Sun Safety Research Articles

Friendship networks and sun safety behavior among children

AbstractSocial networks, particularly those defined by friendships, influence many childhood and adolescent health behaviors such as the use of alcohol, tobacco, and other drugs, as well as diet and physical activity. Few, if any, studies have examined the concordance between friendship networks and sun exposure/safety behaviors. This study examines the friendship networks and sun safety behaviors for a group of fourth and fifth grade students taking part in a larger sun safety intervention, “SunSmart” (n = 128). Intra-class correlation, homophily hypothesis testing, and exponential random graph models were used to test friendship homophily based on sun safety behaviors. Peer Leaders were identified through social network popularity, and sun safety change scores were compared between Peer Leaders and non-leaders. Results show that students cluster based on shared demographic characteristics and some sun safety behaviors, and that there was a trend for Peer Leaders to respond better to the SunSmart intervention than non-leaders. Implications for future sun safety interventions using Peer Leaders as champions for sun safety behavior change are discussed.

Recognizing Sun Safety as an Employee Health Issue.

This commentary discusses a survey study published in JAMA Dermatology that investigated whether government organizations in Colorado had occupational sun protection policies.

Outdoor workers and sun protection strategies: two case study examples in Queensland, Australia

Outdoor workers are at risk of developing skin cancer because they are exposed to high levels of harmful ultraviolet radiation. The Outdoor Workers Sun Protection Project investigated sun protection strategies for high risk outdoor workers in rural and regional Australia. Fourteen workplaces (recruitment rate 37%) across four industries in rural and regional Queensland, Australia were recruited to the OWSPP. In 2011-2012, data were collected using pre- and post-intervention interviews and discussion groups. This article presents two workplaces as case study examples. The flat organisational structure of workplace 1 supported the implementation of the Sun Safety Action Plan (SSAP), whilst the hierarchical organisational nature of workplace 2 delayed implementation of the SSAP. Neither workplace had an existing sun protection policy but both workplaces adopted one. An effect related to the researchers' presence was seen in workplace 1 and to a lesser degree in workplace 2. Overt reciprocity was seen between management and workers in workplace 1 but this was not so evident in workplace 2. In both workplaces, the role of the workplace champion was pivotal to SSAP progression. These two case studies highlight a number of contextually bound workplace characteristics related to sun safety. These issues are (1) the structure of workplace, (2) policy, (3) an effect related to the researchers' presence, (4) the workplace champion and (5) reciprocity. There are several recommendations from this article. Workplace health promotion strategies for sun safety need to be contextualised to individual workplaces to take advantage of the strengths of the workplace and to build capacity.

Effective Sun Safety in Children: A Randomized Controlled Trial of a Multicomponent Program

Improving sun-protective behaviors in children may minimize sun damage and reduce skin cancer risks later in life. Investigators performed a

Health education beyond the school gates: Use of school newsletters to communicate health messages to parents and their families

Western Australian schools are expected to educate beyond the classroom context, promoting the health of students, their families and their communities. Little is known about the frequency with which schools employ newsletters to communicate health messages. This content analysis draws from a sample of 70 newsletters from 46 diverse Western Australian schools, to explore the frequency with which health messages were communicated. Across an average of 1.3 newsletters per school during the November period, 48 instances of a health-promoting message were identified, giving an average of 0.69 health-promoting messages per newsletter. This result suggests that school newsletters may be underutilised as a mechanism for health promotion within school communities. While mental health issues were explored to the greatest extent, a number of areas, such as smoking, alcohol and substance abuse and sun safety received limited attention. Health-promoting messages about driver road safety were comparatively highly represented in the sample, which was unanticipated. While this paper offers insight into the frequency of health message communication through newsletters, and the kinds of messages being transmitted, longitudinal research in this area could provide further insight, in addition to examination of parental perceptions of school newsletter mediated health messages.

Comparison of sun safety knowledge and behavior of Hispanic and non-Hispanic mothers in Miami: A cross-sectional survey

Comparison of sun safety knowledge and behavior of Hispanic and non-Hispanic mothers in Miami: A cross-sectional survey

Environmental variables associated with vacationers' sun protection at warm weather resorts in North America

