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Recommendations for Reducing Exposure to the Sun

 

 

 

Introduction

In view of the damage and health effects of ultraviolet radiation, the policy on this issue focuses on raising awareness to the hazards of exposure and recommending ways of reducing it.  This is an example of primary prevention of a health hazard. In Israel, a program entitled "Smart in the Sun" (Hebrew) was set up in 1995 by the Israel Cancer Association.  The program included educational and health-related messages, based on the Hebrew acronym for "Smart in the Sun".

This chapter will review the sun protection recommendations from Israel and abroad.  The recommendations are backed up by the World Health Organization (WHO), the Ministry of Health (Hebrew), and the Israel Cancer Association (Hebrew), and follow the Hebrew acronym for "Smart in the Sun"

 

   

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  Seek the shade   

During daylight hours shade should be sought whenever one is outdoors, at the beach or the swimming pool.  Note that shade from trees, umbrellas and open-sided sunshades does not provide absolute protection from the sun.

In Israel a policy was outlined relating to shaded areas in educational institutions, expressed in Ministry of Education Directorial Circulars.

In the CEO Circular dealing with safety in kindergartens (Hebrew), the instructions relating to requirements for play areas include sunshades, so that the shaded area would cover at least 25% of the courtyard.  Seats should be provided in the shaded area.

The CEO Circular dealing with safety in buildings of educational institutions (Hebrew) includes instructions relating to shaded areas, such as: walling off a sand-pit in the courtyard and roofing it, providing shaded areas in the courtyard (when the shade over the sand-pit is insufficient), and providing seating arrangements in the shaded areas.

In 2015 a Bill on the subject of "A healthy educational environment" (Hebrew) was placed before the Knesset (A similar proposal was put forward in 2009).  In the section dealing with solar radiation it was proposed that:

11. (a) " Within the educational institution non-roofed areas that are used by the students for any purpose must be protected from solar radiation by natural shading, such as trees and high greenery, or by sunshades, according to the criteria defined by the National Inspector".

(b) "Activities of the educational institution that are to take place in non-shaded areas will take place during the hours when the ultraviolet radiation of the sun is at its lowest intensity during the hours of activity, as defined by the National Inspector".

 

"The Shade Wall" – an example in a world-wide campaign to increase awareness of the hazards of exposure to the sun

 

 
    

Wi-Fi and prevention of skin cancer

In the framework of a campaign to boost awareness of prevention of skin cancer (collaboration between a Belgian advertising agency and the Anti-Cancer League in Peru), a wall three storeys high was built on a beach in Peru to block the sun's rays.

 

The Wi-Fi network was accessible only in the shade of the wall ("Shadow Wi-Fi"), and moved around with the shade.

 

Those wishing to access the network first have to sign up at a site displaying information on the risks of exposure to the sun and on skin cancer.

 

After signing up, access to Wi-Fi s available only when the user is within the shaded area of the wall.  To stay connected to the network, the user has to follow the shade.
 

    

 

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Hats

A hat is a means of protection from the sun.  A broad-brimmed hat is recommended, to shade the face, head, ears and neck.

 

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Sunglasses

Solar radiation may harm the eyes, cause wrinkles in the skin around the eyes, and stimulate the development of cataracts and tumors in the eye and around it.  Sunglasses filter the ultraviolet radiation, thus reducing the risk of harm to the eyes.  It is recommended to use sunglasses that block out UVA and UVB rays. They should bear a label certifying they provide 100% ultraviolet protection to the eyes.  This recommendation applies to all ages, including children.

 
 
 

Suitable clothing   

For protection from the sun, the skin should be covered by clothes.  A shirt with long sleeves is recommended, to cover the shoulders and arms, and trousers should be at least knee high.

 

Fabrics that provide the best protection from solar radiation are the closely-woven ones, such as cotton. When entering water, it is recommended that a full bathing-suit made of a sun-filtering fabric be worn, or a surfing suit or any other protective clothing,

 

Protection of workers exposed to the sun during the course of their work

In Israel, the protection of workers in the workplace against solar radiation hazards is included in the Occupational Safety Regulations (personal protective equipment) – 1997 (Hebrew).  The Regulations require an employer to ensure that a worker is not exposed to the sun's rays unless protected as follows:  "A worker exposed to the sun's rays will wear clothes and a hat that will cover his body and head, to prevent damage from the sun's rays, and will wear suitable sunglasses to screen ultraviolet radiation."

