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Baseline Survey of Managers on Occupational Sun Protection in a Randomized Trial of Scale-up

Baseline Survey of Managers on Occupational Sun Protection in a Randomized Trial of Scale-up

Scale-up is the effort to increase the impact of successful prevention interventions to benefit more people on a lasting basis. Successful and affordable methods for scaling-up evidence-based programs are needed to prevent skin cancer among adults, particularly those who work outdoors in the sun.

Dr. David Buller, Director of Research at Klein Buendel, presented baseline findings from the scale-up of an occupational skin cancer prevention program at the 42nd Annual (Virtual) Meeting & Scientific Sessions of the Society of Behavioral Medicine, April 12-16, 2021.

A randomized trial is being conducted to compare two methods of scaling up, nationwide, an effective occupational sun protection intervention, Sun Safe Workplaces, that promotes policy and education for outdoor workers. Departments of Transportation (DOTs) from 21 U.S. states are participating and their 138 regional districts were randomized following baseline assessment. The state DOTs range in size from 997 to 18,415 employees. At baseline, 1,113 managers (49.0%) completed the pretest. Managers were generally supportive of occupational sun safety policy, but also felt employees should take action on their own on sun protection. A minority reported that their DOT had a written policy or standard operating procedure on occupational sun protection. Just over half reported that the DOT provided training on sun safety to employees and/or managers and supervisors. About two-thirds reported that the DOT provided messaging on sun protection and sun protection resources, such as sunscreen, clothing, hats, or eyewear. Other sun safety actions were less commonly reported (for example, provision of shade, UV Index monitored and outdoor work activities adjusted, or employees encouraged to regularly check skin for signs of skin cancer.

Occupational sun exposure receives some attention at DOTs, mainly in the form of training and provision of sun safety resources. However, it appears that several employees may not be practicing sun protection because of lack of policy and/or sun safety prevention efforts. Policy on occupational sun safety is less common, despite the link of solar UV to skin cancer. Health promotion approaches that incorporate policy with education might help to improve implementation of sun safety at the workplace.

This research project (CA210259; Dr. David Buller, Principal Investigator) is funded as part of the National Cancer Institute’s Cancer Moonshot Initiative, which aims to accelerate cancer research in order to make more therapies available to patients, while also improving the ability to prevent cancer and detect it at an early stage. Collaborators on the conference presentation include Dr. Richard Meenan from Kaiser Permanente’s Center for Health Research, Dr. Gary Cutter from Pythagoras, Inc., Dr. Sherry Pagoto from the University of Connecticut, and Ms. Mary Buller, Ms. Julia Berteletti, Ms. Rachel Eye, and Dr. Barbara Walkosz from Klein Buendel. This baseline data is published in Contemporary Clinical Trails.

Listen to the Research Spotlight presentation.

Association of Occupational Sun Safety Policy with Employee Practices

Association of Occupational Sun Safety Policy with Employee Practices

Occupational sun protection policies are fundamental for the increased implementation of employee sun safety practices. Investigators and staff from Klein Buendel, led by Dr. David Buller, Director of Research, recently published baseline results from a large-scale workplace sun safety policy project in the American Journal of Industrial Medicine.

In the publication, the authors report on the coding and evaluation of written safety policies from 21 state Departments of Transportation (DOTs) enrolled in a randomized trial testing methods for scaling-up an occupational sun safety intervention. A total of 1,113 managers who supervised people who work outdoors reported on workplace and employee sun safety practices in a baseline survey.

Analysis showed that 20 of the state DOTs had a policy with at least one sun protection component (e.g., sunscreen, eye protection, use of shade). Sun safety training was increased at workplaces with written sun safety policy and unwritten standard operating procedures on sun protection. Sun safety actions were highest where there was a written sun safety policy and unwritten standard operating procedures on workplace sun protection. The measures, methods, analyses, results, conclusions, and limitations of the baseline manager survey are detailed in the publication.

This research was funded by a grant from the National Cancer Institute at the National Institutes of Health (CA210259; Dr. David Buller, Principal Investigator). Coauthors include Dr. Barbara Walkosz, Savanna Olivas, Rachel Eye, Xia Liu, Alishia Kinsey, Mary Buller, and Andrew Grayson from Klein Buendel.

Written Policy Predicts Worksite Sun Safety Training and Actions in State Departments of Transportation

Written Policy Predicts Worksite Sun Safety Training and Actions in State Departments of Transportation

Dr. David Buller, Klein Buendel Director of Research, presented a poster on workplace sun safety policies at the virtual 13th Annual Conference on the Science of Dissemination and Implementation in Health December 15-17, 2020.  

The U.S. Surgeon General and Community Guide recommend implementation of interventions to protect outdoor workers from solar ultraviolet radiation (UV) exposure to prevent skin cancer. For the research presented in this poster, written policies at state Departments of Transportation (DOTs) were examined and analyses tested the hypothesis that presence and strength of sun safety policy would be associated with greater implementation of workplace sun safety actions. 

Written policies from 21 U.S. state DOTs were coded for 15 sun safety components including engineering controls (physical work environment), administrative controls (workplace procedures), and personal protection practices (workers’ sun safety). Managers supervising outdoor workers in 138 regional DOT districts reported on workplace sun safety training and actions (monitoring UV Index to adjust work schedules, employees wearing UV-protective clothing, hats, eyewear, and sunscreen, sun safety messages to employees, employer provides sun protection resources and temporary/permanent shade, employer requests contractor staff comply with policy, employer encourages employees to regularly check skin, and employer conducts a risk assessment). 

