Shade Planning for Schools

Division of Cancer Prevention and Control National Center for Chronic Disease Prevention and Health Promotion Centers for Disease Control and Prevention Coordinating Center for Health Promotion

Shade Planning for America’s Schools i ACKNOWLEDGMENTS The Centers for Disease Control and Prevention would like to thank the following individuals who provided guidance in the development of Shade Planning for America's Schools: Sharon Adams-Taylor American Association of School Administrators Jeff Ashley, M.D. Sun Safety for Kids Beverly Berkin, CHES, FASHA American School Health Association Susan Boiko, M.D. National Skin Cancer Council David Buller, Ph.D. Cooper Institute Alan Geller, M.P.H, R.N. Boston University School of Medicine Karen Glanz, Ph.D. Emory University Brenda Green, M.F.A. National School Board Association Sonja Johansson Johansson Design Collaborative Norbert Lechner Auburn University Gary Peiffer University of Georgia Cooperative Extension Service Linda Rutsch, M.B.A., M.P.H. Environmental Protection Agency Phil Schneider Sun Safety Alliance Becky Smith, Ph.D. National Association of Sport and Physical Education Harold Standerfer, M.A. Alhambra, California School System Beth Stevenson, M.P.H. American Cancer Society Connie Tegeler American Academy of Dermatology Linda Crossett CDC, Division of Adolescent and School Health Susan Derrick CDC, Division of Cancer Prevention and Control Nancy Lee, M.D. CDC, Division of Cancer Prevention and Control Susan True, M.Ed. CDC, Division of Cancer Prevention and Control Shade Planning for America’s Schools was developed for the Centers for Disease Control and Prevention (CDC), National Center for Chronic Disease Prevention and Health, Division of Cancer Prevention and Control, by ORC Macro under contract number 200-2002-00574-0004.

ii Shade Planning for America’s Schools The Centers for Disease Control and Prevention would also like to give special thanks to the following reviewers for their insightful comments and contributions: Pam Crookedacre, Principal Woodworth Elementary School Leslie, Michigan Susan Derrick, Public Health Advisor Centers for Disease Control and Prevention Atlanta, Georgia Mattie Gilliam, Public Health Analyst Centers for Disease Control and Prevention Atlanta, Georgia William Graham, School Board Member Palm Beach County School Board Lake Clark Shore, Florida Robert Howe, Superintendent Leslie Public Schools Leslie, Michigan David Kemp, School Board Member Burbank Unified School District Burbank, California Mark Morgan, Principal Elizabeth Middle School Percer, Colorado Norman Ridder, Superintendent Colorado Springs School District Colorado Springs, Colorado Fred Varn, School Board Member Leon County School District Tallahassee, Florida

iii Shade Planning for America’s Schools TABLE OF CONTENTS WHAT IS THE PURPOSE OF THIS MANUAL?.....................................................................1 Why Should Schools Care About Skin Cancer?....................................................1 Why Shade? ..........................................................................................................2 What Are the Additional Benefits of Shade?..........................................................2 Who Should Read This Manual? ...........................................................................3 How Can This Manual Be Used? ..........................................................................3 CHAPTER ONE WHAT IS UV RADIATION?................................................................................................5 What Are the Factors That Affect UV Radiation Levels?.......................................5 What Are Direct and Indirect UV Radiation? .........................................................6 How Is UV Radiation Measured? ..........................................................................7 What Are the Health Effects of Exposure to UV Radiation?..................................7 Where Can I Find More Information? ....................................................................9 INFORMATION ON SKIN CANCER AND ITS PREVENTION.................................................10 SUN SAFETY CURRICULA................................................................................................11 CHAPTER TWO STRATEGIES FOR PROVIDING SHADE...............................................................................13 Solid Roof Structures ...........................................................................................13 Shade Cloth Structures........................................................................................14 Natural Shade ......................................................................................................15 Where Can I Find More Information? ..................................................................16 WILDLIFE HABITAT CREATION.........................................................................................17 RESOURCES FOR NATURAL SHADE SOLUTIONS..............................................................18 RESOURCES FOR FABRIC STRUCTURES...........................................................................19 CHAPTER THREE PLANNING FOR SHADE.....................................................................................................21 The Shade Planning Team ..................................................................................21 The Shade Audit ..................................................................................................21 Shade Design ......................................................................................................24 Funding ................................................................................................................24 Where Can I Find More Information? ..................................................................24 RESOURCES FOR SHADE PLANNING TEAMS ...................................................................25 CHAPTER FOUR CASE STUDIES.................................................................................................................26 Collier County, Florida..........................................................................................26 Pinellas County, Florida .......................................................................................29 The SHADE Foundation and the U.S. Environmental Protection Agency’s SunWise School Program.............................................................................31

iv Shade Planning for America’s Schools CHAPTER FIVE THE EARTH-SUN RELATIONSHIP.....................................................................................34 The Sun’s Annual Path and the Creation of Shade.............................................35 The Sun’s Daily Path and the Creation of Shade................................................36 The Earth’s Rotation and Revolution ...................................................................37 Axis Tilt and Solar Radiation................................................................................38 Putting It All Together...........................................................................................38 Where Can I Find More Information? ..................................................................40 CHAPTER SIX HOW TO CONDUCT A SHADE AUDIT...............................................................................41 Stakeholder Interviews.........................................................................................41 Interview Guides ..................................................................................................41 Sample Questions for School Principals..............................................................42 Sample Questions for School Teachers...............................................................42 Sample Questions for Students ...........................................................................43 Sample Questions for Building Maintenance Engineers .....................................44 Sample Questions for Neighbors.........................................................................44 Behavioral Observations......................................................................................45 Environmental Observations................................................................................45 Considering Potential Shade Strategies ..............................................................47 The Shade Planning Matrix .................................................................................47 Making Recommendations ..................................................................................48 ATTACHMENTS ATTACHMENT A: Building Description..........................................................................50 ATTACHMENT B: Tree Inventory....................................................................................51 ATTACHMENT C: Shade Planning Matrix......................................................................52