 

Also, the Ministry of Economics  published a warning to workers and employers – prevention of sun damage in the workplace (see Link below), including recommendations and rules to prevent uncontrolled exposure to the sun's rays.
http://www.moital.gov.il/NR/exeres/98043961-41D0-49E2-BDA1-18AADA576E4C,frameless.htm (Hebrew)

 

This warning specified that the subject of natural exposure to ultraviolet radiation is fundamental all year round, but especially in the summer, and the Occupational Health and Safety Administration calls for workers in various branches of the economy to minimize exposure to the sun as much as possible, and to protect themselves during the course of their work.  The Administration called for employers to exercise their responsibility towards the workers, as detailed in the above Regulations, and to provide means of protection from the sun, such as suitable clothing and protective sunscreens, and to ensure their utilization.

 

The issue of protection of employees against exposure to the sun is dealt with by many countries, especially sunny ones such as New Zealand and Australia. In New Zealand the commitment of employers towards their employees exposed to the sun during the course of their work is covered by law (since 1992). In Australia, a document providing guidelines for reducing the exposure of workers to ultraviolet radiation, such as from the sun, has been published by the Australian Radiation Protection and Nuclear Safety Agency – ARPANSA.  In Britain, information on the health consequences of working in the sun and recommendations to employers of workers exposed to the sun, may be found on the Website of the Health and Safety Executive,

 

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Safe hours  

It is recommended to avoid, as much as possible, exposure between 10:00 and 16:00 hrs., during which the intensity of solar radiation is at a maximum.

 

      

 

The Ultraviolet Radiation Index – UVI – is the measure accepted world-wide to indicate the risk level for exposure to solar ultraviolet radiation that reaches us, at different hours in different regions.  The index is designed to assist the public in protecting itself from the radiation. In Israel one can refer to the daily forecast of the UVI for each daylight hour from 7:00 to 17:00 hrs, published by the Israel Meteorological Service. The forecast covers the different regions of the country and is published on the Israel Meteorological Service's Website and through other communications media.

 

    

 

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Protection factor 

Using radiation filters can reduce the damage caused by uncontrolled exposure to solar radiation.  Sunscreens contain filters against ultraviolet radiation and are intended for external use on the skin.  Sun filters work in one of two ways: some deflect the ultraviolet radiation reaching them, so that it is not absorbed by the skin, and others absorb the radiation before it reaches the skin layers.

 

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SPF (Sun Protection Factor) Index

Sun-screens bear a number representing the protection factor, grading its effectiveness in blocking UVB radiation.  The level of protection of the filter depends not only on the SPF index, but also on the nature of the skin, the amount of sun-filter applied to the skin, the type of activity in the sun (heavy perspiration or activity in water will remove some of the filter), the duration of exposure, and the frequency of repeated sunscreen application.  The effectiveness of the filter is measured according to the amount of time the preparation protects the skin from reddening (sunburn) caused by the ultraviolet radiation, compared to the amount of time before the skin shows reddening without the protective product (e.g. if a person's skin usually reddens after 10 minutes in the sun, the use of a sun screen with SPF 15 will theoretically prolong the time until redness appears by a factor of 15, i.e. by 150 minutes).

 

Below is a table representing the degree of blocking (expressed as a percentage of UVB radiation) performed by various sun filters.

 

   
SPF 

Percentage of blockage of UV radiation 

4 75
8 87.5
15 93.3
30 96.7
50 98
   

Sayre RM, Agin PP, LeVee GJ, Marlowe E. A comparison of in vivo and in vitro
testing of sunscreening formulas. Photochem Photobiol. 1979; 29:559-566

 

Furthermore, it is important to note that the SPF does not indicate protection from UVA radiation.  Although UVA radiation does not cause skin redness, it permeates the skin and it too may increase the risk of developing skin cancer.  It is therefore important to use sun filters that can protect against UVA radiation as well as UVB radiation (broad spectrum).

