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García-Harana C, Blázquez-Sánchez N, Rodríguez-Martínez A, Rivas-Ruiz F, Aguilar-Ortega D, Rodríguez-Martínez AG, Cambil-Martín J, de Gálvez MV, de Troya-Martín M. Positive impact of Distintivo Soludable on implementation of sun protection policies and practices in schools of Andalusia, Spain. J Public Health Policy 2024; 45:471-483. [PMID: 38858538 DOI: 10.1057/s41271-024-00495-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/06/2024] [Indexed: 06/12/2024]
Abstract
The incidence of skin cancer is increasing worldwide even though its main risk factor is preventable. This study evaluated the impact of the Distintivo Soludable pilot intervention on implementation of photoprotection policies and practices in preschool and primary schools in Andalusia, Spain. We completed two rounds of a Sun Protection Policies and Practices Survey (SPPPS) nine months apart. At baseline, 67 Andalusian schools earned a median score of 3/12 points (range 0-8; IQR: 2). Ten schools involved in Distintivo Soludable intervention group significantly increased their scores from 4 to 7.5/12 points (p = 0.014). We also detected a modest positive effect in 57 control group schools, an increase from 2 to 3 points (p = 0.002). This pilot study demonstrated that the main achievement of the Distintivo Soludable intervention was implementation of organizational policies regarding sun protection, an essential starting point for establishing positive attitudes toward sun protection in school communities.
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Affiliation(s)
- C García-Harana
- Dermatology Department, Hospital Universitario Costa del Sol, Marbella, Spain
- Department of Medicine, University of Málaga, Málaga, Spain
| | - N Blázquez-Sánchez
- Dermatology Department, Hospital Universitario Costa del Sol, Marbella, Spain.
- Hospital Costa del Sol, Autovía A7, KM 187, 29603, Marbella, Spain.
| | - A Rodríguez-Martínez
- Research and Innovation Unit, Hospital Universitario Costa del Sol, Marbella, Spain
| | - F Rivas-Ruiz
- Research and Innovation Unit, Hospital Universitario Costa del Sol, Marbella, Spain
- Research Network on Health Services in Chronic Diseases (REDISSEC), Barcelona, Spain
| | - D Aguilar-Ortega
- Research and Innovation Unit, Hospital Universitario Costa del Sol, Marbella, Spain
| | | | - J Cambil-Martín
- Nursing Department, Faculty of Health Science, University of Granada, Granada, Spain
| | - M V de Gálvez
- Photobiological Dermatology Laboratory Medical Research Center, Department of Dermatology and Medicine, Faculty of Medicine, University of Málaga, Málaga, Spain
| | - M de Troya-Martín
- Dermatology Department, Hospital Universitario Costa del Sol, Marbella, Spain
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Barón DR, Sánchez NB, Ruiz FR, Martínez AR, Arjona JA, de Castro Maqueda G, Araujo IG, de Gálvez Aranda MV, Martínez AR, de Troya Martín M. Occupational Sun Exposure Among Physical Education Teachers in Primary and Secondary Schools in Andalusia, Spain. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2023; 38:1157-1162. [PMID: 36701024 DOI: 10.1007/s13187-022-02242-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/20/2022] [Indexed: 06/17/2023]
Abstract
Chronic sun exposure and sunburns are the main preventable causes of skin cancer. Due to the nature of their work, physical education teachers are at high risk for occupational skin cancer. This descriptive, cross-sectional study analyzes primary and secondary physical education teachers in Andalusia, Spain. All participants were invited to monitor their ultraviolet (UV) radiation exposure using individual biologic dosimeters and record their photoprotection practices over 3 workdays. The teachers spent an average of 2.7 h outdoors and the mean personal UV radiation exposure was 309.9 J/m2 per day, a value three times higher than international recommendations. Based on the photoprotection diary, it was determined that classes held outdoors were not scheduled outside the hours with the highest UV index and that the percentage of participants who followed the photoprotective practices of remaining in the shade or wearing a hat during outdoor lessons were less than 20% and 60%, respectively. The results on sun exposure and photoprotection practices show a need for organizational and educational intervention strategies to mitigate sun exposure and increase compliance with photoprotection measures to reduce skin cancer risk among these workers and promote early diagnosis of the disease.