1 Shade Planning for America’s Schools WHAT IS THE PURPOSE OF THIS MANUAL? In 2002, the Centers for Disease Control and Prevention (CDC) published the Guidelines for School Programs to Prevent Skin Cancer, which outlines steps that school communities can take to develop a comprehensive approach to reducing the risk for skin cancer among students, teachers, staff, and visitors. The guidelines include the following recommendations: • Establish policies that reduce exposure to solar ultraviolet (UV) radiation. • Provide and maintain physical and social environments that support sun safety. • Provide opportunities for students to gain the knowledge, develop the attitudes, and practice the skills needed to prevent skin cancer. • Involve family members in skin cancer prevention efforts. • Provide pre-service and in-service skin cancer prevention education for school administrators, teachers, coaches, school nurses, and other professionals who work with students. • Support sun-safety policies, sun-safe environments, and skin cancer prevention education with school health services. • Evaluate the implementation of policies, environmental change, education, family involvement, professional development, and health services. This manual has been created to support school communities in their implementation of the Guidelines for School Programs to Prevent Skin Cancer and, specifically, to help schools create and maintain a physical environment that supports sun safety by ensuring that school grounds have adequate shade. Why Should Schools Care About Skin Cancer? Cancer of the skin is the most commonly diagnosed cancer in the United States and perhaps the most preventable. Melanoma and non-melanoma cancers, including basal cell cancer and squamous cell cancer, account for as much as 50% of all cancers. Because the reporting of non-melanoma cancers to cancer registries is not required, the exact number of non-melanoma cancer cases is not known. However, estimates indicate that as many as 1 million cases of basal cell and squamous cell skin cancer occur each year.2 2 American Cancer Society. What Are The Key Statistics For Nonmelanoma Skin Cancer? Available at http://www.cancer.org/docroot/CRI/content/CRI_2_4_1X_What_are_the_key_statistics_for_skin_cancer_51.asp?sitearea= Melanoma, which accounts for only about 5% of skin cancer cases, also accounts for 79% of skin cancer deaths. From 1973 and through the early eighties, the incidence rate of melanoma among white men and women in the United States increased by about 6% per year. Since the early eighties, the increase has been around 3% annually. Approximately 55,100 new melanomas were diagnosed in the United States in 2004, and about 7,910 people died of melanoma that same year.3 3 American Cancer Society. What Are The Key Statistics For Melanoma Skin Cancer? Available at http://www.cancer.org/docroot/CRI/content/CRI_2_4_1X_What_are_the_key_statistics_for_melanoma_50.asp?sitearea= Between 68% and 90% of all melanomas result from exposure to ultraviolet radiation.1 1 MMWR 2002; 51(RR04):1-16. Available at http://www.cdc.gov/mmwr/review/mmwrhtm/rr5104a1.htm

2 Shade Planning for America’s Schools Almost all of these cancers are preventable.4 4 American Academy of Dermatology. Skin Cancer. Available at http://www.aad.org/pamphlets/skincan.html In most cases, exposure to solar UV radiation is the cause of the cancer. Using multiple methods for estimating the incidence of melanoma that might be attributable to exposure to the sun, Armstrong and Kricker, reporting in Melanoma Research, suggest that between 68% and 90% of all melanomas result from exposure to UV radiation.5 5 Armstrong BK, Kricker A. How much melanoma is caused by sun exposure? Melanoma Res 1993;3:395-401. Solar Radiation Added to the List of “Known” Carcinogens The federal government’s 11th edition of the Report on Carcinogens listed the sun and any other source of broad spectrum ultraviolet radiation as “known” causes of cancer. “The report cites data indicating a cause-and-effect relationship between this radiation and skin cancer, cancer of the lip and melanoma of the eye. The report goes on to say that skin cancers are observed with increasing duration of exposure and for those who experience sunburn.” From National Institutes of Health News Release dated December 11, 2002 Why Shade? There are many reasons that a school might want to improve the quality and increase the amount of accessible shade on school grounds. The most obvious and one of the most important reasons is that shade provides protection from solar UV radiation. Due to the scheduling complexities of physical education classes, sporting events, and other outdoor activities, students are often exposed to solar UV radiation during the peak sun hours of the day—between 10:00 a.m. and 4:00 p.m. For some schools and for some students, using sun protective methods, such as hats or sunscreen, or implementing policy changes could prove to be problematic. Providing shade in areas where students already participate in outdoor activities can afford passive protection from the sun’s damaging rays. What Are the Additional Benefits of Shade? Extending the Classroom Schools are often looking for ways to extend their classrooms. Two strategies for increasing shade on school grounds can also help schools create novel classroom experiences for their students. These strategies may be employed independently or in concert. The first is to modify existing structures or build new ones to provide shade where students play and socialize. The second calls for the strategic planting of additional shade-producing trees, vines, and shrubs. Structures built to provide shade can also be designed as covered outdoor learning areas, thereby extending the classroom beyond the school walls. Planting shade-producing vegetation affords schools the opportunity to create and maintain natural outdoor classrooms where students can enjoy hands-on experiences in the natural world. Both strategies could potentially provide teachers with new ideas for curricula and new reasons to take their students outdoors.

