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Buller DB, Buller MK, Meenan R, Cutter GR, Berteletti J, Eye R, Walkosz BJ, Pagoto S. Design and baseline data of a randomized trial comparing two methods for scaling-up an occupational sun protection intervention. Contemp Clin Trials 2020; 97:106147. [PMID: 32942054 PMCID: PMC7490282 DOI: 10.1016/j.cct.2020.106147] [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: 06/30/2020] [Revised: 08/21/2020] [Accepted: 09/10/2020] [Indexed: 12/02/2022]
Abstract
Background Successful methods for scaling-up evidence-based programs are needed to prevent skin cancer among adults who work outdoors in the sun. Methods A randomized trial is being conducted comparing two methods of scaling-up the Sun Safe Workplaces (SSW) intervention. Departments of transportation (DOTs) from 21 U.S. states are participating and their 138 regional districts were randomized following baseline assessment. In districts assigned to the in-person method (n = 46), project staff meets personally with managers, conducts trainings for employees, and provides printed materials. In districts assigned to the digital method (n = 92), project staff conduct these same activities virtually, using conferencing technology, online training, and electronic materials. Delivery of SSW in both groups was tailored to managers' readiness to adopt occupational sun safety. Posttesting will assess manager's support for and use of SSW and employees' sun safety. An economic evaluation will explore whether the method that uses digital technology results in lower implementation of SSW but is more cost-effective relative to the in-person method. Results The state DOTs range in size from 997 to 18,415 employees. At baseline, 1113 managers (49.0%) completed the pretest (91.5% male, 91.1% white, 19.77 years on the job, 66.5% worked outdoors; and 24.4% had high-risk skin types). They were generally supportive of occupational sun safety. A minority reported that the employer had a written policy, half reported training, and two-thirds, messaging on sun protection. Conclusions Digital methods are available that may make scale-up of SSW cost-effective in a national distribution to nearly half of the state DOTs. Trial registration: The ClinicalTrials.gov registration number is NCT03278340.
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Affiliation(s)
- David B Buller
- Research at Klein Buendel, Inc, A Health Communication and Media Development Firm, Golden, CO, USA.
| | | | - Richard Meenan
- Investigator at Kaiser Permanente Center for Health Research, Portland, OR, USA
| | - Gary R Cutter
- Emeritus at the University of Alabama, Birmingham, AL, USA
| | | | - Rachel Eye
- Project Coordinator at Klein Buendel, Inc, Golden, CO, USA
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Sun Safe Workplaces: Effect of an Occupational Skin Cancer Prevention Program on Employee Sun Safety Practices. J Occup Environ Med 2019; 60:900-997. [PMID: 30095593 DOI: 10.1097/jom.0000000000001427] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
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.
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Walkosz BJ, Buller DB, Buller MK, Wallis A, Liu X. Senior managers' awareness of sun protection policy predicts implementation of worksite sun safety in a randomized trial. Am J Ind Med 2019; 62:893-900. [PMID: 31403221 DOI: 10.1002/ajim.23033] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Revised: 07/16/2019] [Indexed: 01/03/2023]
Abstract
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.
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Affiliation(s)
| | | | | | - Allan Wallis
- School of Public Affairs, University of Colorado Denver, Denver, Colorado
| | - Xia Liu
- Klein Buendel, Inc, Golden, Colorado
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Buller DB, Walkosz BJ, Buller MK, Wallis A, Andersen PA, Scott MD, Meenan RT, Cutter GR. 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. Am J Health Promot 2018; 33:683-697. [PMID: 30477333 DOI: 10.1177/0890117118814398] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
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.