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Affiliation(s)
| | - Nuria Blázquez Sánchez
- Department of Dermatology, Costa del Sol Hospital, Marbella, Spain.
- PAIDI Group: CTS-1081: Photoprotection and Prevention of Skin Cancer (PHOTOPROTECTION), Marbella, Spain.
| | | | | | - José Aguilera Arjona
- Photobiological Dermatology Laboratory, Medical Research Center, Department of Medicine and Dermatology, University of Málaga, Málaga, Spain
| | | | | | | | | | - Magdalena de Troya Martín
- Department of Dermatology, Costa del Sol Hospital, Marbella, Spain
- PAIDI Group: CTS-1081: Photoprotection and Prevention of Skin Cancer (PHOTOPROTECTION), Marbella, Spain
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de Troya Martín M, Aguilar S, Aguilera-Arjona J, Rivas-Ruiz F, Rodríguez-Martínez A, de Castro-Maqueda G, Cambil-Martín J, de Gálvez-Aranda V, Blázquez-Sánchez N. Risk assessment of occupational skin cancer among outdoor workers in southern Spain: local pilot study. Occup Environ Med 2023; 80:14-20. [PMID: 36424170 DOI: 10.1136/oemed-2022-108454] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Accepted: 08/25/2022] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Overexposure to ultraviolet (UV) radiation is the main preventable cause of skin cancer. Outdoor workers, exposed to the sun for many hours throughout their working lives, are at special risk. The aim of this study is to determine occupational photoexposure and photoprotection among outdoor workers employed by a municipality in southern Spain. METHODS Cross-sectional descriptive study focusing on outdoor workers employed by the municipality of Fuengirola (in areas such as construction, gardening, urban cleaning and beach maintenance). The participants were monitored by personal dosimetry, participated in a dermatological check-up and answered a validated questionnaire (CHACES) on their habits, attitudes and knowledge related to sun exposure. RESULTS The median effective erythema dose of exposure to solar UV radiation during the working day (n=20) was 379.4 J/m2, equivalent to 3.8 standard erythema doses, almost 3 times higher than the recommended limits for an 8-hour workday. Skin examination (n=128) revealed the presence of actinic lentigines (79.7%), actinic keratoses (8.6%) and skin cancer (3.9%). The CHACES questionnaire (n=128) revealed a sunburn rate of 50.0%. Photoprotection practices were markedly deficient: only 16.7% of the survey respondents sought protection in the shade, 20.3% avoided exposure during the peak exposure hours and 33.1% applied sunscreen. CONCLUSIONS This is the first study to evaluate UV radiation exposure, occupational sun protection practices, sunburn and actinic injuries of different outdoor workers in one of the sunniest regions of Spain and underlines the need for effective interventions to protect outdoor workers' health.
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Affiliation(s)
| | - Sierra Aguilar
- Occupational Risk Prevention Service, Fuengirola City Council, Fuengirola, Spain
| | - José Aguilera-Arjona
- Photobiological Dermatology Laboratory, Medical Research Centre, Department of Medicine and Dermatology, University of Malaga, Malaga, Spain
| | | | | | - Guillermo de Castro-Maqueda
- Physical Education Department, Education Science Faculty, University of Cadiz, Cadiz, Spain.,Nursing Department, Health Science Faculty, University of Granada, Granada, Spain
| | - Jacobo Cambil-Martín
- Nursing Department, Health Science Faculty, University of Granada, Granada, Spain
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Doncel Molinero D, Ruiz Paulano M, Rivas Ruiz F, Blázquez Sánchez N, de Gálvez Aranda MV, de Castro Maqueda G, de Troya Martín M. Sun Protection Behaviour and Sunburns in Spanish Cyclists. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2022; 37:957-964. [PMID: 33108803 DOI: 10.1007/s13187-020-01906-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/19/2020] [Indexed: 06/11/2023]
Abstract
Sunburn caused by overexposure to ultraviolet radiation is the main cause of preventable skin cancer. This study aimed to describe the sun protection habits and rate of sunburns associated with the practice of cycling and to identify predictive factors of sunburn among cyclists. A descriptive observational study based on online surveys was conducted. Recruitment of participants was conducted through the Andalusian Cycling Federation (Spain). A questionnaire on behaviour, attitudes, and knowledge related to sun exposure was used. A bivariate analysis was carried out with sunburn episodes during the previous year as outcome variable, and a multivariate logistic regression model was built. Of the 1018 surveys returned, 87.6% were answered by men, mean age was 41.8 years (SD: 11.0), and 37.6% of the participants had phototype I or II. Sunburns during the previous year were reported by 45.6% (95% CI: 42.5-48.7) of the respondents. Sunscreen use was reported by 39.2%, and 61.0% did not examine their skin regularly despite the fact that 34 subjects (3.4%) reported a personal history of skin cancer. The multivariate logistic regression analysis showed that there was a negative correlation between episodes of sunburn and age, phototypes I-II, more than 2 h of sun exposure, and inconsistent use of sunscreen. Cyclists have high rates of sunburns and thus constitute a high-risk group for developing skin cancer. Educational interventions specifically aimed at this group of athletes would improve sun protection knowledge and practices, particularly the use of sunscreen.
