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S U N S A F E F LO R I D A TO O L K I T

Table of Contents

Welcome .............................................................................................................1

Ways to Partner .....................................................................................................5

Social Media .........................................................................................................6

Social Media Cheat Sheet........................................................................................7

In the News ...........................................................................................................9

Resources ............................................................................................................17

Top Five Reasons We Can’t Lose Our Sunscreens .......................................................19

Sunscreen Myth vs Fact .........................................................................................21

Current Science ...................................................................................................23

The Most Important Things To Tell Your Patients About Sunscreens This Year .................25

Faces of Florida ..................................................................................................27

Faces of Florida: George Palmer .............................................................................29

Faces of Florida: Ticoy Domenech ...........................................................................30

Faces of Florida: Jim Hunt .......................................................................................31

Faces of Florida: T.J. Sharpe ....................................................................................32

Faces of Florida: Fern Senra-James ...........................................................................33

Faces of Florida: Kristie Teal ....................................................................................34

Additional Resources ..........................................................................................35

Resource List .......................................................................................................37

S U N S A F E F LO R I D A TO O L K I T | PA G E 1

Welcome Sun Safe Florida is a coalition of local and state physicians, chambers, health groups, business organizations, patients and tourism-related businesses who are educating Florida on the importance and safety of high SPF sunscreen. Sun Safe Florida works with leading dermatologists across the state to prevent cancer here in Florida through use of high SPF sunscreen, protective clothing, and other ways to be sun safe. When Key West began considering a ban of the two most effective UV filters that are required for high SPF sunscreen, dermatologists and patients realized they had to move quickly to save lives and ensure public health. To avoid a public health crisis and protect access to sunscreen, Sun Safe Florida was created to educate Floridians and leaders on the critical importance of high SPF sunscreen and its role in preventing skin cancer, including melanoma.

Peer-reviewed studies and research point to sunscreen being safe for people and the environment (including coral reefs). The media has convinced us that sunscreen’s UV filters bleach coral reefs, yet that is simply untrue. NOAA and national coral reef scientists know what is damaging coral reefs, and it’s not sunscreen. We are working to educate Florida and its policymakers, as well as the media, on what decades of science show.

Preserving coral reefs is an important environmental goal that everyone should take very seriously, but with a recently proposed ban on certain sunscreen ingredients, Florida is being forced into a false choice between protecting human health and protecting coral reefs. We can do both.

There is indisputable science showing that sunscreens provide significant health benefits. Well-established scientific evidence clearly shows that regular daily use of an SPF 30 or higher reduces the risk of developing skin cancer. More people

are diagnosed with skin cancer than all other cancers combined. Every hour, one American dies of melanoma, an aggressive form of skin cancer that is the leading cause of cancer death in women ages 25-30.

Lawmakers need to address the real problems that put coral reefs at risk and strengthen local, state and national policies that address climate change. We need to fix the causes of coral decline, rather than distract ourselves with a ban that won’t help reefs and could harm public health. Sunscreens save lives.

We hope to include you as a member of the Sun Safe Florida coalition. Please let us know if you can engage. We are happy to set up a call with coalition members (dermatologist, coral reef researcher, tourism entity, and/or chamber of commerce) so you can hear first-hand from some of our coalition members.

We need to fix the causes of coral decline, rather than distract ourselves with a ban that won’t help reefs

and could harm public health. Sunscreens save lives.


Ways to Partner


Ways to Partner

We hope to include you as a member of the Sun Safe Florida coalition. Please let us know how you would like to engage. With your help, we can ensure that all Floridians are educated about the importance of sun safety and unrestricted access to sunscreen.

We invite you to join us in spreading the word! Here are some of the ways you can engage and promote sun safety and access to sunscreen in Florida:

• Sharing social media content

• Writing a Letter to the Editor

• Signing onto an Opinion Editorial piece

• Being interviewed by the media

• Telling your story as part of the Faces of Florida initiative

• Speaking at events or meetings on behalf of Sun Safe Florida

Email us at [email protected] and we would be happy to assist you in engaging to ensure Floridians and our visitors have access to high SPF sunscreen.

Please share this toolkit with any colleagues, family, friends, or organizations who may be interested in joining this education effort.

We appreciate your membership as a partner with Sun Safe Florida.

PA G E 6 | S U N S A F E F LO R I D A TO O L K I T

Social Media

Social media has proven to be an extremely effective way to share messaging to the public. We are working to educate Florida and its policymakers, as well as the media, on what decades of science show.

Social Platforms

Social ContentWe have provided some guidelines to help you formulate your content but by no means are these the only things you can do. You will have a much better understanding of what type of content each audience is responsive to and we encourage you to use that.

Top Five Reasons We Can’t Lose Sunscreen – Use the sunscreen facts sheet to craft informative and education posts. These key messages are critical to getting the public to understand the importance of unrestricted access to sunscreen.

Sunscreen Myths vs. Facts – These make for a great series of posts. It would be very simple to schedule out one of these myths every week over the next several months. If posting once a week, it is appropriate to circle back and repost the same messages once all have been exhausted.

Current Science – Use the current science sheet to pull scientific facts. These can be extremely useful for both creating social content and replying to comments and messages on your accounts.

Faces of Florida – These stories add a personal touch to our messaging. Use their stories to emphasize the importance of sun safety, especially here in the sunshine state.

Images and Videos – Visuals have proven to be much more effective in social media. Try and post a picture with the majority of your posts and mix in a video post if you have one related to sun safety. When posting articles, you can use a link shortener like https://bitly.com to be able to include a link to the article and an image.

Sharing Content – Consider sharing content from other Sun Safe Florida members.

*DO NOT engage in argument on social media. Any reply to a comment should be either correcting a false statement or fostering a discussion by

providing a different viewpoint or asking an additional question.

Facebook @SunSafeFlorida

Instagram@SunSafeFlorida

Twitter@SunSafeFlorida


Social Media Cheat Sheet

Social media is a powerful tool each partner can utilize to spread the message of the importance of sun safety and unrestricted access to high-SPF sunscreen. Here are some sample messages you can use on your social media channels and to get inspiration from for original content.

