Appendix: UVR Pilot Project

Appendix: UVR Pilot Project

1. WCPEDN Funding Request

2. Teacher’s Resource, UVR Pilot Project

3. UVR PowerPoint Presentation

4. Parent Letter

5. Pre-Questionnaire, June 2, 2010

6. Post-Questionnaire, June 2, 2010

7. Follow-up Questionnaire, June 2, 2010

8. (Revised) Follow-up Questionnaire, College Heights, December 2, 2010

9. Media Release, May 26, 2010

10. Guelph Mercury newspaper article, May 28, 2010

11. Orangeville Banner web article, June 10, 2010

Wellington Cancer Prevention and Early Detection Network

Funding Request

Network Chapter Wellington

Name of person

applying

Beth Watters

Health Promotion Specialist

Healthy Living Team

Organization/

Subcommittee

Wellington-Dufferin-Guelph Public Health

Contact

Information

[email protected]

(519) 846-2715, ext. 4658

Amount Requested $5,5054.25

(March 5, 2010)

Cancer Care Ontario’s plan – The Ontario Cancer Plan 2008-2011 – has six goals that

span the entire disease. Please indicate which goal this project addresses (check all that

apply):

XReduce the incidence of cancer (through prevention)

Reduce the impact of cancer through effective screening and earlier detection

Ensure timely access to effective diagnosis and high-quality cancer care

Improve the patient experience along every step of the cancer journey

Improve the performance of Ontario’s cancer system

Strengthen Ontario’s ability to translate cancer research into improvements in

cancer services and control

Please indicate which risk factor this project addresses, as outlined in Cancer Care

Ontario’s Cancer 2020 action plan (check all that apply):

Tobacco use reduction

Nutrition, physical activity, obesity and alcohol

Screening and early detection

X Ultraviolet radiation exposure

Occupational carcinogens

Environmental carcinogens

mailto:[email protected]

Please outline the project below by filling in the applicable boxes:

Rationale for

project/

Background

Risk of ultraviolet radiation

Skin cancer is the most common type of cancer diagnosed in Ontarians, accounting for

approximately one-third of all new cancer cases.1 Melanoma (one type of skin cancer)

can be fatal.2 Exposure to ultraviolet radiation (UVR) is the main cause of skin cancer,

which is found both in the sun’s rays, 3 as well as in the light from artificial tanning

equipment. Further, there is an increased risk of ocular melanoma associated with the use

of tanning beds. In fact, a press release issued by the World Health Organization (WHO)

concluded that an International Agency for Research on Cancer Working Group has

classified UV-emitting tanning devices as “carcinogenic to humans”.4

Youth/young adults as a priority group

Despite the risks associated with tanning, 21% of Canadian adults try to get a tan from the

sun. Of those, 49% of young women (aged 16-24) and 28% of young men activity try to

get a tan from the sun – an activity which is rare with seniors. The rate of exposure to

UVR from the sun is greater with young men and women, than it is with older adults or

children. Also, those aged 16-24 are also the least likely to protect themselves from the

sun.5

Unlike exposure to the sun however, the use of tanning equipment is more common

among young women than among young men or older adults. In Canada, 27% of young

women use tanning equipment compared to 15% of women aged 25-44 and 8% of women

aged 45-64.6 This figure is comparable to that determined by the Canadian Cancer

Society, which surveyed women aged 18-34 and found 29% reported using tanning

equipment in the past 12 months.7 The WHO reinforced the importance of addressing

artificial tanning rates in young adults in July 2009 reporting that the risk of melanoma is

increased by 75% when the use of tanning devices starts before age 30. This finding, as

well as the increased risk of ocular melanoma is supported by experimental animal

studies.8

Timely intervention

Given the risks and aforementioned statistics, there is a clear need to raise awareness in

Canada and Ontario – especially with youth, as to the risks associated with UVR using

targeted and evidence-based interventions that are age and culturally appropriate.

Conveniently, reducing skin cancer prevention rates through UVR prevention strategies is

a priority among public health professionals. Specifically, Public Health units across

Ontario are mandated to raise public awareness regarding UVR overexposure in

accordance with the revised Ontario Public Health Standards.9

1 Cancer System Quality Index – CSQI, 2008

2 World Health Organization (WHO), Media Centre – IARC News: Sunbeds and UV Radiation, July 29,

2009, Retrieved from http://www.iarc.fr/en/media-centre/iarcnews/2009/sunbeds_uvradiation.php 3 National Sun Survey Highlights Report, July 10, 2008

4 WHO, 2009.

5 National Sun Survey Highlights Report, July 10, 2008

6 Ibid.

7 Report on Cancer 2020, Ultraviolet Radiation

8 WHO, 2009.

9 Ministry of Health and Long-Term Care, Ontario Public Health Standards, retrieved on February 24,

2010 from

http://www.iarc.fr/en/media-centre/iarcnews/2009/sunbeds_uvradiation.php

Proposed pilot project

In December 2009 the author conducted a literature review to examine effective UVR

interventions targeting youth.10

Studies defined “youth” in different ways, though most

considered youth to be either secondary school age (approximately 14-17), or secondary

school and post-secondary school age (approximately 14-24). For the purpose of this

pilot project, youth within secondary schools, and more specifically, cosmetology classes

within a vocational secondary school will be targeted. A secondary school is being

targeted over the University of Guelph because Public Health Nurses have existing

relationships with the 14 secondary schools in the region and cosmetology classes teach a

skin module that includes information on skin cancer, which is a natural fit with the

project’s subject matter.

The studies reviewed were fairly consistent in their findings. These include:

1. Youth appear to be fairly knowledgeable about the risks of UVR, including skin

cancer

2. Despite youths’ knowledge of UVR risks, they continue to desire and seek a tan

3. Youth value a tanned appearance; they believe it makes someone look healthier

and more attractive

Endeavouring to change youths’ attitudes/beliefs, behaviours, and behavioural intentions,

researchers focused on in-class interventions (i.e. education) with youth. To date, UVR

curriculum that has been most effective incorporated the use of UV technology to enhance

pigmentary changes in the youths’ skin. Exposure to UVR increases pigment in an

individual’s skin, which manifests as age spots. Age spots are also called sun spots, liver

spots, freckles, or hyperpigmentation. Hyperpigmentation is one form of skin damage

while reduced skin elasticity is another, which in turn manifests as lines and wrinkles.11

It

typically takes many years for skin damage caused by the sun (i.e. photoaging or

photodamage) to become apparent. UV technology however, enhances the existing

pigmentary changes which are otherwise less visible to the naked eye. Studies

hypothesize that since youth value tanning mainly for appearance-enhancement reasons,

interventions that illustrate short-term consequences to one’s “beauty” and “appearance”

are likely to be more effective than those that focus on long-term consequences. As such,

UV technology which reveals existing photodamage or emphasizes other immediate

consequences may be more likely to influence attitudes or beliefs. An example of such an

approach is a social marketing campaign that ran in November and December 2009 in the

state of Victoria, Australia. This campaign showed the negative effect of tanning on

one’s appearance by using photos of a young girl, who has a scar on her neck from a

removed tumour.12

Researchers hypothesize that emphasizing short-term consequences especially impacts

upon an individual’s perceived susceptibility to the risk. The Health Belief Model is a

common theoretical framework upon which much research is based and posits that an

individual’s behaviour is mediated by several cognitive factors, namely perceived

susceptibility, severity, benefits, barriers, cues to action, and self-efficacy. The other

theoretical framework upon which many studies are based, is the Transtheoretical Model.

