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

Systematic review and analysis of self-efficacy in sun protection measurement instruments

OBJECTIVE

The objective of this study was toidentify and appraise available sun protection self-efficacy instruments and synthesize information.

DATA SOURCE

A systematic search of electronic databases from 2005 to 2023 included PubMed, CINAHL, Embase and PsycINFO .

BACKGROUND

While instruments have been developed to evaluate sun-protective behaviors and self-efficacy separately, sun-protection self-efficacy instruments have yet to be widely studied. Self-efficacy is an essential antecedent to performing health-related behaviors or practices that can promote or hinder the health of individuals and groups.

STUDY INCLUSION AND EXCLUSION CRITERIA

Studies randomized control trials or descriptive studies that used self-efficacy measurement tools to evaluate behaviors, intentions, and sun protection knowledge were included in this review. Sun protection surveys that targeted providers or parents and non-English articles were excluded.

DATA EXTRACTION

Data were extracted by one independent researcher.

DATA SYNTHESIS

Fifteen studies met the inclusion criterion and included 10 scales of self-efficacy in sun protection. Study design and purpose, and the instrument's validity and reliability statistics, including Cronbach's alphas, were extracted.

RESULTS

The two-factor self-efficacy in sun protection scale was the most common measure for primary prevention, with acceptable reliability and validity. However, other instruments also showed reliable psychometric properties, especially measures of sunscreen self-efficacy.

CONCLUSION

More research in self-efficacy measurement is warranted to examine specific populations and determine the appropriate constructs of self-efficacy. It is crucial to design evidence-based interventions that affect self-efficacy, are measured by a reliable, valid instrument, and have the potential to increase sun-protective and screening behaviors.

Outdoor workers' perceptions of skin cancer prevention: a qualitative study

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.

Destructive effects of UVC radiation on Drosophila melanogaster: Mortality, fertility, mutations, and molecular mechanisms

The detrimental effects of ultraviolet C (UVC) radiation on living organisms, with a specific focus on the fruit fly Drosophila melanogaster, were examined. This study investigated the impact of heightened UVC radiation exposure on D. melanogaster by assessing mortality and fertility rates, studying phenotypic mutations, and investigating the associated molecular mechanisms. The findings of this study revealed that UVC radiation increases mortality rates and decreases fertility rates in D. melanogaster. Additionally, phenotypic wing mutations were observed in the exposed flies. Furthermore, the study demonstrated that UVC radiation downregulates the expression of antioxidant genes, including superoxide dismutase (SOD), manganese-dependent superoxide dismutase (Mn-SOD), zinc-dependent superoxide dismutase (Cu-Zn-SOD), and the G protein-coupled receptor methuselah (MTH) gene. These results suggest that UVC radiation exerts a destructive effect on D. melanogaster by inducing oxidative stress, which is marked by the overexpression of harmful oxidative processes and a simultaneous reduction in antioxidant gene expression. In conclusion, this study underscores the critical importance of comprehending the deleterious effects of UVC radiation, not only to safeguard human health on Earth, but also to address the potential risks associated with space missions, such as the ongoing Emirate astronaut program.

Non-ionizing radiation modeling to predict ambient irradiance in work areas at an indoor cannabis farm

Agricultural workers frequently experience potentially hazardous exposure to non-ionizing radiation from both solar and artificial sources, and measurement of this exposure can be expensive and impractical for large populations. This project develops and evaluates a vegetative radiative transfer model (VRTM) to predict irradiance in a grow room of an indoor cannabis farm. The model uses morphological characteristics of the crop, manufacturer provided lamp emissions data, and dimensional measurements of the grow room and cannabis hedgerows to predict irradiance. A linear regression comparing model predictions with the measurements taken by a visible light spectroradiometer had slopes within 23% of unity and R2 values above 0.88 for visible (400-700 nm), blue (400-500 nm), green (500-600 nm), and red (600-700 nm) wavelength bands. The excellent agreement between the model and the measured irradiance in the cannabis farm grow room supports the potential of using VRTMs to predict irradiance and worker exposure in agricultural settings. Because there is no mechanistic difference between visible and other non-ionizing wavelengths of radiation in regards to mechanisms of radiative transfer, the model developed herein for visible wavelengths of radiation should be generalizable to other radiation bands including infrared and ultraviolet radiation.

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

BACKGROUND

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

OBJECTIVES

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Criteria for Occupational Health Prevention for Solar UVR Exposed Outdoor Workers-Prevalence, Affected Parties, and Occupational Disease

Non-melanoma skin cancer (NMSC) is the most common cancer in western countries. Legislative bodies and stakeholders like WHO and EU strongly promote protection against solar UVR, especially in workers. Occupational health prevention must be introduced as a strong instrument in workers protection also with regard to occupational disease issues. To date, criteria for both occupational health prevention and occupational disease are missing and the identification of risk groups has no metric basis. Here I report a criteria analysis based on the largest comprehensive data set of occupational ultraviolet radiation exposure of outdoor workers. With detailed research on occupation-specific dosimetric measurements of 45.000 measurement days in 176 occupations and sub-occupations, it is possible to map criteria for occupational health prevention specifically and to identify affected occupations. The number of employees affected can be elucidated worldwide. For the first time, a direct link to retrospective occupational disease criteria could be established. Of the 176 occupations and sub-occupations selected for this work, 153 (=87%) exceed the criterion for occupational health prevention and thus need special attention. This includes all occupations with annual exposures of more than 150 SED. Employment figures for the EU and the world yield the total number of affected workers to be 36.1 million and more than 500 million, respectively. These new criteria for occupational health prevention are valid and in good agreement with international research on limit values by WHO and ICNIRP. If applied correctly and consistently, these criteria can prevent occupational disease. It will be possible to identify occupations and sub-occupations that have an urgent need for prevention to avoid chronic skin damage leading to cancer. This research serves as a basis for policy making and clinical risk identification, as well as for daily practice of occupational physicians and employers responsible for risk assesment.

Protocol for a Systematic Review on the Effectiveness of Interventions to Reduce Exposure to Occupational Solar UltraViolet Radiation (UVR) Among Outdoor Workers

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.

Personal Solar Ultraviolet Radiation Exposure of Farmworkers: Seasonal and Anatomical Differences Suggest Prevention Measures Are Required

INTRODUCTION

Farmworkers are at risk of excess exposure to solar ultraviolet radiation (UVR) during their work activities, especially if they work in geographical areas with high ambient solar UVR levels such as in South Africa. Excess exposure to solar UVR may lead to several negative health effects such as certain cataracts and skin cancer. This study evaluated personal solar UVR exposure of a group of farmworkers to determine if they were at risk of health-related problems due to excess solar UVR exposure.

METHODS

Polysulphone film (PSF) badges were placed on the shoulder, arm, and top of the head of outdoor and indoor farmworkers on a macadamia nut and avocado farm in the Limpopo province for the duration of their daily work shift to evaluate their total daily solar UVR exposure. Sixteen days were assessed for each of the three, high solar UVR seasons, i.e. autumn, spring, and summer.

RESULTS

During autumn, farmworkers' arms received the highest solar UVR exposures (geometric mean (GM) = 7.8 SED, where 1 standard erythemal dose (SED) = 100 J/m2, 95% CI 6.1-9.8 SED) while the highest exposures were on the top of the head during spring (GM = 11.6 SED, 95% CI 7.3-17.4 SED) and summer (GM = 13.9, 95% CI 10.4-17.9 SED). Statistically significant differences in solar UVR exposure were found between the body sites during spring and summer but not autumn.

CONCLUSIONS

The relatively high daily solar UVR exposure levels of farmworkers suggest this occupational group is at risk of excess solar UVR exposure and preventive measures with awareness information to safeguard health is necessary for employers and employees.