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Affiliation(s)
| | | | | | - Allan Wallis
- 2 School of Public Affairs, University of Colorado Denver, Denver, CO, USA
| | - Peter A Andersen
- 3 School of Communication, San Diego State University, San Diego, CA, USA
| | | | - Richard T Meenan
- 5 Kaiser Permanente, Center for Health Research, Portland, OR, USA
| | - Gary R Cutter
- 6 Department of Biostatistics, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA
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Taber JM, Dickerman BA, Okhovat JP, Geller AC, Dwyer LA, Hartman AM, Perna FM. Skin cancer interventions across the cancer control continuum: Review of technology, environment, and theory. Prev Med 2018; 111:451-458. [PMID: 29277407 PMCID: PMC5949070 DOI: 10.1016/j.ypmed.2017.12.019] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2017] [Revised: 11/11/2017] [Accepted: 12/19/2017] [Indexed: 12/12/2022]
Abstract
The National Cancer Institute's Skin Cancer Intervention across the Cancer Control Continuum model was developed to summarize research and identify gaps concerning skin cancer interventions. We conducted a mapping review to characterize whether behavioral interventions addressing skin cancer prevention and control from 2000 to 2015 included (1) technology, (2) environmental manipulations (policy and/or built environment), and (3) a theoretical basis. We included 86 studies with a randomized controlled or quasi-experimental design that targeted behavioral intervention in skin cancer for children and/or adults; seven of these were dissemination or implementation studies. Of the interventions described in the remaining 79 articles, 57 promoted only prevention behaviors (e.g., ultraviolet radiation protection), five promoted only detection (e.g., skin examinations), 10 promoted both prevention and detection, and seven focused on survivorship. Of the 79 non-dissemination studies, two-thirds used some type of technology (n=52; 65.8%). Technology specific to skin cancer was infrequently used: UVR photography was used in 15.2% of studies (n=12), reflectance spectroscopy was used in 12.7% (n=10), and dermatoscopes (n=1) and dosimeters (n=2) were each used in less than 3%. Ten studies (12.7%) targeted the built environment. Fifty-two (65.8%) of the studies included theory-based interventions. The most common theories were Social Cognitive Theory (n=20; 25.3%), Health Belief Model (n=17; 21.5%), and the Theory of Planned Behavior/Reasoned Action (n=12; 15.2%). Results suggest that skin cancer specific technology and environmental manipulations are underutilized in skin cancer behavioral interventions. We discuss implications of these results for researchers developing skin cancer behavioral interventions.
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Affiliation(s)
- Jennifer M Taber
- Behavioral Research Program, National Cancer Institute, United States.
| | | | | | - Alan C Geller
- Harvard TH Chan School of Public Health, United States
| | | | - Anne M Hartman
- Behavioral Research Program, National Cancer Institute, United States
| | - Frank M Perna
- Behavioral Research Program, National Cancer Institute, United States
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Andersen PA, Buller DB, Walkosz BJ, Scott MD, Beck L, Liu X, Abbott A, Eye R, Cutter G. A Randomized Trial of an Advanced Sun Safety Intervention for Vacationers at 41 North American Resorts. JOURNAL OF HEALTH COMMUNICATION 2017; 22:951-963. [PMID: 29161214 PMCID: PMC6309206 DOI: 10.1080/10810730.2017.1382615] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Taking vacations in sunny locations is associated with the development of skin cancer. This study tested a multi-component sun protection intervention based on diffusion of innovations theory and transportation theory designed to increase vacationers' comprehensive sun protection, i.e., use of clothing, hats, and shade, and use, pre-application, and reapplication of sunscreen. The trial enrolled 41 warm weather resorts in North America in a pair-matched group randomized pretest-posttest design and assessed samples of adult vacationers at resort outdoor recreation venues regarding sun protection at pretest (n = 3,531) and posttest (n = 3,226). While results showed no overall effect of the intervention on comprehensive sun protection across venues, the intervention produced statistically significant improvements in sun protection at waterside venues (pools and beaches). The intervention's overall effects may have been impeded by a lack of uniformly robust implementation, low interest in skin cancer prevention by guests, or shortcomings of the theories used to create prevention messages. The intervention may have worked best with guests in the highest-risk recreation venue, i.e., waterside recreation where they exposed the most skin. Alternative approaches that alter resort organizations, such as through changes in policy, environmental features, or occupational efforts might be more effective than targeting vacationers with behavior-change messages.