Under this model, most youth would be considered “pre-contemplative” because they

have no intention of changing their tanning behaviours. Again, the perceived benefits

http://www.health.gov.on.ca/english/providers/program/pubhealth/oph_standards/ophs/progstds/pdfs/ophs_

2008.pdf 10

See attached Literature Review: Youth and Tanning for more information 11

New Skin Oasis, Photodamage treatments, retrieved on February 24, 2010 from

http://www.newskinoasis.com/photodamage.asp 12

SunSmart, Cancer Council Victoria, Tanning and solariums, Solariums: Fashion to die for, retrieved on

February 24, 2010 from http://www.sunsmart.com.au/sun_protection/tanning_and_solariums

http://www.health.gov.on.ca/english/providers/program/pubhealth/oph_standards/ophs/progstds/pdfs/ophs_2008.pdf

http://www.health.gov.on.ca/english/providers/program/pubhealth/oph_standards/ophs/progstds/pdfs/ophs_2008.pdf

http://www.newskinoasis.com/photodamage.asp

http://www.sunsmart.com.au/sun_protection/tanning_and_solariums

appear to outweigh the risks – or at least in the short-term.

Evaluations of the interventions relied primarily on self-report data, though some utilized

new technology which measures skin’s exposure to UVR. This is an expensive and new

data collection method, which requires refinement.

Based on evidence, the aforementioned theoretical models, as well as health promotion

best practice, a pilot project is proposed to address one prong of a multi-pronged strategy

to raise awareness of UVR exposure among youth in the County of Wellington and

ultimately change attitudes and behaviours related to UVR exposure. An effective health

promotion strategy must include targeted interventions for different audiences with

different objectives and outcomes (i.e. personal skills, community capacity,

environmental support, and policy13

). Given this, additional interventions and strategies

will be devised to target other priority groups, work with community groups, and

strengthen new or existing efforts to increase environmental supports and develop healthy

policy.

The proposed pilot project will target the youth enrolled in Grade 11 and 12 cosmetology

classes from a secondary school in the City of Guelph. Existing skin and skin cancer

curriculum will be augmented by the use of the software program that enhances digital

photos to show pigmentary changes (i.e. existing skin damage) during one of the lessons.

This lesson will be taught by the cosmetology teacher. Qualitative pre, post, and follow-

up data will be collected with the youth, and quantitative data collected from teacher(s)

through follow-up interviews. Depending on the outcome of this pilot project, additional

funding may be requested through the WCPEDN or other funding bodies to expand the

project to other classes which include a health component (such as physical education,

health/wellness, parenting, etc.) at both vocational and academic secondary schools in the

region.

Goals &

Objectives Goal:

To decrease the morbidity and mortality rates from skin cancer in the County of

Wellington.

Objectives:

1. Increase youth’s awareness and knowledge of the risks associated with

ultraviolet radiation

2. Decrease youth’s perceived benefits UVR exposure

3. Increase youth’s intention to engage in sun protection behaviours and artificially

tan less

4. Decrease youth’s exposure to UVR by increasing sun protection behaviours

5. Decrease youth’s exposure to UVR by decreasing their use of artificial tanning

equipment

Timelines Pilot Project:

Timeline Main Tasks

March 2010 1. Receive funding approval from the WCPEDN

2. Purchase Mirror software, electronics, and supplies

3. Review and complement existing skin cancer module in the

cosmetology curriculum

4. Compile a suggested UVR lesson plan for the application of

the software in the classroom

5. Collect feedback from participating teacher(s) on the UVR

13

First International Conference on Health Promotion, Ottawa Charter for Health Promotion, Ottawa,

November 21, 1986, retrieved on February 24, 2010 from

http://www.who.int/hpr/NPH/docs/ottawa_charter_hp.pdf

http://www.who.int/hpr/NPH/docs/ottawa_charter_hp.pdf

lesson plan

6. Revise the UVR lesson plan and prepare it and any additional

resources for distribution

Late April to

May 2010 College Heights Secondary School

1. Implement pre-test/questionnaire assessing knowledge,

attitudes/beliefs, behaviours, and behavioural intention before

UVR lesson

2. Implement UVR lesson

3. Implement post-test after UVR lesson to assess whether there

was a knowledge increase, any impact on attitudes and

beliefs, or impact on behavioural intention for the coming

months (including summer)

June 2010 1. Conduct interview with teacher(s) to collect feedback on the

UVR lesson plan, additional resources, Mirror software, and

overall impression

2. Compile and summarize results from student and teacher

questionnaires in a mid-term report

September

2010

1. Conduct a 5 month follow-up survey with the youth to assess

knowledge attitudes/beliefs, behaviours, and behavioural

intention post-summer

October

2010

1. Compile and summarize results from student questionnaires

2. Make recommendations for future use

3. Apply for additional funding should the pilot be successful

and outline plan to expand the curriculum to physical

education, health/wellness, and other appropriate classes in

both vocational and academic secondary schools

List other

partners

involved in

the project

At this time, there is one participating school from the County of Wellington:

1. Robert Mayer, Cosmetology Teacher, College Heights Secondary School,

Guelph

Activities Key activities for this pilot project include:

1. Develop a UVR lesson plan in consultation with participating teachers

2. Implement a UVR lesson using the Mirror software with cosmetology classe(s)

3. Conduct a pre and post test with students, as well as a 5-month follow-up survey

4. Collect teacher input through a questionnaire and follow-up meeting

5. Compile findings from the pilot project into a mid-term and final report

How will you

evaluate the

program?

We will evaluate this pilot project using both quantitative and qualitative methods.

Students:

Impact on students’ knowledge, beliefs/attitudes, behaviours, and behavioural intention

with regard to UVR exposure will be measured using a quantitative method. The pre,

post, and follow up questionnaire will be the same, and be administered in the classroom

by the Cosmetology Teacher. The follow-up survey will also be available on Survey

Monkey in case there are some students who do not continue with cosmetology the

following year or have graduated. The primary limitation of this research method is that

it relies on self-reports, which could be influenced by social desirability, memory, or other

factors. We hope to minimize social desirability error by keeping the surveys anonymous

(no names or identifying information will be collected) and confidential (findings will be

posted for public consumption).

Teachers:

Ease, user-friendliness, and appropriateness of the UVR lesson plan, additional resources,

Mirror software will be evaluated using a qualitative method, namely follow-up

interviews with the participating teachers. Interviews will be conducted at a time and

place that is convenient for them. Like the responses from students, their feedback will

remain confidential and be used solely for the future development and enhancement of

similar programs in schools or the community.

How can this

project benefit

other network

members?

How will the

information be

shared with

other network

members?

Network members will have access to the equipment and materials produced in this pilot

project for use and adaptation for other priority groups, as well as any evaluation reports.

