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Keurentjes AJ, Kezic S, Rustemeyer T, Hulshof CTJ, van der Molen HF. Stimulating Sunscreen Use Among Outdoor Construction Workers: A Pilot Study. Front Public Health 2022; 10:857553. [PMID: 35433569 PMCID: PMC9010717 DOI: 10.3389/fpubh.2022.857553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Accepted: 02/22/2022] [Indexed: 11/13/2022] Open
Abstract
Background Outdoor workers (OW) receive a higher dose of ultraviolet radiation (UVR) compared to indoor workers (IW) which increases the risk of non-melanoma skin cancer (NMSC). Regular sunscreen use reduces the NMSC risk, however, adequate sun-safety behavior among OW is poor. The main objective was to conduct method- and intervention-related elements of a future intervention trial among OW, based on providing sunscreen and assessing sunscreen use on group- and individual level. Methods This pilot study was conducted at a construction site in the Netherlands from May-August 2021. Nine dispensers with sunscreen (SPF 50+) were installed at the worksite. OW (n = 67) were invited to complete two (cross-sectional) questionnaires on sun-safety behavior, before and after providing sunscreen. Stratum corneum (SC) samples for the assessment of UV-biomarkers were collected from the forehead and behind the ear from 15 OW and 15 IW. The feasibility of the following elements was investigated: recruitment, (loss to) follow-up, outcome measures, data collection, and acceptability of the intervention. Results The first questionnaire was completed by 27 OW, the second by 17 OW. More than 75 percent of the OW were aware of the risks of sun exposure, and 63% (n = 17) found sunscreen use during worktime important. The proportion of OW never applying sunscreen in the past month was 44.4% (n = 12) before, and 35.3% (n = 6) after providing sunscreen. A majority of OW (59.3%, n = 16) found sunscreen provision encouraging for sunscreen use, the dispensers easy to use (64.7%, n = 17) and placed in practical spots (58.8%, n = 18). Collecting SC-samples was fast and easy, and several UV-biomarkers showed higher levels for sun-exposed compared to less exposed body parts. There was no significant difference in UV-biomarker levels between OW and IW. Conclusions This pilot study revealed low sunscreen use among OW despite providing sunscreen, overall satisfaction with the sunscreen, and the sufficient awareness of the risks of UVR-exposure. Collecting SC-samples at the workplace is feasible and several UV-biomarkers showed to be promising in assessing UVR-exposure. The low participation rate and high loss to follow-up poses a challenge for future intervention studies.
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Affiliation(s)
- Anne J. Keurentjes
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
- *Correspondence: Anne J. Keurentjes
| | - Sanja Kezic
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Thomas Rustemeyer
- Department of Dermatology and Allergology, Amsterdam University Medical Centers (UMC), Amsterdam, Netherlands
| | - Carel T. J. Hulshof
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Henk F. van der Molen
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
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Keurentjes AJ, Kezic S, Rustemeyer T, Hulshof CTJ, van der Molen HF. Protection Against Solar Ultraviolet Radiation in Outdoor Construction Workers: Study Protocol for a Non-randomized Controlled Intervention Study. Front Public Health 2021; 9:602933. [PMID: 33748058 PMCID: PMC7969508 DOI: 10.3389/fpubh.2021.602933] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Accepted: 02/10/2021] [Indexed: 01/18/2023] Open
Abstract
Introduction: Non-melanoma skin cancer (NMSC) incidence is increasing, and occupational solar exposure contributes greatly to the overall lifetime ultraviolet radiation (UVR) dose. This is reflected in an excess risk of NMSC showing up to three-fold increase in outdoor workers. Risk of NMSC can be reduced if appropriate measures to reduce UVR-exposure are taken. Regular use of sunscreens showed reduced risk of NMSC. However, sun-safety behavior in outdoor workers is poor. The objective of this study is to investigate the effectiveness of an intervention aiming at increasing sunscreen use by construction workers. Methods: This non-randomized controlled intervention study is comprised of two intervention and two control groups recruited at four different construction sites in the Netherlands. The study population comprises ~200 construction workers, aged 18 years or older, followed during 12 weeks. The intervention consists of providing dispensers with sunscreens (SPF 50+) at construction sites and regular feedback on the application achieved by continuous electronic monitoring. All groups will receive basic information on UV-exposure and skin protection. Stratum corneum (SC) samples will be collected for measurement of biomarkers to assess internal UV-dose. External UV-dose will be assessed by personal UV-sensors worn by the workers during work-shifts in both groups. To detect presence of actinic keratosis (AK) or NMSC, a skin check of body parts exposed to the sun will be performed at the end of the study. The effect of the intervention will be assessed from data on self-reported sunscreen use by means of questionnaires collected on baseline and after 12 weeks of intervention (primary outcome). Levels of SC biomarkers of internal UV-dose, external UV-dose, number of sunburn episodes, and prevalence of NMSC including AK will be assessed as secondary outcomes. The electronically monitored sunscreen consumption will be assessed as process outcome. Discussion: This study is intended to provide evidence of the effectiveness of a technology-driven intervention to increase sunscreen use in outdoor construction workers. Furthermore, it will increase insight in the UV-protective behavior, external and internal UV-exposure, and the prevalence of NMSC, including AK, in construction workers. Trial Registration: The Netherlands Trial Register (NTR): NL8462 Registered on March 19, 2020.
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Affiliation(s)
- Anne J Keurentjes
- Amsterdam University Medical Centers, University of Amsterdam, Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam, Netherlands
| | - Sanja Kezic
- Amsterdam University Medical Centers, University of Amsterdam, Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam, Netherlands
| | - Thomas Rustemeyer
- Department of Dermatology and Allergology, Amsterdam University Medical Centers, Amsterdam, Netherlands
| | - Carel T J Hulshof
- Amsterdam University Medical Centers, University of Amsterdam, Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam, Netherlands
| | - Henk F van der Molen
- Amsterdam University Medical Centers, University of Amsterdam, Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam, Netherlands
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Rydz E, Harper A, Leong B, Arrandale VH, Kalia S, Forsman-Phillips L, Holness DL, Tenkate T, Peters CE. Sun Protection Use at Work and Leisure by Outdoor Workers in Alberta, Canada. J Occup Environ Med 2021; 63:e138-e144. [PMID: 33395172 DOI: 10.1097/jom.0000000000002133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To assess the prevalence and determinants of sun protection behaviours among outdoors workers at work and leisure in Alberta, Canada. METHODS We collected outdoor workers' demographics, skin cancer risk factors, job information, and sun habits at work and leisure using self-completed questionnaires. For both settings, we compared use of specific behaviours and modelled determinants of sun protection behaviour scores. RESULTS At work, wearing a sleeved shirt (81% often/always) and hat (73%) were most prevalent, while seeking shade (12%) and applying sunscreen (36%) were least prevalent. Workers had higher sun protection scores at work than leisure. Hours spent outdoors was a strong determinant for both models. Additional leisure model predictors were eye colour, sex, skin type, and job group. CONCLUSIONS Differences in behaviours across settings were observed and should be considered when developing solar UVR exposure reduction initiatives.
