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.     

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.     

Adolescent sun protection at secondary school athletic sporting events – a misnomer

Objective : To observe the sun‐protective practices of students and staff and related aspects of the physical environment at secondary school athletics days. Methods : This observational study of 1,225 students and 215 adult supervisors examined the use of sun‐protective items (hats, clothing coverage, sunglasses), sunscreen provision and shade. Results : Sun‐protective behaviour was poor with only 3% of students and 25% of adult supervisors wearing a sun‐protective hat. Shade was not available to most students, either as competitors or while waiting to compete. Sunscreen provision was 50%. Conclusion : Portable shade for students waiting to compete should be available at competitive events. Students should be encouraged to wear sun‐protective hats and clothing while not competing and SPF30+ broad‐spectrum sunscreen should always be provided. Guidelines for adult supervisors should be developed so they role model appropriate sun protection.     

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.     

Trends in Australian adolescents' sun‐protection behaviours: implications for health campaigns

Objective: Protecting the skin from ultraviolet (UV) radiation is critical during adolescence to reduce the risk of developing skin cancer later in life, but adolescents tend to be less likely to engage in sun‐protective behaviours than adults. The present study examined changes and trends (2001/02–2011/12) in sun‐protection behaviours among adolescents living in Western Australia – a region with high levels of UV radiation. Methods: A cross‐sectional survey was conducted during 10 summers between 2001/02 and 2011/12 to investigate how often adolescents engaged in various sun‐protection behaviours, including outdoor protective measures (wearing a hat, wearing protective clothing, using sunscreen, wearing sunglasses, seeking shade) and avoidance of UV radiation by staying inside. Results: Hat use significantly decreased between 2001/02 and 2011/12, whereas use of sunscreen and wearing covering clothes were unchanged in most survey years relative to 2001/02. Use of sunglasses peaked in 2006/07 and 2007/08, but returned to first survey year levels in 2011/12, while staying inside was more frequently reported from 2006/07 onwards. Conclusions: New approaches are needed to minimise reactance responses in adolescents while fostering favourable attitudes to sun protection. Implications and opportunities for interventions to promote better sun‐protection practices among adolescents are provided.     

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.     

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.     

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.     

Communicating Safe Sun Practices to Farm Youth

SUMMARY

The Georgia Harvesting Healthy Habits Campaign evaluated farm youths' skin cancer prevention outcome expectancies using Social Cognitive Theory as a framework. The evaluation was de-signed to enable farm youth to experience sun protection and skin cancer prevention behaviors and to form outcome expectancies about performance. It also provided the opportunity for participants to ob-serve peers performing these promoted practices–a method of facili-tating the formation of outcome expectancies. It was hypothesized that positive outcome expectancies would positively correlate with behavioral intentions to wear and negatively correlate with intentions to not wear particular sunscreens and hats while in the sun. Implica-tions for the design of health education curricula to increase farm youths' positive outcome expectancies for sun protective practices are discussed.     

The relationship between sun protection policy and associated practices in a national sample of early childhood services in Australia

Limiting exposure to sunlight during childhood can significantly reduce the risk of skin cancer. This was the first national study to assess the sun protection policies and practices of early childhood services across Australia. It also examined the key predictors of services' sun protection practices. In 2007, 1017 respondents completed a self-administered survey about the sun protection policies and practices in their early childhood service (response rate of 59%). Most (95%) had a written sun protection policy. The most common policy inclusions were hat wearing (91%), sunscreen use (87%) and enforcement of policy (97%). Less frequently reported inclusions were protective clothing (69%), information for parents/caregivers (58%) and regular reviews/updates of policies (65%). Basic sun protection practices (e.g. required any type of hat and sunscreen use) were more commonly reported than extensive practices (required protective clothing or regularly applied sunscreen). Higher sun protection policy scores, being a formal childcare service as opposed to a kindergarten/pre-school and having SunSmart status as opposed to not, were associated with higher sun protection practice scores (P < 0.001). Sun protection policies may be improved through encouraging services to have more specific policy inclusions and to model their policies on the SunSmart Early Childhood Program.     