Please outline the proposed budget below:

Original budget:

Item Vendor Unit Cost Units Shipping Other Subtotal Tax Total

Mirror software ($2500.00 and $90.00 USD with exchange = approximately $2750.00 and $95.00) plus duty

Canfield Scientific Inc. $2,750.000 1 $95.00 $50.00 $2,895.00 $434.25 $3,329.25

Laptop computer TBD $1,100.000 1 $1,100.00 $165.00 $1,265.00

Laptop case TBD $50.000 1 $50.00 $7.50 $57.50

Portable photo printer TBD $180.000 1 $180.00 $27.00 $207.00

USB cable TBD $5.000 1 $5.00 $0.75 $5.75

Photo paper (100 sheets/pack) TBD $20.000 3 $60.00 $9.00 $69.00

Photo printer ink cartridges TBD $35.000 3 $105.00 $15.75 $120.75

Total $5,054.25

Additional expenses:

Item Vendor Unit Cost Units Shipping Other Subtotal Tax Total

Tim Horton gift cards Tim Horton’s $20.00 3 0 0 $60.00 0 $60.00

CTV news reports CTV news Southwestern $65.00 2 0 0 $130.00 0 $130.00

Pizza (50 students x 2 slices = 100 slices/8 slices per pizza = 13 pizzas) e.g. Pizza Pizza $15.00 13 0 0 $195.00 $25.35 $220.35

Juice (50 students) e.g. No Frills $0.50 50 0 0 $25.00 0 $25.00

Survey prize – gift cards? TBD $65.00 1 0 0 $65.00 0 $65.00

Total ~$500.00

Teacher’s Resource Ultraviolet Radiation (UVR) Pilot Project May 2010

Prepared by: Beth Watters Health Promotion Specialist Healthy Living Team

Teacher’s Resource UVR Pilot Project, May 2010 11

Table of Contents

Lesson Objectives ......................................................................................... 12 Lesson Preparation ....................................................................................... 12 Lesson Plan .................................................................................................... 12 UVR Background Information ....................................................................... 13 Introduction ...................................................................................... 13 What is UVR? ............................................................................. 13 UV Index ..................................................................................... 14 What are the risks of UVR? ......................................................... 15 Summary of Risks ....................................................................... 19 Who is at risk? ............................................................................ 19 Moles .......................................................................................... 21 Mirror Software ................................................................................ 22 What are we seeing? .................................................................. 22 Dark-skinned individuals ............................................................. 23 Harm Reduction & Skill Building: ................................................... 24 How can we reduce our UVR exposure? .................................... 24 What sunscreen do we pick? ...................................................... 16 How do we apply sunscreen? ..................................................... 16 How do we pick a sunless tanning product? ............................... 16 How do we apply a sunless tanning product? ............................. 16 Appendix Indoor Tanning: Myths & Facts ................................................... 17 Recommended Revisions to Science of the Skin ........................ 18 Using the Mirror Software & ―Enhance‖ Tool ............................... 20


Lesson Objectives By the end of the lesson, students should understand that:

1. Skin cancer is very common in Canada, and even occurs in young people 2. Melanoma is the most dangerous form of skin cancer 3. UVR from the sun and tanning beds carries health risks, including the risk

of skin cancer 4. Risk of skin cancer increases with more exposure (including tanning),

sunburns, family history, and skin type 5. Skin damage from UVR happens even though you cannot see it 6. Tans are not a good way to get vitamin D, nor do they protect against skin

damage 7. Suspicious moles should be checked by a doctor 8. Sunscreen should be broad-spectrum (protects against UVA and UVB)

and have an SPF of at least 15

Lesson Preparation Ask for student volunteers – especially fair-skinned students – to take head-shots of themselves. Upload the photos to the laptop. Note: The effects of UVR are more evident with fair-skinned individuals (those who have red or blonde hair, are susceptible to freckling, and have blue or green eyes). Also, photos should be taken without make-up on, in a well-lit room, and using the camera’s flash. Lesson Plan 1. Pre-test a. UV questionnaire 10 min

2. Introduction

a. What is UVR? 5 min

b. What are the risks of UVR? 15 min

c. Who is at risk? 10 min

3. Mirror software

a. What are we seeing? 15 min

b. Dark-skinned individuals 5 min

4. Harm reduction and skill-building

a. How can we reduce our UV exposure? 10 min

b. How do we pick a sunscreen? 5 min

c. How do we apply sunscreen? 5 min

d. How do we pick a sunless tanning product? 5 min

e. How do we apply a sunless tanning product? 5 min

5. Post-test a. UV questionnaire 10 min

Total 100 min (1 hr, 40 min)


UVR Background Information

Introduction:

What is UVR?

Ultraviolet radiation (UVR) is invisible energy in the wavelength range from 100 to 400 nanometres (nm). It is shorter and more energetic than visible light.14

UVR is divided into three wavelength ranges: UVA (long-range radiation between 320 and 400 nm); UVB (short-wave radiation between 280 and 320 nm) and UVC (wavelengths between 100 and 280 nm).15 Broad-spectrum UVR contains UVA and UVB radiation or all three.16

Radiation from the sun and tanning equipment is the same type of radiation17 and is mainly made up of UVA radiation with some UVB.18 UVA can penetrate into the dermis and is responsible for immediate tanning that fades after 3 to 36 hours.19 UVB can penetrate into the epidermis and is responsible for sunburns and delayed tanning that appears within 2-3 days and lasts for a longer period of time.20

14

Health Canada, Sunlight and Ultraviolet Exposure, Retrieved from http://www.hc-sc.gc.ca/hl-vs/sun-

sol/expos/index-eng.php 15

Ibid. 16

U.S. Department of Health and Human Services, 2005. 17

U.S. Department of Health and Human Services, Public Health Service, National Toxicology Program.

Report on Carcinogens, Eleventh Edition, 2005. 18

International Agency for Research on Cancer (IARC), World Health Organization. Exposure to Artificial

UV Radiation and Skin Cancer. 2006. 19

Health Canada. Guidelines for Tanning Salon Owners, Operators, and Users, Revised 2005. 20

Ibid.

http://www.hc-sc.gc.ca/hl-vs/sun-sol/expos/index-eng.php



UVC is very dangerous to all forms of life, even with very little exposure. UVC radiation from the sun is completely absorbed by the ozone layer and never reaches the earth’s level. Indoor tanning equipment should not emit UVC, but if it does, is must comply with regulations.21 UV Index The UV index is a measure of the intensity of the sun’s UVR in the sunburning spectrum. As the UV index rises, so too does the risk to one’s skin, eyes, and immune system. More protection is needed at higher UV levels. The UV index ranges between 0 and 16. The highest UV values are found on mountain tops at the equator. In Canada, the UV index generally ranges between 0 and 10. The UV index is the maximum value expected for a given day usually around solar noon. The UV index is dependent upon thickness of the ozone layer, latitude, altitude, reflection, and clouds.

UV Index Category

+11 Extreme

8 to 10 Very High

6 to 7 High

3 to 5 Moderate

21

Ibid.


UV Index Category

0-2 Low

What are the risks of UVR?


DNA damage

When UVR enters skin cells, it damages DNA – the genetic material of cells. UVB is a complete carcinogen that is absorbed by DNA and can directly damage DNA. UVA is not readily absorbed by DNA but it induces DNA damage through an indirect chemical process. Thus both UVA and UVB can cause cell damage, but through different mechanisms. DNA repair and programmed cell death (apoptosis) protect the cell against UV-induced damage. If the cell is unable to protect itself, then mutations are likely to occur and persist through subsequent cell divisions. These mutations are found in skin cancer patients.22 Both animal and human studies have found that a sunburn is not required to induce DNA damage. One study found UVA-induced injury after repeated exposure to relatively low doses of UVA radiation. This demonstrates the cumulative damage caused by ongoing exposure to UVR, thereby challenging the concept of a ―safe tan‖.23

Skin cancer

Broad-spectrum UVR, such as that emitted from the sun and indoor tanning equipment, can cause skin cancer in humans. Also, UVA, UVB, and UVC radiation are each known individually to cause skin cancer in humans.24 There are three forms of skin cancer: basal cell carcinoma (BCC), squamous cell carcinoma (SCC), and melanoma.

