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Let’s Talk About Skin Cancer

Let’s Talk About Skin Cancer

Family communication about skin cancer risk may motivate people to put sun protection into practice. However, the availability, distribution, and reach of such communication is not well known.

In a recent publication in the Journal of Health Communication, authors including Dr. David Buller from Klein Buendel, describe prevalence and patterns of family communication about skin cancer across 600 diverse primary care patients. The patients were from Albuquerque, New Mexico, a geographical location with low latitude and significant year-round ultraviolet radiation from the sun.

Over half of the patients reported discussing general cancer and skin cancer risks with their families. The most frequent target of skin cancer risk communication included doctors, followed by friends/coworkers, spouse/partner, other family members, sisters, mothers, daughters, sons, fathers, and brothers. On average, participants reported having talked to three family members about skin cancer risks.

The most frequently discussed skin cancer risk communication topics were the use of sun protection, followed by the personal risk of skin cancer, who had skin cancer in the family, family risk of skin cancer, time of sun exposure, and skin cancer screening. Overall, greater family communication about general cancer and skin cancer risks was associated with a family or personal history of cancer, higher perceived risk, higher health literacy, being non-Hispanic, having higher education or income, and proactive sun protective behavior.

These study findings have implications for developing interventions that encourage family discussions about skin cancer risk, sun protection, and skin cancer screening that may foster the adoption of sun-protective behaviors and reduced exposure to harmful ultraviolet radiation.

This research was supported by a grant from the National Cancer Institute (CA181241; Dr. Jennifer Hay and Dr. Marianne Berwick, Multiple Principal Investigators). Authors in addition to the Principal Investigators include Dr. Smita Banerjee (lead author) and Dr. Elizabeth Schofield from the Memorial Sloan Kettering Cancer Center; Dr. Andrew Sussman, Dr. Dolores Guest, Dr. Yvonne Dailey, Dr. Matthew Schwartz, and Dr. Keith Hunley from the University of New Mexico; Dr. Kimberly Kaphingst from the University of Utah; and Dr. David Buller from Klein Buendel.

Skin Cancer Genetic Testing Research

Skin Cancer Genetic Testing Research

Klein Buendel Director of Research, Dr. David Buller, is a co-author on two recent publications reporting the results of studies on genetic testing and treatment decision-making for melanoma patients. Both papers report finding from a study directed by Dr. Jennifer Hay from the Memorial Sloan Kettering Cancer Center in New York and Dr. Marianne Berwick from the University of New Mexico.

Behavioral and Psychological Outcomes Associated with Skin Cancer Genetic Testing

The first paper has been published in the journal Cancer (Basel). The study investigated genomic testing of the common melanocortin-1 receptor (MC1R) gene for skin cancer risk in a randomized controlled trial in primary care settings in Albuquerque, New Mexico. Study participants were randomized 5:1 to a MC1R test invitation or usual care. Three-month sun protection, skin cancer screening, and skin cancer worry outcomes associated with testing, and key effect moderators (such as cancer risk perceptions, and skin cancer risk factors) were assessed.

Full research methods and results are reported in the publication and show that the primary outcomes were unchanged by the MC1R test offer, test acceptance, and level of risk feedback. Moderator analyses results are also presented in the publication. “Risk feedback did not prompt cancer worry, and average risk feedback did not erode existing sun protection,” according to the authors. More study is needed in the understanding and development of tailored strategies to address low skin cancer risk awareness and genetic testing.

This research was supported by the National Cancer Institute (CA181241; Jennifer Hay and Marianne Berwick, Multiple Principal Investigators). Collaborators include Kimberly Kaphingst from the University of Utah; David Buller from Klein Buendel; Elizabeth Schofield and Yuelin Li from the Memorial Sloan Kettering Cancer Center; Kirsten Meyer White from the New Mexico VA Health System; Andrew Sussman, Dolores Guest, Yvonne Dailey, Erika Robers, Matthew Schwartz, and Keith Hunley from the University of New Mexico.

Effect of Superstitious Beliefs and Risk Intuitions on Genetic Test Decisions

The second paper has been published in the journal Medical Decision Making. The study investigated cognitive causation, or superstitious thinking, and negative affect in risk as predictors of MC1R (moderate v. high risk) skin cancer genetic testing and responses to the testing.

