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5E Ultraviolet Radiation Exposure
 

Description | Specific IndicatorsOntario Public Health Standards (OPHS) | Corresponding Health Indicator from Statistics Canada and CIHI  | Corresponding Indicator(s) from Other Sources | Data SourcesSurvey Questions | Analysis Check List | Method of CalculationBasic Categories | Indicator Comments | Cross-References to Other Indicators | Cited References | Other References  | Changes Made

Description

  • Proportion of population aged 18 years and over that report having sunburn in the past 12 months.
  • Proportion of population aged 18 years and over that practice sun safety practices.

Specific Indicators

  • Proportion of population who have had a sunburn in past 12 months
  • Proportion of population avoiding sun during peak times
  • Proportion of population wearing sunglasses
  • Proportion of population wearing protective clothing against the sun
  • Proportion of population using sunscreen

Ontario Public Health Standards (OPHS)

The Ontario Public Health Standards (OPHS) establish requirements for the fundamental public health programs and services carried out by boards of health, which include assessment and surveillance, health promotion and policy development, disease and injury prevention, and health protection. The OPHS consist of one Foundational Standard and 13 Program Standards that articulate broad societal goals that result from the activities undertaken by boards of health and many others, including community partners, non-governmental organizations, and governmental bodies. These results have been expressed in terms of two levels of outcomes: societal outcomes and board of health outcomes. Societal outcomes entail changes in health status, organizations, systems, norms, policies, environments, and practices and result from the work of many sectors of society, including boards of health, for the improvement of the overall health of the population. Board of health outcomes are the results of endeavours by boards of health and often focus on changes in awareness, knowledge, attitudes, skills, practices, environments, and policies. Boards of health are accountable for these outcomes. The standards also outline the requirements that boards of health must implement to achieve the stated results.

          Outcomes Related to this Indicator

  • Societal outcome (Chronic Disease Prevention): Community partners have the capacity to address the risk factors associated with chronic diseases, including poor diet, obesity, tobacco use, physical inactivity, alcohol misuse, and exposure to ultraviolet radiation.
  • Societal Outcome (Chronic Disease Prevention): There is increased adoption of behaviours and skills associated with reducing the risk of chronic diseases of public health importance.
  • Board of Health Outcome (Chronic Disease Prevention): The public is aware of the importance of healthy eating, healthy weights, comprehensive tobacco control, physical activity, reduced alcohol use, and reduced exposure to ultraviolet radiation.

          Assessment and Surveillance Requirement Related to this Indicator:

  • The board of health shall conduct epidemiological analysis of surveillance data...in the area of exposure to ultraviolet radiation (Chronic Disease Prevention).

     http://www.ontario.ca/publichealthstandards

Corresponding Health Indicator from Statistics Canada and CIHI

  • None

Corresponding Indicator(s) from Other Sources

The US Centre for Disease Control has related indicators in its Environmental Public Health Indicators Project, addressing not only individual behaviours but also aspects of the physical and social environment:

  • Number of days in which the UV light index exceeds a safe threshold
  • Proportion of adults who follow protective measures to prevent melanoma and skin cancer
  • Proportion of adolescents who follow protective measures to prevent melanoma and skin cancer
  • Number and type of sun protection messages issued to the public

http://www.cdc.gov/nceh/indicators/sunuv.htm#uv

Data Sources

Numerator & Denominator: Rapid Risk Factor Surveillance System (RRFSS)
Original source:
Public Health Unit
Distributed by:
Public Health Unit
Suggested citation (see Data Citation Notes):
RRFSS [month, year - month, year], Extracted: [month, year]

Survey Questions

The Rapid Risk Factor Surveillance System (RRFSS) contains a module called Sun Safety. This module was core from 2001-2003 and optional from 2004-2005. In 2006 and 2008, this module was rotating core. (Note: a rotating core module in RRFSS is a module that, within a two year cycle, is core in one year but optional in the other).

Data Source

Module

Question

Response Categories

Year

Variable

RRFSS

Sun Safety

Now we want to ask you about sunburns. By sunburn we mean any reddening or discomfort of your skin that lasts longer than 12 hours after exposure to the sun or other ultra violet sources, such as tanning beds or sunlamps. In the last twelve months, has any part of your body been sunburned?