Facebook:Millions of people get diagnosed with skin cancer every year. The Skin Cancer Foundation shares some stories of the brave survivors. https://bit.ly/2tTHA9x

#ICYMI, scientists have found the culprit responsible for the damage to coral reefs. Spoiler Alert: it’s NOT sunscreen. @USA TODAY

Implementing and evaluating science-based coral restoration is a key recovery strategy in the efforts to preserve our coral reefs. @Mote Marine Laboratory & Aquarium

Instagram:#DYK there were 1,599 new cases of melanoma diagnosed in Miami-Dade between 2011-2016? Help us keep Florida safe. ☀#SunSafeFL

#DYK Florida has one of the highest #skincancer rates in the country? Help us keep Floridians safe. #SunSafeFL

The RUMOR…You can still access sunscreen if you schedule a doctor visit and get a #prescription.

The REALITY…Ultraviolet radiation from the sun is a human carcinogen that causes #cancer. Sunscreen is proven to precent UV radiation. Requiring a prescription to access skin cancer prevention puts us all at a higher risk of #skincancer. #SunSafeFL

PA G E 8 | S U N S A F E F LO R I D A TO O L K I T

Twitter:#TipTuesday: When selecting #sunscreen, high-SPF is the way to go! (We recommend 70+) bit.ly/2Hf2mcw #SunSafeFL

Staying out of the sun or covering up isn’t enough. #Sunscreen is a must for everyone! bit.ly/2Hf2mcw #SunSafeFL

#ICYMI, scientists have found the culprit responsible for the damage to #coralreefs. #SpoilerAlert: it’s NOT #sunscreen. Bit.ly/2F2e8mW @USATODAY #SunSafeFL


In The News...

This issue is steadily gaining media attention. Below is the list of some of the most educational pieces surrounding high SPF sunscreen here in Florida. Note: You can find a comprehensive list on our website in the News section at www.SunSafeFlorida.org.”

Treasure Coast News /TC Palm.com

April 1, 2019 | Alexandra Kowcz, Jay SiroisOPINION

Science is clear: We can protect both human health and coral reefs

Preserving coral reefs is an important environmental goal that everyone should take very seriously, but with a recently proposed ban on certain sunscreen ingredients, Florida is being forced into a false choice between protecting human health and protecting coral reefs.

We can do both.

The global coral research community is in near-unanimous agreement that rising ocean temperatures have triggered unprecedented mass coral bleaching over the last decade. A recent seminal study published in a preeminent scientific journal (Nature) analyzing coral bleaching records at 100 reef locations around the world (between 1980 and 2016) demonstrated the high degree to which climate change and bleaching are linked.

The study authors concluded that water quality had little effect on the coral reefs, pointing instead to rising ocean temperatures from global warming as the cause of coral bleaching.

“Water quality and fishing pressure had minimal effect on the unprecedented bleaching in 2016, suggesting that local protection of reefs affords little or no resistance to extreme heat,” the study noted.

A separate study concluded that local population density is not related to coral reef decline and that only concerted global action to reduce ocean temperatures can reverse coral reef decline. Additional studies examining coral populations in the Florida Keys implicate climate change and associated warmer ocean temperatures as the primary determinant of coral disease over the past several decades.

However, proponents of a ban point to two studies performed in laboratory settings that show coral bleaching under artificial conditions. Although these results suggest the need for further research, the science on this is far from settled.

Conversely, there is indisputable science showing that sunscreens provide significant health benefits. Well-established scientific evidence clearly shows that regular daily use of an SPF 30 or higher reduces the risk of developing skin cancer. More people are diagnosed with skin cancer than all other cancers combined.

PA G E 1 0 | S U N S A F E F LO R I D A TO O L K I T

Every hour, one American dies of melanoma, an aggressive form of skin cancer that is the leading cause of cancer death in women ages 25-30. According to the Florida Department of Health, melanoma “claims almost twice as many lives in Monroe County on average than statewide averages.”

The Food and Drug Administration, Centers for Disease Control and Prevention, U.S. Surgeon General, American Academy of Dermatology, Skin Cancer Foundation and health care professionals worldwide emphasize that using sunscreen is a critical part of a safe sun regimen to help prevent sunburn and reduce cancer risk.

Oxybenzone and octinoxate are safe and effective ingredients in over-the-counter sunscreens approved by FDA that provide critical defense against cancer-causing ultraviolet (UV) radiation. They provide broad-spectrum protection from both UVA and UVB rays. Many sunscreens on the market today contain oxybenzone and octinoxate, including those with high SPF formulations.

Along with an SPF greater than 30 and water resistance, AAD recommends the use of broad-spectrum sunscreens (such as oxybenzone) to protect skin from both types of harmful UV rays.

Efforts to restrict consumer access to cancer-preventing sunscreens are not only misinformed, but could, in fact, be dangerous. The proposed Key West ordinance to ban sunscreens containing oxybenzone and/or octinoxate lacks the necessary scientific evidence to support such a policy and ignores the overwhelmingly obvious factor responsible for coral bleaching — global warming.

If enacted, this policy will create confusion, put consumer health at risk and potentially discourage the use of sunscreens while making no meaningful impact on the health of coral reefs.

Sunscreens save lives. Lawmakers need to address the real problems that put coral reefs at risk and strengthen local, state and national policies that address climate change. We need to fix the causes of coral decline, rather than distract ourselves with a ban that won’t help reefs and could harm public health.

Alexandra Kowcz is chief scientific officer of the Personal Care Products Council. Jay Sirois, Ph.D., is senior director of Regulatory and Scientific Affairs, Consumer Healthcare Products Association.

https://www.tcpalm.com/story/opinion/contributors/2019/04/01/we-can-protect-both-human-health-and-coral-reefs-guest-column/3288314002/

S U N S A F E F LO R I D A TO O L K I T | PA G E 1 1

FloridaPolitics.com

April 1, 2019 | Jacob Ogles

Wear sunscreen, experts say—it saves lives without killing coral

Wear sunscreen.

It’s the moral of a classic hypothetical commencement address (as well as a Baz Lurhmann single — and no, it wasn’t written or delivered by author Kurt Vonnegut).

But Miami dermatologist Andrew Weinstein suspects it may be advice many people would not take, given any reason at all.

“We know there’s a culture that favors exposure to the sun, and that there is an epidemic of skin cancer,” he said. “If suntan lotion is less available, we will see an increase in the number of deaths from tumors.”