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Affiliation(s)
| | - Manuel Ruiz Paulano
- Area of Dermatology, Costa del Sol Health Agency, 29603, Marbella- Malaga, Spain
| | - Francisco Rivas Ruiz
- Area of Dermatology, Costa del Sol Health Agency, 29603, Marbella- Malaga, Spain
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Blázquez-Sánchez N, Rivas-Ruiz F, Bueno-Fernández S, Fernández-Morano MT, Arias-Santiago S, Rodríguez-Martínez A, DeCastro-Maqueda G, DeTroya-Martín M. Photoprotection habits, attitudes and knowledge among school communities in the Costa del sol (Spain). Eur J Public Health 2021; 31:508-514. [PMID: 33619546 DOI: 10.1093/eurpub/ckab010] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Scholar photoprotection campaigns are among the most effective strategies for preventing skin cancer. Analysis of the target population constitutes a valuable starting point for the implementation of primary prevention strategies. Our aim is to study photoprotection habits, attitudes and knowledge among a Spanish school community. METHODS Descriptive cross-sectional study targeting schoolchildren, parents and teachers at 20 schools in the area of the Costa del Sol Health Agency in southern Spain. Two population-specific, validated questionnaires were used: the CHRESI (for children aged 0-10 years) and CHACES Questionnaire(for adults and adolescents aged > 11 years). We collected demographic data, skin colour, skin phototype, sunburn episodes, sun exposure and photoprotection practices, attitudes and knowledge. RESULTS 1728 questionnaires were analyzed (22% parents, 14.5% teachers, 44.8% adolescents and 18.6% children). The average ages were 8 years (children), 16 years (adolescents), 39 years (teachers) and 42 years (parents). Globally, the predominant features were: male sex (52%), Spanish nationality (92%) and phototypes II-III (61%). Children, followed by adolescents, reported the highest exposure to the sun, both in frequency and in duration. Adolescents had the higher rate of sunburn (75%), followed by parents/teachers (54.1%) and children (44.1%). Children and their parents were the most likely to adopt photoprotection measures, while adolescents presented more risky attitudes. Knowledge regarding photoprotection was acceptable (6.9/10). CONCLUSIONS This study highlights the need to improve photoprotection knowledge, habits and attitudes among our target population. Scholars, parents and teachers in our area should be addressed in campaigns to promote healthy sun exposure habits, thus reducing skin cancer-related morbidity and mortality in this region.
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Affiliation(s)
| | - F Rivas-Ruiz
- Investigation Department, Hospital Costa del Sol, Marbella, Spain
| | - S Bueno-Fernández
- Optometry and Ophthalmology Department, CEU San Pablo University, Madrid, Spain
| | | | - S Arias-Santiago
- Dermatology Department, Hospital Virgen de las Nieves, Granada University, Spain
| | | | - G DeCastro-Maqueda
- Department of Didactics of Physical, Plastic and Musical Education, Faculty of Educational Sciences, University of Cádiz, Spain
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Sun Exposure during Water Sports: Do Elite Athletes Adequately Protect Their Skin against Skin Cancer? INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18020800. [PMID: 33477791 PMCID: PMC7832317 DOI: 10.3390/ijerph18020800] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 01/09/2021] [Accepted: 01/15/2021] [Indexed: 11/16/2022]
Abstract
Excessive sun exposure is the main avoidable cause of skin cancer. Outdoor sports performed without adequate photoprotection are risky practices in this respect. This study examines whether elite athletes in water sports (specifically surfing, windsurfing, and sailing) take appropriate measures to protect their skin from the sun, and whether there are differences in this respect according to age, gender, or sports discipline. This study is based on a questionnaire-based health survey. World championship competitors completed a self-administered questionnaire on their sun protection and exposure habits, as well as sunburns during the last sports season. In total, 246 participants, with an age range of 16–30 years, completed the questionnaire. Of these, 49.6% used inadequate sun protection. Those who protected their skin appropriately tended to be older than those who did not (average age = 23.28 and 20.69 years, respectively; p = 0.000). There were no significant differences in sun protection habits between male and female athletes. The rate of sunburn was very high (76.7%). A high proportion (22.5%) of participants never used sunscreen. Elite athletes in water sports are at real risk of skin lesions from overexposure to the sun, associated with inadequate photoprotection practices. Campaigns to raise awareness and to promote the early detection of skin cancer should target these risk groups.