 

The sun's rays

The sun's rays

 

In Israel today there is no consensus on recommendations dealing with the protection factor in various sunscreens.

According to the Israel Cancer Association (ICA): "It is recommended to use a radiation filter with SPF30 or higher. Products with a protection factor higher than SPF 30 are recommended for persons at high risk of developing skin cancer". (ICA Website)

 

On the other hand, the Ministry of Health (Hebrew), on its Website, recommends using a product with SPF 15-50, which protects against both UVA and UVB.

 

In February 2014 the Ministry of Health published the Procedure for licensing products (Hebrew)  intended for protection against solar radiation.  It specifies, inter alia, that only preparations with an SPF value of 30 or higher, and the ability to protect against UVA and UVB radiation, are considered as preparations with broad spectrum protection.

 

The State Comptroller's report on "Skin Cancer – prevention, detection and treatment" (Hebrew)  (2014) pointed out the lack of uniformity in the recommendations published by the different bodies in Israel regarding the minimal protective factors recommended.

 

The issue of Protection Factor levels abroad

The World Health Organization (WHO) recommends using products with SPF 15 or higher.

The American Academy of Dermatology recommends using products with SPF 30 or higher

The Cancer Council of Australia recommends using products with SPF 30 or higher (broad spectrum).

 

Additional guidelines for the correct use of radiation filters (according to the Israel Cancer Association)-Hebrew

  • The first layer of the product should be applied about 30 minutes before exposure to the sun – two successive applications are recommended. All parts of the body unprotected by clothing should be covered with sunscreen.
  • To ensure continued protection the product should be applied again every two hours, as well as after swimming and towel-drying. It is recommended to use a water-repellent product as protection against moisture due to perspiration or when swimming.
  • Expiry date: this should be noted on the container.  The shelf-life of a product with no expiry date is three years at most, but it is shorter if the product is exposed to high temperatures,

 

Can using a sunscreen product with high SPF be harmful?

  • The illusion of protection – there is concern that using a protective product will raise the exposure threshold due to:
    • More prolonged exposure – repeated applications are therefore recommended:  successive applications should be repeated every two hours.
    • Exposure to the sun during the hours of peak exposure.  It is recommended to avoid exposure as much as possible during certain hours (the unsafe hours), even with the use of protective products, since some of the UV rays may permeate the skin and cause damage.  In any case, additional forms of protection should be used, rather than just smearing sunscreen.
  • There is concern that reduction of exposure to UVB by using protective sunscreens may reduce the amount of Vitamin D absorbed by the skin.

 

    

 

Public protective sunscreen dispensers

 

In Miami Beach, in a project to reduce the risk of skin cancer, 50 dispensers of sunscreens were set up in public places, including swimming pools and beaches, to encourage people to protect themselves from solar radiation.  Citizens and tourists can thus use the products at no cost.

 

  

 

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  Plentiful drinking   

 It is recommended to drink a lot of water as a routine.  During exposure to the sun the body heats up and cools itself through perspiration.  The body thus loses liquids vital to its normal functioning.

 

On the Ministry of Health's Website you can find details of the recommended daily amounts per person (Hebrew).

 

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Sun beds

 

      

 

Despite information on this subject, and public awareness of the dangers of the sun, there exists a trend whereby people, for reasons of esthetics and beauty, expose themselves to artificial ultraviolet radiation that resembles sunlight, using sun beds and tanning booths, fitted with special radiation-emitting lamps - this trend entails a real danger to health.

During the last decade things have at last begun to change, in Israel and abroad,  certain restrictions are being placed on tanning salons, especially for people younger than 18.

In July 2014, new regulations were formulated in Israel (Hebrew), according to which it is forbidden for the manager of a Tanning Salon or its staff to allow the use of tanning equipment to persons under 18.  Moreover, Tanning Salons are required to post a warning notice, distribute an information leaflet to customers, ensure the use of washed and sterilized eye-shields, and comply with Israeli standards for the equipment.

 

    

 

 

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References

(All documents are in Hebrew unless otherwise specified)

 

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