Implementation

Three steps should be considered to implement primary prevention for overexposure to sunlight.

• Develop collaboration between the NCCP and those in government and NGOs who want to control overexposure to sunlight.

• Perform a sampling survey to determine current beliefs about the dangers of sun exposure.
• Establish a primary prevention program against overexposure to sunlight using the threefold strategy of education, legislation and national leadership as summarized on slide 11 and discussed in more detail below.

Excessive exposure to ultraviolet radiation from the sun, especially of the B spectrum, is a risk factor for skin cancer. Basal and squamous cell carcinomas tend to occur in areas of the skin that have been directly exposed for long periods. Sunlight exposure is also a risk factor for malignant melanoma. In the latter case individuals at high risk have the so-called Celtic skin type characterized by fair hair, blue eyes, and light skin with excessive freckling and benign nevi, which burns easily on sun exposure.

Education programs by ministries of health and by nongovernmental organizations (NGOs) to persuade people to avoid unnecessary exposure to the sun are important components for prevention. Programs try to increase the number of people who are aware of their own risk factors for skin cancer. They aim to persuade people to avoid excessive exposure to the sun and to artificial ultraviolet sources such as tanning parlors. They learn to adopt protective measures for themselves and their children such as the proper use of sunscreens that block both UVA and UVB radiation and that carry an SPF (sun protective factor) of at least15. They learn the importance of clothing and hats to block sunlight, the use of sunglasses, and to avoid or reduce sun exposure at particularly intense times such as between 11:00 and 15:00 hours and in environments like snow, rock or cement where reflection is high. Ultraviolet radiation levels are monitored routinely and the public is informed when levels are high. Programs also try to change public attitudes to the desirability of a tanned appearance. In addition, countries are encouraged to be part of international agreements to reduce the emission of chemicals that damage the earth’s ozone layer.

Evaluation

For control of overexposure to sunlight, WHO (1995) recommends the following indicators as examples.

Process Measures
Over 80% of schoolchildren aged 10 years and over get education about the hazards of too much exposure to the sun.
Over 50% of adults get a message yearly about the hazards of overexposure to sunlight.

Impact Measures
Over 80% of schoolchildren aged 10 years and over are aware of the hazards of sun overexposure (population survey).
Over 50% of adults are aware that sun overexposure can cause some types of cancer (population survey).
Regulations are implemented to ban chemicals that damage the ozone layer.

Outcome Measures
Short term: More than half of adults are moderating their sun exposure.
The thickness of the ozone layer is monitored.
Ultraviolet radiation levels are monitored.
Medium term: Reduced prevalence of sun-damaged skin.
Long term: Reduced incidence of skin cancers.

Click to return to slide 11