Initiatives addressing precarious employment and its effects on workers' health and well-being: a protocol for a systematic review

BACKGROUND

Precarious employment is a significant determinant of population health and health inequities and has complex public health consequences both for a given nation and internationally. Precarious employment is conceptualized as a multi-dimensional construct including but not limited to employment insecurity, income inadequacy, and lack of rights and protection in the employment relation, which could affect both informal and formal workers. The purpose of this review is to identify, appraise, and synthesize existing research on the effectiveness of initiatives aiming to or having the potential to eliminate, reduce, or mitigate workers' exposure to precarious employment conditions and its effects on the health and well-being of workers and their families.

METHODS

The electronic databases searched (from January 2000 onwards) are Scopus, Web of Science Core Collection, and PubMed, along with three institutional databases as sources of grey literature. We will include any study (e.g. quantitative, qualitative, or mixed-methods design) evaluating the effects of initiatives that aim to or have the potential to address workers' exposure to precarious employment or its effects on the health and well-being of workers and their families, whether or not such initiatives were designed specifically to address precarious employment. The primary outcomes will be changes in (i) the prevalence of precarious employment and workers' exposure to precarious employment and (ii) the health and well-being of precariously employed workers and their families. No secondary outcomes will be included. Given the large body of evidence screened, the initial screening of each study will be done by one reviewer, after implementing several strategies to ensure decision-making consistency across reviewers. The screening of full-text articles, data extraction, and critical appraisal will be done independently by two reviewers. Potential conflicts will be resolved through discussion. Established checklists will be used to assess a study's methodological quality or bias. A narrative synthesis will be employed to describe and summarize the included studies' characteristics and findings and to explore relationships both within and between the included studies.

DISCUSSION

We expect that this review's findings will provide stakeholders interested in tackling precarious employment and its harmful health effects with evidence on effectiveness of solutions that have been implemented to inform considerations for adaptation of these to their unique contexts. In addition, the review will increase our understanding of existing research gaps and enable us to make recommendations to address them. Our work aligns with the sustainable development agenda to protect workers, promote decent work and economic growth, eliminate poverty, and reduce inequalities.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO CRD42020187544 .

Health Risks Associated With Excessive Exposure to Solar Ultraviolet Radiation Among Outdoor Workers in South Africa: An Overview

Exposure of outdoor workers to high levels of solar ultraviolet radiation (UVR) poses significant, well-known health risks including skin cancer and eye diseases. In South Africa, little is known about how many workers are potentially overexposed to solar UVR and what the associated impacts on their health might be. In this overview, the geography and solar UVR environment in South Africa are considered, as well as the different outdoor occupational groups likely to be affected by excessive solar UVR exposure. Sunburn, pterygium, cataract, keratinocyte cancers, and melanoma are discussed in the context of outdoor workers. Few studies in South Africa have considered these health issues and the most effective ways to reduce solar UVR exposure for those working outside. Several countries have developed policies and guidelines to support sun safety in the workplace which include training and education, in addition to the provision of personal protective equipment and managerial support. Several gaps in occupational sun protection and workplace sun safety for South Africa are identified. Legislation needs to recognize solar UVR exposure as an occupational health hazard, with sun safety guidelines and training provided for employers and employees.

Exploring Mycosporine-Like Amino Acids (MAAs) as Safe and Natural Protective Agents against UV-Induced Skin Damage

Prolonged exposure to harmful ultraviolet radiation (UVR) can induce many chronic or acute skin disorders in humans. To protect themselves, many people have started to apply cosmetic products containing UV-screening chemicals alone or together with physical sunblocks, mainly based on titanium–dioxide (TiO₂) or zinc-oxide (ZnO₂). However, it has now been shown that the use of chemical and physical sunblocks is not safe for long-term application, so searches for the novel, natural UV-screening compounds derived from plants or bacteria are gaining attention. Certain photosynthetic organisms such as algae and cyanobacteria have evolved to cope with exposure to UVR by producing mycosporine-like amino acids (MAAs). These are promising substitutes for chemical sunscreens containing commercially available sunblock filters. The use of biopolymers such as chitosan for joining MAAs together or with MAA-Np (nanoparticles) conjugates will provide stability to MAAs similar to the mixing of chemical and physical sunscreens. This review critically describes UV-induced skin damage, problems associated with the use of chemical and physical sunscreens, cyanobacteria as a source of MAAs, the abundance of MAAs and their biotechnological applications. We also narrate the effectiveness and application of MAAs and MAA conjugates on skin cell lines.

Ambient Ultraviolet Radiation and Sebaceous Carcinoma Incidence in the United States, 2000-2016

Sebaceous carcinoma (SC) is an aggressive skin tumor. Although ultraviolet radiation (UVR) is an important risk factor for some skin cancer types, no population-level study has evaluated for an association between UVR and SC risk. Herein, we examined satellite-based ambient UVR in relation to SC incidence using Surveillance, Epidemiology, and End Results 18 cancer registry data (2000-2016). There were 3503 microscopically confirmed cases of SC diagnosed during the study period. For non-Hispanic whites, there was an association between increasing ambient UVR and SC risk (incidence rate ratio [per UVR quartile] = 1.15, 95% confidence interval = 1.11 to 1.19; two-sided P < .001) including among individuals with and without putative Muir-Torre syndrome. In contrast, there was no association between ambient UVR and SC risk for other race and ethnicities. Our findings support a role for UVR in SC tumorigenesis, which suggests that photoprotection may reduce SC risk, particularly for high-risk populations (eg, Muir-Torre syndrome).

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

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

Sebaceous Carcinoma Incidence and Survival Among Solid Organ Transplant Recipients in the United States, 1987-2017

Importance

Risk of sebaceous carcinoma (SC), a rare skin cancer associated with Muir-Torre syndrome, is elevated among solid organ transplant recipients (SOTRs). However, population studies evaluating this association and assessing survival for posttransplant cases are lacking, and further understanding of SC epidemiology in this immunosuppressed population could provide etiologic and clinical insights.

Objective

To assess SC incidence and patient survival after solid organ transplantation.

Design, Setting, and Participants

This cohort study, conducted from January 1, 1987, to December 31, 2017, used data from the Transplant Cancer Match Study, which links transplant and cancer registry data for 17 states and 1 metropolitan area in the United States. Altogether, these registries account for approximately 46% of all US transplants. Data on demographic and transplant characteristics as well as induction and initial maintenance immunosuppressive therapies were obtained from the transplant registry. Standardized incidence ratios (SIRs) comparing SC incidence among SOTRs to the general population were calculated. Incidence rate ratios (IRRs) comparing SC risk between SOTR subgroups were calculated using multivariate Poisson regression. Cox regression was used to compare overall survival between SC cases in SOTRs and other individuals.

Main Outcomes and Measures

Sebaceous carcinoma incidence and overall patient survival after transplantation compared with the general population.

Results

A total of 326 282 transplant procedures were performed for 301 075 patients (No. [%] age at transplant, 126 550 [38.8%] aged 0-44 years; 82 394 [25.3%] aged 45-54 years; 82 082 [25.5%] aged 55-64 years; 35 256 [10.8%] aged ≥65 years; 201 354 male patients [61.7%]; 202 557 White patients [62.1%]). A total of 102 SCs were diagnosed in 301 075 SOTRs, corresponding to a 25-fold increased incidence (SIR, 24.8; 95% CI, 20.2-30.1). Incidence was especially elevated among lung recipients (SIR, 47.7; 95% CI, 20.6-94.0) and after a posttransplant diagnosis of cutaneous squamous cell carcinoma (SIR, 104.0; 95% CI, 62.8-163.0). Among SOTRs, factors independently associated with SC risk included male sex (IRR, 2.46; 95% CI, 1.48-4.07; P < .001), race/ethnicity (non-Hispanic Black vs non-Hispanic White, IRR, 0.28; 95% CI, 0.10-0.77; P = .01), older age (IRR, 7.85; 95% CI, 3.85-16.0; ≥65 vs 0-44 years; P < .001 for trend), use of thymoglobulin induction (IRR, 1.82; 95% CI, 1.16-2.86; P = .009), posttransplant cutaneous squamous cell carcinoma (IRR, 4.60; 95% CI, 2.67-7.94; P < .001), and longer time since transplant (IRR, 8.40; 95% CI, 3.94-17.90; ≥10 vs 0-1.9 years; P < .001 for trend). Muir-Torre syndrome-associated cancers were rare among both SOTRs and others with SC (3.3%-4.1%). Among patients with SC, prior transplantation was associated with increased overall mortality (adjusted hazard ratio, 2.09; 95% CI, 1.45-3.01), although few deaths were attributed to SC (4 of 92 SOTRs [4.3%]; 235 of 3585 non-SOTRs [6.6%]).