3 Shade Planning for America’s Schools Extended Periods of Physical Activity In adults, regular physical activity is linked to enhanced health and reduced risk for the development of many chronic diseases. Lifelong physical activity patterns are often developed in childhood and adolescence. In the section on preventing physical activityrelated injuries in CDC’s Guidelines for School and Community Programs to Promote Lifelong Physical Activity Among Young People, the use of shaded spaces or indoor facilities to reduce the incidence of heat-related illnesses is recommended. Not all schools have indoor facilities designed for active play; however, providing shade on existing outdoor play areas could reduce the temperature in those areas by as much as 10° to 20 °, increasing the period of time that students could engage in active outdoor play. School Grounds Aesthetics All too often, school grounds are an environment of concrete, asphalt, steel, turf grass, and chain link fences. In planning strategies to provide or increase shade on school grounds, schools have a second chance to improve the aesthetics of the school property, making the grounds more inviting to students, teachers, staff, parents, and visitors. A wellplanned shade implementation project engages the entire school community in making the school a more pleasant place to learn. Who Should Read This Manual? A school includes not just the principal, teachers, students, and staff, but also key stakeholders and decision-makers that comprise the school community. In addition to school officials, the school community includes parents, neighbors, and members of the broader community, all of whom have a stake in helping to protect the community’s children and adolescents from skin cancer. This manual was written as a reference tool for the entire school community, encompassing both the school district and the individual school. How Can This Manual Be Used? Chapter 1 School board members, superintendents, principals, and school health advisory councils can use this manual to acquaint themselves with issues relating to the damaging effects of solar UV radiation, skin cancer prevention, and planning for shade implementation at their schools. The first chapter gives information on both the short- and long-term effects of UV radiation on health and provides a rationale for developing sun-safe policies in schools. Chapter 2 The second chapter addresses strategies for providing shade at schools and includes some of the advantages and disadvantages of each strategy. School board members, superintendents, principals, school health advisory councils, and school shade planning teams will find this information useful in determining the strategies that will work best at their school. Chapter 3 The third chapter presents an overview of the process of planning a shade implementation project. School board members, superintendents, principals, and school health advisory councils can use it as a brief overview of the process. School shade planning teams can refer to this chapter for an introduction to the process and to chapters 4 and 6 for more detailed information to guide them through the steps of shade planning.

4 Shade Planning for America’s Schools Chapter 4 The fourth chapter presents information about schools and school districts that have engaged in shade planning projects and reveals some successful strategies. The needs of every school differ; there is no onesize-fits-all solution to providing shade at schools. This chapter offers a glimpse of shade strategies that others have employed. Chapter 5 The fifth chapter gives the reader a basic introduction, or reintroduction, to solar geometry and the relationship between the Earth and Sun. Illustrations are included showing the effects of daily and seasonal changes in solar angles on the length and direction of shadows. Chapter 6 The sixth chapter guides shade planning team members through the process of conducting a shade audit. The shade audit allows planning teams to consider the needs of the school in relation to the quantity and quality of shade already available to students, teachers, and staff.

CHAPTER ONE

5 Shade Planning for America’s Schools Chapter 1 WHAT IS UV RADIATION? Ultraviolet (UV) radiation is one component of a broad spectrum of electromagnetic radiation emitted by the sun. The spectrum also includes visible light, which we see, and infrared radiation, which we feel as heat. The ultraviolet area of the spectrum can be further divided into three bands, ultraviolet A (UVA), ultraviolet B (UVB), and ultraviolet C (UVC). All UVC radiation and almost all UVB radiation are absorbed in the ozone layer of the atmosphere. UVA radiation penetrates the atmosphere unimpeded and, until recently, had been considered innocuous. Ultraviolet Visible Infrared UVC UVB UVA 100 280 315 400 700 wavelength (nm) The Sun’s Radiation Spectrum What Are the Factors That Affect UV Radiation Levels? Time of Day At solar noon, the sun is at its highest point of the day. As much as 30% of total UV radiation is received in the hour before and the hour after solar noon, and as much as 75% is received during the 3 hours before and the 3 hours after solar noon.1 1 Diffey, BL. Solar ultarviolet radiation effects on biological systems. Physiology Medica; Biology 1991; 36(3):299-328. Shade Planning Toolbox Q: What time is solar noon? A: That depends on the day of the year, your latitude and longitude, and your location within your time zone. On July 4, solar noon is at: 12:48 (EDT) in Boston 1:40 (EDT) in Knoxville 12:51 (CDT) in Nashville 12:53 (PDT) in San Diego On February 1, solar noon is at: 11:57 (EST) in Boston 12:49 (EST) in Knoxville 12:00 (CST) in Nashville 12:02 (PST) in San Diego To find out what time solar noon occurs on any day of the year at any location, visit the National Oceanic and Atmospheric Administration (NOAA) Surface Radiation Research Branch web site at http://www.srrb.noaa.gov/ highlights/sunrise/sunrise.html. Time of Year Because the angles of the sun change throughout the year, the intensity of UV radiation changes as well. In the northern hemisphere, UV radiation tends to be greater in the summer months. Geographical Latitude UV radiation decreases as the distance from the equator increases. Altitude Because the atmosphere is thinner at higher altitudes and less able to absorb UVB, total UV radiation is greater at higher altitudes. Weather Conditions Although clouds reduce the full spectrum of solar radiation, they do not reduce UV radiation to the same extent that they reduce visible light and

