AgrAbility Fills Important Niche in Safety,Health

ABSTRACT

Farmers have substantial sun exposure and increased skin cancer risk but poor sun protection practices. There are few studies regarding the underlying factors that contribute to inadequate skin cancer prevention practices in the farming population, and minimal data to guide skin cancer awareness and educational interventions for this population. The purpose of this study was to assess skin cancer knowledge, sun protection behaviors and barriers, health care information sources, and the impact of skin cancer screening among midwestern farmers and nonfarmers. Individuals attending a free skin cancer screening during 2011 Wisconsin Farm Technology Days were surveyed for self-reported sun protection use, extent of sun exposure, and skin cancer and sun protection beliefs and knowledge. A total of 476 individuals participated in the study, including 194 farmers. Although farmers identified sun protection benefits, few reported optimal practices, with only 23% of farmers reporting sunscreen use always or frequently when out in the sun for 15 minutes or more. Common barriers to sun protection included discomfort with wearing long pants and long shirts, forgetfulness with sunscreen use, and inconvenience with wearing wide-brimmed hats. Higher knowledge scores in farmers were associated with better sun protection. Farmers utilized different sources of health care information compared with nonfarmers, including farm magazines and newspapers, radio, and farm organizations. Providers should consider the unique characteristics of the farming population to provide skin cancer prevention education that is tailored to the needs of this population, such as reminders for sunscreen use and resources for sun-protective hats that do not interfere with work. Among individuals without prior history of skin cancer, 34% of farmers and 22% of nonfarmers (P = .0127) were referred for additional evaluation due to identification of a concerning lesion at the screening event. Thus, farmers may preferentially benefit from skin cancer screening events, and this population should be targeted for additional screening events in the future. This study identifies unique characteristics of the farming population that can assist providers in caring for this population and guide the future development of skin cancer awareness, prevention, and screening initiatives to benefit farmers.     

“We Don’t Really Do Anything Unless it’s Really Bad”: Understanding Adolescent Sun Protective Knowledge,Attitudes and Behaviors in the U.S.

Risk factors for melanoma, the deadliest form of skin cancer, include lifetime sun exposure and a history of sunburns. However, a minority of adolescents report consistent engagement in sun protective behaviors. The few sun protection interventions that have targeted adolescents have had little effect on behavior change, which suggests that a better understanding of the issue, especially from the adolescents’ perspective, is needed. Although efforts to qualitatively examine adolescent sun protection have been carried out in a handful of countries, no studies to date have focused on U.S. adolescents. We conducted focus groups with 44 6th–8th grade students in Colorado to explore their sun protection knowledge, attitudes and behaviors. Results supported previous findings that adolescents do not engage in regular skin protection but have experienced the negative consequences of sun exposure (e.g., severe sun burns, and blistering). In addition, participants demonstrated limited and sometimes inaccurate knowledge about the long-term risks of sun exposure, as well as effective methods of sun protection. Barriers to engaging in sun protective behaviors included a desire to tan, inconvenience, and physical discomfort. Facilitators included peer and family encouragement, previous experience with sunburns and/or skin cancer, and knowledge of potential consequences. These findings provide valuable insights that can inform future intervention and research related to sun protection among U.S. adolescents.     

Community Empowerment Partners (CEPs): A Breast Health Education Program for African-American Women

Peer educators have been shown to provide effective interventions in breast cancer screening. Few studies have compared the effects of peer education on breast cancer knowledge among peer educators and the community members who are subsequently reached through the peer education. Further, little is known as to whether those who received the education then go on to educate others in the community. The purpose of this study is to address those gaps. Using a pre- and post-test study design, we trained peer educators, provided the educators with resources to train community members, and assessed changes in knowledge. We sought to train ten educators and recommended each train ten community members in breast cancer knowledge and screening strategies. A total of 14 peer educators were trained, who subsequently trained a total of 121 community members, of whom 94 were African American women. Peer educators and community members, showed comparable increases in knowledge. Community members who were educated also increased intention to discuss breast cancer and breast cancer screening with their family, friends, and acquaintances. Our study suggests that it is feasible to train peer educators to increase knowledge among community members to the same level that they themselves experience when trained. Further, community members are interested in sharing information learned related to how much they learn from peer educators.     

