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Effects of the Sun Safe Workplaces Program

Effects of the Sun Safe Workplaces Program

Occupational skin cancer prevention is an international priority. People who work outdoors are routinely exposed to high levels of ultraviolet radiation (UV), the primary risk factor for skin cancer. Dr. Barbara Walkosz from Klein Buendel presented findings from the Sun Safe Workplaces project and a follow-up assessment at the 68th Annual Conference of the International Communication Association in Prague, Czech Republic, May 24-28, 2018.

Sun Safe Workplaces (SSW) was a communication theory-based workplace sun safety program for public organizations that employ people who work outdoors. Examples of outdoor work include road and bridge work, parks and recreation facilitation, sanitation and water works, and public safety. The original SSW project promoted the adoption of workplace sun safety policies in the public organizations and provided training in personal sun protection for outdoor workers in a randomized controlled trial. The follow-up study assessed the impact of SSW on employee sun safety behavior.

Sixty-one of the 98 public employers from the original study participated. Managers and line supervisors reported program implementation. A total of 1,784 outdoor workers (913 from the intervention group and 871 from the control group) completed surveys on personal sun protection practices.

In summary, employees’ sun protection improved statistically significantly in the intervention group receiving the SSW program. SSW’s effect on employee sun protection was mediated by the number of workplace actions to implement elements of sun safety policy including sun protection messages and equipment in the workplace and employee reports of training in sun safety.

This research was funded by a grant from the National Cancer Institute (RO1CA187191; Dr. David Buller, Principal Investigator). In addition to Dr. Walkosz and Dr. Buller from Klein Buendel (KB), collaborators/co-authors included Mary Buller from KB; Dr. Allan Wallis from the University of Colorado Denver; Dr. Richard Meenan from the Kaiser Permanente Center for Health Research; Dr. Michael Scott from Mikonics, Inc.; Dr. Peter Andersen from San Diego State University; and Dr. Gary Cutter from the University of Alabama, Birmingham.

Cost of Occupational Sun Protection Policy Intervention Delivery

Cost of Occupational Sun Protection Policy Intervention Delivery

Dr. Richard Meenan presented cost analysis data from the Sun Safe Workplaces project at the 4th International Conference on UV and Skin Cancer Prevention in Toronto, Canada May 1-4, 2018. His presentation focused on an estimated cost of delivering a sun protection policy intervention to public-sector employers in Colorado. The cost of occupational skin cancer prevention interventions poses challenges for organizations delivering interventions and employers that implement sun protection for outdoor workers.

The Sun Safe Workplaces (SSW) intervention promoted occupational sun protection policies and education to 98 public-sector employers in a randomized controlled trial. Intervention components included in-person meetings and follow-up contact by email and telephone with senior managers, in-person trainings for employees, and printed educational materials sent to the workplace. Using a micro-costing approach, costs to the intervening organization were determined from the project accounting system supplemented by external sources. Costs to employers were estimated from responses to semi-structured interviews in a two-year follow-up with 34 senior managers on implementing sun protection education and other actions to support employee sun safety and were presented at the conference. Employers incurred highest average costs for implementing onsite sun safety training, primarily the estimated value of employee time in attendance.

Costs to employers are likely a barrier to acting on skin cancer prevention. In the SSW trial, employers appeared to incur more costs than the intervening organization. Strategies to control employer costs should be considered when designing occupational skin cancer prevention interventions. Costs will be used to determine: (1) the incremental cost of the SSW intervention (ignoring development and research costs) and (2) the incremental cost of the employers’ skin cancer prevention education and policy adoption actions induced by the SSW intervention.

This research was funded by a grant from the National Cancer Institute (RO1CA187191; Dr. David Buller, Klein Buendel, Principal Investigator). Collaborators include Dr. Barbara Walkosz, Rachel Eye, and Mary Buller from Klein Buendel; Dr. Richard Meenan from the Kaiser Permanente Center for Health Research in Portland, Oregon; and Dr. Allan Wallis from the University of Colorado Denver.

Klein Buendel was one of the North American hosts of the UV 2018 conference. The conference was organized by a joint planning committee of skin cancer prevention experts in Canada and the United States from Ryerson University in Toronto, the Canadian Dermatology Association in Ottawa, and Klein Buendel in Denver.

Sun Safety Ink!

Sun Safety Ink!

