunscreen 20 minutes before going out into the
sun (or as directed by the manufacturer) to give it time to absorb into
your skin. Reapply sunscreen—about 1 ounce—every 2 hours or more
if you are swimming or perspiring.
• Apply sunscreen to all areas of your body that are not covered by cloth-
ing or a hat and that might be exposed to the sun, including ears, feet,
hands, back, bald spots, and the back of the neck, as well as areas under
bathing suit straps, necklaces, bracelets, and sunglasses. To protect your
lips, use a lip balm of at least SPF 15-
• Discard sunscreen after the expiration date or after 3 years, because the
ingredients can become less effective over time.
• Sunscreens labeled "water resistant" should maintain their protection
level for 40 minutes of water immersion. Sunscreens labeled "very water
resistant" should maintain their protection level for 80 minutes of
water immersion. Reapply these sunscreens regularly because heavy per-
spiration, water, and towel drying diminish their effectiveness.
• Occasionally, sunscreen ingredients cause skin irritation or reactions.
If this happens, try using sensitive skin formulas or brands made for
children.
• Using sunscreens does not mean that it is safe to spend more time in
the sun, because they don't block all of the sun's damaging rays. In fact,
there is no evidence that sunscreens protect you from malignant
CHAP
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melanoma—the deadliest form of skin cancer. So when you use sun-
screen, be sure to use other protective measures as well, including limit-
ing your time in the sun and wearing protective clothing, hats, and
sunglasses.
Limit Your Time in the Sun
• The sun's UV rays are strongest between 10 a.m. and 4 p.m. Whenever
possible, limit your exposure to the sun during these hours.
• When you are outside, stay in the shade as much as possible. Staying
under cover is one the best ways to protect yourself from the sun.
• Remember that incidental time in the sun can add up to long-term sun
damage. This includes, for example, time spent walking the dog, win-
dow shopping, performing outdoor chores, or jogging at lunch.
• Sun exposure is not required to get a sufficient amount of vitamin D.
Most people get sufficient vitamin D in their diets. If you are con-
cerned about getting enough vitamin D, you can drink vitamin D-for-
tified milk daily or take a multivitamin.
Wear Protective Sunglasses
• Sunglasses that provide 99 to 100 percent UV-A and UV-B protection
will greatly reduce sun exposure that can lead to cataracts and other eye
damage. Check the label when buying sunglasses. Be aware that dark,
polarizing, or mirror lenses by themselves do not offer effective protec-
tion. Protective wrap-around frames provide the best protection
• If you wear corrective lenses, you should add UV-protective coating or
obtain prescription sunglasses if you spend significant periods outside.
Wear a Wide Brimmed Hat
• Whenever possible, wear a hat with a wide brim. This offers good sun
protection to your eyes, ears, face, and the back of your neck—areas
particularly prone to overexposure from the sun. Be aware that baseball
caps, visors, and narrow-brimmed hats provide less protection, particu-
larly for the ears and nape of the neck.
• Choose a hat made from a close-weave fiber. If you can see through the
hat, then sunlight will also get through.
Wear Protective Clothing
• Clothing that is tightly woven, loose-fitting, and full-length (in other
words, with a collar, long sleeves, and long pants or skirts) provides
good protection from the sun's harmful rays.
• UV rays can pass through the holes and spaces of loosely knit fabrics.
Also, wet, faded, or older clothing provides less protection.
RAISING AWARENESS IN THE COMMUNITY 37
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Avoid Sunlamps, Tanning Parlors, and Suntan Products
• Sunbeds and sunlamps emit UV light that can damage the skin and
unprotected eyes.
• Suntan products do not contain a sunscreen and do not provide any
protection against sun exposure.
Protect Children and Babies
• Children typically spend so much time outdoors that they are at high
risk for overexposure to sunlight. Studies increasingly suggest a link
between early sun exposure and skin cancer as an adult. Encourage
your children to take all the safety steps listed above whenever they go
outside. Started early and followed consistently, each of these steps will
become an accepted habit, as easy as fastening seatbelts every time you
drive the car.
• Keep babies out of direct sunlight. The American Academy of
Pediatrics recommends using sunscreen on infants for small areas such
as the face and back of the hands where protection from clothing is
inadequate. For infants younger than 6 months, consult your physician.
• EPA has been working with schools and communities across the nation
to launch the Sun Wise School Program. Sun Wise teaches children in
elementary schools and their caregivers about how to protect themselves
from overexposure to the sun. Educating children about sun safety is
the key to reducing the risk of future UV-related health problems. For
more information about Sun Wise, visit the program's Web site at
.
Check the UV Index
• The UV Index forecasts the next day's likely intensity of UV rays. This
is a useful tool for planning your outdoor activities to protect yourself
from overexposure to sunlight. See below for more information on
where to find the UV Index and how to use it.
What Is the UV Index and How Can I Use It?
• The UV Index is reported daily for localities across the United States. It
forecasts the next day's likely intensity of UV rays.
• Calculated by the National Weather Service, the UV Index takes into
account many factors, including the amount of ozone and clouds over-
head, latitude, elevation, and time of year.
38 CHAPTER 4
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• UV Index forecasts are reported on a scale of 1 through 10+ as follows:
INDEX NUMBER INTENSITY LEVEL
0 to 2 Minimal
3 to 4 Low
5 to 6 Moderate
7 to 9 High
10+ Very High
The higher the UV Index, the stronger the sun and the greater the need to follow
all the sun protection measures. When a UV intensity of 5 or more is predicted
for your area, it is especially important to protect yourself against sun exposure.
The UV Index should not be used to determine the best time to go out and get
a tan.
• You can obtain your local UV Index forecast daily from local weather
stations or newspapers. EPA's Web site provides the UV Index forecast
for your ZIP code. The address is .
• Because the UV Index is a forecast, it won't always be exactly
correct, but it is very reliable. The UV Index is 84 percent accurate
to within ±2.