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Affiliation(s)
- Ela Rydz
- CAREX Canada, Simon Fraser University, Vancouver, BC, Canada (Ms Rydz, Ms Forsman-Phillips, Dr Peters); Cancer Epidemiology and Prevention Research, Cancer Control Alberta, Alberta Health Services, Calgary, AB, Canada (Mr Harper, Mr Leong, Dr Peters); Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada (Dr Arrandale, Dr Holness); Occupational Cancer Research Centre, Ontario Health, Toronto, ON, Canada (Dr Arrandale); Department of Dermatology and Skin Science, University of British Columbia, Vancouver, BC, Canada (Dr Kalia); Photomedicine Institute and Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research Institute, Vancouver, BC, Canada (Dr Kalia); Departments of Cancer Control, BC Cancer, and Division of Dermatology, BC Children's Hospital, Provincial Health Services Authority, Vancouver, BC, Canada (Dr Kalia); Department of Medicine, University of Toronto, Toronto, ON, Canada (Dr Holness); Department of Medicine and MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada (Dr Holness); School of Occupational and Public Health, Ryerson University, Toronto, ON, Canada (Dr Tenkate); Department of Oncology, Cumming School of Medicine, University of Calgary, Health Sciences Centre - Foothills Campus, Calgary, AB, Canada (Dr Peters)
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Houdmont J, Randall R, Cheyne A, Davis S, Evans H, Faichney J. UK Postal Delivery Workers' Occupational Sun Safety: Using Behavior Change Theories to Identify Intervention Pathways. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16193712. [PMID: 31581620 PMCID: PMC6801953 DOI: 10.3390/ijerph16193712] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Revised: 09/23/2019] [Accepted: 09/28/2019] [Indexed: 11/16/2022]
Abstract
Postal delivery workers have substantial sun exposure. In the United Kingdom (UK) a high proportion of workers possesses a sun sensitive skin type. This population is at elevated risk for skin cancer, yet uptake of sun safety practices is low. Studies are needed to identify the underlying factors that contribute to the uptake of occupational sun safety practices that may be targeted during behavior change interventions. This study integrated the Theory of Planned Behavior (TPB) and the Transtheoretical Model's stages of change (SoC) as guiding frameworks to identify underlying beliefs that influence UK postal delivery workers' uptake of occupational sun safety practices. Thirty-four workers participated in semi-structured interviews that used the SoC to establish current receptiveness to and adoption of two sun safety practices (using sunscreen of at least sun protection factor (SPF) 30 on exposed skin and wearing a wide-brimmed hat when working outdoors in the summer). Beliefs underlying current practices were elicited in accordance with the TPB and stratified by the SoC. For sunscreen use and wearing a wide-brimmed hat, 64% and 3% of participants were in the action or maintenance SoC, respectively. Behavioral and control beliefs differed by SoC, with those in the earlier stages more likely than those in the latter stages to report negative attitudes to, and difficulty enacting, sun safety practices. Normative beliefs concerning the views of colleagues and employers towards sunscreen were relatively consistent across the SoC. This study highlights the need for tailored and targeted behavior change interventions. The SoC-stratified accounts of the influence of TPB components on behavior provide a basis for bespoke interventions that reflect inter-individual and inter-practice differences in their working mechanisms.
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Affiliation(s)
- Jonathan Houdmont
- Centre for Organizational Health and Development, School of Medicine, University of Nottingham, B Floor, Yang Fujia Building, Jubilee Campus, Wollaton Road, Nottingham NG8 1BB, UK.
| | - Raymond Randall
- Management School, University of Sheffield and Loughborough University, Sheffield, S10 1FL, UK.
| | - Alistair Cheyne
- ESSCA School of Management and School of Business and Economics, Loughborough University, Loughborough, LE11 3TU, UK.
| | | | - Hannah Evans
- Management School, University of Sheffield and Loughborough University, Sheffield, S10 1FL, UK.
| | - Joanne Faichney
- Centre for Organizational Health and Development, School of Medicine, University of Nottingham, B Floor, Yang Fujia Building, Jubilee Campus, Wollaton Road, Nottingham NG8 1BB, UK.
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Schilling L, Schneider S, Görig T, Spengler M, Greinert R, Breitbart EW, Diehl K. "Lost in the sun"-The key role of perceived workplace support for sun-protective behavior in outdoor workers. Am J Ind Med 2018; 61:929-938. [PMID: 30175492 DOI: 10.1002/ajim.22905] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/20/2018] [Indexed: 11/10/2022]
Abstract
BACKGROUND Previous studies show that workplace support for sun-protective behaviors plays an important role in the actual sun-protective behavior of outdoor workers. Therefore, our aim was to examine perceived workplace support (organizational and social support) in relation to different sun-protective behaviors. METHODS A Germany-wide sample of outdoor workers (n = 485) was surveyed via telephone. We analyzed associations of workplace support with sun-protective behaviors, sociodemographic, and occupational characteristics, occupational sun exposure, and concerns about sun. RESULTS A large number of outdoor workers perceived no workplace support for sun protection (eg, 17.8% agreed that sun protection is enforced at their workplace). We found that those who do not get any support are less likely to show sun-protective behaviors. CONCLUSIONS A starting point for a better organizational support is the implementation of mandatory sun protection policies in the workplace. Social support for protection against solar UV exposure can be promoted through safety training and education.
