Exposure to the sun and other sources of ultraviolet radiation (UVR) without sufficient protection is a well-established cause of skin cancer. (1) UVR is also known to cause harm to the eyes. (2) National surveys found that in 2006, Canadians spent more time in the sun without improving their sun protection behaviours than in 1996. (3) If current trends continue, there is expected to be a 72% increase in the number of new melanoma cases diagnosed in Canada during the five-year period of 2028-2032, compared to 2003-2007. (4)

Stakeholder consensus on sun safety information for public education across Canada was undertaken to increase message consistency. National consensus was last achieved in 1994 (5) and messages have been updated inconsistently since then. Research suggests that adoption of cancer prevention behaviours among individuals decreases when they are presented with ambiguous information. (6) The result of the consensus process is a core set of recommended content describing protective measures for individuals based on the latest scientific information and balanced by considerations such as physical activity recommendations and the requirements of outdoor work.

The updated content is not expected to improve protection among individuals on its own. The content fulfills a standard step in planning for health communications campaigns by establishing agreement on what should be communicated. Organizations are expected to determine how this information should be communicated, and then tailor the wording of the content, the order in which the content appears and the amount of detail provided according to the needs of different audiences. Developing tailored messages should be based on focus testing among target audiences and identifying communications strategies that research suggests can achieve behaviour change. In addition, some audiences may require information beyond the recommended core content. Integrating further evidence-based information for reducing UVR exposure as needed is encouraged. Similarly, reducing UVR exposure among the public will also require structural changes, such as policies to increase shade. Consensus on personal protection recommendations could support policy development.

The Ontario Sun Safety Working Group (OSSWG) initiated the current work in consultation with a scientific panel (see Supplementary Appendix, in the ARTICLE TOOLS section on the journal site) comprised of nine scientists, in the fields of UVR physics, optometry, dermatology, epidemiology, architectural science with a focus on shade, and endocrinology with a focus on vitamin D; and one health promotion specialist. The panel summarized their knowledge of the best available evidence in their fields. Major evidence reviews were identified where applicable, such as the International Agency for Research on Cancer's review establishing UVR as a cause of skin cancer. (1) Evidence in the field of UVR is otherwise primarily found in studies describing the UVR-protective properties of shade, clothing, eyewear and sunscreen, measured in controlled conditions, and through the measurements of UVR in Canada throughout the day and year and under different conditions, such as cloud, by Environment Canada. Further detail on the evidence is noted in Appendix A. Based on their summary, the panel also drafted a set of content, which served as a starting point for broader discussions, including a review by external experts (see Acknowledgements section) and focus testing among public health stakeholders in Ontario.

The consensus process

In 2014-2015, OSSWG members with Cancer Care Ontario, the Canadian Cancer Society and the Canadian Dermatology Association convened an interdisciplinary national steering committee (see Supplementary Appendix) including scientists and health promotion specialists, and initiated a national consensus process. The objective of the consensus process was to balance the need to reduce UVR exposure as much as possible with the recognition that eliminating all UVR exposure is not practical.

As a first step in the process, the National Steering Committee took the information gathered and revised the wording of the scientific panel's set of content by integrating feedback from the external reviewers and the focus testing process with a view to increasing usability for public education. Revisions were for the purposes of increasing clarity, conciseness and--to support the feasibility of the project--limiting the focus of the content to protective actions for individuals among the general population. Interpretation of the science was not revised; revisions focused on the level of detail to include, with consideration given to the strength of the evidence supporting further detail. Accuracy was maintained through the advice of the scientists on the committee. Information that was not relevant to individual protection, such as developing shade policies, was not considered part of the project's scope. The committee also agreed that addressing the protective requirements of vulnerable populations, such as those with very fair skin and infants, would require further expert review of the evidence. This approach to revisions with scientific oversight was maintained throughout the consensus process.

Following the revisions, the steering committee then:

* engaged a health communications expert;

* identified stakeholders;

* established a framework and criteria for achieving consensus;

* conducted an in-person workshop on March 12, 2015;and

* conducted pre- and post-workshop surveys with stakeholders regarding message content.

