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Let's Discuss: Tools and Policies to Prevent Skin Cancer Through Reduction of UV Exposure

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Skin cancer rates, including rates of melanoma, are increasing in the United States and worldwide. An estimated 3.7 million cases of basal and squamous cell carcinomas and about 60,000 cases of melanoma are diagnosed in the U.S. annually, with approximately 8,500 deaths from melanoma.
A majority of skin cancers are caused by exposure to ultraviolet (UV) radiation from the sun or from indoor tanning devices, and are therefore preventable. Evidence clearly links exposure to UV radiation and a history of sunburn (indicating both intensity of UV exposure and skin sensitivity to radiation) to an increased risk of skin cancer.
More than one-third of U.S. adults aged 18 and older report experiencing one or more sunburns in the past 12 months, and sunburn is even more common among younger adults. Only 10.8% of U.S. high school students report wearing sunscreen with SPF of 15 or higher most of the time or always when outside for more than one hour on a sunny day.
Our R2R July cyber-seminar introduced many of us to how the County Level UV Exposure Data for the Continental United States dataset can help predict potential exposure at local levels. Dr. Tatalovich’s presentation was followed by an overview of New Mexico's robust multi-level effort around skin cancer prevention. Zaria and Beth then join forces for a fascinating discussion on the evolving emphasis on policy within the current projects on sun safety.
And now we turn the discussion over to you...
  • Do tools such as UV Exposure data and mapping tools truly help to build support for implementing evidence-based programs?
  • Beth spoke about a number of low-resource (and no resource) interventions the NMCCCP was able to implement.  Do you have any success stories to share?  What works in your state/county/territory?
  • What did you take away from today's session?


A couple of things I took

A couple of things I took away from this excellent cyber-seminar were the importance of having data and tools to understand the problem of UV exposure, and then policies and interventions to try to ameliorate the problem. 

Regarding the former, it is of utmost importance to have rigorous, accurate data to identify the problem.   Dr. Tatalovich’s presentation showed how the National Solar Radiation Database provided such important data and these data can be accessed by anyone at the associated NCI website:  The good news is that there are other data that are publicly available that stakeholders are encouraged to access.  One example are data from the Health Information National Trends Survey (HINTS) which is a nationally-representative survey of the adult US population that includes questions about sun safety practices (see for data and other documents:  But having data isn’t sufficient unless there are tools to make sense of the data.  Dr. Tatalovich showed some interesting tools developed by her group to take the underlying data and put them in maps and graphs such that most people could easily see and understand where there are particular geographic areas where UV exposure is highest.  Likewise, the developers of the HINTS program offer the data and tools in the form of analytic code so researchers can run their own analyses to track national estimates or test hypotheses; likewise, for results users, the HINTS program has created HINTS briefs which are high-level summaries of important cancer-control outcomes, and in fact, Brief #6 was focused on sun safety behaviors and sociodemographic correlates of these behaviors.   For example, it was found that about 50% of the US adult population in 2005 ‘rarely or never’ used sunscreen when going out on a sunny day (for the full document see: 

Ms. Pinkerton then offered both data (through a survey to identify the problems) and related policy and resulting interventions that act on the data.  Her presentation also highlighted the importance of gathering local data that provides specific information for areas of intervention and I was very happy to see her implementation of evidence-based programs informed by behavior change theory.  Another efficient way to gather useful local data is to reuse items from national surveys, such as HINTS, to allow for comparisons between national estimates and smaller geographic units, which could be a state, county or even neighborhood, and as a member of the HINTS management team, we encourage this reuse of items.  This openness to sharing data is happening across government agencies and one result of this movement is the Healthdata portal that provides access (directly or indirectly) to a wide range of related data (see:  Now more than ever, the data and tools needed by stakeholders in the cancer arena (e.g., researchers, clinicians, policy makers, advocates) are publicly available and I encourage interested individuals to take advantage of these tools to empower them to do the types of studies and interventions that were demonstrated in this cyber-seminar.


