Radiation literature survey

Publication date:

January 2025

Published in:

Bioelectromagnetics

ARPANSA review: 

22 March 2025

Summary

This systematic review and meta-analysis assessed whether mobile phone associated electromagnetic fields (EMF) affect brain activity measurements such as resting state wake electroencephalogram (EEG) and event‐related potentials (ERP). A total of 51 studies were included in the review and 12 studies were included in the meta-analysis. The effect of EMF exposure on the outcomes of EEG and ERP measurements as well as visual and auditory discrimination was investigated. A risk of bias (ROB) assessment was undertaken for the included studies. Meta-analysis results were estimated as standardized mean difference (SMD) with 95% confidence intervals (CI). The meta-analysis showed that mobile phone exposure related to 2G significantly affected the alpha band of the EEG [SMD 0.16 (95% CI: 0.01 to 0.32)]. For the other assessed outcomes such as visual discrimination and auditory discrimination, the meta-analysis did not show significant results. The ROB assessment of the included studies mostly showed either moderate or high risk indicating some concerns. Further, a meta‐analysis for most outcomes could not be conducted due to large heterogeneity among studies. 

Link to the study

Commentary by ARPANSA:

This review and meta-analysis presented in the article indicate that EMF exposure affects the alpha band of the EEG. Alpha band oscillations are a distinctive feature of the EEG when awake and play a prominent role in human brain activity (Klimesch, 1999). However, the review and meta-analysis present some notable limitations. Some studies included in the review did not report appropriate measures of RF-EMF exposure (e.g., power density or specific absorption rate). This compromises RF-EMF characterisation in the included studies however the ROB assessment tool used in this study  does not seem to address this (Sterne et al., 2019).  The review also did not undertake a certainty in evidence assessment, which is an important aspect of a properly conducted systematic review. As noted in the article, future studies should be performed with more robust experimental designs such as adhering to the methodological standard of randomized experiments, double blinding and improved EMF exposure characterisation. Without these improvements, the scientific basis for substantiating other human physiological effects of EMF may continue to be inadequate. 

Based on the current scientific evidence, and consistent with the findings of this review, it is the assessment of ARPANSA that there is no substantiated evidence that mobile phone use (resulting in radiofrequency electromagnetic field (RF-EMF) exposures at levels below the limits set in the ARPANSA Safety Standard) cause any adverse human health effects, including in the brain.

Article publication date

8 March 2025

ARPANSA review date

March 2025

Summary

This European study reports on the creation of a new Job exposure matrix (JEM) for solar ultraviolet radiation (UVR) exposure to outdoor workers. The JEM was created by combining occupational UVR exposure measurements with estimations of the time workers spend outdoors. The exposure measurements were sourced from 12 studies published between 2005 and 2022 which detailed personal UVR exposure for 49 different occupations. The JEM estimates also included an expert assessment rating representing 3 regions of Europe based on latitude (Northern, Central and Southern Europe). The expert assessment rated the average duration of outdoor work for 372 occupations as 0, 1 to 2, 3 to 4, or ≥5 hours per workday. These exposure times were then adjusted based on latitude and on the time of the year (spring, summer, autumn or winter). This JEM will be able to be used in epidemiological studies to estimate occupational UVR exposure when participants’ work histories, and the latitude of worksites and time of year is known. 

Published in

Annals of Work Exposures and Health, 2025

Link to study

A European job-exposure matrix for solar UV exposure 

Commentary by ARPANSA

This study provides the details of the first quantitative measurement-based JEM for UVR exposure. This JEM will improve occupational assessment of UVR exposure in epidemiological studies. However, there are a number of limitations of the JEM, in particular, that 86% of included occupations are not based on measurements, but on expert assessment alone. Other JEMs that have characterised occupational UVR exposure have been solely based on expert assessment (Kauppinen et al, 2009; Peters et al, 2012) and this makes it difficult to accurately quantify exposure–response relationships in subsequent epidemiological studies.

In Australia the impact of UVR exposure has been assessed previously based on ambient UVR at specific latitudes or based on region (Green et al, 1996; Lucas et al, 2013; Sun et al, 2014). This type of exposure characterisation may not accurately reflect UVR exposure due to worker behaviours or other occupational factors. The use of a UVR JEM could improve the exposure characterisation and provide a better understanding of how occupational UV impacts diseases like skin cancer in Australia. However, a different JEM for Australian workers would be required for this purpose as this study restricts its analysis to defined latitudes of Europe. There are distinct differences in UV intensity between latitudes and also between the northern and southern hemispheres.