BackgroundVacationing at sunny, warm weather locations is a risk factor for excessive solar ultraviolet (UV) radiation exposure and skin cancer. ObjectivesThis study examined the association of environmental variables related to UV levels with vacationers' sun protection. MethodsVacationers at 41 summer resorts in 17 states and 1 Canadian Province were interviewed (n=3531) and observed (N=4347) during 2012 and 2013. Clothing coverage, sunglasses, and shade use were observed. Use of sunscreen and sunburns were self-reported. Environmental information was recorded by research staff or acquired from ground stations and the weather service. ResultsTemperature was positively associated with sun protection behaviors; however clothing coverage was negatively associated with temperature. Cloud cover was negatively associated with sun protection, with the exception of clothing coverage which was positively associated with it. Elevation showed a mixed pattern of associations with vacationer's sun protection. Latitude of a resort was negatively associated with most sun protection behaviors, such that sun protection increased at more southerly resorts. Similarly, the farther south a vacationer traveled to the resort, the less sun protection they employed. The UV index showed a weak, positive relationship with some sun protection behaviors even when controlling for temperature. ConclusionsVacationers appeared aware that UV is higher at southern latitudes and may learn UV is intense when living in southern regions. However, many used temperature, an unreliable cue, to judge UV intensity and seemed to adjust clothing for warmth not UV protection. Efforts are needed to help individuals make more accurate sun safety decisions.

How to Stay Healthy While Studying Abroad: Development of an Electronic Magazine for College Students

Increasing numbers of US college students are participating in travel study programs. As part of their pre-departure preparation, institutions provide orientation materials covering a range of topics. These materials typically cover such health-related topics as immunizations, sun safety, psychological distress, personal assault, and water quality. However, comprehensive coverage of strategies to ensure optimal physical wellness while traveling has been overlooked. This article describes the development and evaluation of an electronic (e) magazine entitled, “How to Stay Healthy While Studying Abroad”. This e-magazine not only explains the importance of physical activity, food and beverage practices, sleep, and stress and time management, but also offers tips for achieving wellness during travel. The primary objective of the study was to evaluate the usefulness of the e-magazine. The secondary objective was to enhance the content of the guide based on an assessment of students’ attitudes, perceptions and behaviors related to wellness pre- and post-participation in travel study programs. Prior to travel over 70% of students felt they would be able to engage in healthful eating and physical activity. Fifty-two percent of students found it challenging to eat healthfully and be physically active on their travel study programs. The vast majority of students (87%) reported that they found the guide helpful in promoting healthful behaviors. Hydration, health during travel, and getting enough sleep were the top three e-magazine areas utilized. Self-motivation, social support and tips within How to Stay Healthy While Studying Abroad were the top three factors which contributed to achieving physical wellness. The guide was considered useful based on the findings and evidenced by students’ recommendations that the guide be shared with all university students.

Sun safety knowledge and practice in UK postal delivery workers.

BackgroundPostal delivery workers spend a large proportion of their work time outdoors, placing them at increased risk of skin cancer. To date, no studies have examined occupational sun safety knowledge and practice within this group in the UK.AimsTo describe the occupational sun safety knowledge and practice of UK postal delivery workers and to investigate the association of demographic, personal and occupational factors with knowledge and practice in order to identify potential strategies for improving sun safety in this occupational group.MethodsPostal delivery workers completed a questionnaire that collected data on occupational sun safety knowledge and practice in addition to demographic, personal and workplace characteristics. One-way analysis of variances were applied to assess differences in knowledge and practice by these characteristics.ResultsA total of 1153 postal delivery workers completed the questionnaire, a 60% response rate. Thirty-three per cent reported receiving sun safety training within the previous 12 months. The majority of respondents reported correct knowledge on three of the six domains and good practice on four of the six behavioural domains. However, only one-fifth of respondents reported wearing sunglasses and ensuring a plentiful intake of water. Knowledge and practice differed significantly according to demographic, personal and workplace characteristics.ConclusionsThere is a need to raise the profile of occupational skin cancer in this occupational group and to increase the priority given to occupational sun safety policies alongside targeted and tailored interventions, the effect of which can be evaluated.

Communication Strategies to Promote Health Sun Safety in Outdoor Recreation Settings

The field of interpretation is increasingly acknowledging the potential for strategic health promotion. The purpose of this paper is to introduce Go Sun Smart (GSS) Resorts, a sun safety program directed to guests recreating outdoors at destination resorts and parks in the United States and Canada. This paper aims to present a sun safety intervention that was designed to promote advanced sun safety practices to the field of interpretation. With a foundation in Diffusion of Innovations Theory and Transportation Theory this paper will present the intervention materials and strategies developed by GSS to showcase the potential to promote health behaviors. Intervention materials that were developed include posters, tip cards, a Public Service Announcement (PSA) video, additional electronic and print materials, employee trainings, GSS certification, and an interpretive script for use prior to various outdoor activities.

The Sustainability of an Occupational Skin Cancer Prevention Program.

