Ultraviolet irradiation of human body sites in relation to occupation and outdoor activity: field studies using personal UVR dosimeters

Ultraviolet radiation thin film dosimetry: A review of properties and applications

Spectroradiometry, radiometry, and dosimetry are employed for the measurement of ultraviolet radiation (UVR) irradiance and non-ionizing exposure. Different types of UVR dosimeter have been developed for measuring personal and environmental UVR exposures since film dosimetry was pioneered in the 1970s. An important type of dosimeter is the thin film variant, which contains materials that undergo changes in optical absorbance when exposed to UVR. These changes can be measured at a specific wavelength using a spectrophotometer. Thin film dosimeters allow UVR exposure measurements on humans at various body sites during daily activities, as well as on plants, animals, and any sites of interest when utilized in a field environment. This review examines the properties and applications of five types of thin film UVR dosimeter that have different dynamic exposure limits and spectral responses. Polysulphone, with a spectral response approximating the human erythema action spectrum, was one of the first materials employed in thin film form for the measurement of UVR exposures up to 1 day, and up to 6 days with an extended dynamic range filter. Polyphenylene oxide has been characterized and employed for personal UVR exposure measurements up to approximately four summer days and has also been used for long-term underwater UVR exposures. Phenothiazine and 8-methoxypsoralen have been reported as suitable for the measurement of longer wavelength UVA exposures. Finally, polyvinyl chloride with an extended dynamic exposure range of over 3 weeks has been shown to have predominantly a spectral response in the UVB and extending up to 340 nm.

Seasonal and lifelong changes in skin colour and pigmentation of Austrian farming families: an exploratory study

Farmers are exposed chronically to solar ultraviolet radiation. Their chronically exposed skin undergoes alterations in pigmentation, but quantitative measurements have not be done yet. Therefore, we followed skin color and pigmentation in Austrian farming families (male and female farmers, their spouses, and children) for one year by objective tri-stimulus measurements on different body sites. The difference between constitutive and facultative pigmentation was quantified by the "degree-of-tan" (TAN°), which we defined as the difference in individual typology angle between constitutive and facultative pigmentation. Personal sun exposure was measured in parallel. Measurements of skin colour showed that independent of occupation, adult males had a darker red component in skin color of the forehead than adult females and children, with the highest values observed in males only. This difference develops during puberty and adolescence. Even in late winter, an obvious TAN° was found in all groups at continuously and intermittently exposed body sites. TAN° was higher in adults than in children and highest in farmers. The seasonal changes in TAN° were pronounced in all groups on intermittently exposed body sites but less so on the forehead. In conclusion, TAN° increases in farmers on average during their lifetime but not in their spouses, even though many spouses have higher TAN° than farmers of the same age. Such high TAN° is reversible if sun exposure is low in the following seasons. The highest TAN° values were found in farmers older than 50 years.

Frequency of Going Outdoors and Risk of Poor Oral Health Among Older Japanese Adults: A Longitudinal Cohort From the Japan Gerontological Evaluation Study

BACKGROUND

The association between the frequency of going outdoors and the risk of poor oral health has been reported in several studies; however, the findings have been inconclusive.

METHODS

We conducted a 3-year longitudinal study of 19,972 Japanese adults aged ≥65 years who reported no poor oral condition at baseline in 2013. The respondents rated their frequency of going outdoors in three categories (≤1, 2-3, or ≥4 times/week), and the oral conditions reported in 2016 included tooth loss, chewing difficulty, swallowing difficulty, dry mouth, and composite outcomes. The associations between the frequency of going outdoors and the risk of poor oral health were examined as relative risk ratios (RRs) and 95% confidence intervals (CIs) using multivariable Poisson regression, while mediation analysis was performed to investigate indirect effects.

RESULTS

During the follow-up, 32.5% of participants developed poor oral health. In the mediation analysis, indirect effects were observed through low instrumental activities of daily living, depressive symptoms, little social network diversity, and underweight. Compared to going outdoors ≥4 times/week, the multivariable RRs of composite poor oral health conditions were 1.12 (95% CI, 1.05-1.20) for 2-3 times/week and 1.22 (95% CI, 1.07-1.39) for ≤1 time/week (P-trend < 0.001). Similar associations were observed for tooth loss, chewing difficulty, and swallowing difficulty; the corresponding RRs were 1.07 (95% CI, 0.97-1.19) and 1.36 (95% CI, 1.13-1.64) (P-trend = 0.002), 1.18 (95% CI, 1.06-1.32) and 1.30 (95% CI, 1.05-1.60) (P-trend < 0.001), and 1.15 (95% CI, 1.01-1.31) and 1.38 (95% CI, 1.08-1.77) (P-trend = 0.002), respectively.

CONCLUSION

The frequency of going outdoors was inversely associated with the risk of poor oral health through several modifiable risk factors in the older population.

Sunscreens - another endangered species?

Skin cancer continues to increase in incidence year-on-year and represents the most common form of cancer across the globe. Every human undergoes premature ageing, particularly on the face, neck and hands. Both phenomena are driven primarily by chronic, daily exposure to solar ultraviolet radiation (UVR). While sunscreen products play a primary role in the prevention of UVR skin damage, the active ingredients, i.e., UVR filters, are facing unprecedented challenges in the coming 10 years and their future is by no means certain. This article, therefore, reviews afresh the facts around photoprotection and the role of sunscreen products in the prevention of acute (sunburn) and chronic (cancer, photoageing) skin damage and compares/contrasts these with various emerging questions and opinions around UVR filter technology. We present a passionate defence of this remarkable technology, but also attempt to imagine a world without it.

The GENESIS-UV study on ultraviolet radiation exposure levels in 250 occupations to foster epidemiological and legislative efforts to combat nonmelanoma skin cancer

BACKGROUND

Several hundred million of the 3 billion formally employed people worldwide are at risk from high levels of solar ultraviolet radiation (UVR). Chronic light damage to the skin can lead to nonmelanoma skin cancer (NMSC), especially when irradiation is too high and is acquired for decades. However, data with uniform metrics, high resolution over time and in-depth occupational profiles are not available.