Dr. Robert Dellavalle presented Sun Safety Ink! at the 4th International Conference on UV and Skin Cancer Prevention in Toronto, Canada May 1-4, 2018. His presentation focused on formative research conducted by Klein Buendel and the University of Colorado Denver to develop a skin cancer prevention training program for tattoo artists.

Twenty-five percent (25%) of American adults have a tattoo, and higher rates are found among younger generations. Sun safety promotions to young adults are significant because risk factors are elevated for this population. Tattoo artists may be ideal sources for delivering effective sun safety interventions to this hard-to-reach, at-risk population because sun safety is recommended for tattoo aftercare and the long-term.

Semi-structured interviews with tattoo artists and focus groups with tattooed individuals gathered input on the design of the Sun Safety Ink! (SSI!) online training program for tattoo artists. Tattoo artists had limited knowledge of skin cancer but reported that they alert clients if they observe skin abnormalities. All artists provided written and verbal aftercare instructions that included sun safety recommendations, but only for tattoos. Artists were interested in the SSI! training program. They suggested the use of video training scenarios to help artists learn to communicate with clients and that information about skin cancer (such as statistics and causes), conversation starters, and examples of sun safety practices be included.

Focus group participants had low levels of sun protection. Participants reported most artists do not discuss health topics but were positive about receiving skin cancer prevention messages, especially during lengthy tattoo sessions. Participants noted that sun safety advice from an artist might make a difference in protecting all of their skin not just tattoos. They recommended that artist deliver sun protection information multiple times while the client is getting the tattoo, during follow-up visits, by text message, in aftercare instructions with pictures or skin cancer facts, and via social media.

Both artists and clients were supportive of SSI! Artists are viewed as a trusted source of information and have the potential to impact clients’ sun safety practices. Suggestions regarding training content and format will be incorporated into an online training for tattoo artists.

This research was funded by a grant from the National Cancer Institute (R01CA206569; Dr. Barbara Walkosz and Dr. Robert Dellavalle, Multiple Principal Investigators). Collaborators include Dr. Barbara Walkosz, Dr. David Buller, Mary Buller, Rachel Eye, and Savanna Olivas from Klein Buendel; and Dr. Dellavalle from the University of Colorado, Denver.

Klein Buendel was one of the North American hosts of the UV 2018 conference. The conference was organized by a joint planning committee of skin cancer prevention experts in Canada and the United States from Ryerson University in Toronto, the Canadian Dermatology Association in Ottawa, and Klein Buendel in Denver.

Costs of Sun Safety Policy Implementation in California Elementary Schools

Costs of Sun Safety Policy Implementation in California Elementary Schools

Dr. Richard Meenan is presenting cost analysis data from the Sun Safe Schools project at the 4th International Conference on UV and Skin Cancer Prevention in Toronto, Canada May 1-4, 2018. His presentation focuses on the estimated costs of delivering a sun protection policy intervention to public elementary schools in California.

Implementation of sun safety practices is an important element of efforts by elementary schools to prevent skin cancer among their students. However, cost can significantly impede such implementation. The Sun Safe Schools (SSS) trial provided technical assistance to 118 California public elementary schools interested in implementing sun safety practices consistent with district policy. Intervention components were primarily an initial intervention meeting with school administrators, and follow-up email and telephone communications. Schools chose from 47 possible practices to implement.

Using a micro-costing approach, intervention delivery costs to the intervening organization were determined from the project tracking database supplemented by external sources. Labor and non-labor practice costs incurred by schools were estimated using a project template, which three authors reviewed for reasonableness. The 47 practice codes were collapsed into ten categories, such as outdoor shade and parent outreach. The 58 intervention schools implemented a total of 128 practices. Thirty-seven schools implemented at least one practice. Most common practices were parent outreach, education of students, and teacher training. Data on the average cost of participating in the school-based sun safety intervention will be presented at the conference.

In summary, costs to schools may hinder action on implementation, so cost control strategies should be considered when designing school-based sun safety interventions. Next steps are to determine: (1) the incremental implementation cost of the SSS intervention and (2) the incremental cost of the schools’ sun safety education and policy adoption actions induced by SSS.