• Remember that snow, water, and sand reflect the sun's light, so you can
get a double dose of UV exposure in these environments. The UV
Index does not take these factors into account. If you are outdoors in
these environments, your actual exposure will be higher than the UV
Index value indicates.
• Some medications and diseases (e.g., lupus erythematosus) cause serious
sun sensitivity. The UV Index is not intended for use by seriously sun-
sensitive individuals. Consult your doctor about additional precautions
you may need to take.
RAISING AWARENESS IN THE COMMUNITY 39
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40
CHAPTER 4
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Appendix A:
List of Resources
The following list of Web sites, contact information, and additional suggestions
can help you get started with your UV risk education project. This list includes
examples of existing UV risk outreach tools, information on successful UV risk
education strategies, financial assistance resources, volunteer groups that might be
able to provide assistance, measurement resources, and information on working
with the media.
Examples of Existing UV Risk Outreach Tools
• SunWise . Teachers and schools can
join EPA's SunWise Program and receive a number of educational and
outreach products. These include the SunWise Tool Kit (which
includes a UV-sensitive frisbee), the SunWise Internet Learning Site,
and UV Database. Students and teachers can use the SunWise Internet
Learning Site and UV Database to report and interpret daily measure-
ments of UV radiation, explore interactive Web-based games and activi-
ties, and link to other educational activities and resources. Go to
to join the SunWise Program.
• SunSmart . Australia's SunSmart
Internet site provides comprehensive educational material, technical
assistance tools, and sample sun-safe policies for primary and secondary
schools, child-care facilities, community health service organizations,
local government, medical specialists, workplaces, community groups,
sport and recreation clubs, and the tourism industry.
• Choose Your Cover . The
Choose Your Cover Web site includes facts and statistics about skin
cancer, information about the program, and access to all campaign and
educational materials, some of which can be ordered online.
• PoolCool . PoolCool is a sun safety program especially
designed for use at swimming pools. Swimming pools that join
PoolCool receive an educational toolkit, sun safety signs, and technical
support to promote sun safety during swimming lessons and other
pool activities. For more information, contact Tom Elliot, Project
Coordinator, at or 808 586-3076,
extension 69916.
• Sunwise Stampede . Sunwise Stampede is a sun safety
program that encourages zoo visitors to protect themselves from UV
radiation. The program consists of a tip sheet for parents, coupons
for sunscreen and hats, art activities for children, and sun protection
signs and reminders. The Sunwise Stampede Web site includes fun
LIST OF RESOURCES
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educational games for children. For more information, contact Sunwise
Stampede at or 619 594-8745-
• Raising Awareness About Your Skin (RAYS). The RAYS
program is a skin cancer and sun awareness program for middle
and high school students developed by the RAYS Task Force of the
Montgomery County Ohio Medical Alliance. Contact RAYS at
to receive a CD-ROM with slide
presentations, study guides, and tests.
Successful UV Risk Education Strategies
• Guide to Community Preventive Services
. The Guide to Community Preventive
Services is a federally-sponsored initiative that will help communities
develop effective skin cancer (and other disease) prevention education
programs. The cancer chapter, which will provide recommendations on
successful skin cancer prevention strategies, should be complete by
summer 2002.
• Plain English Network . This Web
site is dedicated to helping make all communication materials more user-
friendly through the use of plain English, which means to organize and
write information with the reader's needs in mind. For tips on writing
user-friendly documents, go to .
Financial Assistance
• EPA Grants Administration Division
. EPA and other government
agencies provide grants to organizations that address a variety of envi-
ronmental issues. To access funding opportunities, go to
. For information on
how to apply for a government grant, go to .
• The Foundation Center . As the
most authoritative source of up-to-date information on private philan-
thropy in the United States, the Foundation Center provides print,
CD-ROM, and online resources to help individuals and organizations
identify appropriate grant sources and develop targeted proposals. To
get started, visit for easy access
to Foundation Center services. Note that some grants are available only
to nonprofit organizations.
42 APPE N DIX A
-------
Volunteer Groups that Could Provide Assistance
• Environmental Alliance for Senior Involvement
. The Environmental Alliance for
Senior Involvement (EASI) seeks to increase opportunities for older
adults to play an active, visible role in protecting and improving the
environment in their communities. Contact EASI to learn more
about the availability of senior volunteers at or
540 788-3274.
• Experience Corps® .
Experience Corps provides schools and youth-serving
organizations with older adults who serve as volunteers to improve
the academic performance and development of young people.
Go to to find
an Experience Corps® in your area.
Measurement Resources
• Surveys Developed by Other UV Risk Education Programs.
Many UV risk education programs use surveys to measure their effec-
tiveness in changing sun protection attitudes and behavior. Contact any
of the programs listed above or mentioned in this handbook's case stud-
ies. (See Appendix B: Case Studies of UV Risk Education Programs to
request sample surveys.)
• InnoNet Evaluation Resources
.
InnoNet helps organizations improve their effectiveness. Go to
for answers to
frequently asked questions on how to evaluate programs and for
background information on a number of evaluation topics.
Working With the Media
• It All Adds Up to Cleaner Air Campaign, Effective Media
Relations
.
This Web page provides good descriptions of different media types and
instructions on successfully working with the media to get your mes-
sage out to the public.
• Buckle Up America Campaign, Working With the Media
. Although focused on increasing seat belt
use, this Web page provides helpful suggestions on generating media
attention and creating newsworthy information.
LISTOFRESOURCES 43
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44
APPENDIX A
-------
Appendix B:
Case Studies of UV Risk
Education Programs
School-Based Program: SunWise
EPA developed the SunWise School Program to raise awareness of the health risks
associated with UV overexposure and to encourage behavior change to reduce
these risks. EPA focused on schools because children are at particular risk for sun
exposure. Along with traditional education practices that promote sun protection,
SunWise encourages schools to implement infrastructure enhancements, such as
providing shade through canopies and trees, and to establish policies such as
requiring hats, sunscreen, and sunglasses when outdoors. The program is designed
to provide maximum flexibility—elements can be used as stand-alone teaching
tools or to complement existing school curricula. Though based in schools,
SunWise also supports community partnerships, such as inviting guest speakers
to school assemblies.