Nearly 500 participants completed baseline assessments using validated measures of cognitive causation (beliefs that thinking about cancer risk increases cancer likelihood) and negative affect in risk (negative feelings generated during risk perception) and subsequently received a test offer. Participants could access a website to learn about and request genetic testing. Those who completed genetic testing for skin cancer completed assessments of cognitive and affective reactions two weeks after testing.

Methods, assessment measures, and full results are reported in the publication. In summary, negative affect in risk did not hamper test information seeking, but did inhibit the uptake of genetic testing. Those with higher cognitive causation showed more fear regarding their test result.

This research was supported by the National Cancer Institute (CA181241; Jennifer Hay and Marianne Berwick, Multiple Principal Investigators). Collaborators include Kristen Riley from Rutgers University; Andrew Sussman, Dolores Guest, Yvonne Dailey, Matthew Schwartz, and Keith Hunley from the University of New Mexico; Elizabeth Schofield from the Memorial Sloan Kettering Cancer Center; David Buller from Klein Buendel; and Kimberly Kaphingst from the University of Utah.

Investigation of Indoor Tanning Policy Enactment

Investigation of Indoor Tanning Policy Enactment

Klein Buendel is collaborating with Dr. Carolyn Heckman and her team from Rutgers University on a new research project to study the process of translating indoor tanning policy efforts into stringent legislation and compliance, and the effects of the legislation on reduced indoor tanning by minors in the United States.

Indoor tanning is a well-established cause of skin cancer (1-8,10). Most tanners begin indoor tanning as teens or young adults (22). In order to reduce indoor tanning and protect this at-risk population, indoor tanning is currently being regulated in two ways. First, some states restrict access by minors or require parental consent or accompaniment (11). Second, the Food and Drug Administration (FDA) attempts to minimize harm from indoor tanning devices with precautions like protective eyewear and session duration limits (12).  Recent evidence suggests that more stringent indoor tanning laws such as age bans (vs. parent consent laws or no law) are associated with less youth indoor tanning (15,16). Unfortunately, enforcement and compliance with laws are variable and inadequate (9,17-21). Although underutilized (13), legislation such as age restrictions and taxation has been quite successful in decreasing engagement in other risky behaviors such as smoking (14).

The goals of this five-year research project are to (1) clarify the indoor tanning legislation adoption process, (2) employ a pseudo-patron assessment, national survey, and archival data to investigate legislation implementation, and (3) integrate data from the first two aims and external data to assess economic effects relevant to policy sustainability of indoor tanning stringency, enforcement, and compliance.

Health-related policy adoption and promotion is an effective, yet underutilized, strategy for health promotion. To protect the public from melanoma and non-melanoma skin cancer, government bodies have begun to enact legislation to restrict minor access to indoor tanning and minimize harm from indoor tanning devices. In order to contribute to the currently limited evidence base for future policy decision making and sustainability and to accelerate reductions in indoor tanning and sunburn, this project will address policy characteristics associated with regulation compliance, cost-benefits of these policies, and barriers and facilitators of policy adoption.

This research project is funded by the National Cancer Institute (CA244370; Dr. Carolyn Heckman, Rutgers University, and Dr. David Buller, Klein Buendel, Multiple Principal Investigators). Collaborators include Dr. Rich Meenan from the Kaiser Permanente Center for Health Research; Dr. Jared Stapleton from the University of Kentucky; Dr. Shawna Hudson, Dr. Cristine Delnevo, and Dr. Kevin Schroth from Rutgers University; and Julia Berteletti from Klein Buendel.

