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Ward J, Hardin-Fanning F, LaJoie AS, Harris L, Simpson A. Outdoor workers' perceptions of skin cancer prevention: a qualitative study. Ann Work Expo Health 2024; 68:636-646. [PMID: 38742833 DOI: 10.1093/annweh/wxae039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Accepted: 04/25/2024] [Indexed: 05/16/2024] Open
Abstract
OBJECTIVES Outdoor workers are at increased risk for skin cancer and melanoma. This qualitative study aimed to explore outdoor workers' perspectives and experiences of primary (i.e. sun protection) and secondary prevention, i.e. skin self-examination (SSE) of skin cancer. METHODS Purposive, snowball, and theoretical sampling was used to recruit outdoor workers in Kentucky and Indiana. Semi-structured interviews via telephone or videoconference of approximately 45 min were conducted with interviewer probes and questions about perceptions of cancer risk, prevention, and screening techniques conducted, perceived barriers and facilitators, and preferences for health dissemination venues. The recordings were transcribed verbatim and de-identified. Analysis involved constructivist grounded theory coding strategies. Using peer debriefing and consensus building around themes, the researcher established a codebook for all interviews to utilize within Dedoose software for systematizing and organizing data. RESULTS Eighteen interviews were conducted. Interviewees (N = 18) ranged in age from 35 to 78 yr, with 3 females. Outdoor industries included agriculture, maintenance, and grounds maintenance. Themes derived from the data showed the underlying factors and perceptions that influence outdoor workers to conduct primary and secondary cancer prevention activities. The level of alarm attributed to disease and the level of trust in information contribute to intentions to conduct activities. The intentions and trust toward healthcare institutions and providers drive the primary or secondary prevention behaviors. Cultural and contextual factors included masculinity and self-sufficiency, familial and occupational priorities, and community ties. CONCLUSIONS These data provide a basis for developing future communications and interventions to decrease skin cancer incidence in outdoor workers. They indicate that secondary prevention and building self-efficacy in conducting SSE should be emphasized in tandem or over primary skin cancer prevention methods in this population. Trusted local healthcare providers should primarily provide prevention information, and materials should utilize testimonials from the local community to best influence this population. Communications and training interventions are needed in this population to induce a proactive level of alarm about cancer and result in the performance of SSE.
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Affiliation(s)
- Jeanne Ward
- Department of Nursing, University of Louisville, 555 S. Floyd, Louisville, KY 40202, United States
| | - Frances Hardin-Fanning
- Department of Nursing, University of Louisville, 555 S. Floyd, Louisville, KY 40202, United States
| | - Andrew Scott LaJoie
- Department of Public Health and Information Sciences, University of Louisville, 485 E. Gray St., Louisville, KY 40202, United States
| | - Lesley Harris
- Department of Social Work, University of Louisville, 2217 S. Third St., Louisville, KY 40292, United States
| | - Anna Simpson
- Department of Public Health and Information Sciences, University of Louisville, 485 E. Gray St., Louisville, KY 40202, United States
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2
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Grifoni D, Betti G, Bogi A, Bramanti L, Chiarugi A, Gozzini B, Morabito M, Picciolo F, Sabatini F, Miligi L. Protective Measures From Solar Ultraviolet Radiation for Beach Lifeguards in Tuscany (Italy): Shade and Clothing Strategies. Saf Health Work 2022; 13:421-428. [PMID: 36579014 PMCID: PMC9772484 DOI: 10.1016/j.shaw.2022.08.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 07/25/2022] [Accepted: 08/29/2022] [Indexed: 12/31/2022] Open
Abstract
Background The exposure to solar ultraviolet radiation is a significant risk factor generally underestimated by outdoor workers and employers. Several studies have pointed out that occupational solar exposure increased eye and skin diseases with a considerable impact on the lives and productivity of affected workers.The main purpose of this study was to evaluate the effectiveness against ultraviolet radiation of some measures recently undertaken for the protection of lifeguards in a coastal area of Tuscany. Methods Different shading structures (gazebos and beach umbrella) were tested during a sunny summer's day on a sandy beach by means of two radiometers; the UV protection offered by some T-shirts used by lifeguards was also tested in the laboratory with a spectrophotometer. Results The analysed shading structures strongly reduced the ultraviolet radiation by up to 90%, however a not always negligible diffuse radiation is also present in the shade, requiring further protective measures (T-shirt, sunglasses, sunscreen, etc.); the tested T-shirts showed a very good-excellent protection according to the Australian/New Zealand standard. Conclusion Results obtained in this study suggest how the adoption and dissemination of good practices, including those tested, could be particularly effective as a primary prevention for lifeguards who are subjected to very high levels of radiation for long periods.
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Affiliation(s)
- Daniele Grifoni
- CNR-IBE - Institute of Bioeconomy - National Research Council, Sesto Fiorentino, Italy,LaMMA Consortium, Sesto Fiorentino, Italy,Corresponding author. Institute of Bioeconomy - National Research Council, Via Madonna del Piano, 10, 50019, Sesto Fiorentino, Italy.
| | - Giulio Betti
- CNR-IBE - Institute of Bioeconomy - National Research Council, Sesto Fiorentino, Italy,LaMMA Consortium, Sesto Fiorentino, Italy
| | - Andrea Bogi
- Physical Agents Sector, Regional Public Health Laboratory, Siena, Italy
| | - Lucia Bramanti
- AUSL North West Tuscany, Hygiene and Health at Work Unit, Prevention Department, Versilia, Italy
| | - Alessandra Chiarugi
- Screening and Secondary Prevention Unit, Institut for Cancer Research, Prevention and Clinical Network (ISPRO), Florence, Italy
| | - Bernardo Gozzini
- CNR-IBE - Institute of Bioeconomy - National Research Council, Sesto Fiorentino, Italy,LaMMA Consortium, Sesto Fiorentino, Italy
| | - Marco Morabito
- CNR-IBE - Institute of Bioeconomy - National Research Council, Sesto Fiorentino, Italy
| | | | - Francesco Sabatini
- CNR-IBE - Institute of Bioeconomy - National Research Council, Sesto Fiorentino, Italy
| | - Lucia Miligi
- Environmental and Occupational Epidemiology Branch - Cancer Risk Factors and Lifestyle Epidemiology Unit, Institute for Cancer Research, Prevention and Clinical Network (ISPRO), Florence, Italy
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Alonso-Belmonte C, Montero-Vilchez T, Arias-Santiago S, Buendía-Eisman A. [Translated article] Current State of Skin Cancer Prevention: A Systematic Review. ACTAS DERMO-SIFILIOGRAFICAS 2022. [DOI: 10.1016/j.ad.2022.04.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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Situación actual de la prevención del cáncer de piel: una revisión sistemática. ACTAS DERMO-SIFILIOGRAFICAS 2022; 113:781-791. [DOI: 10.1016/j.ad.2022.04.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 04/03/2022] [Accepted: 04/12/2022] [Indexed: 11/20/2022] Open
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Diehl K, Thoonen K, Breitbart EW, Pfahlberg AB, Görig T. Sun Protection and Tanning Behaviors in Caregivers: Prevalence, Determinants, and Associations with Children's Behaviors. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19116876. [PMID: 35682459 PMCID: PMC9180203 DOI: 10.3390/ijerph19116876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 06/01/2022] [Accepted: 06/02/2022] [Indexed: 12/03/2022]
Abstract
The association between skin cancer and ultraviolet radiation (UVR) is well established, and sun protection behavior represents an important preventative measure. In children, caregivers play a key role in this regard. The subject of this study was threefold: whether caregivers of 1 to 11 year-old children are more likely to use sun protection measures compared to non-caregivers, whether considering oneself a role model is associated with sun protection behaviors, and whether their sun protection and risk behaviors are related to children’s behaviors. We used data from the 2020 wave of the National Cancer Aid Monitoring (NCAM) comprised of 4000 individuals (including 554 caregivers of at least one child aged 1−10 years) aged 16 to 65 years and living in Germany. Data were collected through telephone interviews between October and December 2020. No significant differences between caregivers and non-caregivers regarding sun protection and risk behaviors were identified (except tanning on vacation). In both groups, sun protection behaviors were deficient. Caregivers who considered themselves role models concerning sun safety were more likely to use sun protection measures (e.g., using sunscreen on the face: OR = 5.08, p < 0.001). In addition, caregivers’ sun protection behaviors were positively associated with children’s behaviors. Caregivers being highly protected against UVR were more likely to report the use of different measures by/in the child (mean = 4.03), compared to caregivers with medium (3.41) and low (2.97, p < 0.001) protection levels. However, we also found that caregivers’ risk behavior was associated with children’s reported risk behavior. For future prevention, it might be worth focusing on the aspect of caregivers serving as role models. A comprehensive public-health strategy is needed, including key figures such as pediatricians to prevent today’s children from developing skin cancer in later life.