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Affiliation(s)
- Laura Schilling
- Mannheim Institute of Public Health, Social and Preventive Medicine (MIPH), Medical Faculty Mannheim; Heidelberg University; Mannheim Germany
| | - Sven Schneider
- Mannheim Institute of Public Health, Social and Preventive Medicine (MIPH), Medical Faculty Mannheim; Heidelberg University; Mannheim Germany
| | - Tatiana Görig
- Mannheim Institute of Public Health, Social and Preventive Medicine (MIPH), Medical Faculty Mannheim; Heidelberg University; Mannheim Germany
| | - Maria Spengler
- Mannheim Institute of Public Health, Social and Preventive Medicine (MIPH), Medical Faculty Mannheim; Heidelberg University; Mannheim Germany
| | - Rüdiger Greinert
- Association of Dermatological Prevention (ADP); Hamburg Germany
- Centre of Dermatology; Elbe Clinics; Buxtehude Germany
| | | | - Katharina Diehl
- Mannheim Institute of Public Health, Social and Preventive Medicine (MIPH), Medical Faculty Mannheim; Heidelberg University; Mannheim Germany
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Grandahl K, Ibler KS, Laier GH, Mortensen OS. Skin cancer risk perception and sun protection behavior at work, at leisure, and on sun holidays: a survey for Danish outdoor and indoor workers. Environ Health Prev Med 2018; 23:47. [PMID: 30285623 PMCID: PMC6169023 DOI: 10.1186/s12199-018-0736-x] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Accepted: 09/14/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To prevent occupational skin cancer, it is essential that the sun-protective behavior of outdoor workers is adequate. The aim is to study the sun-protective behavior of Danish outdoor workers at work, at leisure, and on sun holiday and compare it to that of indoor workers. METHODS This is a cross-sectional study, based on a 53-item survey completed by Danish outdoor (n = 380) and indoor workers (n = 119) in 2016-2017. Status as outdoor or indoor worker was decided based on self-report and behavioral differences were tested using (paired) t tests and multiple regression adjusted for age, sex, educational level, history of smoking, and skin type. RESULTS Danish outdoor workers at work use sun protection less than they do at leisure and on sun holiday (α < .05) where their sun protection behavior is similar to that of indoor workers. The proportion of Danish outdoor workers that always/often use sun protection at work is for shade seeking around noon 4.2%, sunscreen 34.5%, wide-brimmed hat 25.3%, and long trousers and shirt with sleeves 42.4%. Of Danish outdoor workers, 49.5% do not think about the risk of occupational skin cancer and 11.8% think the risk is insignificant, 32.4% think that the use of sun protection is of low or no importance, 84.2% consider sunburn important as skin cancer risk factor still 88.9% have a history of sunburn at work, > 80.0% agree that risk of skin cancer is reduced by the use of sun protection, and only 4.0% dismiss the possibility of sun protection use at work. CONCLUSIONS Skin cancer risk and use of sun protection at work are largely neglected in Danish outdoor workers, more so than at leisure and on sun holiday where their risk behavior resembles that of indoor workers. This indicates an untapped workplace preventive potential.
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Affiliation(s)
- Kasper Grandahl
- The Department of Occupational Medicine, Copenhagen University Holbaek, Gl. Ringstedvej 4B, 4300 Holbaek, Denmark
| | | | | | - Ole Steen Mortensen
- The Department of Occupational Medicine, Copenhagen University Holbaek, Gl. Ringstedvej 4B, 4300 Holbaek, Denmark
- Section of Social Medicine, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
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Duffy SA, Hall SV, Tan A, Waltje AH, Cooper SA, Heckman CJ. The Sun Solutions Intervention for Operating Engineers: A Randomized Controlled Trial. Cancer Epidemiol Biomarkers Prev 2018; 27:864-873. [PMID: 29954736 DOI: 10.1158/1055-9965.epi-17-1023] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Revised: 12/27/2017] [Accepted: 05/15/2018] [Indexed: 11/16/2022] Open
Abstract
Background: Because Operating Engineers (heavy equipment operators) are outdoor workers at risk for skin cancer, interventions are needed to promote sun safety. The objectives were to determine changes in sunscreen use and sunburning among Operating Engineers randomized to four conditions in the Sun Solutions study: (i) education only; (ii) education and text message reminders; (ii) education and mailed sunscreen; and (iv) education, text message reminders, and mailed sunscreen.Methods: In this randomized controlled trial, Operating Engineers (N = 357) were recruited at required safety training sessions throughout Michigan during winter/spring of 2012 to 2013 and provided baseline surveys. The four interventions were delivered over the summer. Postintervention surveys were collected in the fall (82.1% follow-up).Results: Sunscreen use improved significantly from baseline to follow-up in all four conditions (P < 0.05), except sunscreen use among those receiving education and text message reminders was only marginally significant (P = 0.07). There were significantly greater increases in sunscreen use in the two conditions that were mailed sunscreen (P < 0.001). There was a significant decrease in the number of reported sunburns from baseline to follow-up in all four conditions (P < 0.001), but there were no significant differences in sunburns among the groups. Participant evaluated the interventions highly with those who received mailed sunscreen rating the intervention the highest.Conclusions: Providing proper sun-safety education and minimizing barriers to sunscreen use can increase sunscreen use and decrease reported sunburns.Impact: The implementation of the Sun Solutions intervention may be an effective method to modify skin cancer-related behaviors. Cancer Epidemiol Biomarkers Prev; 27(8); 864-73. ©2018 AACR.
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Affiliation(s)
- Sonia A Duffy
- College of Nursing, Ohio State University, Columbus, Ohio. .,VA Center for Clinical Management and Research, Department of Veterans Affairs Healthcare System, Ann Arbor, Michigan.,Department of Psychiatry, University of Michigan, Ann Arbor, Michigan
| | - Stephanie V Hall
- VA Center for Clinical Management and Research, Department of Veterans Affairs Healthcare System, Ann Arbor, Michigan
| | - Alai Tan
- College of Nursing, Ohio State University, Columbus, Ohio
| | - Andrea H Waltje
- Division of Metabolism, Endocrinology and Diabetes, University of Michigan, Ann Arbor, Michigan
| | - Samantha A Cooper
- Department of Veteran's Affairs, Serious Mental Illness Treatment Resource and Evaluation Center, Ann Arbor, Michigan
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Maguire E, Spurr A. Implementation of Ultraviolet Radiation Safety Measures for Outdoor Workers. J Cutan Med Surg 2016; 21:117-124. [PMID: 27940497 DOI: 10.1177/1203475416683389] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Ultraviolet radiation (UVR) poses a major risk for outdoor workers, putting them at greater risk for skin cancer. In the general population, the incidence of both melanoma and nonmelanoma skin cancers is increasing. It is estimated that 90% of skin cancers in Canada are directly attributable to UVR exposure, making this cancer largely preventable with the appropriate precautions. A scoping review was conducted on the barriers and facilitators to UVR safety in outdoor workers to elucidate why these precautions are not in use currently. We discuss these results according to the Hierarchy of Controls as a means to outline effective and feasible prevention strategies for outdoor workers. In doing so, this review may be used to inform the design of future workplace interventions for UVR safety in outdoor workers to decrease the risk of skin cancer in this vulnerable population.