References

  1. Lergenmuller S, Ghiasvand R, Robsahm TE, et al. Association of Lifetime Indoor Tanning and Subsequent Risk of Cutaneous Squamous Cell Carcinoma. JAMA dermatology. 2019:1-9.
  2. O’Sullivan DE, Brenner DR, Villeneuve PJ, et al. Estimates of the current and future burden of melanoma attributable to ultraviolet radiation in Canada. Preventive medicine. 2019;122:81-90.
  3. Gandini S, Dore JF, Autier P, Greinert R, Boniol M. Epidemiological evidence of carcinogenicity of sunbed use and of efficacy of preventive measures. Journal of the European Academy of Dermatology and Venereology : JEADV. 2019;33 Suppl 2:57-62.
  4. Suppa M, Gandini S. Sunbeds and melanoma risk: time to close the debate. Current opinion in oncology. 2019;31(2):65-71.
  5. O’Sullivan DE, Brenner DR, Demers PA, Villeneuve PJ, Friedenreich CM, King WD. Indoor tanning and skin cancer in Canada: A meta-analysis and attributable burden estimation. Cancer epidemiology. 2019;59:1-7.
  6. Boniol M, Autier P, Boyle P, Gandini S. Cutaneous melanoma attributable to sunbed use: systematic review and meta-analysis. BMJ : British Medical Journal. 2012;345:e4757.
  7. Colantonio S, Bracken MB, Beecker J. The association of indoor tanning and melanoma in adults: Systematic review and meta-analysis. Journal of the American Academy of Dermatology. 2014;70(5):847-857.e818.
  8. El Ghissassi F, Baan R, Straif K, et al. A review of human carcinogens–part D: radiation. The Lancet Oncology. 2009;10(8):751-752.
  9. Reimann J, McWhirter JE, Papadopoulos A, Dewey C. A systematic review of compliance with indoor tanning legislation. BMC public health. 2018;18(1):1096.
  10. Burgard B, Schoepe J, Holzschuh I, et al. Solarium use and risk for malignant melanoma: meta-analysis and evidence-based medicine systematic review. Anticancer research. 2018;38(2):1187-1199.
  11. National Council of State Legislatures. Indoor Tanning Restrictions for Minors: A State by State Comparison. http://www.ncsl.org/research/health/indoor-tanning-restrictions.aspx. Published 2018. Updated 11/2/2018. Accessed.
  12. Food and Drug Administration. Sunlamp products and ultraviolet lamps intended for use in sunlamp products. In. Vol 8. Silver Spring, MD: Food and Drug Administration; 2018.
  13. Abrams DB, Graham AL, Levy DT, Mabry PL, Orleans CT. Boosting population quits through evidence-based cessation treatment and policy. American journal of preventive medicine. 2010;38(3 Suppl):S351-363. PMCID: PMC4515751.
  14. Brownson RC, Haire-Joshu D, Luke DA. SHAPING THE CONTEXT OF HEALTH: A Review of Environmental and Policy Approaches in the Prevention of Chronic Diseases. Annual Review of Public Health. 2006;27(1):341-370.
  15. Guy GP, Berkowitz Z, Jones SE, Holman DM, Garnett E, Watson M. Trends in indoor tanning among US high school students, 2009-2013. JAMA dermatology. 2015;151(4):448-450.
  16. Qin J, Holman DM, Jones SE, Berkowitz Z, Guy Jr GP. State Indoor Tanning Laws and Prevalence of Indoor Tanning Among US High School Students, 2009–2015. American journal of public health. 2018;108(7):951-956.
  17. Driscoll DW, Darcy J. Indoor Tanning Legislation: Shaping Policy and Nursing Practice. Pediatric nursing. 2015;41(2).
  18. Gosis B, Sampson BP, Seidenberg AB, Balk SJ, Gottlieb M, Geller AC. Comprehensive evaluation of indoor tanning regulations: a 50-state analysis, 2012. Journal of Investigative Dermatology. 2014;134(3):620-627.
  19. Mayer JA, Hoerster KD, Pichon LC, Rubio DA, Woodruff SI, Forster JL. Peer Reviewed: Enforcement of State Indoor Tanning Laws in the United States. Preventing chronic disease. 2008;5(4).
  20. Williams MS, Buhalog B, Blumenthal L, Stratman EJ. Tanning salon compliance rates in states with legislation to protect youth access to UV tanning. JAMA dermatology. 2018;154(1):67-72.
  21. Woodruff SI, Pichon LC, Hoerster KD, Forster JL, Gilmer T, Mayer JA. Measuring the stringency of states’ indoor tanning regulations: instrument development and outcomes. Journal of the American Academy of Dermatology. 2007;56(5):774-780.
  22. Tripp MK, Watson M, Balk SJ, Swetter SM, Gershenwald JE. State of the science on prevention and screening to reduce melanoma incidence and mortality: the time is now. CA: a cancer journal for clinicians. 2016;66(6):460-480.

Hispanic Tattoo Artists as Skin Cancer Prevention Influencers

Hispanic Tattoo Artists as Skin Cancer Prevention Influencers

Skin cancer is increasing in the Hispanic population and there is a public health need for campaigns to target this often-underrepresented population. In a recent publication in The Journal of Drugs in Dermatology (JDD), authors from the University of Colorado School of Medicine and Klein Buendel examine how Hispanic tattoo artists can serve as skin cancer prevention advocates for the Hispanic population. JDD also released a podcast with the authors about the study earlier this month.