6 Shade Planning for America’s Schools Chapter 1 infrared radiation. Clouds may make us feel cooler and block our view of the sun, but they do not fully protect us from UV radiation. Atmospheric Ozone The stratosphere’s ozone layer provides us with an enormous amount of protection against the damaging effects of UV radiation. Unfortunately, in certain areas, ozone has been depleted to a dangerous extent, primarily due to the release of chlorofluorocarbons (CFCs) and other ozone-depleting chemicals, such as carbon tetrachloride and methyl chloroform, into the atmosphere. Both carbon tetrachloride and methyl chloroform are solvents that have been used in industrial applications, and CFCs have, in the past, been used as refrigerants and aerosol propellants. The use of all three of these chemicals has since been restricted or prohibited.2 2 United Nations Development Programme, Montreal protocol on substances that deplete the ozone layer. Available at http://www.undp.org/seed/eap/montreal.htm. Nonetheless, much of the damage that has been done remains. What Are Direct and Indirect UV Radiation? Direct UV radiation, or UV radiation that travels from the sun in a straight line, may pose the greatest risk to our health, but we are also at risk from exposure to indirect (scattered and reflected) UV radiation. Scattered UV radiation results from being bounced around by atmospheric dust and water droplets in clouds. Throughout the day, the level of indirect UV radiation varies, as does the level of direct UV radiation. In the early morning and late evening when the sun is low on the horizon, indirect UV radiation may exceed direct. Likewise, on a cloudy day, UV radiation scattered by atmospheric particles may result in greater exposure to indirect than to direct UV radiation. UV radiation can also be reflected off buildings and the terrain. Smoother surfaces, such as concrete or asphalt, whether they are dark in color or not, typically result in greater reflectance of UV radiation than irregular surfaces. Surface irregularities, such as that found in grass or bark nuggets, reduce the level of reflectance, thereby reducing exposure to reflected UV radiation. One exception, however, is water. Smooth water absorbs almost all UV radiation, whereas the irregular surface of choppy water reflects a considerable amount of UV radiation. The following table lists surfaces and terrains commonly encountered on school grounds and their UV radiation reflectance. Materials with a lower reflectance are more desirable. Ultraviolet Radiation Reflectance for School Grounds Surfaces Surface UV Radiation Reflectance3,4,5 Grass 1% – 4 % Still water 3% – 8 % Soil 4% – 6 % Asphalt 4% – 9 % Concrete 7% – 12 % Choppy water 8% – 13% Dry sand 15% – 18 % Fresh snow 85% – 88 % 3 Williams ML, Pennella R. Melanoma, melanocytic nevi, and other melanoma risk factors in children. J Pediatr 1994;124:833-45 4 Moore LA. Ocular protection from solar ultraviolet radiation (UVR) in sport: factors to consider when prescribing. The South African Optometrist 2003;62(2):72-79. 5 Sliney, DH. Physical factors in cataractogenesis: ambient ultraviolet radiation and temperature. Invest Ophthalmol Vis Sci 1986; 27(5):781-790.

7 Shade Planning for America’s Schools Chapter 1 How Is UV Radiation Measured? In the past, different countries measured and reported solar UV radiation intensity in different ways. One common way of reporting UV radiation intensity was in the form of estimated “burn time” or “time to burn,” expressed as the number of minutes of solar exposure required for the reddening of a fairskinned person’s exposed skin, assuming a clear sky. Although there may be some advantages to this method of reporting UV radiation intensity, there are a number of disadvantages. In 1994, international agreement was reached on standardizing the measure of UV radiation intensity. Revised by the World Health Organization in 2002 and adopted by the Environmental Protection Agency and the National Oceanic and Atmospheric Administration’s National Weather Service in 2004, the UV Index is the internationally accepted system for reporting the intensity of UV radiation. Although the mathematical model developed to determine the UV Index might be complicated, the measurement is easy to understand. The UV Index is a measure of the amount of damaging UV radiation that reaches the earth’s surface at noon on a given day and at a given location, expressed as a risk scale. It is predicted daily on a scale of 0 to 11+, where 0 represents a minimal risk of overexposure to UV radiation and any number higher than 11 represents an extreme risk of overexposure to UV radiation. Q: Where do I find the UV Index for tomorrow? A: In most communities, the UV Index is reported in newspapers and on television with the daily weather forecast. Every day at approximately 1:30 PM Eastern, the National Oceanic and Atmospheric Administration (NOAA) and the Environmental Protection Agency (EPA) post the UV Index for the next day at the EPA’s Website, http://www.epa.gov/sunwise/ uvindex.html. Shade Planning Toolbox What Are the Health Effects of Exposure to UV Radiation? Few people would dispute the beneficial effects of solar radiation. The sun warms the earth, fuels photosynthesis, and ensures the continued existence of life on earth. Many of us enjoy the warmth of the sun on our skin. But at some point in our lives, most of us have experienced the painful effect of too much sun exposure in the form of sunburn. Having experienced sunburn, many would agree that there must be some negative health effect to exposure to the sun. Although many different conditions occur as a normal response to exposure to UV radiation, they all fall into one of two classifications, acute or chronic. Acute effects of UV radiation exposure usually have a rapid onset and are of short duration, such as sunburn, tanning, and synthesis of vitamin D3 . Chronic effects of UV radiation exposure usually have a gradual onset and are of long duration, such as skin cancer and photoaging. Sunburn Sunburn is an acute injury resulting from excessive exposure to the sun. The redness associated with sunburn results from the dilation of superficial blood vessels in the skin. Redness usually appears within 4 hours of exposure, reaches a maximum within 12 hours, and fades after a few days. High doses of UV radiation can result in blistering and peeling. Skin color, hair color, eye color, and freckles all are characteristics that help predict an individual’s susceptibility to sunburn. Individuals are typically grouped into one of six