Assessment of Sun Safety Behavior among Farmers Attending a Regional Farm Show in North Carolina

ABSTRACT

Background: Due to the nature of working outdoors, many farmers experience high levels of exposure to ultraviolet radiation (UVR) whereby, increasing their risk for skin cancer. The primary goal of this study was to evaluate personal behavior and perception on sun protection among farmers attending a regional farm show in North Carolina. Methods: Farmers (n = 397) were asked to complete a self-administered questionnaire regarding behavior and importance of using personal sun protection (i.e., sunblock, etc.,) when working outdoors. Results: There were 285 (71.8%) male farmers and 79 (19.9%) female farmers with a mean age of 54 years. Overall, the majority of farmers recognized the importance of protecting themselves from the sun, however, actual personal behavior for using proper protection methods ranked low. Farmers with lighter, fairer skin tended to use more sun protection and ranked the importance of sun protection higher when compared to those with skin that was less likely to burn in the sun. Conclusion: The importance of personal sun protection should continue to be stressed to farmers at every available opportunity including farm shows, trainings and through health care providers.     

Long-term development of parental knowledge about skin cancer risks in Germany: Has it changed for the better?

Substantial public health efforts have been undertaken throughout the last 25 years to increase awareness about skin cancer risks in the German population. An evaluation of long-term effects of these awareness campaigns and preventive activities on the population level and in specific subgroups is yet lacking. We address the temporal development of knowledge about skin cancer risk factors and agreement to the necessity of sun protection in different outdoor situations among parents of young children. We compiled data from four population-based surveys comprising data from 8184 parents of 3- to 6-year-old children in two regions of Germany performed over a nineteen-year period between 1993 and 2012. These individual cross-sectional studies used an identical methodology to recruit study subjects and to assess the principal outcome measures. Overall, parental knowledge about skin cancer risk factors and agreement to the necessity of sun protection improved significantly over the nineteen-year period. For instance, the recognition of fair skin/hair, sunburns during childhood and a high number of naevi, respectively, being risk factors for skin cancer increased by 20.0%, 19.9% and 19.2% from the first to the most recent survey. Two remaining knowledge gaps became evident: (i) the underrating of intermittent intensive sun exposure as a skin cancer risk factor and (ii) the erroneous belief that clouds provide sufficient sun protection at midday during summertime. The messages of future public health campaigns in Germany addressing skin cancer risks and informing about preventive measures for sun protection should thus be refined regarding these aspects.     

Concurrent psychosocial predictors of sun safety among middle school youth

Background: Sun‐induced skin damage, which increases skin cancer risk, is initiated in early life and promoted through later sun exposure patterns. If sun safety determinants are well understood and addressed during the school years, skin cancer incidence might be reduced. This study tested psychosocial influences on youth’s sun safety and assessed their strength within and across gender and ethnicity in a sample of 1782 middle school students. Methods: Predictors included sunburn and skin cancer knowledge, tanning attitudes, peer norms, and barriers regarding sun exposure and were assessed with a self‐administered, validated questionnaire. The hypothesized relationships were tested with structural equation models and confirmed with multilevel regression. Results: Across gender and ethnicity, knowledge emerged as an important sun safety predictor with both direct and indirect effects mediated through tanning attitudes. The relationship with barriers did not reach statistical significance within any of the subgroups, possibly due to measurement limitations. An indirect effect of peer norms on sun safety, mediated through tanning attitudes, was confirmed only among girls. Also, an indication that peer norms operate differently within the ethnic groups was found, since this predictor had a statistically significantly stronger relationship with sun safety among non‐Hispanics. Conclusions: Youth’s sun safety is a multifactorial practice, partially determined by ethnicity‐ and gender‐based standards. In order to ensure health‐promoting school environments, needed are multicomponent programs where peer norms and knowledge are salient and where sun safety is addressed individually and together with other health risk behaviors.     

How to improve adolescents' sun protection behavior? Age and gender issues

OBJECTIVE: To explore adolescents' self-reported reasons for sun protection, as adolescents as a group continue to have poor sun protection practices. METHODS: Seventeen age- and gender-segregated focus groups were conducted in Australian high schools. RESULTS: Reasons for using sun protection included personal comfort, appearance, policies, fear of skin cancer, expectations of authority figures, peer actions, and habit. Reasons for not using sun protection included desire for a tan, inconvenience, low perceived risk, and fashion. Age and gender effects were found. CONCLUSIONS: Avenues for intervention with adolescents include authority figures, peer advocacy, the fashion industry, and improved sun protection products.     