Sun Protection Policies and Practices at Child Care Centers in Massachusetts

We assessed the relationship between sun protection policies and practices at child care centers in Massachusetts. We hypothesized that centers with sun protection policies were more likely to have regular sun protection practices in place compared to centers without these policies. We conducted a telephone survey with directors or assistant directors at 327 child care centers during the summer of 2002. The main outcome measure was sun protection practices, which included time spent outside during mid-day and the use of sunscreen, hats, and protective clothing by the majority of children assessed over the last 5 program days. The 36-item survey also inquired about the center’s sun protection policy and included demographic questions. Most centers (73%) reported having a written sun protection policy. Sun protection policies were positively associated with reported sunscreen (χ²=14.63, p = 0.0001) and hat use (χ²=30.98, p < 0.0001) and inversely associated with time outside (χ²=10.76, p = 0.001). Seventy-seven percent of centers followed recommended sunscreen practices. However, centers were far less likely to have recommended hat use (36%) and protective clothing (1.5%) practices. A formal sun protection policy may be an effective way to increase sun protection practices in the child care setting. Further research should assess this relationship in other states. Improving and expanding existing state regulations may be a reasonable strategy to increase sun protection at child care centers. Stacey A. Kenfield is a doctoral candidate in the Epidemiology Department, Harvard School of Public Health, Boston, MA; Alan C. Geller is Research Associate Professor in the Department of Dermatology at the Boston University School of Medicine, Boston, MA; Elizabeth M. Richter is Cancer Prevention and Control Director, Bureau of Family and Community Health, Massachusetts Department of Public Health, Boston, MA; Steve Shuman is Health Specialist for ACF Region 1 Head Start Quality Initiative, Boston, MA; David O’Riordan is Assistant Professor at the Cancer Research Center of Hawaii, University of Hawaii, Honolulu, HI; Howard K. Koh is Harvey V. Fineberg Professor of the Practice of Public Health, Division of Public Health Practice, Harvard School of Public Health, Boston, MA; Graham A. Colditz is Professor of Medicine at Harvard Medical School, Boston, MA.     

A survey of sunscreen use and sun-protection practices in Darwin

Abstract: A study was conducted to determine the prevalence and determinants of sun-protection practices in a sample of the non-Aboriginal population at the outdoor weekend markets in subequatorial Darwin, Northern Territory, at a time of intense sun exposure, between 11 a.m. and 1 p.m. from August to October 1992. All non-Aboriginal market-attenders who were seated within defined areas adjacent to food stalls were eligible to participate. Of 106 eligible market attenders, 105 (99 per cent) agreed to participate. Overall, fewer than 20 per cent of persons in this setting of extreme sun exposure were wearing sunscreen and less than one-third were wearing a hat. Only 44 per cent of people with a past history of skin cancer sitting in the midday sun had applied sunscreen and 61 per cent were wearing a hat; however, this was significantly more than those not reporting skin cancer (P < 0.002). The longer people had lived in the Northern Territory (compared with visitors and short-term residents) the less likely they were to have applied sunscreen in preparation for the midday sun (trend X² = 3.99, P = 0.046). No association was demonstrated between the use of sunscreen and age or sex of the respondent. These results suggest that the sun-protection practices of visitors to the Northern Territory are less than optimal, and that among the longer-term residents of the Northern Territory who are at greatest risk of developing skin cancer, precautions against sun exposure could be greatly improved.     

When to apply sunscreen: a consensus statement for Australia and New Zealand

Introduction : Cancers of the skin are the most common cancers in humans, with Australia and New Zealand having the world’s highest incidence. Primary prevention campaigns advise people to apply sunscreen to exposed body sites when outdoors. However, despite growing evidence that cumulative sub‐erythemal exposures cause mutational damage, and trial data demonstrating benefit from daily sunscreen use, current policies do not consider the hazards of incidental (everyday) sun exposure. Thus, a Sunscreen Summit was convened to review the evidence and update the policies for people living in Australia and New Zealand. Results : After reviewing the benefits and risks of sunscreen application, the policy group concluded that people living in Australia and New Zealand should be advised to apply sunscreen to the face/head/neck and all parts of the body not covered by clothing on all days when the ultraviolet index is forecast to reach three or greater, irrespective of their anticipated activities. For planned outdoors activities, sunscreen should be used alongside other sun protection measures. Conclusions : People living in Australia and New Zealand are now advised to apply sunscreen every day when the UV index is predicted to reach 3 or above. Implications for public health : Increased use of sunscreen as part of the daily routine to reduce incidental sun exposure will lead to decreased incidence of skin cancer in the future.     

The Falmouth Safe Skin Project: evaluation of a community program to promote sun protection in youth.