A total of 28 organizations (Table 1) across Canada with a role in promoting sun safety participated in the consensus process. Participants included: national dermatology, eye health, public health, family medicine and pediatric organizations; Environment Canada; the Public Health Agency of Canada; provincial cancer agencies and Canadian Cancer Society national and provincial divisions.

Most disagreements identified in the pre-workshop survey related to the details included in four topics: time in the sun, sunscreen, vitamin D and eye protection. At the in-person workshop, scientific experts presented on these four topics. After each presentation, attendees discussed content for that topic in small-group and plenary sessions. Final wording was agreed in plenary sessions. Attendees indicated residual disagreements through a voting process. In the follow-up survey to confirm the wording from the workshop, there was a high degree of acceptance and support. Only three statements in the content set were indicated as not accepted, and no more than two consensus participants indicated this position for any one statement. The National Steering Committee reviewed the comments describing the reason for disagreements and changes were integrated into the final set of content with confirmation from the consensus participants.

As a final step, the steering committee elected to undertake further review of the primary statement on eye protection through one additional survey among consensus participants. The survey was not able to identify a resolution on details describing when to wear eye protection. This was primarily due to imprecision in the science and difficulty in making practical recommendations. As a result, the steering committee moved these details to secondary levels of content, which were not the primary focus for achieving consensus.

The Recommended Core Content for Sun Safety Messages in Canada

The result of the consensus process is the new Recommended Core Content for Sun Safety Messages in Canada (Table 2), which comprises four groups of statements:

1. Key Facts: These statements highlight the potential harms of UVR. Additional facts may be added to public communications, but the key facts are core statements for describing why skin and eye protection are needed.

2. Primary Recommended Protective Action Statements: These statements provide information on the specific actions that individuals should take to reduce harmful UVR exposure. They make recommendations for situations where protection is required.

3. Additional Recommended Protective Action Statements: These statements provide additional actions for individuals to consider when planning daily activities, prior to UVR exposure. They would be most relevant to an audience receptive to recommendations for advanced planning.

4. Tips for Implementing the Primary Protective Actions: These statements provide further details on how to implement personal protective actions, as outlined in the primary protective action statements. The tips are a secondary level of information to include in materials where space permits.

Organizations are encouraged to adopt, at minimum, the Primary Recommended Protective Action Statements (group 2) where practical. By doing so, sun safety information will be communicated more consistently, thereby improving knowledge and reducing inaction that may result from message ambiguity. (6)

Table 3 compares the 1994 Strategies to Reduce Ultraviolet Radiation (UVR) Exposure and Related Health Risks, which served as the action statements for the public, to the new action statements. In addition to a shortened list, which focuses on the immediate protective actions that are recommended with UVR exposure, there are several detailed changes in the new set, and greater prominence is given to eye protection.

IMPLICATIONS AND NEXT STEPS FOR PUBLIC EDUCATION

The consensus process was well received and a high degree of agreement on the resulting content was achieved. The process benefitted from interdisciplinary discussions and a phased approach to developing the content.

A longer report, to be posted on the OSSWG website, will provide a summary of the evidence, describe the consensus process in detail and additional considerations for UVR protection.

The recommended core content helps organizations with a role in promoting sun safety in Canada to form a common understanding of what is needed for effective sun protection. A key next step is adapting the agreed-upon content to tailor messages for target audiences, including priority subpopulations, and community-wide campaigns. Most workshop attendees expressed interest in continuing to be involved in the development of public education messages.

APPENDIX A. EVIDENCE AND RATIONALE SUPPORTING THE STATEMENTS ACCEPTED THROUGH THE CONSENSUS PROCESS AND INCLUDED IN THE FINAL SET OF CONTENT_

Where applicable, major reviews were identified and included to develop the Recommended Core Content for Sun Safety Messages in Canada and are noted below. Research in the area of the properties of ultraviolet radiation (UVR) and protective measures is not extensive and therefore limited to individual studies. The scientific panel evaluated these studies and relevant review articles to come to an agreement regarding what is reasonable to recommend in the context of the level of evidence available. The underlying premise of the recommended core content is that whatever individuals can realistically do to reduce UVR exposure will be to their benefit. This is based on the research that UVR is a cause of skin cancer and eye damage. The more limited evidence in other areas, such as how some protective measures have been observed to be more reliable than others (e.g., shade and clothing are more reliable than sunscreen), was evaluated as to whether they are nonetheless reasonable to integrate into the recommended core content.