This research was supported by a grant from the Eunice Kennedy Shriver National Institute for Child Health and Human Development (R01HD074416; Dr. Kim Reynolds, Claremont Graduate University, Principal Investigator). Collaborators include Kim Massie from Claremont Graduate University in California; Dr. David Buller, Julia Berteletti, and Mary Buller from Klein Buendel; Dr. Richard Meenan from the Kaiser Permanente Center for Health Research in Portland, Oregon; and Dr. Jeff Ashley from Sun Safety for Kids in Los Angeles, California.

Klein Buendel is one of the North American hosts of the UV 2018 conference. The conference was organized by a joint planning committee of skin cancer prevention experts in Canada and the United States from Ryerson University in Toronto, the Canadian Dermatology Association in Ottawa, and Klein Buendel in Denver.

Sun Safe Schools Program Implementation

Sun Safe Schools Program Implementation

Ms. Kim Massie is presenting a poster on the implementation of the Sun Safe Schools project at the 4th International Conference on UV and Skin Cancer Prevention in Toronto, Canada, May 1-4, 2018. The poster focuses on the delivery of a sun protection policy intervention to public elementary schools in California.

The U.S. Surgeon General’s Call to Action to Prevent Skin Cancer in 2014 emphasized the importance of sun safety for schools; however, there is limited information on how to effectively assist schools in implementing sun safety. The Sun Safe Schools project was developed to provide technical assistance to 118 public elementary schools in California with the implementation of sun safety practices consistent with district board policy for sun protection (BP 5141.7). A trained coach worked with principals to select sun safety practices within policy categories, such as education of students and parent outreach, and develop their implementation plan. The coach recorded all reported intervention activities within a tracking database including practice selection date, policy category, practice description, and implementation date.

A variety of practices, such as posting the UV Index and providing sunscreen, were implemented at 58 intervention schools. Practices were predominately implemented in the first 12 months of the 20-month program. Most practices were implemented in the spring. Low periods of implementation coincided with summer and winter breaks in the school calendar. The most frequently implemented practices included distributing sun safety information to parents, arranging sun safety presentations for students, and providing a sun safety webinar to staff. Policy categories most frequently implemented included education of students, parent outreach, and education of teachers.

Overall, working with schools presents unique challenges for implementation of sun safety. To be effective, implementation assistance should be designed around the school calendar and allow the principal to determine the pace and priorities.

This research was supported by a grant from the Eunice Kennedy Shriver National Institute for Child Health and Human Development (R01HD074416; Dr. Kim Reynolds, Claremont Graduate University, Principal Investigator). Collaborators include Kim Massie and Brianne Freeth from Claremont Graduate University in California; Dr. David Buller, Julia Berteletti, and Mary Buller from Klein Buendel; and Dr. Jeff Ashley from Sun Safety for Kids, Inc. in Los Angeles, California.

Klein Buendel is one of the North American hosts of the UV 2018 conference. The conference was organized by a joint planning committee of skin cancer prevention experts in Canada and the United States from Ryerson University in Toronto, the Canadian Dermatology Association in Ottawa, and Klein Buendel in Denver.

 

KB and Canada Host World’s Sun Safety Experts

KB and Canada Host World’s Sun Safety Experts

How can sun safety messages convince travelers to seek shade and cover up in the sun on vacation? How can the built environment help increase sun safety by maximizing access to shady areas? How can the use of Big Data drive people to be more “sun smart”?

These and many other issues will be front and center at the 4th International Conference on UV and Skin Cancer Prevention at Ryerson University in Toronto, May 1-4. Held in different countries around the world – the 2015 event was in Sydney, Australia – the International Conference on UV and Skin Cancer Prevention highlights the best in public health and community-based approaches to educating the public about the importance of UV protection.

“This fourth conference really aims to disrupt current ways of thinking in the field of skin cancer prevention by sparking new ideas, proposing new intersections between disciplines, and fostering new connections and collaborations,” said Ms. Mary Buller, conference organizer and Owner and President of Klein Buendel, a Golden, Colorado-based health communication research company whose investigators have been conducting skin cancer prevention research since the early 1990s.

While preventing skin cancer is the galvanizing theme of the conference, sessions cover topics ranging from urban planning, architectural design, public health and radiation science. The common goal is to increase public awareness – and public action – on the need for increasing shade and maximizing sun protection, not just during leisure pursuits, but also in the workplace.

“The sun is a workplace hazard that can cause skin cancer, heat stress and eye damage, yet these conditions are preventable with an increase in awareness,” said Dr. Thomas Tenkate, conference organizer and Director of the School of Occupational and Public Health at Ryerson University.