Australia has some of the highest rates of melanoma and skin cancer in the world and two-thirds of Australians will receive a skin cancer diagnosis of some type in their lifetime. As such, skin cancers, including melanoma, continue to constitute a large public health burden. One of the best way for Australian to protect themselves from the sun is by following the Slip, Slop, Slap, Seek and Slide messaging. More information on UV protection can be found on the ARPANSA Sun Protection factsheet. 

Article publication date

January 2025

ARPANSA review date

26 February 2025

Summary

This systematic review evaluated the association between exposure to low dose ionising radiation (LDIR) and thyroid function among occupational populations. A total of 15 studies (6 case-control studies and 9 cohort studies) published between 1997 and 2022, which included a total of 1,040,763 participants, were included in the review. The effect on thyroid function were evaluated in terms of risk of thyroid cancer, thyroid nodules, and changes in thyroid hormones. Quality assessment of the included studies was also conducted according to the Newcastle-Ottawa Scale (NOS). A qualitative evaluation of the studies was conducted to assess the effect of LDIR on thyroid function. The review showed some evidence of increased thyroid gland volume and nodule formation following the exposure to LDIR, however, this was not shown with certainty. The studies showed a reduction in triiodothyronine (fT3) and an increase or reduction in thyroxine (fT4), while thyroid stimulating hormone (TSH) level did not change following the exposure. Based on the analysis in the review, the authors conclude that even at low doses the function of the thyroid is negatively affected. 

Published in

Journal of Clinical Medicine

Link to study

Low-Dose Ionizing Radiation and Thyroid Diseases and Functional Modifications in Exposed Workers: A Systematic Review 

Commentary by ARPANSA

This review provides an evaluation of whether thyroid function changes following occupational exposure to LDIR. The findings indicate that exposure to LDIR may be a potential risk factor for some aspects of thyroid function. The study shows a few strengths and limitations, which should be considered while interpretating the findings of the review. The review presents only a narrative synthesis of results evaluating multiple health outcomes of thyroid gland e.g., cancer, nodules, and hormones in relation to LDIR exposure; and quantitative meta-analyses of the included studies were not conducted. The cohort studies included in the review had a relatively large sample size. 

The quality assessment of the included studies showed moderate quality, however, the review did not conduct a risk of bias (ROB) assessment of the included studies. ROB assessment has been regarded as an essential critical step in a systematic review to inform the findings and interpretation of the review (NHMRC, 2019). It should be noted that the NOS quality assessment involves the evaluation of the extent to which included studies were designed, conducted, analysed, and reported to avoid systematic errors; while ROB assessment involves the evaluation of bias judgments based on the quality assessment (Furuya-Kanamori et al., 2021). The review also did not undertake a certainty in evidence assessment, which is another important aspect of a properly conducted systematic review. Similarly, although the included studies represent some heterogeneity, it was not assessed in the review. For example, the included studies were conducted in diverse occupational setting (e.g., hospital, nuclear power plants, war industry, and barracks) where the approach to collecting workers’ data would have been different. The findings highlighted in the review are consistent with some comparable studies (e.g., Gudzenko et al., 2022; El-Benhawy et al., 2022; Cioffi et al., 2020). However, there are no similar data available to compare these findings in the Australian context. It is unclear if the review accounted for potential differences in calculating the dose to the thyroid; for example, changes in radiation weighting factors (e.g., ICRP60 to ICRP103), changes in dose conversion factors (e.g., ICRP68 to ICRP137) or inference of thyroid doses based on whole body monitoring. It is our assessment that there is insufficient evidence within this review to definitively conclude that thyroid function is adversely affected by LDIR.

In Australia, The Code for Radiation Protection in Planned Exposure Situations  sets out the requirements for the protection of occupationally exposed persons in all planned exposure situations. All Australian jurisdictions have uniform annual limits (20 mSv) for occupational exposure to ionising radiation. In addition to the dose limits, optimisation of radiation protection and safety involves practising ‘as low as reasonably achievable’ (ALARA) considering economic and societal factors. The Australian system for radiation protection from ionising radiation is closely aligned with international best practice as laid out in the Recommendations of the International Commission on Radiological Protection.