1. Key Facts

                        High-level information statements based on an
                        International Agency for Research on Cancer
                        (IARC) review linking UVR to skin cancer, and
                        measurement studies observing UVR effects on
                        the eye and UVR strength throughout the day
                        and year and under cloudy conditions as cited
                        in Table 2. Recommended Core Content for Sun
                        Safety Messages in Canada.

2. Primary Recommended Protective Action Statements

Enjoy the sun safely.   This statement is based on feedback from the
                        health promotion field and recommendations
                        from the National Institute for Health and
                        Care Excellence (NICE) UK (15) and the
                        International Commission on Non-Ionizing
                        Radiation Protection (ICNIRP) UVI Working
                        Group (16) to acknowledge the sense of well-
                        being individuals experience when outdoors and
                        to ensure that sun protection messages do not
                        conflict with physical activity messages.
                        Evidence also suggests that increased outdoor
                        time, among children and youth in particular,
                        is associated with increased physical
                        activity. (17,18)

Protect your skin.      Skin protection is needed to reduce
                        ultraviolet radiation (UVR) exposure from the
                        sun and UVR- emitting tanning devices because
                        UVR exposure has been classified as
                        carcinogenic to humans by the IARC:

                        * Solar UVR causes melanoma, and basal and
                        squamous cell carcinoma. (19)

                        * UVR-emitting tanning devices cause melanoma.
                        (19)

Protect your eyes.      There is sufficient evidence that UVR-emitting
                        tanning devices are a cause of some forms of
                        ocular melanoma, although the evidence is
                        limited for solar UVR. (19)

                        Some evidence suggests chronic exposure to
                        UVR, in general, is a risk factor for several
                        other eye- related disorders, including
                        cortical cataracts and pterygium. (20,21)
                        Acute exposure to UVR can also cause
                        photokeratitis, photoconjunctivitis, and
                        retinal burns (e.g., from looking directly at
                        the sun). (22) Age-related macular
                        degeneration is likely related to exposure to
                        the visible light portion of sunlight,
                        specifically the blue light range. (2)

When the UV Index is    The UV Index is based on the erythemal
3 or higher, protect    (sunburn) action spectrum and primarily
your skin as much as    includes the UVB spectrum and a portion of the
possible.               UVA spectrum. The minimal erythema dose (MED)
                        is the measure of the minimum dose of UVR to
                        produce a just-noticeable erythema on
                        previously unexposed skin. The MED varies by
                        skin type, sensitivity to UVR and time. When
                        the UV Index is 3, the first sign of erythema,
                        or 1 MED, occurs after 44.4 minutes for skin
                        type I, the most sensitive skin type (e.g.,
                        fair skin and burns easily) and about 56
                        minutes of exposure for skin type II. (9,23) A
                        UV Index of 3 is used as a threshold for
                        increased risk of skin damage during common
                        outdoor activities for the broadest segment of
                        the population. The ICNIRP UVI Working Group
                        has recommended using a single sun protection
                        message to coincide with times when the UV
                        Index is 3 and above, and to indicate times of
                        day when sun protection is recommended. (16)

In general, the UV      The strength of the rays of the sun that cause
Index in Canada can     sunburn, which is what the UV Index measures,
be 3 or higher from     is greatest around solar noon on a clear day
11 a.m. to 3 p.m.       in the summer. The UV Index can remain strong
between April and       at 3 or higher, from about 10 a.m. to 2 p.m.
September, even when    local solar time (approximately 11 a.m. to 3
it's cloudy.            p.m. during daylight savings time) from April
                        to September in Canada. While the UV Index
                        declines with increasing latitude, the
                        differences between Toronto (44[degrees]N) and
                        Edmonton (54[degrees]N) are not very large.
                        (8)

                        Previously, 11 a.m. to 4 p.m. was established
                        to account for variations in solar noon time
                        across the country. Based on the more recent
                        studies cited from Environment Canada
                        scientists, this variation was determined to
                        not be substantial and consensus participants
                        agreed that a narrower time frame would likely
                        increase its acceptability with the public.