Multiple in-depth interviews were conducted with Hispanic tattoo artists at various tattoo studios in Salt Lake City, Utah. The interviews provided insight into the artist’s skin cancer knowledge, their current sun safety recommendations to clients, and their willingness to incorporate skin cancer prevention into their future work routines.

Data analysis indicated that a most of the artists had a large percentage of Hispanic clients and repeat customers. All artists also had some level of skin cancer knowledge, though not extensive enough to provide basic sun protection tips in their regular tattoo aftercare instructions to clients (such as what specific Sun Protection Factor to use, when to reapply sunscreen, and the use of cover up clothing). Despite this, all artists were enthusiastic about providing sun safety messages on their social media pages and would be willing to partake in some level of skin cancer prevention training and education in the future.

With lengthy tattoo sessions and repeat clientele, Hispanic tattoo artists could serve as beneficial influencers in the early detection of skin cancers in the Hispanic population. Researchers concluded that by providing comprehensive full-body sun protection information to their clients through tattoo aftercare instructions, alerting clients to suspicious moles, and using social media messages, Hispanic tattoo artists could have a big impact on their clients’ skin health. The study’s complete analysis and discussion can be found in the publication.

This project was funded by a grant and a supplement from the National Cancer Institute (CA206569; Dr. Barbara Walkosz and Dr. Robert Dellavalle, Multiple Principal Investigators). Authors include Dr. Cristian Gonzalez, and Dr. Adrian Pona from the University of Colorado School of Medicine; Dr. Barbara Walkosz from Klein Buendel; and Dr. Robert Dellavalle from the University of Colorado School of Medicine and the U.S. Department of Veterans Affairs Rocky Mountain Regional VA Medical Center Dermatology Service.

Project SHINE for Adolescent Tanning Prevention

Project SHINE for Adolescent Tanning Prevention

Dr. David Buller, Klein Buendel Director of Research, is a Co-Investigator on a new research project funded by the National Cancer Institute and being led by Dr. Yelena Wu, Principal Investigator, from the University of Utah. Project SHINE (Sun-safe Habits Intervention and Education) is a multi-modal intervention that targets adolescents’ views on the personal relevance of skin cancer and their ability to prevent the disease in order to increase their sun protection use and decrease their intentional tanning.

Project SHINE incorporates action plans, sun damage photographs, and education to teachers and parents in order to build on adolescents’ interest in novelty and need for highly personalized interventions. It also promotes environmental supports for adolescent skin cancer prevention. SHINE is novel in its application of the Extended Parallel Process Model, used in smoking and drug abuse interventions, to pediatric skin cancer prevention. The five-year study will be conducted with 30 high schools and over 10,000 students in 9th or 10th grade health classes. To support the rigor of this research, the project will objectively measure ultraviolet radiation (UVR) exposure among 10% of the sample who will wear a UVR monitoring device for 3-day periods after self-reported assessments.  

Dr. Buller is part of a well-established team that includes experts in skin cancer prevention, adolescent health behavior change, dermatology, school programs, and randomized trials. He will provide input on the design and implementation of the study, help develop parent/teacher education materials, and participate in results interpretation and manuscript preparation.

Skin cancer is a significant public health priority. It is the most commonly diagnosed form of cancer, afflicting more than 5 million people in the United States each year. Treatment costs total more than $8 billion each year. Skin cancer is highly preventable if individuals limit UVR exposure by using sun protection strategies, such as sunscreen, hats, protective clothing, and by avoiding tanning. Use of prevention strategies is critical during childhood and adolescence, when skin cells are particularly vulnerable to UVR damage leading to skin cancer. Due to their poor use of sun protection and likelihood to intentionally tan, adolescents, more than any other pediatric group, urgently need efficacious skin cancer preventive interventions. Schools offer the ideal setting to deliver skin cancer preventive interventions to large numbers of adolescents.

Melanoma Receptor Variation in a New Mexico Population

Melanoma Receptor Variation in a New Mexico Population

Dr. David Buller, KB Senior Scientist and Director of Research, is a co-author on a paper published recently in Cancer Epidemiology, Biomarkers & Prevention. The paper examines the Melanocortin 1 Receptor (MC1R) in a multicultural New Mexican population. MC1R is a risk factor for developing melanoma skin cancer because it contributes to skin pigmentation. The paper’s lead author is Dr. Kirsten White from the University of New Mexico. Other co-authors are from the Memorial Sloan Kettering Cancer Center in New York, the University of Utah, and the University of New Mexico.