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Sun Safety Policy at Work and School

Sun Safety Policy at Work and School

KB scientists, research staff, and collaborators are presenting research findings at the 39th Annual Meeting and Scientific Sessions of the Society of Behavioral Medicine, April 11-14, 2018 in New Orleans, Louisiana. One presentation and one poster address sun protection and skin cancer prevention policy in workplaces and schools:

Moderators of Implementation of Occupational Sun Protection Policy

Outdoor workers are at high risk for skin cancer. Dr. David Buller, KB Director of Research and SBM Fellow, is giving a presentation on the Sun Safe Workplaces Project. In this study, organizational and employee characteristics were examined as moderators of implementation of occupational sun protection policy. Public employers (n=98) in Colorado participated in a randomized controlled trial evaluating the Sun Safe Workplaces (SSW) intervention. Based on Diffusion of Innovations Theory, project staff promoted sun safety policy adoption and trained workers in sun protection. Line supervisors (n=3,650) and workers (n=1,555) completed a two-year follow-up survey at 68 employers. Among other findings, greater communication with employees occurred by employers with a policy than without one. The research was funded by a grant from the National Cancer Institute (R01CA134705; Dr. David Buller, PI). Dr. Barbara Walkosz, Mary Buller, and Lucia Liu from KB participated on the research team. Additional collaborators include Dr. Allan Wallis from the University of Colorado, Denver, and Dr. Richard Meenan from the Kaiser Permanente Center for Health Research in Portland, Oregon.

Correlates of Sun Safe Policy Implementation Among Elementary Schools

In 2014, the U.S. Surgeon General issued a Call to Action to Prevent Skin Cancer, citing its high and increasing prevalence and cost. The Centers for Disease Control and Prevention and the Surgeon General identified sun safety in schools as a priority to reduce UV exposure and sunburns of children, with school district policy a key aspect of school-based efforts to prevent skin cancer. Dr. Kim Reynolds, KB Collaborator from Claremont Graduate University (CGU), is presenting a poster on the Sun Safe Schools Project.  This study explored correlates of the implementation of sun-safe practices, consistent with district board policy, among principals and teachers in public elementary schools. The sample included elementary school principals (N=118) and teachers (N=113) recruited from 40 California public school districts that had adopted Board Policy 5141.7 for sun safety and posted it online. Principals and teachers from the elementary schools reported on student sun protection policies and practices when surveyed. The study looked at the number of practices implemented consistent with California Senate Bill 1632 (Billy’s Bill), which protects the right of students to apply sunscreen at school without a physician note and to wear UV-protective clothing including hats on school grounds. Improved awareness of the existence and content of district board policy for sun safety may increase implementation of school skin cancer prevention.

This research was funded by a grant from the Eunice Kennedy Shriver National Institute of Child Health and Human Development at the National Institutes of Health (R01HD074416; Dr. Kim Reynolds, CGU, and Dr. David Buller, KB, PIs). Collaborators included Julia Berteletti and Mary Buller form KB, Kim Massie from CGU, Dr. Jeff Ashley from Sun Safety for Kids in Los Angeles, California and Dr. Richard Meenan from the Kaiser Permanente Center for Health Research in Portland, Oregon.

Accuracy of Principal and Teacher Knowledge of School District Sun Protection Policies in California Schools

Accuracy of Principal and Teacher Knowledge of School District Sun Protection Policies in California Schools

School policies that improve sun safety for children are essential to comprehensive school-based skin cancer prevention; however, a policy is only successful if school administration and teachers are aware of it and implement it. California was one of the first states that enacted legislation governing sun protection for students in public schools. In a recent publication in Preventing Chronic Disease, KB’s Dr. David Buller, Julia Berteletti and Mary Buller along with collaborators at Claremont Graduate University (CGU), Kaiser Permanente Center for Health Research (KPCHR) and the non-profit organization, Sun Safety for Kids (SSK), discuss how they explored the extent and accuracy of knowledge among principals and teachers in California public school districts about the content written in their district’s written sun safety policy.

Elementary schools in California school districts were recruited to a parent study via their principal and were eligible if 1) they subscribed to the California School Boards Association, 2) had adopted the recommended sun safety Sample Board Policy (designated BP 5141.7), and 3) posted their version of Board Policy 5141.7 online. A total of 118 principals provided consent for their school to participate and nominated one teacher or staff member who would be involved in implementing sun safety practices at the school and 109 of the 118 teachers completed the baseline survey.