OBJECTIVES

To build a worldwide usable matrix of UVR exposure in occupations and to show use cases for the data.

METHODS

One thousand test persons were recruited to wear electronic data logger dosimeters during their working time for 7 months each. The measurements yielded 3.7 billion data points for around 48 000 days with high-quality data capture covering more than 250 occupations and 650 activities. Scientific evaluation of the data included daily and half-hourly means, geographical transfer calculations to the world, threshold exceedance quotas, transcriptome effects, and occupational disease estimates.

RESULTS

A compendium for global use is presented. In-depth analyses and the resulting implications for research have been elaborated to directly link exposure data to effects in the human body. Interestingly, the annual irradiances of the different occupations span a wide range of values: from about 650 to 50 standard erythemal doses, with different distributions over the months. Detailed exposure data per occupation were derived, and the risk on an occupational or activity basis assuming different exposure level quotas was quantified. This showed that, for example, in temperate latitudes, all activities with a duration of > 2 h outdoors are associated with increased NMSC risk.

CONCLUSIONS

We offer our work to enable sound studies on the nature of ultraviolet-induced skin cancer, dose-response relationships, intermittency of skin exposure, and derivation of limit values. Sociological studies on prevention are now possible. Practitioners may use the findings for their daily work with employees.

Modeling acute and cumulative erythemal sun exposure on vulnerable body sites during beach vacations utilizing behavior-encoded 3D body models

Vacationers in a high-solar-intensity beach setting put themselves at risk of ultraviolet radiation (UV) over-exposure that can lead to acute and chronic health consequences including erythema, photoaging, and skin cancer. There is a current gap in existing dosimetry work on capturing detailed time-resolved anatomical distributions of UV exposure in the beach vacation setting. In this study, a radiative transfer model of the solar conditions of Tampa Bay, St. Petersburg, Florida, USA (27.8°N, 82.8°W) is combined with an in silico three-dimensional body model and data on typical beach vacation behaviors to calculate acute and cumulative body-site-specific UV exposure risk during a beach vacation. The resulting cumulative UV exposure calculated for a typical mix of clothing choices, settings, and activities during a week-long (7-day) beach vacation is 172.2 standard erythemal doses (SED) at the forearm, which is comparable with the average total annual UV exposure of European and North American residents and consistent with existing dosimetry studies. This model further estimates that vacationers choosing to spend a full day exclusively in the beach or pool setting can experience UV exposure in excess of 50 SED a day at multiple body sites. Such exposure indicates that significant sun protective measures would be required to prevent sunburn across all skin types in this setting. This work clarifies the significant role that beach vacations play in UV exposure and corresponding acute and cumulative health risks and highlights the importance of behavioral choices (including clothing, activity and photoprotection) as crucial factors in differentiating personal solar exposure risks.

UVR Exposure and Prevention of Street Construction Workers in Colombia and Germany

(1) Solar ultraviolet radiation (UVR) poses a major risk factor for developing skin cancer after years of chronic exposure. The irradiation is strongly dependent upon the activity or occupation carried out, but also on the climate conditions at the workplace. Knowledge of both has been tested within the occupational group of road construction workers in Colombia and Germany. (2) The GENESIS-UV measurement system has been used at both locations for consistency. A number of workers in both countries wore an electronic data logging dosimeter for several months to deliver detailed information on UVR exposure. (3) It was found that in a tropical climate, UVR exposure remains constant throughout the year, while in a temperate climate seasonal effects are visible, superimposed by behavioural aspects e.g., in springtime. The daily distribution of the radiation shows a distinct dip, especially in the Colombian data. Derived data show the high fraction of working days exceeding a threshold set by the skin type. (4) Road construction work involves high UVR exposure. In both countries, preventive measures are required to reduce the personal exposure to a minimum. Exceedance of the minimal erythema dose (MED) suggests a possible enhancing effect, especially in fair skinned people. Intercomparison of UVR exposure at workplaces is possible between countries and climate zones, emphasizing efforts for global action against skin cancer.

Probing Different Approaches in Ultraviolet Radiation Personal Dosimetry - Ball Sports and Visiting Parks

Solar ultraviolet radiation (UVR) continues to be a decisive influencing factor for skin health. Besides acute damage (e.g. erythema), chronic light damage is of particular relevance. Skin cancer can develop on the basis of this light damage. Knowledge about irradiation is crucial for the choice of preventive measures, but has so far been incomplete in many occupational and leisure activities. Often a methodological problem in study design is the cause. Here we report on the clarification of two issues. First, further values are to be determined on the way to a comprehensive exposure register of leisure-related activities. Furthermore, it is to be determined to what extent the measurement setting can have an influence on the measurement campaigns. For long-term measurements, football referees were equipped with dosimeters over several months, selective measurements during visits to parks were carried out by on-site recruitment of test persons. It turned out that the choice of method also depends on the expected compliance of the test persons. Long-term measurements of specific activities such as playing football are particularly suitable for observing the course of UV exposure over the year and generating resilient mean values. Point measurements such as visits to parks can also do this if there are enough such events spread over the year. However, they are particularly suitable for such on-site campaigns, as they may be combined with awareness campaigns of the issue of skin cancer. They also allow many measurements to be taken at the same time in one place. Both playing football and visiting parks are associated with high levels of radiation, so specific prevention concepts need to be developed. We were able to determine that the sunburn dose for light skin types was reached or exceeded for both of the investigated activities.