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Affiliation(s)
- Katharina Diehl
- Department of Medical Informatics, Biometry and Epidemiology, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), 91054 Erlangen, Germany; (A.B.P.); (T.G.)
- Correspondence:
| | - Karlijn Thoonen
- Centre for Environmental Safety and Security, National Institute for Public Health and the Environment, 3721 MA Bilthoven, The Netherlands;
| | | | - Annette B. Pfahlberg
- Department of Medical Informatics, Biometry and Epidemiology, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), 91054 Erlangen, Germany; (A.B.P.); (T.G.)
| | - Tatiana Görig
- Department of Medical Informatics, Biometry and Epidemiology, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), 91054 Erlangen, Germany; (A.B.P.); (T.G.)
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Keurentjes AJ, Kezic S, Rustemeyer T, Hulshof CTJ, van der Molen HF. Stimulating Sunscreen Use Among Outdoor Construction Workers: A Pilot Study. Front Public Health 2022; 10:857553. [PMID: 35433569 PMCID: PMC9010717 DOI: 10.3389/fpubh.2022.857553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Accepted: 02/22/2022] [Indexed: 11/13/2022] Open
Abstract
Background Outdoor workers (OW) receive a higher dose of ultraviolet radiation (UVR) compared to indoor workers (IW) which increases the risk of non-melanoma skin cancer (NMSC). Regular sunscreen use reduces the NMSC risk, however, adequate sun-safety behavior among OW is poor. The main objective was to conduct method- and intervention-related elements of a future intervention trial among OW, based on providing sunscreen and assessing sunscreen use on group- and individual level. Methods This pilot study was conducted at a construction site in the Netherlands from May-August 2021. Nine dispensers with sunscreen (SPF 50+) were installed at the worksite. OW (n = 67) were invited to complete two (cross-sectional) questionnaires on sun-safety behavior, before and after providing sunscreen. Stratum corneum (SC) samples for the assessment of UV-biomarkers were collected from the forehead and behind the ear from 15 OW and 15 IW. The feasibility of the following elements was investigated: recruitment, (loss to) follow-up, outcome measures, data collection, and acceptability of the intervention. Results The first questionnaire was completed by 27 OW, the second by 17 OW. More than 75 percent of the OW were aware of the risks of sun exposure, and 63% (n = 17) found sunscreen use during worktime important. The proportion of OW never applying sunscreen in the past month was 44.4% (n = 12) before, and 35.3% (n = 6) after providing sunscreen. A majority of OW (59.3%, n = 16) found sunscreen provision encouraging for sunscreen use, the dispensers easy to use (64.7%, n = 17) and placed in practical spots (58.8%, n = 18). Collecting SC-samples was fast and easy, and several UV-biomarkers showed higher levels for sun-exposed compared to less exposed body parts. There was no significant difference in UV-biomarker levels between OW and IW. Conclusions This pilot study revealed low sunscreen use among OW despite providing sunscreen, overall satisfaction with the sunscreen, and the sufficient awareness of the risks of UVR-exposure. Collecting SC-samples at the workplace is feasible and several UV-biomarkers showed to be promising in assessing UVR-exposure. The low participation rate and high loss to follow-up poses a challenge for future intervention studies.
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Affiliation(s)
- Anne J. Keurentjes
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
- *Correspondence: Anne J. Keurentjes
| | - Sanja Kezic
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Thomas Rustemeyer
- Department of Dermatology and Allergology, Amsterdam University Medical Centers (UMC), Amsterdam, Netherlands
| | - Carel T. J. Hulshof
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Henk F. van der Molen
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
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Perez M, Abisaad JA, Rojas KD, Marchetti MA, Jaimes N. Skin Cancer: Primary, Secondary, and Tertiary Prevention. Part I. J Am Acad Dermatol 2022; 87:255-268. [DOI: 10.1016/j.jaad.2021.12.066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 12/03/2021] [Accepted: 12/15/2021] [Indexed: 10/19/2022]
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8
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Boothby-Shoemaker WT, Mohammad TF, Ozog DM, Lim HW. Photoprotection by clothing: A review. PHOTODERMATOLOGY, PHOTOIMMUNOLOGY & PHOTOMEDICINE 2022; 38:478-488. [PMID: 35073443 DOI: 10.1111/phpp.12776] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 12/19/2021] [Accepted: 01/13/2022] [Indexed: 12/18/2022]
Abstract
Clothing is recognized by leading health agencies as a primary method to protect against the harmful effects of photodamage caused by ultraviolet (UV) radiation and visible light. The photoprotective capacity of clothing is commonly measured as the ultraviolet protective factor (UPF). While the technology driving photoprotective clothing has been well-established, there continues to be efforts to discover new materials to improve the UPF of clothing. Here, we show increased Google searches for photoprotective clothing over the last decade, suggesting a high level of public interest in photoprotective clothing. In addition, we investigate the frequency of UPF-graded photoprotective clothing sold by large retail stores featured in Fortune 1000. We review factors that alter the UPF of clothing and describe emerging textile technologies used to increase clothing's photoprotective capacity. Finally, we compare how photoprotective clothing is regulated among different countries, the importance of photoprotective clothing in occupational health, and research in visible light and clothing photoprotection.
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Affiliation(s)
- Wyatt T Boothby-Shoemaker
- Photomedicine and Photobiology Unit, Henry Ford Health System, Detroit, Michigan, USA.,Michigan State University College of Human Medicine, East Lansing, Michigan, USA
| | - Tasneem F Mohammad
- Photomedicine and Photobiology Unit, Henry Ford Health System, Detroit, Michigan, USA
| | - David M Ozog
- Photomedicine and Photobiology Unit, Henry Ford Health System, Detroit, Michigan, USA
| | - Henry W Lim
- Photomedicine and Photobiology Unit, Henry Ford Health System, Detroit, Michigan, USA
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Modenese A, Loney T, Rocholl M, Symanzik C, Gobba F, John SM, Straif K, Silva Paulo M. Protocol for a Systematic Review on the Effectiveness of Interventions to Reduce Exposure to Occupational Solar UltraViolet Radiation (UVR) Among Outdoor Workers. Front Public Health 2021; 9:756566. [PMID: 34858932 PMCID: PMC8632259 DOI: 10.3389/fpubh.2021.756566] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 10/22/2021] [Indexed: 01/15/2023] Open
Abstract
Background: Solar UltraViolet Radiation (UVR) is considered the most relevant occupational carcinogenic exposure in terms of the number of workers exposed (i.e., outdoor workers) and UVR-induced skin cancers are among the most frequent types of occupational cancers worldwide. This review aims to collect and evaluate all the available preventive interventions conducted on outdoor workers to reduce their solar UVR related risk, with the final purpose of reducing the burden of occupational skin cancers for outdoor workers. Methods: We will search the following databases for peer-reviewed original research published: MEDLINE (through PubMed), Scopus, and EMBASE. We will include only interventional studies, both randomized and non-randomized, with an adequate comparison group, therefore excluding cross-sectional studies, as well as case-reports/series, reviews, and letters/comments. The systematic review will adhere to the “Preferred Reporting Items for Systematic reviews and Meta-Analyses” (PRISMA) guidelines for reporting systematic reviews. After the literature search, studies to be included will be independently reviewed by two Authors, first based on title and abstract, then based on the full text, according to the inclusion criteria. Conflicts will be solved by a third Author. Two authors will independently extract the required data from included studies and perform quality assessment according to the relevant domain for Risk of Bias assessment proposed by the Cochrane collaboration group. In case of sufficient homogeneity of interventions and outcomes evaluated, results from subgroups of studies will be pooled together in a meta-analysis. Discussion: Following the principles for the evaluation of interventions for cancer prevention established by the International Agency for Research on Cancer, this systematic review will investigate the effectiveness of the interventions, and consequently it will provide reliable indications for the actual reduction of skin cancer incidence in outdoor workers.