Date of review by ARPANSA

February 2025

Article publication date

February 2025

Summary

The International Commission on Non-Ionizing Radiation Protection (ICNIRP) have published a new document that outlines gaps in scientific knowledge that are relevant to setting limiting values for exposure to radiofrequency electromagnetic fields (RF-EMF). To maintain relevance to exposure guidelines, the ICNIRP specifically highlighted gaps in knowledge where there exists sufficient support in the scientific literature for a link between RF-EMF exposure and an endpoint and between that endpoint and health. These gaps were identified during the development of the 2020 guidelines for limiting exposure to electromagnetic fields (100 kHz to 300 GHz) and with consideration of literature that has been published since. 

The identified research gaps cover shortfalls in knowledge in various areas of dosimetry and on adverse effect exposure thresholds for eye damage, contact currents and heat-induced pain. The document also provides brief analyses on other topical areas of research related to RF-EMF and health outcomes while additionally providing justifications for why they are not prioritised in the identified research gaps.

Commentary by ARPANSA

Although research into health outcomes related to RF-EMF covers an extremely broad cross-section of various aspects of health, currently there are only a few effects that have been substantiated by the scientific literature. ICNIRP’s statement does not aim to establish new links between RF-EMF exposure and health outcomes but to further inform the numerical levels and exposure assessment methodology of the existing guidelines. Additional research investigating other health outcomes is ongoing and such research is warranted but it is not of immediate relevance to setting exposure guidelines. The state of the science in these other areas is best summarised by the set of systematic reviews that have been recently published as part of an ongoing World Health Organization project reviewing the topic.

The Australian radiofrequency standard RPS-S1 outlines limit values for RF-EMF exposure in Australia. RPS-S1 is aligned with the ICNRIP 2020 guidelines mentioned above. ARPANSA continues to monitor and evaluate research developments to ensure that the limits outlined in RPS-S1 remain fit for purpose and are aligned with international best practice. ARPANSA has research recommendations, and a research framework that informs how and what research should be conducted in Australia. These recommendations are part of the ARPANSA EME action plan that aims to promote health and safety and address misinformation about EME emissions. 

Date of review by ARPANSA

February 2025

Article publication date

1 February 2025

Summary

This study measured the personal radiofrequency-electromagnetic field (RF-EMF) exposures associated with mobile networks (including 5G) across different micro-environments in Switzerland. The exposure was measured during three different mobile use scenarios: with an inactive device (environmental), while a device is continuously uploading (max UL) and while a device is continuously downloading (max DL). The highest levels were measured during the max UL measurements, particularly in rural micro-environments. Compared to environmental exposure (e.g., median 1 mW/m² for urban business areas), exposure levels increased considerably during the max DL measurements due to the 5G band at 3.5 GHz mostly in urban areas (e.g., median 12 mW/m² in an industrial area). The highest RF-EMF levels (e.g., median 37 mW/m² in a rural centre) were observed during the max UL scenarios in rural areas. In conclusion, inducing mobile DL and UL traffic networks substantially increased personal RF-EMF exposures. 

Published in

Environmental Research

Link to the study

Exploring RF-EMF levels in Swiss microenvironments: An evaluation of environmental and auto-induced downlink and uplink exposure in the era of 5G 

ARPANSA's commentary

This study generated new knowledge by pioneering an activity-based approach to exposure assessment. The findings indicate the relevance of including near-field and far-field personal exposures to estimate cumulative RF-EMF exposures in future epidemiological studies. This has been highlighted in some recent literature (e.g., van Wel et al., 2021; Birks et al., 2021), which estimated personal RF-EMF exposures originating from near-field RF-EMF sources. A key strength of this study is that it characterized exposures associated with different types of mobile use scenarios such as no mobile phone use, and phone use with continuously downloading and uploading a file. Further, this study supports the application of its methodology to a larger European study, which is expected to provide more comprehensive exposure assessments. A notable limitation of the study is that the use of the measurement device on a specific body area to estimate the personal exposure might have resulted in some measurement uncertainties. Importantly, while mobile handset originated (i.e., auto-induced UL) exposures contributed the highest amount of personal RF-EMF exposure levels, these levels lie below the safety limits recommended by the 2020 ICNIRP guidelines and Australian standard (RPS-S1). According to the standard, the general public safety limit is 2-10 W/m² depending on the operating frequency of telecommunication infrastructure. RF-EMF exposures in Australian public environments are generally far below the limits given in the standard (Henderson et al., 2023; Bhatt et al., 2024). The standard is designed to protect people of all ages and health statuses from the adverse health effects of exposure to RF-EMF exposures. Furthermore, it is ARPANSA’s assessment that such low-level RF-EMF exposures do not pose any health risk in populations.

