1. Excessive Sun Exposure in teenage females Shannon Dembowske Crystal Thayer Erin Scarbrough-Raden

2. Objectives: Define what excessive sun (UVA rays) exposure is. Relate how it affects female teenagers. Identify how to prevent UVA exposure. Understand statistical information behind sun and UVA exposure Discuss the health belief model Identify the health promotion tool. How can we spread the word? Evaluation of how this tool is effective Support how this relates to Healthy People 2020

3. What is excessive sun or UV exposure According to the American Cancer Society, ultraviolet (UV) radiation is a form of electromagentic radiation, with the main source being rays from the sun, but can also be from tanning beds. o UVA rays: While they are the weakest rays, they can cause skin cells to age and cause indirect damage to cells’ DNA. Mainly linked to long-term skin damage such as wrinkles. May also play a role in some skin cancers. o UVB rays: Slightly stronger than UVA rays. Cause direct damage to DNA of cells, causes sunburn, and is responsible for most skin cancers. o UVC rays: Strongest UV rays. Fortunately they react with ozone higher in the atmosphere and never reach the ground. However, in the past they were found in some tanning beds.

4. Why is Sun Exposure so Important? US teenagers report approximately 1-4 hours a day outdoors between the hours of 10am and 4 pm in the summer (Green, Wallingford, & McBride, 2011, p. 350). “In America, 15-19 year olds melanoma incidence increased 85% from 1973-2006 and was higher in southern registries than in northern ones” (Green, Wallingford, & McBride, 2011, p. 351). Reducing risk factors such as Ultraviolet light (UV) exposure can prevent cancer! (United States Department of Health and Human Services [HHS], Healthy People 2020, 2014)

5. How does sun/UV exposure affect female teens? UV exposure affects female teens in a variety of ways. While there is a stigma that tanner skin is prettier, is the long-term risk worth it? Exposure comes from recreational time in the sun without the proper use of sunscreen, living in an area with high amounts of sun, and the use of tanning beds and lamps. Increased sun and tanning bed exposure leads to sunburns, skin spots, rough patches called actinic keratoses and solar elactosis (thick, dry, wrinkled skin formed on the neck). These skin abnormalities can lead to melanoma, basal and squamous cell cancers. There is a higher risk of melanoma in women who artificially tan before the age of 30-35, and a higher risk of basal and squamous cell cancer in women who tan before the age of 20-25 (American Cancer Society).

6. Other ways sun/UV exposure affects female teenagers UV rays can also cause damage to the eyes in several ways. It can cause cataracts (clouding of the lens of the eye), pterygium (tissue growth on surface of the eye), and retinal damage (part of eye that sense light). UV rays can weaken the immune system, making it more difficult for the body to fight off infection. UV rays can cause allergic reactions and skin rashes, and can worsen some medical conditions (American Cancer Society).

7. Prevention of excessive exposure Primary Prevention for reducing sunburns and sun exposure: Sunscreen Use of hats Avoidance from the sun (finding shade, perhaps under a sun umbrella) Protective clothing Avoid peak sun hours of the day (10am-4pm) Avoid use of artificial UV light (tanning beds) Parental influences- “Though parental influence on teens’ sun protection practices become less important as peer influence increases, they still have a positive effect on adolescents’ sun behaviors” (Green, Wallingford, & McBride, 2011, p. 353).

8. Slip! Slop! Slap! Wrap! The American Cancer Society recommends several easy steps in preventing dangerous UV exposure: 1.Slip on a shirt 2.Slop on some broad spectrum sunscreen with SPF of 30 or greater on all uncovered skin 3.Slap on a hat 4.Wrap on some sunglasses to protect your eyes and the delicate skin around your eyes Also, NO tanning beds and limit time in sun when rays are the strongest between 10 am and 4 pm (American Cancer Society).

9. Barriers: “Though their knowledge about skin cancer and associated risk factors is high, adolescents are generally more reluctant than children to use sun protection” (Green, Wallingford, & McBride, 2011, p. 353). Barriers can include inconvenience of sun protection such as messy and greasy sunscreens; cost of sunscreen and other protective apparel; lack of financial resources to design and execute interventional programs, shade structures, and educational materials on sun protection; interference of sun protection clothing on sports and fashion; desire to be tan; forgetfulness in applying and reapplying sunscreen; time constraints in applying sunscreen; lack of counseling by parents and pediatricians on skin protection; and lack of sun protection policies within the schools (Dadlani & Orlow, 2008).