That’s why he felt horrified when he watched the Key West City Commission consider a ban sunscreens with oxybenzone and octinoxate. Those difficult-to-pronounce chemicals happen to give high-SPF sunscreen its protective power against ultraviolet rays.

But officials felt swayed by a couple of studies suggesting the chemicals pose a threat to coral reefs.

“What if we don’t pass this, and three to five years down the road we have no reef?” said Commissioner Jimmy Weekley, according to the Miami Herald.

The ban won’t take full effect until 2021, and further research into coral reef decline will continue in the meantime. In the Florida Keys, damage to coral represents a serious fear.

But it’s one many that scientists say doesn’t stand up to serious scrutiny — at least not yet. And those devoting their lives to preventing skin cancer don’t think a mob at City Hall should have the power to overrule science.

Scrutinizing The ScienceNanette Schimpf, spokeswoman for Sun Safe Florida, said the key to proper skin care remains access. So long as sunscreen remains easily available to customers, they can be urged to use it.

But right now, anyone out in the sun at beautiful Key West must bring their own lotion or buy it from outside city limits.

“The coral reef is safe with oxybenzone in the water,” she said. “But these people have to wear sunscreen.”

The organization points to the work of Dr. Carys Mitchelmore, a University of Maryland professor who for years studied chemical toxins in waters around Hawaii.

Mitchelmore said she began her work after some small studies inspired uproar around sunscreen.

Specifically, Craig Downs published a laboratory study in 2016 asserting that oxybenzone caused “toxicopathological effects” on coral reefs.

“Oxybenzone poses a hazard to coral reef conservation and threatens the resiliency of coral reefs to climate change,” Downs concluded.


But when Mitchelmore actually sought out research affirming such findings, she learned little research had been done at all.

Mitchelmore said determining environmental risk requires two sets of data, concentrations of the chemicals around reefs and coral toxicity studies. The single data point for oxybenzone and lack of data for octinoxate concentrations in seawater around Hawaii led her to start researching this.

For Mitchelmore, she decided to conduct a comprehensive assessment of sunscreen chemical concentrations in seawater around Hawaii. It was important to check areas with little human visitation and then major tourist attractions like Waikiki Beach.

She indeed found more oxybenzone in the water around Waikiki. In fact, the low population areas have less than 10 parts per trillion in the water, while Waikiki had 136 parts per trillion. She recently published findings in the journal STOTEN.

What seemed more notable, the Mitchelmore concentrations found were far less than the Downs research suggested. Her study shows the chemical levels 141 times lower than Downs found.

Mitchelmore notes the concentrations her team found in their 57 samples are similar to the majority of other published work near coral reefs. Downs was from a single sample. Furthermore, Downs’ research did not measure octinoxate and Mitchelmore pointed out her team could find no measurable levels of octinoxate in any seawater sample from Hawaii.

Regardless, there remained a question whether oxybenzone does significant harm to coral reefs.While she said toxicologists consider the risk for any new chemical found in seawater, she stresses that there’s many chemical pollutants in seawater and so it’s important to determine which ones are the priority.

Mitchelmore said she’s not actually drawn any conclusion. There’s simply not enough data to do so, and a single un-replicated study is not enough evidence and this is an emerging area of research.

She stressed her work remains independent of efforts by Sun Safe Florida or any such group. But today, no serious impacts on coral because of sunscreen pollutants have been determined.

“To put things in perspective, everything is toxic, but just because you detect something doesn’t mean harm,” she said.

Overruling The MobStill, the Downs research on its own convinced Hawaii to ban sunscreens with oxybenzone altogether. Skin safety experts in Florida feared similar fear would grip Florida after the Key West ban advanced.

But scientific pushback averted that so far. Miami Beach city commissioners rejected a proposed banmonths after the Key West prohibition went into effect.

Weinstein, president of the Florida Society of Dermatology and Dermatologic Surgery, appreciates that but remains fearful what fights lay ahead.

“The argument very much reminds me of the arguments against vaccination,” the doctor said. “A single quasi-scientist was really the impetus behind most of the discourse involving Autism and immunization.”

He referenced a since-debunked study by British surgeon Andrew Wakefield.


After watching debate play out in Key West, he’s fearful of a populist mob taking over city commission hearings in more coastal communities.

“And unwittingly you can have a municipality have a ban on safe and important sunscreen,” he said.

That’s why he applauds legislation the state Legislature seeking to pre-empt sunscreen bans in cities. In Weinstein’s eyes, bans on cosmetic items and regulated substances should be done at the state level.

Of course, the most notable legislation, state Rep. Michael Grant’s bill HB 3, would impact localities ability to regulate many business functions. LGBTQ activists condemn the legislation for potential workforce protection interference.

Weinstein understands that. But just as he feels the state Legislature will be more deliberative that a city commission facing a mob, he believes amendments will be made before a bill gets passed.

The prospect of Florida having a patchwork of regulations on what chemicals can exist in retail products, though sounds untenable. Worse, it could take a cancer-preventing product off shelves for reasons that don’t check out.

Mitchelmore said it could be some time before scientists can conclusively say sunscreen does or does not threaten reefs.

“People are being led to believe that there is extensive scientific evidence of the toxicity of oxybenzone and octinoxate on corals, when there simply is not,” she said.

“This is very much an emerging area of research, especially as concentrations in seawater seem to be very variable… this means much more work is needed.”

Notably, pre-emption legislation won’t stop a sunscreen ban. It just kicks it to the state to make the decision.

Until that happens, dermatologists suggest, as they have for so many years, to trust them on the sunscreen.

https://floridapolitics.com/archives/292288-sunscreen-lives-killing-coral


CBS 4 News

March 13, 2019 | Frances Wang

Miami Beach Commissioners Vote Not To Ban Sunscreen Ingredients Experts Say Harm Coral ReefsMIAMI (CBSMiami) – Miami Beach commissioners voted on Wednesday not to prohibit the sale of sunscreens containing two ingredients experts believe harm coral reefs.

Oxybenzone and octinoxate are the ingredients in question and they are present in over-the-counter sunscreens approved by FDA.

Dave Doebler, the chair of the sustainability committee for the city of Miami Beach spoke at the meeting about the harms the chemicals have on the city’s coral reef.

Commissioner Michael Gongora proposed the ban and emphasized it does not eliminate sunscreen.