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De Castro-Maqueda G, Lagares Franco C, Gutiérrez-Manzanedo JV, Gobba F, Blázquez Sánchez N, De Troya-Martin M. What Sun Protection Practices Should Be Adopted by Trainee Teachers to Reduce the Risk of Skin Cancer and Other Adverse Outcomes? INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:E529. [PMID: 33435239 PMCID: PMC7826784 DOI: 10.3390/ijerph18020529] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 01/03/2021] [Accepted: 01/04/2021] [Indexed: 01/13/2023]
Abstract
Excessive sun exposure and insufficient protection are the main risk factors for the onset of melanoma and non-melanoma skin cancer (the most common types of cancer suffered by fair-skinned populations) and other adverse effects on the skin and eyes. Epidemiological data highlight the scant awareness of this risk among young people and the high rates of sunburn often recorded among this population. The main aim of the present study is to examine sun exposure and protection behavior by university students. A cross-sectional questionnaire-based study was undertaken to investigate sun exposure and protection practices among students of education sciences at a university in southern Spain. The data obtained were used to perform a descriptive, comparative analysis, by groups and by gender, of photoprotection and skin self-examination practices. The reliability and validity of the questionnaire were both tested. Of the 315 students who completed the questionnaire, 74.6% had suffered at least one sunburn during the previous year. Few made frequent use of sunscreen or protective clothing and 89.5% did not self-examine their skin. The metric properties of the questionnaire revealed its excellent reliability and validity. Among the Spanish university students considered, there was little awareness of the risk of excessive sun exposure, self-protection was insufficient, the potential exposure to dangerous levels of ultraviolet radiation was high, and most had suffered one or more sunburns in the last year. Intervention strategies should be implemented to highlight the risks involved and the need for more appropriate sun protection practices. Information campaigns should be conducted in this respect so that, when these students become teachers, they will have adequate knowledge of the risks involved and of the benefits of addressing this problem effectively, and will ultimately transfer these health education competences to their own students.
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Affiliation(s)
- Guillermo De Castro-Maqueda
- Department of Physical Education, Faculty of Education Sciences and University of Cádiz, 11519 Cádiz, Spain;
| | | | - José V. Gutiérrez-Manzanedo
- Department of Physical Education, Faculty of Education Sciences and University of Cádiz, 11519 Cádiz, Spain;
| | - Fabriziomaria Gobba
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, 41121 Modena, Italy;
| | - Nuria Blázquez Sánchez
- Dermatology Department, Costa del Sol Hospital, 29603 Marbella, Spain; (N.B.S.); (M.D.T.-M.)
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Keratinocyte skin cancer risks for working school teachers: Scenarios and implications of the timing of scheduled duty periods in Queensland, Australia. JOURNAL OF PHOTOCHEMISTRY AND PHOTOBIOLOGY B-BIOLOGY 2020; 213:112046. [PMID: 33074139 DOI: 10.1016/j.jphotobiol.2020.112046] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 09/20/2020] [Accepted: 09/29/2020] [Indexed: 01/01/2023]
Abstract
Relative keratinocyte skin cancer risks attributable to lifetime occupational and casual sunlight exposures of working school teachers are assessed across the state of Queensland for 1578 schools. Relative risk modeling utilizing annual ultraviolet exposure assessments of teachers working in different geographic locations and exposed during periods of measured daily playground duty times for each school were made for local administrative education districts by considering traditional school opening and closing hours, and playground lunchtime schedules. State-wide, basal cell carcinoma (BCC) and squamous cell carcinoma (SCC) relative risk estimates varied by 24% for BCC and 45% for SCC. The highest relative risk was calculated for the state's north (sunshine) coast education district which showed that risk could increase by as much as 32% for BCC and 64% for SCC due to differences in teacher duty schedules. These results highlight the importance of playground duty scheduling as a significant risk factor contributing to the overall burden of preventable keratinocyte skin cancers in Queensland.