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Affiliation(s)
- Alberto Modenese
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena & Reggio Emilia, Modena, Italy
| | - Tom Loney
- College of Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, United Arab Emirates
| | - Marc Rocholl
- Department of Dermatology, Environmental Medicine and Health Theory, Institute for Health Research and Education, University of Osnabrück, Osnabrück, Germany.,Institute for Interdisciplinary Dermatological Prevention and Rehabilitation (iDerm), University of Osnabrück, Osnabrück, Germany
| | - Cara Symanzik
- Department of Dermatology, Environmental Medicine and Health Theory, Institute for Health Research and Education, University of Osnabrück, Osnabrück, Germany.,Institute for Interdisciplinary Dermatological Prevention and Rehabilitation (iDerm), University of Osnabrück, Osnabrück, Germany
| | - Fabriziomaria Gobba
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena & Reggio Emilia, Modena, Italy
| | - Swen Malte John
- Department of Dermatology, Environmental Medicine and Health Theory, Institute for Health Research and Education, University of Osnabrück, Osnabrück, Germany.,Institute for Interdisciplinary Dermatological Prevention and Rehabilitation (iDerm), University of Osnabrück, Osnabrück, Germany
| | - Kurt Straif
- Instituto Salud Global (ISGlobal), Barcelona, Spain.,Department of Biology, Boston College, Chestnut Hill, MA, United States
| | - Marilia Silva Paulo
- Institute of Public Health - College of Medicine, United Arab Emirates University, Al Ain, United Arab Emirates
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Keurentjes AJ, Jakasa I, van Dijk A, van Putten E, Brans R, John SM, Rustemeyer T, van der Molen HF, Kezic S. Stratum corneum biomarkers after in vivo repeated exposure to sub-erythemal dosages of ultraviolet radiation in unprotected and sunscreen (SPF 50+) protected skin. PHOTODERMATOLOGY PHOTOIMMUNOLOGY & PHOTOMEDICINE 2021; 38:60-68. [PMID: 34278599 DOI: 10.1111/phpp.12717] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 06/16/2021] [Accepted: 07/04/2021] [Indexed: 02/06/2023]
Abstract
BACKGROUND There is a need for non-invasive biomarkers to assess in vivo efficacy of protective measures aiming at reducing ultraviolet radiation (UVR) exposure. Stratum corneum (SC) biomarkers showed to be promising markers for internal UVR dose and immune response. PURPOSE To establish a dose-response relationship for SC biomarkers and explore their suitability for in vivo assessment of the blocking effect of two sunscreens with a high sun protection factor (SPF) (50+). METHODS Twelve volunteers were exposed to a broad-spectrum UVB (280-320 nm), five times a week, during one week. Unprotected back skin was irradiated with 0.24, 0.48, 0.72 and 1.44 standard erythema dose (SED) and sunscreen-protected skin with 3.6 SED. SC samples for determination of the relative amount of cis-urocanic acid (cUCA) and thirteen immunological makers including cytokines and matrix metalloproteinases (MMP) were collected after each irradiation. RESULTS cUCA sharply increased after the first irradiation in a dose-dependent fashion. However, it levelled-off after subsequent exposures and reached a plateau for the highest UV-dose after the third irradiation. None of the immunological markers showed dose-dependency. However, MMP-9, IL-1β and CCL27 increased gradually from baseline during repetitive exposures to the highest UV-dose. Assessed from cUCA, both sunscreens blocked >98% of the applied UV-dose. CONCLUSIONS cUCA is a sensitive, non-invasive marker of the internal UVR dose enabling in vivo assessment of the blocking effect of high SPF sunscreens in the UVB-region. Immunological SC markers show low sensitivity in detecting immune response at sub-erythemal UVR dosages, suggesting they might be suitable only at higher and/or repetitive UVR exposure.
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Affiliation(s)
- Anne Josephine Keurentjes
- Department of Public and Occupational Health, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health research institute, Amsterdam, The Netherlands
| | - Ivone Jakasa
- Department of Chemistry and Biochemistry, Laboratory for Analytical Chemistry, Faculty of Food Technology and Biotechnology, University of Zagreb, Zagreb, Croatia
| | - Arjan van Dijk
- Center for Environmental Safety and Security, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - Edith van Putten
- Center for Environmental Safety and Security, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - Richard Brans
- Department of Dermatology, Environmental Medicine and Health Theory, University of Osnabrück, Osnabrück, Germany.,Institute for Interdisciplinary Dermatological Prevention and Rehabilitation (iDerm) at the University of Osnabrück, Osnabrück, Germany
| | - Swen Malte John
- Department of Dermatology, Environmental Medicine and Health Theory, University of Osnabrück, Osnabrück, Germany.,Institute for Interdisciplinary Dermatological Prevention and Rehabilitation (iDerm) at the University of Osnabrück, Osnabrück, Germany
| | - Thomas Rustemeyer
- Department of Dermatology and Allergology, Amsterdam UMC, Amsterdam, The Netherlands
| | - Henk F van der Molen
- Department of Public and Occupational Health, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health research institute, Amsterdam, The Netherlands
| | - Sanja Kezic
- Department of Public and Occupational Health, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health research institute, Amsterdam, The Netherlands
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Determinants of Sailors' Protective Behaviors in Fishing Spots against the Risks of Sunlight and Skin Cancer: A Qualitative Study in Iran. J Skin Cancer 2021; 2021:9954946. [PMID: 34327024 PMCID: PMC8310437 DOI: 10.1155/2021/9954946] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Accepted: 07/13/2021] [Indexed: 11/18/2022] Open
Abstract
Introduction The growing rate of nonmelanoma skin cancer (NMSC) and melanoma has been a great challenge for global health system. The present research aims to determine sailors' protective behaviors against the risks of sunlight and skin cancer in Iran. Materials and Methods The present research was qualitative in type, and its data were collected from August to December 2019. To this aim, 23 participants were recruited with whom semistructured interviews were held. The data collection continued until data saturation, and the interviews were coded in MAXQDA 10. Conventional content analysis was used to analyze the qualitative data. Results Analysis of sailors' perceptions and experiences revealed 7 categories: protective behaviors, hard personal and familial conditions, social interactions, poor social support, feeling of satisfaction, self-care, and fear. Conclusion Sailors are prone to skin cancer due to their specific work conditions. Perceptions and determinants of skin cancer and protective behaviors against sunlight were identified among sailors. Promotion of protective behaviors and beliefs that impeded preventive behaviors are among issues that require special attention.