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Affiliation(s)
- Peter A. Andersen
- School of Communication, San Diego State University, San Diego, California, USA
| | | | | | | | - Larry Beck
- L. Robert Payne School of Hospitality and Tourism Management, San Diego State University, San Diego, California, USA
| | - Xia Liu
- Klein Buendel, Inc., Golden, Colorado, USA
| | - Allison Abbott
- School of Communication, San Diego State University, San Diego, California, USA
| | - Rachel Eye
- Klein Buendel, Inc., Golden, Colorado, USA
| | - Gary Cutter
- School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama, USA
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Buller DB, Andersen PA, Walkosz BJ, Scott MD, Beck L, Cutter GR. Effect of an intervention on observed sun protection by vacationers in a randomized controlled trial at North American resorts. Prev Med 2017; 99:29-36. [PMID: 28189810 PMCID: PMC5432386 DOI: 10.1016/j.ypmed.2017.01.014] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Revised: 12/05/2016] [Accepted: 01/29/2017] [Indexed: 11/15/2022]
Abstract
During vacations, many individuals receive high-risk sun exposure that is associated with skin cancer. Vacationers in outdoor recreation venues (pretest n=4347; posttest n=3986) at warm-weather destination resorts in North America (n=41) were enrolled in a pair-matched, group-randomized pretest-posttest controlled quasi-experimental design in 2012-14. Print, audiovisual, and online messages based on Transportation Theory and Diffusion of Innovation Theory and promoting advanced sun protection (e.g., use of clothing, hats, shade and pre-application/reapplication of sunscreen and reliable cues to high UV) were delivered through resort channels. Vacationers' sun protection practices observed by trained research staff (i.e., body coverage and shade use analyzed individually and in combined scores) did not differ by experimental condition (p>0.05) or intervention implementation (p>0.05). However, recreation venue moderated intervention impact. The intervention improved sun protection at waterside recreation venues (z-score composite: intervention pre=-22.74, post=-15.77; control pre=-27.24, post=-23.24) but not non-waterside venues (z-score composite: intervention pre=20.43, post=20.53; control pre=22.94, post=18.03, p<0.01). An additional analysis showed that resorts with greater program implementation showed more improvements in sun protection by vacationers at waterside (z=score composite: high implementation pre=-25.45, post=-14.05; low implementation pre=-24.70, post=-21.40) compared to non-waterside (z-score composite: high implementation pre=14.51, post=19.98; low implementation pre=24.03, post=18.98, p<0.01) recreation venues. The intervention appeared effective with the vacationers in recreation venues with the highest-risk for sun exposure, waterside venues. However, it was not effective throughout all the resort venues, possibly because of the sun-seeking desires of vacationers, information overload at the resorts, and constraints on clothing styles and sun protection by recreation activity.
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Affiliation(s)
- David B Buller
- Klein Buendel, Inc., 1667 Cole Boulevard, Suite 225, Golden, CO 80401, USA.
| | - Peter A Andersen
- School of Communication, San Diego State University, 5500 Campanille, San Diego, CA 92182-4560, USA
| | - Barbara J Walkosz
- Klein Buendel, Inc., 1667 Cole Boulevard, Suite 225, Golden, CO 80401, USA
| | - Michael D Scott
- Department of Communication Arts and Sciences, 400 W 1st Street, California State University, Chico, CA 95929, USA
| | - Larry Beck
- L. Robert Payne School of Hospitality and Tourism Management, San Diego State University, San Diego, CA 92182, USA
| | - Gary R Cutter
- School of Public Health, University of Alabama, Birmingham, 1667 University Blvd, Ryals 410b, Birmingham, AL 35294, USA
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Buller DB, Walkosz BJ, Buller MK, Wallis A, Andersen PA, Scott MD, Eye R, Liu X, Cutter G. Results of a Randomized Trial on an Intervention Promoting Adoption of Occupational Sun Protection Policies. Am J Health Promot 2017; 32:1042-1053. [PMID: 28447466 DOI: 10.1177/0890117117704531] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
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.
