1
|
Wu YP, Parsons B, Jo Y, Chipman J, Haaland B, Nagelhout ES, Carrington J, Wankier AP, Brady H, Grossman D. Outdoor activities and sunburn among urban and rural families in a Western region of the US: Implications for skin cancer prevention. Prev Med Rep 2022; 29:101914. [PMID: 35911574 PMCID: PMC9326324 DOI: 10.1016/j.pmedr.2022.101914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 07/07/2022] [Accepted: 07/18/2022] [Indexed: 11/30/2022] Open
Abstract
Skin cancer risk differs between individuals in rural versus urban communities. Differing skin cancer risk could be due to unique patterns of outdoor activities. Rural versus urban adults and children engage in different outdoor activities. Preventive interventions could target activities with high sunburn risk.
Prevention of skin cancer involves decreasing exposure to ultraviolet radiation (UVR) and avoiding sunburn, especially early in life. Individuals living in urban versus rural areas, as defined by the Rural Urban Commuting Area (RUCA) code classification, have different risks for skin cancer, likely due to differing patterns of outdoor activities and preventive behaviors employed when outdoors. However, few studies have examined differences in outdoor activities between rural and urban individuals and examined this among both adults and children. This study compared the outdoor activities, sun protection strategies, tanning behaviors, and sunburn occurrence of adults and children (n = 97 dyads) in rural versus urban settings in a Western region of the United States. The relationships between outdoor activities and sunburn occurrence were examined in both groups. Analyses employed Barnard’s Exact Test and logistic generalized estimating equations models. Individuals in rural and urban areas reported differences in sun protection strategies used, tanning behaviors, and outdoor activities. Individuals in urban areas more commonly reported use of certain forms of sun protection, such as sunscreen and shade, whereas long pants and skirt wearing were more common for children in rural areas. Individuals in rural areas were more likely than those in urban areas to engage in farm work, yard work, and youth sports. Gender differences in these outcomes were also identified. Skin cancer preventive interventions could be tailored for rural and urban families to target sun protection strategies to outdoor activities and to situations in which sunburns are likely to occur.
Collapse
Affiliation(s)
- Yelena P Wu
- Department of Dermatology, University of Utah Health Sciences Center, 30 North 1900 East, 4A330 - Salt Lake City, UT 84132, USA.,Huntsman Cancer Institute, University of Utah, 1950, 2000 Cir of Hope Dr, Salt Lake City, UT 84112, USA
| | - Bridget Parsons
- Huntsman Cancer Institute, University of Utah, 1950, 2000 Cir of Hope Dr, Salt Lake City, UT 84112, USA
| | - Yeonjung Jo
- Department of Population Health Sciences, University of Utah, 295 Chipeta Way, Williams Building, Room 1N410, Salt Lake City, UT 84108, USA
| | - Jonathan Chipman
- Huntsman Cancer Institute, University of Utah, 1950, 2000 Cir of Hope Dr, Salt Lake City, UT 84112, USA.,Department of Population Health Sciences, University of Utah, 295 Chipeta Way, Williams Building, Room 1N410, Salt Lake City, UT 84108, USA
| | - Benjamin Haaland
- Huntsman Cancer Institute, University of Utah, 1950, 2000 Cir of Hope Dr, Salt Lake City, UT 84112, USA.,Department of Population Health Sciences, University of Utah, 295 Chipeta Way, Williams Building, Room 1N410, Salt Lake City, UT 84108, USA
| | | | - James Carrington
- School of Medicine, University of Utah, 30 N 1900 E, Salt Lake City, UT 84132, USA
| | - Ali P Wankier
- Huntsman Cancer Institute, University of Utah, 1950, 2000 Cir of Hope Dr, Salt Lake City, UT 84112, USA
| | - Hannah Brady
- Huntsman Cancer Institute, University of Utah, 1950, 2000 Cir of Hope Dr, Salt Lake City, UT 84112, USA
| | - Douglas Grossman
- Department of Dermatology, University of Utah Health Sciences Center, 30 North 1900 East, 4A330 - Salt Lake City, UT 84132, USA.,Huntsman Cancer Institute, University of Utah, 1950, 2000 Cir of Hope Dr, Salt Lake City, UT 84112, USA
| |
Collapse
|
2
|