Sustainability of prevention programs is a public health goal. 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. 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. Exposure to prevention messages is an important determinant of program effectiveness and potentially of program sustainability.

Melanoma Risk and Survival among Organ Transplant Recipients

Solid organ transplant recipients, who are medically immunosuppressed to prevent graft rejection, have increased melanoma risk, but risk factors and outcomes are incompletely documented. We evaluated melanoma incidence among 139,991 non-Hispanic white transplants using linked U.S. transplant-cancer registry data (1987–2010). We used standardized incidence ratios (SIRs) to compare incidence to the general population, and incidence rate ratios (IRRs) from multivariable Poisson models to assess risk factors. Separately, we compared post-melanoma survival among transplant recipients (N=182) and non-recipients (N=131,358) using multivariable Cox models. Among transplant recipients, risk of invasive melanoma (N=519) was elevated (SIR=2.20, 95%CI 2.01-2.39), especially for regional stage tumors (SIR=4.11, 95%CI 3.27–5.09). Risk of localized tumors was stable over time after transplantation, but higher with azathioprine maintenance therapy (IRR=1.35, 95%CI 1.03–1.77). Risk of regional/distant stage tumors peaked within 4 years following transplantation and increased with polyclonal antibody induction therapy (IRR=1.65, 95%CI 1.02–2.67). Melanoma-specific mortality was higher among transplant recipients than non-recipients (HR 2.98, 95%CI 2.26–3.93). Melanoma exhibits increased incidence and aggressive behavior under transplant-related immunosuppression. Some localized melanomas may result from azathioprine, which acts synergistically with ultraviolet radiation, while T-cell depleting induction therapies may promote late stage tumors. Our findings support sun safety practices and skin screening for transplant recipients.

Estimating the Prevalence of Heat-Related Symptoms and Sun Safety–Related Behavior among Latino Farmworkers in Eastern North Carolina

ABSTRACTIn hot weather, thermal heat generated by the body, combined with environmental heat from the sun, can lead outdoor workers to experience heat-related stress, severe illness, or even death. The aims of this study were to estimate the prevalence of heat-related symptoms and potential risk factors associated with sun safety–related behavior among Latino farmworkers. Data from interviewer-administered questionnaires were collected from a cross-sectional survey among farmworkers (N = 158) from August to September 2013. Data analysis assessed associations between work activities, sun safety behavior, and the prevalence of heat-related illness (HRI) symptoms among workers. Nearly two thirds (72%) of farmworkers experienced at least one HRI symptom and lacked proper cooling methods when working outdoors. Most workers reported wearing long-sleeved shirts (85%), long pants (98%), and baseball caps (93%). The prevalence of having one HRI symptom was 72% and 27% among workers having three or more HRI symptoms. The majority of farmworkers experience symptoms of HRI and are not provided with proper shade protection when working outdoors. Increased emphasis on administrative controls, particularly educating field supervisors and workers on how to avoid and recognize HRI, should be a priority.

Patterns of sun protective behaviors among Hispanic children in a skin cancer prevention intervention

BackgroundInvasive melanoma is becoming more common in U.S. Hispanics, yet little is known about the sun protection behaviors in this population, particularly children and adolescents who incur high ultraviolet (UV) exposures. MethodsWe used latent class analysis to examine patterns of sun protective behaviors in a cross-sectional survey of Hispanic elementary students participating in a sun safety intervention in Los Angeles from 2013- to 2014 (N=972). Five behavior indicators in two environments (school and home) representing multiple methods of sun protection were selected for the model. ResultsResults suggested a four-class model best fit the data. Classes were labeled in order of increasing risk as multiple protective behaviors (28%), clothing and shade (32%), pants only (15%), and low/inconsistent protective behaviors (25%). Children who reported high parental engagement with sun protection were significantly more likely to be classified in high overall protective categories (odds ratio (OR)=4.77). Girls were more likely than boys to be classified in the highest protecting class (OR=3.46), but were also more likely to be in the “pants only” class (OR=2.65). Sensitivity to sunburn was associated with less likelihood of being in the “clothing and shade” class (OR=0.53). ConclusionThe differences among these classes and their predictors reveal the heterogeneity and complexity of Hispanic children’s sun protective behaviors. These findings have implications for the design and delivery of future sun protection interventions targeting Hispanic children, as strategies tailored to specific subgroups may be more effective in achieving meaningful behavioral changes.