Factors associated with skin cancer prevention practices in a multiethnic population.

A better understanding of factors influencing sun protection practices can improve the design and evaluation of skin cancer prevention programs. These data are from a cross-sectional survey of 756 parents with children in Grades 1 through 3, and 176 recreation program staff members in a multiethnic population in Hawaii. Questionnaires asked about skin cancer prevention practices (sunscreen use, covering up, shade seeking), knowledge, benefits and barriers, policies, and staff norms for prevention. The most important correlates of children's prevention practices were their parents' sun protection habits. Multiple regression models--which included knowledge, beliefs, program policies, and covariates related to sun protection--explained a total of between 38% and 41% of the variance in children's sun safety habits, 22% to 25% of parents' habits, and 24% of recreation staff members' sun safety habits. The models were less successful at predicting the use of hats, shirts, and shade seeking and a composite sun protection habits index. Parents and caregivers' knowledge, beliefs, and behaviors, as well as recreation program policies, are strong predictors of sun protection practices among children in Grades 1 to 3 in a multiethnic sample.     

Primary prevention of skin cancer: a review of sun protection in Australia and internationally

The incidence of skin cancer is increasing worldwide. Protecting the skin from the sun by wearing protective clothing, using a sunscreen with appropriate sun protection factor, wearing a hat, and avoiding the sun are recommended as primary preventive activities by cancer agencies. In this paper the recent data relating to skin cancer primary preventive behaviour in Australia and other countries is reviewed. Comparison of the studies in a table format summarizing the methods, objectives, participants, findings and implications may be obtained from the corresponding author. The sun protection knowledge, attitudes and behaviour patterns observed in Australia are similar in other countries, although Australian studies generally report higher knowledge levels about skin cancer and higher levels of sun protection. The findings suggest that sunscreen is the most frequent method of sun protection used across all age groups, despite recommendations that it should be an adjunct to other forms of protection. While young children's sun protective behaviour is largely influenced by their parents' behaviours, they are still under protected, and sun protective measures such as seeking shade, avoiding the sun and protective clothing need to be emphasized. Adolescents have the lowest skin protection rates of all age groups. Within the adult age range, women and people with sensitive skin were most likely to be using skin protection. However, women were also more likely than men to sunbath deliberately and to use sun-tanning booths. The relationship between skin protection knowledge and attitudes, attitudes towards tanning and skin protection behaviour needs further investigation. Further studies need to include detailed assessments of sunscreen use and application patterns, and future health promotion activities need to focus on sun protection by wearing clothing and seeking shade to avoid increases in the sunburn rates observed to date.     

Knowledge, attitudes, and behaviors toward skin cancer in Maryland youths.

PURPOSE: To describe the knowledge, attitudes, and practices of 7th-graders in Maryland with respect to sun protection and skin cancer. METHODS: Maryland middle school students ages 10 to 16 years (55% girls, estimated 67% white) from 6 counties completed an in-school questionnaire (n = 2,775) developed by the Coalition for Skin Cancer Prevention in Maryland in 1999 to assess knowledge, attitudes, and behaviors concerning sun exposure and skin cancer. To evaluate for gender and age differences, mean knowledge and attitude scores were compared using Student's t-tests and the prevalence of behaviors were compared using Chi-square tests. Multiple regression was used to model how age, gender, knowledge, and attitudes predicted the likelihood of being sunburned the previous summer. RESULTS: On average, these youths correctly answered 65% of 13 true/false items and 43% of 7 multiple choice items. Approximately one-third (32%) felt a tan looked healthy and 51% felt a tan looked attractive; on the other hand, 36% agreed/strongly agreed that sun protection was "cool." Attitudes toward skin protection became less favorable with age (p-for-trend < .001). When out in the sun the previous summer, 37% rarely or never used sunscreen and 43% never wore a hat. The prevalence of two or more painful sunburns during the past summer was 30%. Less favorable attitudes toward skin protection were associated with a higher likelihood of sunburn (p < .001). The likelihood of sunburn did not differ by gender, even though when compared with boys, girls had significantly higher knowledge scores (p < .01), more favorable attitudes (p < .001), and were significantly more likely to report using sunscreen (p < .001). CONCLUSIONS: A substantial proportion of youths were not protecting themselves adequately from sunlight. The overall low levels of knowledge accentuate the need to incorporate basic knowledge of skin cancer and sun protective behaviors in preventive interventions designed for this population. The results particularly emphasize the need to positively impact attitudes toward sun protective behavior early in life to help curb the epidemic of skin cancer.     

