Solar Ultraviolet Radiation Exposure and Sun Protection Behaviors and Knowledge Among a High‐Risk and Overlooked Group of Outdoor Workers in South Africa

The exposure of outdoor car guards to solar ultraviolet radiation (UVR), the majority with deeply pigmented skin, to solar UVR was measured for five consecutive days during early spring (September 2017) in South Africa using electronic UVR dosimeters attached to the upper arm of each participant. The exposure of the nape of the neck, forehead, nose, cheek and hand was extrapolated from the measurements. The onsite ambient solar UVR on a flat, horizontal, unshaded surface was measured concurrently. The sun‐related knowledge, behavior and attitudes of the car guards were evaluated using questionnaires. Total personal daily solar UVR exposure as a percentage of the ambient solar UVR exposure was 24%. The exposure of car guards on several body sites was in excess of the occupational threshold limit value. Sleeved shirts and hats were the most commonly used sun protection measures (worn by 70% and 80%, respectively). Considering the high levels of solar UVR reported on most days throughout the year in South Africa, more studies quantifying the personal exposure of outdoor workers in both the informal and formal sectors are necessary.     

UV Radiation Exposure of Outdoor Workers in Antarctica

The Antarctic region is a place of increasing interest. A growing number of personnel are working outdoors in extreme environmental conditions. They receive significant exposure to solar ultraviolet radiation (UVR) and are thereby at increased risk of adverse consequences. The aim of this study was to evaluate the UVR dose received by the outdoor workers at the Bulgarian Antarctic Base. Ten Caucasian healthy subjects, 8 males and 2 females with a mean age of 38 years (29–51) were enrolled. Of them, 5 were scientists and 5 were logistic workers. We measured the accumulated daily dose of UVR assessed by standard erythemal dose (SED) in the two groups. All subjects wore personal dosimeters located near the face—he only noncovered skin area. The dosimeters were factory calibrated for use in the Antarctic region. No statistical difference (P = 0.441) could be revealed between the SEDs in the two groups. The maximum UVR dose detected in a single day was 67.9 SEDs, and the highest cumulative dose was 548.03 SEDs. Study results are showing extreme measurements of UVR received by the members of the expeditions. We suggest meticulous UV protection for outdoor workers.     

Sunburn Risk Among Children and Outdoor Workers in South Africa and Reunion Island Coastal Sites

To estimate potential sunburn risk for schoolchildren and outdoor workers, ground‐based ambient solar ultraviolet radiation (UVR) measurements were converted into possible child (5% of ambient solar UVR) and outdoor worker (20% of ambient solar UVR) solar UVR exposures by skin type and season for three coastal sites: Durban, Cape Point (South Africa) and Saint Denis (Reunion Island, France). Cumulative daily ambient solar UVR levels were relatively high at all sites, especially during summer, with maximum values of about 67, 57 and 74 Standard Erythemal Dose (SED) (1 SED = 100 J m^?2) at Durban, Cape Point and Saint Denis respectively. Sunburn risk was evident for both children and outdoor workers, especially those with skin types I and II (extremely to moderately sensitive) during summer, early autumn and/or late spring at all three sites. Although results need to be verified with real‐time, instantaneous and nonintegrated personal solar UVR measurements, this understanding of sunburn risk is useful for initiating the development skin cancer prevention and sun protection awareness campaigns in both countries.     

Sex as a Risk Factor for Solar Ultraviolet Radiation Exposure?–Dosimetry in Danish Outdoor Workers

Solar ultraviolet radiation (UVR) exposure is a known risk factor for the development of skin cancer. Heterogeneity in solar UVR exposure may explain the diversity in skin cancer incidence between men and women. This, however, has not previously been investigated in Danish outdoor workers using UVR dosimetry. The aim of this study was to evaluate sex differences in solar UVR dosimetry in Danish outdoor workers on working and leisure days. A cross-sectional design was used to collect dosimetry data during the Danish summer season (May to September). Analysis was based on an electronic questionnaire and dosimetry data from 450 outdoor workers (88 women, 362 men). Dosimetry data were reported as standard erythema dose (SED). The daily median SED (Interquartile range) on working days was 1.6 (2.5) in men and 1.5 (2.1) in women while on leisure days it was 0.5 (1.4) in men and 0.6 (1.3) in women. Analysis by multiple linear regression did not show any association between daily median SED and sex on either working or leisure days. In conclusion, solar UVR exposure in Danish outdoor workers did not vary according to sex.     