Review on Occupational Personal Solar UV Exposure Measurements

During leisure time, people can decide if they want to expose themselves to solar ultraviolet (UV) radiation and to what extent. While working, people do not have this choice. Outdoor workers are exposed to solar UV radiation (UVR) on a daily basis. This may pose a certain health risk, which can be estimated when the personal solar UVR exposure (PE) is known. During past decades, a variety of studies were conducted to measure PE of outdoor workers and our knowledge of the PE of outdoor workers has increased remarkably. As shown by this review, studies clearly indicate that PE of most outdoor workers exceeds the internationally proposed threshold limit value, which is comparable to 1.0 to 1.3 standard erythema dose (SED), respectively, to 1.1 to 1.5 UV Index received over one hour. Besides working in a high UVR environ, monotonic workflow (limited movement, nearly static posture) is a risk factor. In such cases, PE can be higher than ambient UVR. In this review, we provide also a list of milestones, depicting the progress and the most important findings in this field during the past 45 years. However, in many respects our knowledge is still rudimentary, for several reasons. Different measuring positions have been used so that measured PE is not comparable. Few studies were designed to enable the extension of measured PE to other locations or dates. Although the importance of a proper calibration of the measuring devices in respect to the changing solar spectrum was pointed out from the beginning, this is often not performed, which leads to high uncertainties in the presented PE levels. At the end of our review, we provide some key points, which can be used to evaluate the quality of a study respectively to support the design of future studies.

Review of Wearable and Portable Sensors for Monitoring Personal Solar UV Exposure

Sunlight is one of the main environmental resources that keeps all the organisms alive on earth. The ultraviolet (UV) radiation from the sun is essential for vitamin D synthesis in the human body, which is crucial for bone and muscle health. In addition, sun exposure also helps to reduce the risk of some cardiovascular diseases and cancers. However, excessive UV exposure can lead to adverse effects, including some eye diseases, premature aging, sunburn and skin cancers. The solar UV irradiance itself depends on many environmental factors. In fact, the UV index reported in weather forecasts is an estimation under cloudless conditions. Personal UV exposure also depends on one's outdoor activities and habits. Furthermore, the UV intake depends on the skin sensitivity. Therefore, there is a need for research into monitoring the optimal daily UV exposure for health benefits, without developing potential health risks. To facilitate the monitoring of solar UV intensity and cumulative dose, a variety of UV sensors have been developed in the past few decades and many are commercially available. Examples of sensors being marketed are: portable UV dosimeter, wearable UV radiometer, personal UV monitor, and handheld Solarmeter®. Some of the UV sensors can be worn as personal health monitors, which promote solar exposure protection. The paper provides a comprehensive review of the wearable and portable UV sensors for monitoring personal UV exposure, including a discussion of their unique advantages and limitations. Proposals are also presented for possible future research into reliable and practical UV sensors for personal UV exposure monitoring.

Solar ultraviolet radiation exposure among outdoor workers in Alberta, Canada

BACKGROUND

Outdoor workers are at risk of prolonged and high solar ultraviolet radiation (UVR) exposure, which is known to cause skin cancer. The objectives of this study were to characterize the UVR exposure levels of outdoor workers in Alberta, Canada, and to investigate what factors may contribute to their exposure.

METHODS

This study collected objective solar UVR measurements from outdoor workers primarily in Alberta during the summer of 2019. Workers were recruited via the management or health and safety teams from building trade unions and employers. Calibrated, electronic UVR dosimeters were worn by workers on their hardhats, wrists, or lapels for five working days. Data on workers' demographics, jobs, sun protection behaviors, and personal risk factors were collected using questionnaires, and meteorological data for each sampling day were noted. Mean daily exposure measured as the standard erythemal dose (SED) was calculated and compared to the international occupational exposure limit guideline (1.3 SED). Marginal models were developed to evaluate potential determinants of occupational solar UVR exposure.

RESULTS

In total, 883 measurements were collected from 179 workers. On average, workerswere exposed to 1.93 SED (range: 0.03-16.63 SED) per day. Just under half of workers (45%) were exposed to levels exceeding the international exposure limit guideline. In the bivariate analyses, landscape and maintenance workers, as well as trade and recreation workers, had the highest levels of exposure (average: 2.64 and 1.84 SED, respectively). Regional variations were observed, with the "other" cities/regions (outside of Edmonton and Calgary) experiencing the highest average levels (2.60 SED). Workers who placed the dosimeters on their hardhats experienced higher levels compared to the other groups. Exposure was highest on sunny and mixed days. Education, trade, city, dosimeter placement, forecast, hair colour, and number of hours outside were included in the final exposure model, of which trade, dosimeter placement, forecast, and number of hours outside at work were statistically significant.

CONCLUSIONS

Exposure to elevated solar UVR levels is common among outdoor workers in Alberta. The study findings can help inform future monitoring studies and exposure reduction initiatives aimed at protecting workers.

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.

The Early Days of Personal Solar Ultraviolet Dosimetry

In the early 1970s, environmental conservationists were becoming concerned that a reduction in the thickness of the atmospheric ozone layer would lead to increased levels of ultraviolet (UV) radiation at ground level, resulting in higher population exposure to UV and subsequent harm, especially a rise in skin cancer. At the time, no measurements had been reported on the normal levels of solar UV radiation which populations received in their usual environment, so this lack of data, coupled with increasing concerns about the impact to human health, led to the development of simple devices that monitored personal UV exposure. The first and most widely used UV dosimeter was the polymer film, polysulphone, and this review describes its properties and some of the pioneering studies using the dosimeter that led to a quantitative understanding of human exposure to sunlight in a variety of behavioral, occupational, and geographical settings.

Personal ultraviolet Radiation exposure in a cohort of Chinese mother and child pairs: the Chinese families and children study

BACKGROUND

Few studies in China have examined personal ultraviolet radiation (UVR) exposure using polysulfone dosimetry.

METHODS

In this study, 93 mother and adolescent child pairs (N = 186) from two locations in China, one rural (higher latitude) and one urban (lower latitude), completed 3 days of personal UVR dosimetry and a sun/clothing diary, as part of a larger pilot study.