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Affiliation(s)
- Erin Maguire
- 1 Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Alison Spurr
- 1 Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
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Abstract
BACKGROUND Postal delivery workers spend a large proportion of their work time outdoors, placing them at increased risk of skin cancer. To date, no studies have examined occupational sun safety knowledge and practice within this group in the UK. AIMS To describe the occupational sun safety knowledge and practice of UK postal delivery workers and to investigate the association of demographic, personal and occupational factors with knowledge and practice in order to identify potential strategies for improving sun safety in this occupational group. METHODS Postal delivery workers completed a questionnaire that collected data on occupational sun safety knowledge and practice in addition to demographic, personal and workplace characteristics. One-way analysis of variances were applied to assess differences in knowledge and practice by these characteristics. RESULTS A total of 1153 postal delivery workers completed the questionnaire, a 60% response rate. Thirty-three per cent reported receiving sun safety training within the previous 12 months. The majority of respondents reported correct knowledge on three of the six domains and good practice on four of the six behavioural domains. However, only one-fifth of respondents reported wearing sunglasses and ensuring a plentiful intake of water. Knowledge and practice differed significantly according to demographic, personal and workplace characteristics. CONCLUSIONS There is a need to raise the profile of occupational skin cancer in this occupational group and to increase the priority given to occupational sun safety policies alongside targeted and tailored interventions, the effect of which can be evaluated.
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Affiliation(s)
- J Houdmont
- Division of Psychiatry and Applied Psychology, School of Medicine, University of Nottingham, Yang Fujia Building, Jubilee Campus, Wollaton Road, Nottingham NG8 1BB, UK,
| | - S Davis
- Royal Mail Group, 185 Farringdon Road, London EC1A 1AA, UK
| | - A Griffiths
- Institute of Mental Health, School of Medicine, University of Nottingham , Innovation Park, Triumph Road, Nottingham NG7 2TU, UK
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McWhirter JE, Hoffman-Goetz L. Coverage of Skin Cancer Risk Factors and UV Behaviors in Popular U.S. Magazines from 2000 to 2012. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2016; 31:382-388. [PMID: 25761763 DOI: 10.1007/s13187-015-0808-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Mass media is an influential source of skin cancer and tanning information for the public, but we know little about its content or emphasis. The objective of this research was to describe the volume and nature of skin cancer and tanning messages in 20 popular U.S. men's and women's magazines (2000-2012). We used a directed content analysis to determine frequency information about risk factors and ultraviolet (UV) behaviors in 608 articles and 930 images. Chi-square and Fisher's exact tests determined coverage differences based on content type (text vs. image) and target audience (women vs. men). UV exposure was the most common risk factor mentioned (37.7 %) and sunscreen use the most common behavior encouraged (60.0 %); information about other risk factors and protective behaviors was uncommon. Both articles (25.2 %) and images (36.9 %) promoted the tanned look as attractive. In most cases, images infrequently contained helpful information on skin cancer risk factors and prevention, except for high-SPF sunscreens. Women's magazines published more articles on skin cancer and tanning than men's magazines (456 vs. 159, χ(2) = 143.43, P < .01), and the nature of the messages differed between them. Magazine skin cancer and tanning content may contribute to inaccurate public understanding of risks and prevention. These findings are relevant to cancer educators, who may wish to counter potentially harmful messages and enhance positive ones through cancer education efforts.
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Affiliation(s)
- Jennifer E McWhirter
- School of Public Health and Health Systems, University of Waterloo, 200 University Ave West, Waterloo, ON, N2L 3G1, Canada
| | - Laurie Hoffman-Goetz
- School of Public Health and Health Systems, University of Waterloo, 200 University Ave West, Waterloo, ON, N2L 3G1, Canada.
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Peters CE, Koehoorn MW, Demers PA, Nicol AM, Kalia S. Outdoor Workers' Use of Sun Protection at Work and Leisure. Saf Health Work 2016; 7:208-12. [PMID: 27630789 PMCID: PMC5011087 DOI: 10.1016/j.shaw.2016.01.006] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2015] [Revised: 01/18/2016] [Accepted: 01/27/2016] [Indexed: 11/19/2022] Open
Abstract
Background Outdoor workers are at risk of high ultraviolet radiation exposure, and may have difficulty using sun protection. The objectives were to determine the prevalence of sun protection behaviors in a sample of outdoor construction workers, and to assess which factors predict better sun protection practices. Methods Participants were recruited via construction unions. Workers answered a questionnaire on demographics, skin cancer risk, sun protection behaviors, and job. Sun protection behavior scores (from questions on sunscreen use, sleeved shirt, hat, shade seeking, sunglasses) were calculated by converting Likert-scale answers to scores from 0 to 4, and taking the mean (separately for work and leisure). Determinants of sun protection behavior scores were examined for work and leisure using generalized linear models. Results Seventy-seven workers had complete questionnaire data (participation 98%). Sun protection behaviors used most often were hats (79% often/always) and sleeved shirts (82% often/always); least prevalent were shade-seeking (8% often/always) and sunscreen (29% often/always). For both work and leisure scores, the strongest predictor was skin type, with fairer-skinned individuals having higher sun protection behavior scores. Workers had higher scores at work than on weekends. Workplaces that required hats and sleeved shirts for safety purposes had higher protection behavior scores. Conclusion This high-participation rate cohort helps characterize sun protection behaviors among outdoor workers. Workers practiced better sun protection at work than on weekends, suggesting that workplace policies supportive of sun protection could be useful for skin cancer prevention in the construction industry.
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Affiliation(s)
- Cheryl E Peters
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Mieke W Koehoorn
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Paul A Demers
- Occupational Cancer Research Centre, Cancer Care Ontario, Toronto, ON, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Anne-Marie Nicol
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
| | - Sunil Kalia
- Dermatology and Skin Science, University of British Columbia, Vancouver, BC, Canada
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Kramer DM, Tenkate T, Strahlendorf P, Kushner R, Gardner A, Holness DL. Sun Safety at Work Canada: a multiple case-study protocol to develop sun safety and heat protection programs and policies for outdoor workers. Implement Sci 2015; 10:97. [PMID: 26159710 PMCID: PMC4702388 DOI: 10.1186/s13012-015-0277-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2015] [Accepted: 06/05/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND CAREX Canada has identified solar ultraviolet radiation (UV) as the second most prominent carcinogenic exposure in Canada, and over 75 % of Canadian outdoor workers fall within the highest exposure category. Heat stress also presents an important public health issue, particularly for outdoor workers. The most serious form of heat stress is heat stroke, which can cause irreversible damage to the heart, lungs, kidneys, and liver. Although the need for sun and heat protection has been identified, there is no Canada-wide heat and sun safety program for outdoor workers. Further, no prevention programs have addressed both skin cancer prevention and heat stress in an integrated approach. The aim of this partnered study is to evaluate whether a multi-implementation, multi-evaluation approach can help develop sustainable workplace-specific programs, policies, and procedures to increase the use of UV safety and heat protection. METHODS/DESIGN This 2-year study is a theory-driven, multi-site, non-randomized study design with a cross-case analysis of 13 workplaces across four provinces in Canada. The first phase of the study includes the development of workplace-specific programs with the support of the intensive engagement of knowledge brokers. There will be a three-points-in-time evaluation with process and impact components involving the occupational health and safety (OHS) director, management, and workers with the goal of measuring changes in workplace policies, procedures, and practices. It will use mixed methods involving semi-structured key informant interviews, focus groups, surveys, site observations, and UV dosimetry assessment. Using the findings from phase I, in phase 2, a web-based, interactive, intervention planning tool for workplaces will be developed, as will the intensive engagement of intermediaries such as industry decision-makers to link to policymakers about the importance of heat and sun safety for outdoor workers. DISCUSSION Solar UV and heat are both health and safety hazards. Using an occupational health and safety risk assessment and control framework, Sun Safety at Work Canada will support workplaces to assess their exposure risks, implement control strategies that build on their existing programs, and embed the controls into their existing occupational health and safety system.