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Rocholl M, Weinert P, Bielfeldt S, Laing S, Wilhelm KP, Ulrich C, John SM. New methods for assessing secondary performance attributes of sunscreens suitable for professional outdoor work. J Occup Med Toxicol 2021; 16:25. [PMID: 34225747 PMCID: PMC8256554 DOI: 10.1186/s12995-021-00314-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 06/23/2021] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Outdoor workers (OW) are highly exposed to solar ultraviolet radiation (UVR) and thus at increased risk for developing skin cancer. An essential part of an overall strategy to reduce workplace UVR-exposure to OW's skin is the usage of sunscreens. However, compliance with regular sunscreen usage seems to be low, as products are usually designed for recreational sun exposure and thus do not meet the requirements of physically active OW. To date, no standardized test procedures assess the suitability of sunscreens for professional use. The aim of this pilot study was to develop standardized methods of testing secondary performance attributes (PA) to represent real-life working conditions of outdoor work. METHODS Ten sunscreen products, carefully selected after a detailed market survey of all relevant producers available on the German market, were evaluated regarding their suitability for professional outdoor work on 24 healthy volunteers in a newly designed test procedure. In addition to three standardized efficacy characteristics, i.e., sun protection factor, water-resistance, and UVA protection, we evaluated each PA involving parameters typically associated with outdoor workplaces. RESULTS We developed standardized methods for objectifying the suitability of sunscreen products for professional outdoor work. The test procedures used are well feasible and appropriate for testing the PA because they represent practical working conditions in detail - although the degree of discriminability of single test methods varied. The claimed sun protection factor (SPF) of the products was confirmed; bio-stability of the SPF after physical activity was achieved in most cases. While most products hardly irritate the eyes and are quickly absorbed, the evaluation of the subjective skin feeling and non-slip grip is inconsistent. CONCLUSIONS In this pilot study, for the first time secondary PA are defined and examined. Although further objectification of the PA assessment as well as the establishment of minimum standards should be sought, the new methods could already complement the so far mandatory labels and in this way provide a significant impetus for the current scientific and political focus on the improvement of occupational health in highly UVR-exposed OW.
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Affiliation(s)
- Marc Rocholl
- Institute for Health Research and Education, Department of Dermatology, Environmental Medicine and Health Theory, University of Osnabrück, Am Finkenhügel 7a, 49076, Osnabrück, Germany. .,Institute for Interdisciplinary Dermatological Prevention and Rehabilitation (iDerm) at the University of Osnabrück, Am Finkenhügel 7a, 49076, Osnabrück, Germany.
| | - Patricia Weinert
- Institute for Interdisciplinary Dermatological Prevention and Rehabilitation (iDerm) at the University of Osnabrück, Am Finkenhügel 7a, 49076, Osnabrück, Germany
| | - Stephan Bielfeldt
- proDERM Institute of Applied Dermatological Research GmbH, Kiebitzweg 2, 22869, Schenefeld, Hamburg, Germany
| | - Sabrina Laing
- proDERM Institute of Applied Dermatological Research GmbH, Kiebitzweg 2, 22869, Schenefeld, Hamburg, Germany
| | - Klaus Peter Wilhelm
- proDERM Institute of Applied Dermatological Research GmbH, Kiebitzweg 2, 22869, Schenefeld, Hamburg, Germany
| | - Claas Ulrich
- Department of Dermatology and Allergy, Skin Cancer Center, Charité-Universitätsmedizin, Charitéplatz 1, 10117, Berlin, Germany
| | - Swen Malte John
- Institute for Health Research and Education, Department of Dermatology, Environmental Medicine and Health Theory, University of Osnabrück, Am Finkenhügel 7a, 49076, Osnabrück, Germany.,Institute for Interdisciplinary Dermatological Prevention and Rehabilitation (iDerm) at the University of Osnabrück, Am Finkenhügel 7a, 49076, Osnabrück, Germany
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Keurentjes AJ, Kezic S, Rustemeyer T, Hulshof CTJ, van der Molen HF. Protection Against Solar Ultraviolet Radiation in Outdoor Construction Workers: Study Protocol for a Non-randomized Controlled Intervention Study. Front Public Health 2021; 9:602933. [PMID: 33748058 PMCID: PMC7969508 DOI: 10.3389/fpubh.2021.602933] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Accepted: 02/10/2021] [Indexed: 01/18/2023] Open
Abstract
Introduction: Non-melanoma skin cancer (NMSC) incidence is increasing, and occupational solar exposure contributes greatly to the overall lifetime ultraviolet radiation (UVR) dose. This is reflected in an excess risk of NMSC showing up to three-fold increase in outdoor workers. Risk of NMSC can be reduced if appropriate measures to reduce UVR-exposure are taken. Regular use of sunscreens showed reduced risk of NMSC. However, sun-safety behavior in outdoor workers is poor. The objective of this study is to investigate the effectiveness of an intervention aiming at increasing sunscreen use by construction workers. Methods: This non-randomized controlled intervention study is comprised of two intervention and two control groups recruited at four different construction sites in the Netherlands. The study population comprises ~200 construction workers, aged 18 years or older, followed during 12 weeks. The intervention consists of providing dispensers with sunscreens (SPF 50+) at construction sites and regular feedback on the application achieved by continuous electronic monitoring. All groups will receive basic information on UV-exposure and skin protection. Stratum corneum (SC) samples will be collected for measurement of biomarkers to assess internal UV-dose. External UV-dose will be assessed by personal UV-sensors worn by the workers during work-shifts in both groups. To detect presence of actinic keratosis (AK) or NMSC, a skin check of body parts exposed to the sun will be performed at the end of the study. The effect of the intervention will be assessed from data on self-reported sunscreen use by means of questionnaires collected on baseline and after 12 weeks of intervention (primary outcome). Levels of SC biomarkers of internal UV-dose, external UV-dose, number of sunburn episodes, and prevalence of NMSC including AK will be assessed as secondary outcomes. The electronically monitored sunscreen consumption will be assessed as process outcome. Discussion: This study is intended to provide evidence of the effectiveness of a technology-driven intervention to increase sunscreen use in outdoor construction workers. Furthermore, it will increase insight in the UV-protective behavior, external and internal UV-exposure, and the prevalence of NMSC, including AK, in construction workers. Trial Registration: The Netherlands Trial Register (NTR): NL8462 Registered on March 19, 2020.
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Affiliation(s)
- Anne J Keurentjes
- Amsterdam University Medical Centers, University of Amsterdam, Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam, Netherlands
| | - Sanja Kezic
- Amsterdam University Medical Centers, University of Amsterdam, Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam, Netherlands
| | - Thomas Rustemeyer
- Department of Dermatology and Allergology, Amsterdam University Medical Centers, Amsterdam, Netherlands
| | - Carel T J Hulshof
- Amsterdam University Medical Centers, University of Amsterdam, Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam, Netherlands
| | - Henk F van der Molen
- Amsterdam University Medical Centers, University of Amsterdam, Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam, Netherlands
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Rydz E, Harper A, Leong B, Arrandale VH, Kalia S, Forsman-Phillips L, Holness DL, Tenkate T, Peters CE. Sun Protection Use at Work and Leisure by Outdoor Workers in Alberta, Canada. J Occup Environ Med 2021; 63:e138-e144. [PMID: 33395172 DOI: 10.1097/jom.0000000000002133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To assess the prevalence and determinants of sun protection behaviours among outdoors workers at work and leisure in Alberta, Canada. METHODS We collected outdoor workers' demographics, skin cancer risk factors, job information, and sun habits at work and leisure using self-completed questionnaires. For both settings, we compared use of specific behaviours and modelled determinants of sun protection behaviour scores. RESULTS At work, wearing a sleeved shirt (81% often/always) and hat (73%) were most prevalent, while seeking shade (12%) and applying sunscreen (36%) were least prevalent. Workers had higher sun protection scores at work than leisure. Hours spent outdoors was a strong determinant for both models. Additional leisure model predictors were eye colour, sex, skin type, and job group. CONCLUSIONS Differences in behaviours across settings were observed and should be considered when developing solar UVR exposure reduction initiatives.