RESULTS

The average daily ambient UVR in each location as measured by dosimetry was 20.24 Minimal Erythemal Doses (MED) in the rural location and 20.53 MED in the urban location. Rural mothers had more average daily time outdoors than urban mothers (5.5 h, compared with 1.5 h, in urban mothers) and a much higher daily average personal UVR exposure (4.50 MED, compared with 0.78 MED in urban mothers). Amongst adolescents, rural males had the highest average daily personal UVR exposure, followed by rural females, urban females and urban males (average 2.16, 1.05, 0.81, and 0.48 MED, respectively).

CONCLUSIONS

Although based on small numbers, our findings show the importance of geographic location, age, work/school responsibilities, and sex of the adolescents in determining personal UVR exposure in China. These results suggest that latitude of residence may not be a good proxy for personal UVR exposure in all circumstances.

Review on Nonoccupational Personal Solar UV Exposure Measurements

Solar ultraviolet (UV) radiation follows people during their whole life. Exposure to UV radiation is vital but holds serious risks, too. The quantification of human UV exposure is a complex issue. UV exposure is directly related to incoming UV radiation as well as to a variety of factors such as the orientation of the exposed anatomical site with respect to the sun and the duration of exposure. The use of badge-sensors allows assessing the UV exposure of differently oriented body sites. Such UV devices have been available for over 40 years, and a variety of measuring campaigns have been undertaken since then. This study provides an overview of those studies which reported measurements of the personal UV exposure (PE) during outdoor activities of people not related to their occupation. This overview is given chronologically to show the progress of knowledge in this research and is given with respect to different activities. Special focus is put on the ratio of personal exposure to ambient UV radiation. This ratio, when given as a function of solar elevation, allows estimating PE at any other location or date if ambient UV radiation is known.

Schoolyard Shade and Sun Exposure: Assessment of Personal Monitoring During Children's Physical Activity

Childhood exposure to ultraviolet radiation (UVR) is a major risk factor for the development of melanoma later in life. However, it is challenging to accurately determine personal outdoor exposure to UVR, specifically erythemally weighted UVR (UV_Ery ), due to technological constraints, variable time-activity patterns, and the influence of outdoor environmental design. To address this challenge, this study utilized mobile and stationary techniques to examine the UV_Ery exposures of 14 children in a schoolyard in Lubbock, TX, in spring 2016. The aims of the study were to examine the influence of artificial shade on personal UV_Ery exposures and to assess full sun exposure ratios (ERs) within the same playground microenvironment. On average, personal wrist dosimeters worn during play in the sun measured 18% of the total onsite UV_Ery measured by a stationary UV pyranometer. Shade was found to significantly reduce the personal UV_Ery exposures by 55%, UVB_{280-315 nm} exposures by 91%, and the overall solar radiation by 84%. Substantial benefits can be garnered through focused design of children's recreational space to utilize shade-both natural and artificial-to reduce UVR exposures during play, and to extend safe outdoor stays. Finally, although the wrist is a practical location for a dosimeter, it often underestimates full exposures, particularly during physical activity.

Novel approach to analysing large data sets of personal sun exposure measurements

Personal sun exposure measurements provide important information to guide the development of sun awareness and disease prevention campaigns. We assess the scaling properties of personal ultraviolet radiation (pUVR) sun exposure measurements using the wavelet transform (WT) spectral analysis to process long-range, high-frequency personal recordings collected by electronic UVR dosimeters designed to measure erythemal UVR exposure. We analysed the sun exposure recordings of school children, farmers, marathon runners and outdoor workers in South Africa, and construction workers and work site supervisors in New Zealand. We found scaling behaviour in all the analysed pUVR data sets. We found that the observed scaling changes from uncorrelated to long-range correlated with increasing duration of sun exposure. Peaks in the WT spectra that we found suggest the existence of characteristic times in sun exposure behaviour that were to some extent universal across our data set. Our study also showed that WT measures enable group classification, as well as distinction between individual UVR exposures, otherwise unattainable by conventional statistical methods.

Sun-Protective Behaviors of Student Spectators at Inter-school Swimming Carnivals in a Tropical Region Experiencing High Ambient Solar Ultraviolet Radiation

Skin cancer is the most common cancer in humans and Australia (particularly in Queensland) has the highest incidence globally. Sunlight is a known skin carcinogen and reflects off water, exacerbating the risk of sunburn. In 1988, the "SunSmart Program" was developed to promote sun-protection to Australian children. Within a decade, it evolved to include a voluntary national accreditation program for schools, known as the SunSmart Schools (SSS) Program. Additionally, in 2008, it became compulsory for primary schoolchildren attending Queensland government-funded schools to wear a shirt during all water-based activities, except when competing. We observed the proportion of student spectators from 41 Townsville (latitude 19.3°S) primary schools (65.9% SSS) wearing hats at inter-school swimming carnivals in 2009-2011 and 2015 and the proportion wearing a shirt. Overall, a median of 30.7% student spectators from each school wore a hat [max 46.2% (2009); min 18% (2015)] and 77.3% wore a shirt [max 95.8% (2009); min 74.5% (2015)], suggesting that hats are under-utilized. Students from non-government (private) schools were twice as likely as students from government schools to wear a hat (41 vs. 18.2% p = 0.003). Neither the hat nor the shirt-wearing behaviors of student spectators were significantly influenced by their school's size (number of students), educational advantage, sun-protection policy score, or SunSmart status, indicating that other socioeconomic factors, not assessed here, may have influenced the results. Our findings suggest that the mandatory swim-shirt policy introduced in 2008 was very effective, especially initially. However, monitoring and feedback of results to schools may be needed to maintain high levels of compliance in the longer-term. Schoolchildren attending swimming carnivals should not rely on sunscreen or shade alone to protect against direct and reflected-sunlight, and need prompting to put a hat and shirt back on immediately after a race. This responsibility could be delegated to either a parent or a student prefect, if teachers are too busy to encourage and monitor sun-safety compliance among the students in their care.