Healthcare providers' sun-protection promotion and at-risk clients' skin-cancer-prevention outcomes

BACKGROUND: This study aims to determine whether healthcare providers' (HCPs') communication dealing with sun-protection (i.e., counseling) is associated with clients' skin-cancer-related prevention practices, detection self-efficacy, and knowledge. METHODS: Secondary analysis of two surveys of 1,469 randomly sampled farmers and soccer participants from southeast and coastal Georgia. RESULTS: Farmers and soccer participants who report ever having been counseled by a HCP about how to protect their skin from the sun report being more likely to wear sunscreen (P < 0.05), get clinical exams of their skin (P < 0.001), be certain that they can recognize unhealthy changes in their skin (P < 0.001), be certain that they know how to perform a skin exam (P < 0.001), and be knowledgeable about skin cancer prevention (P < 0.05 and P < 0.001, respectively); soccer participants are additionally more likely to wear protective headgear (P < 0.05) and perform monthly self-exams of their skin (P < 0.001). All analyses incorporated three control variables: participants' prior history of skin cancer, age, and non-HCP-derived skin-cancer awareness. CONCLUSIONS: Findings suggest that HCPs' counseling can positively shape skin-cancer-related prevention practices, detection self-efficacy, and knowledge. Additional research is needed on HCPs' actual communication about skin cancer and sun protection and its influence on client outcomes.     

Legally brown: using ethnographic methods to understand sun protection attitudes and behaviours among young Australians 'I didn't mean to get burnt--it just happened!'

Sun protection is not commonly perceived as an important issue by adolescents yet this behaviour would, if adopted, confer significant lifelong protection against skin cancer. Despite the world's highest skin cancer rates, Australia remains a culture which values sun seeking, tanning and outdoor activities. This qualitative study used ethnographic methods to produce insights into sun protection behaviours and attitudes of Australian adolescents aged 15 and 16 years. Applying the Theory of Planned Behaviour to the analysis, the study involving 51 adolescents revealed the complexity of the factors that influence sun protection behaviours, such as peers, lifestyle, environments, social norms and fashion. Sun protection was imbued with associations of negativity, dullness and irritation which was dissonant with adolescents' buoyant, dynamic and 'fun filled' experience of the sun. Key barriers to sun protection were found to stem from the perceived impact of sun protection behaviour on the peer dynamic, negative perceptions around what sun protection communicates about the user, the tone of existing sun protection communications and the spontaneous unplanned nature of the adolescent lifestyle. The paper concludes by discussing the implications for health promotion with this hard to reach group.     

Sun exposure and primary prevention of skin cancer for infants and young children during autumn/winter

OBJECTIVE AND METHOD: Excessive sun exposure in childhood has been associated with the development of skin cancer, and appropriate levels of sun protection during the early years of a child's life can significantly reduce the risks. A survey of 133 mothers was undertaken in south-east Queensland to examine the levels of sun exposure and skin protection of infants and young children. RESULTS: Among this sample of 133 mothers, use of appropriate skin protection was relatively high for themselves and their children. However, even by six months of age, a third had been sunburnt and 15% had experienced painful sunburn. By three years of age, 82% had been sunburnt and one-third had experienced painful sunburn, though mothers' knowledge levels of sun safety issues were very high. The predictors associated with primary prevention varied across the type of prevention behaviour, but indicated that interventions should focus on susceptibility to sunburn and history of sunburn. Similar programs could be applicable across a broad range of socio-demographic groups, but require attention to mother's country of birth as a factor that significantly influences their use of protection for their young children. CONCLUSIONS: Ongoing public education that targets specific groups and settings may contribute to adoption of appropriate sun protective behaviours for young children. IMPLICATIONS: Results of the study provide some of the needed baseline data to assist future skin cancer prevention campaigns for young children and infants. A similar study of levels of sun exposure and skin protection for children during summer is under way.     

