Occupational UV Exposure in French Outdoor Workers

Sun-related knowledge and practices in Irish construction and agricultural workers

BACKGROUND

Agricultural and construction workers spend much of their work time outdoors and have higher risks of developing skin cancer when compared to indoor workers. However, there is limited research on ultraviolet radiation (UVR) exposure knowledge, sun safety practices and constraints within these occupational groups in Ireland.

AIMS

This study aimed to examine self-reported time spent outdoors in a sample of Irish agricultural and construction workers; to describe and compare UVR exposure knowledge, safety practices and perceived constraints in both occupational groups, and to assess the association of demographic, personal and occupational factors with sun-related knowledge, practices and perceived constraints.

METHODS

Agricultural workers (n = 154) and construction workers (n = 467) completed a questionnaire, which measured solar UVR exposure knowledge, safety practices, and perceived constraints to sun personal protective equipment and sunscreen use in addition to demographic, personal, and workplace characteristics. Mann-Whitney and Kruskal-Wallis tests were used to examine differences in knowledge, practices and perceived constraints by these characteristics.

RESULTS

Both groups spend a significant proportion of their working week outdoors (25 hours per week on average). Although participation in sun safety training was high for both groups, UVR exposure knowledge and sunscreen use were low, and annual rates of reported sunburn were high. Knowledge, practices and perceived constraints also differed significantly according to demographic, personal, occupational and workplace characteristics.

CONCLUSIONS

In addition to training by employers and advisory groups, interventions are required to address perceived barriers that impede the uptake and usage of control measures that can lower risk.

Understanding the Perceived Relationship between Sun Exposure and Melanoma in Atlantic Canada: A Consensual Qualitative Study Highlighting a "Sunscreen Paradox"

Globally, cutaneous melanoma (CM) incidence is increasing, with sun exposure identified as a key modifiable risk factor. The Atlantic provinces of Canada display varied CM incidence rates: New Brunswick aligns with the national average, while Nova Scotia and Prince Edward Island exceed it, and Newfoundland and Labrador fall below this benchmark. We investigated the relationship between sun exposure and CM in these provinces. Twenty-two focus groups encompassing 95 Atlantic Canada residents were conducted and transcribed. A thematic analysis was conducted in MAXQDA using the social-ecological model as a framework. Residents of high-CM incidence provinces demonstrated greater sun exposure awareness, consulting UV indices, and using sunscreen and sun-protective clothing. However, they received greater UV exposure due to warmer climates and outdoor work and cultural activities. Conversely, those in low-incidence provinces used sunscreen and sun-protective clothing less often, engaged in occupations and hobbies affording less sun exposure, and lived in cooler climates. Our data supports a possible "sunscreen paradox", whereby increased sunscreen use is correlated with augmented sun exposure, leading to a deceptive sense of security. Public health initiatives in Atlantic Canada promoting sun safety must address this paradox while integrating community-specific behaviors and norms in order to develop tailored campaigns.

An epidemiological study on skin tumors of the elderly in a community in Shanghai, China

The morbidity of skin tumors (ST) in China is a great concern as the population ages. No epidemiological survey on ST in elderly communities in China has been reported. A questionnaire survey was conducted among the residents over 60 years old in a community in Shanghai, China from May 1, 2011 to November 30, 2011. The prevalence of cutaneous tumors and associated factors were analyzed. Among 2038 valid cases, a total of 78 (3.8%, 95% CI 3.0-4.7) skin cancers (SC) were confirmed. According to the final multivariate regression analysis, age, gender and previous occupation were the significantly influential factors for SC. Actinic keratosis (AK) accounted for the largest proportion (63, 3.1%) in SC. The head and neck was the physiological site with the highest incidence of SC (64, 82.1%), and AK was the most common (55, 87.3%) in head and neck SC. The common concomitant diseases of SC were hypertension (26, 33.3%) and diabetes mellitus (9, 11.5%). Seborrheic keratosis (SK) was the most common benign skin tumor with a prevalence of 100%. Men and women developed SK in significantly different parts of the body (P < 0.0001). The incidence of ST in the elderly population in Shanghai community increased with age. ST preferred to occur in the head and neck, which might be attributed to excessive ultraviolet (UV) exposure in these areas. Therefore, early diagnosis and sun-protection education are essential interventions for ST in the elderly.