Date of review by ARPANSA

30 January 2025

Article publication date

13 January 2025

Summary

This in vivo study explored the effects of high power 28 gigahertz (GHz) radiofrequency electromagnetic fields (RF-EMF) on the ocular response and corneal damage threshold of rabbit eyes. Thirty-five male rabbits were first anaesthetised and immobilised before their right eyes were exposed to RF-EMF (28 GHz) for 6 minutes with power densities ranging from 2 to 7.5 kW/m². The corresponding left eyes were not exposed and served as controls. The eyes were assessed prior to exposure and at 10 minutes, 1, 2 and 3 days following exposure. 

No eye damage was observed at incident power densities of 3 kW/m² and below. Some types of eye damage were observed beginning at 3.5 kW/m² with their prevalence increasing with power density. The study estimated that the threshold for eye damage from a 6-minute exposure to 28 GHz RF-EMF is between 3.5 and 3.8 kW/m².

Published in

Health Physics

Link to study

Investigation of the Ocular Response and Corneal Damage Threshold of Exposure to 28 GHz Quasi-millimeter Wave Exposure 

ARPANSA's commentary

RF-EMF at high power levels can heat biological tissue which can lead to heat-related damage. The eyes are particularly sensitive to RF heating. In their 2020 RF safety guidelines, the International Commission on Non-Ionizing Radiation Protection (ICNIRP, 2020) acknowledge a shortage of studies that use sufficiently high power to cause heat-induced injury.  The lack of information on eye damage thresholds was also recently reiterated in an updated knowledge gap analysis document (ICNIRP, 2025). These types of studies are considered difficult to conduct because they must be carefully designed in order to remain within the bounds of ethical guidelines for animal research (ARVO, 2024) while still providing relevant information. 

This study pioneers knowledge in this area by exploring how high-power 28 GHz RF-EMF may cause eye damage, establishing a threshold level for cornea damage. Together with other studies by the same research group on higher frequencies (Kojima et al., 2018; 2020; 2022), this body of research provides more clarity on the levels at which RF-EMF causes damage to the eyes. Such research on eye exposure is important for frequencies above 6 GHz due to the fact that RF-EMF at these frequencies is mostly absorbed on the outer surface of the skin or eyes (Sasaki et al., 2017).

In Australia, exposure to RF-EMF is governed by the Australian radiofrequency safety standard RPS-S1. Under the standard, exposure of the general public to RF-EMF at 28 GHz is restricted to 10 W/m² for whole body exposure and 30 W/m² for localised exposure. These levels are far below the threshold for ocular damage estimated by this study, confirming the effectiveness of RPS-S1 for protecting against the adverse effects of RF-EMF. 

ARPANSA article review date

December 2024

Article publication date

February 2025

Summary

This study was a re-analysis of data from the INTEROCC case-control study and assessed the risk of glioma and meningioma from occupational exposure to radiofrequency electromagnetic energy (RF EME) using an updated job exposure matrix (JEM). The study included data from 7 countries (Australia, Canada, France, Germany, Israel, New Zealand, and the United Kingdom) collected between 2000 and 2004. Participants were aged from 30–59 years and included 1819 glioma and 1758 meningioma cases and 5227 controls. The RF exposure was estimated for both the electric and magnetic fields using a JEM that estimates the exposure for 468 different occupations. The study generally found no statistically significant associations. Overall, the authors concluded there was no risk of glioma or meningioma. 

Link to the study

Occupational exposure to radiofrequency electromagnetic fields and brain tumor risk: Application of the INTEROCC job-exposure matrix

Published in

Cancer Epidemiology

Commentary by ARPANSA

This study was a re-analysis of the INTEROCC study by Vila et al (2018 and 2022) that estimated occupational exposure based on spot measurements. This study obtained similar results, with Vila et al (2018 and 2022) who also concluded there was no clear association between occupational RF-EME exposure and glioma or meningioma. One limitation of the study was that 70% of the occupational exposures relied on data from 5 or less measurements. This reduces the reliability of the JEM and could mean that exposures in the JEM for individual occupations may not be completely represented. 

The overall conclusion of this study is consistent with the findings of the recent WHO systematic review by Karipidis et al (2024) that reported no overall increase in the risk of glioma from occupational RF exposure. The systematic review reported there was limited research on the risk of meningioma from occupational RF exposure. However, the review did report that there was no increased risk in meningioma among mobile phone users. The conclusions are also consistent with studies that investigated trends in brain tumour incidence rates over time (Elwood et al, 2022; Deltour et al, 2022), including an Australia study (Karipidis et al, 2018) that have consistently found no increase in the rates of brain tumours.  