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Affiliation(s)
- Desre M Kramer
- Occupational Cancer Research Centre, Cancer Care Ontario, 3rd floor, 525 University Avenue, Toronto, ON, M5G 1X3, Canada.
| | - Thomas Tenkate
- School of Occupational and Public and Health, Ryerson University, 350 Victoria Street, Toronto, ON, M5B 2K3, Canada
| | - Peter Strahlendorf
- School of Occupational and Public and Health, Ryerson University, 350 Victoria Street, Toronto, ON, M5B 2K3, Canada
| | - Rivka Kushner
- Occupational Cancer Research Centre, Cancer Care Ontario, 3rd floor, 525 University Avenue, Toronto, ON, M5G 1X3, Canada
| | - Audrey Gardner
- School of Occupational and Public and Health, Ryerson University, 350 Victoria Street, Toronto, ON, M5B 2K3, Canada
| | - D Linn Holness
- St Michael's Hospital, 30 Bond St., Toronto, ON, M5B 1W8, Canada
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Nahar VK, Ford MA, Boyas JF, Brodell RT, Hutcheson A, Davis RE, Beason KR, Bass MA, Biviji-Sharma R. Skin cancer preventative behaviors in state park workers: a pilot study. Environ Health Prev Med 2014; 19:467-74. [PMID: 25271053 DOI: 10.1007/s12199-014-0412-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2014] [Accepted: 09/05/2014] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVES Considering the potential for occupational sun exposure among state park workers, the purpose of this pilot study was to identify skin cancer knowledge, health beliefs, self-efficacy, and sun protection behaviors (SPBs) among state park employees. METHODS The current study used a cross-sectional survey research design with state park workers in a Southern state. Of the 94 possible employees who could have participated in the study, 87 completed the survey. RESULTS Assessment of the participants' skin cancer knowledge demonstrated an average correct response rate of 68.8 %. While the vast majority (87.4 %) believed that skin cancer is a serious disease, a minority (42.5 %) believed they would develop skin cancer sometime during their lifetime, and even fewer (35.6 %) believed their risk was higher than average. Collectively, workers reported low levels of SPBs. The most commonly reported barriers to sun protection were "inconvenient," "too hot to wear," and "forget to protect." Half of the participants (50.6 %) were highly confident in their ability to wear long pants while in the sun. About the same proportion of participants was highly confident they could wear a wide-brimmed hat (21.8 %) and sunscreen (20.7 %). CONCLUSIONS Based on available evidence, a need exists to develop individual and worksite programs and interventions to increase skin cancer prevention behaviors among this occupational group. This data could serve as a baseline to monitor and evaluate the efficacy of these interventions.
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Affiliation(s)
- Vinayak K Nahar
- Department of Health, Exercise Science and Recreation Management, School of Applied Sciences, University of Mississippi, 215 Turner Center, P.O. Box 1848, Oxford, MS, 38677, USA,
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Lee C, Duffy SA, Louzon SA, Waltje AH, Ronis DL, Redman RW, Kao TS. The impact of Sun Solutions educational interventions on select health belief model constructs. Workplace Health Saf 2014; 62:70-9. [PMID: 24812691 DOI: 10.1177/216507991406200204] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The purpose of this study was to offer the Sun Solutions intervention to operating engineers (N = 232) to decrease sun exposure and skin cancer. The majority (82%) of the engineers worked outside between 10 a.m. and 3 p.m., 4 to 5 hours a day; 81.4% reported more than one sunburn during the past year and 70% sometimes or never used sunscreen compared to 30% who wore sunscreen approximately 50% or more of the time. Most reported that the intervention was helpful (97%), most were satisfied (96%) with the intervention, and 84% expressed a future intention to use sunscreen. Regarding sun protective behaviors, the intervention significantly improved perceived self-efficacy (p < .05) and increased perceived barriers (p < .05). Regarding sunburn and skin cancer, the intervention increased perceived benefits (p < .05), susceptibility (p < .05), and severity (p < .05) for sunburning, but not skin cancer (p > .10). The Sun Solutions intervention showed the potential to increase sunscreen use and decrease the risk of sunburn and skin cancer among operating engineers.