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Affiliation(s)
| | | | | | - Allan Wallis
- 2 School of Public Affairs, University of Colorado Denver, Denver, CO, USA
| | - Peter A Andersen
- 3 School of Communication, San Diego State University, San Diego, CA, USA
| | - Michael D Scott
- 4 Department of Communication Arts and Sciences, California State University, Chico, CA, USA
| | | | - Xia Liu
- 1 Klein Buendel, Inc, Golden, CO, USA
| | - Gary Cutter
- 5 Department of Biostatistics, School of Public Health, University of Alabama, Birmingham, AL, USA
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Maguire E, Spurr A. Implementation of Ultraviolet Radiation Safety Measures for Outdoor Workers. J Cutan Med Surg 2016; 21:117-124. [PMID: 27940497 DOI: 10.1177/1203475416683389] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Ultraviolet radiation (UVR) poses a major risk for outdoor workers, putting them at greater risk for skin cancer. In the general population, the incidence of both melanoma and nonmelanoma skin cancers is increasing. It is estimated that 90% of skin cancers in Canada are directly attributable to UVR exposure, making this cancer largely preventable with the appropriate precautions. A scoping review was conducted on the barriers and facilitators to UVR safety in outdoor workers to elucidate why these precautions are not in use currently. We discuss these results according to the Hierarchy of Controls as a means to outline effective and feasible prevention strategies for outdoor workers. In doing so, this review may be used to inform the design of future workplace interventions for UVR safety in outdoor workers to decrease the risk of skin cancer in this vulnerable population.
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Affiliation(s)
- Erin Maguire
- 1 Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Alison Spurr
- 1 Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
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Dagenais C, Plouffe L, Gagné C, Toulouse G, Breault AA, Dupont D. Improving the health and safety of 911 emergency call centre agents: an evaluability assessment of a knowledge transfer strategy. INTERNATIONAL JOURNAL OF OCCUPATIONAL SAFETY AND ERGONOMICS 2016; 23:50-59. [PMID: 27455876 DOI: 10.1080/10803548.2016.1216355] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
A knowledge transfer (KT) strategy was implemented by the IRSST, an occupational health and safety research institute established in Québec (Canada), to improve the prevention of psychological and musculoskeletal problems among 911 emergency call centre agents. An evaluability assessment was conducted in which each aspect of the KT approach was documented systematically to determine whether the strategy had the potential to be evaluated in terms of its impact on the targeted population. A review of the literature on KT in occupational health and safety and on the evaluation of such KT programmes, along with the development of a logic model based on documentary analysis and semi-structured interviews with key stakeholders, indicated that the KT strategy was likely to have had a positive impact in the 911 emergency call centre sector. Implications for future research are discussed.