Abstract CN02-02: Research on establishing policies for comprehensive UV protection

Abstract Skin cancer is the most common cancer in the United States. In July 2014, the U.S. Surgeon General issued a Call to Action to prevent skin cancer by reducing exposure to solar and non-solar ultraviolet radiation (UV), a primary risk factor. Policies in educational, occupational, and public spheres are an important component in these prevention efforts. Comprehensive policies are comprised of environmental controls, administrative procedures, and personal protection practices. Policy approaches can overcome low perceived risk, equalize differences among subgroups, maximize health education, and clarify personal and organizational responsibilities. Policy initiatives require effective strategies to achieve changes in organizations. This presentation reviews research by the author and other scientists evaluating strategies for promoting policy change. This works was guided by the diffusion of innovations theory, which holds that policy promotion is achieved through two phases initiation in which organization leaders identify a problem and decide that policy addresses it and implementation where actions dictated by the policy are initiated, organizations adjust their practices or the policy to improve fit, and policy actions become institutionalized. Children are a key target for sun protection interventions and schools have been a common venue for these efforts. A policy promotion program containing in-person meetings with district administrators, printed and online policy materials, and follow-up communication was evaluated in a randomized controlled trial enrolling 112 public school districts in Colorado (n=56) and California (n=56). At follow-up, school districts assigned to the intervention had more (M=2.41) and stronger (M=3.21) school board approved sun protection policies than control districts (content M=1.35, p=0.020; strength M=1.68, p=0.013). Policies on sunscreen (p=0.026), outdoor shade (p=0.026), and parent outreach (p=0.096) were improved. Individuals who work outdoors are chronically exposed to UV and have high prevalence of skin cancer. Workplace sun protection policies are being promoted to city, county, and special district employers (n=98) in a randomized controlled trial in Colorado. The campaign includes training for employees and a sun safety consultant who works with senior managers on policy creation. Assessment of written workplace policies showed that while 86% of employers already had a policy on a sun safety component (e.g., headwear and eyewear) at baseline, most pertained only to personal protection and only 21% were explicitly intended for sun protection. Proximity to the urban Colorado Front Range was the sole predictor of having a sun safety policy (p<0.01). In the public arena, efforts are underway to convince state legislators to restrict access to indoor tanning (IT) facilities by minors. Up to 15% of teens indoor tanned in the past year (23% of girls; 6% of boys). Nearly all states (n=44) have some IT policies. Currently, 23 states have age restrictions but only 11 ban all minors under 18. Also, 28 states have exceptions for parental permission. Age restrictions are more effective at reducing IT by minors than parental permission. Many parents are unaware of the risks and maternal permissiveness is a strong predictor of IT initiation by girls. There are several important lessons from this research. Policy change is feasible with a theory-based, systematic intervention but it takes time to succeed. Most organizations prefer policies on personal protection; strategies are needed to change environments and administrative procedures. Many decision makers need to be educated on skin cancer prevention, and policy initiatives can face strong competing pressures. Making policy adoption easy and supporting policy implementation are necessary to achieve their potential benefits. Citation Format: David Buller. Research on establishing policies for comprehensive UV protection. [abstract]. In: Proceedings of the Thirteenth Annual AACR International Conference on Frontiers in Cancer Prevention Research; 2014 Sep 27-Oct 1; New Orleans, LA. Philadelphia (PA): AACR; Can Prev Res 2015;8(10 Suppl): Abstract nr CN02-02.

Abstract IA06: Social media and cancer control: Addressing health disparities through innovative communication science

Abstract Mobile and social media have become mainstays of life in the modern world. The growth and rapid adoption of these technologies, as well as the fact that these tools are relatively low in cost and widely accessible, suggests that they have the potential to help us address health disparities and reduce the burden that disproportionately falls on the members of the population who are least served by the healthcare system. Some cancer control and prevention efforts have already begun to tap into the social media environment in order to generate insight and improve population health. For example, observational studies have been conducted in order to increase our understanding of cancer-related attitudes and behaviors, including those of populations most acutely affected by cancer health disparities. At the same time, intervention research has largely focused on developing and testing cancer prevention initiatives that leverage mobile and social media platforms in order to motivate desired behaviors around topics such as tobacco cessation, sun safety, and screening practices. Some of these endeavors specifically aim to address cancer health disparities by engaging with populations that may otherwise be hard to reach for a variety of reasons, including restricted mobility and geographic isolation, limited health literacy, or mistrust in the health care system. However, as non-traditional media and technologies are increasingly being deployed in cancer control and prevention efforts, there are growing concerns over the possibility that these initiatives might exacerbate existing disparities rather than eliminating them. Inequalities in access and technology adoption, lack of health literacy in a crowed online environment where health information is ubiquitous, and the inappropriate reliance on technology as a substitute for in-person communication in cancer care all have the potential to increase health disparities among individuals who are less educated or not as technologically-savvy. The final presentation of this panel will focus on the role of social media and user-generated content in cancer prevention and control efforts, with special consideration given to populations most affected by cancer health disparities in the United States. In addition to reporting on studies examining social media conversations about cancer and obesity, the presentation will highlight a number of relevant empirical research studies in a variety of cancer control domains to describe the state of the science in cancer communication in the digital age. New data sources, analytic approaches, study designs, and measurement techniques will be highlighted through these examples. We will conclude with a specific set of promising future directions for the use of social media in reducing cancer health disparities. Citation Format: Wen-ying Sylvia Chou. Social media and cancer control: Addressing health disparities through innovative communication science. [abstract]. In: Proceedings of the Seventh AACR Conference on The Science of Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; Nov 9-12, 2014; San Antonio, TX. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2015;24(10 Suppl):Abstract nr IA06.