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Janda M, Stoneham M, Youl P, Crane P, Sendall MC, Tenkate T, Kimlin M. What Encourages Sun Protection among Outdoor Workers from Four Industries? J Occup Health 2014; 56:62-72. [DOI: 10.1539/joh.13-0179-oa] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Monika Janda
- School of Public Health and Social Work, Institute of Health and Biomedical Innovation, Queensland University of TechnologyAustralia
| | - Melissa Stoneham
- Public Health Advocacy Institute of Western Australia, Faculty of Health SciencesCurtin UniversityAustralia
| | | | - Phil Crane
- School of Public Health and Social Work, Institute of Health and Biomedical Innovation, Queensland University of TechnologyAustralia
| | - Marguerite C Sendall
- School of Public Health and Social Work, Institute of Health and Biomedical Innovation, Queensland University of TechnologyAustralia
| | - Thomas Tenkate
- School of Occupational and Public Health, Ryerson UniversityCanada
| | - Michael Kimlin
- School of Public Health and Social Work, Institute of Health and Biomedical Innovation, Queensland University of TechnologyAustralia
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Lee C, Duffy SA, Louzon SA, Waltje AH, Ronis DL, Redman RW, Kao TS. The Impact of Sun SolutionsEducational Interventions on Select Health Belief Model Constructs. Workplace Health Saf 2014. [DOI: 10.3928/21650799-20140121-04] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Horsham C, Auster J, Sendall MC, Stoneham M, Youl P, Crane P, Tenkate T, Janda M, Kimlin M. Interventions to decrease skin cancer risk in outdoor workers: update to a 2007 systematic review. BMC Res Notes 2014; 7:10. [PMID: 24397996 PMCID: PMC4028889 DOI: 10.1186/1756-0500-7-10] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2013] [Accepted: 12/16/2013] [Indexed: 11/10/2022] Open
Abstract
Background Outdoor workers are at high risk of harmful ultraviolet radiation exposure and are identified as an at risk group for the development of skin cancer. This systematic evidence based review provides an update to a previous review published in 2007 about interventions for the prevention of skin cancer in outdoor workers. Results This review includes interventions published between 2007-2012 and presents findings about sun protection behaviours and/or objective measures of skin cancer risk. Six papers met inclusion criteria and were included in the review. Large studies with extended follow-up times demonstrated the efficacy of educational and multi-component interventions to increase sun protection, with some higher use of personal protective equipment such as sunscreen. However, there is less evidence for the effectiveness of policy or specific intervention components. Conclusions Further research aimed at improving overall attitudes towards sun protection in outdoor workers is needed to provide an overarching framework.
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Affiliation(s)
| | | | | | | | | | | | | | - Monika Janda
- School of Public Health and Social Work, Institute of Health and Biomedical Innovation, Queensland University of Technology, Victoria Park Road, Kelvin Grove 4059, Queensland, Australia.
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Nahar VK, Ford MA, Hallam JS, Bass MA, Vice MA. Sociodemographic and Psychological Correlates of Sun Protection Behaviors among Outdoor Workers: A Review. J Skin Cancer 2013; 2013:453174. [PMID: 24251040 PMCID: PMC3819754 DOI: 10.1155/2013/453174] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2013] [Revised: 08/29/2013] [Accepted: 09/01/2013] [Indexed: 11/17/2022] Open
Abstract
Outdoor workers are at a higher risk for developing skin cancer due to their increased sun exposure. The primary objective of this review was to synthesize the current research literature that addresses sociodemographic and psychological factors related to sun protection behaviors in outdoor workers. Two additional purposes were to provide an overview of sun exposure and describe sun protection behaviors of outdoor workers. To identify the studies for this review, a methodical search was performed in the PubMed, PsycInfo, MEDLINE, and ERIC databases. Fifteen studies met the review criteria. Despite regular and prolonged sun exposure, many outdoor workers fail to engage in sufficient sun protection behaviors. Correlates of outdoor workers' sun protection behaviors include being female, older age, being white, personal skin cancer history, time (hours/years) spent at work, sun safety training, perceived prioritization of sun protection, concern about sun exposure, workplace support, families' expectations, and familial information giving. However, limited attention is given to designing theoretically grounded studies to identify factors to inform future research. There is a need to conduct research based on solid theoretical foundations that explains the relationships among the factors in this domain.
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Affiliation(s)
- Vinayak K. Nahar
- Department of Health, Exercise Science & Recreation Management, The University of Mississippi, 215 Turner Center, P.O. Box 1848, University, MS 38677, USA
| | - M. Allison Ford
- Department of Health, Exercise Science & Recreation Management, The University of Mississippi, 215 Turner Center, P.O. Box 1848, University, MS 38677, USA
| | - Jeffrey S. Hallam
- Department of Social and Behavioral Sciences, College of Public Health, Kent State University, 750 Hilltop Drive, Kent, OH 44242, USA
| | - Martha A. Bass
- Department of Health, Exercise Science & Recreation Management, The University of Mississippi, 215 Turner Center, P.O. Box 1848, University, MS 38677, USA
| | - Michael A. Vice
- Department of Health, Exercise Science & Recreation Management, The University of Mississippi, 215 Turner Center, P.O. Box 1848, University, MS 38677, USA
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Skin Cancer Knowledge, Beliefs, Self-Efficacy, and Preventative Behaviors among North Mississippi Landscapers. Dermatol Res Pract 2013; 2013:496913. [PMID: 24223037 PMCID: PMC3816039 DOI: 10.1155/2013/496913] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2013] [Accepted: 08/25/2013] [Indexed: 11/17/2022] Open
Abstract
There are slightly over one million workers in the landscape service industry in the US. These workers have potential for high levels of solar ultraviolet radiation exposure, increasing their risk of skin cancer. A cross-sectional sample of 109 landscapers completed a self-administered questionnaire based on Health Belief Model (HBM). The participants correctly answered 67.1% of the knowledge questions, 69.7% believed they were more likely than the average person to get skin cancer, and 87.2% perceived skin cancer as a severe disease. Participants believed that the use of wide-brimmed hats, long sleeved shirts/long pants, and sunscreen was beneficial but reported low usage of these and other sun protective strategies. The primary barriers to using sun protection were “I forget to wear it” and “it is too hot to wear.” Of the HBM variables, perceived benefits outweighing perceived barrier (r = .285, P = .003) and self-efficacy (r = .538, P = .001) were correlated with sun protection behaviors. The reasons for absence of the relationship between perceived skin cancer threat and sun protection behaviors could be lack of skin cancer knowledge and low rate of personal skin cancer history.