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Stölzel F, Wolff M, Fieber V, Glausch M, Wachs C, Breitbart E, Bornhäuser M, Seidel N. UV protection for young athletes: using participatory program planning to develop a sports schools program. Environ Health Prev Med 2020; 25:39. [PMID: 32778053 PMCID: PMC7418192 DOI: 10.1186/s12199-020-00872-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 07/14/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The incidence of melanoma increased rapidly throughout the last decades, with overexposure to ultraviolet (UV) radiation being an established risk factor. Due to their intensive sun exposure, many student athletes (SAs) have an increased risk for skin cancer. The Clever in Sun and Shade Program (CSSP) aims at enforcing positive attitudes toward UV protection (UVP) and at supporting sports schools in establishing UVP strategies. METHODS CSSP was developed in 2019 using participatory program planning (PPP) as well as following WHO recommendations for UVP at schools. After drafting first material, within a PPP groups were conducted at a partner school (convenience sample 1) with students (n = 20), teachers (n = 5), school administration (n = 2), and coaches (n = 5). Materials were then adapted. Program acceptance and feasibility were tested at two further schools (convenience sample 2) with PPP groups of students (n = 95) and school administration (n = 2). Content analyses and descriptive statistics were conducted. RESULTS Less than 50% of SAs and coaches of sample 1 expressed positive attitudes toward UVP, less than 10% reported appropriate UVP behavior. By using PPP, program material was adapted to the target groups' needs, i.e., by including specific barriers and solutions. Only the most accepted video drafts were produced. The majority of SAs of sample 2 (80-86%) used predominantly positive adjectives such as "important" and "positive" to describe the completed videos and the behavior self-check poster. CONCLUSIONS PPP process has greatly influenced concept and materials of CSSP for sports schools. Integration of future program participants has proven to be an important component in creating a fitting and feasible program. CSSP for sports schools is a program free of charge that enables sports schools to integrate UVP into their daily routine. It will be disseminated in cooperation with German Olympic Sports Confederation and German Cancer Aid in 2021.
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Affiliation(s)
- Friederike Stölzel
- University Hospital Carl Gustav Carus, TU Dresden, Dresden, Germany. .,National Center of Tumor Diseases (NCT/UCC), Fetscherstraße 74, 01307, Dresden, Germany.
| | - Michaela Wolff
- University Hospital Carl Gustav Carus, TU Dresden, Dresden, Germany.,National Center of Tumor Diseases (NCT/UCC), Fetscherstraße 74, 01307, Dresden, Germany
| | - Vera Fieber
- University Hospital Carl Gustav Carus, TU Dresden, Dresden, Germany.,National Center of Tumor Diseases (NCT/UCC), Fetscherstraße 74, 01307, Dresden, Germany
| | - Melanie Glausch
- University Hospital Carl Gustav Carus, TU Dresden, Dresden, Germany.,National Center of Tumor Diseases (NCT/UCC), Fetscherstraße 74, 01307, Dresden, Germany
| | - Claudia Wachs
- University Hospital Carl Gustav Carus, TU Dresden, Dresden, Germany.,National Center of Tumor Diseases (NCT/UCC), Fetscherstraße 74, 01307, Dresden, Germany
| | - Eckhard Breitbart
- Arbeitsgemeinschaft Dermatologische Prävention (ADP), Hamburg, Germany
| | - Martin Bornhäuser
- University Hospital Carl Gustav Carus, TU Dresden, Dresden, Germany.,National Center of Tumor Diseases (NCT/UCC), Fetscherstraße 74, 01307, Dresden, Germany
| | - Nadja Seidel
- University Hospital Carl Gustav Carus, TU Dresden, Dresden, Germany.,National Center of Tumor Diseases (NCT/UCC), Fetscherstraße 74, 01307, Dresden, Germany
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