Conclusions and Relevance

Among SOTRs, results of this large cohort study suggest that SC was associated with measures of immunosuppression, and overall survival was worse than for other patients with SC. Findings also suggest a possible role for UV radiation in carcinogenesis.

Economic Evaluation of an Intervention Promoting Adoption of Occupational Sun Protection Policies

OBJECTIVE

Economic evaluation of an intervention promoting adoption of occupational sun protection actions by Colorado public sector employers.

METHODS

Randomized controlled trial with 2-year follow-up conducted during 2010 to 2013. Thirty-three intervention and 30 attention-control worksites in final economic sample. Twenty-four-month intervention of personal contacts, training, and materials. Intervention delivery micro-costed. Costs of implemented actions from employer self-report.

RESULTS

Twenty-four-month intervention costs: $121,789, 51.8% incurred by project staff (per-worksite mean=$1,732). Worksite costs: $58,631 (mean = $1,777). Per-employee costs: $118 project staff, $56 worksites. Materials cost: $5990 (mean = $181). Intervention worksites implemented 72 nontraining sun protection actions post-Sun Safe Workplaces (SSW) (mean = 2.18). Control worksites implemented 39 actions (mean = 1.30). Total costs to intervention worksites of implementing the 72 post-SSW actions: $90,645 (mean = $2,747). Control worksite costs: $66,467 (mean = $2,216). Per-employee implementation costs are comparable to other worksite health interventions.

CONCLUSION

SSW expanded adoption of sun protection actions at a reasonable per-employee cost.

Skin cancer risk and shade: comparing the risk of foresters with other outdoor workers

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.

Genetic and environmental factors underlying keratinocyte carcinoma risk

Recent large-scale GWAS and large epidemiologic studies have accelerated the discovery of genes and environmental factors that contribute to the risk of keratinocyte carcinoma (KC), which includes basal cell carcinoma (BCC) and squamous cell carcinoma (SCC). This Review summarizes the genomic regions associated with SCC and BCC risk, examines the genetic overlap between SCC and BCC, and discusses biological pathways involved in SCC and BCC development. Next, we review environmental factors that are associated with KC risk, including those that are shared between SCC and BCC as well as others that associated with only one type of KC. We conclude with a critical appraisal of current research and potential directions for future research.

"Live Sun Smart!" Testing the effectiveness of a sun safety program for middle schoolers

BACKGROUND

Skin cancer is a well-recognized public health issue, and primary prevention is the most effective strategy for reducing skin cancer risk. The current recommendations are that behavioral counseling for sun safety measures is most beneficial and effective for children and adolescents and that targeting this population at primary and middle schools is the ideal intervention strategy to increase sun-protective behaviors and reduce UV exposure, sunburn incidence, and formation of new moles. Numerous studies on the effectiveness of school-based sun safety interventions among elementary and middle school students have shown an increase in sun safety knowledge, attitudes, and behaviors following the intervention.

OBJECTIVE

To conduct a pilot feasibility study of "Live Sun Smart!," (LSS) a school-based, multicomponent, interactive sun safety presentation, at changing sun safety knowledge, attitudes, and behaviors among middle school students.

METHODS

A non-randomized, single-group pretest-posttest interventional pilot study of the LSS program among children enrolled in grade 6.

RESULTS

After exposure to LSS, participants were more likely to give correct answers to knowledge-based sun safety questions and to report negative attitudes toward tanning. Minimal and not significant changes were found in self-reported sun safety behaviors, though students did report an intention to change behaviors following the intervention. Participants were satisfied with the program and believed it increased their sun safety knowledge.

CONCLUSION

Live Sun Smart! appears to be an effective school-based, multicomponent sun safety program for improving sun safety knowledge and attitudes toward tanning among middle school students in this initial test of it. The strengths and weaknesses of this pilot study have implications for future research.

[Skin cancers in Madagascar: where do we stand?]

Introduction

Skin cancers are malignant keratinizing tumors of epidermal, melaninic or adnexal origin. These cancers are still little known. However they affect people living in Madagascar where the amount of sunshine remains very high with an impact that varies depending on the skin type. The purpose of our study was to determine the epidemio-clinical profile of skin cancers in Antananarivo.

Methods

We conducted a retrospective descriptive study of skin cancers in the Department of Oncology of the Joseph Ravoahangy Andrianavalona Hospital, Antananarivo over a period of seven years. It included patients with tumoral skin lesions confirmed by histological examination.

Results

We collected data from 47 cases of skin cancers (male predominance; sex ratio 1.13). The average age of patients was 49.3 years. Farmers were the most affected. The lesions mainly occurred in the head, neck (44%) and lower limbs (42%). Localized skin cancers were detected in 61.7% of cases. Squamous cell carcinoma was the most common skin cancer in Madagascar (37%), followed by the melanoma (21%) and the basal cell carcinoma (11%). Treatment was mainly based on surgery (74.19%).

Conclusion

Squamous cell carcinoma is the most common cancer in Madagascar, followed by melanoma and basal cell carcinoma. Skin cancers affect mainly the young population and require appropriate management.

Sun Safe Workplaces: Effect of an Occupational Skin Cancer Prevention Program on Employee Sun Safety Practices

OBJECTIVE

Occupational skin cancer prevention is a priority because outdoor workers are exposed to high levels of ultraviolet radiation, the primary risk factor for skin cancer.

METHODS

A 2-year follow-up assessment of the impact of Sun Safe Workplaces (SSW), a workplace sun safety program that promoted policy adoption and education, on employee sun safety behavior was conducted. Sixty-three of 98 local government organizations from the original study participated.

RESULTS

Outdoor workers (n = 1724) completed surveys on personal sun protection practices. Employees' sun protection improved statistically significantly in the intervention group receiving the SSW program. SSW's effect was mediated by the number of workplace actions to implement elements of the policy, including sun protection messages and equipment and employee reports of sun safety training.

CONCLUSION

Policy promotion is a feasible approach to occupational skin cancer prevention.

Senior managers' awareness of sun protection policy predicts implementation of worksite sun safety in a randomized trial

BACKGROUND

Outdoor workers experience chronic exposure to harmful ultraviolet radiation (UV) elevating their risk for skin cancer.

METHODS

A controlled randomized trial promoted the adoption of workplace sun safety policy and employee education at 98 public organizations in Colorado. A 2-year follow-up study with 68 organizations assessed the association of senior manager awareness of sun safety policies and implementation of sun safety actions.

RESULTS

Senior managers' awareness of existing sun safety policies, but not their personal sun protection behaviors, predicted implementation of sun safety actions including the number of sun protection messages and sun protection items in the workplace and increased communication about sun safety to employees.

CONCLUSIONS

Organizational adoption of sun safety policy must include efforts to broadly inform a workplace's senior management to ensure the policies are actually implemented and provide support for sun protection behaviors by outdoor workers to reduce UV exposure and skin cancer risk.