SunWise Partner Schools receive materials and tools free of charge to help imple-
ment SunWise in their classrooms and communities. The SunWise Toolkit con-
tains cross-curricular classroom lessons and background information for K
through 8 learning levels. The toolkit also includes tools, including a UV-sensi-
tive frisbee, a hand-held UV meter (if requested), and the On the Trail of the
Missing Ozone comic book, that reinforce sun safety lessons. To reward your stu-
dents for their participation in the SunWise Program, the kit also contains an eas-
ily photocopied "Certificate of Sun Wisdom."
Along with the toolkit, SunWise offers several brochures, fact sheets, and activity
books with suggestions and recommendations for sun safety practices and activi-
ties. The program also maintains an Internet Learning site and a newsletter high-
lighting issues, trends, and success stories. The SunWise Web site
(www.epa.gov/sunwise) gives details on the program and the importance of sun
safety and is divided into sections for educators, students, health care providers,
and the media.
The SunWise Web site offers a database for partner schools to enter their local
daily UV forecast and intensity data. This collected data can then be accessed to
create maps and graphs that can be used as educational tools. For more informa-
tion, go to or contact Kevin Rosseel at
.
Community-Wide Program: Working with
New Hampshire Caregivers To Protect Children from
the Sun (The SunSafe Project)
By training a variety of caregivers on how to promote sun protection to children
and parents, health specialists at Dartmouth Medical School in New Hampshire
demonstrated that community-wide UV risk education programs can lead to
long-term positive changes in sun protection behavior. After initial SunSafe
CASE STUDIES OF UV RISK EDUCATION PROGRAMS
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project interventions at New Hampshire schools, daycare centers, primary care
physician offices, and beaches in 1996, and then a brief follow-up in 1997, the
proportion of children 2 to 11 years of age practicing at least some sun protection
behavior increased from 58 percent to 73 percent. SunSafe also resulted in an
increase in the proportion of children fully protected by sunscreen, clothes, and
shade (from 31 percent to 50 percent), a decrease in the proportion of children
without any sun protection (from 42 percent to 27 percent), and an increase in
the proportion of parents receiving sun protection information from physicians
and schools (from 46 percent to 62 percent).
Ten New Hampshire communities participated in the SunSafe project, with five
receiving interventions, and five acting as controls. Instead of targeting children
and parents directly, project organizers instead focused on teachers, primary care
physicians, and lifeguards.
• Teachers at schools and daycare centers received SunSafe curricula with
lesson plans and educational activities modeled after Australia's
SunSmart program (see page 48).
• Primary care physicians received a manual that teaches office staff and
clinicians how to promote sun protection during medical checkups. In
addition, to enhance sun protection counseling, project organizers pro-
vided physicians with educational posters, pamphlets, and self-adhesive
reminder notes.
• Lifeguards received displays about the UV Index and sun protection to
be posted at beaches. Project organizers also encouraged lifeguards to
provide SunSafe pamphlets and free sunscreen samples to beachgoers.
In addition to providing outreach and educational materials, organizers visited
principals, teachers, physicians, and lifeguards to encourage implementation of
the SunSafe project and provide technical assistance with activities. All outreach
and educational materials conveyed the same basic messages:
• Avoid or limit exposure during the sun's peak hours of 11 am to 2pm.
Teach your child to seek shade if he or she is outside during peak
hours.
• Cover up with clothing and a hat with a brim. Wear a shirt and long
shorts that go to the knee or below.
• Block the sun's rays through the use of a sunscreen with an SPF of 15
or higher. Be sure to put sunscreen on all areas not covered up.
• Say something to your friends and family about being SunSafe. Remind
them that shirts, hats, and sunscreen are important for the whole family
to use every time you are going to be out in the sun.
To track changes in children's sun protection behavior, project organizers trained
a number of observers to visit beaches, interview parents, and detail children's sun
protection behavior. Based on their observations and analyses, Dartmouth
46 APPENDIXB
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Medical School health specialists demonstrated that the SunSafe UV risk educa-
tion project provided long-term benefits to the community.
Since completing the study in 1998, project organizers have initiated a new
SunSafe project that targets adolescents. This project, which will run through
2003, will provide educational materials to middle school teachers and outdoor
sports and recreation staff, and will ask teenagers to participate in a survey and
keep a diary to track their sun protection behavior during the summer. For more
information, contact the SunSafe Project, Department of Community and Family
Medicine, Dartmouth Medical School, at 603 650-1566, or visit the SunSafe
Web site at .
Outdoor Recreation Program: Helping Georgia Soccer
Coaches Promote Sun Protection
In Georgia, where sports are played almost year-round, more than 75,000 youth
play soccer in recreational and competitive leagues. To address the need to protect
soccer-playing youth from overexposure to the sun, university medical researchers
and health communication professionals developed a UV risk education pilot
project that trained soccer coaches to promote sun-safe behavior to young soccer
players. The project focused on eight soccer teams of the St. Simons Island's youth
soccer association in south Georgia.
To determine the content of the soccer coach training program, project organiz-
ers conducted a pretest survey to understand the sun protection practices and
beliefs among soccer coaches and parents of soccer-playing youth. The pretest
identified, for example, that coaches and parents believed it would be difficult for
them to get youths to practice sun protection behaviors. The pretest also under-
scored knowledge gaps, such as in understanding the differences between water-
proof, water-resistant, and sports sunscreens.
Project organizers randomly selected half of the soccer coaches who had partici-
pated in the pretest survey to receive the UV risk education training. Based on the
results and insights gained from the pretest, the program trained coaches to serve
as role models by practicing sun-safe behaviors themselves, encouraging youth to
apply sunscreen before coming to games and soccer practices, and educating par-
ents about the importance of sun protection. To complete the training, coaches
attended a sun protection seminar and received an informational booklet on sun-
burn prevention strategies, skin cancer, and the importance of reducing sun expo-
sure in youth. During the course of the season, coaches promoted sun protection
to youths and parents, and served as positive role models.