Understanding age-induced alterations to the biomechanical barrier function of human stratum corneum

BACKGROUND

The appearance and function of human skin are dramatically altered with aging, resulting in higher rates of severe xerosis and other skin complaints. The outermost layer of the epidermis, the stratum corneum (SC), is responsible for the biomechanical barrier function of skin and is also adversely transformed with age. With age the keratin filaments within the corneocytes are prone to crosslinking, the amount of intercellular lipids decreases resulting in fewer lipid bilayers, and the rate of corneocyte turnover decreases.

OBJECTIVES

The effect of these structural changes on the mechanical properties of the SC has not been determined. Here we determine how several aspects of the SC's mechanical properties are dramatically degraded with age.

METHODS

We performed a range of biomechanical experiments, including micro-tension, bulge, double cantilever beam, and substrate curvature testing on abdominal stratum corneum from cadaveric female donors ranging in age from 29 to 93 years old.

RESULTS

We found that the SC stiffens with age, indicating that the keratin fibers stiffen, similarly to collagen fibers in the dermis. The cellular cohesion also increases with age, a result of the altered intercellular lipid structure. The kinetics of water movement through the SC is also decreased.

CONCLUSIONS

Our results indicate that the combination of structural and mechanical property changes that occur with age are quite significant and may contribute to the prevalence of skin disorders among the elderly.

Farmers sun exposure, skin protection and public health campaigns: An Australian perspective

Non-melanoma skin cancer is a common and costly cancer in agricultural populations. Prevention and early detection are an effective way to decrease the burden of disease and associated costs. To examine sun exposure and skin protection practices in agricultural workers and farmers a thematic review of the literature between 1983 and 2014 was undertaken. Comparison between studies was complicated by differences in study design, definitions of skin protection, and analytic methods used. Farmers are the most exposed to harmful ultraviolet (UV) radiation of all outdoor workers and the level of reported skin protection by farmers is suboptimal. Years of public health campaigns have failed to adequately address farmers' specific needs. Increased rates of skin cancer and subsequent higher costs are expected. Estimates of sun exposure and skin protection practice indicate that protective clothing is the most promising avenue to improve on farmers' skin protection. Early detection needs to be part of public health campaigns. This review explores the quantitative data about Australian farmers and their skin protective behaviours. We investigate what the documented measurable effect of the public health campaign Slip!Slop!Slap! has had on agricultural workers and farmers and make recommendations for future focus.

Sun Safety at Work Canada: a multiple case-study protocol to develop sun safety and heat protection programs and policies for outdoor workers

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.

Occupational exposure to solar radiation in Australia: who is exposed and what protection do they use?

OBJECTIVE

Solar ultraviolet radiation (UVR) exposure is widely recognised as a leading cause of skin cancer, with outdoor workers being particularly at risk. Little is known on a national level about how many workers are exposed to solar radiation, the circumstances in which they are exposed, or their use of protective measures.

METHODS

The Australian Work Exposures Study (AWES) was a cross-sectional telephone survey of 5,023 Australian workers aged 18 to 65. A subset of 1,113 respondents who indicated they worked outdoors was asked about their exposure to solar radiation in terms of the amount of time they spent working outdoors, their working location and their use of sun protective measures.

RESULTS

A total of 1,100 respondents (22% overall) were assessed as being exposed to solar radiation at work. Exposure was more likely among males and those residing in lower socioeconomic and regional areas. Sun protection was used by 95% of the respondents, although the level of protection varied among workers, with only 8.7% classified as fully protected.

CONCLUSIONS

This study provides valuable information regarding solar exposure that has not previously been available.

IMPLICATIONS

The results of this study will inform strategies for risk reduction.

Adoption of sun safe workplace practices by local governments

CONTEXT

Outdoor workers are especially susceptible to skin cancer--the most common, but also one of the most preventable, forms of cancer. Colorado, the location of the study, has the second highest rate of skin cancer deaths in the nation.

OBJECTIVE

Local government managers in Colorado-in municipalities, counties, and special districts-were surveyed to ascertain the extent to which they engage in formal (written) and informal practices to protect their outdoor workers against excessive exposure to sun.

DESIGN

The survey consisted of 51 questions assessing awareness of formal or informal practices for sun protection of outdoor workers. An index of practices--the study's dependent variable--was created that was composed or practices such as providing employees free or reduced-cost sunscreen, wide-brimmed hats, sunglasses, long-sleeved work shirts, long work pants, and temporary or permanent outdoor shade shelters. Proscriptive policies, such as restricting the use of broad brimmed hats, were subtracted from the index. Surveys were completed by 825 administrators representing 98 jurisdictions. Responses from administrators in the same jurisdiction were averaged.

RESULTS

More than 40% of responding jurisdictions indicated that they engaged in informal sun safety practices. Tests conducted to determine what variables might account for the adoption of these sun protection practices found that the degree to which a community could be regarded as cosmopolite and as having an individualistic political culture were significant predictors. Type of government was also significant. Although, higher community income was a significant predictor, neither local government budget nor size was significant.

CONCLUSIONS

The adoption of sun safe practices bears low costs with potentially high returns. Findings from this study suggest that awareness campaigns might most effectively target cosmopolite communities, but that the greatest impact might be achieved by targeting localite communities. Government size and budget do not appear to be constraints in the adoption of sun safe practices.

Adoption of photoprotection measures on lip and perioral regions among beach workers in North Brazil

BACKGROUND

Workers from various occupational groups stand out as being more susceptible to photodamage. Behaviors that can reduce the risk of onset of these disorders include the limitation or reduction of sun exposure, use of photoprotective clothing, and correct use of sunscreen. The present study aimed to verify the use of photoprotection measures by beach workers on the lips and perioral regions, as well as investigate possible associations with sociodemographic, occupational, and health variables.