[Occupational skin cancer : Prevention and recommendations for UV protection as part of the treatment approved by the public statutory employers' liability insurance]

In Germany, approximately 2 to 3 million employees work in outdoor professions. They are exceptionally exposed to solar ultraviolet (UV) radiation for a large part of their daily working time. Cumulative UV exposure is associated with a significantly increased risk of skin cancer for outdoor workers from various occupational groups (e. g. landscape and horticulture, agriculture and forestry, fisheries and seafaring, construction and trade, as well as sports teachers, lifeguards and mountain guides). Since 1 January 2015, squamous cell carcinoma and multiple actinic keratosis due to natural UV radiation can be recognised as occupational disease No. 5103 by the German statutory social accident insurance. Reducing cumulative UV exposure is the main prevention aspect of this type of skin damage. Therefore, technical, organisational and personal UV protection measures should be implemented in the professional and private environment. Moreover, they have to be regularly used in an appropriate way. In addition to guideline-oriented therapy, training and counselling of patients with already existing actinic skin damage or a recognised occupational disease No. 5103 is therefore of particular importance. The focus should be on improving the individual UV protection behaviour. This article gives an overview of current recommendations for UV protection in the professional environment. It outlines possible solutions for patient counselling in terms of UV protection in everyday practice.

Occupational Safety and Health in U.S. Aquaculture: A Review

Objectives: Aquaculture encompasses a variety of species in both freshwater and marine settings and can combine elements of agriculture and fishing, two recognized hazardous occupations. Efforts are underway to expand the aquaculture sector in the United States (U.S.), and should be informed by occupational safety and health (OSH) research. The objectives of this review paper are to: i) describe the U.S. aquaculture sector, ii) summarize statistics, peer-reviewed studies, and reports focused on U.S. aquaculture OSH, and iii) describe the policy landscape specific to U.S. aquaculture OSH.Methods: Literature searches employed databases and Internet search engines to identify relevant peer-reviewed articles, reports, and other resources. Due to the expected U.S. expansion of marine aquaculture and paucity of peer-reviewed U.S.-based OSH literature in this sector, additional searches for international research on marine aquaculture were conducted.Results: The U.S. Bureau of Labor Statistics estimated high rates of illness and injury among U.S. aquaculture workers in 2014 and 2015. Peer-reviewed literature on aquaculture OSH identified numerous physical, chemical, and biological OSH risks depending on production methods and settings. Significant policy gaps exist regarding U.S. aquaculture OSH surveillance, reporting, and regulation.Conclusion: This review identifies a critical need for research, surveillance, and best practices information, specific to the major types of aquaculture in the U.S., to augment and inform worker safety and health efforts in this expanding sector.

Outdoor testing of the photoprotection provided by a new water-based broad-spectrum SPF50+ sunscreen product: two double-blind, split-face, randomized controlled studies in healthy adults

Purpose

Users often under-apply sunscreens, and one of the main reasons cited for this is the cosmetic formulation of the product. To address this, we developed a water-based sunscreen. The product underwent standard laboratory testing (ISO 24444: 2010) and was determined as sun protection factor (SPF) 50+. However, such laboratory testing does not take into account environmental factors of in-use conditions that could potentially affect sunscreen efficacy, particularly of new cosmetic formulations. We aimed to test this product in conditions more representative of real-life solar exposure, to confirm its reported laboratory efficacy.

Methods

Two double-blind, randomized, controlled, split-face intra-individual studies were conducted during summer months in Barcelona. One study compared the product against an SPF15 control (reference standard P3 of ISO 24444: 2010), while the other compared against an SPF50+ control (another commercially available sunscreen). A technician applied the products before sun exposure: investigational product (IP) to one half of the face and the respective control product to the other. Subjects spent 4–6 hrs outdoors performing quiet activities, and sunscreens were reapplied at 2 hourly intervals. A dermatologist clinically scored facial erythema at baseline and at 24 hrs.

Results

Sixty-five subjects were included in total. In both studies, skin treated with the IP showed no significant increase in clinical erythema scoring at 24 hrs. There were statistically significant differences between the IP and the SPF15, but not between the IP and the SPF50+ control. SPF15 did not protect all subjects against solar-induced erythema.

Conclusion

These outdoor studies confirm the efficacy of this new SPF50+ water-based sunscreen in conditions that closer represent real-life sun exposure.

Solar Ultraviolet Radiation Exposure among Outdoor Workers in Three Canadian Provinces

Introduction

Solar ultraviolet radiation (UVR) exposure places outdoor workers at risk of skin cancer and exposure is difficult to control. In response, the Sun Safety at Work Canada (SSAWC) project was undertaken (2014–2016). The purpose of this substudy was to characterize the UVR exposure levels of outdoor workers in the SSAWC project.

Methods

Thirteen workplaces in the provinces of British Columbia, Ontario, and Nova Scotia participated in an exposure monitoring campaign (late summer/early fall 2016). Study participants were workers from power utilities and municipalities. Participants wore a UVR measurement badge (light-sensitive polysulfone plastic) on their wrist, shoulder, or hardhat. Badge calibration and absorbance measurements were performed in the AusSun Research Lab. Personal UVR doses are presented as standard erythemal doses (SED) and compared with the internationally recommended exposure limit (1.3 SED), as well as to the total available UVR by date. Generalized linear models were used to examine determinants of solar UVR for personal UVR dose (for both SED and percent of ambient UVR). Models considered badge placement, date, province, industry, main job task, and the hours spent outdoors.

Results

Mean personal UVR dose of participating workers was 6.1 SED (nearly 5× the recommended limit). Just 14% of workers experienced ‘acceptable’ levels of solar radiation; 10% were exposed at >10 times the limit. In univariate analyses, workers in Ontario had the highest levels (mean 7.3 SED), but even in the lowest exposed province (British Columbia), the mean personal UVR dose was 4.5 SED. Utility workers had double the exposure of municipal workers (10.4 and 5.5 SED, respectively). In the determinants of exposure models, the differences by province were muted, but utility line workers and those in general maintenance had higher predicted exposures. Those who wore their badge on their hardhat also had higher values of SED in the fully adjusted determinants models.

Conclusions

Solar ultraviolet overexposure among outdoor workers is a concern, even in a country like Canada with relatively low ambient UVR. Implementation of sun safety programs should be supported in an effort to reduce exposure in this vulnerable group of workers.

Skin cancer-related coping appraisal among farmers of rural areas: Applying protection motivation theory

BACKGROUND

Skin cancers are the most common malignancies in Iran. According to the statistics, skin cancer is the most prevalent cancer in Ilam city. This study is conducted to evaluate skin cancer coping of farmers in rural areas of Ilam city.

METHODS

This is a cross-sectional study. Samples were collected by multistage random sampling. The required data were collected by a researcher-made questionnaire from 248 farmers in rural areas of Ilam city. Questions were based on the protection motivation theory, and they were related to the subscales of response efficacy, self-efficacy, and response costs. Collected data were analyzed by SPSS software version 16.

RESULTS

Results of this study indicated that efficacy and perceived self-efficacy in farmers were low and response cost was high. The efficacy and perceived self-efficacy were high in 18.1% and 4.8% of farmers, respectively, and only 4.4% of them had low response costs, in association with protective behaviors. Regarding coping appraisal status also results showed that 204 people of farmers (82.3%) were unacceptable, one person (0.4%) was in the borderline, and 43 people (17.3%) were acceptable. There was a statistically significant association between coping appraisal status and education level and also income amount (P < 0.001) but there was no statistically significant association between coping appraisal status and family size (P > 0.670).

CONCLUSION

The founding proved that a coping appraisal is a beneficial approach for predicting cognitive determinants of skin cancer behavior among rural farmers. The most farmers have been the low level of coping appraisal (82.3% were unacceptable).