In Canada, non-melanoma cancers (BCC and SCC) are the most common form of cancer that is diagnosed.25 Although melanoma is not as common as BCC and SCC, it is the third most common cancer in young women between the ages of 15 and 29.26 Also, more young women in Canada, between the ages of 16 and 24, tan than young men or older women.27

BCC is the most common form of skin cancer in Canada. Fortunately it is the least dangerous form of skin cancer but it still must be treated as it will continue to grow, invading other cells and eventually causing

22

IARC, 2006. 23

Woo, D.K., Eide, M.J. Tanning beds, skin cancer, and vitamin D: an examination of the scientific

evidence and public health implications. Dermatologic Therapy, Vo. 23, 2010, 61-71. 24

Ibid. 25

Canadian Cancer Society, Canadian Cancer Statistics 2009, Special Topic: Cancer in Adolescents and

Young Adults, April 2009. 26

Ibid. 27

National Sun Survey, Highlights Report, July 10, 2008.


disfigurement.28 It usually appears on sun-exposed areas of skin, especially the face and neck, but also the trunk, arms, and legs. Solar UVR is the main cause of this skin cancer.29 SCC is the second-most common form of skin cancer in Canada. It too must be treated as it can continue to grow, invade other cells, and spread to other areas of the body.30 It appears on chronically sun-exposed areas of the body, such as the head and neck, arm, back of the hand, and leg. Cancers on the rim of the ear and lip can be more aggressive.31

Malignant melanoma is the least common form of skin cancer in Canada, though it’s the most dangerous. 32 When found at an early stage, it has one of the highest cure rates of all cancers. If untreated, it can invade other cells, enter the bloodstream and lymphatic system, and spread to other parts of the body. It can be fatal. Melanoma starts in the melanocytes and forms a tumour. It’s often found on the back in men and the leg in women. Experts estimate about 90% of melanomas are caused by UVR and sunburns.33

Solar radiation (from the sun) increases the risk of all three types of skin cancer. In 2009, the International Agency for Research on Cancer stated that the risk of cutaneous [skin] melanoma is increased by 75% when the use of tanning devices starts before age 30.34

Types of Skin Cancer by UVR Source

Solar radiation Tanning bed radiation

Basal cell carcinoma

Squamous cell carcinoma

Melanoma

Melanoma

Premature aging

Skin aging is affected by ―intrinsic‖ and ―extrinsic‖ factors. Intrinsic factors are genetically determined, while sun exposure is the main extrinsic factor. Both UVB and UVA are held responsible for aging.

28

Canadian Dermatology Association (CDA), Skin Cancer, Retrieved from

http://www.dermatology.ca/skincancer/index.html 29

CDA, Basal Cell Skin Cancer, Retrieved from

http://www.dermatology.ca/sap/safety_resources/cancer/basal_cell.html 30

CDA, Skin Cancer. 31

CDA, Squamous Cell Skin Cancer, Retrieved from

http://www.dermatology.ca/sap/safety_resources/cancer/squamous_cell.html 32

CDA, Skin Cancer. 33

CDA, Melanoma, Retrieved from http://www.dermatology.ca/programs/melanomainfo/index.html 34

World Health Organization (WHO), Media Centre – IARC News: Sunbeds and UV Radiation, July 29,

2009, Retrieved from http://www.iarc.fr/en/media-centre/iarcnews/2009/sunbeds_uvradiation.php

http://www.dermatology.ca/skincancer/index.html

http://www.dermatology.ca/sap/safety_resources/cancer/basal_cell.html

http://www.dermatology.ca/sap/safety_resources/cancer/squamous_cell.html

http://www.dermatology.ca/programs/melanomainfo/index.html



Intrinsic ageing is characterized by thinning of the skin accompanied by reduction in collagen levels. The changes caused from sun exposure (i.e. photoaging) are loss of elasticity, pigmentary change, and deep wrinkling. Most of these changes result from damage to the dermis. Few studies have looked at indoor tanning and aging in humans.35

Other risks36

UVR can cause sunburns. Sunburns in childhood or adulthood is a risk factor for melanoma. The more sunburns you have, the more your risk increases. You can also get a sunburn from tanning beds – 18-55% of indoor tanners in Europe and North America report burns. Note: You can still burn with a base tan – it only provides an SPF between 2 and 437. Also, a base tan provides little to no protection against sun-induced DNA [skin] damage.38 Given that skin damage is cumulative, you may be increasing your risk of skin cancer the more you tan.39 Solar UVR can suppress the immune system. Few studies have looked at indoor tanning and the effect on the immune system.

35

IARC, 2006. 36

Ibid. 37

Canadian Dermatology Association. Indoor Tanning is Out. Copyright 2004-2009. Retrieved from

http://www.dermatology.ca/indoortanning/index.html 38

IARC, 2006. 39

Woo et al, 2010.

http://www.dermatology.ca/indoortanning/index.html


Solar UVR can aggravate a wide variety of skin conditions, such as eczema or psoriasis. It seems that exposure to tanning devices may have a similar effect. Solar UVR can cause cataracts and pterygium (benign growth on the eye), and some studies also suggest that solar radiation may be associated with melanoma of the eye and non-Hodgkin’s lymphoma.40 Also, the risk of ocular (eye) cancer is increased by using tanning devices. 41 Summary of Risks

Solar radiation Tanning bed radiation

Skin damage

Basal cell carcinoma

Squamous cell carcinoma

Melanoma

Premature aging (loss of elasticity, pigmentary changes, wrinkles)

Sunburn

Suppressed immune system

Aggravation of skin conditions

Cataracts

Benign eye growths

Possibly ocular melanoma & non-Hodgkin’s lymphoma

Skin damage

Melanoma

Ocular melanoma

Sunburn

Possibly aggravation of skin conditions

Who is at risk?42

A person’s risk of sun-induced skin damage and developing a skin cancer (SCC, BCC, or melanoma) is closely related to their pigmentary traits. People with the following characteristics have a higher risk of developed a skin cancer:

Hair colour: red hair, then blonde hair, then light brown hair

Skin phototype: those who always burn and never tan when going unprotected in the sun (skin photoype I) have a much higher risk than those who never burn and always develop a deep tan (skin phototype IV); intermediate risk categories are those who always burn then develop a light tan (skin phototype II) and those who sometimes burn and always develop a tan (skin phototype III); those with skin phototypes V and VI have natural brown or black skin and are resistant to sunlight

40

U.S. Department of Health and Human Services, 2005. 41

World Health Organization, 2009. 42

Ibid.


Freckling sensitivity: freckles on the face, arms or shoulders; risk increases with increasing sensitivity to freckling

Skin colour: pale colour, followed by increasing pigmentation

Eye colour: blue, followed by grey/green eyes, then brown eyes *Those with red hair, many freckles, who never tan are at particularly high risk for skin cancer.

Type Skin Colour Eye Colour Sun

Exposure Tanning

Response Response to UV

I Porcelain (white)

Blue Always burns

Never tans Extensive freckles early; total loss of melanin in areas

II Sea shell (winter wheat)

Green Always burns

Sometimes tans

Freckles; no complete loss of melanin in areas

III Cameo (sandy brown)

Hazel Sometimes burns

Always tans Patches of freckles and/or hyperpigmentation

IV Almond Glo (burnt sienna)

Brown Rarely burns Rapid tanning

Hyperpigmentation (may be blotchy but no freckles)

V Nutmeg (amber)

Dark brown May develop slight redness

Dark tan Uniform hyperpigmentation (no blotching)

VI Black (walnut)

Black Never burns Dark black Uniform pigment

Additions to the Fitzpatrick Sun-reactive Skin Types I through VI43

A person’s risk of melanoma is also increased if they have:

Many moles—more than 50.