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Affiliation(s)
| | | | - Charles Gagné
- b Institut de recherche en santé et en sécurité du travail (IRSST) , Canada
| | - Georges Toulouse
- b Institut de recherche en santé et en sécurité du travail (IRSST) , Canada
| | | | - Didier Dupont
- c Research officer in human and social sciences , Canada
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Buller DB, Andersen PA, Walkosz BJ, Scott MD, Beck L, Cutter GR. Rationale, design, samples, and baseline sun protection in a randomized trial on a skin cancer prevention intervention in resort environments. Contemp Clin Trials 2015; 46:67-76. [PMID: 26593781 DOI: 10.1016/j.cct.2015.11.015] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2015] [Revised: 11/17/2015] [Accepted: 11/19/2015] [Indexed: 10/22/2022]
Abstract
INTRODUCTION Exposure to solar ultraviolet radiation during recreation is a risk factor for skin cancer. A trial evaluated an intervention to promote advanced sun protection (sunscreen pre-application/reapplication; protective hats and clothing; use of shade) during vacations. MATERIALS AND METHODS Adult visitors to hotels/resorts with outdoor recreation (i.e., vacationers) participated in a group-randomized pretest-posttest controlled quasi-experimental design in 2012-14. Hotels/resorts were pair-matched and randomly assigned to the intervention or untreated control group. Sun. protection (e.g., clothing, hats, shade and sunscreen) was measured in cross-sectional samples by observation and a face-to-face intercept survey during two-day visits. RESULTS Initially, 41 hotel/resorts (11%) participated but 4 dropped out before posttest. Hotel/resorts were diverse (employees=30 to 900; latitude=24° 78' N to 50° 52' N; elevation=2ft. to 9726ft. above sea level), and had a variety of outdoor venues (beaches/pools, court/lawn games, golf courses, common areas, and chairlifts). At pretest, 4347 vacationers were observed and 3531 surveyed. More females were surveyed (61%) than observed (50%). Vacationers were mostly 35-60years old, highly educated (college education=68%) and non-Hispanic white (93%), with high-risk skin types (22%). Vacationers reported covering 60% of their skin with clothing. Also, 40% of vacationers used shade; 60% applied sunscreen; and 42% had been sunburned. CONCLUSIONS The trial faced challenges recruiting resorts but result showed that the large, multi-state sample of vacationers were at high risk for solar UV exposure.
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Affiliation(s)
- David B Buller
- Klein Buendel, Inc., 1667 Cole Boulevard, Suite 225, Golden, CO 80401, United States.
| | - Peter A Andersen
- School of Communication, San Diego State University, 5500 Campanile Drive, San Diego, CA 92182, United States.
| | - Barbara J Walkosz
- Klein Buendel, Inc., 1667 Cole Boulevard, Suite 225, Golden, CO 80401, United States.
| | - Michael D Scott
- California State University and President of Mikonics, Inc., 40 B Old Road South, Santa Fe, NM 87540, United States.
| | - Larry Beck
- L. Robert Payne School of Hospitality and Tourism Management, Room PSFA 445, San Diego State University, San Diego, CA 92182, United States.
| | - Gary R Cutter
- Department of Biostatistics, School of Public Health, RPHB 401B, University of Alabama, 1720 2nd Avenue South, Birmingham, AL 35294, United States.
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Abstract
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.
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Kramer DM, Tenkate T, Strahlendorf P, Kushner R, Gardner A, Holness DL. Sun Safety at Work Canada: a multiple case-study protocol to develop sun safety and heat protection programs and policies for outdoor workers. Implement Sci 2015; 10:97. [PMID: 26159710 PMCID: PMC4702388 DOI: 10.1186/s13012-015-0277-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2015] [Accepted: 06/05/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND CAREX Canada has identified solar ultraviolet radiation (UV) as the second most prominent carcinogenic exposure in Canada, and over 75 % of Canadian outdoor workers fall within the highest exposure category. Heat stress also presents an important public health issue, particularly for outdoor workers. The most serious form of heat stress is heat stroke, which can cause irreversible damage to the heart, lungs, kidneys, and liver. Although the need for sun and heat protection has been identified, there is no Canada-wide heat and sun safety program for outdoor workers. Further, no prevention programs have addressed both skin cancer prevention and heat stress in an integrated approach. The aim of this partnered study is to evaluate whether a multi-implementation, multi-evaluation approach can help develop sustainable workplace-specific programs, policies, and procedures to increase the use of UV safety and heat protection. METHODS/DESIGN This 2-year study is a theory-driven, multi-site, non-randomized study design with a cross-case analysis of 13 workplaces across four provinces in Canada. The first phase of the study includes the development of workplace-specific programs with the support of the intensive engagement of knowledge brokers. There will be a three-points-in-time evaluation with process and impact components involving the occupational health and safety (OHS) director, management, and workers with the goal of measuring changes in workplace policies, procedures, and practices. It will use mixed methods involving semi-structured key informant interviews, focus groups, surveys, site observations, and UV dosimetry assessment. Using the findings from phase I, in phase 2, a web-based, interactive, intervention planning tool for workplaces will be developed, as will the intensive engagement of intermediaries such as industry decision-makers to link to policymakers about the importance of heat and sun safety for outdoor workers. DISCUSSION Solar UV and heat are both health and safety hazards. Using an occupational health and safety risk assessment and control framework, Sun Safety at Work Canada will support workplaces to assess their exposure risks, implement control strategies that build on their existing programs, and embed the controls into their existing occupational health and safety system.
