Jennifer K. Makin

Population and age-group trends in weekend sun protection and sunburn over two decades of the SunSmart programme in Melbourne, Australia

Background  In response to the high skin cancer burden in Australia, the multicomponent, community‐wide SunSmart programme has worked since 1988 to reduce excessive sun exposure.

The role of public health advocacy in achieving an outright ban on commercial tanning beds in Australia.

Although many countries still face opposition to the legislation of artificial tanning beds, all Australian states and territories have announced a total ban on commercial tanning beds. A combination of epidemiological and policy-centered research, powerful personal stories, and the active advocacy of prominent academics, cancer organizations, and grassroots community campaigners contributed to the decisions to first legislate standards and then ban all commercial tanning beds. We have illustrated that incremental change can be an effective pathway to securing substantial public health reforms.

Implications of Lessons Learned From Tobacco Control for Tanning Bed Reform

Tanning beds used according to the manufacturer’s instructions expose the user to health risks, including melanoma and other skin cancers. Applying the MPOWER model (monitor, protect, offer alternatives, warn, enforce, and raise taxes), which has been used in tobacco control, to tanning bed reform could reduce the number of people at risk of diseases associated with tanning bed use. Among the tactics available to government are restricting the use of tanning beds by people under age 18 and those with fair skin, increasing the price of tanning bed services through taxation, licensing tanning bed operators, and banning unsupervised tanning bed operations.

Fifty years of changes in UV Index and implications for skin cancer in Australia

Surface ultraviolet (UV) radiation plays an important role in human health. Increased exposure to UV radiation increases the risk of skin cancer. In Australia, public campaigns to prevent skin cancer include the promotion of daily UV forecasts. If all other atmospheric factors are equal, stratospheric ozone decreases result in UV increases. Given that Australia still has the highest skin cancer rates in the world, it is important to monitor Australia’s stratospheric ozone and UV radiation levels over time because of the effects cumulative exposure can have on humans. In this paper, two long-term ozone datasets derived from surface and satellite measurements, a radiation code and atmospheric meteorological fields are used to calculate clear-sky UV radiation over a 50-year period (1959–2009) for Australia. The deviations from 1970–1980 levels show that clear-sky UV is on the rise. After the 1990s, an overall annual increase from 2 to 6% above the 1970–1980 levels was observed at all latitudes. Examining the summer and winter deviations from 1970–1980 showed that the winter signal dominated the annual changes, with winter increases almost twice those in summer. With ozone levels not expected to recover to pre-depletion levels until the middle of this century, UV levels are expected to continue to rise. Combined with Australians favoring an outdoor life-style, when temperatures are warmer, under high levels of UV, the associated risk of skin cancer will increase.

Sometimes it takes a loss of life to make a difference

Media coverage of one death from melanoma helped spur on Australian legislation on sunbeds, but the groundwork had already been laid

The increase in solariums in Australia, 1992–2006

Re: Wigglesworth E. Occupational injuries by hour of day and day of week: a 20-year study. Published in the December 2006 issue of the Australian and New Zealand Journal of Public Health, pages 505-8. I read this paper with some concern. If the paper was purely an analysis of historical data, perhaps as an example of the sort of exercise that occupational health and safety (OHS) practitioners undertook at the time relating to the data, then it is an interesting historical piece. However, Dr Wigglesworth implies in the final paragraph that he sees this analysis as potentially useful for today’s OHS practitioner to assist them in improving safety within the workplace. I am surprised that an experienced researcher as Dr Wigglesworth would imply this. There are two specific issues that make this implication very difficult. First, in the 20 years since the last of these data were collected, and certainly since the first data were collected nearly 40 years ago, the Australian workplace and worker have undergone quite dramatic changes. The important ones with some relevance to injury causation include changes to industry type, OHS regulation, composition of the workforce, availability of OHS information, industrial relations, unionisation, and type of employment. I am not implying that all these changes work towards a reduction or otherwise of injuries or improvement in safety, only that these are uncontrolled variables in relation to the 1968-88 data that will have an impact on current OHS. Their effect will need to be examined if trying to extrapolate from this set of past data. Second, OHS legislation today requires employers to identify and reduce risk within the workplace to ‘acceptable levels’. There is no indication within the paper that the inherent risk of the job (necessarily covering all jobs in Queensland in the data examined) varied with time of day or day of week. Dr Wigglesworth rightly examines the possibility of fatigue and points out that there would appear to be no intra-day or intra-week effect from fatigue (in fact, the opposite is suggested). Perhaps as employees ‘warm up’ to their tasks (both physically and mentally), they are likely to have fewer injuries. However, there is no direct evidence of this. The point is that these data do not provide any direction for today’s OHS advisers and operating managers on how to reduce risk in the workplace. The courts have determined employees will make operating mistakes from lack of concentration or other factors, and that employers have to structure the workplace to be safe in spite of such human errors. Moreover, there is a large body of research from the quality movement that has identified that the majority of errors are caused by the work system itself (insufficient training, inadequate supervision, resources, etc), rather than by ‘careless’ workers. Quality processes such as Six-Sigma are designed specifically to find and correct such system errors. I am not suggesting that Dr Wigglesworth is blaming careless workers, but that inference can be made from the paper and could be seized on by employers seeking to avoid their legislated responsibilities. That would not be helpful from the point of view of furthering OHS research within Australia. There are pitifully few OHS researchers and too little OHS research done in Australia. It seems a pity that a researcher of Dr Wigglesworth’s stature is wasting his time on such outdated material.