                        The statement on cloudy conditions is included
                        because partly cloudy skies will either
                        magnify or mitigate UVR, depending on the
                        pattern of cloud cover and the sun's relative
                        position, (24) while uniform cloud cover
                        reduces UVR in relation to its thickness. (25)

Seek shade or bring     Evidence suggests reported use of shade and
your own (e.g., an      protective clothing is more strongly related
umbrella). Wear         to reduced risk of sunburn than sunscreen use.
clothing and a wide-    (26-28) Research has measured substantially
brimmed hat that        higher levels of protection with clothing
cover as much skin as   compared to sunscreen. (12,13) Shade and
possible, as            clothing can provide broader and more visible
appropriate to the      coverage than sunscreen and therefore appear
activity and weather.   before the statement on sunscreen.

Use sunscreen           The effectiveness of sunscreens labelled
labelled "broad         "broad spectrum" (filtering UVA and UVB) is
spectrum" and "water-   determined by laboratory tests. (29)
resistant" with a sun   Water-resistant sunscreen is recommended to
protection factor       reduce the amount removed through perspiration
(SPF) of at least 30    and swimming. Sunscreens labelled "water
on skin not covered     resistant" in Canada must continue to provide
by clothing. Apply      protection for at least 40 minutes in water.
sunscreen generously    (29)
and reapply when
required.               SPF 15 is the minimum accepted protection
                        level for sunscreens in Canada, based on
                        Health Canada regulations. Laboratory tests
                        also show that sunscreen with an SPF of 15
                        filters 93.33% of UVB, while an SPF of 30
                        filters 96.67%.30 SPF testing to determine the
                        labelled value is based on an application of 2
                        mg/[cm.sup.2]. However, tests of volunteers
                        reporting sunscreen use in community settings
                        show that application densities typically
                        range from 0.5 mg/[cm.sup.2] to 1.3 mg/
                        [cm.sup.2]--substantially less than the
                        recommended amount. A minimum SPF of 30 is
                        therefore recommended for use by the public to
                        offset the typically lower volume of
                        application. (31)

                        Reapplication after two hours is not included
                        as a recommendation because research has
                        measured only a 25% reduction in SPF after a
                        day without physical activity or UVR
                        exposure,32 and even after eight hours on a
                        day with physical activity and bathing, 43% of
                        the initial protective effect of sunscreen was
                        still present. (33)

                        Nonetheless, evidence for improved outcomes
                        with sunscreen use is not as strong as for
                        shade, as described above, which may be in
                        part due to the typically inadequate sunscreen
                        application patterns among the public.
                        Therefore, shade and clothing appear before
                        sunscreen in the action statements because
                        they are considered better UVR-protection
                        options.

Don't use UV tanning    UVR from the sun and UVR-emitting tanning
equipment or            devices has been classified by IARC as
deliberately try to     carcinogenic to humans. UVR-emitting tanning
get a suntan, and       devices cause melanoma. (19)
avoid getting a
sunburn.                Reported history of sunburns and tan-seeking
                        behaviour may be associated with an increased
                        risk of melanoma. (34,35)

Wear sunglasses or      The UV Index is a measure of the shorter
prescription            wavelengths of the UVR spectrum that cause
eyeglasses with UV-     sunburns, primarily within the UVB spectrum.
protective lenses.      Since the longer wavelengths of UVR, primarily
                        within the UVA spectrum, are more directly
                        associated with eye health and can be strong
                        throughout the day, eye protection
                        recommendations apply on days even when the UV
                        Index is low, and are therefore separate from
                        the skin protection recommendations and do not
                        include specific times for when eye protection
                        is needed. The cornea fully absorbs UVB, but
                        UVA penetrates surface layers and reaches the
                        lens of the eye. (36)

                        Modern sunglass and eyeglass lens materials
                        that are commonly available, including
                        polyurethanes (mid- to high-index plastics),
                        polycarbonate and CR39 with UV blocking dye
                        (UV400), provide UVR protection. (37)

Wear a wide-brimmed     Wide-brimmed hats provide additional eye
hat for added eye       protection when worn in conjunction with
protection.             eyewear, especially when eyewear does not
                        cover the peripheral areas of the eyes.