MATERIALS AND METHODS

For this purpose, calibrated researchers applied validated questionnaires. The participants were 362 beach workers with a minimum age of 18 years. Data were analyzed using chi-square tests and robust Poisson regression.

RESULTS

In regard to photoprotection measures, most of the population studied reported using some form of protection (80.1%). Among these, the most common were the use of a cap/hat (66.2%) and sunscreen (41.6%). Applying lipstick (3.6%) and using some other measure (4.2%) were the least reported. When compiling a multivariate analysis model, type of work (P = 0.001) was the only variable that explained the adoption of photoprotection measures, regardless of daily and accumulated exposure and the presence of habits.

CONCLUSIONS

In general, most workers reported using some form of photoprotection in the oral and perioral regions, and those exposed to direct solar radiation effectively confirmed this.

Measurements of personal UV exposure on different parts of the body during various activities

Within this study, the erythemal ultraviolet (UV) exposure received by different parts of the body during four different activities is determined. Optoelectronic devices were used to measure the erythemal UV exposure at 10 different positions of the body. The measuring devices were fixed on the forehead, on the shoulders, on the arms, on the chest, on the thighs and on the lower legs. The measurements were performed during the following activities of the test persons: walking, sitting, lying and sitting up. The measurements were performed on four clear sky days in the early afternoon at 1 s interval. One measurement sequence was taking 30-40 min. For the analysis of the measured UV exposures, the ambient UV is taken as a reference to remove the atmospheric fluctuations on the measured UV exposure. The strong dependence of the UV exposure on the activity and on the orientation of the test person is shown. Most of the body parts receive the highest exposure, when the test subject is sitting up or lying. The shoulders are most at risk when the test person is walking, whereas during the activities sitting up and lying the legs are most at risk.

Prevalência de lesões labiais em trabalhadores de praia e fatores associados

OBJETIVO: Analisar a prevalência de lesões labiais decorrentes da exposição solar e potenciais associações em trabalhadores de praia. MÉTODOS: Estudo transversal com 362 trabalhadores de cinco praias urbanas em Natal, RN, de agosto a dezembro de 2010. Os participantes responderam um questionário validado com dados pessoais, de ocupação e de saúde e passaram por exame clínico dos lábios feito por pesquisadores calibrados. As possíveis associações das variáveis sociodemográficas, ocupacionais e de saúde geral com a presença de lesões labiais foram avaliadas pelo teste do qui-quadrado para um nível de significância de 5%. A análise multivariada foi feita utilizando-se a regressão robusta de Poisson. RESULTADOS: Dos trabalhadores examinados, 27,1% apresentavam lesões labiais. Desses, 76,8% eram do sexo masculino; 61,6% tinham pele morena ou negra; 94,5% trabalhavam informalmente; e 85,4% trabalhavam expostos ao sol. A maioria (81,1%) relatou uso de algum tipo de fotoproteção: protetor solar (38,7%); protetor labial (15,3%); boné/chapéu (72,4%). Aproximadamente 28% eram fumantes e 48% consumiam álcool regularmente. A fotoproteção com uso de boné/chapéu foi associada à presença de lesões labiais decorrentes da exposição solar. CONCLUSÕES: Observou-se alta prevalência de lesões labiais nos indivíduos expostos ao sol, a qual foi associada ao uso de boné/chapéu como forma de fotoproteção.

The Effects of Twins, Parity and Age at First Birth on Cancer Risk in Swedish Women

The effect of reproductive history on the risk of cervical, colorectal and thyroid cancers and melanoma has been explored but the results to date are inconsistent. We aimed to examine in a record- linkage cohort study the risk of developing these cancers, as well as breast, ovarian and endometrial cancers, among mothers who had given birth to twins compared with those who had only singleton pregnancies. Women who delivered a baby in Sweden between 1961 and 1996 and who were 15 years or younger in 1961 were selected from the Swedish civil birth register and linked with the Swedish cancer registry. We used Poisson regression to assess associations between reproductive factors and cancer. Twinning was associated with reduced risks of breast, colorectal, ovarian and uterine cancers, although no relative risks were statistically significant. The delivery of twins did not increase the risk of any cancers studied. Increasing numbers of maternities were associated with significantly reduced risks of all tumors except thyroid cancer. We found positive associations between a later age at first birth and breast cancer and melanoma, while there were inverse associations with cervix, ovarian, uterine and colorectal cancers. These findings lend weight to the hypothesis that hormonal factors influence the etiology of colorectal cancer in women, but argue against any strong effect of hormones on the development of melanoma or tumors of the thyroid.

Mean exposure fractions of human body solar UV exposure patterns for application in different ambient climates

In this research, the erythemally effective UV measured using miniaturized polysulphone dosimeters to over 1250 individual body sites and collected over a 4-year period is presented relative to the total exposed skin surface area (SSA) of a life-size manikin model. A new term is also introduced, the mean exposure fraction (MEF). The MEF is used to weight modeled or measured horizontal plane UV exposures to the total unprotected SSA of an individual and is defined as the ratio of exposure per unit area received by the unprotected skin surfaces of the body relative to the exposure received on a horizontal plane. The MEF has been calculated for a range of solar zenith angles (SZA) to provide a sunburning energy data set weighted to the actual SSA of a typically clothed individual. For this research, the MEF was determined as 0.15, 0.26 and 0.41 in the SZA ranges 0°-30°, 30°-50° and 50°-80° providing information that can be used in a variety of different ambient, latitudinal and seasonal climates where total human body UV exposure information is not available.