Date of review by ARPANSA

2 December 2024

Article publication date

29 September 2024

Summary

This study examined the effect of short wavelength ultraviolet (UV) radiation on the acute skin response in mice. Hairless mice were irradiated with UVC light of wavelengths between 200-270 nanometres (nm) at varying intensity. The mice were then visually inspected for various skin damage markers like reddening and fissures at 24, 48 and 72 hours after exposure. The UV radiation dose required to produce a perceptible skin response increased greatly as the wavelength became shorter, ranging from 80.8 J/m² at 270 nm to 269000 J/m² at 215 nm. Doses for wavelengths shorter than 215 nm increased further but were excluded from later discussion due to high measurement uncertainty. 

The highest dose where no adverse skin effect was observed was estimated as the safe dose for that wavelength and compared to limits published by the International Commission on Non-Ionizing Radiation Protection (ICNIRP) and the American Conference of Governmental Industrial Hygienists (ACGIH). The comparison shows that substantially more UVC radiation (at wavelengths below 240 nm) was needed to cause skin damage in mice than the limit values described by the ICNIRP and the ACGIH. The authors further suggest that the values derived from the mouse tests will under-estimate the threshold in humans due to the thicker outer layers in human skin.

Published in

Photochemistry and Photobiology

Link to study

Extending the acute skin response spectrum to include the far-UVC

ARPANSA's commentary

Historically, interest in UV radiation with respect to health has been mostly restrained to wavelengths that are a component of solar radiation at the Earth’s surface (280-400 nm). An increase in interest for germicidal applications of far UVC light represents a need to re-evaluate the potential health effects of this type of light so that germicidal devices can be used safely. This study presents new evidence for the level at which UVC radiation can cause acute skin effects and thus how antimicrobial technology could be more effectively operated at higher power while maintaining safety. 

It should be noted that this study only investigated the acute skin effects of UVC exposure. Other well-documented effects of UV radiation like direct DNA damage (Mizutani, R. & Yokoyama, H., 2014; You, Y. et al., 2001) and the production of ozone (Claus, H. 2021) which can lead to chronic health outcomes must also be evaluated for a complete assessment of safety. The exposure limits set by the ICNIRP are designed to protect against long-term and delayed effects of UV radiation in addition to acute skin effects. Therefore, the comparison between the ICNIRP limits and the results of this study, which only considers acute skin effects, is somewhat mismatched. Further, when assessing the overall safety of far UVC light, consideration must also be given to the harmful effects to the eyes in addition to the skin.

Although exposure to UVC radiation from germicidal devices poses some hazards, exposure to intense UVA and UVB radiation from the sun remains the largest contributor to personal UV radiation exposure and risk for Australians. ARPANSA recommends following the five sun protection principles whenever the UV index is over three. 

Date of review by ARPANSA

November 2024

Article publication date

October 2024

Summary

This systematic review and meta-analysis assessed the association between artificial light-at-night (ALAN) exposure and cancer incidence in human populations. A total of 28 studies (15 cohort, 13 case-control) were included in the review and meta-analysis. The strength of the association was reported in risk ratio (RR) with a 95% confidence interval (CI). RR of cancer (breast, prostrate, and others - colorectal, pancreatic, non-Hodgkin lymphoma and thyroid cancer) were assessed. The studies had indoor ALAN exposure data assessed through self-reported questionnaires, whereas outdoor ALAN exposure data were collected from satellite data. Risk of bias and quality of the included studies were evaluated using the tool recommended by the Joanna Briggs Institute (Munn et al. 2015). The meta-analyses showed no statistically significant association for indoor ALAN exposure and breast cancer, and outdoor ALAN exposure and prostate cancer. Higher levels of outdoor ALAN exposure were associated with increased breast cancer risk (RR =1.12, 95 % CI 1.03–1.23). The qualitative synthesis of evidence indicated positive associations between ALAN exposure and risk of non-Hodgkin lymphoma, colorectal, pancreatic and thyroid cancer. Overall, the included studies had high quality scores. 