Moles which are large or unusual in colour or shape.

A close family history of melanoma or a personal history of melanoma.

Had excessive exposure to UV from the sun or sunbeds.

A history of severe sunburns.

The risk can be multiplied if you have several of these risk factors, for example, if you have unusual moles and a family history of melanoma. A person’s risk for BCC may be increased if they had an organ transplant and have a compromised immune system. Similarly, a person’s risk for SCC is may be increased if they have had solid tissue transplantations (e.g. kidney, heart, or liver) because it can spread to other areas of the body.

43

Fulton, J.E. Utilizing the ultraviolet (UV detect) camera to enhance the appearance of photodamage and

other skin conditions. Dermatology Surgery, 1997; 23:163-169.


A person can check for signs of melanoma in their moles using ABCDE:

Asymmetry - the shape on one side is different from that on the other side Border - the border or visible edge is irregular, ragged and imprecise Colour - there is a colour variation, with brown, black, red, grey or white within the lesion Diameter - growth is typical of melanoma. It can measure more than 6 mm, although it can be less.

Evolution - Look for change in colour, size, shape or symptom, such as itching, tenderness or bleeding.

The ugly duckling sign This is a tip to help you detect melanoma. Most moles on a person’s body look similar. However, melanomas look different from all other moles—the ugly duckling sign. Generally only one melanoma appears at a time, so a spot that looks or even feels different, or changes differently compared to other moles on the body, should be checked by your dermatologist or family doctor as soon as possible.44

44

CDA, Melanoma.


Mirror Software:

What are we seeing?

The Mirror Software makes pigment, fine lines, and other surface features more apparent.45

Tanned skin

Tanned skin is a result of DNA damage. There is evidence to suggest skin can get damaged from UVR without going through the tanning process, but tanning cannot occur unless DNA is damaged. This is based on the ―tanning pathway‖ (the biological means by which tanning occurs).46 When UVR enters the squamous cells of the epidermis (keratinocytes) it damages the DNA – the genetic material of cells. This initiates a series of chemical events which eventually leads to an increase in the production of melanin (melanogenesis) in the melanocytes, melanocytic differentiation, and the transfer of melanosomes (organelles that contain melanin) from melanocytes to keratinocytes.47 Note: The Mirror Software may not show surface features in tanned individuals as well as fair-skinned individuals.

45

Canfield Imaging Systems, Mirror Photofile: advanced medial image management software, User

Guide, The Enhance Tool, Version 7, 2009. 46

Woo et al, 2010. 47

Ibid.


Freckles and dark patches of skin

Sun exposure causes ―photoaging‖, or premature aging, which includes loss of elasticity, pigmentary change, and deep wrinkling.48 Pigmentary changes include tanning, freckles, age spots (small, darkened patches of skin usually found on the hands and face). 49 An individual’s pigmentary traits – whether they tan, burn, freckle, etc. are determined by their genetics.50 Most freckles, which especially occur in people with fair skin, are usually due to sun exposure51.

―The freckles one gets in youth typically occur in sun-exposed, sun-damaged skin and not in sun protected areas. These are enhanced by…UV camera[s]‖.52

Although the Mirror software is not exactly like a UV camera because ―the light source and reflected light are not filtered to include only near UV wavelengths‖, it nonetheless shows ―much of the same info you see on a real UV photo‖.53

As such, exposure to the sun can cause pigmentary changes (tanning, freckles, age spots, and other darkened skin patches) which can become darker and more pronounced [visible] with more exposure. 54 These pigmentary changes are indicative of exposure to harmful UVR and skin damage you cannot see. Note: The Mirror software does not replace an assessment or diagnosis by a medical professional. It is used as an awareness-raising tool and to help identify possible areas of concern. If you are concerned about a mole or risk of skin cancer, contact your doctor.

Dark-skinned individuals

Depending on a person’s pigmentary traits, including their skin type, they may be more or less susceptible to skin cancer and the other harmful effects of UVR.55

48

IARC, 2006. 49

American Osteopathic College of Dermatology, Hyperpigmentation, Retrieved from

http://www.aocd.org/skin/dermatologic_diseases/hyperpigmentation.html 50

IARC, 2006. 51

American Academy of Dermatology, Sun Protection for Children, Retrieved from

http://www.aad.org/public/publications/pamphlets/sun_sunprotection.html 52

Email correspondence with Roger I Ceilley, M.D. through the WHO UV INTERSUN Programme

Listserv, dated April 28, 2010. 53

Email correspondence with Tom Bialoglow, Canfield Scientific, dated December 21, 2009. 54

American Osteopathic College of Dermatology. 55

IARC, 2006.

http://www.aocd.org/skin/dermatologic_diseases/hyperpigmentation.html

http://www.aad.org/public/publications/pamphlets/sun_sunprotection.html


Melanoma is rare in black people and others with dark skin. When it does develop in dark-skinned people, it tends to occur under the fingernails or toenails, or on the palms of the hands or soles of the feet.56 Scientists are not completely sure if the darker skin itself is responsible for protection against UVR, or if individuals with darker skin have a greater ability to repair damaged DNA, and that is why there is a lower incidence of skin cancer.57 Depending on an individual’s skin type, dark-skinned individuals may still burn and therefore should protect themselves from overexposure.

Harm Reduction & Skill Building:

How can we reduce our UVR exposure?

1. Don’t tan, or tan less – both indoors or outdoors, especially if you

are at high risk for skin cancer 2. Wear sunscreen – SPF 30 is the recommended minimum 3. Wear a hat – preferably those with a wide brim to cover your neck,

face, and ears 4. Wear light-coloured, loose clothing, or clothing that protects against

UVA/UVB radiation 5. Wear sunglasses to protect your eyes from UVR 6. Stay in the shade when possible

If you tan outdoors:

Tan less often

Tan for shorter periods of time

Wear sunscreen – especially on the face

Avoid the high UV index hours between 11 am and 4 pm

Wear sunglasses

If you tan indoors:

Tan less often

Tan for shorter periods of time

Use eye protection

56

National Cancer Institute, U.S. National Institutes of Health. What you need to know about Melanoma:

Melanoma. Retrieved from http://www.cancer.gov/cancertopics/wyntk/melanoma/page6 57

IARC, 2006.

http://www.cancer.gov/cancertopics/wyntk/melanoma/page6


What sunscreen do we pick?

The Canadian Cancer Society58 and Canadian Dermatology Association59 recommend an SPF of 15. (Note: the American Academy of Dermatology recommends an SPF of at least 30.60 Similarly, a report of proceedings and outcomes from a stakeholder consultation by the National Skin Cancer Prevention Committee in 2008 indicated that and SPF of 30 or higher protects against suppression of the immune system. Further, the report notes that in the absence of standardization, Canadians should look for products that are ―broad spectrum‖ to ensure they protect against both UVA and UVB radiation.)61

Although an SPF of 30 may be recommended for Canadians in the future, at this time a broad-spectrum sunscreen with an SPF of 15 is recommended.

How do we apply sunscreen? Refer to Chapter 1: Science of the Skin, Applying Sunscreen Q&A.62

TIP: Apply sunscreen before applying insect repellent. Sunscreen should be applied at least 20 minutes before repellent to allow for proper absorption into the skin.