A critical assessment of two types of personal UV dosimeters

Doses of erythemally weighted irradiances derived from polysulphone (PS) and electronic ultraviolet (EUV) dosimeters have been compared with measurements obtained using a reference spectroradiometer. PS dosimeters showed mean absolute deviations of 26% with a maximum deviation of 44%, the calibrated EUV dosimeters showed mean absolute deviations of 15% (maximum 33%) around noon during several test days in the northern hemisphere autumn. In the case of EUV dosimeters, measurements with various cut-off filters showed that part of the deviation from the CIE erythema action spectrum was due to a small, but significant sensitivity to visible radiation that varies between devices and which may be avoided by careful preselection. Usually the method of calibrating UV sensors by direct comparison to a reference instrument leads to reliable results. However, in some circumstances the quality of measurements made with simple sensors may be over-estimated. In the extreme case, a simple pyranometer can be used as a UV instrument, providing acceptable results for cloudless skies, but very poor results under cloudy conditions. It is concluded that while UV dosimeters are useful for their design purpose, namely to estimate personal UV exposures, they should not be regarded as an inexpensive replacement for meteorological grade instruments.

Estimating natural UV personal exposure with radiative transfer calculations

The following study has investigated whether straightforward radiative transfer calculations can be used to adequately document natural UV personal exposure. The method was evaluated by comparing the results with erythemal doses accumulated by polysulphone films positioned on mannequins. The calculations succeeded in reproducing the variability associated with changing solar zenith angle and atmospheric conditions. A possible use of the model has been illustrated by estimating the daily exposure during 1 y of a hypothetical office worker, according to a simple occupational schedule. The calculated daily exposures indicated the importance of holiday periods in the risk of acute overexposure and in the total yearly dose.

Diurnal variations in solar ultraviolet radiation at typical anatomical sites

OBJECTIVE

Solar ultraviolet (UV) radiation is an important environmental factor that affects human health. The understanding of diurnal variations of UV radiation at anatomical sites may be helpful in developing ways to protect humans from the harmful effects of UV radiation.

METHODS

In order to characterize the diurnal variations, the UV exposure values were measured at 30 min intervals by using Solar-UV Sensors and a rotating manikin in Shenyang city of China (41 degrees 51'N, 123 degrees 27'E). Measurement data for four representative days (in each of the four seasons respectively) were analyzed.

RESULTS

The diurnal variations in solar UV radiation at the shoulder, the forehead and the chest were similar to those associated with a horizontal control measurement. However, the diurnal variations at the eye and the cheek exhibited bimodal distributions with two peaks in spring, summer and autumn, and a unimodal distribution in winter. The UV exposure peaks at the eye and the cheek were measured at solar elevation angles (SEA) of about 30 degrees and 40 degrees , respectively.

CONCLUSION

The protection of some anatomical sites such as the eye from high UV exposure should not be focused solely on the periods before and after noon, especially in the places and seasons with high SEA.

Sun protection intervention for highway workers: long-term efficacy of UV photography and skin cancer information on men's protective cognitions and behavior

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.

UV exposition during typical lifestyle behavior in an urban environment

In this study the personal exposure to solar UV radiation in an urban environment was measured. Lifestyle in an urban environment is characterized by staying indoors during most of the day. Furthermore, the ambient UV radiation is mitigated by shadowing by buildings. The aim of the study was to find out activities which may contribute to UV-induced health risk in a low exposure environment. Exposure was measured during typical outdoor activities: shopping, walking, sitting in a sidewalk café, cycling, sightseeing and at an open-air pool (solar elevation: 10 degrees-70 degrees). Measurements were taken with an optoelectronic device which was fixed on the chest. Besides the UV Index we used the sun burn time (SBT) for risk assessments. Generalization of our results was made by calculating ratios of personal exposure to the ambient UV radiation. UV exposure was by far the highest when our study subject stayed at the swimming pool. The SBT was around 30 min for melano-compromised skin type. For all other activities, except shopping, the SBT range up to 1 h. With respect to photodamage we found that at high solar elevation (>45 degrees) photoprotective measures should be applied for certain activities even within a city.

Organ transplant recipients and skin cancer: assessment of risk factors with focus on sun exposure

BACKGROUND

Organ transplant recipients (OTRs) have an increased risk of developing skin cancer, especially epithelial tumours. A number of factors such as immunosuppression, age, ultraviolet radiation and skin type are considered as important in aetiology.

OBJECTIVES

The purpose of this study was to further evaluate the risk factors for OTRs regarding skin cancer after transplantation. A detailed investigation of the specific compounds of sun exposure was realised.

METHODS

A questionnaire-based study was performed in a specialist OTR dermatology clinic from January to April 2009. The subjects were 70 organ transplanted patients who had developed some form of skin cancer after transplantation. As controls served 69 organ transplanted patients who had no history of skin cancer. The controls were matched concerning age, transplanted organ and gender. Photo protection, sun exposure and transplantation data were part of the questionnaire. Statistical analysis was performed with Mann-Whitney-U-test, chi-square test or Fisher's exact test.

RESULTS

The total sun burden (TSB) and the recreational sun exposure in particular attained higher scores in the skin cancer group (TSB-score: mean 11.8 vs. 10.0, P<0.05; recreational sun exposure: mean 6.3 vs. 5.1, P<0.05). The skin cancer group had fairer skin types than the control group (median skin type 2 vs. 3, P<0.05). The OTRs who developed skin cancer have been more likely to have a history or present intake of azathioprine (mean 42% vs. 21%, P<0.05). Also, the skin cancer group has been transplanted for a longer time (mean 12.3 vs. 7.2 years, P<0.001), analogously had a younger age at transplantation (mean 49.5 vs. 52.7 years, P<0.001).

CONCLUSIONS

Recreational sun exposure is of central importance for OTRs. A long period of transplantation and thus immunosuppression presents a main risk factor for the development of skin cancer in OTRs. A multi disciplinary management with the best medication and a focus on sun protection is needed to prevent skin cancer in OTRs.