Published in

Science of the Total Environment

Link to study

Indoor and outdoor artificial light-at-night (ALAN) and cancer risk: A systematic review and meta-analysis of multiple cancer sites and with a critical appraisal of exposure assessment

ARPANSA's commentary

The review indicates an association between outdoor ALAN exposure and increased breast cancer. Importantly, this review contributes to the body of knowledge on the potential risk of cancer incidence associated with ALAN exposures. The risk estimates provided by this meta-analysis are comparable to those provided by other reviews (Urbano et al., 2021; Luo et al., 2023). Strengths of this review are that it included prostate cancer in the meta-analysis and other cancers in the qualitative review, and it critically appraised exposure assessment. Accordingly, it highlighted some methodological limitations of the included studies, such as self-reported assessment of indoor ALAN exposure that results in recall bias, exposure measurement error and exposure misclassification potentially biasing the risk estimates. Similarly, the satellite data used in estimating outdoor ALAN exposure in the included studies had poor spatial resolution and had no colour (e.g., blue light) data. Therefore, as highlighted in the review, future epidemiological research using robust GIS-based ALAN exposure data and methods, controlling for potential confounders (such as noise, pollution, green space) are needed to improve the risk estimates of cancer incidence. 

The International Commission on Non-ionizing Radiation Protection (ICNIRP) has published a statement on short wavelength light (SWL) exposure from indoor artificial source and human health. The ICNIRP acknowledges that there is no scientific consensus on whether ALAN exposure from SWL light causes health effects. It is important to note that the studies informing an association between ALAN exposure and cancer risk have limitations. Therefore, well-designed epidemiological studies with improved exposure assessment tools are required to better inform on whether long-term ALAN exposure is a human health risk. There are also other publications which provide some recommendations for visible light exposure and potential health effects (e.g. SSLC, 2024; Brown et al., 2022). 

Article review date

Oct 2024

Summary

This systematic review examined the awareness and use of the ultraviolet radiation (UV) index according to the World Health Organisation definition. The authors identified 40 publications with an outcome related to either awareness of the UV index (UVI), sun exposure or protective behaviours in association with UVI, and the impact of UVI interventions. The review also assessed the risk of bias within the included studies using the working group guidelines of Joanna Briggs Institute (Munn et al. 2015).  The review identified variation in public awareness of the UV index between countries.  The highest level of awareness was noted in Australia with over 90% of study participants reporting to have UV index awareness. Notably, the awareness in other countries was reported to be much lower (Europeans 50%, New Zealanders 43%, North Americans 34%). Despite being the high awareness of the UV index in Australia, only less than 10% of Australians use the UV index to inform their sun protection behaviour. There was a high risk of bias for all the outcomes that examined the use of the UV index for sun protective behaviours in Australia. The review recommended that further information needs to be disseminated on the advantages on using the UV index to better inform sun protection behaviours globally. 

Published in:

Kaiser et al. Photochemistry and Photobiology, 2024

 Link to study

A systematic review has examined the awareness of UV index and how it is used to inform sun protection messaging globally, and in Australia 

ARPANSA commentary

The study shows that awareness of UV index considerably varied globally with Australians having the highest awareness of the UV index. This finding demonstrates the success of the Australian sun protection messaging to spread awareness of the UV index. However, the UV index has not always been considered by the Australian public while considering how to protect themselves from UV exposure. In Australia, there are policies and recommendations in place to protect people from harmful UV exposure. For example, in Victoria, 97% of early childhood services and 90% of primary schools have policies to use the UV index to inform sun protection (SunSmart 2024) in their settings. Similar data for other Australian state and territory are lacking. The use of media and app to enhance the dissemination awareness of the UV index has been highlighted in the study. One of the limitations of the review is that it is difficult to draw qualitative evidence on how UV index is used to inform sun protection behaviours. Therefore, more research is needed to understand how Australians use the UV index. 

Despite the high awareness of the UV index in Australia and the Slip, Slop, Slap, Seek and Slide messaging, Australia has some of the highest rates of melanoma and skin cancer in the world and two-thirds of Australians will receive a skin cancer diagnosis of some type in their lifetime. As such, skin cancers, including melanoma, continue to constitute a large public health burden. This indicates that further work is needed to improve Australians’ sun protection behaviours and improve awareness on how to use the UV index to inform those behaviours. The UV index helps Australians know when UV exposure is high, and they should avoid sun exposure or practice other sun protection measures. More information on UV protection can be found on the ARPANSA Sun Protection factsheet. The UV index must be disseminated with greater efficacy via the media and apps. Currently, a free SunSmart Global UV app is available to know live UV index of global cities in view of boosting public awareness of the UV index globally.