8 Shade Planning for America’s Schools Chapter 1 sun-reactive types, ranging from those with blue or green eyes and very light skin that never tans to those with very dark hair and eyes and dark skin that almost never burns. Although sunburn is not as common among blacks, compared to whites, blacks are susceptible. Approximately 15% of the African American respondents to a national health survey reported experiencing mild to severe sunburns.6 6 Hall HI, Rogers JD. Sun protection behaviors among African Americans. Ethnicity and Disease 1999;9(1):126-31. Differences also exist in the sunsensitivity of different parts of the body. The face, neck, and trunk are two to four times more sensitive than the limbs.7 7 Olson RL, Sayre RM, Everett M A. Effect of anatomic location and time on ultraviolet erythema. Arch Dermatol 1996;93(2): 211-15. Tanning Tanning, or melanin pigmentation, is a consequence of overexposure to the sun that many people find desirable. UVA exposure results in the skin’s production of more melanin, the substance responsible for skin’s pigmentation. There are two ways in which our skin can tan, by immediate tanning and by delayed tanning. Immediate tanning occurs as quickly as 5 to 10 minutes after exposure to the sun and will last as long as 2 hours. One’s ability to exhibit immediate tanning is directly related to the genetically determined pigmentation of the skin. Delayed tanning, which is the more familiar form of tanning, is noticeable 1 to 2 days after exposure, increases for several days, and lasts for weeks or months. Although having a tan provides some degree of protection from UVB, melanin is not an effective sunscreen for Caucasian skin.8 8 Diffey BL. Ultraviolet radiation and human health. Clinics in Dermatology 1998;16:83-9. Photosynthesis of Vitamin D 3 The only positive health effect associated with exposure to solar UV radiation is the synthesis of vitamin D3 . Without UVB, the body cannot synthesize vitamin D3 , which is essential for regulating calcium metabolism. Few studies have examined the effect of sun avoidance or the use of sunscreen on the production of vitamin D3 in children or adults. Therefore, the American Academy of Pediatrics has recommended that infants, children, and adolescents who do not consume at least 500 mL (16.9 oz) of vitamin D-fortified milk or formula daily should take one of the many available daily multivitamin supplements that contain 400 IU of vitamin D3 . 9 9 Gartner LM, Greer FR. Prevention of rickets and vitamin D deficiency: new guidelines for vitamin D intake. Pediatrics 2003;111(4 Pt 1): 908-10. Photoaging of the Skin Exposure to UVA and UVB radiation, and perhaps to radiation in the infrared range as well,8 causes photoaging, a process in which the skin’s elastic fibers break down leading to wrinkled and leathery-looking skin. Dryness, deep wrinkles, sagging, loss of elasticity, and mottled pigmentation are all photoaging symptoms . Eye Damage Eye damage from solar radiation is a risk factor for developing a number of eye disorders including cataracts, skin cancer around the eyes and degeneration of the macula. Although the evidence is not conclusive, such damage appears to have a dose-response relationship and to be cumulative; that is, the more unprotected solar radiation exposure to the eyes over an entire lifetime, the greater one’s risk for developing cataracts.8, 10, 11 10 West SK, Duncan DD, Munoz B, Rubin GS, Fried LP, Bandeen-Roche K, et al. Sunlight exposure and risk of lens opacities in a population-based study: the Salisbury Eye Evaluation project. JAMA1998;280:714-8. 11 Rosmini F, Stazi MA, Milton RC, Sperduto RD. Pasquini P, Maraini G. A dose-response effect between a sunlight index and age-related cataracts. Italian-American Cataract Study Group.[comment]. Annals of Epidemiology. 4(4):266-70.

