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Vol. 110. Issue 7.
Pages 610-612 (September 2019)
Vol. 110. Issue 7.
Pages 610-612 (September 2019)
Case and Research Letters
DOI: 10.1016/j.adengl.2018.01.006
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Green, yellow and red hours to go to the beach
Horas de color verde, amarillo y rojo para ir a la playa
Visits
...
O. Correiaa,b,c,d, A.F. Duartea,b,
Corresponding author
duarte.af.t30@gmail.com

Corresponding author.
, A. Picotob
a Centro de Dermatología Epidermis, Instituto CUF, Sra da Hora, Portugal
b Asociación Portuguesa de Cáncer de Piel, Oporto, Portugal
c Unidad de Inmunología, Facultad de Medicina, Universidad de Oporto, Oporto, Portugal
d CINTESIS, Center for Health Technology and Services Research, Universidad de Oporto, Oporto, Portugal
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Statistics
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Tables (1)
Table 1. Arrivals and Departures in 2009 and 2014.
Full Text
To the Editor:

Exposure to sunlight, whether intentional or for recreational purposes, especially during the holidays, tends to occur at the beach. Simple rules such as spending more time in the shade not spending more time than necessary are useful at all latitudes and times of year.1 The Portuguese Skin Cancer Association (http://www.apcancrocutaneo.pt) developed a traffic-light system in 2005 to raise awareness in the population about the best times for sunbathing (Fig. 1), with green before 11 am and after 5 pm, amber between 11 am and 12 pm and between 4 pm and 5 pm, and red between noon and 4 pm. Since then, copies have been sent every year to many of the country's beaches during the months of July and August.

Figure 1.

Sun clock.

(0.41MB).

To access the behavior of the population, a cross-sectional study was carried out between July 18, 2009 (maximum temperature, 32°C; UV index, 10) and July 12, 2014 (maximum temperature, 30°C; UV index, 9) at Vilamoura beach, one of the most frequented beaches in Portugal's Algarve region, with approximately 5000 visitors per day in July and up to 10000 visitors per day in August. Between 90% and 95% of people who visit the beach do so by crossing a particular bridge, which was the ideal place for recording arrivals and departures. At one end of the bridge, a team of 3 pharmacists recorded arrivals each hour, on a computer, between 8 am and 8 pm, while another team recorded departures. Approximate ages were evaluated and divided into groups of under 16 years of age, between 16 and 24 years of age, between 25 and 40 years of age, and over 40 years of age. Proportions were compared using the χ2 test of independence.

A team of dermatologists and volunteers worked together to promote rules for safe sunbathing, distribute information leaflets with photographic information on skin cancer and self-examination of the skin.

Table 1 shows the arrivals and departures, by age group, in the 8-11am, 11am-5pm, and 5-8 pmtime intervals, and in the 8-12am, noon-4pm, and 4-8pm time intervals, in 2009 and 2014.

Table 1.

Arrivals and Departures in 2009 and 2014.

Arrivals    20092014    20092014 
    P    P 
General  8-11am  1607  26  1467  30  <.001  8 am-noon  2448  39  2074  42  <.001 
  11 am-5pm  3521  56  2719  55    Noon-4pm  1691  27  1453  29   
  5-8pm  1153  18  764  15    4-8pm  2142  34  1423  29   
Total    6281    4950        6281    4950     
<16 years  8-11am  307  23  366  37  <.001  8 am-noon  540  40  518  52  <.001 
  11 am-5pm  783  58  458  46    Noon-4pm  359  27  210  21   
  5-8pm  258  19  166  17    4-8pm  449  33  262  26   
                         
16-24 years  8-11am  114  10  156  19  <.001  8 am-noon  214  18  215  26  <.001 
  11 am-5pm  847  72  594  73    Noon-4pm  431  37  361  44   
  5-8pm  209  18  62    4-8pm  525  45  236  29   
                         
25-40 years  8-11am  384  27  289  21  .001  8 am-noon  550  38  413  31  <.001 
  11 am-5pm  755  53  800  59    Noon-4pm  383  27  443  33   
  5-8pm  292  20  262  19    4-8pm  498  35  495  37   
                         
