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      Shade as an Environmental Design Tool for Skin Cancer Prevention

      1 , 1 , 1 , 1
      American Journal of Public Health
      American Public Health Association

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          Abstract

          <p class="first" id="d134050e141">Little work has been done to explore the use of shade for skin cancer prevention in the context of the built environment. In an effort to address this gap and draw attention to the intersection between architectural and public health practice, we reviewed research on shade design, use, and policies published from January 1, 1996, through December 31, 2017. </p><p id="d134050e143">Our findings indicate that various features influence the sun-protective effects of shade, including the materials, size, shape, and position of the shade structure; the characteristics of the surrounding area; and weather conditions. Limited research suggests that shade provision in outdoor spaces may increase shade use. Shade audit and design tools are available to inform shade planning efforts. Shade policies to date have mostly been setting specific, and information on the implementation and effects of such policies is limited. </p><p id="d134050e145">Integrating shade planning into community design, planning, and architecture may have a substantial impact and will require a multidisciplinary approach. </p>

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          Most cited references22

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          A randomized trial of skin cancer prevention in aquatics settings: the Pool Cool program.

          Skin cancer is increasing, and prevention programs are essential. This study evaluated the impact of a skin cancer prevention program on sun-protection habits and swimming pool environments. The intervention included staff training; sun-safety lessons; interactive activities; providing sunscreen, shade, and signage; and promoting sun-safe environments. A randomized trial at 28 swimming pools in Hawaii and Massachusetts tested the efficacy of this program (Pool Cool) compared with an attention-matched injury-prevention control program. Results showed significant positive changes in children's use of sunscreen and shade, overall sun-protection habits, and number of sunburns and improvements in parents' hat use, sun-protection habits, and reported sun-protection policies and environments. Observations corroborated the positive findings. Pool Cool had significant positive effects at swimming pools in diverse audiences.
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            Shade provision for UV minimization: a review.

            Minimizing exposure to ultraviolet (UV) radiation is an essential component of skin cancer prevention. Providing and using natural and built shade is an effective protection measure against harmful UV. This article describes the factors that must be addressed to ensure quality, effective, well-designed shade and recommends best practice approaches to improving the protection factor (PF) of shade structures. It identifies examples of interventions to increase shade availability and use, and examples of effective shade based on measured protection factors or measured reductions in UV exposures. Finally, this article considers examples of best practice for undertaking shade audits. The article is based on refereed articles and reviews, reports, conference papers and shade practice and policies from reports and on web sites. Articles for the Australian setting are considered first, followed by those in an international setting.
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              Is Open Access

              Adolescents’ use of purpose built shade in secondary schools: cluster randomised controlled trial

              Objective To examine whether students use or avoid newly shaded areas created by shade sails installed at schools. Design Cluster randomised controlled trial with secondary schools as the unit of randomisation. Setting 51 secondary schools with limited available shade, in Australia, assessed over two spring and summer terms. Participants Students outside at lunch times. Intervention Purpose built shade sails were installed in winter 2005 at full sun study sites to increase available shade for students in the school grounds. Main outcome measure Mean number of students using the primary study sites during weekly observations at lunch time. Results Over the study period the mean change in students using the primary study site from pre-test to post-test was 2.63 (95% confidence interval 0.87 to 4.39) students in intervention schools and −0.03 (−1.16 to 1.09) students in control schools. The difference in mean change between groups was 2.67 (0.65 to 4.68) students (P=0.011). Conclusions Students used rather than avoided newly shaded areas provided by purpose built shade sails at secondary schools in this trial, suggesting a practical means of reducing adolescents’ exposure to ultraviolet radiation. Trial registration Exempt.
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                Author and article information

                Journal
                American Journal of Public Health
                Am J Public Health
                American Public Health Association
                0090-0036
                1541-0048
                December 2018
                December 2018
                : 108
                : 12
                : 1607-1612
                Affiliations
                [1 ]Dawn M. Holman, Meredith Shoemaker, and Meg Watson are with the Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA. George Thomas Kapelos is with the Department of Architectural Science, Ryerson University, Toronto Ontario, Canada.
                Article
                10.2105/AJPH.2018.304700
                6236749
                30359104
                b1928bd4-4ced-4b19-bf66-797266f6737d
                © 2018
                History

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