Yes,
No,
Don't Know,
Refused

2001-
Present

sun_s1

[skip except May to Sept]

How often do you avoid being in the sun between 11 am and 4 pm:  would you say always, often, sometimes, rarely or never?

Always,
Often,
Sometimes, Rarely,
Never,
Don't know,
Refused

2001-
Present

sun_s2

[skip except May to Sept]

How often do you wear sunglasses with UV (ultra violet) protection when in the sun:  would you say always, often, sometimes, rarely or never?

Always,
Often, Sometimes,  Rarely,
Never ,
Don't know,
Refused

2001-
Present

sun_s3

[skip except May to Sept]

How often do you wear protective clothing, including a hat, when in the sun? Would you say always, often, sometimes, rarely or never?

Always,
Often,  Sometimes,  Rarely,
Never,
Don't Know,
Refused

2001-
Present

sun_s4

How often do you use sun screen? Would you say always, often, sometimes, rarely or never?

Always,
Often, Sometimes,  Rarely,
Never,
Don't know,
Refused

2001-
Present

sun_s6

Analysis Check List 

RRFSS

  • Users should refer to the most recent RRFSS Manual of Operations for a complete list of RRFSS analysis guidelines.
  • Denominator Data - cell size less than 30 not to be released (based on unweighted data).
  • Numerator Data - cell size less than 5 not to be released (based on unweighted data).
  • Coefficients of variation (CV) should be calculated for every estimate. The following categories determine the release of the data:
  • CV between 0 and 16.5:  estimate can be released without qualification.
  • CV between 16.6 and 33.3:  estimate can be released with qualification:  interpret with caution.  High variability.
  • CV greater than 33.3:  estimate should not be released, regardless of the cell size.
  • 95% confidence intervals should accompany all released estimates.  In general the simple computation of the C.I. for a proportion assuming SEp = sqrt(pq/n) and CI95% = p +/- 1.96*SEp is sufficient. However, if estimates are close to 0 or 100% and the simple computation confidence intervals include values less than zero or greater than 100 then the Fleiss 2nd edition computation for skewed estimates should be employed.
  • Weighting:
    • General household weight will be applied for questions related to the individual. 
    • Household weight is to be applied for questions about households when we wish to determine the population/number of people affected. 
    • Household weight is not to be applied for child proxy questions (bicycle helmet use, car seat safety), dog and cat immunization modules, or other questions that relate to the household rather than the respondent. 
    • Household weights are not required to be recalculated for sub-population based questions; for example mammography in women ages 35+ years and 50-74 years.
    • If the weights supplied with the data set (health unit wave specific, health unit cumulative total, all health units combined wave specific, all health units combined cumulative total) are not appropriate for the required analysis, then a time-specific weight must be calculated.  For example, a new weight is required for all seasonal modules.
  • If the cell size of ‘Don't Know' responses is 5% or greater, ‘Don't Know' responses should be included in the denominator of the analyses and reported separately.
  • If the cell size of ‘Refusal' responses is 5% or greater, ‘Refusal' responses should be included in the denominator of the analyses and reported separately.
  • When an indicator is being compared between groups (e.g. health units, time periods, gender), if any one group has ‘Don't Know' and/or ‘Refusal' responses that are 5% or greater, ‘Don't Know' and/or ‘Refusal' responses should be included in the denominator of the analyses and reported separately for all groups.
  • A provincial sample is not available with the RRFSS.
  • Refer to the RRFSS Data Dictionaries at http://www.rrfss.ca/ for more information about module questions and indicators.

Method of Calculation

Sunburn
Weighted # adults (18+) who reported a sunburn in the past 12 months (sun_s1=1)

Weighted all adults (18+)
 X 100

Avoid sun
Weighted # adults (18+) who always or often avoid the sun (sun_s2=1 or sun_s2=2)

Weighted all adults (18+)
 X 100

Protective clothing
Weighted # adults (18+) who always or often wear protective clothing in the sun (sun_s4=1 or sun_s4=2)

Weighted all adults (18+)
 X 100

Sunscreen use
Weighted # adults (18+) who always or often report using sunscreen (sun_s6=1 or sun_s6=2)

Weighted all adults (18+)
 X 100

Sunglasses
Weighted # adults (18+) who always or often wear sunglasses (sun_s3=1 or sun_s3=2)

Weighted all adults (18+)
 X 100

Basic Categories

  • Age groups for age-specific rates: 18-24, 25-44, 45-64, 65+.
  • Sex: male, female and total.
  • Geographic areas: RRFSS - participating health units that chose the sun safety module (varies by wave, check documentation).