41 years  8-11am  802  34  656  37  .219  8 am-noon  1144  49  928  52  .002 
  11 am-5pm  1136  49  867  48    Noon-4pm  518  22  439  24   
  5-8pm  394  17  274  15    4-8pm  670  29  430  24   
Departures    2009  2014  P    2009  2014  P         
         
General  8-11am  34  54  <.001  8 am-noon  256  225  .013 
  11 am-5pm  2705  52  1951  54    Noon-4pm  2262  43  1572  44   
  5-8pm  2486  48  1599  44    4-8pm  2707  52  1797  50   
Total    5225    3604        5225    3594     
<16 years  8-11am  <.001  8 am-noon  60  66  10  <.001 
  11 am-5pm  614  44  400  61    Noon-4pm  528  38  309  47   
  5-8pm  785  56  247  38    4-8pm  819  58  278  43   
                         
16-24 years  8-11am  <.001  8 am-noon  13  26  <.001 
  11 am-5pm  298  55  214  40    Noon-4pm  252  46  150  28   
  5-8pm  246  45  319  59    4-8pm  280  51  363  67   
                         
25-40 years  8-11am  10  14  .159  8 am-noon  65  58  .335 
  11 am-5pm  598  51  488  53    Noon-4pm  490  42  403  44   
  5-8pm  565  48  412  45    4-8pm  618  53  453  50   
                         
41 years  8-11am  15  28  .007  8 am-noon  118  75  .746 
  11 am-5pm  1195  57  839  56    Noon-4pm  992  47  710  48   
  5-8pm  890  42  621  42    4-8pm  990  47  703  47   

In general terms, the number of arrivals between 8am and 11am improved from 2009 to 2014 (from 26% to 30%, P<.001). Improvement was found in the group of visitors under 16 years of age (from 23% to 37%, P<.001) and the group aged between 16 and 24 years (from 10% to 19%, P<.001); this was not the case for the group of visitors aged between 25 and 40 years (from 27% to 21%, p<.001).

The number of arrivals in the amber and red time intervals was higher in the group aged between 16 and 24 years (72% in 2009 and 73% in 2014), but worsened in the group aged between 25 and 40 years (from 53% to 59%, p<.001). Analysis of the hours in red (noon to 4 pm) showed that the group aged between 16 and 24 years was the worst in 2009 (37%) and was even worse 5 years later (44%, P<.001). The same occurred in the group aged between 25 and 40 years (from 27% to 33%, P<.001).

Despite the limitations of the study (such as the small sample size and the confidence in the method for calculating age), the data reveal important findings. A large percentage of the population arrived at the beach during the amber and red time intervals (between 11 am and 5 pm) (56% in 2009 and 53% in 2014).

A greater number of arrivals and a smaller number of departures was observed. This may be because of the large number of people who remained on the beach until sunset (approximately 9 pm at that time). All our campaigns are designed to encourage people to enjoy the beach at the end of the day until sunset.

The fact that the vast majority of people entered the beach between noon and 4 pm, with the highest numbers recorded among young people aged between 16 and 24 years, underscores the need to raise awareness regarding the need to wear hats and clothing that protects the torso and upper extremities, sunglasses and, particularly, to shelter under good shade, ideally tents, at times of greatest risk or more than 1 or 2hours after the last application of sunblock.

Many measures aimed at preventing skin cancer have led to greater knowledge and awareness of exposure to the sun and skin cancer.1,2 The change in behavior is, however, slow and insufficient, especially among young adults.2–7

Prevention strategies must be adapted to each age group.8 Lifeguards and celebrities from the world of fashion and sport are good role models for protection against exposure to the sun and can be powerful allies for raising awareness among young adults.9,10 The use of the media as a platform for amplifying the message is of inestimable value.

Our intention is to continue to use the sun clock to attract the attention of younger people and to encourage older people to take responsibility when they see this warning on entering and leaving the beach.

Conflicts of Interest

None of the authors have declared a conflict of interest.

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Please cite this article as: Correia O, Duarte AF, Picoto A. Horas de color verde, amarillo y rojo para ir a la playa. Actas Dermosifiliogr. 2019;110:610–612.

Copyright © 2018. Elsevier España, S.L.U. and AEDV
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