How do we pick a sunless tanning product? (Teacher’s lesson – to insert information) How do we apply a sunless tanning product? (Teacher’s lesson – to insert information)

58

Canadian Cancer Society, Being Safe in the Sun, Last modified March 30, 2010, Retrieved from

http://www.cancer.ca/Canada-wide/Prevention/Use%20SunSense/Using%20SunSense.aspx?sc_lang=en 59

Canadian Dermatology Association, Sunscreen FAQs, June 25, 2009, Retrieved from

http://www.dermatology.ca/patients_public/info_patients/sun_safety/sunscreen_faq.html 60

American Academy of Dermatology, Facts about Sunscreens, Copyright 2010, Retrieved from

http://www.aad.org/media/background/factsheets/fact_sunscreen.htm 61

National Skin Cancer Prevention Committee Primary Prevention Action Group, Canadian Partnerships

Against Cancer, Report of Proceedings and Outcomes: Consultation with Stakeholders, June 8, 2008. 62

UFCW Canada, Training and Development, Cosmetics, Chapter 1: Science of the Skin.

http://www.cancer.ca/Canada-wide/Prevention/Use%20SunSense/Using%20SunSense.aspx?sc_lang=en

http://www.dermatology.ca/patients_public/info_patients/sun_safety/sunscreen_faq.html

http://www.aad.org/media/background/factsheets/fact_sunscreen.htm

Indoor Tanning: Myths and Facts

“It’s safer to get a tan in a tanning salon than from the sun” No, it’s not. If you start using tanning beds before the age of 30, your risk of developing melanoma, the most dangerous form of skin cancer, is increased by 75%. You also increase your risk of ocular (eye) cancer.63 “Tanning beds give off different types of UV radiation than the sun” No, they don’t. Tanning beds give off UVA and UVB radiation – the same types of ultraviolet radiation that are given off by the sun. The difference is that the proportion of UVA and UVB given off by tanning equipment is a set amount, whereas the amount of UVA and UVB you are exposed to from the sun can vary based on the time of day, altitude, latitude, season, and cloud cover.64 “Having a tan is healthy.”

No, it’s not. Tanning from the sun or tanning beds exposes you to ultraviolet radiation which is known to cause cancer in humans. A safe way to look tanned is to use sunless tanning products like bronzers. But don’t forget to use sunscreen when you use these products – they don’t protect your skin.

“Having a base tan protects me from the sun”

No, it won’t. At most, a tan provides protection equal to a sunscreen with a sun protection factor (SPF) of 2 to 4, which means you are still exposed to damaging ultraviolet radiation and could still get burned. The Canadian Dermatology Association recommends wearing sunscreen with at least an SPF of 15. 65

“Tanning indoors is a good way to get vitamin D”

No, it’s not. Tanning indoors is not a safe way to get vitamin D, nor is tanning outdoors. You do not need to tan to get the recommended amount of vitamin D. Tanning increases your risk of skin cancer and other health conditions. You can get vitamin D from a short time in the sun and a healthy diet. You can also get vitamin D from supplements,66 though talk to your doctor about that first

63

World Health Organization (WHO), Media Centre – IARC News: Sunbeds and UV Radiation, July 29,

2009, Retrieved from http://www.iarc.fr/en/media-centre/iarcnews/2009/sunbeds_uvradiation.php 64

U.S. Department of health and Human Services, Public Health Service, National Toxicology Program.




Canadian Cancer Society, Vitamin D, Last modified on February 4, 2010.



Recommended revisions to Cosmetics Binder, Chapter 1, Science of the Skin Page 10 Add ―Avoid indoor tanning‖ in the list of bulleted points

Page 13 Revise title to ―Ultraviolet radiation effects on our skin‖ from ―Sun effects on our skin‖ to encompass all forms of UVR including tanning salons or sunlamps

Remove the paragraphs on UVB and UVA rays due to the following inaccuracies

o Some people will burn from UVA rays as well if they are intense, not just UVB

o Both, and probably all three components of broad-spectrum ultraviolet radiation (UVA, UVB, and UVC) are likely to cause skin cancer, not just UVA

o Based on current research, UVB rays are considered most responsible for skin cancer, not UVA

Replace removed paragraphs with the following:

Ultraviolet radiation (UVR) is invisible light energy and has three components: UVA, UVB, and UVC.67 Radiation from the sun (solar) and tanning equipment is mainly made up of UVA with some UVB.68 Solar UVR can cause skin cancer, sunburn, premature skin aging, cataracts and other eye conditions, aggravationof skin conditions, and weakening of the immune system.69 Solar radiation can cause all three types of skin cancer – melanoma, squamous cell carcinoma, and basal cell carcinoma. UVR from tanning equipment can cause sunburn, skin cancer (melanoma), and ocular (eye) melanoma. 70

Page 19 Revise the answer to the tanning salon question as follows:

Tanning beds increase your chances of skin cancer (melanoma) and eye (ocular) cancer. They give off UVA and UVB radiation – the same types of ultraviolet radiation that is given off by the sun.

At most, a base tan provides protection equal to a sunscreen with a sun protection factor (SPF) of 2 to 4, which means you are still exposed to damaging ultraviolet radiation and could still get

67

Health Canada, Sunlight and Ultraviolet Exposure, Retrieved from http://www.hc-sc.gc.ca/hl-vs/sun-

sol/expos/index-eng.php 68

U.S. Department of health and Human Services, Public Health Service, National Toxicology Program.


Health Canada. Guidelines for Tanning Salon Owners, Operators, and Users, Revised 2005. 70

National Cancer Institute. Melanoma, Posted March 31, 2003, Retrieved from





burned. The Canadian Dermatology Association recommends wearing sunscreen with at least an SPF of 15. 71

Page 26 Elaborate on who’s at risk of developing skin cancer under the ―Skin Cancer‖ subheading as follows:

Non-melanoma skin cancers (basal cell carcinoma and squamous cell carcinoma) are the most common form of cancer in Canadians.72 People who have fair skin and burn or freckle easily are more at risk than those with darker skin for developing a skin cancer. These people usually have red or blonde hair and blue eyes. 73 Skin cancer is less common in persons with darker skin tones and tends to occur under the fingernails or toenails, or on the palms or soles.74

71



National Sun Survey: Highlights Report, July 10, 2008. 73


Who’s at Risk? Retrieved from http://www.cancer.gov/cancertopics/wyntk/melanoma/page7 74


Melanoma. Retrieved from http://www.cancer.gov/cancertopics/wyntk/melanoma/page6




Using the Mirror Software and “Enhance” Tool Setting up:

1. Plug in and turn on the computer. Plug in the printer and attach the USB cable between the two.

2. Enter the password ―mirror‖ (same as the username) on the computer.

3. Insert the license key into any USB drive.

Note: If the license key is not inserted, an error message will appear and the program will not run without it.

Uploading photos:

4. Insert the digital camera’s memory card in the card reader (located at the front of the laptop) – these photos do not need to be uploaded on the computer – they are automatically sorted into a folder.

If you are connecting a digital camera to the laptop via a USB cable, you will need to upload the photos using the Wizard. Save the photos on the desktop or My Photos.

Importing & saving photos:

5. Open the Mirror program from the desktop. A search screen as below should open.

6. Import photos into the software program by clicking on ―Capture‖ in the toolbar and then ―Import Images‖.

The Import Images window will appear. If you do not see your photos

displayed, you can search for them by either clicking ―Find Images‖ repeatedly until they appear, or by clicking the ―Directory‖ button at the bottom of the window.