In addition to informing the content of the training program, the pretest survey
provided baseline data that project organizers used in conjunction with a post-test
survey to evaluate the effectiveness of the pilot project. The evaluation showed
that as a result of the program, coaches and parents were more likely to tell youths
to wear sunscreen, and coaches were better able to get youths to practice sun-safe
behaviors. For more information, contact Roxanne Parrott of the Office of Health
Communication, University of Georgia, at .
CASE STUDIES OF UV RISK EDUCATION PROGRAMS 47
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Young Adult Program: School-Based Education for
Teenagers in Australia
Because teenagers are often susceptible to peer pressure, it is a particular challenge
to influence them to adopt behaviors that their peers might find socially unac-
ceptable. Researchers from the Center for Health Promotion and Cancer
Prevention Research at the University of Queensland in Australia developed a
school-based UV risk education curriculum that sought to address the peer pres-
sures that teenagers face.
Health and physical education teachers at 13 schools in Queensland, Australia,
taught the curriculum to students every year for 3 years, from 8th to 10th grade,
during a 4- to 6-week period just prior to summer vacation. Through role play-
ing, problem-solving, and student-directed activities, students explored the myths
about sun exposure, the role of peer pressure in tanning, and motivations for act-
ing in health-compromising or health-enhancing ways. Students also learned to
plan ahead for sun safety and practiced critical thinking by analyzing how the
mass media favors certain images. To help students put their newly acquired
knowledge to work, teachers encouraged them to create advertisements that
debunked media images and to brainstorm possible sun protection school policies
that students might find acceptable.
To measure the effectiveness of the curriculum, researchers used surveys before
and after each year's program to assess students' sun protection knowledge, atti-
tudes, and behavior. To ensure the results of the surveys were due to the curricu-
lum and not to any other factors, the researchers also surveyed students in 13
other schools in Queensland that did not receive the curriculum. In the 9th grade,
the students receiving the curriculum showed a marked improvement in knowl-
edge and some behavior change compared to students not receiving the curricu-
lum; however, when the students were surveyed in the 10th grade, it appeared
they were not practicing sun-safe behaviors as often as before. The researchers
attribute the regression in behavior to the many social and cultural pressures
teenage students face inside and outside of school, such as the priority given to
sun protection by peers and the acceptability of wearing hats or long-sleeved shirts
in public. For more information, contact Dr. John Lowe at the Center for Health
Promotion and Cancer Prevention Research, Medical School at the University of
Queensland in Australia at .
National and Community-Wide Program: Australia's
SunSmart Program
Australia's SunSmart program, an initiative of the Anti-Cancer Council of
Victoria, promotes awareness of skin cancer and sun protection measures to chil-
dren, teenagers, and adults. The SunSmart program includes a media campaign,
outreach programs, and research efforts. The media campaign includes advertise-
ments in magazines and trade journals, television commercials, and press cover-
age of SunSmart activities and messages.
Through a variety of outreach programs, SunSmart provides technical assistance,
research, training, and a variety of educational and promotional resources to
48 APPENDIXB
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organizations that can reach many at-risk individuals. SunSmart outreach pro-
grams target primary and secondary schools, child-care facilities, community
health service organizations, local government, medical specialists, workplaces,
community groups, sport and recreation clubs, and the tourism industry. One
goal of SunSmart is to encourage these organizations to institute sun-safe policies,
such as requiring participation in educational programs or the building of shade
infrastructure.
To determine the effectiveness of its media and outreach activities and to guide
future changes to the program, the Anti-Cancer Council of Victoria periodically
evaluates SunSmart. In its most recent evaluation, the council determined the fol-
lowing to be key elements to SunSmart's success:
• Consistency and continuity. SunSmart has been successful because
it has been able to sustain its efforts over the long term—SunSmart has
been operating full-scale since 1988. SunSmart has achieved consistency
and continuity because it has been hosted by a stable and supportive
organization with common goals and a strong research capability, and it
has had reliable and sufficient funding from its host organization and
outside sources with similar health promotion goals.
• Research and evaluation. SunSmart has tailored its efforts based
on research of its target audience's attitudes and behaviors towards sun
protection and skin cancer and on aspects of society that could support
or undermine health messages. In addition, the progress of SunSmart
has been consistently evaluated, helping the organization reshape its
focus when necessary to achieve its goals.
More information on SunSmart can be found at .
Media-Based Program: Choose Your Cover
Through the Choose Your Cover media campaign, the CDC develops and dis-
tributes sun-safe public service announcements (PSAs) and press releases to
broadcast and print outlets nationwide. The campaign also has included several
strategic partnerships to further disseminate sun protection messages. For exam-
ple, since 1999, CDC has worked with Seventeen magazine to sponsor photogra-
phy and T-shirt contests that educate young adults about skin cancer and sun-safe
behaviors. In addition, the campaign has included partnerships with the U.S.
Olympic Synchronized Swimming Team and the Weather Channel.
Another important component of the Choose Your Cover campaign are educa-
tional materials, including posters, brochures, and a Web site. The Choose Your
Cover Web site includes facts and statistics
about skin cancer, information about the program, and access to all campaign and
educational materials, some of which can be ordered online. A number of state
health programs have incorporated or modified Choose Your Cover materials into
their own skin cancer prevention programs.
CASE STUDIES OF UV RISK EDUCATION PROGRAMS
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National Program: National Skin Cancer Prevention
Education Program
The Choose Your Cover campaign is only one part of CDC's
National Skin Cancer Prevention Education Program (NSCPEP)
. In addition to the Choose Your Cover
media campaign, CDC conducts research, funds outreach programs, and builds
partnerships to extend the reach and improve the effectiveness of skin cancer pre-
vention efforts in the United States. For example, CDC established the National
Council on Skin Cancer Prevention, a coalition of organizations dedicated to
fighting skin cancer on a nationwide basis. The goals of the coalition—which
includes 24 organizations, including the American Academy of Dermatology and
the American Cancer Society—are to:
• Increase skin cancer awareness and prevention behaviors among all
populations, particularly those at high risk.