3. Additional Recommended Protective Action Statements

Check the daily         The UV Index provides more detailed guidance
forecast for the UV     on the level of protection required on a given
Index and protect       day. The UV Index can reach up to 10 in Canada
your skin               and higher in other parts of the world. The
accordingly.            higher the UV Index value, the more protection
                        is needed.

                        However, information on the UV Index is not
                        always accessible throughout the day and
                        real-time values may differ from forecasted
                        values. Therefore, this recommendation is
                        listed as an additional recommended protective
                        action statement, rather than as a primary
                        action statement.

Between April and       An additional measure to reduce UVR exposure
September, whenever     is to limit time outdoors. At all stages of
possible, plan          the consensus process, consensus participants
outdoor activities      were in agreement that prioritizing this
for before 11 a.m. or   statement would result in losing the attention
after 3 p.m.            of most audiences. Therefore, this statement
                        appears as an additional recommended
                        protective action statement and for when
                        planning outdoor activities would be feasible.

Use sources of          Although UVB exposure can increase vitamin D
vitamin D that are      levels, the science has not established a safe
safer than UVR          level of exposure in terms of health risk.
exposure, e.g.,         This recommendation to not use UVR exposure
dietary sources,        for obtaining vitamin D is consistent with
including fortified     Health Canada's recommendation, which is based
foods, and vitamin D    on an extensive review by the Institute of
supplements.            Medicine. (38)
Intentional UVR
exposure to meet
vitamin D
requirements is not
recommended.

4. Tips for Implementing the Primary Protective Actions

                        These tips are based on expert knowledge on
                        the evidence for the UVR-protective properties
                        of shade, clothing, sunscreen and the field of
                        eye health and eye protection. Citations where
                        applicable are included in the main table.

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Received: March 7, 2016

Accepted: June 5, 2016

Loraine D. Marrett, PhD, [1,2] Maria B.H. Chu, MA, MISt, [1] John Atkinson, MSW, [3] Robert Nuttall, PhD, [4] Gillian Bromfield, MSc, [5] Larry Hershfield, MA, [2,6] Cheryl F. Rosen, MD, FRCPC, [7,8] for Representatives in the National Consensus Process on the Recommended Core Content for Sun Safety Messages in Canada

Author Affiliations

[1.] Cancer Care Ontario, Toronto, ON

[2.] Dalla Lana School of Public Health, University of Toronto, Toronto, ON

[3.] Canadian Cancer Society, Ontario Division, Toronto, ON

[4.] Canadian Cancer Society, National Office, Toronto, ON

[5.] Cancer Care Ontario, Toronto, ON, formerly with Canadian Cancer Society, National Office, Toronto, ON

[6.] Larry Hershfield & Associates, Ltd., Toronto, ON

[7.] Division of Dermatology, Toronto Western Hospital, University Health Network Hospitals, and Mount Sinai Hospital, Toronto, ON

[8.] Department of Medicine, University of Toronto, Toronto, ON Correspondence: Maria Chu, Cancer Care Ontario, 505 University Avenue, 14th Floor, Toronto, ON M5G 1X3, Tel: 416-971-9800, E-mail: maria.chu@ cancercare.on.ca

Acknowledgements: The National Steering Committee for Consensus on Content for Sun Safety Messages acknowledges funding support from the Canadian Institutes of Health Research (FRN 137214), Cancer Care Ontario, Canadian Cancer Society (National and Ontario Divisions), Canadian Dermatology Association, and Saskatchewan Cancer Agency/Sun Smart Saskatchewan. The authors thank the Ontario Sun Safety Working Group for its advice through the entire process; the Ontario public health sun safety leads, who focus tested an earlier version of the message content with their stakeholders; staff at Cancer Care Ontario, Prevention and Cancer Control and Canadian Cancer Society, Ontario Division who provided extensive support; Jennifer McWhirter for reviewing the manuscript for submission; and for their review of an earlier version of the message content: Marianne Berwick, David Broadhurst, David Buller, B. Ralph Chou, Richard Gallagher, DeAnn Lazovich, Robyn Lucas and Craig Sinclair.

Additional acknowledgements of consensus process participants, committee members, and scientific panel members may be found in the Supplementary Appendix (see ARTICLE TOOLS section on the journal site).