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Affiliation(s)
- Desre M Kramer
- Occupational Cancer Research Centre, Cancer Care Ontario, 3rd floor, 525 University Avenue, Toronto, ON, M5G 1X3, Canada.
| | - Thomas Tenkate
- School of Occupational and Public and Health, Ryerson University, 350 Victoria Street, Toronto, ON, M5B 2K3, Canada
| | - Peter Strahlendorf
- School of Occupational and Public and Health, Ryerson University, 350 Victoria Street, Toronto, ON, M5B 2K3, Canada
| | - Rivka Kushner
- Occupational Cancer Research Centre, Cancer Care Ontario, 3rd floor, 525 University Avenue, Toronto, ON, M5G 1X3, Canada
| | - Audrey Gardner
- School of Occupational and Public and Health, Ryerson University, 350 Victoria Street, Toronto, ON, M5B 2K3, Canada
| | - D Linn Holness
- St Michael's Hospital, 30 Bond St., Toronto, ON, M5B 1W8, Canada
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Walkosz BJ, Buller DB, Andersen PA, Scott MD, Liu X, Cutter GR, Dignan MB. Translation of a Ski School Sun Safety Program to North American Ski and Snowboard Schools. Health Promot Pract 2015; 16:560-70. [PMID: 25761916 PMCID: PMC4485589 DOI: 10.1177/1524839915577081] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Health promotion programs that develop and implement strategies to promote sun safety practices to children have the potential to reduce skin cancer occurrence later in life. Go Sun Smart (GSS), a sun safety program for employees and guests of ski areas, was distributed to determine if an enhanced dissemination strategy was more effective than a basic dissemination strategy at reaching parents at ski and snowboard schools. On-site observations of GSS use and surveys of 909 parents/caregivers with children enrolled in ski and snowboard schools at 63 ski areas were conducted and analyzed using techniques for clustered designs. No differences were identified by dissemination strategy. Greater implementation of GSS (>5 messages posted) was associated with greater parental recall, 36.6% versus 16.7%, of materials, but not greater sun protection practices. Greater recall of messages, regardless of level of implementation, resulted in greater sun protection practices including applying sunscreen (p < .05), providing sunglasses and goggles (p < .01), and more use of all sun protection practices (p < .01). Ski areas with more program materials appeared to reach parents with sun safety advice and thus convinced them to take more precautions for their children. Sun safety need not be at odds with children's outdoor recreation activities.