Skin care experts say a partial ban may not be the best way.

“This is a public health issue because when you eliminate 90% of your favorite products you’re left with things people won’t use,” said Dr. Jackie Dosal, a dermatologist in Coral Gables. “In light of this and the trend of people talking about toxic sunscreen, consumers may just say sunscreen is bad and not use at all.”

Others against the ban say there just isn’t enough scientific research yet.

“It needs to be studied”, said Dr. Martin Zaiac with Mount Sinai Medical Center. “We want to protect our reefs. We want to protect our fish. We want to protect our people.”

Ultimately, that’s why the ban didn’t pass, with only two commissioners, including Góngora voting yes.

“If we can get more precision and clarity on science,” said Mayor Dan Gelber,” the commission would clearly vote on behalf of the reefs.”

Gongora said he was disappointed. “It seemed like a no brainer,” said Gongora, adding that he hoped with more facts and research, the item will be brought back to the table.

Last month, the Key West City Commission passed a ban on sunscreens containing these two chemicals.

The Key West city commission voted 6-1 to pass an ordinance banning the sale or distribution of any sunscreen that contains the chemicals.

Key West and the Florida Keys island chain are paralleled by the continental United States’ only living coral barrier reef, lying within the Florida Keys National Marine Sanctuary.

Various studies indicate that oxybenzone and octinoxate can increase coral bleaching, cause mortality in developing coral, and cause genetic damage to corals and other marine organisms.

Key West Mayor Teri Johnston said, “To me, it boils right down to the fact that there are thousands of sunscreens out there and we have one reef, and we have an opportunity to do one small thing to protect that,” said Key West Mayor Teri Johnston. “I believe it’s our obligation.”

The ordinance will go into effect Jan. 1, 2021, and will be enforced through warnings and civil citations Exceptions are to be made for medically licensed prescriptions.

https://miami.cbslocal.com/2019/03/13/miami-beach-city-commission-meets-to-discuss-ordinance-that-would-ban-chemicals-in-sunscreen/


Sarasta Herald Tribune /HeraldTribune.com

April 26, 2019 | Staff Report

Mote racing to turn back threat to Florida’s coral reefs

Mote Marine Laboratory scientists are accelerating their efforts to help Florida’s coral reefs combat a rapidly spreading disease outbreak that experts say puts the natural resources at risk of functional extinction.

Stony coral tissue loss disease plagues nearly half the coral species on the Florida Reef Tract, with mortality rates frequently exceeding 80 percent, in an outbreak that stretches from Martin County to Key West, Mote said in a report Tuesday. Susceptible corals include maze, brain, boulder and other species groups that form the essential foundations of the Florida Reef Tract, an economic engine worth $8.5 billion and supporting 70,400 jobs.

In response, Mote is undertaking the first year of its new Florida Keys Coral Disease Response & Restoration Initiative; taking care of rescued coral fragments from sites ahead of the disease front and initiating long-term coral gene banking efforts; reporting its new research results on bacterial changes in the infected corals; and implementing and evaluating science-based coral restoration as a key recovery strategy, with Mote co-leading a multi-institution Restoration Trials Team.

On April 13, the public can meet Mote scientists working on the projects during Mote’s Ocean Fest: A Community Celebration, in Key West.

Mote said it is coordinating with the Florida Fish and Wildlife Conservation Commission, the Florida Department of Environmental Protection, the National Oceanic and Atmospheric Administration and others.

“There is no stopping this coral plague from running its course — it is highly unlikely that our devastated coral populations will be able to execute a natural recovery on their own,” Mote President and CEO Michael P. Crosby said. “That means conservation strategies alone cannot solve this dilemma.

“Mote has proposed a bold, science-based coral disease response and restoration initiative that is essential to actively assist the recovery of this ecosystem,” Crosby said. “The Florida Legislature is currently considering a $2 million request for launching our proposed collaborative initiative, and Sen. Marco Rubio was instrumental in recently shepherding a congressional $5 million addition to NOAA’s budget to help support our initiative to respond to this environmental disaster.”

Erinn Muller, science director and manager of Mote’s Coral Health & Disease Research Program, is leading Mote’s pursuit of solutions.

“We are screening our native coral genotypes for resistance to stressors, and we have some genotypes highly resistant to stony coral tissue loss disease,” Muller said. “Through restoration, we now have the power to incorporate that trait within our population, along with genetic diversity to ensure resistance to a variety of stressors. Now is a critical time. Either we’re going to lose our coral reefs in the next decade, or were going to make sure they survive and continue the functions that are so critical for our livelihoods and our well-being.”

https://www.heraldtribune.com/news/20190326/mote-racing-to-turn-back-threat-to-floridas-coral-reefs

Resources


RANKS #1FLORIDA

Between 2011-2016

IN CASES OF

Have Been Diagnosed

MELANOMA

29,913

We Can’t Lose Our SunscreensSome Florida communities are considering a ban on two of the most widely available, effective UV filters in sunscreen today. They paused to study the issue. Here are 5 reasons we can’t let access to our sunscreens be taken away!

Florida leads the nation in skin cancer and sunscreen helps protect users from melanoma THE RUMOR…This will help the coral and there is no public health impact.

THE REALITY…One American dies every hour from melanoma in the US.In Florida from 2011-2015, there were 29,913 new cases of Melanomas diagnosed. During that same time, 3,863 people died from skin cancer.

TOP 5 REASONS

SPF80

KIDS SPORT

SPF50

SENSITIVESKIN

SPF50

SPF100ULTRASHEER

R E AS O N # 1

Creating barriers to sunscreen risks public health THE RUMOR…You can still access sunscreen if you schedule a doctor visit and get a prescription.

THE REALITY…Ultraviolet radiation from the sun is a human carcinogen. Sunscreen is proven to reduce exposure from UV radiation. Requiring a prescription to access skin cancer prevention puts us all at higher risk of skin cancer.

R E AS O N # 2

SUNSCREENis not aPrescription

Requiring a

for Sunscreen Creates Barriers to Access UV Protection & Increases Skin Cancer Risk

Rx

We may no longer have our choice of our favorite sunscreenTHE RUMOR…There are plenty of other sunscreens to choose from.