PERSONAL DOSIMETRY OF SOLAR UV RADIATION FOR DIFFERENT OUTDOOR ACTIVITIES

Abstract Quantifying individual exposure to ultraviolet radiation (UVR) is critical to understanding the etiology of a number of diseases including nonmelanotic and melanotic skin cancers. Measurements of personal exposure to solar UVR were made in Hobart, Tasmania in February (summer) 1991 for six different outdoor activities using UVR-sensitive polysulfone (PS) film attached at seven anatomical sites. Concurrent behavioral and environmental observations were also made. To date many studies have relied on subject recall to quantify past solar UVR exposures. To gain insight into the accuracy of subject recall the measured UVR exposures received by different subjects using the PS film were compared to those calculated from personal diaries and ambient solar UVB levels from a monitoring station. In general, when UVR exposure activities took place under close supervision, good correlations were obtained between the PS badges and the ambient measurements/diaries approach. Ultraviolet radiation exposures for the field study involving 94 subjects engaged in a number of outdoor activities are presented.     

Solar Ultraviolet Radiation Exposure of South African Marathon Runners During Competition Marathon Runs and Training Sessions: A Feasibility Study

Marathon runners spend considerable time in outdoor training for and participating in marathons. Outdoor runners may experience high solar ultraviolet radiation (UVR) exposure. South Africa, where running is popular, experiences high ambient solar UVR levels that may be associated with adverse health effects. This feasibility study explores the use of personal dosimeters to determine solar UVR exposure patterns and possible related acute health risks of four marathon runners during marathons and training sessions in Cape Town and Pretoria. Runners running marathons that started early in the day, and that did not exceed 4 hours, yielded low total solar UVR exposure doses (mean 0.093 SED per exposure period run, median 0.088 SED, range 0.062–0.136 SED; average of 16.54% of ambient solar UVR). Training sessions run during early morning and late afternoon presented similar results. Several challenges hindered analysis including accounting for anatomical position of personal dosimeter and natural shade. To assess health risks, hazard quotients (HQs) were calculated using a hypothetical runner's schedule. Cumulative, annual solar UVR exposure‐calculated acute health risks were low (HQ = 0.024) for training sessions and moderate (HQ = 4.922) for marathon runs. While these data and calculations are based on 18 person‐days, one can measure marathon runners' personal solar UVR exposure although several challenges must be overcome.     

Solar UVR exposure, concurrent activities and sun-protective practices among primary schoolchildren

Comprehensive measures of ultraviolet radiation (UVR) exposure, concurrent activities and sun-protective practices are needed to develop and evaluate skin cancer prevention and sun protection interventions. The UVR exposures of 345 primary schoolchildren at 23 schools around New Zealand were measured using electronic UVR monitors for 1-week periods over 12 weeks in 2004 and 2005. In addition, ambient UVR levels on a horizontal surface were measured on-site at each school. Children completed activity diaries during the period UVR measurements were made and provided information on their indoor and outdoor status and clothing and sun protection worn. Mean total daily UVR exposure (7:00-20:00 h NZST + 1) at the body location where the UVR monitors were worn was 0.9 SED (standard erythemal dose, 1 SED = 100 J m(-2)). This was 4.9% of the ambient UVR on a horizontal surface. Mean time spent outdoors was 2.3 h day(-1). Differences in children's UVR exposure could be explained in part by activity, where outdoor passive pursuits were associated with higher UVR exposure rates than outdoor active and outdoor travel pursuits. Compared with older children, the activities of younger children, although labeled the same, resulted in different UVR exposures, either as a result of reporting differences or a real difference in UVR exposure patterns. UVR exposure rates were generally higher on weekdays compared with the weekend, confirming the important role of school sun protection and skin cancer prevention programs. High UVR exposure activities included physical education, athletics and lunch break.     