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Participatory action research, mixed methods, and research teams: learning from philosophically juxtaposed methodologies for optimal research outcomes

BACKGROUND

Workplace health interventions incorporating qualitative and quantitative components (mixed methods) within a Participatory Action Research approach can increase understanding of contextual issues ensuring realistic interventions which influence health behaviour. Mixed methods research teams, however, face a variety of challenges at the methodological and expertise levels when designing actions and interventions. Addressing these challenges can improve the team's functionality and lead to higher quality health outcomes. In this paper we reflect on the data collection, implementation and data analysis phases of a mixed methods workplace health promotion project and discuss the challenges which arose within our multidisciplinary team.

METHODS

This project used mixed methods within a Participatory Action Research approach to address workers' sun safety behaviours in 14 outdoor workplaces in Queensland, Australia, and elucidate why certain measures succeeded (or failed) at the worker and management level. The project integrated qualitative methods such as policy analysis and interviews, with a range of quantitative methods - including worker surveys, ultraviolet radiation (UVR) exposure measurement, and implementation cost analyses.

RESULTS

The research team found the integration of qualitative and quantitative analyses within the Participatory Action Research process to be challenging and a cause of tensions. This had a negative impact on the data analysis process and reporting of results, and the complexity of qualitative analysis was not truly understood by the quantitative team. Once all researchers recognised qualitative and quantitative data would be equally beneficial to the Participatory Action Research process, methodological bias was overcome to a degree to which the team could work cooperatively.

CONCLUSIONS

Mixed methods within a Participatory Action Research approach may allow a research team to discuss, reflect and learn from each other, resulting in broadened perspectives beyond the scope of any single research methodology. However, cohesive and supportive teams take constant work and adjustment under this approach, as knowledge and understanding is gained and shared. It is important researchers are cognisant of, and learn from, potential tensions within research teams due to juxtaposed philosophies, methodologies and experiences, if the team is to function efficiently and positive outcomes are to be achieved.

Implementation of Occupational Sun Safety at a 2-Year Follow-Up in a Randomized Trial: Comparison of Sun Safe Workplaces Policy Intervention to Attention Control

PURPOSE

Implementation of employer sun safety actions was assessed in a 2-year follow-up to an occupational sun protection policy intervention.

DESIGN

Two-year follow-up assessment in a randomized pretest-posttest controlled design.

SETTING

Local government organizations with workers in public safety, public works, and parks and recreation.

PARTICIPANTS

Sixty-three local government organizations (participation = 64%) and 330 frontline supervisors and 1454 workers.

INTERVENTION

Sun Safe Workplaces (SSW) intervention promoting occupational sun safety policy and education.

MEASURES

Observations of SSW messages and sun safety items and surveys on organizations' communication and actions on sun safety.

ANALYSIS

Comparison between SSW and control groups was conducted using regression models and adjusted for clustering where appropriate, with α criterion set at P = .05 (2-tailed).

RESULTS

At intervention worksites, more SSW messages ( P < .001) and sun safety items ( P = .025) were observed; more frontline supervisors reported organizations provided free/reduced price sunscreen ( P = .005) and communicated about sun safety ( P < .001); and more workers recalled receiving sun safety messages ( P < .001) and sun safety training ( P <.001) compared to control organizations. Implementation was greater at larger than smaller intervention organizations for wide-brimmed hats ( P = .009), long work pants ( P = .017), and shade structures ( P = .036). Older workers received the most written messages ( P = .015).

CONCLUSIONS

Sun Safe Workplaces appeared to produce actions by organizations to support employee sun safety. Large organizations may have processes, communication channels, and slack resources to achieve more implementation.

"Lost in the sun"-The key role of perceived workplace support for sun-protective behavior in outdoor workers

BACKGROUND

Previous studies show that workplace support for sun-protective behaviors plays an important role in the actual sun-protective behavior of outdoor workers. Therefore, our aim was to examine perceived workplace support (organizational and social support) in relation to different sun-protective behaviors.

METHODS

A Germany-wide sample of outdoor workers (n = 485) was surveyed via telephone. We analyzed associations of workplace support with sun-protective behaviors, sociodemographic, and occupational characteristics, occupational sun exposure, and concerns about sun.

RESULTS

A large number of outdoor workers perceived no workplace support for sun protection (eg, 17.8% agreed that sun protection is enforced at their workplace). We found that those who do not get any support are less likely to show sun-protective behaviors.

CONCLUSIONS

A starting point for a better organizational support is the implementation of mandatory sun protection policies in the workplace. Social support for protection against solar UV exposure can be promoted through safety training and education.

Next-Gen Therapeutics for Skin Cancer: Nutraceuticals

Growing modernization and lifestyle changes with limited physical activity have impacted diet and health, leading to an increased cancer mortality rate worldwide. As a result, there is a greater need than before to develop safe and novel anticancer drugs. Current treatment options such as chemotherapy, radiotherapy and surgery, induce unintended side effects, compromising patient's quality of life, and physical well-being. Therefore, there has been an increased global interest in the use of dietary supplements and traditional herbal medicines for treatment of cancer. Recently, nutraceuticals or "natural" substances isolated from food have attracted considerable attention in the cancer field. Emerging research suggests that nutraceuticals may indeed prevent and protect against cancer. The intent of this article is to review some of the current spice-derived nutraceuticals in the treatment of melanoma and skin cancer.

The Sun Solutions Intervention for Operating Engineers: A Randomized Controlled Trial

Background: Because Operating Engineers (heavy equipment operators) are outdoor workers at risk for skin cancer, interventions are needed to promote sun safety. The objectives were to determine changes in sunscreen use and sunburning among Operating Engineers randomized to four conditions in the Sun Solutions study: (i) education only; (ii) education and text message reminders; (ii) education and mailed sunscreen; and (iv) education, text message reminders, and mailed sunscreen.Methods: In this randomized controlled trial, Operating Engineers (N = 357) were recruited at required safety training sessions throughout Michigan during winter/spring of 2012 to 2013 and provided baseline surveys. The four interventions were delivered over the summer. Postintervention surveys were collected in the fall (82.1% follow-up).Results: Sunscreen use improved significantly from baseline to follow-up in all four conditions (P < 0.05), except sunscreen use among those receiving education and text message reminders was only marginally significant (P = 0.07). There were significantly greater increases in sunscreen use in the two conditions that were mailed sunscreen (P < 0.001). There was a significant decrease in the number of reported sunburns from baseline to follow-up in all four conditions (P < 0.001), but there were no significant differences in sunburns among the groups. Participant evaluated the interventions highly with those who received mailed sunscreen rating the intervention the highest.Conclusions: Providing proper sun-safety education and minimizing barriers to sunscreen use can increase sunscreen use and decrease reported sunburns.Impact: The implementation of the Sun Solutions intervention may be an effective method to modify skin cancer-related behaviors. Cancer Epidemiol Biomarkers Prev; 27(8); 864-73. ©2018 AACR.

Occupational Exposures and Health Outcomes Among Immigrants in the USA

PURPOSE OF REVIEW

Immigrants experience higher rates of occupational injury and fatality than their native-born counterparts. This review summarizes the current data related to occupational/environmental exposures and explores potential reasons for the disparities.

RECENT FINDINGS

Immigrant workers are employed in sectors that expose them to dangerous working conditions. They experience increased risk for exposure to heat, pesticides, hazardous chemicals, and cleaning agents, as well as physical hazards such as falls. Immigrant workers are at increased risk for occupational injury and fatality due to the nature of the work they traditionally perform, a lack of enforced safety regulations, and limited access to health care or worker's compensation benefits.

Prevalence and factors associated with exposure to sunlight and sunscreen among physical education teachers in Pelotas, southern Brazil

BACKGROUND

Decreasing the time of exposure to the sun and increasing sunscreen use are important actions to prevent skin cancer.