THE REALITY…70% of the sunscreens on shelves today would be banned, including high SPF sunscreens. You won’t be able to get most of the products you count on for protection!

R E AS O N # 3


Not all sunscreens provide the same protection you want and need THE RUMOR…This ingredient doesn’t matter – manufacturers can just use a different one.

THE REALITY…Making sunscreen is like baking a cake – you can’t leave out one ingredient or swap water for milk, and you can’t just swap one sun filter for another and get the same protection against UV! There are only a few FDA-approved sun filters. Oxybenzone is one of the only ingredients that provides broad-spectrum protection against UVA and UVB radiation.

Sunscreen is a MUST for everyone! THE RUMOR…Just stay out of the sun, or cover up, or stand in the shade, or…

THE REALITY…For people who work outdoors, like workers in tourism, hospitality, or construction, avoiding the sun is just not possible. And for beachgoers, sportsmen, and especially families, this just isn’t practical! Without the right SPF available, you will be uncomfortable – or worse, unhealthy – when you go to work, to the beach, or outside for to enjoy our beautiful Miami Beach sun.

Make Sure Your Sunscreen Isn’t Taken Away. HERE’S WHAT WE CAN DO!

FORMULAIS UNIQUE

EACH

Take action to protect your access to sunscreen and learn more about the science behind sunscreens at

www.SunSafeFlorida.org

R E AS O N # 4

R E AS O N # 5


Sunscreen Myth vs Fact

Value of SunscreenMyth: Lower SPF sunscreens work at least as well as those with higher SPF.

Fact: High SPF formulas offer superior protection for people most vulnerable to skin cancer, including cancer survivors and those with fair skin. Scientists and medical experts know that high SPF sunscreen is a game changer, and it saves lives. The Journal of the American Academy of Dermatology in 2017 announced their studies found SPF 100+ sunscreen is more protective against sunburn than SPF 50+ in actual use.

People typically only apply 25-30% of the amount of sunscreen used in SPF lab testing, thereby receiving 25-50% of the labeled SPF value. Because most people under apply, high SPF provides a margin of safety in actual use. According to a recent study published by the American Academy of Dermatology, SPF 100+ sunscreen was significantly more effective in protecting against sunburn than SPF 50+ sunscreen in actual use conditions. And, any sunscreen with an SPF value of 70+ requires oxybenzone as an ingredient to stabilize the formula and provide broad spectrum protection.

Myth: All sunscreen is created equal.

Fact: Sunscreen is personal. Dermatologists agree the best sunscreen is the one you prefer and will use. There are many factors people consider when choosing a sunscreen including formula aesthetics, SPF value, product form, and special needs like for sensitive skin or water activity. A variety of choice is important so all consumers can follow sun protection guidelines.

Myth: Sunscreen is not always necessary.

Fact: Many people believe that you only need to apply sunscreen on cloudy days or when your entire body is exposed to sunlight. This is false. Ultraviolet light is still harmful when the sun is not visible. Wearing sunscreen all the time will help protect your skin, even when you don’t think you need to put it on.

Sunscreen SafetyMyth: Oxybenzone is an unnecessary ingredient in most sunscreens.

Fact: Oxybenzone is found in 9 out of the 10 sunscreens that consumers prefer and most often use. It’s also found in 70% of the overall sunscreen products on the market. This is partially because the chemical enhances the spreadability and application of sunscreen resulting in a higher likelihood of reapplication.

Oxybenzone is one of two FDA-approved filters that provide protection from both UVA and UVB rays (broad spectrum). The UV filter is unmatched in its ability to keep formula stable in sunlight and to be used in combination with other filters for the greatest broad-spectrum protection. It’s also is required for high SPF values of SPF 70+. Using sunscreen without oxybenzone puts a person at risk of not protecting their skin entirely. It’s the only commonly used FDA-Approved UV filter on the market other than zinc oxide that protects from both UVA and UVB rays.

Myth: Oxybenzone isn’t safe for human use.

Fact: Oxybenzone was approved for use in thousands of products by the FDA in the early 1980s. Oxybenzone has been safely used in sunscreens, lip balms, anti-aging creams, shampoos, and nail polish.


It’s also used in many other consumer products like fabric, plastic bottles, paints, and anything that might be exposed to the sun.

Myth: Sunscreen is toxic and puts dangerous chemicals on your skin.

Fact: Some lab studies suggest that chemicals in sunscreens such as oxybenzone may cause skin allergies or mimic hormones, but no studies have convincingly established health problems in people. Meanwhile, it’s well proven that damage from UV rays can cause skin cancer.

Reef SafeMyth: Sunscreen containing oxybenzone is scientifically linked to causing coral decline.

Fact: According to the National Oceanic and Atmospheric Administration (NOAA), the cause of coral decline is due to global climate change, leading to high ocean temperatures, elevated water levels, and ocean acidification from increased global Co2. Local stressors include things like unsustainable fishing practices and pollution from agricultural and municipal run-off. There is no sound data that shows oxybenzone is a significant cause of coral decline. Bans on certain sunscreen ingredients are based on two poorly designed studies that that do not reflect the true natural complexity and ecosystem of a coral reef

Myth: “Reef-Safe” is a legitimate regulated category for consumer products.

Fact: “Reef-Safe” is not a legitimate category, nor is it a regulated category by the Federal Trade Commission (FTC) or any regulatory body anywhere in the world. The FTC requires that all claims in advertising be truthful and not misleading with competent and reliable scientific evidence to support all claims.

Myth: Sunscreen bans have proven a benefit to coral health.

Fact: Sunscreen bans have no proven benefit to coral health- and will pose risk to public health. Sunscreen is proven to prevent skin cancer especially in places like Florida which has one of the highest rates of skin cancer in the country. Key West and Monroe County specifically have an especially high UV index and melanoma claims almost twice as many lives on average as elsewhere in Florida. According to the National Oceanic and Atmospheric Administration (NOAA), the cause of coral bleaching is due to global climate change, ocean acidification, and unsustainable fishing practices. Florida is being forced into a false choice between protecting human health and protecting coral reefs. Both can be done.

Sunscreen AccessMyth: Sunscreen can be medically prescribed to a person.