The baseline survey for both principal and teacher asked whether or not the school district had a policy on sun protection for students. Those who answered yes were presented with a list of policy components and asked to indicate which components were included in the policy. Respondents were also asked about job characteristics, skin type, personal or family history of skin cancer, and demographic characteristics. Policy knowledge among principals and teachers was compared with the content of the written school district sun safety policy and principals’ and teachers’ knowledge of each component was classified as accurate or inaccurate.

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Behavioral Counseling Recommendations for Skin Cancer Prevention

Behavioral Counseling Recommendations for Skin Cancer Prevention

In the March 20, 2018 issue of the Journal of the American Medical Association, the U.S. Preventive Services Task Force (USPSTF) published a recommendation statement on behavioral counseling to prevent skin cancer.

The publication updated the 2012 USPSTF recommendation on behavioral counseling for the prevention of skin cancer.

The USPSTF determined that behavioral counseling interventions are of moderate benefit in increasing sun protection behaviors in children, adolescents, and young adults with fair skin types (aged 6 months to 24 years old). They found adequate evidence that behavioral counseling interventions result in a small increase in sun protection behaviors in adults older than 24 years with fair skin types.

The USPSTF, however, found inadequate evidence on the benefits and harms of counseling adults about skin self-examination to prevent skin cancer. This conclusion was based on the lack of evidence that skin self-examination is beneficial.

Two editorials  – one led by Dr. June Robinson from the Department of Dermatology at the Northwestern University Feinberg School of Medicine in Chicago and the other led by Dr. David Buller, Director of Research at Klein Buendel –  were also published along with the Task Force recommendations.

The editorial by Robinson and Jablonski points out that while physicians are trusted sources of health information, people at risk for skin cancer or with a family history of skin cancer may also find family members to be useful networks for information on prevention and self-examination.

The editorial by Buller, Heckman, and Manne expresses disappointment in the Task Force not recommending skin self-examination and points out that some ongoing studies to determine effectiveness of skin self-examination may find that it is effective.

Both editorials describe the Task Force’s definition of risk as “fair skin types” as narrow. They believe that many other people are at risk for skin cancer and could benefit from sun protection education and counseling. Some groups mentioned in the editorials include people who sunburn but are not considered fair-skinned, people who use indoor tanning equipment, children and adolescents, Hispanics, and people who are physically active outdoors. According to the authors, it is important not to disenfranchise these groups within the diverse U.S. population.

A Randomized Study of Shade Sails and Passive Recreation in Public Parks in Two Hemispheres

A Randomized Study of Shade Sails and Passive Recreation in Public Parks in Two Hemispheres

Skin cancer is the most common type of cancer1 but the primary risk factor for skin cancer, UV exposure, is the most avoidable.2 Purpose-built shade not only reduces UV exposure,3 it can also come with other benefits like provide protection without requiring planning4 and may even provide protection for individuals with negative attitudes towards sun safety who seek shade to keep cool.5

In a recent publication in American Journal of Public Health, KB’s Dr. David Buller, Mary Buller and collaborators in Australia, at the University of Melbourne (Dr. Dallas English) and Cancer Council Victoria, (Dr. Suzanne Dobbinson) conducted a stratified randomized study in Melbourne, Australia and Denver, Colorado where shade sails were built in 1 of 2 passive recreation areas (PRAs) in full sun in 144 parks (71 in Melbourne and 73 in Denver). The use of the PRAs with shade sails built as part of the study were compared with the nearby non-shaded PRAs for use by park visitors. The authors tested two hypotheses – the first being that the introduction of shade sails over PRAs would increase the use of these PRAs by visitors compared to unshaded PRAs – and the second being that the increase in use of shaded PRAs would be larger in Melbourne, Australia than Denver, Colorado due to stronger norms for sun safety in Australia than the United States.

Public parks enrolled in the study had to contain at least two unshaded PRAs that were in full sun at pretest, and one of the two PRAs had to contain a space where a shade sail could be constructed. Trained observers made observations at the PRAs for 30-minute periods on four weekend days during a 20-week period in the summer months for each city at pretest and posttest to determine the number of visitors during peak UV hours (11 am to 3 pm). Shade sails were designed to be attractive while also providing shade during peak UV times and the shade cloth selected reduced UV by at least 94%.

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