• Develop and support partnerships to extend and reinforce core mes-
sages for behavior change.
• Coordinate nationwide efforts to reduce skin cancer incidence and
mortality.
• Develop a national skin cancer prevention and education plan.
CDC also established a Federal Council on Skin Cancer Prevention to promote
sun-safe behaviors among federal agency employees and their families.
To support innovative state and national skin cancer prevention education initia-
tives, CDC funds a number of outreach programs through NSCPEP. One cur-
rently funded program, PoolCool, seeks to educate parents, lifeguards, pool
managers, and young children about sun-safe behavior when they visit swimming
pools. NSCPEP research focuses on determining national trends in sun protec-
tion behaviors and evaluating current skin cancer prevention efforts. CDC
research also supports the Guide to Community Preventive Services, a federally
sponsored initiative that will help communities develop effective skin cancer (and
other disease) prevention education programs. For more information on this
guide, see .
50 APPENDIXB
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Appendix C:
Examples of Successful
SunWise Programs
Raising Awareness About Your Skin (RAYS),
Montgomery County, Ohio
RAYS is an active volunteer committee that educates students throughout
Montgomery County, Ohio, about the dangers of ultraviolet radiation. The com-
mittee has reached 19,500 students in 35 school districts.
Consisting of more than 32 dermatologists, plastic surgeons, internists, obstetri-
cians, optometrists, and neurologists, along with 25 other volunteers, the com-
mittee arranges assemblies and classroom presentations in middle and high
schools throughout the year. Volunteers use SunWise lesson plans and a captivat-
ing slide presentation to teach students about the early signs of skin cancer and
what risky behaviors to avoid. In addition, volunteers provide SunWise materials
and information to schools and encourage teachers and administrators to join the
SunWise Program. The committee's efforts have been tremendously successful.
Not only has the program been highlighted on the news several times and won
the prestigious Health Awareness Promotion (HAP) award, but its message has
reached an incredible number of students.
The program got its start in 1999 when a group of dermatologists from the Ohio
Medical Association passed a resolution to teach students throughout the state
about the hazards of the sun and tanning salons. Volunteers from the
Montgomery County Medical Alliance decided to take action on the resolution.
When the committee read about the SunWise Program in a newspaper article and
used SunWise materials, it succeeded in attracting schools to the idea.
For more information about RAYS, send an e-mail to .
Center for Creative Learning, St. Louis, Missouri
For the past 4 years, students at the Center for Creative Learning in Missouri's
Rockwood School District have learned about ozone depletion, sun safety, and
skin cancer prevention. As part of their SunWise participation, students in Dottie
Fundakowski's class have conducted videoconferences with EPA SunWise staff,
allowing them to interact with a scientific expert. In addition to answering spe-
cific questions posed by the students, SunWise staff reminded students of their
responsibility to protect their skin and eyes from UV radiation.
Two of Dottie's students even launched their own skin cancer awareness campaign
as their final class project. The project, called "Got Sunscreen?" after the "Got
Milk?" advertisements, was presented to parents, school administrators, and com-
munity experts. The two students designed T-shirts emblazoned with their cam-
paign name and filmed a commercial showing the benefits of using sunscreen.
EXAMPLES OF SUCCESSFUL SUNWISE PROGRAMS 51
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In addition, two other students of Dottie's petitioned the Rockwood School
Board in an effort to change the district policy to allow students to carry and
apply sunscreen at school, for example, during recess or on outdoor field trips.
Sunscreen technically is considered an over-the-counter drug, similar to aspirin or
cough drops, and in most state school districts, they are prohibited from student
use without doctors' and parents' permission to allow nurses or aides to adminis-
ter them. The two students pointed out that if it is difficult to use sunscreen,
fewer students will apply it, and the risk for skin damage will increase. The stu-
dents presented their case well, and the Rockwood School policy now allows stu-
dents to apply sunscreen while on school grounds. They received national press
coverage for their efforts.
Central Middle School, Tinley Park, Illinois
A group of Illinois students recently discovered that asking the right questions can
also save lives. Debbie Brennan, the learning coordinator at Central Middle
School in Tinley Park, Illinois, works with the top 5 percent of the seventh and
eighth grade students as part of the school's gifted program. Brennan practices
"inquiry learning," a loose system that allows students to ask questions about a
topic of their choice and conduct activities to answer them.
"A few years ago in May, a group of my students noticed some high school kids
lined up outside a tanning salon in preparation for their prom," Brennan said. "I
overheard them complaining that tanning causes skin cancer, and I asked them
how they knew for sure." To find the answer, the students began a research proj-
ect on the effects of exposure to ultraviolet (UV) radiation. Not long after that,
Brennan discovered EPA's Sun Wise Web site. She began working with EPA to cre-
ate activities based on Sun Wise materials that fit the Illinois state learning stan-
dards, incorporating language, fine arts, science, and math.
For many of their activities, the students conduct both group and individual
research and then find creative ways to share what they learn. One part of their
research effort was to contact the American Cancer Society, which sent them
information, bookmarks, and stickers related to sun safety. Brennan has also
forged relationships with a local oncologist and a Chicago-based meteorologist,
both of whom are available to answer students' questions.
To share what they learned, the students created flyers on sun safety and distrib-
uted them to local youth sports teams. The students also decorated and gave away
visors and bandanas with UV-sensitive paint and performed experiments by
applying sunscreen to necklaces they made from UV-sensitive beads. As part of a
long-term activity, the students monitor and chart daily local UV intensity. The
students also share their information by writing articles for the school newsletter,
posting articles and notices on a school bulletin board, and posting information
on their Web site .
52 APPENDIXC
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Science Explorer Program, University of Colorado at
Boulder
For the University of Colorado at Boulder's (CU's) Science Explorer Program,
teachers and students put new science curricula to the test. In a series of 30 one-
day workshops held throughout the state, Colorado and New Mexico teachers
and students tried out new science lessons focused on ground-level and stratos-
pheric ozone, as well as UV radiation.
