Network Sites: LOOKING FIT National Tanning Training Institute
| Network Sites: LOOKING FIT National Tanning Training Institute |
| |||||||
| Visit Our Sponsors! |
| Science of UV Technical regulatory issues and explanations, medical and dermotology information. |
 |
| | LinkBack | Thread Tools | Display Modes |
30th January 2006, 01:35 PM
| #1 (permalink) |
| Hall of Famer  Join Date: Nov 2004 Location: Virtual Reality
Posts: 2,429
|  The ABCs of Sun Protection for Children The ABCs of Sun Protection for Children Maryellen Maguire-Eisen, MSN, RN, OCN; Karen Rothman, MD; Marie France Demierre, MD, FRCPC Dermatol Nurs. 2005;17(6):419-433. ©2005 Jannetti Publications, Inc. Posted 01/18/2006  Abstract and Introduction Abstract Excessive sun exposure in childhood is a critical variable influencing skin cancer risk. Nurses must teach parents how to properly protect their children from excessive sun exposures by demystifying UV radiation and teaching proper sun-protection measures. Protecting children from excessive sun exposure, while not curtailing recreation, should be the goal of all nurses caring for children. Introduction Skin cancer is the most prevalent cancer in our society with over 1 million new cases annually. Skin cancer is becoming more common in children and accounts for approximately 4% of pediatric malignancies. It is estimated that 90% of all skin cancers are preventable (Schmid-Wendtner et al., 2002). This is a staggering statistic when you consider that one American dies every hour from skin cancer. Nurses can play a pivotal role in prevention and early detection of this serious cancer by teaching proper sun protection to children and their parents. Background Skin cancers are malignancies that develop in the epidermis, dermis, or the adnexal structures of the skin most often due to overexposure to both natural and artificial sources of ultraviolet light. There are three major types of skin cancer: basal cell carcinoma, squamous cell carcinoma, and melanoma. Anyone can get skin cancer but inherent risk factors are very important (Maguire-Eisen, 2003). Skin color, eye color, freckling tendency, nevi count, and family history increase one's risk of developing skin cancer. However, the individual's childhood sun-exposure history appears to significantly influence the risk of skin cancer (Kennedy, Bajdik, Willemze, & Gruijl, 2003; Rhodes, 1995; Silverberg, 2001; Tsao, Atkins, & Sober, 2004). Skin cancers are associated with both intense, sporadic sun exposure (sunburn) and with chronic sun exposure (tanning) (Koh, Geller, Miller, Grossbart, & Lew, 1996). Overexposure to ultraviolet radiation is a growing health concern for children in our society due to environmental changes and cultural trends. The ozone layer acts as a planetary "sunscreen" reflecting and absorbing ultraviolet radiation. Ozone depletion has resulted in increasing levels of ultraviolet (UV) radiation reaching the Earth's surface. Between 1983 and 1993, there was a 6% drop in total ozone. It is estimated that for every 1% drop in ozone there is a 1% to 5% increase in skin cancer (Grant-Kels, 1993). Sunburn incidence among American children is extremely high, ranging from 29% to 83% for the previous summer season and between 7% and 13% for the previous summer weekend (Geller et al., 2002; Robinson, Rigel, & Amonette, 2000). Repeated and severe sunburns affect 12% of adolescents with reports of five or more sunburns during one summer season (Davis, Cokkinides, Weinstock, O'Connell, & Wingo, 2002). Sun burn incidence is associated with increasing age, fair skin, time spent outdoors, sporadic sunscreen use, and inadequate protective clothing (Geller et al., 2002). These factors are important because one sunburn may double a child's risk for developing melanoma. Parental attitudes that a child looks "healthier with a tan" may be a contributing factor influencing sun damage and skin cancer risk (Robinson, Rigel, & Amonette, 1997). Overexposure to ultraviolet radiation via indoor tanning is another growing concern. Artificial tanning is a billion dollar industry frequented by an increasing number of teenage girls (Lazovich & Forster, 2005). Tanning rates for teenage girls double between ages 14 to 15 and 15 to 16 (Geller et al., 2002). Indoor tanning is driven by social pressures, appearance motivation, physiologic effects on mood, and having a parent who tans (Feldman et al., 2004; Lazovich, et al., 2004; Stryker et al., 2004). Health risks associated with indoor tanning include severe skin or corneal burns, cataract formation, skin infections, photoaging, exacerbation of photosensitive disorders, and skin cancer. Basal cell carcinomas, squamous cell carcinomas, and cutaneous melanomas are the most serious health risks. Sun-Protection Actions Sun-protection policies recommend avoiding artificial and natural ultraviolet light sources, proper use of sunscreens, and the appropriate use of shade or sun-protection gear (see Table 1 ) (American Academy of Pediatrics, 1999; Centers for Disease Control [CDC], 2002). However, studies indicate that sun-protection measures are infrequently utilized to prevent sun