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Affiliation(s)
- Ela Rydz
- CAREX Canada, Simon Fraser University, Vancouver, BC, Canada (Ms Rydz, Ms Forsman-Phillips, Dr Peters); Cancer Epidemiology and Prevention Research, Cancer Control Alberta, Alberta Health Services, Calgary, AB, Canada (Mr Harper, Mr Leong, Dr Peters); Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada (Dr Arrandale, Dr Holness); Occupational Cancer Research Centre, Ontario Health, Toronto, ON, Canada (Dr Arrandale); Department of Dermatology and Skin Science, University of British Columbia, Vancouver, BC, Canada (Dr Kalia); Photomedicine Institute and Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research Institute, Vancouver, BC, Canada (Dr Kalia); Departments of Cancer Control, BC Cancer, and Division of Dermatology, BC Children's Hospital, Provincial Health Services Authority, Vancouver, BC, Canada (Dr Kalia); Department of Medicine, University of Toronto, Toronto, ON, Canada (Dr Holness); Department of Medicine and MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada (Dr Holness); School of Occupational and Public Health, Ryerson University, Toronto, ON, Canada (Dr Tenkate); Department of Oncology, Cumming School of Medicine, University of Calgary, Health Sciences Centre - Foothills Campus, Calgary, AB, Canada (Dr Peters)
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Schielein MC, Tizek L, Ziehfreund S, Sommer R, Biedermann T, Zink A. Stigmatisierung durch Haarausfall – eine systematische Literaturübersicht. J Dtsch Dermatol Ges 2020; 18:1357-1369. [PMID: 33373136 DOI: 10.1111/ddg.14234_g] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Accepted: 04/07/2020] [Indexed: 12/01/2022]
Affiliation(s)
- Maximilian Christian Schielein
- Klinik und Poliklinik für Dermatologie und Allergologie am Biederstein, Fakultät für Medizin, Technische Universität München
| | - Linda Tizek
- Klinik und Poliklinik für Dermatologie und Allergologie am Biederstein, Fakultät für Medizin, Technische Universität München
| | - Stefanie Ziehfreund
- Klinik und Poliklinik für Dermatologie und Allergologie am Biederstein, Fakultät für Medizin, Technische Universität München
| | - Rachel Sommer
- Institut für Versorgungsforschung in der Dermatologie und bei Pflegeberufen (IVDP), Universitätsklinikum Hamburg-Eppendorf (UKE), Hamburg
| | - Tilo Biedermann
- Klinik und Poliklinik für Dermatologie und Allergologie am Biederstein, Fakultät für Medizin, Technische Universität München
| | - Alexander Zink
- Klinik und Poliklinik für Dermatologie und Allergologie am Biederstein, Fakultät für Medizin, Technische Universität München
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16
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Schielein MC, Tizek L, Ziehfreund S, Sommer R, Biedermann T, Zink A. Stigmatization caused by hair loss - a systematic literature review. J Dtsch Dermatol Ges 2020; 18:1357-1368. [PMID: 33015951 DOI: 10.1111/ddg.14234] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Accepted: 04/07/2020] [Indexed: 11/28/2022]
Abstract
Hair loss is a symptom that can cause stigmatization and severe impairment of quality of life. The aim of this systematic review was to evaluate the literature on stigmatization of hair loss. Using predefined MeSH terms and keywords, a systematic search was performed in the databases MEDLINE (PubMed), EMBASE, PsycINFO and PsycNET. No time restriction was chosen (last update: May 07, 2019; PROSPERO registration number: CRD42019122966). A total of 98 studies were identified, of which eleven were selected for inclusion in this work. The Hairdex, a questionnaire on disease-specific quality of life, was the most frequently used instrument for the quantitative assessment of stigma. The studies were highly heterogeneous and values for stigmatization of androgenetic alopecia varied widely. However, regardless of the pathogenesis, patients with hair loss often suffer from stigmatization which limits their quality of life. Stigmatization of people with visible skin lesions has often been neglected in clinical practice and in daily contact with affected individuals. Studies that specifically address the stigma of hair loss are rare. Further studies are needed to achieve comparability within pathogeneses as well as with other visible dermatoses in order to better understand the enormous psychosocial burden of hair loss.
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Affiliation(s)
| | - Linda Tizek
- Department of Dermatology and Allergology, Faculty of Medicine, Technical University of Munich, Munich, Germany
| | - Stefanie Ziehfreund
- Department of Dermatology and Allergology, Faculty of Medicine, Technical University of Munich, Munich, Germany
| | - Rachel Sommer
- Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Tilo Biedermann
- Department of Dermatology and Allergology, Faculty of Medicine, Technical University of Munich, Munich, Germany
| | - Alexander Zink
- Department of Dermatology and Allergology, Faculty of Medicine, Technical University of Munich, Munich, Germany
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17
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Snyder A, Valdebran M, Terrero D, Amber KT, Kelly KM. Solar Ultraviolet Exposure in Individuals Who Perform Outdoor Sport Activities. SPORTS MEDICINE - OPEN 2020; 6:42. [PMID: 32880767 PMCID: PMC7471243 DOI: 10.1186/s40798-020-00272-9] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Accepted: 08/13/2020] [Indexed: 12/18/2022]
Abstract
BACKGROUND Skin cancer is the most common cancer in the USA. Therefore, it is important to review the contribution of ultraviolet radiation (UVR) exposure to skin cancer in individuals with the highest risk. Documenting the relationship between outdoor sports solar ultraviolet exposure and their risk of skin cancer along with appropriate risk mitigation strategies can help inform clinicians of practical information for counseling sun protective behaviors in this population. METHODS We conducted a review of the current evidence using PubMed to answer the following research questions: (1) How is ultraviolet radiation measured? (2) What is the modern utility of the ultraviolet index in modifying recreational sun protection behaviors? (3) What is the risk of developing skin cancer for outdoor sport participants? (4) What is the prevalence of skin cancer in sport participants? and (5) Is the number of nevi and solar lentigines elevated in outdoor sport participants? RESULTS Based on the literature, individuals who practice outdoor sport-related activities receive high ultraviolet radiation exposure, have a high risk for skin cancer, have a high prevalence for pigmented lesions, and may benefit from electronic sun protection educational interventions. CONCLUSIONS Individuals who practice outdoor sports experience substantially higher ultraviolet radiation exposure, routinely exceed the recommended exposure limits, and are at a higher risk of developing skin cancer. Therefore, those who are frequently engaged in outdoor leisure activities should be coached about efficient sun protective practices and relevant mobile technologies that may facilitate adherence.
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Affiliation(s)
- Alan Snyder
- College of Graduate Studies, Medical University of South Carolina, Charleston, SC, USA.
| | - Manuel Valdebran
- Division of Pediatric Dermatology, Department of Dermatology, Medical University of South Carolina, Charleston, SC, USA
| | - David Terrero
- College of Pharmacy and Pharmaceutical Sciences, University of Toledo, Toledo, OH, USA
| | - Kyle T Amber
- Department of Dermatology, University of Illinois at Chicago, Chicago, IL, USA
| | - Kristen M Kelly
- Department of Dermatology, University of California, Irvine, Irvine, CA, USA
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18
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Keurentjes AJ, Jakasa I, John SM, Ulrich C, Bekkenk MW, Rustemeyer T, Kezic S. Tape stripping the stratum corneum for biomarkers of ultraviolet radiation exposure at sub-erythemal dosages: a study in human volunteers. Biomarkers 2020; 25:490-497. [PMID: 32657162 DOI: 10.1080/1354750x.2020.1792551] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
PURPOSE Prevalence of skin cancer is rapidly increasing. There is a need for non-invasive biomarkers to assess efficacy of prevention strategies aiming at reduction of exposure to ultraviolet radiation (UVR). Recently, stratum corneum (SC) biomarkers were applied in various inflammatory skin diseases. Here, we explore their suitability as candidate biomarkers for UVR. MATERIAL AND METHODS Twelve volunteers were exposed to a UVB-dose of 0.72 SED, three times a week, during three weeks. As candidate biomarkers, cis-isomers of urocanic acid (cUCA) and 25 immunological mediators were measured in the SC. RESULTS Eight immunological markers significantly changed from baseline. Of them, IL-1RA/IL-1α and a placental growth factor (PIGF) showed gradual changes during UVR-exposure (p < 0.01 for linear trend). cUCA increased sharply already after the first exposure, however, reached a plateau in the second week. CONCLUSIONS SC represents a promising, non-invasive alternative to skin biopsy in detecting UVR-induced changes. cUCA is the marker of choice for assessment of single UVR-exposure; however, it is less suitable for cumulative UVR-dose. Immunological markers including IL-1RA/IL-1α and PIGF showed gradual changes, and therefore are convenient for monitoring chronic UVR-exposure. These candidate biomarkers might facilitate assessment of the efficacy of preventive measures in the workplace and general population.