Buller DB, Walkosz BJ, Olivas S, Eye R, Liu X, Kinsey A, Buller MK, Grayson A. Association of occupational sun safety policy and actions in state transportation sector in the United States. Am J Ind Med 2021; 64:274-282. [PMID: 33393708 DOI: 10.1002/ajim.23214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 11/25/2020] [Accepted: 12/10/2020] [Indexed: 11/11/2022]
Abstract
BACKGROUND Occupational sun protection is recommended by government health authorities. Sun safety policies and predictors of managers' reports of sun safety actions were assessed. METHODS Written policies from 21 state departments of transportation (DOTs) enrolled in a randomized trial to test methods for scaling-up an occupational sun safety intervention were coded for sun safety content at baseline. Managers (n = 1113) supervising outdoor workers reported on sun safety actions in a baseline survey. RESULTS Twenty state DOTs (95.2%) have a policy with at least one sun protection component. Sun safety training was increased at workplaces with a written sun safety policy (p < 0.001) and unwritten standard procedures on sun protection (p < 0.001). Reported sun safety actions were highest where there was a written sun safety policy (p < 0.001) and unwritten standard procedures on sun protection (p < 0.001). CONCLUSIONS Policies are essential for the implementation of employee sun safety. There is room for improvement in existing policies of state DOTs.
Collapse
Affiliation(s)
| | | | | | | | - Xia Liu
- Klein Buendel, Inc. Golden Colorado USA
| | | | | | | |
Collapse
|
3
|
Economic Evaluation of an Intervention Promoting Adoption of Occupational Sun Protection Policies. J Occup Environ Med 2020; 61:978-983. [PMID: 31490321 DOI: 10.1097/jom.0000000000001707] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
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.
Collapse
|
4
|
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.
Collapse
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
| | | | | |
Collapse
|
5
|
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.
Collapse
|
6
|
Heckman CJ, Auerbach MV, Darlow S, Handorf EA, Raivitch S, Manne SL. Association of Skin Cancer Risk and Protective Behaviors with Health Literacy Among Young Adults in the USA. Int J Behav Med 2019; 26:372-379. [PMID: 31147962 DOI: 10.1007/s12529-019-09788-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND The goal of this study was to investigate the association of health literacy with skin cancer risk and protective behaviors among young adults at moderate to high risk of skin cancer, the most common cancer. METHOD A US national sample of 958 adults, 18-25 years old, at moderate to high risk of developing skin cancer, completed a survey online. Behavioral outcomes were ultraviolet (UV) radiation exposure (e.g., indoor and outdoor tanning, sunburn) and protective (e.g., sunscreen use, sunless tanning) behaviors. Multivariable regression analyses were conducted to determine whether health literacy (a four-item self-report measure assessing health-related reading, understanding, and writing) was associated with behavioral outcomes while controlling for demographic factors. RESULTS Higher health literacy was independently associated with less sunbathing, odds ratio (OR) = 0.77, 95% confidence interval (CI) = 0.60-0.98; less indoor tanning, OR = 0.38, CI = 0.31-0.48; and less use of tanning oils, OR = 0.54, CI = 0.43-0.69. However, health literacy was also associated with a lower likelihood of wearing long pants, OR = 0.76, CI = 0.58-0.99, or a hat, OR = 0.68, CI = 0.53-0.87, when outdoors. On the other hand, higher health literacy was associated with higher incidental UV exposure, OR = 1.69, CI = 1.34-2.14, and a greater likelihood of ever having engaged in sunless tanning, OR = 1.50, CI = 1.17-1.92. CONCLUSION Interestingly, higher health literacy was associated with lower levels of intentional tanning yet also higher incidental UV exposure and lower skin protection among US young adults. These findings suggest that interventions may be needed for young adults at varying levels of health literacy as well as populations (e.g., outdoor workers, outdoor athletes/exercisers) who may be receiving large amounts of unprotected incidental UV.