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Affiliation(s)
| | | | | | | | - X Liu
- Klein Buendel, Inc., Golden, CO, USA
| | - G R Cutter
- University of Alabama, Birmingham, AL, USA
| | - M B Dignan
- University of Kentucky, Lexington, KY, USA
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Sustained use of an occupational sun safety program in a recreation industry: follow-up to a randomized trial on dissemination strategies. Transl Behav Med 2015; 5:361-71. [PMID: 26622909 DOI: 10.1007/s13142-015-0321-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
The sustainability of evidence-based programs is needed to obtain long-term benefits. To assess sustainability of Go Sun Smart (GSS), an occupational skin cancer prevention program disseminated to the North American ski industry. Fifty-three of the 68 ski areas from the original dissemination trial participated in 2012 and 2013, 5 to 7 years after program distribution by enhanced or basic dissemination strategies. Sustained use was measured by: (1) on-site observation of sun protection communication and (2) an online survey with senior managers. In the sustainability assessment, sun safety communication had declined, and dissemination strategy did not affect continued use. Managers held weaker attitudes about skin cancer importance and program fit, but more managers provided free/reduced-cost sunscreen than in the dissemination trial. Manager turnover was a key factor in program discontinuance. Sustainability remains a challenge. Additional research is needed to determine the best strategies for sustainability.
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Glanz K, Escoffery C, Elliott T, Nehl EJ. Randomized Trial of Two Dissemination Strategies for a Skin Cancer Prevention Program in Aquatic Settings. Am J Public Health 2014; 105:1415-23. [PMID: 25521872 DOI: 10.2105/ajph.2014.302224] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We compared 2 strategies for disseminating an evidence-based skin cancer prevention program. METHODS We evaluated the effects of 2 strategies (basic vs enhanced) for dissemination of the Pool Cool skin cancer prevention program in outdoor swimming pools on (1) program implementation, maintenance, and sustainability and (2) improvements in organizational and environmental supports for sun protection. The trial used a cluster-randomized design with pools as the unit of intervention and outcome. The enhanced group received extra incentives, reinforcement, feedback, and skill-building guidance. Surveys were collected in successive years (2003-2006) from managers of 435 pools in 33 metropolitan areas across the United States participating in the Pool Cool Diffusion Trial. RESULTS Both treatment groups improved their implementation of the program, but pools in the enhanced condition had significantly greater overall maintenance of the program over 3 summers of participation. Furthermore, pools in the enhanced condition established and maintained significantly greater sun-safety policies and supportive environments over time. CONCLUSIONS This study found that more intensive, theory-driven dissemination strategies can significantly enhance program implementation and maintenance of health-promoting environmental and policy changes. Future research is warranted through longitudinal follow-up to examine sustainability.
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Affiliation(s)
- Karen Glanz
- Karen Glanz is with Perelman School of Medicine and School of Nursing, University of Pennsylvania, Philadelphia. Cam Escoffery, Tom Elliott, and Eric J. Nehl are with Rollins School of Public Health, Emory University, Atlanta, GA
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18
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Walkosz BJ, Buller DB, Andersen PA, Scott MD, Dignan MB, Cutter GR, Liu X, Maloy JA. Dissemination of go sun smart in outdoor recreation: effect of program exposure on sun protection of guests at high-altitude ski areas. JOURNAL OF HEALTH COMMUNICATION 2014; 19:999-1016. [PMID: 24617350 PMCID: PMC4146645 DOI: 10.1080/10810730.2013.864725] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
Go Sun Smart is a theory-based health communication program designed to influence sun-protection behaviors of employees and guests at high-altitude ski areas to reduce skin cancer risk. The effects of Go Sun Smart, in a Phase IV dissemination randomized posttest-only trial, on sun-protection behaviors of ski area guests are reported. Program use was assessed by on-site observation and guest message exposure, and sun protection was measured in intercept surveys at ski areas. Dissemination strategy-enhanced versus basic-was not significantly related to sun safety practices. Additional analyses examined the relation between message exposure and guests' sun safety practices. Ski areas displaying at least 6 Go Sun Smart materials in guest-only areas and 9 Go Sun Smart materials throughout the area increased guests' message exposure. Higher message exposure within the high-use ski areas was associated with improved sun protection by guests but not within the low-use ski areas. The authors underscore the importance of program implementation and message exposure on the success of evidence-based health communication efforts applied industrywide.