Sun safety in construction: a UK intervention study

Interventions to promote sun safety in the U.K. construction sector are warranted given the high incidence of skin cancer attributable to sun exposure relative to other occupational groups. To evaluate change in sun safety knowledge and practices among construction workers in response to an educational intervention. A baseline questionnaire was administered, followed by a bespoke sector-specific DVD-based intervention. At 12-month follow-up, participants completed a further questionnaire. Analyses were conducted on a sample of 120 workers (intervention group, n = 70; comparison group, n = 50). At follow-up, the proportion of intervention group participants that reported correct sun safety knowledge was not significantly greater than at baseline. However, the intervention group demonstrated significant positive change on 9 out of 10 behavioural measures, the greatest change being use of a shade/cover when working in the sun followed by regularly checking skin for moles or unusual changes. Exposure to this intervention was linked to some specific positive changes in construction workers' self-reported sun safety practices. These findings highlight the potential for educational interventions to contribute to tackling skin cancer in the UK construction sector. The findings support the development of bespoke educational interventions for other high-risk outdoor worker groups.

The impact of ultraviolet photography on the sun safety awareness and behavior of skiers and snowboarders

Objective: Snow sport enthusiasts, such as snowboarders and skiers, are a less studied population at significant risk for ultraviolet(UV) exposure due to long hours spent at high altitudes with more intense UV radiation. Studies have documented the efficacy ofUV photography to impact sun protection habits by individuals with a range of skin cancer risk factors. Informing snow sportenthusiasts of their sun damage through UV photography may be a way to change this population’s perception and behavior of sun protection.Methods: A UV camera was utilized at the 2013 SnowSports Industries America Snow Show in Colorado to assess the levelof accumulated sun damage in show attendees. A follow-up survey was performed at this same event one year later in 2014. Participants at the 2013 event were recruited to a UV camera booth and completed a ten-question pre-survey assessing baselinesun-safety awareness and behaviors. Full-face frontal photographs using two different UV camera models were then takenand shown on a digital screen to the participants. Individualized education was provided regarding the degree of sun damage revealed by the intervention as well as sun safety recommendations. Participants were at the 2013 event were then contacted viaemail six months later to complete a ten-question survey on surveymonkey.com. The survey assessed the permanence of the UV photography intervention on sun habits over the duration of the ski/snowboard season. Email was used for communication purposes after a poor response rate using telephone for a one-month post-intervention follow-up.Results: The 2013 post-intervention study revealed a 41% response rate (n=46) with overall positive influence of UV photographyon sun protection behavior in the survey. Post-intervention survey results for the 2014 study with an observed response rate of 28% (n=37) with a similar overall positive influence of our intervention on sun protection behavior.Conclusions: UV photography-based interventions and education may impact sun-safety behavior in high-risk populations such as skiers and snowboarders that may otherwise not receive appropriate education regarding the dangers of UV exposure and prevention of skin cancer. However, more controlled studies should be conducted to positively associate UV photography intervention and education and sun safety behavior.

Skin cancer part 1: recognition, patient education and sun safety

Aesthetic nurses observe and assess the skin on a daily basis and therefore need to have an awareness of recognising skin lesions or moles that may be suspicious. In addition, aesthetic nurses have an important patient education role and can advise individuals who present to their clinic on checking their skin lesions and moles, skin self-examination, sun protection, and risk factors/prevention of skin cancer. This article aims to inform and update aesthetic nurses' knowledge on skin cancer. The article will cover recognition of skin cancer and patient education, including sun safety and self-examination. Skin cancer treatment will be covered in the second article in this series.

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

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