Specifically, single-nucleotide polymorphisms (SNPs) in MC1R and their association with race and ethnicity, skin type, and perceived cancer risk were evaluated by genotyping MC1R in 191 primary care clinic patients in Albuquerque, New Mexico. A full description of the methods, results, conclusions, and limitations of the research can be found in the publication.

Overall, the authors concluded that a specific variant of interest in MC1R may not be a risk factor for melanoma among New Mexican Hispanics, and that genetic risk cannot be inferred from Northern European populations directly to non-European populations.

May is Skin Cancer Awareness Month

May is Skin Cancer Awareness Month

Skin cancer is the most common type of cancer in the United States. Ultraviolet (UV) radiation from the sun is the main cause of skin cancer. UV radiation can also come from tanning booths or sunlamps. The most dangerous kind of skin cancer is called melanoma.

The good news? Skin cancer can almost always be cured when it’s found and treated early – and that includes melanoma.

Here are some helpful resources for information, graphics, and materials to raise awareness about skin cancer and help people take action to prevent or detect it early when it is easier to treat.

American Academy of Dermatology (AAD)

Centers for Disease Control and Prevention (CDC)

Healthfinder.gov- Skin Cancer Prevention

Skin Cancer Foundation

Real Health Photos

Use Real Health Photos® for improving the impact of health messages for Skin Cancer Awareness Month. The stock photography website includes numerous images of diverse people being sun safe with hats, sunglasses, shade, and sunscreen. Real Health Photos images show diversity of gender, race, ethnicity, age, income level, and health condition.

For more images, visit Real Health Photos.

Real Health Photos is a stock photography service owned and operated by KB. It was created and evaluated with a research grant (R44MD003338, Mary Buller, Principal Investigator) from the National Institute of Minority Health and Health Disparities at the National Institutes of Health. Real Health Photos is designed to capture the diversity of health through photography and promote the inclusion of all populations in health promotion materials and media.

Skin Cancer Awareness for Winter Enthusiasts

Skin Cancer Awareness for Winter Enthusiasts

Last month, Klein Buendel (KB) teamed up with the Colorado Skin Cancer Task Force (CSCTF) and Rocky Mountain Sunscreen (RMS) at the Annual Outdoor Retailer and Snow Show to spread skin cancer awareness to outdoor winter enthusiasts.

Per their website, the Outdoor Retailer Snow Show is the largest outdoor snow sports industry gathering in North America. The trade show brings outdoor industry brands, suppliers, retailers, and leaders together for a three-day expo at the Colorado Convention Center. Although the trade show is closed to the public, last year the event attracted over 29,000 attendees with representatives from over 1,000 brands.

The extensive Snow Show provides the opportunity to reach thousands of individuals who work and recreate outdoors. Every year, for over a decade, KB has partnered with the CSCTF and RMS to raise awareness about UV radiation and skin cancer prevention at the event. We stress the importance of practicing sun safety at high elevation during the winter months when UV can reach very high levels.

Specifically, KB increases people’s awareness of their personal risk for skin cancer by taking individual’s UV photographs using a Reveal Imager. The imager by Canfield, has the ability to capture and expose a lifetime of sun damage in a single image of someone’s face that is otherwise invisible to the naked eye. From the image, KB staff point out problem areas that have received damage from the sun and suggested simple sun safety practices for people to better protect themselves from accruing further UV damage.

Other members of the CSTF, including Colorado dermatologists and dermatology interns, were also present to help field questions and to perform free skin examinations on request.

Sun Safety Curriculum for Grades K-5 is Now Free for Schools

Sun Safety Curriculum for Grades K-5 is Now Free for Schools

Sunny Days Healthy Ways, an evidence-based sun safety curriculum that provides sun protection education for grades K-5, is now available free online by its authors at Klein Buendel, Inc. Schools can use the curriculum to fulfill the school-based goals of the Surgeon General’s Call to Action to Prevent Skin Cancer.

“I was inspired to remove any barriers to schools having access to the curriculum by previous Surgeon General Dr. Boris Lushniak’s impassioned presentation at the 4th Annual Conference on UV and Skin Cancer Prevention,” explained Mary Buller, President of Klein Buendel.

Sunny Days Healthy Ways provides an average of 15 lessons per grade, that teachers can tailor to their timeframe and needs. Prepared lesson plans, student activity sheets, storybooks, learning objectives, and common core standards minimize prep time and make teaching students about sun safety easy. Project-based learning and technology connections make it fun.