Risk assessment of occupational skin cancer among outdoor workers in southern Spain: local pilot study

OBJECTIVE

Overexposure to ultraviolet (UV) radiation is the main preventable cause of skin cancer. Outdoor workers, exposed to the sun for many hours throughout their working lives, are at special risk. The aim of this study is to determine occupational photoexposure and photoprotection among outdoor workers employed by a municipality in southern Spain.

METHODS

Cross-sectional descriptive study focusing on outdoor workers employed by the municipality of Fuengirola (in areas such as construction, gardening, urban cleaning and beach maintenance). The participants were monitored by personal dosimetry, participated in a dermatological check-up and answered a validated questionnaire (CHACES) on their habits, attitudes and knowledge related to sun exposure.

RESULTS

The median effective erythema dose of exposure to solar UV radiation during the working day (n=20) was 379.4 J/m², equivalent to 3.8 standard erythema doses, almost 3 times higher than the recommended limits for an 8-hour workday. Skin examination (n=128) revealed the presence of actinic lentigines (79.7%), actinic keratoses (8.6%) and skin cancer (3.9%). The CHACES questionnaire (n=128) revealed a sunburn rate of 50.0%. Photoprotection practices were markedly deficient: only 16.7% of the survey respondents sought protection in the shade, 20.3% avoided exposure during the peak exposure hours and 33.1% applied sunscreen.

CONCLUSIONS

This is the first study to evaluate UV radiation exposure, occupational sun protection practices, sunburn and actinic injuries of different outdoor workers in one of the sunniest regions of Spain and underlines the need for effective interventions to protect outdoor workers' health.

Alcohol use patterns and risk of incident cataract surgery: a large scale case-control study in Japan

To examine the risk of incident cataract surgery associated with alcohol use patterns among Japanese adults. This was a case-control study evaluating 14,861 patients with incident cataract surgery and 14,861 matched controls. Subjects admitted to any of the 34 hospitals in Japan and aged between 40 and 69 years were included. Drinking patterns (drinking frequency, daily average drinks, and total amount of lifetime drinking), smoking history, lifestyle-related comorbidities, and occupational factors were surveyed by trained interviewers. Odds ratios (ORs) and 95% confidence intervals (CIs) were estimated using conditional logistic regression models. For drinking frequency, ORs in the 1-3 days/week and 4-7 days/week groups were 1.10 (95% CI 1.03-1.17) and 1.30 (1.21-1.40), respectively. For average drinks, ORs in > 0-2 drinks/day, > 2-4 drinks/day, and > 4 drinks/day were 1.13 (1.06-1.20), 1.23 (1.12-1.35), and 1.16 (1.03-1.31), respectively. Both men and women had an increased risk of incident cataract surgery with increased total lifetime drinking, with a significant increase in risk occurring at > 90 drink-years for men and > 40 drink-years for women. A positive dose-response relationship was observed between alcohol consumption and cataract. Restricted drinking may help to reduce the progression of cataracts.

Assessment of sunlight exposure across industries and occupations using blood vitamin D as a biomarker

Objective

Exposure to ultraviolet (UV) radiation from sunlight induces the production of essential vitamin D, whereas overexposure to sunlight leads to skin cancer. Sunlight exposure has been measured using questionnaires, dosimeters, and vitamin D levels. Several studies have measured vitamin D in the working population; however, these studies were limited to certain occupations such as farmers and construction workers. In the present study, we evaluated sunlight exposure using blood vitamin D as an exposure surrogate across industries and occupations.

Methods

The Korea National Health and Nutrition Examination Survey (KNHANES) is a nationwide study representing the Korean population. We analyzed data from KNHANES between 2008 and 2009. We examined the association between vitamin D levels and pertinent personal, seasonal, residential, and occupational factors. Furthermore, we developed a multiple regression model with factors other than occupational factors (industry and occupation) and obtained residual values. We computed the third quartile (Q3) of the residuals and then calculated the fractions exceeding the Q3 level for each combination of industry and occupation.

Results

Age, sex, body mass index, year, season, latitude, living area, living in an apartment, industry, and occupation were significantly associated with vitamin D levels. Based on the exceeding fraction, the armed forces showed the highest exceeding fraction level of 0.71.