Twenty state DOTs had a policy with at least one sun protection component (e.g., sunscreen, clothing, hat, shade provision, adjusting schedules), but almost none included training of employees, managers or supervisors. Many policies were also not explicitly intended for sun safety, except for sunscreen. Though not written, some reported unwritten standard operating, administrative, or training procedures on sun protection. Sun safety training and actions were predicted by a written sun safety policy and unwritten procedure, managers’ behaviors, job responsibilities, and characteristics. 

Policies are essential for implementation and maintenance of employee sun safety. While many state DOTs have policies, they could be improved by explicitly referencing sun safety. Also, training should be added to policy to create collective commitment among managers to support policy implementation and improve employees’ sun safety skills on the job. 

This research is funded by a grant from the National Cancer Institute (CA134705; Dr. David Buller, Principal Investigator). Additional poster coauthors included Dr. Barbara Walkosz, Mary Buller, Rachel Eye, Andrew Grayson, Alishia Kinsey, Xia Liu, and Savanna Olivas from Klein Buendel. 

Listen to the poster presentation.

Scaling-up an Evidence-based Workplace Sun Safety Program

Scaling-up an Evidence-based Workplace Sun Safety Program

Authors of a recent online publication in Contemporary Clinical Trails recommend that “successful methods for scaling-up evidence-based programs are needed to prevent skin cancer among adults who work outdoors in the sun.” The paper describes the design and baseline descriptive data from a workplace intervention being conducted by Klein Buendel and several research collaborators. The on-going randomized trial compares two methods of scaling-up the Sun Safe Workplaces intervention with 21 state Departments of Transportation and their employees who work outdoors. 

A total of 138 regional districts from the Departments of Transportation were randomly assigned to either an in-person program where project staff meet personally with managers, conduct trainings for employees, and provide printed materials, or a digital program where project staff conduct these same activities virtually, using conferencing technology, online training, and electronic materials.

Delivery of Sun Safe Workplaces in both groups is tailored to managers’ readiness to adopt occupational sun safety. Posttesting will assess manager’s support for and use of Sun Safe Workplaces and employees’ sun safety. An economic evaluation will explore whether the method that uses digital technology that may result in lower implementation of Sun Safe Workplaces, is more cost-effective relative to the in-person method.

The 21 state Departments of Transportation vary in size from 997 to 18,415 employees. At baseline, managers reported being generally supportive of occupational sun safety. A minority reported that the Departments had a written sun safety policy, half reported sun safety training for employees, and two-thirds reported messaging and communication about sun protection for employees. The research will help determine whether digital methods can facilitate a cost-effective scale-up of Sun Safe Workplaces for outdoor workers in industries across the country.  

This research project (CA210259) is funded as part of the National Cancer Institute’s Cancer Moonshot Initiative, which aims to accelerate cancer research in order to make more therapies available to patients, while also improving the ability to prevent cancer and detect it at an early stage. This project, Sun Safe Workplaces-Technology, is being led by KB’s Director of Research, Dr. David Buller, as Principal Investigator. Co-authors on the Contemporary Clinical Trails publication include Dr. Richard Meenan from Kaiser Permanente’s Center for Health Research, Dr. Gary Cutter from Pythagoras, Inc., Dr. Sherry Pagoto from the University of Connecticut, and Ms. Mary Buller, Ms. Julia Berteletti, Ms. Rachel Eye, and Dr. Barbara Walkosz from Klein Buendel.

An Implementation Model for the Cost-effective Scale-up of the Sun Safe Workplaces Program

An Implementation Model for the Cost-effective Scale-up of the Sun Safe Workplaces Program

Dr. David Buller and Dr. Barbara Walkosz from Klein Buendel presented a poster on a new implementation model for the cost-effective scale-up of an occupational sun protection program at the 12th Annual Conference on the Science of Dissemination and Implementation in Health in Washington, DC, December 4-6, 2019. The poster was nominated for Best Poster from the Prevention and Public Health Division.

Scale-up is the effort to increase the impact of successful programs to benefit more people on a lasting basis. Scale-up efforts must increase reach, retain effectiveness, and lower costs to provide greater access to benefits and close the research-to-practice gap between effective programs and real-world application. This project is studying the nationwide scale-up of an occupational sun safety intervention, Sun Safe Workplaces, with state Departments of Transportation (DOTs), a public works sector with thousands of outdoor workers.

Costs of national distribution can be daunting and influence intervention intensity and program effectiveness. Identifying cost-effective scale-up strategies is essential for moving research into practice. The new framework draws upon existing implementation models, including those developed for occupational health and safety, and operationalizes implementation for scale-up within RE-AIM. The RE-AIM framework was adapted for this new framework by incorporating cost as a primary factor.

In a randomized trial, Sun Safe Workplaces (SSW) is assessing implementation rate and costs associated with two methods of scaling-up SSW. The original intervention depended on personal visits with managers, materials promoting sun protection policies and education, in-person sun safety training for employee groups, and on-going follow-up communication with managers supporting sun safety (SSW-IP), a resource-intensive form of intervention. Now SSW-IP is being contrasted to a scale-up strategy that uses web-based and telephone conferencing, responsive training platforms, and electronic resources for virtual contacts and training (SSW-T). Technology-based programs have the potential to deliver standardized, engaging content and increase portability while decreasing cost of delivery to enable reaching more employers when scaled-up to nationwide distribution. Districts within DOTs are randomized to one of the two scale-up methods. The SSW-IP and SSW-T interventions are being delivered in 21 state DOTs with 141 districts.

This research is funded by a grant from the National Cancer Institute (CA134705; Dr. David Buller and Dr. Barbara Walkosz, Multiple Principal Investigators). Additional poster coauthors include Dr. Richard Meenan from the Kaiser Permanente Center for Health Research; and Mary Buller, Rachel Eye, Andrew Grayson, and Savanna Olivas from Klein Buendel.