10. Health Belief Model Threat/susceptibility: The female teenager’s individual assessment for their perceived risk of getting sunburned and subsequent skin cancer. Severity: How serious does this teenager believe this health risk to be? How severe are their tanning behaviors that may but them at risk? Do they already have a history of serious sunburns? Family history of skin cancer? Do they properly use sunscreen? Benefits of taking action: What are the benefits for the teenage female to take action against excessive sun exposure? Prevention of skin damage, wrinkles, melanoma, and basal and squamous cell cancer. Barriers: What may be preventing them from taking action against the goal of health promotion? Influences that may help facilitate or discourage the use of sun protection.

11. Health Promotion Tool: Informative video or documentary Action plan: Hire a screen writing contractor. Create a script of what information we want to promote. Facts about sun/UVA damage Why female teenagers are at greater risk Why sun exposure prevention is so important A need for change of the perception of beauty Celebrity stories Personal skin cancer stories Approach a film or broadcasting company Show video as a part of a educational speech in high schools

12. Resources needed for Health Promotion Tool Film crew Actors and actresses (including celebrities and those with skin cancer/damage stories and physicians being interviewed) Props Equipment such as video cameras and other film equipment Location to shoot video Marketing tools to promote the video in schools and other places that reach the female teenage audience

13. Evaluation of How Effective Health Promotion Tool is Effectiveness of Informative Documentary Administer an anonymous survey that relates to the material presented: Poll the female teenage population before and after the film Ask the population if their mothers tan or if their parents allow them to tan Use screenshots from the film to assess the audiences perception of tan people Other data sources that can be used to evaluate an increase in UV protection or reduction of UV exposure is through the Youth Risk Behavior Surveillance System (YRBSS), CDC/NCHHSTP (HHS, Healthy People 2020, 2014).

14. Healthy People 2020 Objectives : C-20: Increase the proportion of persons who participate in behaviors that reduce their exposure to harmful ultraviolet (UV) irradiation and avoid sunburn C-20.1(Developmental): Reduce the proportion of adolescents in grades 9 through 12 who report sunburn C-20.3: Reduce the proportion of adolescents in grades 9 through 12 who report using artificial sources of ultraviolet light for tanning Baseline reporting for use -15.6% (2009) Goal for reporting use -14.0% C-20.5: Increase the proportion of adolescents in grades 9 through 12 who follow protective measures that may reduce the risk of skin cancer Baseline for following protective measures -9.3% (2009) Goal for following protective measures- 11.2% (HHS, Healthy People 2020, 2014)

15. References: American Cancer Society (2013). Be safe in the sun. Retrieved from http://www.cancer.org/healthy/besafeinthesun/. Balk, S.,Fisher, D., & Geller, A.(2013). Teens and indoor tanning: A Cancer Prevention Opportunity for Pediatricians. American Academy of Pediatrics, 131, 772-785. doi: 10.1542/peds.2012-2404 Boynton, A & Oxlad, M. (2011). Melanoma and its relationship with solarium use: health knowledge, attitudes and behavior of young women. Journal of Health Psychology, 6 (6), 969-979. doi: 10.1177/1359105310397962 Dadlani, C. & Orlow, S. (2008). Planning for a brighter future: A review of sun protection and barriers to behavioral change in children and adolescents. Dermatology Online Journal, 14( 9). Retrieved from https://escholarship.org/uc/item/6vs1r0r9. Green, A.C., Wallingford, S.C., McBride, P. (2011). Childhood exposure to ultraviolet radiation and harmful skin effects: epidemiological evidence. Progress in biophysics and molecular biology, 107, 349- 355. doi: 10.1016/j.pbiomolbio.2011.08.010 United States Department of Health and Human Services, Healthy People 2020. (2014, October 30). Cancer: Overview. Retrieved from http://www.healthypeople.gov/2020/topicsobjectives/topic/cancer/objectives