Measurement of the UVR exposures of expeditioners on antarctic resupply voyages

A study to assess the potential exposure to solar UV radiation of expeditioners on Australian Antarctic resupply voyages was carried out over the Austral summers of 2004/2005 to 2006/2007. Subjects wore UVR-sensitive polysulphone (PS) badges on the chest for the duration of their working day, which generally ranged from 5 to 10 h, but could be as long as 14 h. Measurements were carried out during unloading of two vessels while they were at the three Australian Antarctic stations. The subjects wore standard Australian Antarctic Division clothing assemblages, although the face and hands and in some cases more of the limbs were uncovered and subjected to exposure to UVR. The badges worn by the subjects received exposures ranging from 0.2 to 18 standard erythemal doses (SEDs), with a median of 3.2 SEDs. However, comparison with occupational exposure limits showed that more than 80% of the subjects' PS badges received UVR exposures in excess of the limits while 31% received more than five times the limits. Despite sun protection being provided more than 70% of the workers reported mild erythema.

Measured occupational solar UVR exposures of lifeguards in pool settings

BACKGROUND

The aim of this study was to measure ultraviolet radiation (UVR) exposures of lifeguards in pool settings and evaluate their personal UVR protective practices.

METHODS

Lifeguards (n = 168) wore UVR sensitive polysulfone (PS) film badges in wrist bracelets on 2 days and completed a survey and diary covering sun protection use. Analyses were used to describe sun exposure and sun protection practices, to compare UVR exposure across locations, and to compare findings with recommended threshold limits for occupational exposure.

RESULTS

The measured UVR exposures varied with location, ranging from high median UVR exposures of 6.2 standard erythemal doses (SEDs) to the lowest median of 1.7 SEDs. More than 74% of the lifeguards' PS badges showed UVR above recommended threshold limits for occupational exposure. Thirty-nine percent received more than four times the limit and 65% of cases were sufficient to induce sunburn. The most common protective behaviors were wearing sunglasses and using sunscreen, but sun protection was often inadequate.

CONCLUSIONS

At-risk individuals were exposed to high levels of UVR in excess of occupational limits and though appropriate types of sun protection were used, it was not used consistently and more than 50% of lifeguards reported being sunburnt at least twice during the previous year.

Patterns of real-time occupational ultraviolet radiation exposure among a sample of outdoor workers in New Zealand

OBJECTIVES

Exposure to solar ultraviolet radiation (UVR) is an occupational health and safety issue for outdoor workers since excessive exposure is associated with negative health outcomes, including eye conditions and skin cancers. The objective of this research was to describe the pattern of UVR exposure experienced by outdoor workers from selected occupations in New Zealand in order to identify the impact of behaviour and work conditions on exposure.

STUDY DESIGN

This paper reports on the occupational UVR exposure arm of a dual arm cross-sectional study that also examined workers' sun protection practices.

METHODS

For five consecutive working days in January-March 2007, electronic dosimeters were used to record the time-stamped UVR exposure of a sample of 77 outdoor workers from three occupations (building, horticulture and roading) in Central Otago, New Zealand.

RESULTS

The geometric mean total daily UVR exposure (between 1100 and 1600 h) was 5.32 standard erythemal doses (SED; 95% reference range 0.28-19.97 SED). The geometric mean total daily UVR exposure as a percentage of the total daily ambient UVR was 20.5% (95% confidence interval 1.4-83.0%). Personal UVR exposure dipped between 1200 h and 1300 h--the same time that ambient UVR peaked--indicating the effect of shade seeking over the lunch period. Personal UVR exposure peaked between 1400 h and 1500 h, alongside decreasing ambient UVR levels, suggesting the influence of behavioural rather than climatic factors. The difference in workers' exposure between 1200 h and 1300 h, and 1400 h and 1500 h was statistically significant for both measured personal exposure (P < 0.005) and exposure calculated as a percentage of concurrent available ambient UVR (P < 0.005).

CONCLUSIONS

All the workers in this study recorded mean daily UVR exposure in excess of the current recommended occupational exposure limits. Only a minority of workers sought shade during their lunch break; most remained in highly exposed conditions. There is no evidence that work tasks which involve substantial sun exposure are being scheduled outside the high UVR period.

Outdoor workers' acceptance of personal protective measures against solar ultraviolet radiation

The acceptance and usability of personal protection against solar UV radiation was evaluated in a field study with a group of tinsmiths in Austria. The personal protective measures (PPM) tested involved four categories: shirts, headwear, sunglasses and topically applied sunscreens; at least six different products per category were tested. Recommendations for the "ideal" shirt, headwear, pair of sunglasses and topical sunscreen are given based on data from questionnaires, i.e., from the point of view of the workers, independently from the actual physical level of protection (such as low transmittance or area of coverage) provided. It is argued that in practice it is important to consider the acceptance and usability of protective measures as well as the level of physical protection when providing PPM.

A pilot study of the validity of self-reported ultraviolet radiation exposure and sun protection practices among lifeguards, parents and children

Outdoor recreation settings, such as swimming pools, provide a promising venue to assess UVR exposure and sun protection practices among individuals who are minimally clothed and exposed to potentially high levels of UVR. Most studies assessing sun exposure/protection practices rely on self-reported data, which are subject to bias. The aim of this study was to establish the feasibility of conducting a multimethod study to examine the validity of self-reported measures within a swimming pool setting. Data were collected from 27 lifeguards, children and parents in Hawaii. Each participant filled out a survey and a 4 day sun habits diary. On two occasions, researchers assessed observable sun protection behaviors (wearing hats, shirts, sunglasses), swabbed the skin to detect the presence of sunscreen, and subjects wore polysulphone dosimeters to measure UVR exposure. Overall, observed sun protection behaviors were more highly correlated with diary reports than with survey reports. While lifeguards and children reported spending comparable amounts of time in the sun, dosimeter measures showed that lifeguards received twice as much UVR exposure. This study demonstrated the feasibility of implementing a multimethod validity study within a broader population of swimming pools.

Reducing ultraviolet radiation exposure among outdoor workers: state of the evidence and recommendations

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.