This seminar provided

This seminar provided excellent information on the measurement of UV radiation and great insights on tools and policies to help reduce exposure to UV radiation – and prevent skin cancer. The Skin Cancer Foundation wants to ensure that participants are aware of “Sun Smart U”, a free education program that helps educate students about the importance of sun protection and give them the tools they need to help prevent skin cancer. You can view the program and download lesson plans at

Now in its third year, the program aims to make sun safety behaviors, like wearing sun-protective clothing and sunscreen, automatic and easy for students. The curriculum, aimed at students in grades 6 to 12, also emphasizes the importance of early detection with information about the warning signs of skin cancer. Sun Smart U also features video stories of young adults living with melanoma and their advice for kids.

Teachers and others can download the lesson plans in the most commonly used presentation formats: a SMART or Promethean interactive whiteboard, or Microsoft PowerPoint. Through classroom instruction and activities, these lessons are a fun and easy way to teach students lifelong sun safety habits.

We would very much appreciate feedback on these materials – send your thoughts to Please help us spread the word about Sun Smart U. The materials were carefully developed with dermatologists and other researchers, and are consistent with CDC guidelines.

I was having a case of "the

I was having a case of "the Mondays" until I read an email from the Surgeon General's office thanking us for putting them in touch with July's speaker Beth Pinkerton and the NM Department of Health and Comprehensive Cancer Control Program.  

As a follow up to the July R2R cyber-seminar  Tools and Policies to Prevent Skin Cancer Through Reduction of UV Exposure, R2R staff worked to connect acting Surgeon General Boris Lushniak with Beth and her colleagues.   While in New Mexico, Dr Lushniak toured on of the schools highlighted in the July cyber-seminar and referenced the NCI County Level UV Exposure Data for the Continental United States, presented in July by Dr. ZariaTatalovich. 

So good to make these valuable connections and spread the exciting work being done by the R2R community!



Schools can play an important part in protecting children and teens from sun exposure that can lead to skin cancer in the future.

Schools and child care centers can help lower students’ risk of getting skin cancer by—

  • Allowing students to use sun protection, such as sunscreen and hats.
  • Providing shade and avoiding outdoor activities during peak sunlight hours.
  • Teaching students about sun safety.

According to CDC’s School Health Policies and Practices Study, few schools take these steps to help prevent skin cancer. In 2012, most states and school districts did not have sun safety policies, like allowing students to apply sunscreen or avoiding outdoor activities at the hottest times of the day. Also in 2012, most school districts did not recommend or require sun-safety strategies—like wearing long-sleeved shirts or long pants, hats or visors, or sunglasses when in the sun—for their students. In 2014, almost half of schools allowed students to apply sunscreen, and two-thirds taught students about sun safety or skin cancer prevention.

Some schools prevent students from taking steps to protect themselves from the sun. For example, about 8% of schools prohibited students from wearing hats or visors, and about 7% of schools prohibited students from wearing sunglasses when in the sun during the school day. Also, some school policies prohibited students from using sunscreen or required a school nurse to apply it. Previous research found that nearly half of schools required a doctor’s prescription for staff to apply sunscreen to students.

What Can Be Done to Promote Sun Safety in Schools?

Parents and parent organizations can help change school policies to allow students to use sunscreen and wear hats and protective clothing when in the sun during the school day. They can also encourage schools to provide shade in outdoor activity areas, and teach students how to lower their risk of getting skin cancer.

Health care professionals, including dermatologists, can educate school boards and policy makers about the importance of school policies and programs that support sun safety.


Guy GP Jr, Holman DM, Watson M. The important role of schools in the prevention of skin cancer. JAMA Dermatology 2016.


This article was originally posted as a CDC article summary, but has been reproduced here with the permission of the author, Gery Guy.

Followers of this discussion

Followers of this discussion will be interested to know that the U.S. Preventive Services Task Force is seeking comments on a draft recommendation statement and draft evidence review on behavioral counseling to prevent skin cancer.

The Task Force finds that clinicians should provide counseling to anyone with fair skin ages 6 months to 24 years. The draft recommendation statement and draft evidence review are available for review and public comment from October 10, 2017 through November 6, 2017 at

Do you have anything to add to this recommendation?  Other interventions that you think would be helpful for this population? Or if the age-range target should be modified?