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Reeder AI, Gray A, Mccool JP. Occupational Sun Protection: Workplace Culture, Equipment Provision and Outdoor Workers' Characteristics. J Occup Health 2013; 55:84-97. [DOI: 10.1539/joh.12-0182-oa] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Anthony I. Reeder
- Cancer Society of New Zealand Social and Behavioral Research Unit, Department of Preventive and Social MedicineDunedin School of Medicine, University of OtagoNew Zealand
| | - Andrew Gray
- Department of Preventive and Social MedicineUniversity of OtagoNew Zealand
| | - Judith P. Mccool
- Department of Social and Community HealthSchool of Population Health, University of AucklandNew Zealand
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Reinau D, Weiss M, Meier C, Diepgen T, Surber C. Outdoor workers’ sun-related knowledge, attitudes and protective behaviours: a systematic review of cross-sectional and interventional studies. Br J Dermatol 2013; 168:928-40. [DOI: 10.1111/bjd.12160] [Citation(s) in RCA: 98] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Duffy SA, Ronis DL, Waltje AH, Choi SH. Protocol of a randomized controlled trial of sun protection interventions for operating engineers. BMC Public Health 2013; 13:273. [PMID: 23530608 PMCID: PMC3616939 DOI: 10.1186/1471-2458-13-273] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2013] [Accepted: 03/21/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Skin cancer are increasing and some types of skin cancer are among the most lethal cancers yet are easily preventable. However, sun protection interventions are rarely implemented among outdoor workers. Our prior work shows that Michigan Operating Engineers (heavy equipment operators) spend an average of 4-5 hours in the sun, about one-third reported getting sun burned at least once a summer, and over half burned more than once a summer. About three-quarters of the sample never or only sometimes used sun block. METHODS/DESIGN Using the Health Belief Model as a guide, this randomized controlled trial (RCT) will test the efficacy of four sun protection interventions targeting Operating Engineers: a) education only; b) education and mailed sunscreen; c) education and text message reminders; and, d) education, mailed sunscreen, and text message reminders. Participations in the study will be offered during regularly scheduled safety trainings at the Local 324 Training Center. Pre- and post-intervention surveys will be collected to determine changes in sunscreen use and sun burning, the primary dependent variables. The analyses will include: a) paired t-tests to determine changes over time (from pre-intervention to post-intervention) in outcome variables (sunscreen use and burning) separately in the 4 intervention groups, b) Repeated Measures Analysis of Variance (RM-ANOVA) to compare the changes in outcomes across the 4 groups, and c) t-tests on change scores as follow-ups to the RM-ANOVA to determine exactly which groups differ from each other. DISCUSSION Based on the outcome of this study, we will develop a RO1 for wider scale testing and dissemination in conjunction with the International Training Center which services North America (including the US, Mexico, and Canada). Wide scale dissemination of an efficacious sun protection intervention has the potential to substantially impact skin cancer rates among this population. The ultimate goal is for high reach, high efficacy, and low cost. TRIAL REGISTRATION NCT01804595.
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Affiliation(s)
- Sonia A Duffy
- School of Nursing, Department of Otolaryngology and Psychiatry, University of Michigan, Ann Arbor VA Center for Clinical Management Research, 400 North Ingalls Building #3178, Ann Arbor, MI 48109-5482, USA.
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Measuring sun exposure habits and sun protection behaviour using a comprehensive scoring instrument – An illustration of a possible model based on Likert scale scorings and on estimation of readiness to increase sun protection. Cancer Epidemiol 2012; 36:e265-9. [DOI: 10.1016/j.canep.2012.03.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2011] [Revised: 03/08/2012] [Accepted: 03/09/2012] [Indexed: 11/24/2022]
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Sun protection intervention for highway workers: long-term efficacy of UV photography and skin cancer information on men's protective cognitions and behavior. Ann Behav Med 2010; 38:225-36. [PMID: 20049658 PMCID: PMC2819486 DOI: 10.1007/s12160-009-9151-2] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background The risk for skin cancer is increased among older males and outdoor workers who have high levels of ultraviolet (UV) exposure. Purpose This study was designed to examine the long-term efficacy of UV photography interventions on male outdoor workers, the potential mediators of its impact, and the efficacy of UV photography and skin cancer vs. aging information with this population. Methods One hundred forty-eight male outdoor workers were randomly assigned to one of four intervention conditions or a control condition in a two by two plus one factorial design. The men in the intervention conditions received or did not receive a UV photo of their face and watched either a photoaging or skin cancer educational video. Participants completed pre-intervention, immediate post-intervention, and 2-month and 1-year follow-up assessments. Results Analysis of covariance and structural equation modeling revealed that participants in the UV photography and cancer information interventions reported higher levels of sun protection cognitions, which were significant partial mediators of increases in sun protection behaviors and decreases in skin color. Conclusions This study provides evidence for effective sun protection interventions on male outdoor workers that may help reduce skin cancer risk.
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Kütting B, Drexler H. UV-induced skin cancer at workplace and evidence-based prevention. Int Arch Occup Environ Health 2010; 83:843-54. [PMID: 20414668 DOI: 10.1007/s00420-010-0532-4] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2009] [Accepted: 04/06/2010] [Indexed: 11/27/2022]
Abstract
PURPOSE The present review is aimed at providing an overview of skin cancer with particular focus on occupational concern and giving evidence-based recommendation for effective prevention at workplace. METHODS We performed a systematic search of literature using PubMed and the Cochrane Library. RESULTS Outcome of preventive strategies depends either on efficacy of the strategy itself but also on acceptance and implementation of protective means among the persons at possible risk for hazardous health effects. Epidemiological studies have reported significantly more non-melanoma skin cancer in men than in women. Life-style choices and difference in immunosuppression play a major role in this gender disparity. Tumor biology of skin cancer is diverging: severe blistering sunburns corresponding to intermittent intense UV exposures are associated with an increased risk for both melanoma and basal cell carcinoma (BCC); whereas the risk of squamous cell carcinoma (SCC) and actinic keratoses (AK) is strongly associated with chronic UV exposure. Several clinical trials give evidence that long-term use of sunscreen prevents the appearance of non-melanotic skin cancer such as AK and SCC, but not of BCC. All technical and organizing measures aimed at reducing UV exposure at workplace belong to first-line prevention; however, there is much room for improvement. The efficacy of personal protection means (second-line strategy) strongly depends on the workers' compliance which is quite low at workplace. CONCLUSION Evidence-based data confirming the benefit of sun protective strategies are scarce, general recommendations are mainly based on the avoidance of UV radiation being identified as potential risk factor for non-melanoma skin cancer in epidemiological studies. Occupational screenings should include regular interventions aimed at enhancing a clear understanding of risk factors for individuals and finally improving the acceptance and maintenance for UV-protective means at workplace.
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Affiliation(s)
- Birgitta Kütting
- Institute and Outpatient Clinic of Occupational, Social and Environmental Medicine, University of Erlangen- Nuremberg, Schillerstr. 25 + 29, 91054, Erlangen, Germany.
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Pichon LC, Corral I, Landrine H, Mayer JA, Norman GJ. Sun-protection behaviors among African Americans. Am J Prev Med 2010; 38:288-95. [PMID: 20171530 DOI: 10.1016/j.amepre.2009.10.041] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2009] [Revised: 08/12/2009] [Accepted: 10/31/2009] [Indexed: 11/20/2022]
Abstract
BACKGROUND Data suggest that the prevalence of sun-protection behaviors is low (44%) among African Americans; the samples in such studies, however, tended to be small or nonrepresentative. PURPOSE This article aims to examine the prevalence and correlates of sun-protection behaviors among a large, random, statewide sample of African-American adults living in California to ascertain behavioral patterns and highlight directions for targeted interventions. METHODS From September 2006 through May 2008, an anonymous health survey collected data on sunscreen, sunglasses, and wide-brim hat use among a random sample of 2187 African-American adults, and assessed demographic, regional, skin type, and other potential correlates of these behaviors. The analysis was conducted in 2009. RESULTS Only 31% engaged in at least one sun-protection behavior; of the three behaviors, sunscreen use was the least prevalent, with 63% never using sunscreen. Multivariate logistic regressions revealed that gender, SES, and skin type were significant predictors of sun-protection behaviors. CONCLUSIONS Tailored interventions to increase sun-protection behaviors among African Americans (men in particular) are needed.