OBJECTIVE

This study aimed to verify the prevalence of exposure to the sun and the use of sunscreen, as well as associated factors among physical education teachers of the basic education network from city of Pelotas, southern Brazil.

METHODS

A census type study was conducted with physical education teachers of the basic education network from Pelotas. This study assessed the time of exposure to the sun in the workplace for at least 20 min, between 10am and 4pm, and the use of sunscreen during the workday.

RESULTS

188 teachers answered the questionnaire. The prevalence of exposure to the sun between 10:00am and 4:00pm was 89.2% (95% CI of 83.8% -93.3%), while sunscreen use was 63.3% (95% CI of 56.0% -70.2%). However, when the sample was stratified by sex, women reported a higher rate of sunscreen use (78.5% -95% CI of 72.2-84.3) than men (38.9% -95% CI of 31.8-46.2) (p<0.001). Teachers with longer work weeks were at greater risk of exposure to the sun. In addition, women, with normal weight and who worked less hours, were more likely to use sunscreen.

STUDY LIMITATIONS

Cross-sectional study and lack of information on the proper use and frequency of use of sunscreen.

CONCLUSION

Physical education teachers were highly exposed to solar radiation, and less than two-thirds used sunscreen during the workday. Interventions with this professional group are necessary to reduce the risk of skin cancer.

Assessment of occupational exposure to heat stress and solar ultraviolet radiation among groundskeepers in an eastern North Carolina university setting

Groundskeepers spend most of the year working outdoors, exposing them to heat and solar ultraviolet (UV) radiation and increasing their risk to related adverse health effects. Various studies on heat and UV exposures in different occupations have been published, but those on groundskeepers are rare. The purpose of this study was to assess the exposure to heat stress and solar UV radiation among groundskeepers in an eastern North Carolina university setting. Wet bulb globe temperature (WBGT) index using a heat stress monitor and UV effective irradiance (UV_eff) index using a digital UV meter were recorded in various work areas three times a day (morning, noon, afternoon) and during three seasons (spring, summer, fall). Data analysis was conducted using descriptive statistics, analysis of variance (ANOVA), Tukey Honestly Significant Difference (HSD), and Pearson Correlation tests. The mean (±SD) WBGT index was the highest in the afternoon (25.4 ± 5.0°C), summer (27.8 ± 3.1°C), and July (29.0 ± 2.6°C); the mean UV_eff index was the highest at noon, summer and June (0.0116 ± 0.0061, 0.0101 ± 0.0081, and 0.0114 ± 0.0089 mW/cm², respectively). Differences in the mean WBGT and UV_eff indices within the time periods of day, seasons and months were significant (P < 0.01). The overall correlation between WBGT and UV indices was moderate (r = 0.42, P < 0.01) but lack of correlation was found during different times of the day during the fall and summer seasons. The largest percentages of WBGT indices exceeding the American Conference of Governmental Industrial Hygienists (ACGIH) threshold limit values (TLVs) for different workloads were found in the afternoon (11.3-40.7%), summer (14.6-56%), and July (28.8-76.3%). The mean UV_eff for noon (0.0116 mW/cm²) and afternoon (0.0100 mW/cm²) exceeded the TLV for 30-min exposure. This study shows that groundskeepers are potentially exposed to excessive heat stress and UV radiation, and are at risk to developing heat- and UV-related illnesses. The study findings will be beneficial in implementing recommended control measures to prevent heat stress and UV exposure among groundskeepers and other similar outdoor workers.

Knowledge, attitudes, and sun-safety practices among agricultural workers in the Autonomous Province of Trento, North-Eastern Italy (2016)

BACKGROUND

The purpose of this study was to determine and evaluate sun safety knowledge, attitudes and practices (KAP) among agricultural workers (AWs) in the Autonomous Province of Trento (North-Eastern Italy).

METHODS

A cross sectional study was performed among AWs who attended pesticide training courses (2016). Participants received a structured questionnaire focusing on KAP towards sun protective behaviors. Synthetic scores for knowledge (GKS), risk perception (RPS), behavioral adaptation and use of personal protective equipment (SPPS) were calculated. Regression analysis was modelled in order to assess GKS, RPS and individual factors as predictors of SPPS.

RESULTS

The sample included 204 AWs (89.7% males, 10.3% females, mean age 43.9±15.9 years). Sun protective behaviors were irregularly referred by participants, in particular receiving medical skin assessment by a dermatologist (33.8%), avoiding sun radiations at noon and taking rest breaks in shady areas (30.9%), and wearing sunscreen (13.3%). GKS was correlated with RPS, and RPS was characterized as a significant predictor of SPPS (B=0.307; 95% CI 0.224-0.389, P<0.001), alongside increased seniority (B=4.957: 95% CI 3.064-6.851, P<0.001) and previous history of sunburns (B=5.829; 95% CI 1.520-10.139, P=0.008).

CONCLUSIONS

Our findings indicate that AWs are not appropriately aware of the risks associated with occupational exposure to solar radiation, and eventually report inadequate skin cancer prevention practices. Since SPPS found significant predictors in individual factors, tailored interventions and training may contribute to fill knowledge gaps and raise the concerns of AWs towards occupational dermatological disorders.

Determinants of Skin Cancer Preventive Behaviors Among Rural Farmers in Iran: an Application of Protection Motivation Theory

Skin cancer is one of the most prevalent cancers, worldwide, which happens more among those with more sunlight exposure like farmers. The aim of this study was to explore the determinants of skin cancer preventive behaviors (SCPBs) among rural farmers using Protection Motivation Theory (PMT). In this cross-sectional study, multistage random sampling was employed to enroll 238 farmers referring to rural health houses (HH) in Chaldoran County, Iran. A valid and reliable instrument based on PMT variables was used. Significant correlations were found between all PMT variables with SCPBs (p < 0.05). Hierarchical multiple linear regressions were performed with Protection Motivation and SCPBs as outcome variables. Predictors for these two outcome variables were classified in two different blocks according to their natures. Demographic characteristics (p > 0.05) and PMT constructs (p < 0.001) explained 3 and 63.6 % of the observed variance in Protection Motivation, respectively. Also, no significant effect was found on SCPBs by demographic variables, in the first block (∆R ² = 0.025); however, in the second block, Perceived Susceptibility (p = 0.000), Rewards (p = 0.022), Self-efficacy (p = 0.000), and Response Cost (p = 0.001) were significant predictors of SCPBs (∆R ² = 0.432). Health care providers may consider PMT as a framework for developing educational interventions aiming at improving SCPBs among rural farmers.

Results of a Randomized Trial on an Intervention Promoting Adoption of Occupational Sun Protection Policies

PURPOSE

To evaluate an intervention promoting adoption of occupational sun protection policies by employers in a randomized trial.

DESIGN

A randomized pretest-posttest controlled design with 2-year follow-up was conducted in 2010 to 2013.

SETTING

Local government organizations in Colorado who had outdoor workers in public works, public safety, and/or parks and recreation.

PARTICIPANTS

Ninety-eight local government organizations (n = 51 municipalities, 10 counties, and 37 special districts).

INTERVENTION

Organizations were randomly assigned to receive a policy and education intervention comprised of personal contacts and theory-based training and materials or to an attention control group.

MEASURES

Occupational policy documents were coded for sun safety content by a trained research assistant blind to condition.

ANALYSIS

Policy scores were analyzed with logistic and Poisson regression models using imputation.

RESULTS

At posttest, more organizations in the intervention group had a sun protection policy than in the control group (odds ratio [OR] = 4.91, P < .05; intent to treat: OR = 5.95, P < .05) and policies were more extensive (χ² = 31.29, P < .01; intent to treat: χ² =73.79, P < .01) and stronger (χ² = 24.50, P < .01; intent to treat: χ² = 51.95, P < .01). Policy adoption was higher when the number of contacts and trainings increased ( P < .05).