Changes in solarium numbers in Australia following negative media and legislation

Objective: To monitor changes in the number of indoor tanning facilities in Australias capital cities following widespread negative publicity and the introduction of legislation in some states.

Community-wide Interventions to Prevent Skin Cancer ☆: Two Community Guide Systematic Reviews

CONTEXT Skin cancer is a preventable and commonly diagnosed cancer in the U.S. Excessive ultraviolet radiation exposure is a known cause of skin cancer. This article presents updated results of two types of interventions evaluated in a previously published Community Guide systematic review: multicomponent community-wide interventions and mass media interventions when used alone. EVIDENCE ACQUISITION Studies assessing multicomponent community-wide and mass media interventions to prevent skin cancer by reducing ultraviolet radiation exposure were evaluated using Community Guide systematic review methods. Relevant studies published between 1966 and 2013 were included and analyzed for this review. EVIDENCE SYNTHESIS Seven studies evaluating the effectiveness of multicomponent community-wide interventions showed a median increase in sunscreen use of 10.8 (interquartile interval=7.3, 23.2) percentage points, a small decrease in ultraviolet radiation exposure, a decrease in indoor tanning device use of 4.0 (95% CI=2.5, 5.5) percentage points, and mixed results for other protective behaviors. Four studies evaluating the effectiveness of mass media interventions found that they generally led to improved ultraviolet protection behaviors among children and adults. CONCLUSIONS The available evidence showed that multicomponent community-wide interventions are effective in reducing the deleterious effects of ultraviolet radiation exposure by increasing sunscreen use. There was, however, insufficient evidence to determine the effectiveness of mass media interventions alone in reducing ultraviolet radiation exposure and increasing ultraviolet protection behaviors, indicating a continuing need for more research in this field to improve assessment of effectiveness.

Compliance with age and skin type restrictions following the introduction of indoor tanning legislation in Melbourne, Australia.

The study aimed to establish compliance of indoor tanning businesses with 2009 legislation, particularly with requirements to provide information on skin cancer and exclude people under 18 or with fair skin.

Shade provision for toddlers at swimming pools in Melbourne.

This study assessed the UVR protection provided by shade structures over toddler pools at swimming pool centers in Melbourne. The UVR protection was measured using a combination of UV sensitive polysulfone film to derive an average value during the middle of the day (1–2 P.M.) and handheld UV meters to derive the time variability in UV protection between 11 A.M. and 3 P.M. The amount of UVR protection provided by the shade structures depended upon a number of factors such as location, size, and materials used, but generally ranged from a protection factor (PF) of 2 to ~ 16. The higher PFs were generally for larger structures or where the shade had other structures nearby. The handheld UV meter measurements showed the UV protection varied with position under the shade structure as well as with time of day. While provision of shade structures is becoming more widespread around Australia, improving the shade availability at the pool centers overall, the application of recommendations regarding the provision of shade has been followed to a varying degree by many of the pools visited in this study. In many cases, continued further improvements can be made to provide more adequate protection and further reduce UV exposures.