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ASCO Educational Book; 2009
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Interventions to Lower Ultraviolet Radiation Exposure: Education, Legislation, and Public Policy

David J. Hill, PhD, Suzanne J. Dobbinson, MSc, PhD, and Jennifer K. Makin

From Cancer Council Victoria, Carlton, Victoria, Australia

Authors’ disclosures of potential conflicts of interest are found at the end of this article.

Address reprint requests to David J. Hill, Cancer Council Victoria, 1 Rathdowne Street, Carlton Vic 3053, Australia; e-mail: David.Hill{at}cancervic.org.au

Overview: Australia and a number of other countries have high rates of skin cancer, due principally to exposure of fair-skinned populations to high levels of ultraviolet radiation (UVR). The World Health Organization (WHO) recommends reducing excessive personal UVR exposure by using protective measures such as hats, sunscreen, and shade, and by avoiding sunbeds. There are two broad dimensions to reducing UVR exposure: 1) public communication and education; and 2) public policy and legislation for more protective environments. Reviews have provided evidence to support specific strategies; however, ideally, multiple levels of influence on behaviors need to be addressed to maximize population change. In the Australian state of Victoria, a multicomponent, communitywide approach to skin cancer prevention combines public education with targeted interventions in specific settings, and advocacy and support for legislative and structural change. Results from 11 waves of a standardized survey show marked improvements in the population's sun protective behavior and sunburn since the launch of the program. Additional analyses have provided evidence of the positive effects of mass media campaigns. Concurrently, several studies have tracked policy development and practices in diverse settings. These have demonstrated the potential for environmental interventions to reduce exposure to ultraviolet radiation. Advocacy for legislative change has also been successful, for example by tightening controls in the sunbed industry and establishing employers’ duty of care around UVR exposure of their employees. Although skin cancer prevention requires a comprehensive, multifaceted, and sustained approach, health economic analyses show it is an excellent investment, and there is emerging evidence of longer-term effects on incidence.