Conclusions

Our results present the high exposure groups to sunlight across industries and occupations. Our results may provide a source for prioritizing occupational groups with a high risk of adverse health effects from sunlight exposure.

National and subnational burden of disease attributable to occupational exposure to solar ultraviolet radiation (SUVR) in Iran, 2005-2019

Overexposure to solar ultraviolet radiation (SUVR) can cause skin and eye adverse effects for outdoor workers. In this study, the burden of disease induced by occupational exposure to SUVR and its spatiotemporal trend at national and sub-national levels in Iran, 2005-2019 were assessed. The attributable burden of disease was assessed using the following five datasets: (1) distribution of occupational exposure to SUVR, (2) total incidences and deaths of health outcomes of SUVR exposure, (3) population attributable fractions of the health outcomes of SUVR exposure, (4) age-gender distribution of outdoor workers, and (5) disability-adjusted life year (DALY) calculation constants. During 2005-2019, the attributable DALYs increased from 2442 to 2907 and the attributable DALY rate (per 100,000 workers) slightly decreased from 11.94 to 11.91. The share of YLL in the attributable burden of disease was in the range of 43%-46%. Out of nine causes, about 90% of the attributable burden of disease in 2019 was related to cataracts (29.9%), malignant skin melanoma (27.4%), squamous-cell carcinoma (18.6%), and sunburn (17.2%). During the study period, the attributable DALY rate in women increased by 60.95% (from 5.04 to 8.11) and in men decreased by 2.06% (from 13.03 to 12.76). The total attributable DALYs and DALY rate rose by age during 2005-2019. The contributions of population growth, risk-deleted DALY rates, exposure risk, and population age structure in temporal changes of the attributable burden of disease were 19.27%, 9.13%, -1.35%, and -14.8%, respectively. The three highest attributable DALY rates in 2019 were observed in South Khorasan (21.28), Chahar Mahal and Bakhtiari (17.42), and Kordestan (17.26), respectively. The preventive interventions against SUVR overexposure, regular screenings, and early treatments with an emphasis on occupations with continuous sun exposure and provinces with increasing attributable DALY rates should be considered in the occupational health action plan in the country.

Comparison between EPA UV index app and UV monitor to assess risk for solar ultraviolet radiation exposure in agricultural settings in Eastern North Carolina

Agricultural workers are exposed to solar ultraviolet (UV) radiation due to the significant amount of time spent working outdoors. Risk information on UV exposure from the EPA SunWise UV Index mobile app is conveniently available for timely advice on risk management, but its reliability is unknown. The purpose of this study was to determine the reliability of the EPA UV Index app in providing accurate risk information to reduce UV exposure and prevent related illnesses among agricultural workers in eastern North Carolina. UV radiation effective irradiance (UV _eff ) indices were datalogged at two agricultural sites using radiometers from April-August 2019 and were assigned to risk levels (low, moderate, high, very high, extreme) based on the ACGIH^® Threshold Limit Values (TLVs^®). The UV index (UV _app ) and its corresponding risk level were obtained using the app. Hourly UV _app -based risk level assignments were time-matched to their corresponding UV _eff /TLV-based risk level assignments (871 pairs) and analyzed using cross tabulation by determining the percentage of hourly UV _eff /TLV-based risk levels ("gold standard") with the same hourly UV _app -based risk levels, with a larger percentage indicating higher app reliability. Results showed that the app correctly identified 100% of low risk conditions, but its reliability decreased as the UV risk condition became more severe. The app correctly identified 0% of moderate, high and very high risk conditions but instead assigned 100% of them to lower risk levels (30-100% as low risk, 5-70% as moderate risk), indicating that the app was less protective in assessing UV risk. The app correctly identified 0.6% of extreme risk conditions but assigned 99.4% of them to lower risk levels (9.4% as low, 29.7% as moderate, 24.6% as high, 35.8% as very high). It is concluded that the performance of the EPA UV Index app in assessing occupational UV risk is not protective of workers particularly for high risk conditions, and that the use of the app for the assessment of risk to UV exposure in agricultural settings is not recommended.