Conflict of Interest: The Canadian Cancer Society receives an annual financial contribution from Johnson and Johnson. Cheryl Rosen has received honoraria from Neutrogena and La Roche Posay in the past. The other co-authors have no conflicts to declare.

Table 1. Participant organizations in the 2014-2015 National
Consensus Process on Content for Sun Safety
Messages in Canada

* Alberta Health Services

* British Columbia Cancer Agency

* British Columbia Cancer Research Centre

* Canadian Association of Optometrists

* Canadian Cancer Society, British Columbia

* Canadian Cancer Society, National Office

* Canadian Cancer Society, Ontario Division

* Canadian Cancer Society, Quebec

* Canadian Cancer Society, Saskatchewan

* Canadian Dermatology Association

* Canadian Ophthalmological Society

* Canadian Paediatric Society

* Canadian Partnership Against Cancer

* Canadian Public Health Association

* Cancer Care Nova Scotia

* Cancer Care Ontario

* CancerCare Manitoba

* CNIB [Canadian National Institute for the Blind]

* College of Family Physicians of Canada

* Environment Canada

* New Brunswick Department of Health, Office of the Chief Medical
Officer of Health

* Newfoundland and Labrador Department of Health and Community
Services, Healthy Living Division

* Ontario Sun Safety Working Group

* Public Health Agency of Canada

* Saskatchewan Cancer Agency with Sun Smart Saskatchewan

* SunSafe Nova Scotia

* Toronto Cancer Prevention Coalition

* University of Waterloo, School of Optometry and Vision Science

Table 2. Recommended Core Content for Sun Safety Messages in Canada

1. Key Facts

* Sources of ultraviolet radiation (UVR) are the sun and
UVR-emitting devices, e.g., tanning beds. UVR causes skin cancer
and other forms of skin damage (e.g., wrinkling and photoaging of
the skin) and causes harm to the eyes. (1,2)

* Skin cancer is the most common cancer in Canada, and incidence
rates for melanoma, the most fatal form of the disease, continue to
increase. (4) Skin cancer is also one of the most preventable
cancers. (7)

* While UVR that is harmful to the skin is primarily present in the
sun's rays from 11 a.m. to 3 p.m. between April and September in
Canada, (8,9) UVR that is harmful to the eyes is present in the
sun's rays all year round and throughout the day. (10) In both
cases, UVR can be harmful, even when it's cloudy. (8-10)

2. Primary Recommended Protective Action Statements Enjoy the sun
safely: Protect your skin, protect your eyes.

Protect your skin

* When the UV Index is 3 or higher, protect your skin as much as
possible. In general, the UV Index in Canada can be 3 or higher
from 11 a.m. to 3 p.m. between April and September, even when it's
cloudy.

* Seek shade or bring your own (e.g., an umbrella).

* Wear clothing and a wide-brimmed hat that cover as much skin as
possible, as appropriate to the activity and weather.

* Use sunscreen labelled "broad spectrum" and "water-resistant"
with a sun protection factor (SPF) of at least 30, on skin not
covered by clothing. Apply sunscreen generously and reapply when
required.

* Don't use UV tanning equipment or deliberately try to get a
suntan, and avoid getting a sunburn.

Protect your eyes

* Wear sunglasses or prescription eyeglasses with UV-protective
lenses.

* Wear a wide-brimmed hat for added eye protection.

3. Additional Recommended Protective Action Statements

* Check the daily forecast for the UV Index and protect your skin
accordingly.

* Between April and September, whenever possible, plan outdoor
activities for before 11 a.m. or after 3 p.m.

* Use sources of vitamin D that are safer than UVR exposure, e.g.,
dietary sources, including fortified foods, and vitamin D
supplements. Intentional UVR exposure to meet vitamin D
requirements is not recommended.

4. Tips for Implementing the Primary Protective Actions Shade

* Good-quality shade includes dense vegetation and covered
structures that offer shade from the side, and not just overhead,
to protect against scattered UVR. (11)

* As a general guide, wider and denser sources of shade provide
increased SPF. (11)

* Cloth sources of shade, such as canopies and umbrellas, should
have tightly woven fabric.

* Additional personal protection (clothes, sunglasses and
sunscreen) is recommended even when in the shade to protect against
scattered UVR, especially on high UV Index days.

Clothing

* Hats should shade the head, face, ears and back of the neck with
a wide brim.