Measurements of the solar UVR protection provided by shade structures in New Zealand primary schools

To reduce ultraviolet radiation (UVR) exposure during childhood, shade structures are being erected in primary schools to provide areas where children can more safely undertake outdoor activities. This study to evaluate the effectiveness of existing and purpose built shade structures in providing solar UVR protection was carried out on 29 such structures in 10 schools in New Zealand. Measurements of the direct and scattered solar UVR doses within the central region of the shade structures were made during the school lunch break period using UVR-sensitive polysulfone film badges. These measurements indicate that many of the structures had UVR protection factors (PF) of 4-8, which was sufficient to provide protection during the school lunch hour. However, of the 29 structures examined, only six would meet the suggested requirements of UVR PF greater than 15 required to provide all-day protection.     

Occupational UV Exposure of Environmental Agents in Valencia,Spain

Excessive exposure to ultraviolet radiation (UVR) is considered the most important environmental risk factor in the development of melanoma and skin cancer. Outdoor workers are among those with the highest risk from exposure to solar UVR, as their daily activities constantly expose them to this radiation source. A study was carried out in Valencia, Spain, in summer 2012 and involved a group of 11 workers for a period of six 2‐day recordings. Sensitive spore‐film filter‐type personal dosimeters (VioSpor) were used to measure erythemal UVR received by environmental agents in the course of their daily work. Median 2‐day UV exposure was 6.2 standard erythema dose (SED), with 1 SED defined as effective 100 J m^?2 when weighted with the Commission Internationale de L′Eclairage's (CIE) erythemal response function. These workers were found to receive a median of 8.3% total daily ambient ultraviolet erythemal radiation. Comparison with the occupational UV exposure limit showed that the subjects had received an erythemal UV dose in excess of occupational guidelines, indicating that protective measures against this risk are highly advisable.     

Seasonal Minimum and Maximum Solar Ultraviolet Exposure Measurements of Classroom Teachers Residing in Tropical North Queensland,Australia

The risk of keratinocyte skin cancer, malignant melanoma and ultraviolet radiation (UVR)‐induced eye disease is disproportionately higher in Australia and New Zealand compared to equivalent northern hemisphere latitudes. While many teachers are aware of the importance of reinforcing sun safety messages to students, many may not be aware of the considerable personal exposure risk while performing outdoor duties in locations experiencing high to extreme ambient UVR year‐round. Personal erythemally effective exposure of classroom teachers in tropical Townsville (19.3°S) was measured to establish seasonal extremes in exposure behavior. Mean daily personal exposure was higher in winter (91.2 J m^‐2, 0.91 Standard Erythema Dose [SED]) than summer (63.3 J m^?2, 0.63 SED). The range of exposures represents personal exposures that approximate current national guidelines for Australian workers at the study latitude of approximately 1.2 SED (30 J m^?2 effective to the International Commission on Non‐Ionizing Radiation Protection). Similar proportions of teachers spent more than 1 h outdoors per day in winter (28.6%) and summer (23.6%) as part of their teaching duties with seasonal differences having little effect on the time of exposure. Personal exposures for teachers peaked during both seasons near school meal break times at 11:00 am and 1:00 pm, respectively.     