Improved protection of outdoor workers from solar ultraviolet radiation: position statement

The vast majority of non-melanoma skin cancer (NMSC) is attributable to excessive exposure to ultraviolet radiation (UVR). Outdoor workers are exposed to an UVR dose at least 2 to 3 times higher than indoor workers and often to daily UVR doses 5 times above internationally recommended limits. The risk of UVR workplace exposure is vastly neglected, and the evident future challenges presented in this statement are contrasted with the current situation regarding legal recognition, patient care and compensation. While prevention is crucial to reduce cancer risks for outdoor workers, it is as much of relevance to better protect them through legally binding rules and regulations. Specific actions are outlined in five recommendations based on a Call to Action (table 1). The role of health professionals, including dermatologists, in this context is crucial.

Sun protection habits and behaviors of a group of outdoor workers and students from the agricultural and construction sectors in north-Italy

Background:

Despite the relevant frequency of ultraviolet induced adverse health effects in workers, solar ultraviolet radiation (UVR) exposure is an occupational risk not adequately minimized in Italy.

Objective:

To assess the characteristics and prevalence of sun exposure habits and behaviors in a group of students and outdoor workers (OW) from the agricultural and construction sectors of a north-Italian region.

Methods:

Based on a previously developed standardized questionnaire, we collected full information on individual sun exposure habits at work and during leisure activities.

Results:

In 2018, 380 high school students and OW from the agricultural and construction sectors participated in a sun-safety campaign. More than a third (39.0%) of OW reported never using sunglasses, 52.8% never applied sunscreens at work, and a quarter never wear a UV protective hat. Considering leisure-time, students reported more frequent sunburns compared to OW: 25.0% vs. 13.8%; half (51.6%) of students and a third (36.4%) of OW reported never wearing a UV protective hat. A third (30.1%) of students and 37.2% of OW never or only seldom applied sunscreens on holidays.

Discussion:

The majority of OW in our study reported poor protective solar exposure habits. Young students of the construction and agricultural sectors indicated even worse sun-protective behaviors, both during apprenticeship and leisure activities. Our study highlights the low health literacy related to solar UVR in OW and apprentices. Further educational initiatives are required in Italy to improve the adoption of protective behaviors during outdoor activities.

Exposure to solar UV radiation in outdoor construction workers using personal dosimetry

Occupational exposure to solar UV radiation (SUVR), a Group 1 carcinogen according to the IARC classification is at high exposure levels in outdoor construction workers, usually above the suggested occupational limits. Furthermore, there are no regulations related to this exposure in the EU, except for the artificial UVR. Also, the use of the ICNIRP exposure guideline in an outdoor setting poses problems of adequate dose assessment. In this context, the main purpose of the study was to perform direct measurements of the SUVR dose in outdoor workers from the construction sector, using individual SUVR dosimeters (GENESIS-UV system), for a period of 7 months, from April to October, in a prospective, observational study in two groups of 10 outdoor workers in Romania, located at two different geographic sites. In term of cumulative standard erythema dose (SED), our study population of outdoor construction workers received high levels of solar UV radiation, ranging from 165 SED to 453 SED during 7 months of occupational activity, from April to October. Our results, ranging from 1.28 SED (standard erythema dose) per day to 6.4 SED per day pose an alarm signal to the national and European health authorities to take preventive action for outdoor workers, as the ICNIRP suggested limit value of 1.33 SED for mean daily erythemal UV exposure is vastly exceeded. We suggest that personal dosimetry for SUVR, from simple devices to complex systems as GENESIS-UV should be regularly and mandatory used in outdoor workers, similarly to the usage of personal dosimetry in occupational exposure to ionizing radiations, which could be included in European and national legislation to reduce both, the level of exposure and the detrimental effects on outdoor workers' health.

Relationship between occupational sunlight exposure and the incidence of renal cancer

BACKGROUND

The risk factors for renal cancer include smoking, obesity, hypertension, and exposure to trichloroethylene. Recent studies have shown that low sunlight exposure increases the risk of developing a range of cancers, including renal cancer. Given that most of the daytime is spent at work, a lack of occupational sunlight exposure can be a risk factor for renal cancer. Therefore, this study examined the relationship between occupational sunlight exposure and the incidence of renal cancer.