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Affiliation(s)
- Anne J Keurentjes
- Coronel Institute of Occupational Health, Amsterdam University Medical Centers, Location AMC, Amsterdam, The Netherlands
| | - Ivone Jakasa
- Department of Chemistry and Biochemistry, Faculty of Food Technology and Biotechnology, Laboratory for Analytical Chemistry, University of Zagreb, Zagreb, Croatia
| | - Swen M John
- Department of Dermatology, Environmental Medicine, University of Osnabrueck, Osnabrueck, Germany.,Institute for Interdisciplinary Dermatological Prevention and Rehabilitation (iDerm), Lower-Saxonian Institute of Occupational Dermatology (NIB), University of Osnabrück, Osnabrueck, Germany
| | - Claas Ulrich
- Skin Cancer Centre/HTCC, Hautklinik der Charité, Berlin, Germany
| | - Marcel W Bekkenk
- Department of Dermatology, Amsterdam University Medical Centers, Location AMC, Amsterdam, The Netherlands
| | - Thomas Rustemeyer
- Department of Dermatology and Allergology, Amsterdam University Medical Centers, Location AMC, Amsterdam, The Netherlands
| | - Sanja Kezic
- Coronel Institute of Occupational Health, Amsterdam University Medical Centers, Location AMC, Amsterdam, The Netherlands
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19
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[Effects of an unconventional skin cancer prevention campaign : Impacts on the sun protection behavior of outdoor workers]. Hautarzt 2020; 71:455-462. [PMID: 32206841 DOI: 10.1007/s00105-020-04574-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND The disease burden of actinic keratoses and keratinocyte carcinoma can be reduced by primary and secondary prevention. However, these measures are often poorly received, especially among the high-risk group of outdoor workers. OBJECTIVES The aim of this follow-up study was to investigate whether an improvement in sun protection and awareness of skin changes could be observed among the study population, especially outdoor workers, one year after a prevention campaign focusing on this topic. MATERIALS AND METHODS In 2017, all participants who initially participated in a study at the Bavarian Central Agricultural Festival 2016 and agreed to participate in the follow-up study were contacted by mail and received the same questionnaire and evaluation questions regarding possible behavioral changes. RESULTS A total of 400 people took part in the follow-up study (response rate 52.8%). Of the 240 outdoor workers, 45.0% said they were more conscious of protecting themselves from the sun and 68.8% said they were more aware of skin changes. About 85.0% of outdoor workers indicated that they would consult a dermatologist earlier and 65.8% desired further prevention campaigns regarding skin cancer and sun protection. CONCLUSION Overall, the majority of participants reported that they had improved sun protection behavior and awareness of skin changes after the intervention. Based on the participants' self-disclosure, especially outdoor workers tended to use sun protection measure more frequently. These findings underline the importance of target group-oriented awareness and prevention campaigns to reduce the burden of skin cancer.
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20
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Weber A, Tizek L, Biedermann T, Zink A. High-risk body sites for actinic keratosis in outdoor and indoor workers: A retrospective review. J Am Acad Dermatol 2020; 83:655-657. [PMID: 32561289 DOI: 10.1016/j.jaad.2019.12.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Revised: 11/28/2019] [Accepted: 12/06/2019] [Indexed: 12/30/2022]
Affiliation(s)
- Annemarie Weber
- Institute for Medical Information Processing, Biometry and Epidemiology-IBE, LMU Munich, Munich, Germany; Pettenkofer School of Public Health, Munich, Germany; Department of Dermatology and Allergy, School of Medicine, Technical University of Munich, Munich, Germany
| | - Linda Tizek
- Institute for Medical Information Processing, Biometry and Epidemiology-IBE, LMU Munich, Munich, Germany; Department of Dermatology and Allergy, School of Medicine, Technical University of Munich, Munich, Germany
| | - Tilo Biedermann
- Department of Dermatology and Allergy, School of Medicine, Technical University of Munich, Munich, Germany
| | - Alexander Zink
- Department of Dermatology and Allergy, School of Medicine, Technical University of Munich, Munich, Germany.
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21
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Tizek L, Schielein MC, Berger U, Ege MJ, Schneider S, Zink A. Skin cancer risk and shade: comparing the risk of foresters with other outdoor workers. J Eur Acad Dermatol Venereol 2020; 34:2526-2533. [PMID: 32365247 DOI: 10.1111/jdv.16560] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Accepted: 04/07/2020] [Indexed: 12/20/2022]
Abstract
BACKGROUND Keratinocyte carcinoma (KC) is an increasingly important public health problem with an especially high prevalence in outdoor workers. In contrast to other occupations, foresters spend most of their outdoor time under the shade of trees. OBJECTIVES We aimed to compare the unique sun exposure patterns and sun protection behaviour of foresters with those of other outdoor workers and their relation to the KC risk. METHODS In July 2018, a cross-sectional study was conducted at an international forestry fair using a questionnaire about health awareness and skin cancer screening by dermatologists to assess the prevalence of KC. RESULTS A total of 591 participants (78.7% male; mean age 46.8 ± 16.2 years) including 193 foresters were enrolled. Of all foresters, 72% experienced sunburns (solar erythema) within the past year and 50% of them experienced the worst sunburn during work. Foresters were most likely to often/always wear protective clothes (29.0%) but were least likely to often/always avoid midday sun (23.8%) and stay in the shade (31.1%). Having an outdoor profession or spending hours outside for leisure was negatively associated with sun protection. Skin examination revealed an overall KC prevalence of 16.7%, with 16.5% of foresters being affected. CONCLUSION Despite being protected by trees, the risk of KC for foresters is comparable to that of other professional groups. Shade alone may not provide sufficient protection. Additional sun protection measures are necessary.