Wellington Playgrounds Uncovered: An Examination of Solar Ultraviolet Radiation and Shade Protection in New Zealand

Providing effective shade in summer recreation spaces can reduce children's risk of skin cancer. This study explored the quantity and protective quality of shade in Wellington, New Zealand playgrounds. Two researchers visited 50 randomly selected playgrounds during peak ultraviolet radiation (UVR ) hours in summer and recorded the mean shade cover of playground equipment, seats, tables and open areas. A solar meter was used to calculate the proportion of UVR blocked by each built structure and tree. The results found that 95% of playground equipment and 64% of sitting and eating areas had no shade protection. Trees blocked a mean of 80.1% (95% CI : 66.0–94.1) of direct solar UVR , but mostly covered open areas, not playground equipment, seats and tables. The findings demonstrate that Wellington playgrounds have insufficient shade available. Increased shade in Wellington playgrounds is urgently needed to protect children from harmful UVR exposure, particularly through planting trees with heavy foliage and building structures with large, protective roofing. This may well be the case for other regions of NZ and for other countries where UVR exposure is dangerous. The method used in this study provides a reliable means to evaluate shade.     

Schoolyard Shade and Sun Exposure: Assessment of Personal Monitoring During Children's Physical Activity

Childhood exposure to ultraviolet radiation (UVR) is a major risk factor for the development of melanoma later in life. However, it is challenging to accurately determine personal outdoor exposure to UVR, specifically erythemally weighted UVR (UV_Ery), due to technological constraints, variable time–activity patterns, and the influence of outdoor environmental design. To address this challenge, this study utilized mobile and stationary techniques to examine the UV_Ery exposures of 14 children in a schoolyard in Lubbock, TX, in spring 2016. The aims of the study were to examine the influence of artificial shade on personal UV_Ery exposures and to assess full sun exposure ratios (ERs) within the same playground microenvironment. On average, personal wrist dosimeters worn during play in the sun measured 18% of the total onsite UV_Ery measured by a stationary UV pyranometer. Shade was found to significantly reduce the personal UV_Ery exposures by 55%, UVB_{280–315 nm} exposures by 91%, and the overall solar radiation by 84%. Substantial benefits can be garnered through focused design of children's recreational space to utilize shade—both natural and artificial—to reduce UVR exposures during play, and to extend safe outdoor stays. Finally, although the wrist is a practical location for a dosimeter, it often underestimates full exposures, particularly during physical activity.     

Agreement between diary records of time spent outdoors and personal ultraviolet radiation dose measurements

Little is known about the validity of self-recorded sun exposure and time spent outdoors for epidemiological research. The aims of the current study were to assess how well participants' self-recorded time outdoors compared to objective measurements of personal UVR doses. We enrolled 124 volunteers aged 40 and above who were identified from targeted subgroups of US radiologic technologists. Each volunteer was instructed to wear a polysulfone (PS) dosimeter to measure UVR on their left shoulder and to complete a daily activity diary, listing all activities undertaken in each 30 min interval between 9:00 A.M. and 5:00 P.M. during a 7 day period. In a linear regression model, self-recorded daily time spent outdoors was associated with an increase of 8.2% (95% CI: 7.3-9.2%) in the personal UVR exposure with every hour spent outdoors. The amount of self-recorded total daily time spent outdoors was better correlated with the personal daily UVR dose for activities conducted near noon time compared to activities conducted in the morning or late afternoon, and for activities often performed in the sun (e.g. gardening or recreation activities) compared to other outdoor activities (e.g. driving) in which the participant is usually shaded from the sun. Our results demonstrated a significant correlation between diary records of time spent outdoors with objective personal UVR dose measurements.     

Standard ultraviolet daylight for nonextreme exposure conditions

The skin is exposed to ultraviolet radiation (UVR) from natural or artificial sources on a daily basis. The effects of chronic low dose exposure merit investigation, even when these effects are neither conspicuous nor clinically assessable. The purpose of the present study was to define a relative spectral UV irradiance that is representative of frequent nonextreme sun exposure conditions and therefore more appropriate for studies of the long-term and daily effects of solar UV on the skin. Solar spectral UV irradiance values were calculated for different dates and locations by using a radiative transfer model. The spectral irradiance values obtained when the solar elevation is lower than 45 degrees were averaged. An important feature is the dUVA (320-400 nm) to dUVB (290-320 nm) irradiance values ratio, which was found to be 27.3 for the overall average. When the months corresponding to extreme irradiance values (low or high) were excluded from the calculations, the dUVA to dUVB ratio ranged from 27.2 to 27.5. The mean spectral irradiance of the model presented here represents environmental UV exposure conditions and can be used both as a standard to investigate the biological effects of a nonextreme UVR and to assess the effectiveness of products for daily skin protection.     