METHODS

This was a university hospital-based case-control study on renal cancer. Of the 706 newly diagnosed patients with renal cell carcinoma (RCC), 633 cases were selected; 73 who had no occupational history were excluded. In addition, 633 controls were selected from the general population after 1:1 matching with respect to sex, age (within 5 years), and residential area (constituency-level). Information on sunlight exposure by the occupational group was referred to data from France. To estimate the association between occupational sunlight exposure and the RCC risk, the odds ratios (ORs) were calculated using conditional logistic regression analysis.

RESULTS

Sunlight exposure was divided into quartiles and the risk of RCC was analyzed. The adjusted OR of RCC (OR: 0.664, 95% confidence interval: 0.449-0.983) was significantly lower for the Q4 group than Q1 group but the Q2 and Q3 groups did not show significant results. The risk of RCC tended to decrease with increasing exposure to sunlight (p for trend < 0.028).

CONCLUSIONS

Higher occupational sunlight exposure reduces the risk of RCC.

Occupational Exposure to Solar UV Radiation of a Group of Fishermen Working in the Italian North Adriatic Sea

Occupational solar radiation exposure is a relevant heath risk in the fishing sector. Our aim was to provide a detailed evaluation of individual UV exposure in three different fishing activities in Italy, with personal UV dosimeters and a simple formula to calculate the fraction of ambient erythemal UV dose received by the workers. The potential individual UV exposure of the fishermen was between 65 and 542 Joules/m². The percentages of the ambient exposure were estimated between 2.5% and 65.3%. Workers’ UV exposure was mainly influenced by the characteristics of the work activity, the postures adopted, and the type of boats. Overall, our data showed that 43% of the daily measurements could result largely above the occupational limits of 1–1.3 standard erythemal dose (i.e., 100 Joules/m²) per day, in case of exposure of uncovered skin areas. Measurements of individual UV exposure are important not only to assess the risk but also to increase workers’ perception and stimulate the adoption of preventive measures to reduce solar UV risk. Furthermore, the simple method proposed, linking ambient erythemal UV dose to the workers’ exposure, can be a promising tool for a reliable assessment of the UV risk, as time series of environmental UV dose are widely available.

Macular degeneration: peculiar sunlight exposure in an agricultural worker

Background:

Occupational exposure to sunlight, in particular to blue light (wavelength of 380-550 nm), is a risk factor for several pathologies, including chronic retinal photochemical damage and, more specifically, age-related macular degeneration (AMD). Moreover, in addition to the effect of blue light, there is evidence about the role of near ultraviolet light (UV-A) as a risk factor for AMD since, given the wavelength, a precise “turning point” between effect and no effect is not definable.

Methods and results:

This work reports the case of a woman employed in the agricultural sector from 15 to 25 years of age, with no significant occupational exposure to other risk factors for AMD, who later developed this pathology. The case is of particular interest given that she worked as a “mondina”, a task involving the transplanting of young rice seedlings into water-flooded fields and manual weed control. This practice, although replaced by the introduction of pesticides, entailed the exposure to sunlight reflection on the water surface in addition to direct exposure to natural light.

Conclusion:

This brief case-report points out that occupational exposure to the short wavelength component of visible light and UV-A deserve further attention regarding preventive measures and the adoption of adequate personal protective equipment, in particular in productive sectors involving lengthy eye exposure to solar radiation and to the reflectance of surrounding surfaces. Furthermore, the cases of AMD and cataract should receive a complete and accurate occupational anamnesis for a more proper recognition of the possible role of occupational solar radiation exposure in the induction of the disease.

Quantifying the effects of a low-ozone event and shallow stratocumulus clouds on ultraviolet erythemal radiation exposure

Meteorological and dosimetric ultraviolet (UV) erythemal radiation (UVER) measurements were performed in Didcot, England, on 6 and 7 April 2017. Both days were characterized by clear-sky conditions in the morning and the afternoon with development of shallow stratocumulus clouds (SSC) around noon. In addition, a low-ozone event occurred on 7 April characterized by a 34 DU (Dobson Unit) drop in total stratospheric ozone content. Compared to 6 April, the ozone mini-hole caused UVER increases of 2.67 standard erythema dose (SED) for diffuse and 4.32 SED for global radiation characterized by radiation amplification factors (RAF) of 1.62 and 1.52, respectively. The total global UVER dose reductions due to SSC coverage amount to 2.33 SED (6 April) and 2.81 SED (7 April). As innovation the RAF is decomposed into two parts, named cloud ozone factor (COF) and radiation amplification factor based on measured data (RAF_m), to quantify the low-ozone event's effect and the SSC influence in independently modifying the UVER doses. Hereby, the weight of each of these two effects acting during the same low-ozone event is expressed by the new COF. In this case, the COF values range between -0.13 and -0.11 for diffuse UVER and -0.03 to -0.07 for the global UV and UV-B parts. A positive COF value (0.18) results for the global UV-A range.