Teams comprised of one teacher and five students, from fifth through eighth
grade, participated in three 75-minute classes throughout the workshops. Each
class featured a variety of ozone-related, hands-on lessons; for example, the teams
searched for ground-level ozone by using Schoenbein paper—a special paper
made of cornstarch, distilled water, and potassium iodide—which turns blue or
purple when in contact with ozone.
In another activity, students and teachers learned about the effects of stratospher-
ic ozone depletion—such as increased UV radiation reaching Earth's surface.
Using color-changing, UV-sensitive Frisbees, the teams evaluated the effectiveness
of various sun-protection materials, including sunscreen, sunglasses, and fabrics.
The teams also constructed chemical models of ozone molecules out of gumdrops
and toothpicks. Studying the conditions of Antarctica, over which an ozone hole
exists, is another topic for curricula activities. After participating in the Science
Explorer activities, students and teachers took their new knowledge and materials
back to their classrooms to share with fellow students and colleagues.
Designed to encourage student interest and aptitude in science, math, and tech-
nology in Colorado and the West, the CU-Boulder Science Discovery Program
has been operating the Science Explorer Program for 15 years, introducing new
curricula to about 300 teachers each year.
For more information about CU's Science Explorer program, contact Lannie
Hagan at 303 492-0771.
Goddard Middle School, Glendora, California
Students in Glendora, California, are using technology to explore the science
behind Sun Wise. Greg Morrison's science class at Goddard Middle School uses
many tools, including the Internet, CD-ROMs, videos, and laboratory experi-
ments to collect, report, and analyze UV-related data. In a favorite class activity,
students use hand-held UV monitors, available from EPA, to measure the inten-
sity of UV rays at ground level. After gathering this data, the students can upload
their results to the Sun Wise Web site.
With the help of the local Rotary Club's Teacher Mini Grant Program, Morrison
runs another popular experiment using UV-sensitive beads to teach students
about the sun's UV rays and the effects of UV radiation on human skin and
health. Outside, students observe the beads changing from clear, light colors to
darker colors, corresponding to the strength of the sun's UV rays. The students
then examine and record the effectiveness of different types of sun protection,
EXAMPLES OF SUCCESSFUL SUNWISE PROGRAMS 53
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covering the beads with sunscreens of various SPF levels, sunglasses, wet and dry
clothing, and plastic.
In addition, Morrison uses video tapes of national newscasts about the ozone
layer, which further demonstrate the scope and breadth of the subject. All these
sun-science activities and students' work are featured on Morrison's class Web site,
< www. morris onlabs. com>.
APPENDIX C
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Appendix D:
How Is the UV Index
Calculated?
The UV Index is calculated by collecting data on stratospheric ozone levels and
forecasted cloud amounts and then transforming these data into a useful metric
that describes how intense the next day's UV radiation will be.
The calculation begins with measurements of current total stratospheric ozone
levels for the entire globe, obtained via two satellites operated by the National
Oceanic and Atmospheric Administration (NOAA). These data are then used to
produce a forecast of stratospheric ozone levels for the next day for various cities
in the United States.
Next, a mathematical model is used to determine the amount of UV radiation
expected to reach the Earth's surface based on the forecasted stratospheric ozone
levels. This mathematical model—a radiative transfer model—takes into account
the time of day, latitude of the city, and day of the year, and then determines
the expected UV levels for wavelengths measuring 290 nanometers to 400
nanometers.
Because some UV wavelengths are more dangerous to human skin than others,
another mathematical function is used to apply a greater emphasis or weight to
the magnitude of the more dangerous UV wavelengths than the less dangerous
UV wavelengths. The weighted UV wavelength levels are then integrated togeth-
er to produce a new value that represents how dangerous the UV radiation is to
human skin.
Cloud cover and elevation affect the level of UV radiation reaching the Earth's
surface, so another calculation is made to take these factors into account. Cloudier
skies limit the amount of UV radiation reaching the surface, and cities at higher
elevations receive more UV radiation. (Although atmospheric pollutants, haze,
and surface reflection (e.g., from sand, water, or snow) also affect the level of UV
exposure, the UV Index currently does not account for these effects).
Lastly, to obtain the UV Index, the adjusted value is scaled down by dividing it
by a conversion factor and rounding this number to the nearest whole number.
Note: the UV Index is calculated differently in different countries around
the world. This section only represents how the United States calculates the
UV Index.
Each year, the National Weather Service (NWS) gathers data on the level of UV
radiation reaching the Earth's surface to measure the accuracy of the UV Index.
Several government agencies, private companies, hospitals, and universities collect
and provide these surface UV data to NWS, which then conducts statistical analy-
ses of the data to determine discrepancies. These validations have shown that the
UV Index forecast is quite accurate.
HOW IS THE UV INDEX CALCULATED? 55
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Surface UV data are often collected using Brewer spectrophotometers. These
monitoring devices are automated instruments that can infer the amount of total
ozone in the stratosphere based on measurements of the UV radiation that reach-
es the Earth's surface. To ensure that all UV monitoring devices are taking similar
and accurate measurements, NOAA's Central UV Calibration Facility compares
UV readings from different monitoring devices and calibrates the devices as need-
ed based on recommendations from the National Institutes of Standards and
Technology.
APPENDIX D
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Appendix E:
Examples of UV Monitoring
Networks and Scientific
Studies in the United States
The National Oceanic and Atmospheric Administration monitoring and satellite
equipment used for collecting data to help calculate the UV Index (see Appendix
D: How is the UV Index Calculated?) is just one of several UV monitoring net-
works in the United States. A number of government agencies, universities, and
institutions have developed other UV monitoring networks to study the effects of
UV radiation on human health, ecological processes, wildlife, and climate. These
data are sometimes publicly available on the Internet.