Erythemal Ultraviolet Exposure in Two Groups of Outdoor Workers in Valencia, Spain

UVexposure is considered to be one of the most important risk factors in skin cancers, mainly in outdoor occupational activities. Outdoor workers receive regular and significant solar UV erythemal radiation (UVER). To quantify the UVER exposure of certain groups of workers, dosimeters are used to measure the biologically effective UV radiation received in the course of their daily work. Two groups of outdoor workers, composed of gardeners and lifeguards, were measured for UVER exposure using sensitive spore-film filter-type personal dosimeters (Viospor). The study took place in Valencia, Spain, in June and July 2008, and involved one group of four gardeners and another of five beach lifeguards for a period of 4 and 6 days, respectively. The gardeners' mean UV exposure was 4.13 ± 0.60 SED day⁻¹, where 1 SED is defined as effective 100 J m⁻² when weighted with the CIE erythemal response function, whereas the lifeguards received 11.43 ± 2.15 SED day⁻¹. The mean exposure ratio (ER) relative to ambient of gardeners was 0.09 ± 0.01 and for lifeguards was 0.27 ± 0.05. ER is defined as the ratio between the personal dose on a selected anatomical site and the corresponding ambient dose on a horizontal plane during the same exposure period. The lifeguards received the highest UVER exposure, although both groups had measured UVER exposure in excess of occupational guidelines, indicating that protective measures are necessary.     

Sunscreens Containing Cyclodextrin Inclusion Complexes for Enhanced Efficiency: A Strategy for Skin Cancer Prevention

Unprotected exposure of skin to solar ultraviolet radiation (UVR) may damage the DNA of skin cells and can lead to skin cancer. Sunscreens are topical formulations used to protect skin against UVR. The active ingredients of sunscreens are UV filters that absorb, scatter, and/or reflect UVR. Preventing the formation of free radicals and repairing DNA damages, natural antioxidants are also added to sunscreens as a second fold of protection against UVR. Antioxidants can help stabilise these formulations during the manufacturing process and upon application on skin. However, UV filters and antioxidants are both susceptible to degradation upon exposure to sunlight and oxygen. Additionally, due to their poor water solubility, natural antioxidants are challenging to formulate and exhibit limited penetration and bioavailability in the site of action (i.e., deeper skin layers). Cyclodextrins (CDs) are cyclic oligosaccharides that are capable of forming inclusion complexes with poorly soluble drugs, such as antioxidants. In this review, we discuss the use of CDs inclusion complexes to enhance the aqueous solubility of antioxidants and chemical UV filters and provide a protective shield against degradative factors. The role of CDs in providing a controlled drug release profile from sunscreens is also discussed. Finally, incorporating CDs inclusion complexes into sunscreens has the potential to increase their efficiency and hence improve their skin cancer prevention.     

POTENTIAL EFFECTS OF ALTERED SOLAR ULTRAVIOLET RADIATION ON HUMAN SKIN CANCER

There is highly significant evidence that non-melanoma skin cancers are primarily due to chronic repeated exposure to solar ultraviolet radiation, and that there is a significant, although somewhat different relationship between solar radiation and the development of cutaneous malignant melanoma. Recent experimental and epidemiologic studies show that the biologically most effective UVR wavelengths are in the segment of the solar UVR spectrum that would be significantly augmented by decreases in stratospheric ozone content. A recent report on measurements of column ozone changes in the stratosphere has shown that in the past 18 yrs, there has been an ozone decrease between 2 and 3%, greater in the winter months, and somewhat differing with latitude in the Northern Hemisphere. Calculations of the relationship of ozone decrease to increase in biologically effective UVR show great dependence on the biologic action spectrum assumed. Based on extensive epidemiologic studies of skin cancer incidence, it appears that the estimated increase in biologically effective UVR due to the measured ozone decreases in the past (almost) two decades are not likely to be the cause of the sharp increase in skin cancer incidence which have been observed. Most likely these increases in incidence are the result of increasing personal exposure, due to striking changes in personal behavior that have taken place for social reasons. However, there is every reason to believe that increases in biologically effective UVR due to stratospheric ozone decreases will have significant impact on human skin cancer incidence in the future.     

