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Media Dissemination of and Public Response to the Ultraviolet Index -- United States, 1994-1995

Exposure to the ultraviolet component of sunlight may be associated with an increased risk for some skin cancers. The Ultraviolet Index (UVI) links a rating by the National Weather Service (NWS) of solar ultraviolet intensity (on a scale of 0 {minimal} to 10+ {very high}) to recommendations for appropriate sun-protection behaviors *. During the summers of 1994 and 1995, the NWS, in collaboration with the Environmental Protection Agency (EPA), the American Academy of Dermatology, the National Association of Physicians for the Environment, and CDC, disseminated UVI forecasts to selected major television stations and newspapers in the United States. In 1995, the Boston University School of Medicine conducted three surveys to evaluate how widely the UVI was televised, printed in newspapers, and used by adults (aged greater than or equal to 18 years) to modify their behaviors to reduce exposure to ultraviolet light. This report summarizes the findings of the evaluation, which indicate generally high rates of television broadcast and public awareness of the UVI.

UVI forecasts were transmitted by radio daily from local weather offices to all 221 television stations and more than 100 newspapers in 58 selected U.S. cities (comprising one city in each state {most of these were the most populated city in each state} and Puerto Rico, Washington, D.C., and six other cities frequented by tourists). To determine how often the UVI was televised, in July 1995 questionnaires were mailed to weather forecasters at the 221 television stations; the questionnaire asked forecasters whether their station broadcast the UVI during the summers of 1994 and 1995 daily, only on weekends, only once a week, only on particularly hot or sunny days, or not at all. Open-ended questions were asked to obtain opinions about the UVI, how it was used, and suggestions for improvement of the information distributed with the UVI. To determine how often the UVI was published in newspapers, in 54 of the 58 cities the weather page of the newspaper with the highest circulation in each city was reviewed for one randomly chosen day during July 21-August 25, 1995 (newspapers from four cities were unavailable). To characterize use of the UVI by adults, in September 1995, random-digit-dialing was used to select a population-based probability sample of 700 white non-Hispanic and white Hispanic persons (who are at higher risk for melanoma) aged greater than or equal to 18 years living in households in the 58 cities and surrounding metropolitan areas. Responses were stratified according to demographic and socioeconomic variables of the 58 cities. Logistic regression was used to select the best set of statistically significant predictors of UVI awareness and change in habits.

All 221 television stations reported whether they had access to UVI information and used it in their weathercasts. Eighteen stations did not provide regularly scheduled weathercasts (n=14) or had inadequate access to NWS data (n=four). Of the remaining 203 stations, weather broadcasters at 185 (91%) stations provided follow-up interviews. Of these 185 television stations, 129 (70%) reported broadcasting the UVI daily; at least weekly reports were broadcast in 53 (91%) of the 58 cities. The 129 stations broadcasting the UVI daily potentially reached an estimated 13 million adults. In response to open-ended questions, more than half (95 {51%}) of the weather forecasters reported that they believed the UVI to be an important public health service and that it provides valuable information about sun protection. A total of 37 (20%) television stations reported impediments to incorporating the UVI into their forecasts (e.g., lack of time); 35 of these reported resistance to regularly reporting an index that may not change throughout the summer. Forecasters also suggested providing additional information with the UVI, including sun-protection information with easily understood messages for the public; improving graphics and mapping programs that depict UVI warnings; and simplifying recommendations, possibly by including a "minutes to burn" index for at-risk persons.

The weather page for newspapers in 54 of the 58 cities were reviewed; of the 54 newspapers, 33 (61%) included the UVI. The UVI generally was presented with the pollen count, heat index, and wind chill factors on the weather page. Information on interpreting the UVI and sun-protection information also were included.

The mean age of the 700 persons who participated in the telephone survey was 46 years (95% confidence interval {CI}=45.1-46.9 years); among the 688 persons for whom sex was known, 414 (60% {95% CI=56%-64%}) were women, and among the 676 persons for whom education level was known, 258 (38% {95% CI=34%-42%}) had at least a college degree. A total of 445 (64%) participants indicated that they either had "ever heard of" or read anything about the UVI; of those, 400 (90%) accurately explained the UVI in response to an open-ended question about the UVI. Respondents reported that television (40%) and newspapers (30%) were the most common sources of information about the UVI. Among those who knew about the UVI, 240 (54%) had heard or read about it at least five times; 15% of respondents reported that the UVI was "hard to understand." Male and female respondents were equally aware of the UVI. Awareness of the UVI was greater among persons aged less than 60 years (68.1% among persons aged less than 40 years {reference group} and 72.4% among persons aged 40-59 years {prevalence ratio (PR)=1.06 (95% CI=0.95-1.19)}, compared with 45.1% among persons aged greater than or equal to 60 years {PR=0.66 (95% CI=0.55-0.80)}); those with at least some college education (65.8% {PR=1.27 (95% CI=1.08-1.50)}, compared with 51.7% among persons with up to a high school degree {reference group}); those who had actively sought a tan at least once (70.6% among those who actively sought a tan more than five times {PR=1.18 (95% CI=1.02-1.37)} and 76.2% among those who actively sought a tan one to five times {PR=1.27 (95% CI=1.13-1.44)}, compared with 59.7% among those who never actively sought a tan {reference group}); and those who always or often used sunscreen (71.4% {PR=1.17 (95% CI=1.05-1.31)}, compared with 60.8% among those who sometimes, rarely, or never used sunscreen {reference group}).