7. After your images are displayed you will need to save them to a ―patient‖. Click once on the photos you want (they will turn blue), or just click ―All‖ if want to enhance all the photos, then click ―Add‖. The Add/Modify Patient Record window will appear (as above). Assign a random name to file of photos (e.g. College Heights). Click ―Save‖ to close the Patient Record.

Note: You must fill in at least the last name of the Patient Record – the rest can remain blank.

8. To complete the saving process, click the ―Save and Close‖ button on the Import Images window. The original search screen will reappear after a couple seconds, however the images you imported will now be saved in the ―Chart‖ portion of the screen.

Enhancing photos

9. To convert a photo using the ―Enhance‖ tool, first double-click on a photo in the Chart screen to enlarge it. After it’s enlarged, click on ―View‖ in the toolbar and then ―Enhance‖. The photo will automatically be enhanced and both photos will be displayed side by side.

After a photo is enhanced, it needs to be saved (the original photo will still be preserved). Click on the small folder icon in the top right-hand corner, and then right-click anywhere on the photo to return to the enlarged screen. Click on ―File‖ in the toolbar, and then ―Save Images‖. Make the photo(s) you want saved are selected (turn blue), and then click ―Save and Close‖. After the enhanced image is saved, it will be added to the other photos on the

chart screen. You can open the Chart and click on one or more photos by clicking on the Chart tab along the right-side of the screen.

Printing photos

10. Turn on the printer and insert paper (a cartridge is already installed). 11. Click on it in the Chart screen (so it turns blue), and then click the printer icon

in the toolbar (or ―File‖ and then ―Print‖).

The Print screen will open. From here you can add headers or footers (for example, the date, class name or school, etc.) and also enlarge the photo size. To change the header or footer, click on ―Options‖ in the toolbar, then ―Page Properties‖, and then ―‖Edit Headers/Footers‖. You can add two lines for the header and two lines for the footer. When you are ready to print, just click the ―Print‖ button on the toolbar. To exit the print screen, right click anywhere on the Print screen, or click the ―X‖ in the top right hand corner to return to the Chart screen.

Deleting photos/files

12. To delete a photo file (i.e. ―patient record‖), click on ―File‖ and then ―Delete Patients‖. You will be prompted to ―Delete Patient Record and Images?‖ – click ―Yes‖.

If you create more than one ―Patient Record‖, you will have to purge the files after deleting them. To do so, click ―File‖ and ―Delete Patients‖ again. After selecting the file, click ―Purge‖. The photos that were uploaded to the Mirror program have been deleted. Finally, if you uploaded and saved photos to the computer (desktop or My Pictures) initially, you will now need to delete those files as well. Find those files and delete them from their location and then from the recycle bin.

Shutting down the computer

13. After deleting the photos from the Mirror program and computer, you are now ready to shut down the computer. Exit the Mirror program by clicking on the ―X‖ in the top right-hand corner. Disconnect any USB cables (from the printer and digital camera, if applicable) and memory cards by clicking on the ―Safely Remove Hardware‖ icon on the computer’s task bar.

Note: The license key does not need to be disconnected using the “Safely Remove Hardware” icon – it can simply be removed from the USB drive before shutting down.

14. Shut down the computer using the ―start‖ button and disconnect any other

cables.

UVR PowerPoint Presentation

Slide 1

Ultraviolet Radiation (UVR)

What is it?

What are the risks?

How can we reduce our risk?

Slide 2 UVR: invisible energy with

wavelengths between 100-400 nm

Slide 3 ―Broad-spectrum‖ UVR has more

than 1 type of radiation

(usually just UVA and UVB)

Slide 4 Radiation from the sun and tanning

equipment are ―broad-spectrum‖

Slide 5 We get most UVR exposure from

the sun

Slide 6 UVA goes into the dermis

UVB goes into the epidermis


Slide 7 UVA causes immediate tanning,

but it fades after 3-36 hrs

Slide 8 UVB causes sunburns and tanning

that lasts for a longer time

Slide 9 Broad-spectrum UVR is known to

cause skin cancer in humans

• Basal cell carcinoma

(non-melanoma)

• Squamous cell

carcinoma

(non-melanoma)

• MelanomaSkin graft on the shoulder

after a tumour is removed

Slide 10 Non-melanoma skin cancers are

the most common cancer in

Canada

Basal cell carcinoma Squamous cell carcinoma

Slide 11 Melanoma is the most dangerous

skin cancer AND it’s the 3rd most

common cancer in girls age 15-29

Slide 12 The sun can cause all three types

of skin cancer


Slide 13 Tanning beds can cause

melanoma & eye cancer

Slide 14 In fact, the WHO says using

tanning beds before 30 increases

your risk of melanoma by 75%


Slide 15 Miss Maryland Urging Teens to

Quit Indoor Tanning (2008)

http://www.youtube.com/watch?v=qHy375pMXmk&feature=player_embedded

Slide 16 The sun can also cause wrinkles,

age spots and freckles

Slide 17 Any UVR can damage the skin –

you just can’t see it…

Slide 18 But for some people, we can see

where it may be hiding


Slide 19 Tans aren’t healthy because you’re

causing skin damage underneath

http://www.sunsmart.com.au/campaigns/dark_side_of_tanning OR

http://www.youtube.com/watch?v=7zfOlIX-xdU (subtitles)

Slide 20

http://www.cbc.ca/health/story/2010/04/09/pei-students-tan-prom-584.html

Slide 21

http://www.teenvogue.com/

connect/blogs/soundoff/200

9/06/cruel-summer-dying-

for-a-tan.html

Slide 22 There are safer ways to get your

vitamin D than tanning

Foods like egg yolks and fish, as

well as foods fortified with vitamin D

(dairy, soy milk, etc.)Vitamin D supplements

Limited

sunshine

Slide 23 Those most at risk have red or

blonde hair, pale skin, & blue or

green eyes

Slide 24 They also never tan and always

burn (skin type 1)


Slide 25 Family history of skin cancer,

sunburns (especially in childhood),

and tanning increase the risk

Slide 26 It’s less common in dark-skinned

people, but it tends to be on the

palms, soles or under fingernails

Slide 27 Check your moles for ABCDE

Asymmetry

(Is it the same all over?)

Border

(Is it a circle?)

Colour

(Is it one colour?)

Diameter

(Is it bigger than 6 mm?)

Evolving

(Has it changed over time?)

Slide 28 Talk to your doctor if you’re worried

about a mole or your risk

Slide 29 How can someone reduce their

exposure to UVR?