9 Shade Planning for America’s Schools Chapter 1 Basal Cell Cancer Typically occurring on the most sun-damaged parts of the body, basal cell carcinoma is a slow-growing cancer that begins as a raised lump on the skin and eventually breaks open to form an exposed sore. Although most of these types of cancers are colorless, some are dark in color. Like other skin cancers, basal cell cancer usually appears in middle age, as a result of UV radiation exposure during childhood or adolescence. Squamous Cell Cancer Squamous cell cancer is a more aggressive form of skin cancer that ultimately resembles basal cell cancer in appearance. It often follows a pre-cancerous condition called actinic keratosis, which is a dry and crusty area on the skin. Both basal cell and squamous cell carcinoma usually result from chronic exposure to UV radiation over a period of years. Melanoma By far, the most serious consequence of exposure to UV radiation is malignant melanoma. Unlike the other two types of skin cancer, basal cell and squamous cell, melanomas involve the dark pigmented cells of the skin, the melanocytes. A growing body of evidence indicates that intermittent sun exposure, as opposed to chronic sun exposure, causes this most deadly of skin cancers. Of particular concern, findings from certain studies point to childhood exposure to sunlight, especially severe childhood sunburn, as an indicator for melanoma as an adult.12, 13, 14, 15 12 Westerdahl J, Olsson H, Ingvar C. At what age do sunburn episodes play a crucial role for the development of malignant melanoma. Eur J Cancer 1994; 30A(11):1647-54. 13 Zanetti R, Franceschi S, Rosso S, Colonna S, Bidoli, E. Cutaneous melanoma and sunburns in childhood in a southern European population. Eur J Cancer 1992;28A(6-7):1172-76. 14 Elwood JM, Whitehead SM, Davison J, Stewart M, Galt M. Malignant melanoma in England: risks associated with naevi, freckles, social class, hair colour, and sunburn. Int J Epidemiol 1990;19(4):801-10. 15 Gandini S, Sera F, Cattaruzza MS, et al. Meta-analysis of risk factors for cutaneous melanoma: II. Sun exposure. Eur J Cancer 2005;41:45-60. Sun Protection Is the Key The vast bulk of skin cancers in the U.S. are due to excessive skin exposure to UV radiation from the sun, so sun protection is the key to preventing the disease. Martin Weinstock, MD, PhD Director of Dermatoepidemiology at Brown University and Chair of the American Cancer Society (ACS) Skin Cancer Advisory Board Where Can I Find More Information? Chapter 5, “The Earth-Sun Relationship,” provides more information on seasonal sun angles and their effects on shade design. On the following pages are internet links to more information on skin cancer and its prevention as well as to sun-safety curricula.

10 Shade Planning for America’s Schools Chapter 1 INFORMATION ON SKIN CANCER AND ITS PREVENTION The Centers for Disease Control and Prevention www.cdc.gov/cancer/nscpep/ skin.htm CDC provides leadership for nationwide efforts to reduce illness and death caused by skin cancer. Although these efforts comprise a variety of approaches and strategies, their common focus is education and prevention. CDC’s Web site describes programmatic approaches to skin cancer prevention and education. The National Cancer Institute www.nci.nih.gov/cancertopics/types/ skin The National Cancer Institute (NCI) is a component of the National Institutes of Health (NIH) and is the federal government’s principal agency for cancer research and training. Articles related to the causes of cancer, diagnosis, prevention, treatment, and the most current cancer statistics are available at NCI’s Web site. The United States Environmental Protection Agency www.epa.gov/ebtpages/ humasunprotection.html The Environmental Protection Agency’s mission is to protect human health and to safeguard the natural environment. The agency’s Web site contains information about the health risks posed by UV radiation and describes the steps people can take to protect themselves from overexposure to the sun. The National Council on Skin Cancer Prevention www.skincancerprevention.org The mission of the National Council on Skin Cancer Prevention is to facilitate national skin cancer awareness and prevention efforts through education and promotion of sun-safe behaviors. The council, comprising of 30 separate organizations, increases awareness and prevention behaviors among all populations by providing special programs addressing high-risk populations, including infants, children, young adults, parents, educators, outdoor workers, and athletes. Back issues of NEWSLINK, the council’s quarterly electronic newsletter, are available at the ogranization’s Web site. The American Cancer Society www.cancer.org The American Cancer Society is the nationwide communitybased voluntary health organization dedicated to eliminating cancer as a major health problem by preventing cancer through research, education, advocacy, and service. The organization’s Web site provides the latest research , information about activities and resources at the local level, and educational and advocacy materials. The Skin Cancer Foundation www.skincancer.org The Skin Cancer Foundation is the only national and international organization that is concerned exclusively with the world’s most common malignancy—cancer of the skin. The foundation’s Web site offers information on the three types of skin cancer; information on skin cancer prevention; news of local and national events; and public information posters, pamphlets, and brochures. Commercial Products Disclaimer The list of product manufacturers and retailers is provided for general information purposes only and does not represent an inclusive list of vendors. Furthermore, reference to any specific commercial products or services by trade name, trademark, manufacturer, or otherwise, does not constitute or imply its endorsement, recommendation or favoring by the Centers for Disease Control and Prevention (CDC). The list of product manufacturers and retailers contains URL addresses to Web sites and information created and maintained by private organizations. These links are provided for convenience of reference only. The CDC does not control or guarantee the accuracy, relevance, timeliness, or completeness of this outside information. The inclusion of URL addresses to particular Web sites is not intended to reflect their importance, nor is it intended to endorse any views expressed or products or services offered by the author of the site or by the organization operating the server on which the site is maintained.