Fact: Prescription sunscreen does not exist. Sunscreen is classified as an over-the-counter (OTC) product and cannot be labeled as “Rx only.” There is no process to store or sell sunscreens as prescription products for retailers and pharmacies. Also, requiring a prescription for sunscreen would put an unnecessary barrier to access UV protection. By reducing access to sunscreen, the increased risk of skin cancer is guaranteed. Especially for Floridians, where Florida is expected to rank second in the nation for rate of new melanoma cases.

Take action to protect your access to sunscreen and learn more about the science behind sunscreens at www.SunSafeFlorida.org


Current Science

The decline of the world’s coral reefs is a serious concern, with scientists largely agreeing that global warming, ocean acidification, and invasive disease species are among top, driving factors.1, 2, 3 Yet while some recent, misinformed policy actions might indicate otherwise, the science is clear: no validated, replicated evidence shows a correlation between oxybenzone, a popular UV filter and valuable public health protector, and coral decline.

The “Hawaii ban” is primarily based on two shaky toxicity studies on coral that have not corroborated or reproduced in a real-world environment.4,5 Both studies have serious methodological flaws:

• They use coral samples, juvenile coral, and isolated coral cell culture methods. None of these methods are indicative of true environmental conditions.

• They use unrealistically high exposure concentrations

• Sample size, replicates, and analytical methods described are poor

Because of these methodological flaws, they cannot be used for policy making.

A third research group (He, et al) recently published toxicity studies and estimated a medium environmental risk for the two ingredients based on conservative exposure endpoints.

Only four studies have been published in peer-review scientific journals that assess coral toxicity of the UV filters oxybenzone and octinoxate.4, 5, 6 Despite widespread media coverage of these studies claiming that they show how oxybenzone and octinoxate are killing coral, a closer examination of the results demonstrates several

flaws and an overall lack of support for the position that the sunscreen causes coral mortality in the environment:

• These studies do not reflect conditions in a reef ecosystem, where a sunscreen would be rapidly dispersed and diluted.

• Each one of the studies use concentrations of UV filters (parts per million) much higher than what has typically been found in the marine environment (parts per trillion).

• Only the He, et al paper directly tested toxicity of octinoxate.

Typical environmental risk assessments are done using model organisms that are routinely raised in a lab setting, because they tolerate lab culture and can be used to assess potential toxicants. Coral, however, are extremely sensitive organisms, with various symbionts and holobionts (algae and microorganisms that are critical to their growth and survival).

• Coral rely on other reef-dwelling animals to maintain the overall reef health and ecology.

• Taking coral out of the complex reef environment creates stress that makes them immediately vulnerable; they are simply not good laboratory model organisms.

• Each study makes the incorrect assumption that sunscreen ingredient exposure comes via two ways: directly from people engaged in recreational water activities or from wastewater treatment.

• UV filters are used in numerous products, including plastics, packaging, color-fast fabrics, etc.

• No one has yet determined where the UV filters found in the environment originate.

• Plants and some marine organisms make benzophenone compounds naturally.

1 National Academy of Sciences, Nov. 2018, https://www8.nationalacademies.org/pa/projectview.aspx?key=dels-osb-17-01#collapseC 2 National Oceanic and Atmospheric Administration’s (NOAA), Coral Reef Conservation Program, Coral Threats; Available at: https://coralreef.noaa.gov/issues/welcome.html3 National Academy of Sciences, Nov. 2018, https://www8.nationalacademies.org/pa/projectview.aspx?key=dels-osb-17-01#collapseC4 Downs, et al. 2016 Toxicopathological Effects of the Sunscreen UV Filter, Oxybenzone (Benzophenone-3), on Coral Planulae and Cultured Primary Cells and Its Environmental Contamination in Hawaii and the U.S. Virgin Islands. Arch Envtl Contam Toxicol 70: 265-288.5 Danovaro, et al. 2008 Sunscreens cause coral bleaching by promoting viral infections. Environ Health Perspectives 116(4):441-7.6 He, et al. 2019. Comparative toxicities of four benzophenone ultraviolet filters to two life stages of two coral species. Science of the Total Environment 651: 2391-2399. He, et al. 2019. Toxicological effects of two organic ultraviolet filters and a related commercial sunscreen product in adult corals. Environmental Pollution 245: 462-4


The coral reef scientific community is unanimous in the conclusion that increased sea temperatures, as a result of global climate change, is the single most important factor in coral survival.

An International Coral Reef Initiative report states: “There is a lack of firm evidence of widespread negative impacts at reef community and/or ecosystem level. The evidence available may not properly reflect conditions on the reef, where pollutants may rapidly disperse and be diluted. Concentrations of UV filters used in experimental work have generally been higher than those likely to be encountered in the reef environment, although no study has assessed the levels of these chemicals in the tissues of long-lived species.”7

• According to the U.S. National Oceanic and Atmospheric Administration’s (NOAA) Coral Reef Conservation Program, coral reefs are impacted by an increasing array of hazards – primarily from global climate change, ocean acidification, and unsustainable fishing practices.8

• This year, the foremost researchers on coral published a seminal paper in Science analyzing coral bleaching records at 100 globally distributed reef locations from 1980 to 2016, linking the bleaching events to increased sea temperatures.

• There is no scientific evidence that under realistic conditions, sunscreen ingredients are a relevant source for coral bleaching. In fact:

o Hawaiian researchers from the Hawaiì Institute of Marine Biology at the University of Hawaiì, Kaneòhe have shown that local conditions do not contribute to coral bleaching events9

o The Australian government found the majority of coral bleaching occurs where there is low to no human interaction and that coral is healthiest in tourist or high traffic areas.

FUTURE SCIENTIFIC STUDIESKEY WEST-AREA WATER QUALITY STUDYThe aim of this study is to provide information that will allow City Officials in Key West to assess the relative impact of factors that could contribute to the degradation of local coral reef communities. Deliverables include:

1) a summary of literature on factors that are known or suspected to contribute to coral decline and their relative magnitude of impact;

2) a summary of reported detections of sunscreen ingredients around Key West and other coastal waters; 3) a screening evaluation of local anthropogenic factors (e.g., agriculture, WWTP, tourism, shipping traffic) in

context with their proximity to coral and associated bathymetry and ocean currents; 4) a relative ranking of factors that may be contributing to degradation of coral in marine waters around Key

West; and 5) triage-oriented recommendations for next steps.