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Affiliation(s)
- L Tizek
- Department of Dermatology and Allergy, Technical University of Munich, School of Medicine, Munich, Germany.,Institute for Medical Information Processing, Biometry and Epidemiology (IBE), Ludwig-Maximilians University Munich, Munich, Germany
| | - M C Schielein
- Department of Dermatology and Allergy, Technical University of Munich, School of Medicine, Munich, Germany.,Institute for Medical Information Processing, Biometry and Epidemiology (IBE), Ludwig-Maximilians University Munich, Munich, Germany
| | - U Berger
- Institute for Medical Information Processing, Biometry and Epidemiology (IBE), Ludwig-Maximilians University Munich, Munich, Germany
| | - M J Ege
- Dr. von Hauner Children's Hospital, Member of the German Center of Lung Research (DZL), Ludwig-Maximilians University Munich, Munich, Germany
| | - S Schneider
- Medical Faculty Mannheim, Mannheim Institute of Public Health, Social and Preventive Medicine (MIPH), Heidelberg University, Mannheim, Germany
| | - A Zink
- Department of Dermatology and Allergy, Technical University of Munich, School of Medicine, Munich, Germany
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Chambergo-Michilot D, Tellez WA, Becerra-Chauca N, Zafra-Tanaka JH, Taype-Rondan A. Text message reminders for improving sun protection habits: A systematic review. PLoS One 2020; 15:e0233220. [PMID: 32428021 PMCID: PMC7236986 DOI: 10.1371/journal.pone.0233220] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Accepted: 04/30/2020] [Indexed: 12/11/2022] Open
Abstract
Background Excessive exposure to ultraviolet radiation increases the risk of skin cancer and other conditions. SMS text reminders may be a useful tool to improve sun protection habits due to its massive reach, low cost, and accessibility. Objective To perform a systematic review of randomized controlled trials (RCTs) that evaluated the effects of SMS text reminders in promoting sun protection habits. Methods We performed a systematic search in PubMed, Central Cochrane Library, and Scopus; following the PRISMA recommendations to perform systematic reviews. We included RCTs published up to December 2018, which evaluated the benefits and harms of SMS text reminders to improve sun protection habits. Random-effects meta-analyses were performed whenever possible. The certainty of the evidence was assessed for RCTs estimates using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology. The study protocol was registered in PROSPERO (CRD42018091661). Results Five RCTs were included in this review. When pooled, the studies found no effect of SMS text reminders in “sunburn anytime during follow-up” (two studies, risk ratio: 0.93; 95% confidence interval: 0.83–1.05). Contradictory results were obtained for sunscreen use (three RCTs) and sun protection habits (two RCTs), however, they could not be meta-analyzed because outcomes were measured differently across studies. The certainty of the evidence was very low for these three outcomes according to GRADE methodology. Conclusions RCTs that assessed effects of SMS text reminders did not find a significant benefit on objective outcomes, such as having a sunburn, sunscreen use and composite score of sun protection habits. Since certainty of the evidence was very low, future high-quality studies are needed to reach a conclusion regarding the balance of desirable and undesirable outcomes. Protocol registration number PROSPERO (CRD42018091661).
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Affiliation(s)
| | | | - Naysha Becerra-Chauca
- Instituto de Evaluación de Tecnologías en Salud e Investigación—IETSI, EsSalud, Lima, Perú
| | | | - Alvaro Taype-Rondan
- Universidad San Ignacio de Loyola, Unidad de Investigación para la Generación y Síntesis de Evidencias en Salud, Lima, Peru
- * E-mail:
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Al-Qarqaz F, Marji M, Bodoor K, Al ALshiyab D, Muhaidat J, Al Ghamdi S. Awareness about proper use of sunscreen in people of color: A Jordanian-based survey. J Cosmet Dermatol 2020; 19:1131-1136. [PMID: 31468687 DOI: 10.1111/jocd.13120] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Revised: 07/24/2019] [Accepted: 08/01/2019] [Indexed: 11/29/2022]
Abstract
INTRODUCTION The use of sunscreen is an important preventive measure against skin cancer and treatment for other skin conditions. There is evidence pointing to lack awareness and misconceptions regarding use of Sunscreen. This is especially evident in populations with skin of color (POC). METHODS This is a cross-sectional study of 2000 individuals. A structured questionnaire was designed to collect data on general knowledge and use of sunscreen as well as reasons for stopping use of sunscreen. RESULTS The results of this study indicate a clear deficiency in the use and knowledge about sunscreen among Jordanians. Females are using sunscreen more than males. However, the use of sunscreen is inadequate in many aspects including timing of application, frequency of use, and amount used among other things. There is an obvious lack of knowledge about sunscreen as shown by lack of awareness about benefits of use in various times of the year, use in children, use for all skin types, and several misconceptions among other knowledge gaps. Main reasons for stopping sunscreen include side effects, cost, and being not suitable for skin. Awareness about sunscreen can be improved by proper counseling by healthcare professionals and utilization of various media platforms. CONCLUSIONS The use of sunscreen is inadequate in this population of color (POC). Lack of proper counseling, failure to read use instructions can contibute to inadequate use of sunscreen. Risks and benefits of sunscreen should be explained by medical professionals. The media should be more utilized to disseminate such knowledge.
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Affiliation(s)
- Firas Al-Qarqaz
- Department of Dermatology, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Maha Marji
- Department of Dermatology, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Khaldon Bodoor
- Department of Biotechnology and Genetic Engineering, Faculty of Science, Jordan University of Science and Technology, Irbid, Jordan
| | - Diala Al ALshiyab
- Department of Dermatology, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Jihan Muhaidat
- Department of Dermatology, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Saleh Al Ghamdi
- Department of Dermatology, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
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Ludewig M, Rocholl M, John SM, Wilke A. Secondary prevention of UV-induced skin cancer: development and pilot testing of an educational patient counseling approach for individual sun protection as standard procedure of patient care. Int Arch Occup Environ Health 2020; 93:765-777. [PMID: 32162123 PMCID: PMC7320965 DOI: 10.1007/s00420-020-01532-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2019] [Accepted: 02/23/2020] [Indexed: 01/07/2023]
Abstract
Objective To outline the development and pilot testing of a patient counseling approach for individual sun protection for patients in outdoor professions diagnosed with squamous cell carcinoma or multiple actinic keratosis due to solar UV radiation. This is a secondary prevention measure as part of the standard procedure of patient care by the respective statutory accident insurance. Methods Results of guideline-based qualitative interviews with seven outdoor workers and a search of literature formed the basis for the counseling approach, which was compiled in a manual. Interdisciplinary experts (dermatologists and educators) reviewed and consented the final manual. The pilot testing was conducted in consecutive steps (N1 = 36 patients and N1 = 2 counselors; N4 = 12 patients and N4 = 6 counselors). The first two stages of the revised guideline ‘Criteria for Reporting the Development and Evaluation of Complex Interventions in healthcare (CReDECI 2)’ serve as background and structure for presenting the results. Results The ‘counseling approach for individual sun protection (ILB: Individuelle Lichtschutz-Beratung)’ consists of seven general and eight add-on modules. These can be combined and tailored according to the patient’s individual needs. Interactive, educational components (e.g. haptic experiments) are crucial elements of the counseling approach. Conclusions The special requirements of outdoor workers are hardly taken into consideration in Germany, even though the interest for an improved sun protection behavior of some occupational groups is high. The advantage of the presented approach is that the heterogeneous needs of patients can be specifically addressed with its various modules.
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Affiliation(s)
- Michaela Ludewig
- Department of Dermatology, Environmental Medicine and Health Theory, Institute for Health Research and Education, University of Osnabrück, Osnabrück, Germany. .,Institute for Interdisciplinary Prevention and Rehabilitation at the University of Osnabrück, Osnabrück, Germany.
| | - Marc Rocholl
- Department of Dermatology, Environmental Medicine and Health Theory, Institute for Health Research and Education, University of Osnabrück, Osnabrück, Germany.,Institute for Interdisciplinary Prevention and Rehabilitation at the University of Osnabrück, Osnabrück, Germany
| | - Swen Malte John
- Department of Dermatology, Environmental Medicine and Health Theory, Institute for Health Research and Education, University of Osnabrück, Osnabrück, Germany.,Institute for Interdisciplinary Prevention and Rehabilitation at the University of Osnabrück, Osnabrück, Germany
| | - Annika Wilke
- Department of Dermatology, Environmental Medicine and Health Theory, Institute for Health Research and Education, University of Osnabrück, Osnabrück, Germany.,Institute for Interdisciplinary Prevention and Rehabilitation at the University of Osnabrück, Osnabrück, Germany
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Ziehfreund S, Krause J, Rotter M, Biedermann T, Zink A. [Primary and secondary prevention of skin cancer in rural areas : A cross-sectional study in the Bavarian Forest]. Hautarzt 2020; 71:365-373. [PMID: 32157344 DOI: 10.1007/s00105-020-04566-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Skin cancer is the most common malignancy of the fair-skinned population worldwide. To reduce skin cancer's burden primary and secondary prevention are critical. However, various studies indicate an inadequate prevention behavior among rural populations. OBJECTIVE To examine the risk and prevention behavior with respect to skin cancer and to identify subgroups in rural areas with specific need for prevention efforts. MATERIALS AND METHODS In a cross-sectional study carried out in the first quarter of 2017, patients and their accompanying persons (≥18 years) were interviewed on the subject of primary and secondary prevention in waiting rooms of nondermatological medical practices in the Bavarian Forest, Germany. Data were collected using paper-based questionnaires. Associations were calculated using logistic regression models. RESULTS In all, 880 persons (57.7% women, mean age = 49.5 years) were included in the analysis, of whom 53.6% had undergone a skin cancer screening at least once before. Sunscreen was the most frequently used sun protection measure. Male sex and being 18-34 years of age were significantly associated with not using prevention measures (depending on the measure: odds ratio [OR]: 1.4-2.4 and 1.8-3.7, respectively). In addition, not using skin cancer screening was associated with UV exposure more than 6 h daily in summer (OR: 1.8, 95%-CI [confidence interval]: 1.14-2.97). CONCLUSION Future prevention strategies should increasingly focus on young adults, on men and people with high solar UV exposition particularly, to reduce the burden of skin cancer in rural areas.