Skin cancer is the most common cancer in the U.S. and is increasing at an alarming rate. Even though skin cancer occurs mainly in adults, much of the damage was likely done during childhood. Long periods of unprotected sun exposure and severe sunburning as a child can lead to skin cancer and eye damage later in life. Good health habits started in childhood are more likely to last a lifetime.

Sunny Days Healthy Ways was first created and evaluated with research grants from the National Cancer Institute (CA62968 & CA23074) and the Arizona Disease Control Research Commission (9403). To access the free curriculum, visit the Sunny Days Healthy Ways website at https://www.sdhw.info/.

Effect of an Occupational Skin Cancer Prevention Program on Employee Sun Safety Practices

Effect of an Occupational Skin Cancer Prevention Program on Employee Sun Safety Practices

Exposure to the sun’s UV rays is the biggest risk factor for skin cancer. It is also the easiest risk factor to modify through practicing sun-safe behaviors. Outdoor workers are at an elevated risk for skin cancer, especially melanoma, due to the amount of UV exposure they endure over the years. In a recent ePub-ahead-of-print paper in the Journal of Occupational and Environmental Medicine, Klein Buendel’s Dr. Barbara Walkosz, Dr. David Buller, Ms. Mary Buller and their co-authors discuss the outcomes of the follow-up assessment to Sun Safe Workplaces, a workplace sun safety program that promoted sun safety policy adoption and education.

Two years after the Sun Safe Workplaces intervention, a follow-up assessment was conducted to determine the impact of the program on employee sun safety behavior. All participants of the original intervention (n=98) were invited to partake in the two-year assessment and 63 (n=33 for intervention, n=30 for control) participated. The sample included local government organizations throughout Colorado with outdoor workers in at least one of the following service areas: parks and recreation, public works, and public safety. Project staff visited each employer to evaluate the sun protection policies in place, sun protection messages, and personal sun protection equipment available at each organization. An assessment of the sun safety policies was conducted that included three domains (administrative procedures, environmental controls, and personal protection practices) with 15 content categories. Additionally, policy implementation was measured through senior manager and line supervisor reports on whether or not employers communicated or provided training about sun safety to employees and/or provided any of the types of the recommended personal sun protection equipment for employees (sunscreen, wide-brimmed hats, sunglasses, long-sleeved shirts, long pants, or outdoor shade). Lastly, key contact managers were asked to assist study staff with distributing self-administered surveys to front-line supervisors and employees who worked outdoors, which included time spent outdoors at work, frequency of sun protection at work, prevalence of sunburn in the past 12 months on the job, attitudes toward occupational sun safety and self-efficacy for sun safety on the job, attitudes toward workplace health and sun safety policy, and job and demographic information. A total of 1,784 (n=913 for intervention, n=871 for control) outdoor workers completed surveys.

Results showed that compared to control workplaces, employees in the intervention workplaces reported more sun protection practices overall as well as more frequent use of sunscreen on the body, wearing of wide-brimmed hats, and more often had sunscreen, sunglasses, and a hat with them when at work. Employees in the intervention workplaces also reported fewer sunburns than those in the control workplaces. Additionally, sun protection messages and equipment, as well as employee training in sun safety, were more likely to occur in intervention workplaces and such actions increased the frequency of employees having sunscreen, sunglasses, and a hat on the job.  For employees at employers with a best-practice policy, the total composite sun safety score was significantly higher than in the no-policy group and employees also reported more frequent use of sunscreen on the face and other exposed body parts and having sunscreen, sunglasses, and a hat with them while at work compared to those at no-policy employers. However, unlike the intervention group, there was no effect of policy on the prevalence of sunburns among the employees.

The authors concluded that policy adoption is an important step towards improving sun protection and preventing sunburns on the job for outdoor workers but recommend that a robust approach that includes a policy, training for employees, and personal protection equipment that can support sun safety is needed to effectively change employees’ sun protection behaviors.

This research was funded by a grant from the National Cancer Institute at the National Institutes of Health (RO1CA134705; Dr. David Buller and Dr. Barbara Walkosz, Principal Investigators). Coauthors included Ms. Mary Buller, Dr. Alan Wallis from University of Colorado Denver, Dr. Richard Meenan from the Kaiser Permanente Center for Health Research, Dr. Gary Cutter from Pythagoras, Dr. Peter Andersen from San Diego State University, and Dr. Michael Scott from Mikonics.