11 Shade Planning for America’s Schools Chapter 1 SUN SAFETY CURRICULA National Safety Council—Environmental Health Center 1025 Connecticut Avenue, NW Suite 1200 Washington, DC 20036 www.nsc.org/ehc/sunwise/ activity.htm The National Safety Council’s Enviromental Health Center developed the Sun Safety Activity Guide for elementary school representatives who would like to incorporate sun safety into their school curricula. The guide includes cross-curriculum classroom activities and background information packaged as a 1-hour “core” sun-safety lesson. The core is divided into three 20-minute units, including the effects of UV, risk factors for overexposure to the sun, and sun protection habits. Included in the guide are developmentally appropriate activities for primary (grades K through 2) and intermediate (grades 3 through 6) learning levels. Project S.A.F.E.T.Y. The University of Texas M. D. Anderson Cancer Center with Texas Cancer Council www.mdanderson.org/departments/ projectsafety/ Project S.A.F.E.T.Y. (Sun Awareness for Educating Today’s Youth) is a cross-curricular, multimedia skin cancer prevention program for grades 4 through 9. It is available free of charge to any school in Texas. It is also available to schools outside of Texas for a minimal cost. The SHADE Foundation 10510 N. 92nd Street Suite 100 Scottsdale, AZ 85258 www.shadefoundation.org The mission of The SHADE Foundation, a non-profit organization, is to eradicate melanoma through the education of children and the community in the prevention and detection of skin cancer and the promotion of sun safety. In collaboration with the Environmental Protection Agency (EPA), the Foundation has developed partnerships with schools which implement the EPA SunWise School Program and, in turn, are awarded shade structures to the schools. Sunny Days, Healthy Ways Klein Buendel, Inc. 14023 Denver West Parkway Suite No. 190 Golden, CO 80401 (877) 258-2915 www.info@sdhw.info/ Sunny Days, Healthy Ways is a sun-safety curriculum that uses a comprehensive, cross-curricular approach to teaching skin cancer prevention skills to children in grades K through 5. The curriculum provides an average of 8 hours of sun-safety instruction per grade that can be tailored to the teacher’s time frame and needs. The curriculum includes prepared lesson plans, student activity sheets, experiment materials, story books, and assessments. The SunSafe Project Norris Cotton Cancer Center Dartmouth Medical School One Medical Center Drive Lebanon, NH 03756 (603) 650-8254 http://sunsafe.dartmouth.edu The SunSafe intervention aims to enhance and promote sun protection of children ages 2 to 9 years through the delivery of a multicomponent intervention in three settings: elementary schools and day care centers, town beach areas, and primary care practices. The school/day care component consists of an agespecific (2 to 9 years old) and grade-specific curriculum promoting sun protection. Child-care providers and elementary school teachers need 2 theme days or 2 class periods to deliver SunSafe materials. Ongoing reminder activities are suggested as a means for reinforcing the SunSafe message.

12 Shade Planning for America’s Schools Chapter 1 SUN SAFETY CURRICULA (CONTINUED) The United States Environmental Protection Agency SunWise School Program www.epa.gov/sunwise/ The SunWise School Program is an environmental and health education program that aims to teach children and their caregivers how to protect themselves from overexposure to the sun. Using classroom-based, school-based, and community-based components, the SunWise School Program seeks to develop sustained sun-safe behaviors in schoolchildren. The program’s learning components build on a solid combination of traditional and innovative education practices already in use in many U.S. elementary and middle schools. Through the program, students and teachers will increase their awareness of simple steps that they can take to protect themselves from overexposure to the sun. Students will demonstrate the ability to practice health-enhancing behaviors and reduce health risks. Children also will acquire scientific knowledge and develop an understanding of environmental concepts related to sun protection. Currently, more than 12,000 schools are registered for the SunWise program, representing all 50 states, the District of Columbia, and Puerto Rico. Commercial Products Disclaimer The list of product manufacturers and retailers is provided for general information purposes only and does not represent an inclusive list of vendors. Furthermore, reference to any specific commercial products or services by trade name, trademark, manufacturer, or otherwise, does not constitute or imply its endorsement, recommendation or favoring by the Centers for Disease Control and Prevention (CDC). The list of product manufacturers and retailers contains URL addresses to Web sites and information created and maintained by private organizations. These links are provided for convenience of reference only. CDC does not control or guarantee the accuracy, relevance, timeliness, or completeness of this outside information. The inclusion of URL addresses to particular Web sites is not intended to reflect their importance, nor is it intended to endorse any views expressed or products or services offered by the author of the site or by the organization operating the server on which the site is maintained.