University of Georgia (UGA)/EPA Monitoring Network
or UV-Net Program
The UGA/EPA Monitoring Network is used to validate the UV Index. This net-
work consists of 21 monitoring devices located in 14 different national parks and
7 urban areas across the country. See for more informa-
tion and to access data.
Park Research and Intensive Monitoring of Ecosystems
Network (PRIMENet)
PRIMENet is a joint EPA/National Park Service program to assess the effects
of environmental stressors, including UV radiation, on ecological systems
nationwide. The UGA/EPA Monitoring Network's 14 monitoring devices
are located in national parks and are used in PRIMENet. A major research
aim of PRIMENet is to investigate the effects of UV radiation on frogs
and other amphibians. For general information on PRIMENet, see
. For information on PRIMENet
amphibian studies, see .
U.S. Department of Agriculture (USDA) UV-B
Monitoring Program
The USDA UV-B Monitoring Program uses a network of 36 monitoring devices
located throughout the United States, including Hawaii and Alaska. These
monitors quantify the atmospheric effects that influence UV radiation and
assess the potential impacts of increased UV radiation levels on agricultural
crops and forests. For more information and to access data, see
.
EXAMPLES OF UV MONITORING NETWORKS AND SCIENTIFIC
STUDIES IN THE UNITED STATES 57
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National Science Foundation (NSF) Polar UV
Monitoring Network
The NSF Polar UV Monitoring Network includes six monitoring devices
that measure UV spectral irradiance at the polar regions. These data are
used by researchers studying the effects of ozone depletion on terrestrial
and marine biological systems. For more information and access to data, see
< www. biospherical.com/nsf/index. asp>.
58 APPENDIXE
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Appendix F:
Frequently Asked Questions
Q: Why is overexposure to the sun dangerous?
A: The sun emits powerful ultraviolet (UV) radiation that can cause a number
of health problems as a result of overexposure. In addition to causing sunburn,
UV radiation can cause health problems that might not become apparent until
many years after sun exposure. These problems include skin cancer, premature
aging of the skin, cataracts, and suppression of the immune system.
Q: Is skin cancer a significant problem in the United States?
A: Skin cancer is the most common form of cancer in the United States. In addi-
tion, the incidence of malignant melanoma, the most dangerous form of skin can-
cer, is increasing more quickly in the United States than for any other form of
cancer. Although skin cancer can usually be cured if detected and treated early, if
detected late or left untreated, skin cancer can cause considerable damage, disfig-
urement, and even death.
Q: If I have darker skin, do I still need to be concerned about
skin cancer?
A: Although the incidence of skin cancer is lower in people with darker skin, the
disease can still occur and often is not detected until it has reached a later, more
dangerous stage. In addition to skin cancer, overexposure to the sun can cause
other health problems in all populations, regardless of skin type. These include
cataracts, premature aging of the skin, and immune suppression.
Q: How is the ozone layer related to UV radiation and skin cancer?
A: The ozone layer serves as a shield in the upper reaches of the atmosphere to
protect the Earth from most of the UV radiation emitted by the sun. In recent
years, scientists have documented seasonal depletions of the ozone layer over
Antarctica, the Arctic, and mid-latitude regions such as North America. Because
the depletion of the ozone layer allows more UV radiation to reach the Earth's sur-
face, scientists are concerned that this phenomenon might create an increased
threat to human health.
Q: What's causing ozone layer depletion and how can it be fixed?
A: Scientists have determined that a variety of synthetic halocarbon chemicals,
such as chlorofluorocarbons, are responsible for depleting the ozone layer.
Countries around the world have recognized this threat and signed a treaty—the
Montreal Protocol on Substances that Deplete the Ozone Layer—to reduce the
global production of ozone-depleting substances. With full compliance from
participating countries, the ozone layer should be restored by the middle of the
21st century. Until that time, increased levels of UV radiation will reach the
Earth's surface.
FREQUENTLY ASKED QUESTIONS 59
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Q: How can I prevent the health problems associated with overex-
posure to UV radiation?
A: A number of sun-safe behaviors can help reduce the risks associated with
overexposure to UV radiation. These include:
• Limiting your time in the sun between 10 a.m. and 4 p.m.
• Seeking shade whenever possible.
• Using a broad-spectrum sunscreen with a SPF of at least 15-
• Wearing a wide-brimmed hat and if possible, tightly woven, full-length
clothing.
• Wearing UV-protective sunglasses.
• Avoiding sunlamps and tanning salons.
• Watching for the UV Index daily and taking appropriate precautions
based on the Index level.
In addition, by educating children and others in your community, you can help
them understand the risks of overexposure to UV radiation and can encourage
them to adopt sun-safe behaviors as well.
Q. When I go out in the sun, my skin tends to tan, not burn. I like
the way a tan looks, but is this safe for my skin?
A: There is no such thing as a healthy suntan. Any change in your natural skin
color is a sign of skin damage. Every time your skin color changes after sun expo-
sure, your risk of developing sun-related ailments increases.
Q: What is the UV Index and where can I find it?
A: Developed by the National Weather Service and EPA, the UV Index provides
a daily forecast (on a 0 to 10+ scale) of the expected intensity of UV radiation
from the sun and helps people determine appropriate sun-safe behaviors. The
lower the number, the less UV radiation is reaching the Earth's surface. Lower
numbers occur during overcast conditions or early and later in the day, while
higher numbers occur during clear or partly cloudy conditions and in the middle
of the day. The Index considers many factors, including latitude, day of the year,
time of day, ozone, elevation, and predicted cloud conditions at solar noon. You
can determine the UV Index for your ZIP code by accessing the following Web
site at .
APPENDIX F
-------
Q: What is SunWise?
A: SunWise is a UV risk education program created by EPA to teach elementary
and middle school students about the science of UV radiation and sun-safe behav-
iors. Schools participating in SunWise receive a variety of ready-made education-
al materials and gain access to the SunWise Internet database where students can
enter and view UV measurement data. In addition to sponsoring classroom and
schoolwide activities, SunWise schools are encouraged to form community part-
nerships and organize sun-safe events. For more information, visit
.