Of those aware of the UVI, 170 (38%) reported that awareness of the UVI prompted them or a family member to change behavior with respect to sun exposure. The most frequently reported change was "staying out of direct sunlight as much as possible" (70%). In all age groups, women reported changing sun-protection behavior more frequently than did men. Based on logistic regression analyses, among men, protective behaviors were predicted most strongly by being aged less than 40 years and being exposed frequently to the UVI; for women, there were no independent predictive factors for sun-protection behaviors.

Reported by: School of Medicine, Boston Univ, Massachusetts. American Academy of Dermatology, Schaumburg, Illinois. National Association of Physicians for the Environment, Bethesda, Maryland. National Weather Svc, National Oceanic and Atmospheric Administration, US Dept of Commerce. US Environmental Protection Agency. Div of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, CDC.

Editorial Note

Editorial Note: The data described in this report are the first to provide national assessments of the effects of television and newspaper dissemination of the UVI and to characterize public understanding of and response to the index. These findings indicate that the UVI had been broadcast daily by 70% of the television stations and at least weekly in 91% of the selected cities. Because the UVI can be broadcast in a few seconds, this information can be readily incorporated into segments such as the weather forecast.

The telephone survey indicated that messages about measures to reduce exposure to ultraviolet light should be directed especially toward persons with a high school education or less and men. Respondents with a high school education or less were least aware of the UVI, a finding consistent with a previous report documenting a relation between low education level and reduced awareness of sun-protection behaviors (1). Although the prevalences of awareness of the UVI were similar among men and women, men were less likely to report changes in sun-protection behavior in response to the index; previous reports also indicated that men were less likely than women to use sunscreen (2-6). An important limitation of this survey approach is that it did not provide information about health outcomes associated with UVI-related behaviors.

Because most of a person's lifetime sun exposure occurs during childhood and adolescence, CDC programs targeting parents, caregivers, and children are encouraging "early" safe sun-protection behaviors. Reducing sunburns, a key preventable risk factor for melanoma, is one important risk strategy.

This assessment of the UVI is being used to assist the NWS and EPA in improving prevention messages, increasing outreach to at-risk groups, and coordinating programs to increase awareness of sun-protection measures. Monitoring of reporting and public awareness of the UVI also can assist in these efforts, and dissemination of the UVI may be expanded to 110 new cities. CDC's National Skin Cancer Prevention Education Program aims to reduce behaviors associated with increased risk for skin cancer. In collaboration with other organizations, this program develops and disseminates educational messages to the public about the dangers of unprotected exposure to the sun and how to modify sun-protection behavior. Information about CDC's cancer prevention and control program is available from the World-Wide Web at http://www.cdc.gov/nccdphp/dcpc.

References

  1. Miller DR, Geller AC, Wyatt SW, et al. Melanoma awareness and self-examination practices: results of a United States survey. J Am Acad Dermatol 1996;34:962-70.

  2. Koh HK, Bak SM, Geller AC, et al. Sunbathing habits and sunscreen use in Caucasian adults: results of a national survey. Am J Public Health (in press).

  3. Berwick M, Fine JA, Bolognia JL. Sun exposure and sunscreen use following a community skin cancer screening. Prev Med 1992;21:302-10.

  4. King PH, Murfin G, Hanagiasko K. Skin cancer/melanoma knowledge and behavior in Hawaii: changes during a community-based cancer control program. In: Progress in cancer control IV: research in the cancer center. New York, New York: Alan R. Liss, Inc., 1983:135-44.

  5. Keesling B, Friedman HS. Psychosocial factors in sunbathing and sunscreen use. Health Psychol 1987;6:477-93.

  6. Hill D, Rassaby J, Gardner G. Determinants of intentions to take precautions against skin cancer. Community Health Stud 1984;8:33-44.

* Reduce unprotected sun exposure during 10 a.m.-4 p.m., when the sun's rays are the strongest; thoroughly apply sunscreen with a sun-protection factor of at least 15; and wear protective clothing, such as long-sleeve shirts and wide-brimmed hats.




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