CONCLUSION

The intervention had a large effect on adoption of formal sun protection policies, perhaps because of its fit with legal requirements to maintain safe workplaces. Personal contacts with managers were influential on adoption of occupational policy even in this age of communication technology and social media.

Rationale, design, and baseline data of a cross-national randomized trial on the effect of built shade in public parks for sun protection

Environments can be structured to reduce solar ultraviolet radiation (UV) exposure to prevent skin cancer. A prospective randomized trial is being conducted to test whether introducing shade sails in passive recreation areas (PRAs) in public parks will increase use and decrease UV exposure in the shaded compared to unshaded PRAs. Shade effects will be compared between Melbourne, Australia and Denver, USA. The trial enrolled 145 public parks with PRAs suitable for shade construction and randomized parks to intervention or control in a 1:3 ratio. Use of PRAs and UV levels were recorded at each park by trained observers during 30-minute periods on four weekend days in each of two summers (pretest and posttest). Shade sails were constructed between the summers. Given low numbers of users at pretest, the outcome measure was modified to use of the PRA (use vs. no use) and unit of analysis to the individual observation. Observations (n=580) occurred on average 29days from the summer solstice and 55min from solar noon in warm weather (mean=26.2°C) with some cloud cover but only slight or no wind. Typically, PRAs had benches and picnic tables and were located near playgrounds. PRAs were in use during 13.3% of observations (mean=0.41 users). UV over 30-minutes at the PRA boundary (mean=3.2 standard erythemal dose [SED]) and center (mean=3.3 SED) was high. Shade for skin cancer prevention has been understudied. This study will address this gap by determining whether purpose-built shade structures promote greater use of shaded areas within public parks.

Skin cancer risk in outdoor workers: a European multicenter case-control study

BACKGROUND

Exposure to ultraviolet radiation (UVR) is the most important external risk factor for skin cancer. Outdoor workers, who are exposed to high ambient UVR levels are at increased risk.

OBJECTIVE

To compare outdoor with indoor workers in terms of: (i) skin cancer risk factors, and (ii) risk of developing skin cancer.

METHODS

Using descriptive methods and a large multicenter European case-control study, we compared risk factor patterns between outdoor (N = 1416) and indoor workers (N = 1863). Risk of developing basal cell carcinoma (BCC), squamous cell carcinoma (SCC), melanoma and actinic keratosis (AK) were analysed by type of work using multivariate logistic regression models, for three categories of work: indoor; farming/construction; other outdoor work.

RESULTS

Although skin phototype was equally distributed by type of work, significantly less outdoor than indoor workers used sunscreen in their own country (44.3% vs. 60.2%), but had more outdoor hobbies (66.2% vs. 58.2%). Outdoor workers had lower educational levels, and felt less confident in understanding medical information and filling medical forms (all P < 0.001). Outdoor workers had more signs of photodamage (78.1% vs. 65.5%) and among the skin cancer patients, 37.7% of outdoor workers vs. 28.6% of indoor workers had ≥2 skin cancers diagnosed during their lifetime. Multivariate logistic regression models showed significantly increased risk of outdoor vs. indoor work for AK (ORother outdoor = 1.55, ORfarming/construction = 2.58), SCC (ORother outdoor = 1.32, ORfarming/construction = 2.77) and BCC (ORother outdoor = 1.53, ORfarming/construction = 1.83). No significant associations were found for melanoma. The risk of all types of skin cancer and AK was significantly increased for workers with ≥5 years of outdoor work.

CONCLUSIONS

Outdoor workers had more risk behaviour with similar constitutional skin cancer risk factors: more UV exposure (both occupational and leisure) and less sunscreen use and lower health literacy. This results in higher exposure, more photodamage and an increased risk of developing AK, BCC and SCC.

Adoption of sun safe workplace practices by local governments

CONTEXT

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

OBJECTIVE

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

DESIGN

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

RESULTS

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

CONCLUSIONS

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

Baby Boomers and Birth Certificates: Early-Life Socioeconomic Status and Cancer Risk in Adulthood

BACKGROUND

Early-life socioeconomic status (SES) may play a role in cancer risk in adulthood. However, measuring SES retrospectively presents challenges. Parental occupation on the birth certificate is a novel method of ascertaining early-life SES that has not been applied in cancer epidemiology.

METHODS

For a Baby-Boom cohort born from 1945-1959 in two Utah counties, individual-level Nam-Powers SES (Np-SES) was derived from parental industry/occupation reported on birth certificates. Neighborhood SES was estimated from average household income of census tract at birth. Cancer incidence was determined by linkage to Utah Cancer Registry records through the Utah Population Database. Hazard ratios (HR) for cancer risk by SES quartile were estimated using Cox proportional hazards regression.

RESULTS

Females with low Np-SES at birth had lower risk of breast cancer compared with those in the highest Np-SES group [HR_Q1/Q4 = 0.83; 95% confidence interval (CI), 0.72-0.97; HR_Q2/Q4 = 0.81; 95% CI, 0.69-0.96]. Np-SES was inversely associated with melanoma (HR_Q1/Q4 = 0.81; 95% CI, 0.67-0.98) and prostate cancer (HR_Q1/Q4 = 0.70; 95% CI, 0.56-0.88). Women born into lower SES neighborhoods had significantly increased risk for invasive cervical cancer (HR_Q1/Q4 = 1.44; 95% CI, 1.12-1.85; HR_Q2/Q4 = 1.33; 95% CI, 1.04-1.72). Neighborhood SES had similar effects for melanoma and prostate cancers, but was not associated with female breast cancer. We found no association with SES for pancreas, lung, and colon and rectal cancers.

CONCLUSIONS

Individual SES derived from parental occupation at birth was associated with altered risk for several cancer sites.

IMPACT

This novel methodology can contribute to improved understanding of the role of early-life SES on cancer risk. Cancer Epidemiol Biomarkers Prev; 26(1); 75-84. ©2016 AACR.

Occupational exposure to solar ultraviolet radiation and the risk of prostate cancer

OBJECTIVES

Preventable risk factors for prostate cancer are poorly understood; sun exposure is a possible protective factor. The goal of this study was to investigate prostate cancer risk in outdoor workers, a population with high sun exposure.

METHODS

Prostate cancer cases and controls from a large study (conducted between 1994 and 1997) were used for this analysis. A job exposure matrix (JEM) was used to assign solar ultraviolet radiation (UVR) at work as moderate (2 to <6 hours outside/day) or high (≥6 hours). Average daily satellite UV-B measures were linked to the latitude/longitude of the residences of each participant. Several other exposure metrics were also examined, including ever/never exposed and standard erythemal dose by years (SED×years). Logistic regression was used to evaluate the association between solar UVR exposure and the odds of prostate cancer.

RESULTS

A total of 1638 cases and 1697 controls were included. Men of Indian and Asian descent had reduced odds of prostate cancer (ORs 0.17 (0.08 to 0.35) and 0.25 (0.15 to 0.41), respectively) compared with Caucasian men, as did single men (OR 0.76 (0.58 to 0.98)) compared with married men. Overall, no statistically significant associations were observed between sun exposure and prostate cancer with 1 exception. In the satellite-enhanced JEM that considered exposure in high category jobs only, prostate cancer odds in the highest quartile of cumulative exposure was decreased compared with unexposed men (OR 0.68 (0.51 to 0.92)).

CONCLUSIONS

This study found limited evidence for an association with prostate cancer, with the exception of 1 statistically significant finding of a decreased risk among workers with the longest term and highest sun exposure.

Worldwide cutaneous malignant melanoma incidences analyzed by sex, age, and skin type over time (1955-2007): Is HPV infection of androgenic hair follicular melanocytes a risk factor for developing melanoma exclusively in people of European-ancestry?