Estimated completion date: April/May 2019

WASH-OFF STUDYDeveloping a laboratory model to evaluate the release of target compounds from skin products into seawater under simulated swimming conditions. This study will help determine the level of exposure to the marine environment from sunscreen use.

Estimated completion date: Q3 2019

CORAL TOXICITY STUDYRegulatory agencies use Environmental Risk Assessments (ERA) to characterize the nature and magnitude of health risks to ecological receptors (e.g., coral) from chemical contaminants and other stressors that may be present in the environment. Risk assessments predict the probability, nature, and magnitude of the adverse health effects that may occur. Oftentimes, key data points are not available, and a risk assessor must make assumptions and estimates to calculate the potential risk. While we have several reliable monitoring studies on which we can base exposure models, we are missing reliable toxicity datapoints. We are proposing to run chronic and acute toxicity assays to calculate a more accurate ERA.

7 Wood, Elizabeth, 2018 Marine Conservation Consultant, UK. Impacts of Sunscreen on Coral Reefs, International Coral Reef Initiative8 National Oceanic and Atmospheric Administration’s (NOAA) Coral Reef Conservation Program, Coral Threats; Available at: https://coralreef.noaa.gov/issues/welcome.html9 Rodgers et al. Patterns of bleaching and mortality following widespread warming events in 2014 and 2015 at the Hanauma Bay Nature Preserve, Hawaiì. PeerJ, 2017;5:e3355; DOI 10.7717/peerj.3355; available at https://peerj.com/articles/3355/?utm_source=TrendMD&utm_campaign=PeerJ_TrendMD_0&utm_medium=TrendMD


When It Comes to Sunscreen Science, We Trust The Experts

Protecting the EnvironmentToday, there is no credible scientific evidence proving that sunscreen filters cause coral bleaching.

Protecting PeopleLimiting access to effective sunscreen may adversely affect public health.

THE PROVEN CAUSES OF CORAL DECLINE**U.S. National Oceanic and Atmospheric Administration

WHY IS SUNSCREEN IMPORTANT?According to the

World Health Organization

skin cancer cases can be

PREVENTED BY WEARING

SUNSCREEN.

ONLY FDA-APPROVED UV FILTERS

CAN BE USED.

Replacing or eliminating key ingredients can lead to

INCREASED EXPOSURE, SUNBURN, INCREASED

CANCER RISK, AND UNPLEASANT FORMULAS.

NOT ALL SUNSCREENS ARE CREATED EQUAL.

Pollution from waste water also is a contributor to

CORAL DECLINE AND STRESS.

WARMINGOCEANS

cause thermal stress that

contributes to coral bleaching

and disease.

THE BEST SUN PROTECTION IS THE ONE THAT CONSUMERS WILL USE. Ingredients matter & cannot be swapped.

OXYBENZONE is one of the few sunscreen ingredients available in the U.S. that provides the best levels of protection from both UVA and UVB rays.

It is an FDA-approved filter that has been proven safe and effective for decades.

OVER FISHINGalso contributes.

AGRICULTURAL RUN-OFF

and

The scientific consensus agrees:

CLIMATE CHANGEKILLS CORAL

There is no solid evidence that sunscreen ingredients

are a relevant source of coral bleaching in the

environment.

FLORIDA


The Most Important Things To Tell Your Patients About Sunscreens This Year

Misinformation and sensationalized media coverage around sunscreen are creating confusion with your patients. These are some of the most important

messages to share with your patients.

Sunscreen formulated with FDA-approved ingredients are available in many forms that feel good on your skin. The best sunscreen is the one you will wear consistently, every day.

Sunscreen usage lowers skin cancer risk and can help prevent the appearance of UV damage to skin.

Certain sunscreen ingredients, like oxybenzone, are critical to making high SPF sunscreens, proven to provide superior broad spectrum protection from UV rays.

Sunscreens are one part of a total sun protection plan, including wearing a hat and sunglasses, avoiding mid-day sun, and using sun protective clothing.

If you are concerned about the effects of sunscreens with certain ingredients like oxybenzone, you can choose a mineral-based option.

You may have seen media coverage around sunscreen and the oceans, and you may be concerned about it. Science does not support sunscreens as a cause of coral bleaching in Hawaii or elsewhere.

The proven causes of coral bleaching around the world, not just at populated beaches, are climate change, warming oceans, over-fishing and ocean acidification.

Take action to protect your access to sunscreen and learn more about the science behind sunscreens at


Faces of Florida



George moved to Florida as an infant and grew up enjoying outdoor sports on the water and on the land. His father was the executive director of the state board of medical examiners and was the fourth in a long line of generations of physicians. George is a dynamic Floridian who has enjoyed an amazing life, both personally and professionally. He raised three children who are all happy and productive professionals, all while representing the Florida Medical Association for many years.

He is unstoppable and defies the odds at every turn. As a five-time Ironman athlete who accepts challenges with grace and a smile, George has battled five melanomas and numerous squamous and basal cell carcinomas. He sees his dermatologist every six months without fail. George still enjoys the outdoors and can be found scalloping or doing yard work. His dermatologist requires him to wear protective clothing every time he goes outside, and directs George to use sunscreen--the higher SPF, the better. Moffitt Cancer Center, where he has been treated, says he is the poster child for melanoma because he is fair skinned, has red hair, and is outdoors often.

GeorgePA L M E R

FAC E S O F F LO R I DA

George’s advice to fellow Floridians is, “Don’t be a statistic. Wear protective clothing and high SPF sunscreen every time you go outside. Life is too precious to be cut short because you didn’t protect your skin and your health.”



Ticoy is a Floridian who enjoys the sun and spending time outdoors in beautiful Miami Beach. She didn’t take sunscreen seriously for many years and as a result has battled skin cancer for nearly 10 years. She’s had three surgeries removing small to large melanomas in the last seven years. Ticoy’s dermatologist plays a critical role in her healthcare team and together they’ve developed a plan for her preventive care. Even when she is only running errands, her dermatologist recommends that she wear protective clothing, sunglasses and her high SPF sunscreen of choice.

TicoyD O M E N E C H


“I am like so many Floridians who live every day in our

sunshine. After having three malignant freckles surgically

removed from my back, high SPF sunscreen is truly a life-

preserving necessity for me. I survive because of the

safe, effective UV filters in sunscreen. Having access

to critical life-saving sunscreen is one of the most

important parts of my day — I could not live without

having the sunscreen I need.”