A multidimensional community-based skin cancer prevention program was conducted in Falmouth, Massachusetts, combining community activism with publicity campaigns and behavioral interventions to improve sun protection knowledge; attitudes; and practices in parents, caregivers, and children. The program was associated with improvements in target outcomes, based on two telephone surveys of random samples of parents (n = 401, 404). After program implementation, fewer parents reported sunburning of their children, particularly among children 6 years old or younger (18.6% in 1994 vs. 3.2% in 1997), and more parents reported children using sunscreen, particularly continuous use at the beach (from 47.4% to 69.9% in younger children). Hat and shirt use did not increase. Improvements also were seen in parent role modeling of sun protection practices, parents' self-efficacy in protecting children from the sun, and sun protection knowledge. While these findings must be interpreted cautiously, they do suggest that this project was effective in promoting sun protection.     

Trends in sun protection behaviour among Australian young adults

OBJECTIVE: To study changes in sun protection behaviour, exposure and sunburn that occur from late adolescence to young adulthood. METHOD: A longitudinal design was used to survey a cohort on their sun-protection behaviour from the middle of their final year at school to more than three years after finishing school. RESULTS: Males reported higher exposure, less use of sunscreen and deeper tans than females. Yet males wore hats more frequently. People with skin that just burnt were more likely to protect themselves from the sun than people with skin that tanned. Longitudinally, the level of reported exposure and the depth of tan declined, frequency of covering up, hat wearing and sunscreen use remained unchanged, and a slight U-shaped trend was observed for sunburn. CONCLUSIONS: Young adulthood may be an important time where deteriorating trends for sun protection found in the teen years are averted. Males are at greater risk of sun exposure than females. Implications: It is recommended that health promotion programs capitalise on the trend of improved sun-protective behaviours during the transition from adolescence to young adulthood, with a particular focus on young men.     

A Randomized Trial of an Advanced Sun Safety Intervention for Vacationers at 41 North American Resorts

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.     

Australian primary school communities' understandings of SunSmart: a qualitative study

Objectives: Skin cancer represents a major health issue for Australia. Childhood sun exposure is an important risk factor and evidence suggests the use of sun protection measures by Australian school children could be improved. This study examines how the SunSmart Program, a school‐based skin cancer prevention resource, can be supported to further increase sun protection behaviours to assist in lowering skin cancer incidence. Methods: The Health Promoting Schools (HPS) framework was adopted to select key stakeholders from a convenience sample of five school communities. Students, teaching staff and parents participated in semi‐structured focus group and individual interviews. A thematic analysis was used to extract key themes from the data. Results: Although these school communities were aware of sun protection practices and the risks associated with sun exposure, their understandings of the SunSmart Program were limited. Sun protection policy implementation was inconsistent and students were unlikely to engage in sun protection practices beyond the school setting. Conclusion and implications: School communities require additional support and engagement to holistically enforce the principles of the SunSmart Program.     

Cancers in Australia attributable to exposure to solar ultraviolet radiation and prevented by regular sunscreen use

Objectives: To estimate the proportion and numbers of cancers occurring in Australia attributable to solar ultraviolet radiation (UVR) and the proportion and numbers prevented by regular sun protection factor (SPF) 15+ sunscreen use. Methods: We estimated the population attributable fraction (PAF) and numbers of melanomas and keratinocyte cancers (i.e. basal cell carcinomas and squamous cell carcinomas) due to exposure to ambient UVR resulting from residing in Australia versus residing in the UK (for melanoma) or Scandinavia (for keratinocyte cancers). We also estimated the prevented fraction (PF): the proportion of cancers that would have occurred but were likely prevented by regular sunscreen use. Results: An estimated 7,220 melanomas (PAF 63%) and essentially all keratinocyte cancers occurring in Australia were attributable to high ambient UVR levels in Australia. We estimated that regular sunscreen use prevented around 14,190 (PF 9.3%) and 1,730 (PF 14%) people from developing SCC and melanoma, respectively. Conclusions: Although our approach was conservative, a high proportion of skin cancers in Australia are attributable to high ambient levels of UVR. Prevailing levels of sunscreen use probably reduced skin cancer incidence by 10–15%. Implications: Most skin cancers are preventable. Sunscreen should be a component of a comprehensive sun protection strategy.     

Skin Cancer Prevention: A Time for Action

Skin cancer is the most common malignancy in the United States accounting for more than 840,000 cases and 9,400 deaths annually. It is estimated that 90% of non-melanoma skin cancers and much of melanoma incidence can be attributed to sun exposure. The evidence suggests that regular use of sunscreen (Sun Protective Factor (SPF) of 15 or higher), wearing protective, tightly woven clothing and wide brimmed hats, and avoiding sun exposure when the ultraviolet rays are strongest (between 11:00 a.m. and 3:00 p.m.) can dramatically reduce the risk of skin cancer. Interventions to promote sun-protection behaviors that target children and adults are necessary to reduce the growing incidence rate of skin cancer in the United States.MA during the time of this research