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Affiliation(s)
- Latrice C Pichon
- Department of Health Management and Policy, School of Public Health, University of Michigan, 109 Observatory, Ann Arbor MI 48109-2029, USA.
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Skin cancer-related prevention and screening behaviors: a review of the literature. J Behav Med 2009; 32:406-28. [PMID: 19521760 DOI: 10.1007/s10865-009-9219-2] [Citation(s) in RCA: 154] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2008] [Accepted: 05/23/2009] [Indexed: 02/03/2023]
Abstract
Primary prevention and early detection continue to be of paramount importance in addressing the public health threat of skin cancer. The aim of this systematic review was to provide a comprehensive overview of the prevalence and correlates of skin cancer-related health behaviors in the general population. To achieve this aim, 91 studies published in international peer-reviewed journals over the past three decades were reviewed and synthesized. Reported estimates of sunscreen use varied considerably across studies, ranging from 7 to 90%. According to self-report, between 23 and 61% of individuals engage in skin self-examination at least once per year, and the documented prevalence of annual clinical skin examination ranges from 8 to 21%. Adherence to sun protection and screening recommendations is associated with a range of factors, including: female gender, sun-sensitive phenotype, greater perceived risk of skin cancer, greater perceived benefits of sun protection or screening, and doctor recommendation for screening. The literature suggests that a large proportion of the general population engage in suboptimal levels of sun protection, although there is substantial variability in findings. The strongest recommendation to emerge from this review is a call for the development and widespread use of standardized measurement scales in future research, in addition to more studies with a population-based, multivariate design. It is also recommended that specific targeted interventions are developed to increase the prevalence of preventative and early intervention behaviors for the control of skin cancer.
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Glanz K, Buller DB, Saraiya M. Reducing ultraviolet radiation exposure among outdoor workers: state of the evidence and recommendations. Environ Health 2007; 6:22. [PMID: 17686155 PMCID: PMC1995198 DOI: 10.1186/1476-069x-6-22] [Citation(s) in RCA: 95] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2007] [Accepted: 08/08/2007] [Indexed: 05/16/2023]
Abstract
OBJECTIVE Outdoor workers have high levels of exposure to ultraviolet radiation and the associated increased risk of skin cancer. This paper describes a review of: 1) descriptive data about outdoor workers' sun exposure and protection and related knowledge, attitudes, and policies and 2) evidence about the effectiveness of skin cancer prevention interventions in outdoor workplaces. DATA SOURCES Systematic evidence-based review. DATA SYNTHESIS We found variable preventive practices, with men more likely to wear hats and protective clothing and women more likely to use sunscreen. Few data document education and prevention policies. CONCLUSION Reports of interventions to promote sun-safe practices and environments provide encouraging results, but yield insufficient evidence to recommend current strategies as effective. Additional efforts should focus on increasing sun protection policies and education programs in workplaces and evaluating whether they improve the health behavior of outdoor workers.
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Affiliation(s)
- Karen Glanz
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, 1518 Clifton Road, NE, Atlanta, Georgia, 30322, USA
| | | | - Mona Saraiya
- Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control, Atlanta, Georgia, USA
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Mayer JA, Slymen DJ, Clapp EJ, Pichon LC, Eckhardt L, Eichenfield LF, Elder JP, Sallis JF, Weinstock MA, Achter A, Balderrama C, Galindo GR, Oh SS. Promoting sun safety among US Postal Service letter carriers: impact of a 2-year intervention. Am J Public Health 2007; 97:559-65. [PMID: 17267715 PMCID: PMC1805012 DOI: 10.2105/ajph.2005.083907] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We examined whether US Postal Service letter carriers who received a sun safety intervention would wear wide-brim hats and sunscreen significantly more often than those who did not receive the intervention. METHODS We used a 2-group randomized design with 2662 evaluation cohort participants from 70 US postal stations. Evaluations were conducted at baseline, 3 months, 1 year, and 2 years. Questionnaire items assessed occupational use of sun-screen and wide-brim hats. The 2-year sun safety intervention included the provision of wide-brim hats, accessible sunscreen, reminders, and 6 educational sessions. RESULTS At the 3-month follow-up evaluations, the odds ratio (OR) for regular sun-screen use was 2.8 times higher among the intervention group than among the control group (95% confidence interval [CI]=2.2, 3.5); at the 2-year follow-up evaluations, the rate was still significantly higher (OR=2.0; 95% CI=1.6, 2.6). Intervention group participants also had significantly higher rates of hat use, with the differences remaining consistent across all follow-ups (OR=2.9; 95% CI=2.3, 3.6). CONCLUSIONS The intervention should be disseminated to postal stations nationwide and possibly to other occupational groups that work outdoors.
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Affiliation(s)
- Joni A Mayer
- Graduate School of Public Health, San Diego State University, San Diego 92123, USA.
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Kimlin MG, Tenkate TD. Occupational exposure to ultraviolet radiation: the duality dilemma. REVIEWS ON ENVIRONMENTAL HEALTH 2007; 22:1-37. [PMID: 17508696 DOI: 10.1515/reveh.2007.22.1.1] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
Human exposure to ultraviolet (UV) radiation is a component of everyday life and a significant hazard for outdoor workers. In addition, a large range of artificial sources also has the potential to provide extreme occupational UV exposure. Even though the human health risks of overexposure to UV are well documented, to date relatively little is known quantitatively about UV exposure. For example, the evidence indicates that workers who are exposed to particular sources (for example, welding arcs) are exposed to extreme UV exposures, despite the use of current control measures. In contrast, increasing evidence points to significant health impacts resulting from underexposure to UV, particularly with the production (or more correctly lack of production) of vitamin D in the skin. The latter poses a serious issue for the work-force, with specific risks for workers lacking adequate sun exposure-underground miners, long-haul flight crews, shift workers, and perhaps indoor workers. Using a risk-management approach, this paper provides a comprehensive review of occupational UV sources, health impact of occupational UV exposure, occupational exposure standards, and levels of exposure in various settings, and discusses the appropriate control measures. In addition, the duality aspect of health impacts from overexposure and underexposure to UV and the associated occupational health implications are specifically explored.
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Affiliation(s)
- Michael G Kimlin
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia
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