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Reynolds KD, Buller DB, French SA, Buller MK, Ashley JL. School sun-protection policies: measure development and assessments in 2 regions of the United States. THE JOURNAL OF SCHOOL HEALTH 2012; 82:499-507. [PMID: 23061553 PMCID: PMC3475509 DOI: 10.1111/j.1746-1561.2012.00729.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
BACKGROUND In 2002, the US Centers for Disease Control and Prevention recommended that schools adopt policies that reduce exposure of children to ultraviolet radiation to prevent skin cancer. We report here the development of a school sun-safety policy measure and baseline descriptive statistics from the assessment of written policies collected in 2005-2007 from public school districts that enrolled in a randomized trial evaluating a policy promotion program. METHODS Written policies were collected from 103 of 112 school districts in Colorado and Southern California prior to randomization. We developed methods for selecting policy headings/sections topics likely to contain sun-safety policies for students and for assessing the presence, strength, and intent of policies. Trained coders assessed the content of each policy document. RESULTS Overall, 31% of districts had a policy addressing sun safety, most commonly, protective clothing, hats, sunscreen, and education at baseline. More California districts (51.9%) had these policies than Colorado districts (7.8%, p < .001). Policy scores were highest in districts with fewer Caucasian students (b = -0.02, p = .022) in Colorado (b = -0.02, p = .007) but not California (b = 0.01, p = .299). CONCLUSION The protocol for assessing sun-safety policy in board-approved written policy documents had several advantages over surveys of school officials. Sun-protection policies were uncommon and limited in scope in 2005-2007. California has been more active at legislating school policy than Colorado. School district policies remain a largely untapped method for promoting the sun protection of children.
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Affiliation(s)
- Kim D. Reynolds
- Claremont Graduate University School of Community and Global Health 675 W. Foothill Blvd, Suite 310 Claremont, CA 91711 Phone: 909-607-7300 Fax: 909-621-5221
| | - David B. Buller
- Klein Buendel, Inc. 1667 Cole Boulevard, Suite 225 Golden, CO 80401 Phone: 303-565-4340 Fax: 303-565-4320
| | - Simone A. French
- Division of Epidemiology & Community Health University of Minnesota Suite 300 1300 South Second Street Minneapolis MN 55454 Phone: 612-626-8594
| | - Mary K. Buller
- Klein Buendel, Inc. 1667 Cole Boulevard, Suite 225 Golden, CO 80401 Phone: 303-565-4330 Fax: 303-565-4320
| | - Jeff L. Ashley
- Sun Safety for Kids 2625 W. Alameda Ave., Ste. 517 Burbank, CA 91505 Phone: 818-845-8538
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Expanding occupational sun safety to an outdoor recreation industry: a translational study of the Go Sun Smart program. Transl Behav Med 2011; 2:10-18. [PMID: 23105954 DOI: 10.1007/s13142-011-0101-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022] Open
Abstract
A successful occupational sun-protection program was translated to 67 ski areas where the effectiveness of two dissemination strategies was assessed. An industry professional association distributed materials to the resorts. Half of the resorts received the basic dissemination strategy (BDS) in which the materials were simply distributed to the resorts. In a randomized trial, the BDS was compared with an enhanced dissemination strategy (EDS) that added interpersonal contact with managers. Employees (n=2,228) at worksites that received the EDS had elevated program exposure (74.0% at EDS vs. 57.5% at BDS recalled a message). Exposure increased at two levels of program use: from less than four (55% exposed) to four to eight (68%) and to nine or more (82%) program items in use. More employees exposed to messages engaged in sun-safety behaviors than those unexposed. At worksites using nine or more items (versus 4-8 or <4), employees engaged in additional sun-safety behaviors. Program effects were strongly mediated by increased self-efficacy. Partnerships with industry associations facilitate dissemination of evidence-based programs. Dissemination methods are needed to maximize implementation and exposure to reduce health risk behaviors.
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