Slide 30 Sunscreen should be ―broad-

spectrum‖ and at least SPF 15


Slide 31 Don’t forget: bronzers and sprays

don’t protect you from the sun

Pre-Questionnaire, June 2, 2010

#_______

The information from this questionnaire/form is being collected by WDG Public Health. We are collecting this information to find out if the ultraviolet radiation (UVR) lesson is a good way to learn about UVR. If it is, then we will look at sharing this lesson with other schools. Even though you are writing your name below, it will not be shared with Public Health. Only your teacher will know who answered this form. You don’t need to fill out this form if you don’t want to. If you have questions about this form you can call Beth Watters, Health Promotion Specialist at WDG Public Health (519) 846-2715, ext. 4658. Thank you! Please write your name below: Name: ______________________________________


# _______

Ultraviolet Radiation (UVR) Form

Age: ______

Sex/gender (check): Female _____ Male _____

Skin type (circle): 1 I always burn & never tan

2 I always burn & sometimes tan

3 I sometimes burn & always tan

4 I rarely burn & tan fast

5 I may get a little red & tan dark

6 I never burn & tan dark black

A) Please circle if the following questions are true (T) or false (F):

1. Broad-spectrum UVR is made up of 2 types of radiation – UVA and UVB.

T F

2. Melanoma is the most dangerous form of skin cancer. T F

3. A sunscreen with an SPF of 5 is recommended. T F

4. People with skin type I are most at risk for skin cancer. T F

5. Dark-skinned people can’t get melanoma. T F

B) Please check (√) if you agree or not with the following statements: Strongly

disagree Disagree Agree

Strongly agree

1. Only older people get skin cancer.

2. Having a base tan protects you from skin damage.

3. UVR can cause skin damage that I can’t see.

4. Tanning indoors is safer than tanning outdoors.

5. Only sunburns increase your risk of skin cancer.

6. Tanned skin means there’s skin damage underneath.

7. Young people don’t get skin cancer.

8. The more I am exposed to UVR, the more I may be damaging my skin.

9. As long as you don’t get sunburned, you’re not damaging your skin.


C) Please answer the following questions: 1. This summer, how often do you plan to:

Never Sometimes Most of the time

All the time

Wear sunscreen on your face

Wear sunscreen on your body

Wear a hat

Wear sunglasses

Stay in the shade

2. This summer, how often do you plan to:

Never Once/mth 2-3 times/mth

Every week

Tan indoors

Tan outdoors

Wear tanning product instead of tanning

3. Do you have any comments about tanning or sun protection?

Post-Questionnaire, June 2, 2010

# _______ The information from this questionnaire/form is being collected by WDG Public Health. We are collecting this information to find out if the ultraviolet radiation (UVR) lesson is a good way to learn about UVR. If it is, then we will look at sharing this lesson with other schools. Even though you are writing your name below, it will not be shared with Public Health. Only your teacher will know who answered this form. You don’t need to fill out this form if you don’t want to. If you have questions about this form you can call Beth Watters, Health Promotion Specialist at WDG Public Health (519) 846-2715, ext. 4658. Thank you! Please write your name below: Name: ______________________________________


# _______


Age: ______










T F







Strongly agree











C) Please answer the following questions: 1. After learning more about UVR, do you plan to decrease your indoor

exposure to UVR? Yes No

If yes, how so? 2. After learning more about UVR, do you plan to decrease your outdoor

exposure to UVR?

Yes No If yes, how so? 3. This summer, how often do you plan to:


All the time



Wear a hat

Wear sunglasses

Stay in the shade

4. This summer, how often do you plan to:


Every week

Tan indoors

Tan outdoors



Follow-up Questionnaire, June 2, 2010

# _______ The information from this questionnaire/form is being collected by WDG Public Health. We are collecting this information to find out if the ultraviolet radiation (UVR) lesson is a good way to learn about UVR. If it is, then we will look at sharing this lesson with other schools. Even though you are writing your name below, it will not be shared with Public Health. Only your teacher will know who answered this form. You don’t need to fill out this form if you don’t want to. If you have questions about this form you can call Beth Watters, Health Promotion Specialist at WDG Public Health (519) 846-2715, ext. 4658. Thank you! Please write your name below: Name: ______________________________________


# _______


Age: ______










T F







Strongly agree











C) Please answer the following questions: 1. During the summer, did you decrease your indoor exposure to UVR?

Yes No

If yes, how so? 2. During the summer, did you decrease your outdoor exposure to UVR?

Yes No If yes, how so? 3. During the summer, how often did you:


All the time



Wear a hat

Wear sunglasses

Stay in the shade

4. During the summer, how often did you:


Every week

Tan indoors

Tan outdoors



Follow-up Questionnaire, College Heights, December 2, 2010

The information from this form is being collected by WDG Public Health. We are collecting this information to find out if the ultraviolet radiation (UVR) lesson is a good way to learn about UVR. If it is, then we will look at sharing this lesson with other schools. Even though you are writing your name below, it will not be shared with Public Health. Only your teacher will know who answered this form. You don’t need to fill out this form if you don’t want to. If you have questions about this form you can call Beth Watters, Health Promotion Specialist at WDG Public Health (519) 846-2715, ext. 4658. Thank you! Please write your name below: Name: ______________________________________



Age: ______ Sex/gender (check): Female _____ Male _____

Skin type (check one):

A) Did you participate in the UVR lesson last spring? Yes No

………If “yes”, did you get your picture taken? Yes No

B) Please circle if the following questions are true (T) or false (F):


T F





C) Please check off (√) if you agree or not with the following statements:

Strongly disagree

Disagree Agree Strongly

agree




4. Tanned skin means there is skin damage underneath.

5. Young people can get skin cancer.


7. Sunburns are the only sign of skin damage.

1 I always burn & never tan







D) Please answer the following questions: 1. Because of the UVR lesson, did you protect yourself more from UVR over the

summer of 2010 compared to other summers? (circle your answer) Yes No I don’t remember I didn’t do the lesson

a) If you did protect yourself more the summer of 2010 compared to other summers, please check off (√) how:

Compared to other summers… Yes No Don’t

remember

I. I tried a tanning lotion/spray for the first time instead of tanning

II. I used tanning lotions/sprays more often than tanning

III. I tanned indoors less (i.e. in a tanning bed)

IV. I tanned outdoors less (i.e. in the sun)

V. I wore sunscreen on my face more often

VI. I wore sunscreen on my body more often

VII. I wore a hat more often

VIII. I wore sunglasses more often

b) Did you do anything else to protect yourself from UVR during the summer

of 2010?

2. If you didn’t protect yourself more from UVR during the summer of 2010 compared to other summers, please tell us why:

3. Other comments?

MEDIA RELEASE

New technology in the classroom helps expose effects of UV radiation Guelph, May 26, 2010 If a picture is worth a thousand words, local high school students have a lot to talk about. The cosmetology and parenting classes at College Heights in Guelph and Orangeville District Secondary School are seeing the effects of ultra violet (UV) radiation on their own skin using a new software program. Mirror Software highlights a student’s skin surface features—including colour, freckling and age spots—to reveal possible areas of underlying skin damage. ―We know through the tanning process UV radiation can damage skin,‖ says Beth Watters, health promotion specialist at WDG Public Health. ―Similarly, most freckling occurs in sun-exposed areas of the body, like the hands and face, so there could likely be underlying damage in those areas. The software helps identify areas that may have been damaged from UV radiation and should especially be protected.‖ Student volunteers provide digital head shots to their teacher who uploads them to the software program. The program enhances the photos and allows the class to see differences in the surface areas most susceptible to damage. ―Students are very interested to see what their faces look like using the software,‖ says Robb Mayer, cosmetology teacher at College Heights. ―But more importantly, they understand that while a little bit of sun is good, the UV rays from a lot of sun or artificial tanning damages the skin below the surface. We’ve got quite a few newly-committed sunscreen users after participating in the lesson.‖ The software is part of a pilot program organized by WDG Public Health and funded by the Wellington Cancer Prevention and Early Detection Network. Following evaluation, the group hopes to expand the project to include more schools in the fall. For more information about the pilot program call WDG Public Health--1-800-265-7293 ext. 4658. -30- Contact:

Beth Watters Health Promotion Specialist Wellington-Dufferin-Guelph Public Health 519-846-2715 ext. 4658

Guelph Mercury, May 28, 2010

The Orangeville Banner, Print Editions, June 10, 2010

Appendix: UVR Pilot Project

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Transcript of Appendix: UVR Pilot Project