[The use of sunglasses during leisure time and work : Lack of prevention of sun-induced eye damage]

OBJECTIVE

This study aimed at collecting representative national data on the use of sunglasses on sunny summer days during leisure time or work as well as identifying population and professional groups with a pronounced lack of preventive measures to avoid sun-induced eye damage.

MATERIAL AND METHODS

Within the representative National Cancer Aid Monitoring, data on the use of sunglasses during leisure time was assessed among 3000 individuals aged 14-45 years in 2015, as well as on the use during outdoor work among 485 workers aged 14-45 years in 2016. Associations between the use of sunglasses and sociodemographic characteristics were assessed with the χ²-test. Additionally, descriptive and bivariate methods were used to assess connections between the use of sunglasses at work and each professional group.

RESULTS

While more than half of the general population normally or often wear sunglasses on a sunny summer day, only one third of outdoor workers do so. While approximately every seventh individual surveyed never wears sunglasses during leisure time, among outdoor workers it is one out of three. The use during leisure time increases with age.

DISCUSSION

Use of sunglasses during work could be supported by targeted information on UV-induced eye damage by ophthalmologists and company physicians with additional support from accident insurances and employers. Concerning preventive measures occupational groups such as landscapers, farmers and bricklayers who are strongly exposed to sunlight but rarely wear sunglasses are important groups.

Solar Radiation Exposure and Outdoor Work: An Underestimated Occupational Risk

A considerably high number of outdoor workers worldwide are constantly exposed for the majority of their working life to solar radiation (SR); this exposure is known to induce various adverse health effects, mainly related to its ultraviolet (UV) component. The skin and the eye are the principal target organs for both acute and long-term exposure. Actinic keratosis, non-melanoma skin cancers, and malignant melanoma are the main long-term adverse skin effects, whereas in the eye pterygium, cataracts, and according to an increasing body of evidence, macular degeneration may be induced. Despite this, SR exposure risk is currently undervalued, if not neglected, as an occupational risk factor for outdoor workers. SR exposure is influenced by various environmental and individual factors, and occupation is one of the most relevant. For a better understanding of this risk and for the development of more effective prevention strategies, one of the main problems is the lack of available and adequate methods to estimate SR worker exposure, especially long-term exposure. The main aims of this review were to provide a comprehensive overview of SR exposure risk of outdoor workers, including the UV exposure levels and the main methods recently proposed for short-term and cumulative exposure, and to provide an update of knowledge on the main adverse eye and skin effects. Finally, we also outline here preventive interventions to reduce occupational risk.

Determinants of Sunburn and Sun Protection of Agricultural Workers During Occupational and Recreational Activities

OBJECTIVE

The aim of this study was to identify determinants of occupational sunburn in agricultural workers and assess their occupational and recreational sun protection habits.

METHODS

Specific surveys of agricultural workers in Switzerland and France were conducted (N = 1538). Multivariate logistic regressions identified occupational sunburn determinants. Occupational and recreational sun protection habits were estimated and correlated.

RESULTS

One-year occupational and recreational sunburn prevalences were 19.8% and 11.5%, respectively. Occupational sunburn increased with having a recent recreational sunburn, highly sensitive skin, young age, high perceived skin cancer risk, using sunscreen, and not wearing a hat. Correlation between protection habits during work and leisure was substantial (rs 0.5 to 0.7). Skin health knowledge was high and pro-tanning attitude moderate.

CONCLUSION

Potentially modifiable sunburn determinants and suboptimal recreational and occupational sun protection practices were identified in agricultural workers. Refining and tailoring sun protection messages targeting the agricultural sector are needed.