SOLAR UVR EXPOSURES OF THREE GROUPS OF OUTDOOR WORKERS ON THE SUNSHINE COAST, QUEENSLAND

The solar ultraviolet radiation (UVR) exposures of three groups of outdoor workers, physical education (PE) teachers, ground staff/gardeners and lifeguards were measured using UVR-sensitive polysulfone (PS) film badges. The exposures all took place on the Sunshine Coast, Queensland over 5 consecutive weekdays in November 1992. For the three groups, the shoulder badges received greater UVR exposures than the chest badges, in agreement with previous studies. The PE teachers received the highest UVR exposures while the lifeguards received the least. One of the 5 days of the study was overcast with some rain showers and UVR doses for this day for all groups were significantly lower than on the other 4 days, however the ratio of exposure to ambient remained relatively constant. All groups had measured UVR exposures in excess of occupational guidelines, indicating that protective measures, including education and behavior modification, which are becoming much more common in occupational situations in Australia, are both timely and necessary.     

A Comparison of Solar Ultraviolet Radiation Exposure in Urban Canyons in Venice,Italy and Johannesburg,South Africa

Urban environments can have high-risk spaces that can provide excess personal sun exposure, such as urban or street canyons, and the spaces between buildings, among others. In these urban spaces, sun exposure can be high or low depending on several factors. Polysulphone film (PSF) was used to assess possible daily solar ultraviolet radiation (UVR) exposure in urban canyons in Venice, Italy and, for the first time in Africa, in Johannesburg, South Africa. The photodegradation of PSF upon solar exposure was monitored at a wavelength of 330 nm by ultraviolet-visible spectrophotometry, and the resultant change was converted to standard erythemal dose (SED) units (1 SED = 100 J m⁻²). Mean daily ambient solar UVR exposure measured for Venice and Johannesburg ranged between 20–28 SED and 33–43 SED, respectively. Canyon-located PSF exposures were lower in Venice (1–9 SED) than those in Johannesburg (9–39 SED), depending mainly on the sky view factor and orientation to the sun. There was large variation in solar UVR exposure levels in different urban canyons. These preliminary results should be bolstered with additional studies for a better understanding of excess personal exposure risk in urban areas, especially in Africa.     

Seasonal Variation in Measured Solar Ultraviolet Radiation Exposure of Adults in Subtropical Australia

Generating accurate population-specific public health messages regarding sun protection requires knowledge about seasonal variation in sun exposure in different environments. To address this issue for a subtropical area of Australia, we used polysulphone badges to measure UVR for the township of Nambour (26° latitude) and personal UVR exposure among Nambour residents who were taking part in a skin cancer prevention trial. Badges were worn by participants for two winter and two summer days. The ambient UVR was approximately three times as high in summer as in winter. However, participants received more than twice the proportion of available UVR in winter as in summer (6.5%vs 2.7%, P < 0.05), resulting in an average ratio of summer to winter personal UVR exposure of 1.35. The average absolute difference in daily dose between summer and winter was only one-seventh of a minimal erythemal dose. Extrapolating from our data, we estimate that ca. 42% of the total exposure received in the 6 months of winter (June–August) and summer (December–February) is received during the three winter months. Our data show that in Queensland a substantial proportion of people’s annual UVR dose is obtained in winter, underscoring the need for dissemination of sun protection messages throughout the year in subtropical and tropical climates.