Collapse
Affiliation(s)
- Carolyn J Heckman
- Rutgers Cancer Institute of New Jersey, 195 Little Albany St, New Brunswick, NJ, 08901, USA.
| | | | - Susan Darlow
- National Comprehensive Cancer Network, Plymouth Meeting, PA, USA
| | | | | | - Sharon L Manne
- Rutgers Cancer Institute of New Jersey, 195 Little Albany St, New Brunswick, NJ, 08901, USA
| |
Collapse
|
7
|
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.
Collapse
Affiliation(s)
| | | | | | - Allan Wallis
- School of Public Affairs, University of Colorado Denver, Denver, Colorado
| | - Xia Liu
- Klein Buendel, Inc, Golden, Colorado
| |
Collapse
|
8
|
Ragan KR, Buchanan Lunsford N, Thomas CC, Tai EW, Sussell A, Holman DM. Skin Cancer Prevention Behaviors Among Agricultural and Construction Workers in the United States, 2015. Prev Chronic Dis 2019; 16:E15. [PMID: 30730830 PMCID: PMC6395080 DOI: 10.5888/pcd16.180446] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
Introduction Nearly 5 million people are treated for skin cancer each year in the United States. Agricultural and construction workers (ACWs) may be at increased risk for skin cancer because of high levels of ultraviolet radiation exposure from the sun. This is the first study that uses nationally representative data to assess sun-protection behaviors among ACWs. Methods We analyzed data from the 2015 National Health Interview Survey Cancer Control Supplement to examine the prevalence of sun-protection behaviors among ACWs. We calculated national, weighted, self-reported prevalence estimates. We used χ2 tests to assess differences between ACWs by industry and occupation. Results Most of the 2,298 agricultural and construction workers studied were male (by industry, 72.4% in agriculture and 89.3% in construction; by occupation, 66.1% in agriculture and 95.6% in construction) and non-Hispanic white. About one-third had at least 1 sunburn in the past year. The prevalence of sunscreen use and shade seeking was low and did not significantly differ among groups, ranging from 15.1% to 21.4% for sunscreen use and 24.5% to 29.1% for shade seeking. The prevalence of wearing protective clothing was significantly higher among agricultural workers than among construction workers by industry (70.9% vs 50.7%) and occupation (70.5% vs 53.0%). Conclusion Our findings could be used to improve occupational health approaches to reducing skin cancer risk among ACWs and to inform education and prevention initiatives addressing skin cancer. Sun-safety initiatives may include modifying work sites to increase shade and adding sun safety to workplace policies and training. Employers can help reduce occupational health inequities and protect workers by creating workplaces that facilitate sun protection.
Collapse
Affiliation(s)
- Kathleen R Ragan
- Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Division of Cancer Prevention and Control, Atlanta, Georgia.,Division of Cancer Prevention and Control; Centers for Disease Control and Prevention, 4770 Buford Hwy, MS F76, Atlanta, GA 30341.
| | - Natasha Buchanan Lunsford
- Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Division of Cancer Prevention and Control, Atlanta, Georgia
| | - Cheryll C Thomas
- Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Division of Cancer Prevention and Control, Atlanta, Georgia
| | - Eric W Tai
- Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Division of Cancer Prevention and Control, Atlanta, Georgia
| | - Aaron Sussell
- Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, Spokane Mining Research Division, Spokane, Washington
| | - Dawn M Holman
- Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Division of Cancer Prevention and Control, Atlanta, Georgia
| |
Collapse
|
9
|
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.
Collapse
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
| |
Collapse
|
10
|
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.
Collapse
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
| |
Collapse
|