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Affiliation(s)
- Stefanie Ziehfreund
- Technische Universität München, Fakultät für Medizin, Klinik und Poliklinik für Dermatologie und Allergologie am Biederstein, Biedersteiner Str. 29, 80802, München, Deutschland.
| | - Julia Krause
- Technische Universität München, Fakultät für Medizin, Klinik und Poliklinik für Dermatologie und Allergologie am Biederstein, Biedersteiner Str. 29, 80802, München, Deutschland.,Institut für medizinische Informationsverarbeitung, Biometrie und Epidemiologie, Pettenkofer School of Public Health, Ludwig-Maximilian-Universität München, München, Deutschland
| | - Markus Rotter
- Research Unit of Molecular Epidemiology, Helmholtz Zentrum München, München, Deutschland
| | - Tilo Biedermann
- Technische Universität München, Fakultät für Medizin, Klinik und Poliklinik für Dermatologie und Allergologie am Biederstein, Biedersteiner Str. 29, 80802, München, Deutschland
| | - Alexander Zink
- Technische Universität München, Fakultät für Medizin, Klinik und Poliklinik für Dermatologie und Allergologie am Biederstein, Biedersteiner Str. 29, 80802, München, Deutschland.
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Rocholl M, Ludewig M, John SM, Bitzer EM, Wilke A. Outdoor workers' perceptions of skin cancer risk and attitudes to sun-protective measures: A qualitative study. J Occup Health 2020; 62:e12083. [PMID: 31478315 PMCID: PMC6970388 DOI: 10.1002/1348-9585.12083] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Revised: 07/11/2019] [Accepted: 08/13/2019] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVES Since January 2015, squamous cell carcinoma or multiple actinic keratosis of the skin caused by natural ultraviolet irradiation (UVR) is recognized as occupational disease in Germany. Interventions which improve the sun protection behavior of outdoor workers are urgently needed. When developing preventive interventions, the attitudes of target groups need to be taken into consideration. Therefore, outdoor workers' perceptions and attitudes were investigated. METHODS Seven guided, problem-centered qualitative interviews with healthy male outdoor workers were conducted. A qualitative content analysis was used to analyze the data. RESULTS We found an underestimation of the perceived skin cancer risk in the seven outdoor workers and heterogeneous attitudes toward the usage of sun-protective measures. Participants stated that the feasibility of technical sun-protective measures depends on the size of the working area. While using a headgear seemed common, none of the participants stated using additional neck protection. Wearing long-sleeved shirts and long trousers were considered problematic. The interviews revealed important requirements for sun-protective clothes, especially in terms of different materials. Although the usage of sunscreen was common, our interviewees seemed to apply it wrongly. CONCLUSION Risk perceptions of outdoor workers and their attitudes toward sun protection measures may influence the factual UV protection behavior in the workplace. Structures to facilitate the implementation of technical and organizational sun-protective measures seem to be necessary. Educational interventions and clear instructions which are tailored to the individual needs and attitudes of outdoor workers are required to improve the UV protection behavior and to avoid common mistakes.
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Affiliation(s)
- Marc Rocholl
- Department of Dermatology, Environmental Medicine and Health Theory, Institute for Health Research and Education, University of Osnabrück, Osnabrück, Germany
- Institute for Interdisciplinary Dermatological Prevention and Rehabilitation at the University of Osnabrück, Osnabrück, Germany
| | - Michaela Ludewig
- Department of Dermatology, Environmental Medicine and Health Theory, Institute for Health Research and Education, University of Osnabrück, Osnabrück, Germany
- Institute for Interdisciplinary Dermatological Prevention and Rehabilitation at the University of Osnabrück, Osnabrück, Germany
| | - Swen Malte John
- Department of Dermatology, Environmental Medicine and Health Theory, Institute for Health Research and Education, University of Osnabrück, Osnabrück, Germany
- Institute for Interdisciplinary Dermatological Prevention and Rehabilitation at the University of Osnabrück, Osnabrück, Germany
| | - Eva Maria Bitzer
- Public Health and Health Education, University of Education Freiburg, Freiburg im Breisgau, Germany
| | - Annika Wilke
- Department of Dermatology, Environmental Medicine and Health Theory, Institute for Health Research and Education, University of Osnabrück, Osnabrück, Germany
- Institute for Interdisciplinary Dermatological Prevention and Rehabilitation at the University of Osnabrück, Osnabrück, Germany
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Heckman CJ, Auerbach MV, Darlow S, Handorf EA, Raivitch S, Manne SL. Association of Skin Cancer Risk and Protective Behaviors with Health Literacy Among Young Adults in the USA. Int J Behav Med 2019; 26:372-379. [PMID: 31147962 DOI: 10.1007/s12529-019-09788-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND The goal of this study was to investigate the association of health literacy with skin cancer risk and protective behaviors among young adults at moderate to high risk of skin cancer, the most common cancer. METHOD A US national sample of 958 adults, 18-25 years old, at moderate to high risk of developing skin cancer, completed a survey online. Behavioral outcomes were ultraviolet (UV) radiation exposure (e.g., indoor and outdoor tanning, sunburn) and protective (e.g., sunscreen use, sunless tanning) behaviors. Multivariable regression analyses were conducted to determine whether health literacy (a four-item self-report measure assessing health-related reading, understanding, and writing) was associated with behavioral outcomes while controlling for demographic factors. RESULTS Higher health literacy was independently associated with less sunbathing, odds ratio (OR) = 0.77, 95% confidence interval (CI) = 0.60-0.98; less indoor tanning, OR = 0.38, CI = 0.31-0.48; and less use of tanning oils, OR = 0.54, CI = 0.43-0.69. However, health literacy was also associated with a lower likelihood of wearing long pants, OR = 0.76, CI = 0.58-0.99, or a hat, OR = 0.68, CI = 0.53-0.87, when outdoors. On the other hand, higher health literacy was associated with higher incidental UV exposure, OR = 1.69, CI = 1.34-2.14, and a greater likelihood of ever having engaged in sunless tanning, OR = 1.50, CI = 1.17-1.92. CONCLUSION Interestingly, higher health literacy was associated with lower levels of intentional tanning yet also higher incidental UV exposure and lower skin protection among US young adults. These findings suggest that interventions may be needed for young adults at varying levels of health literacy as well as populations (e.g., outdoor workers, outdoor athletes/exercisers) who may be receiving large amounts of unprotected incidental UV.
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Affiliation(s)
- Carolyn J Heckman
- Rutgers Cancer Institute of New Jersey, 195 Little Albany St, New Brunswick, NJ, 08901, USA.
| | | | - Susan Darlow
- National Comprehensive Cancer Network, Plymouth Meeting, PA, USA
| | | | | | - Sharon L Manne
- Rutgers Cancer Institute of New Jersey, 195 Little Albany St, New Brunswick, NJ, 08901, USA
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