Q: How do I get SunWise educational materials?
A: Join SunWise by signing up through the SunWise Web site at .
Q: Why does SunWise focus on children and schools?
A: Children spend many hours outdoors during recess, physical education class-
es, after-school activities, and sports programs. As a result, most of the average
person's lifetime sun exposure occurs before the age of 18. Schools and teachers
can play a major role in protecting children from overexposure to UV radiation
by teaching sun-safe behaviors.
Q: In addition to SunWise, are there any other UV risk education
programs that I could join?
A: In addition to SunWise, a number of local, state, and national UV risk edu-
cation programs exist. See Appendix B: Case Studies of UV Risk Education
Programs, for information on some of these programs. You can also contact your
local or state health department for more information.
FREQUENTLY ASKED QUESTIONS
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62
APPENDIX F
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Appendix G
Glossary
Basal Cell Carcinoma: Skin cancer tumors that might appear as slow-grow-
ing, translucent, pearly nodules, which can crust, discharge pus, or even bleed.
These tumors typically develop where you are most exposed to the sun—on the
face, lips, tops of ears, and hands.
Chlorofluorocarbons (CFCs): Stable, low-toxic, and inexpensive chemicals
that were most commonly used as refrigerants, solvents, and aerosol propellants
until scientists discovered their destructive power. When strong UV radiation
breaks down CFCs, they release atomic chlorine, which accelerates the natural
destruction of ozone and contributes to ozone depletion. Nations around the
world have agreed to reduce and eventually eliminate production of CFCs.
EMPACT: Environmental Monitoring for Public Access and Community
Tracking, a program begun by EPA in 1996, helps communities collect, manage,
and distribute environmental information, providing residents with up-to-date
and easy-to-understand information they can use to make informed, day-to-day
decisions.
Melanoma: The most fatal form of skin cancer. Malignant melanomas can
appear suddenly without warning as a dark mole or other dark spot on the skin
and can spread quickly.
Montreal Protocol: The Montreal Protocol on Substances that Deplete the
Ozone Layer is an agreement adopted by international governments in 1987 to
reduce and eventually eliminate the emissions of human-made ozone-depleting
substances such as chlorofluorocarbons. The agreement has since been strength-
ened four times as scientists discovered the severity of ozone depletion.
National Weather Service (NWS): Government agency that provides weath-
er, hydrologic, and climate forecasts and warnings for the United States. NWS
issues the UV Index daily.
Ozone Depletion: Acceleration of the natural process of destroying and regen-
erating stratospheric ozone caused by human-made chemicals such as chlorofluo-
rocarbons. The ozone found in the upper atmosphere (stratosphere) is destroyed
and regenerated naturally, but certain human-made chemicals accelerate this
process and damage the protective ozone layer. As this ozone layer breaks down,
it absorbs smaller amounts of UV radiation, allowing the UV radiation to reach
the Earth.
Spectrophotometer: An instrument for measuring the relative intensities of
light in different parts of the spectrum. Scientists use spectrophotometers to
measure the amount of UV radiation reaching the Earth.
Squamous Cell Carcinoma: Skin cancer tumors that might appear as nod-
ules or red, scaly patches, which can develop into large masses and spread to other
parts of the body.
GLOSSARY 63
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Stratosphere: Portion of the atmosphere extending from about 10 km to about
50 km above the Earth. The stratosphere includes the stratospheric ozone layer,
which absorbs most of the sun's harmful rays.
Stratospheric Ozone: A bluish gas composed of three oxygen atoms. Found in
the upper atmosphere, it helps shield the Earth from the sun's UV radiation.
Natural processes destroy and regenerate ozone in the atmosphere. When ozone-
depleting substances such as chlorofluorocarbons accelerate the destruction of
ozone, there is less ozone to block UV radiation from the sun, allowing more UV
radiation to reach the Earth.
Sunscreen: A substance, usually a lotion, that is applied to skin to protect it
from UV radiation. Sunscreen protects by reflecting UV radiation away from skin
and by absorbing UV radiation before it can penetrate your skin.
SunWise School Program: EPA program that aims to teach grades K-8 school
children and their caregivers how to protect themselves from overexposure to the
sun. The program raises children's awareness of stratospheric ozone depletion and
ultraviolet radiation, and encourages simple sun-safety practices.
SunWise Partner Schools: Participants in the SunWise School Program
receive materials and tools for students to actively learn about the health and envi-
ronmental effects of the sun. Schools sponsor cross-curricular classroom lessons,
including measuring and posting UV Index measurements on the Internet.
UV Index: A tool developed by the National Weather Service that predicts the
next day's UV intensity on a scale from 0 to 10+, helping people determine appro-
priate sun-protective behaviors. The lower the number, the less amount of radia-
tion is reaching the Earth's surface. Based on this number, people should take
appropriate sun-safe precautions.
UV Monitoring Networks: Combination of ground-based and satellite data
monitoring stations that track changes in the ozone layer around the world and
help validate the UV index. Using scientific data gathered by monitoring
networks, scientists study a wide variety of health and environmental effects
of UV radiation on humans, crops, forests, and ecological processes on land and
in water.
UV Radiation: A portion of the electromagnetic spectrum with wavelengths
shorter than visible light. UV radiation produced by the sun is responsible for
sunburn and other adverse health effects. Scientists classify UV radiation into
three types: UV-A, UV-B, and UV-C.
APPENDIX A
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United States
Envlroflfnental Protection
Agency
Please make all necessary changes on the below label,
detach or copy, and return to the address in the upper
left-hand corner.
If you do not wish to receive these reports CHECK HERE D:
detach, or copy this cover, and return to the address in the
upper left-hand corner.
PRESORTED STANDARD
POSTAGE & FEES PAID
EPA
PERMIT No. G-35
National Risk Management
Research Laboratory
Office of Research and Development
Cincinnati, OH 45268
Official Business
Penalty for Private Use $300
EPA/625/R-02/008
July 2002
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