Sun Safety Among Farmers and Farmworkers: A Review

Farmers and farmworkers face increased risks of skin cancer from exposure to solar ultraviolet radiation (UVR) when working outdoors. The objective of this study was to evaluate the evidence from behavioral and intervention studies from the peer-reviewed studies related to sun safety among farmers and farmworkers and identify any gaps in the literature. A comprehensive review was conducted between 1990 and 2013; 22 studies were identified related to behavior and health interventions of sun safety among these targeted groups. The inconsistency of data collection methods makes it difficult to estimate with accuracy any overall meaningful results of behavior. However, from the studies reviewed, farmers and farmworkers most frequently reported wearing some type of hat (23.6%–100%) as a primary method of protection from the sun when working outdoors. Female farmers were more likely than male farmers to use sunscreen and engage in indoor tanning behavior. All sun safety educational interventions studies reviewed reported positive increases in behavioral change. To a large degree, adequate sun protection is lacking and varies geographically among farmers. Although targeted education is key to making improvements on sun protection behavior, aggressive attempts have to be made. Studies related to farmworkers, sun safety behavior, and skin cancer are scarce and more research is needed in this area.     

Compensation strategies in sun protection behaviors by a population with nonmelanoma skin cancer

BACKGROUND. Initiation of sun protection strategies can be promoted, to some extent, by educational efforts, but little is known about the merit of continuing education interventions in sustaining the desired behaviors or adding new behaviors. This prospective study clarifies the choices individuals make among the four strategies that allow them to maintain lifestyle changes. METHODS. From 1983 to 1987, the population received education about sun protection coupled with the removal of a nonmelanoma skin cancer. One year later, their choice of sun protection methods was determined. Then annually from 1985 to 1989, they received written recommendations about sun protection for a period of 2-6 years after the initial education. The maintenance, cessation, and addition to the initial sun protection behaviors were ascertained by a questionnaire, as was the intention to change. Frequency of physician visits and development of subsequent nonmelanoma skin cancer were evaluated by medical chart review for the 2-6 year phase of continued education. RESULTS. One percent of the population consisting mostly of women described ceasing tanning after 2-6 years of education. The population related a greater use of protective clothing and/or sunscreen with an SPF of 15 or greater as their reported restrictions on outdoor activities ceased. An emerging new strategy of some of the population (n = 185) was the use of sunscreens with an SPF less than 15 in association with attempts to deliberately tan and longer daily outdoor exposure. Neither frequency of physician visits nor numbers of subsequent nonmelanoma skin cancers influenced continuation or addition of sun protection behaviors. CONCLUSIONS. While the greatest reported change in behavior was temporarily associated with educational intervention linked to removal of the skin cancer, continued educational efforts may have recruited some individuals to cease tanning and encouraged others to adopt the use of protective clothing or more frequent sunscreen use as they were unable to maintain the limitations on outdoor activities. It is not possible to structure a control group restricted from mass media education; therefore, the effectiveness of specific behavior-directed education cannot be precisely determined. Nonetheless, the population described using knowledge to develop compensation sun protection strategies that preserved lifestyle.     

Using Process Evaluation Results to Compare Peer and Adult Leader Delivery of the PAWS (Peer-Education about Weight Steadiness) Club Program

To date, there is limited published literature on process evaluation of adolescent health promotion programs. In this paper, we describe the methods and results of PAWS Club process evaluation over 2 years of implementation to compare the effectiveness of delivery by peer and adult leaders. PAWS (Peer-education About Weight Steadiness) Club was a 12-week healthy lifestyle program, delivered to 6th and 7th graders by peer and adult educators, using cluster randomized controlled design. Peer educators were 8th graders in the program schools and adult educators were staff/teachers in the program schools. Trained university students filled out fidelity logs at each session led by peer and adult educators to assess program delivery. The fidelity logs included questions to collect information about the number of participants, duration of the session, percent of activities completed, and if lessons started on time, lesson objectives were clearly stated, lesson objectives were emphasized, demonstrations were visible to participants, all activities were completed, the leader was familiar with lessons, the leader maintained an appropriate pace, the leader kept participants on track, and the leader asked if participants had any questions. Adult educators had a higher mean performance for all questions compared to peer leaders. Significant differences were observed for emphasizing lesson objectives (p = 0.005), making demonstrations visible to participants (p = 0.031), being familiar with the lesson plan (p = 0.000), maintaining an appropriate pace (p = 0.000), keeping participants on track (p = 0.000), and asking if participants had any questions (p = 0.000). Significance was set at p < 0.05. Findings from the current study have implications for designing and conducting a process evaluation of complex healthy lifestyle programs with adolescents in schools. Additional training of peer educators may be needed to enhance program delivery.     