Indicator Comments

  • The International Agency for Research on Cancer (IARC) has classified solar radiation as a human carcinogen, causing all forms of skin cancer, and UVA and UVB as probable human carcinogens.1 The US National Toxicology Program has, in addition, identified exposure to sunlamps or sunbeds as a human carcinogen.2 Solar radiation can also cause other health problems, including sunburn, photoaging and cataracts.3
  • The indicator concerning sunglasses relates not to cancer (probably not even to (rare) ocular melanoma) but to cataracts and possibly other conditions like age-related macular degeneration (Loraine Marrett, Cancer Care Ontario, personal communication 2008; Tony Cullen, Professor Emeritus (Optometry), University of Waterloo, personal communication 2006).
  • UVR indicators would ideally provide information on the following (Loraine Marrett, Cancer Care Ontario, personal communication, 2008):
    • Proportion avoiding sun (time in the sun <30 minutes a day between 11 am and 4 pm during the summer months);
    • Proportion not avoiding sun (time in the sun >30 minutes a day between 11 am and 4 pm during the summer months) but who always or often seek shade or wear a hat and protective clothing;
    • Proportion not avoiding sun (time in the sun >30 minutes a day between 11 am and 4 pm during the summer months) and who do not always or often seek shade or wear a hat, but always or often use sunscreen with SPF > 15 on the face;
    • Proportion not avoiding sun (time in the sun >30 minutes a day between 11 am and 4 pm during the summer months) and who do not always or often seek shade or wear protective clothing, but always or often use sunscreen with SPF > 15 on the body;
    • Proportion always or often wearing sunglasses in the sun
    • Proportion who have not had a sunburn in the past 12 months
    • Proportion who have not used tanning equipment in the past 12 months
  • Neither RRFSS nor CCHS questions (see below) completely address this set of indicators.
  • Although an optional sun safety module has been available for selection in CCHS beginning with 2005, it has not been selected for Ontario pending suggested changes from the National and/or Ontario Sun Safety Working Groups.
  • RRFSS has an additional module, Artificial Tanning Equipment, with a potential 18 questions. 

Cross-References to Other Indicators 

For melanoma incidence and mortality

  • Cancer incidence (Section 4B: Cancer Incidence and the Early Detection of Cancer)
  • Cancer mortality (Section 4B: Cancer Incidence and the Early Detection of Cancer)

Cited References

  1. International Agency for Research on Cancer (IARC). Solar and ultraviolet radiation. IARC monographs on the evaluation of carcinogenic risks to humans, Vol. 55. Lyon: IARC, 1992. Summary available at: http://monographs.iarc.fr/ENG/Monographs/allmonos60.php.
  2. U.S. Department of Health and Human Services, Public Health Service, National Toxicology Program. Report on Carcinogens, Eleventh Edition, 2005.
  3. Marrett LD, Broadhurst D, Charron S, Fraser L, From L, Hunter W, Payne P, Yarema ML, Rosen C. The Ontario sun safety working group. Chron Dis Can 2003;24(1):27-31.

Other References

Changes made

 

Date

Formal Review or Ad Hoc?

Changes
made by

Changes

June 10, 2009

Formal review.

Cancer, Smoking and Sun Safety subgroup of Core Indicators.

  • A new section on the Ontario Public Health Standards was added to replace the section on the Corresponding Mandatory Objectives because the Mandatory Health Programs and Service Guidelines are now out of date.
  • The following sections were updated: Corresponding indicators from other sources, Analysis check list, Basic categories and Indicator comments.
  • The references section was separated into Cited references and Other references in alignment with the new Guide to Creating or Editing Core Indicator Pages
  • The section called Alternative data sources used to contain survey questions from the CCHS ‘Sun Safety Behaviours' module. This section has been deleted because this optional module, offered in CCHS 2005 (3.1) and in CCHS 2007 (4.1), was not selected by Ontario.
  • The name of this indicator was changed from "Sun Safety" to "Ultraviolet Radiation Exposure" to match the wording used in the Ontario Public Health Standards.

 
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