CHAPTER TWO

13 Shade Planning for America’s Schools Chapter 2 STRATEGIES FOR PROVIDING SHADE A number of strategies for providing shade on school grounds are available; however, no single approach is best for all schools. This chapter introduces three strategies for providing shade on school grounds: solid roof structures, shade cloth structures, and natural shade. Some of the advantages and disadvantages of each approach are discussed. This information will assist schools in determining how best to provide shade for their students, teachers, staff, and visitors. Regional differences in vegetation, the need for winter warmth, playground usage patterns, and seasonal weather threats to playground structures factor into the decision process of determining the best approach for each school. For many schools, a combination of strategies that capitalizes on the advantages of several approaches will be the most effective. Outdoor classroom at Poplar Creek Elementary School—Siler, Kentucky With little more than a few hundred dollars, the support of local businesses, and a State environmental education grant, Principal Tom Shelly and the teachers at Poplar Creek Elementary School, along with the students and their parents, were able to fund the construction of this outdoor classroom and nature trail on their school grounds that otherwise would have cost as much as $30,000. Solid Roof Structures Solid roof structures are permanent structures that provide protection from the sun’s harmful rays and can be designed to serve a multitude of purposes. Typically, the structures are designed to be open on at least three sides and often include furniture that can be moved around. To maximize flexibility, the design can include lighting and plumbing. Advantages • Provides “all-weather” protection. • Provides additional classroom space. • Provides exercise space during inclement weather. • Provides flexibility of design. • Can be used as a lunch or picnic area. • Has a long life span. Disadvantages • Requires drainage and guttering. • Can be more expensive than other strategies. Considerations • Schools considering any type of construction project will need to determine which of their local building codes and fire codes are applicable to their project. • Careful planning will result in the positioning of the structure so that it creates shade at the right place, at the right time of day, throughout the year. • Schools located in areas that experience heavy snowfall will need to consider the snow load when designing the roof of the structure. • Likewise, schools located in areas that experience high winds will need to design accordingly.

14 Shade Planning for America’s Schools Chapter 2 • Exposed roof supports may be attractive nesting sites for birds. Strategies to deter this should be incorporated into the building’s design. • Lighting will allow for evening use of the building. • To provide additional light during daytime hours, polycarbonate panels can be incorporated into the roof design and provide a great deal of light while blocking up to 99% of ultraviolet (UV) radiation. • No matter what type of design is selected, all buildings require maintenance. A maintenance schedule and estimated costs should factor into the design selection process. • In the design of the structure, efforts should be made to close off the view of the sky by extending the eaves as far as possible. If the sky can be seen by people under the structure, they are at risk for exposure to indirect UV radiation. • The design of any structure should ensure access for people with disabilities. • If the structure is to be used as a classroom or meeting room, the acoustics of the building should also be addressed. Outdoor classroom at Hermantown School Duluth, Minnesota Constructed by the Duluth Skyline Rotary Club as a gift to the Hermantown School District, the outdoor classroom is directly behind the Hermantown Elementary School. Besides serving as an outdoor classroom, the building is accessible to elementary school students during recess periods. According to Fred Majeski, the Superintendent of the Hermantown School District, the building, with its metal framing and roof and concrete floor, would have cost the school well over $25,000 to build, had it not been donated by the Rotary Club. Shade Cloth Structures Another strategy for providing shade on school grounds is the use of shade cloth or structural fabric supported by a framework or poles. This strategy often is used when the goal is to cover large play areas without employing extensive structural support. Shade cloth is typically a knitted or woven fabric that is rated as to how much sun is blocked. Transmission of the sun’s rays through the fabric depends on the tightness of the weave or knit, with more densely woven or knitted fabric blocking out more of the sun’s radiation. Fabrics with a looser weave transmit between 50% and 80% of the sun’s harmful rays and are typically designed for horticultural applications. Shade cloth that blocks 80% of solar radiation provides the approximate protective equivalent of sunscreen with a sun protection factor (SPF) of 6.7, whereas shade cloth that blocks 94% of solar radiation provides the approximate protective equivalent of sunscreen with an SPF rating of 15. Shade cloth rated to block 94% of solar radiation is the minimum that schools should consider.

15 Shade Planning for America’s Schools Chapter 2 Sun Protection Factor (SPF) What Does SPF Mean? The common interpretation is how much longer skin covered with sunscreen takes to burn as compared to unprotected skin. Sunscreens can be rated for their protective factor against either UVA or UVB radiation or both. The thickness and thoroughness of application, the type of sunscreen, and the frequency of reapplication factor into whether or not sunscreen delivers the protection for which it is rated. Advantages • Can be relatively inexpensive to construct. • Generally requires minimal upkeep. Disadvantages • Provides varying UV radiation protection. • Can be susceptible to weather damage. • Has a shorter life span than solid roof structures. Considerations • Because the UV protection qualities of shade cloth and other structural fabrics vary widely, care should be taken in determining the most appropriate fabric. • Care must be taken in the positioning of supporting posts so that they do not create a danger to children at play. • As with any other structure, one of shade cloth should be positioned for maximum sun protection. • The structural integrity of a fabric structure is related to its curvature and positioning. Structures must be designed to withstand the snow and wind loads that can be expected in their locations. • The design and installation of these structures should be left to specialists. Names and contact information of organizations that design and install fabric shade structures can be found at the end of this chapter. Natural Shade Incorporating natural shade into the overall design offers several advantages. The best approach to creating shade is one that provides protection from the sun’s harmful radiation during the spring, summer, and fall, yet does not completely block the sun’s warmth during winter months. Incorporating deciduous trees, shrubs, and vines into the design provides the seasonal variation in protection that structures alone cannot provide. Likewise, evergreen trees, vines, and shrubs planted alongside structures can serve to block wind in the winter and provide protection from scattered UV radiation during the rest of the year. Advantages • Reduces the ambient temperature more so than structures. • Provides seasonal sun protection. • Provides low-cost alternatives. • Improves the aesthetics of the school grounds. • Provides an opportunity for students to learn about nature.

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