damage. Sunscreens, hats, sunglasses, and avoiding midday sun are routinely used by less than one-third of children (Banks, Silverman, Schwartz, & Tunnessen, 1992; Hall, McDavid, Jorgenson, & Kraft, 2001; Geller et al., 2002; Olson et al., 1997). Most schools in the United States lack sun-protection policies. The CDC (2002) and the National Association of State Boards of Education (2005) have sample school policies on skin cancer prevention. Recently, states began introducing legislation that addresses skin cancer prevention for children at school. California has led the way in this effort with the ratification of the Billy Bill (CA-SB 310). This bill prevents schools from prohibiting children from wearing sunglasses or hats on campus (Sun Safety for Kids, 2005; William S. Graham Foundation for Melanoma Research, 2005). Ultraviolet Protection Ultraviolet radiation varies dramatically both daily and seasonally. Peak readings occur at midday during noon time and seasonally on the Summer solstice, June 21st. UV intensity is higher in May than in August, leading to a high incidence of sunburn in the Spring. Altitude is another important variable to consider, because UV intensity is greater at higher altitudes, increasing by 2% for every 1,000 feet above sea level. Water, sand, and snow create reflective surfaces that increase scatter by 10%, 15%, and 80% respectively (Environmental Protection Agency [EPA], 2004) Educating parents and teachers how to use the Global UV Index to gauge the potential for sun damage from natural sources is an important way to protect children from excessive exposures to the sun. The UV Index, developed by the National Weather Service and the EPA, is a prediction or estimate of UV intensity and the associated risk of overexposure to human skin. There are sun precautions or actions that correspond to UV intensity levels. These actions include sunglasses, sunscreens, physical protection, and sun avoidance (see Table 2 ). Dermatology nurses should be pragmatic regarding limiting midday exposures and outdoor play. Instruct parents that when the UV intensity is high, early morning, late afternoon, or early evening outdoor activities should be planned whenever possible. If midday activities are unavoidable, recommend portable shade including parasols, beach umbrellas, and sun tents, as well as protective clothing and sunblock. They are all practical and easy to employ. Advising parents about the real risks of indoor tanning is imperative. There is no such thing as a "safe tan" despite advertisements to the contrary. Indoor tanners are at increased risk of developing all forms of skin cancer (Lazovich & Forster, 2005). Legislation forbidding indoor tanning in young teens has been ratified in Wisconsin and Illinois. Many other states are working on bills to protect this population (Lim et al., 2005). Sun-Protective Clothing Sun-protective clothing is an excellent way to shield children from ultraviolet radiation exposure. Sun-protective clothing can range from hats, t-shirts, and sunglasses to specialized garments. Hats can provide shade to the face and neck. Hats with wide brims provide the most protection. Summer clothing usually provides limited protection because of the looseness of weave, ranging from 2 to 6.5 SPF (sun-protection factor). Synthetic materials used in sun-protective garments provide better protection because of the tightness of the weave (Adams, 1999). These specialized garments demonstrate high solar protection in studies despite color or moisture content. Sun-protective clothing is now widely available and can be found at local stores or via the Internet. Coolibar, Sun Precautions, Nozone, and Solartex are some of the retailers that offer these garments for children and adults. The styles are practical and stylish and have become popular with children and adults worldwide. Laundry additives can enhance the sun protection afforded by garments by boosting the SPF in garments. Rit® Sun Guard™ is one commercially available additive available at local drugstore retailers or via the Internet. Sunglasses are recommended for children of all ages. Appropriate sunglasses should provide broad-spectrum protection with 99% of the ultraviolet rays blocked. Broad spectrum denotes protection against both UVB (shorter wavelengths ranging from 280 to 320 nm) and UVA (longer wavelengths ranging from 320 to 400 nm). Look for sunglasses that indicate the glass absorbs ultraviolet light up to 400 nm. Sunglasses are an essential component of sun-protection attire and should not be overlooked. They may protect the eyes from ultraviolet damage and help prevent against cataracts, macular degeneration, and ocular mela noma (American Academy of Ophthalmology, 2005). Sunblock The SPF, spectrum of protection, vehicle, and substantivity (water resistance) should be considered when recommending a sunblock. Sun-protection factor is a concept that parents must understand because it is a measure of protection afforded by sunblocks against ultraviolet B (burning rays) only. The SPF rating is calculated based on the time it takes for the skin to develop minimal erythema (sunburn) with the application of 