Jim grew up in Melbourne Beach and spent much of his time outdoors as a youth and teenager. His family has a history of skin cancer and he is fair skinned, so he is a high risk patient. He visits his dermatologist frequently for preventive care. Sadly, one of his sisters died from a melanoma before she was even 50 years old. Another younger sister had to undergo extensive treatment for a melanoma at the Moffitt Clinic in Tampa. While Jim didn’t always wear sunscreen, he is now an avid believer in high SPF sunscreen, as part of a protection plan that also includes protective clothing and other measures to prevent future skin cancer. Jim’s dermatologist has operated on his face, arms, back and shoulders where he’s removed dozens of growths and multiple melanomas. When Jim goes to the store, he looks for SPF 100 to minimize his risk of having to undergo surgery again.

JimH U N T


“I lived outside growing up in Melbourne Beach, Florida.

My family has a long history of skin cancer and truly high

SPF sunscreen is a lifesaver for our entire family. I would

not spend any time outdoors if I did not have the much-

needed protection of sunscreen. I choose SPF 100 sunscreen

to give me quality coverage and I visit my dermatologist

regularly to be sure I am addressing any pre-cancerous areas of

my skin.”



T.J. grew up in Southern New Jersey going to the shore often as a child though he didn’t wear sunscreen. In his early 20s, he was diagnosed with Stage I Melanoma in his clavicle. He moved to South Florida and married a native Floridian. In 2010, he had a daughter and two years later had a son. Four weeks after his son was born, he went to the hospital with a spiking fever not knowing what was wrong. He left 16 days later with a Stage IV melanoma diagnosis.

His melanoma diagnosis in August 2012 showed melanoma tumors in multiple organs. T.J. faced the biggest obstacle imaginable to being a good Dad and supportive husband—actually remaining alive. The first surgery removed the largest tumor, which was an 8 cm tumor from his small bowel. He still had tumors in his lungs, liver and spleen they did not remove. Since then, he has undergone six surgeries and four immunotherapy treatments over two different clinical trials.

His first clinical trial was unsuccessful. The turning point came while at Holy Cross Hospital in a second-ever clinical trial with an immunotherapy drug. Melanoma is in the forefront of this immunotherapy treatment.

His family is thrilled that the trial has worked and successfully attacked his tumors. At this point, doctors believe there is no cancer remaining in T.J.’s body.

T.J. visits his dermatologist three times per year. His children go every 9 months. His dermatologist is very vocal about preventive care, so he and his family wear high SPF sunscreen daily, and reapply every two hours when engaged in outdoor activities to ensure they are fully protected.

T.J.S H A R P E


“More people walk out of their doctor’s offices with what ends up being a terminal diagnosis. I am lucky. Yet I know I will be a skin cancer patient the rest of my life. We know our children are more susceptible to being affected by skin cancer and they have to be sun smart by wearing high SPF sunscreen. This prevention early on would save far more lives.”



Fernando was born in Miami and was no stranger to the beach or outdoor activities. Weekends were always spent on the family’s boat in Key Largo and enjoying South Florida’s abundant sunshine. Taking after his fair-skinned mom, sunburns were a part of life despite her constant reminders to apply sunscreen daily, especially when spending time outdoors.

Shortly after turning 20 and coming home from college for the summer, he mentioned to his parents that he had a skin growth on his inner forearm. He admitted it had been there for nearly two years before bringing it to anyone’s attention and throughout that time it had definitely grown in size.

A biopsy revealed that it was melanoma and it was removed via Mohs surgery at the Sylvester Comprehensive Cancer Center in Miami. Fernando continues to receive yearly comprehensive dermatological exams and is encouraged by his dermatologist to apply high SPF sunscreen during any time spent outdoors as sunscreen is the most effective way to prevent future skin cancer.

FernS E N R A- J A M E S


“Having dealt with skin cancer at a young age helped me realize that it doesn’t take an entire lifetime to develop this disease. You can be an 18-year-old who doesn’t fully understand why it’s important to speak up when something on your arm doesn’t look quite right. I now take skin care very seriously and want to make sure I have access to any and all sun protection that can help me live my life without feeling restricted.”



KristieT E A L


Kristie grew up in Southern California and spent every moment at the beach when she wasn’t attending school. With her fair skin, she was accustomed to getting a sunburn the first few times out in the summer sun, but she looked forward to being tan after a few sunburns. At the time, sunscreen was an afterthought for Kristie. In January 2016, at the age 42 and mother of two elementary school aged children, Kristie was diagnosed with stage 3 melanoma after a mole appeared on her back. Less than six months later, after three major surgeries and radiation, she would discover that the melanoma had already spread, and she was now a stage 4 cancer patient. The melanoma had spread to her breast, lungs and liver.

Skin cancer is much more significant than most people understand, and she now realizes it can involve so much more than simply having a mole removed. It has now been just over three years since her diagnosis. After immunotherapy treatments, Kristie is proud to say that she currently has NED (no evidence of disease). High SPF sunscreen is now a significant part of her daily routine, as well as for her family members. Her children were 6 and 11 when she was diagnosed, so they were old enough to see and understand all that she went through. Kristie reminds her family almost daily that the best way they can protect themselves (and hopefully avoid all the suffering of skin cancer) is to continue using quality, high SPF sunscreen.

“The proper use of high SPF sunscreen is critical to remain sun safe and protecting your skin. Skin cancer, especially melanoma, is life threatening and I do everything possible to protect my family from experiencing the pain and suffering caused by skin cancer. We typically use an SPF 70 or higher when choosing our sunscreen, but when I have a choice I use the highest SPF possible. Fighting melanoma was one of the hardest battles of my life, so I urge everyone to wear protective sunscreen and clothing.”

ADDITIONAL

Resources


Additional Resources Available

The following materials are available to all partners upon request:

From this toolkit:Current Science PDF

Sunscreen Facts PDF

Faces of Florida PDF

Sunscreen Myth vs. Fact PDF

For Our Dermatologists PDF

Other materials:Sun Safe Florida PowerPoint

Sun Safe Florida letterhead

Letter templates

Sun Safe Florida logo variations

Email headers

Materials can be requested by email at

[email protected].

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