* In general, clothing provides better protection than sunscreen.
(12,13)

* Tightly woven or UV-protective labelled clothing is recommended.
(13,14)

Sunscreen

* Sunscreen should be used on exposed skin not covered by
protective clothing. Consider using sunscreen for the lips (e.g.,
sunscreen lip balm) as well.

* Use a generous amount of sunscreen (e.g., the average adult
requires approximately two to three tablespoons of
lotion-formulated sunscreen to cover the whole body, and a teaspoon
to cover the face and neck).

* Reapply after swimming, strenuous exercise, or towelling off.

* Use sunscreen that says on the label:

* "Broad spectrum"

* "SPF 30" or higher

* "Water resistant"

* Sunscreen comes in a variety of formulations. Find one that suits
you best and apply it properly with thorough coverage. Sunscreen
formulations that you find easier to apply thoroughly will be more
effective.

Eye protection

* Because UVR that is harmful to the eyes is present in the sun's
rays all year round and throughout the day, eye protection may be
required even when skin protection is not.

* Eye protection is required around highly reflective environments,
such as snow, sand and water.

* The best UV protection for eyes is offered by close-fitting
wraparound sunglasses.

* Look for sunglasses or prescription lenses with full UVA and UVB
protection. Examples of appropriate labels are "UV400" or "100% UV
protection."

* Contact lenses, even those with UV protection, do not provide
full coverage for the eye and the skin around the eye.

Table 3. Comparison of 1994 and 2014-2015 protective action statements

1994 strategies to reduce            2014-2015 Recommended Core Content
ultraviolet radiation (UVR)          for Sun Safety Messages in Canada
exposure and related health risks    --primary recommended protective
                                     action statements

It is possible to enjoy healthy      Enjoy the sun safely: Protect your
outdoor activity while reducing      skin, protect your eyes.
exposure to UVR.

Minimize sun exposure                Protect your skin

* Plan your outdoor activity to      * When the UV Index is 3 or
take place before 11:00 a.m. or      higher, protect your skin as much
after 4:00 p.m., when sun rays are   as possible. In general, the UV
the weakest. Consult the UV index    Index in Canada can be 3 or higher
for daily forecasts of UVR           from 11 a.m. to 3 p.m. between
intensity.                           April and September, even when
                                     it's cloudy.

* Practice sun protection
behaviours when you are outdoors
between April through September,
between 11:00 a.m. and 4:00 p.m.
every day.

* In winter, practice sun
protection behaviours during
periods of extended exposure,
and/or when you are near
fresh/bright snow.

* When visiting warmer climates,
remember that UVR is more intense
there and sun protection is
especially important.

* There is no such thing as a        * [statement on tanning moved
"healthy" tan. Tanning parlours      down]
and sunlamps are not a safe way to
tan.

Seek shade

* Seek shade, especially from        * Seek shade or bring your own
11:00 a.m. to 4:00 p.m.              (e.g., an umbrella).

* Work towards creating shade in
the form of shelters, canopies
and trees.

Cover up

* Wear clothing to cover your arms   * Wear clothing and a wide-
and legs.                            brimmed hat that cover as much
                                     skin as possible, as appropriate
                                     to the activity and weather.

* Wear a hat with a wide brim to     * [eye protection given separate
shade your face and neck.            section]

* Wear sunglasses that absorb UVR.

Use sunscreen

* Sunscreens should be used in       * Use sunscreen labelled "broad
conjunction with shade, clothing,    spectrum" and "water-resistant"
hats and sunglasses, not instead     with a sun protection factor (SPF)
of them. * Sunscreens are not        of at least 30, on skin not
intended to lengthen the time        covered by clothing. Apply
spent in the sun, but to reduce      sunscreen generously and reapply
exposure and provide some            when required.
protection from sunburn when
people need to be in the sun.

* Use a sunscreen with SPF #15 or    * Don't use UV tanning equipment
higher that has both UVA and UVB     or deliberately try to get a
protection.                          suntan, and avoid getting a
                                     sunburn.

                                     Protect your eyes

                                     * Wear sunglasses or prescription
                                     eyeglasses with UV-protective
                                     lenses.

                                     * Wear a wide-brimmed hat for
                                     added eye protection.