2 cc/cm2 of sunscreen. Minimal erythema or sunburn is the result of overexposure to UVB rays. SPF is not a measure of the potential damage from UVA rays and does not denote protection from the tanning rays. There is no official rating system for UVA protection at this time. A label that specifies broad-spectrum protection is the best indication of UVA protection. Proper sunscreen application is the only way to achieve the SPF rating indicated by the manufacturer. A consumer must apply one ounce of sunblock per total body application (a handful) for an adult and half ounce for the average child. A SPF 15 sunscreen rating indicates that the protected skin is shielded from UVB radiation for 15 times longer than unprotected skin. On a day with high UV intensity (>6) a person with pale skin would burn in an average of 10 minutes. Therefore, a SPF 15 sunscreen applied in the appropriate dose would protect the individual for approximately 150 minutes, provided there isn't any heavy perspiration or prolonged water submersion. However, because most consumers apply a sub-therapeutic does of sunblock there is a resulting relative lowering of the sun-protection factor. For example, when a parent applies 25% of the recommended does of a SPF 15 sunblock instead of the correct dose, the sunblock protection approximates a SPF 4. Nurses should recommend sunblocks with a broad spectrum of protection (UVB/UVA), in a cosmetically appealing vehicle, with a waterproof or water-resistant rating. Water resistant denotes a longer period of protection than waterproof. Waterproof claims indicate that a sunscreen maintains its SPF after two 20-minute water immersions or moderate physical activity. Water resistant claims indicate that a sunscreen maintains its SPF after 80 minutes of water immersion or extreme physical activity. Titanium dioxide, zinc oxide, or Avobenzone (Parsol 1789), a PABA derivative, provide excellent broad-spectrum protection. Sunblocks should be applied 30 minutes before sun exposure and reapplied every 2 hours or after swimming or heavy perspiration. Although spray sunblocks are appealing due to the ease of application, their coverage is often inadequate due to difficultly in judging dosing and thickness of application and are not recommended. Because sunblocks work by reflecting or absorbing ultraviolet radiation, they are broken down or depleted more quickly on a high UV intensity day. A higher SPF or more frequent application is advisable on a very high or extreme UV day (see Table 3 ). Sun-Safety Education School nurses must take responsibility for protecting children from excessive amounts of ultraviolet radiation at school. There are many wonderful sun-safety educational curriculums that have been developed for pre- school through high school. They can be easily implemented to teach sun safety (see Table 4 ). Experts in the field of education and health care have collaborated to create fun and informative programs that teach sun protection to children and early detection of skin cancer to adolescents. Many of these programs are available free of cost, and can be adapted or modified for application in the community. Although the best curriculum is the one that results in both improved knowledge and sun-protective practices, it is important to remember that repeated health messages are necessary to promote behavior change. Conclusion Sun protection is the responsibility of both parents and nurses. We can no longer think of sunburn or sun damage as a minor health problem for children but rather as permanent genetic damage. Many parents do not know how to adequately protect their children from excessive ultraviolet radiation. Well-informed nurses are invaluable in teaching parents effective sun protection. Sun-safety education must be taught with a common sense approach. With proper guidance and support from nurses, parents should be able to protect their children from overexposure to the sun's dangerous rays without it affecting their children's quality of life or dampening their enjoyment of recreational activities. CE Information The print version of this article was originally certified for CE credit. For accreditation details, please contact the publisher, Anthony J. Jannetti, Inc.,East Holly Avenue Box 56,Pitman, New Jersey 08071-0056  Table 1. Sun Protection Glossary Sun Term Definition Application Table 2. The UV Index and Corresponding Sun Precautions Table 3. Appropriate Sunblock Application
Table 4. Sun-Protection Curriculums Curriculum Organization Grade Level Web Address Content Evaluations References
The authors thank Jane Shanney and Rachel Butler for their editorial review. Maryellen Maguire-Eisen, MSN, RN, OCN, is an Oncology Certified Nurse, and Executive Director, Sun Protection Foundation, Hingham, MA. Karen Rothman, MD, is an Assistant Professor of Medicine and Pediatrics, Division of Dermatology, University of Massachusetts Medical School, Worcester, MA. Marie France Demierre, MD, FRCPC, is an Assistant Professor, and Director, Skin Oncology Program, Boston University School of Medicine, Boston, MA. Source |
|  |
|
| Thread Tools | |
| Display Modes | |
| |
Linear Mode