The cutaneous malignant melanoma (CMM) incidence has been increasing in an exponential manner in certain populations around the world for over 7 decades. To help illuminate the etiology, we performed worldwide temporal (1955–2007) CMM incidence analysis by sex, age (0–14, 15–29, 30–49, 50–69, 70–85+), and skin type on 6 continents using data from the International Agency for Research on Cancer. We observe an exponential increase in the CMM incidence over time and an increase of about 2 orders of magnitude between age groups 0–14 and 15–29 exclusively in European-ancestry populations around the world independent of skin type (I–III or III–IV). Other populations like the Chinese (III-IV) had much lower CMM incidences that either remained stable or temporally decreased but did not display a dramatic increase between the youngest age groups. The dramatic increase in the incidence between the youngest age groups found only in European-ancestry populations suggests one of the most important risk factors for CMM may be developing androgenic hair, the occurrence of which appears to correlate with the distribution of CMM over male and female body sites. Besides that potential new risk factor, the increasing CMM incidence with increasing age, known not to be from cumulative UV doses, may be associated with age-related changes to skin, i.e., thinning epidermis causing lower vitamin D₃ levels, and hair, i.e., whitening from higher reactive oxygen species. The temporal exponential increasing CMM incidence in European-ancestry populations may be due to Human Papilloma Virus infection of follicular hair melanocytes, found in CMM biopsies.

Nucleotide Excision Repair and Vitamin D--Relevance for Skin Cancer Therapy

Ultraviolet (UV) radiation is involved in almost all skin cancer cases, but on the other hand, it stimulates the production of pre-vitamin D3, whose active metabolite, 1,25-dihydroxyvitamin D3 (1,25VD3), plays important physiological functions on binding with its receptor (vitamin D receptor, VDR). UV-induced DNA damages in the form of cyclobutane pyrimidine dimers or (6-4)-pyrimidine-pyrimidone photoproducts are frequently found in skin cancer and its precursors. Therefore, removing these lesions is essential for the prevention of skin cancer. As UV-induced DNA damages are repaired by nucleotide excision repair (NER), the interaction of 1,25VD3 with NER components can be important for skin cancer transformation. Several studies show that 1,25VD3 protects DNA against damage induced by UV, but the exact mechanism of this protection is not completely clear. 1,25VD3 was also shown to affect cell cycle regulation and apoptosis in several signaling pathways, so it can be considered as a potential modulator of the cellular DNA damage response, which is crucial for mutagenesis and cancer transformation. 1,25VD3 was shown to affect DNA repair and potentially NER through decreasing nitrosylation of DNA repair enzymes by NO overproduction by UV, but other mechanisms of the interaction between 1,25VD3 and NER machinery also are suggested. Therefore, the array of NER gene functioning could be analyzed and an appropriate amount of 1.25VD3 could be recommended to decrease UV-induced DNA damage important for skin cancer transformation.

Skin Protection Behaviors among Young Male Latino Day Laborers: An Exploratory Study Using a Social Cognitive Approach

Latino Day Laborers (LDLs) are employed in occupations where multiple work hazards exist. One such hazard is the overexposure to solar ultraviolet radiation for continuous periods of time. Regular sun exposure can put individuals at increased risk of developing skin cancers, especially without adequate protection. The purpose of this cross-sectional exploratory study was to use a social cognitive framework to assess skin protective behaviors among LDLs. A community-based nonrandom and purposive sample of LDLs was recruited in two states: Mississippi and Illinois. The study sample consisted of 137 male participants, of which the majority were of Mexican ancestry (72%). The average age was 35.40 (SD = 9.89) years. Results demonstrated that a substantial number of LDLs do not adequately practice sun protection behaviors on a regular basis. The skin cancer knowledge scores were very modest. The most frequently indicated barriers towards sun protection were “inconvenient,” “forget to use,” and “not being able to reapply sunscreen.” Overall, LDLs had moderate confidence in their abilities to adopt successful sun protection strategies. This study underscores the need for intervention programs aimed at LDLs to reduce extended time in the sun and increase use of sun protective measures when working outdoors.

Occupational exposure to carcinogens in Australian road transport workers

BACKGROUND

Road transport workers (RTWs) are at high risk of exposure to several occupational carcinogens. However, there are gaps in knowledge regarding the extent and the circumstances of exposure. As a sub-study of the Australian Work Exposures Study, this study investigated the prevalence of occupational exposure in Australian RTWs.

METHODS

A random sample of Australian working population was invited to a telephone interview regarding their current jobs. An automated expert-assessment procedure was applied to self-reported job-related tasks using a web-based application. 162 RTWs were included in this study.

RESULTS

RTWs were exposed to diesel exhaust (97%), solar ultraviolet radiation (78%), environmental tobacco smoke (55%), benzene (29%), silica (15%), and asbestos (10%) at work. Besides driving on roads, vehicle maintenance-related tasks were the major source of carcinogen exposures among RTWs.

DISCUSSION

Most RTWs are exposed to at least one carcinogen at work. We have identified tasks where the use of control measures could potentially reduce exposures.

Factors Associated With Occupational Sun-Protection Policies in Local Government Organizations in Colorado

IMPORTANCE

Skin cancer prevention remains a national priority. Reducing chronic UV radiation exposure for outdoor workers through sun-safety practices is an important step to help reduce the incidence of skin cancer.

OBJECTIVE

To determine the presence of occupational sun-safety policies at local government organizations in a single state.

DESIGN, SETTING, AND PARTICIPANTS

Of 571 potentially eligible local government organizations of Colorado cities, counties, and special tax districts, we enrolled 98 in a randomized pretest-posttest controlled experiment starting August 15, 2010, that evaluated an intervention to promote the adoption of sun-safety policies. We used a policy-coding protocol to evaluate personal sun-protection practices, environmental and administrative controls, and policy directives for sun safety starting February 10, 2011. We report the baseline assessment of the occupational sun-protection policies of these organizations.

MAIN OUTCOMES AND MEASURES

The presence of an occupational sun-safety policy.

RESULTS

Overall, 85 local government organizations (87%) had policies that required personal sun-protection practices, including the use of eyewear, hats, and protective clothing. However, of the 98 responding organizations, only 8 hat policies (8%), 10 eyewear policies (10%), and 7 clothing policies (7%) mentioned sun protection as the intent of the policy. Only cosmopoliteness, operationalized as proximity to an urban area, was associated with the presence of a sun-safety policy (odds ratio, 0.99 [95% CI, 0.98-1.00]; P = .02).

CONCLUSIONS AND RELEVANCE

Outdoor workers are at increased risk for skin cancer because of long-term exposure to solar UV radiation. Although organizational policies have the potential to increase sun protection in occupational settings, occupational sun-safety policies were uncommon among local governments. Opportunities exist for dermatologists and other physicians to influence occupational sun-safety practices and policies, which are consistent with other safety procedures and could easily be integrated into existing workplace practices.

The Sustainability of an Occupational Skin Cancer Prevention Program

OBJECTIVE

Sustainability of prevention programs is a public health goal.

METHODS

The effectiveness of Go Sun Smart, an occupational skin cancer prevention program, was evaluated 5 to 7 years out from the conclusion of a controlled randomized dissemination trial that compared an enhanced versus basic dissemination strategy at 53 ski areas enrolled in the trial.

RESULTS

Employees (n = 2940) at ski areas in the enhanced condition reported fewer sunburns but did not differ from employees in the basic condition on other sun-protection measures. Significant differences for all sun-protection practices were identified at ski areas that displayed nine or more Go Sun Smart materials or a combined total of nine or more Go Sun Smart and other sun safety messages.

CONCLUSIONS

Exposure to prevention messages is an important determinant of program effectiveness and potentially of program sustainability.