UVI and Risk Communication

The workshop convened by ICNIRP and WHO met to assess whether modifications of the UVI were warranted, and to discuss ways of improving its effectiveness as a guide to healthy sun-protective behaviour.

The adequacy of the UV Index (UVI), a simple measure of ambient solar ultraviolet (UV) radiation, has been questioned on the basis of recent scientific data on the importance of vitamin D for human health, the mutagenic capacity of radiation in the UVA wavelength, and limitations in the behavioural impact of the UVI as a public awareness tool.

A UV Index greater than 3 was confirmed as indicating ambient UV levels at which harmful sun exposure and sunburns could occur and hence as the threshold for promoting preventive messages. There is currently insufficient evidence about the quantitative relationship of sun exposure, vitamin D and human health to include vitamin D considerations in sun protection recommendations. The role of UVA in sunlight-induced dermal immunosuppression and DNA damage was acknowledged, but the contribution of UVA to skin carcinogenesis could not be quantified precisely. As ambient UVA and UVB levels mostly vary in parallel in real life situations, any minor modification of the UVI weighting function with respect to UVA-induced skin cancer would not be expected to have a significant impact on the UV Index.

Though it has been shown that the UV Index can raise awareness of the risk of UV radiation to some extent, the UVI does not appear to change attitudes to sun protection or behaviour in the way it is presently used. Changes in the UVI itself were not warranted based on these findings, but rather research testing health behaviour models, including the roles of self-efficacy and self-affirmation in relation to intention to use sun protection among different susceptible groups, should be carried out to develop more successful strategies towards improving sun protection behaviour.

A Workshop report written by the speakers Sarah Allinson, Monika Asmuss, Cornelia Baldermann, Joan Bentzen, David Buller, Nathalie Gerber, Adele C. Green, Ruediger Greinert, Michael Kimlin, Julie Kunrath, Ruediger Matthes, Christiane Pölzl-Viol, Eva Rehfuess, Constanze Rossmann, Natalie Schüz, Craig Sinclair, Emilie van Deventer, Ann Webb, Wolfgang Weiss, Gunde Ziegelberger was published (Validity and use of the UV Index: Report from the UVI Working Group, Schloss Hohenkammer, Germany, 5-7 December 2011. Health Physics 103(3):301-306; 2012).

History and description of the UVI - What is the UV-Index and why was it developed?
E. van Deventer

Session 1 – Technical issues around the UVI - Chair: R. Matthes

What is the impact of UVA exposure, sunburn and low-level (UVI 1-3) exposure on skin cancer risk across different age groups? Is the action spectrum for erythema a reliable base for skin cancer risk?                     

from an epidemiological point of view
A. Green

from a mechanistic point of view
S. Allinson

How is the UVI calculated? What impact would it have, if the UVI were to incorporate the UVA spectrum and recent knowledge about the body’s ability to generate vitamin D, particularly at low UVI levels?
M. Kimlin

Discussion - Key questions

• Is there a (science-based) need for an UVI update (considering UV-A, Vit D)?
• Has the standardized UVI to be complemented by country- and population-specific factors?
• Research needs?

Tuesday, 6 Dec 2011

Session 2 – Disseminating and explaining the UVI - Chair: C. Pölzl

Results of a systematic review on the UVI as a (successful?) educational tool
E. Rehfuess

Possible improvements to the UVI

2 tiers vs. 3 tiers, inclusion of Vitamin D, real-time vs. maximum value, introducing hours during the day when protection required
C. Sinclair

How to make better use of existing technologies and new media to promote the UV index
D. Buller

Session 3 – Communicating the UVI on the way to change sun protection behaviour

Improving health communication - What we learn from health psychology, cognitive psychology and communication science
C. Rossmann

Predicting and changing sun protection behaviour: Behavioral interventions tailored to the specific needs of teenagers and individuals with strong appearance reasons for tanning
N. Schuez

Session 4 - Working groups - Chair: E. Rehfuess

Key questions:

• How can the UVI be best communicated (text versus graphs, on daily basis versus only when needed, like in spring)? Lessons learned (e.g. keep it simple)
• In other words: Is there a need for an UVI update regarding simplicity and better understanding (e.g. reduce to 2 or 3 tiers, show variability over daytime)? If the information is very/too simple, should risk communication work without using the UVI?
• What is already known about successful sun protection programmes (e.g. multi-faceted intervention programmes, role of UVI within national sun protection programmes)?
• How to integrate UVI in broader skin cancer prevention programmes (different settings?)
• Where we have gone wrong (and right) in the promotion of the UVI to achieve positive behavioural outcomes?
• How to achieve long-term behaviour changes?
• Research needs?

Presentation of group work and discussion - Chair: E. Rehfuess

Wednesday 7 December 2011

Session 5 - Development of recommendations to improve the impact of the UV index in
motivating positive behaviour change - Chair: W. Weiss

Summing up and final discussion on main messages and recommendations

Outline of the subsequent paper, list of authors and further steps