All or nothing... or just a hat? Farmers' sun protection behaviors

Farmers have an increased risk for developing skin cancers and thus comprise an important audience for messages that address sun protection practices. This project examines sun protection behaviors of farmers from southeastern Georgia and uses those measured behaviors to conduct a cluster analysis. Farmers (N = 480) were clustered into three groups using six variables that measured their frequency of sun protective and purchasing behaviors. The three groups were characterized as either engaging heavily in sun protective behaviors, engaging in none of the recommended sun protective behaviors, or only wearing hats as a sun protective behavior. Practitioners seeking to develop health message interventions that target farming populations should consider the current behaviors of subgroups of farmers when developing audience segments to tailor messages aimed at increasing sun protective behaviors. Practical recommendations for message content targeted toward the subgroups of farmers are provided.     

Sun protection and sunburn in primary school children: the influence of age, gender, and coloring

BACKGROUND: Childhood is a high-risk period for skin damage due to excessive sun exposure. This damage may lead to skin cancer later in life. METHODS: The present study measured children's knowledge and attitudes, and reported usual behavior relevant to sun protection and parents' encouragement of their children's sun protection among a sample of 735 primary school students and their parents, in Victoria, Australia. The incidence of sunburn among the children over late spring and early summer was monitored weekly for 8 weeks. RESULTS: The results indicate that children's knowledge of sun protection is moderately high and that positive sun protection attitudes, reported frequency of parents encouraging protection, and children carrying out sun protection are generally high. Trends for age indicate that while knowledge of sun protection increases with age, attitudes and behaviors supportive of sun protection decline. Sunburn rates increase with age. There was some evidence to suggest that children with fairer coloring receive greater encouragement from parents to protect themselves and are marginally better protected than children with darker coloring. However, this highly susceptible group still suffers more burns. There was little variation based on children's gender. CONCLUSIONS: The mid-primary school years may be a critical time for interventions promoting sun protection.     

Young Adults' Responses to News About Sunscreen and Skin Cancer: The Role of Framing and Social Comparison

Young adults read a news article about skin cancer that used a gain frame (e.g., using sunscreen keeps skin healthy) or a loss frame (e.g., not using sunscreen increases skin cancer risk), and included a personal exemplar (healthy or ill). Compared to a control group, both frames increased intentions to use sunscreen. Planned SPF was higher for men in the loss frame but was unaffected by framing for women. The framing manipulation had opposite effects on sun protection behaviors among individuals who were high versus low in perceived similarity to the exemplar. Overall, the gain frame was more effective for people who were high in similarity, whereas the loss frame was more effective for those low in similarity. In addition, individuals who felt more similar to the exemplar reported more personal risk in the loss frame but stronger intentions to use sun protection behaviors in the gain frame. Last, social comparison orientation was associated with more personal risk in the gain frame (suggesting upward comparison) but lower intentions to engage in sun protection behaviors regardless of the frame. Interpretations of the findings and implications for the use of exemplars in health messages are discussed.     

Sun-related attitudes and beliefs among Queensland school children: the role of gender and age

Abstract: A cross-sectional study of the sun-related attitudes and beliefs of 3 655 children in Grades 7 to 11 attending 55 representative Queensland schools was undertaken using a structured questionnaire administered at school. Factors derived from a series of focus groups were incorporated into the questionnaire. Knowledge about risk factors in the aetiology of skin cancer and the role of protective measures was high. Several potential barriers to the use of sun protection were identified, including the desire to be tanned, the perceived attitudes of the peer group to sun protection, and difficulties with the use of specific sun protection measures. In general, these barriers were significantly more prominent among boys and children from older grades than other students. These data will be used to design school-based sun protection interventions which are sensitive to these age and sex differences.