From: Interventions to decrease skin cancer risk in outdoor workers: update to a 2007 systematic review
Author, date, design, duration | Population & sample size | Intervention | Results summary | Limitations | Evidence levela |
---|---|---|---|---|---|
Stock et al., 2009 [18] | n = 148 (97.3% retention at 12 months) | 2-component intervention; photo taken with UV filter camera, and educational video on sun protection and either skin cancer or photoageing | Significantly great increase in sun protection score (combined self-reported use of sunscreen, hat, long-sleeves; and objective skin tanning measure) at 12 months in groups #3-5 (+9%; +21%; +14% respectively) compared to control (−17%) & group #2 (−11%) | Small sample size per group; limited variation in gender/ethnicity | II |
Randomised controlled trial (RCT) | Workers for Iowa Department of Transportation (DOT) | 2 x 2 + 1 factorial design | |||
#1: control- no intervention | |||||
#2: no UV photo, ageing video | |||||
#3: no UV photo, skin cancer video | |||||
#4: UV photo, ageing video | |||||
#5: UV photo, skin cancer video | |||||
2- and 12-month follow-up | 100% male, 97% white, mean age 46.5 years | ||||
Malak et al., 2011 [32] | n = 194 | 2 day training course on skin cancer prevention, identifying skin cancers and sun protection methods + reinforcement posters around village + distribution of wide-brimmed hats | No significant difference in proportion using sunglasses, hats, or long-sleeved shirts | No control group; retention rate not stated; self-reported data; culturally specific sample e.g. preference for scarfs prevents use of hats | IV |
Pre-post test | Farmers living in a village in western Turkey | Significant increase in proportion of those using sunscreen (+9.5%; p = 0.001) and shade umbrella (+75.2%; p < 0.001); and decrease in proportion of those working in the sun at peak UV periods (−15.3%; p = 0.003) | |||
6-month follow up | 44% male, 58% dark-skinned, mean age 39.1 years | ||||
Woolley et al., 2008 [12] | n = 47 | Case condition (n = 26): Employees in a workplace with long-standing mandatory sun protection policy | No significant differences in sun burns in past month; level of tanning on right hand or forearm, number of solar keratoses on right forearm, or usually wearing a wide-brim hat or sunscreen while at work | Limited power due to small sample size, did not adjust for potential covariates e.g. length of time spent working for organisation | III-2 |
Case control | Road workers and construction workers in Queensland, Australia | Control (n = 21): Employees in a workplace where sun protection is voluntary | Mandatory workplace employees had fewer solar keratoses on dorsum of right hand (0.3 vs 4.0, p = 0.006), less previously excised self-reported skin cancers (0.5 vs 3.5, p = 0.008), and were more likely to usually wear a long-sleeved shirt at work (81% vs 29%, p < 0.001) | ||
Single timepoint | 89% male, mean age 42 years | ||||
Anderson et al., 2008 [33] | n = 4,007 (39% retention) | Intervention: n = 13 ski areas received Go Sun Smart (GSS) Health Communication Campaign: advice/training to wear sun protection (sunscreen & protective lip-balm, hat, protective eyewear) delivered through workplace communication channels using 23 items including posters, magnets, website, newsletter articles, training programs for managers | At 6-month follow up, significantly less reported sunburn > =1 over past summer in intervention group (50%) compared to control (53%, p = 0.01) | Fluctuating study population due to nature of the organisation; low retention rate; implementation of program varied per ski area | III-2 |
Pair-matched group-randomised before and after controlled design | Ski area employees, in 26 ski areas in Western USA and Canada. | Control: n = 13 ski areas did not receive GSS | Significantly better sun protection scale (combined average of sun protection behaviours: sunscreen; lip-balm; protective clothing; hat; sunglasses/goggles; limit time in sun; stay in shade; have sunscreen, sunglasses and hat with them at all times; watch skin closely to avoid sunburning) in intervention group compared to control (3% adjusted difference, p = 0.04) | ||
3- and 6-month follow-up | 64% male, 96% white, average age 34 years | ||||
Mayer et al., 2007 [34] | n = 2,662 (82% retention) | Intervention: 35 postal stations (n = 1,257) received SUNWISE sun safety program: provision of wide-brim hats and sunscreen, sun safety educational sessions and visual cues prompting sun safe reminders | Significant increase in proportion who always use sunscreen at 2-years in intervention group (+12%) compared to control (+3%) | II | |
RCT | Letter-carriers at 70 US postal stations in 3 geographic regions in Southern California, USA | Control: 35 postal stations (n = 1,405) did not receive SUNWISE sun safety program. | Significant increase in proportion who always wear a wide-brim hat at 2-years in intervention group (+13%) compared to control (+1%) | ||
3-month, 1- and 2-year follow-up | 70% male, mean age 43.0 years | ||||
Andersen et al., 2012 [35] | n = 2228 | Intervention (n = 33 ski areas): BDS (Basic Dissemination Strategy) + EDS (Enhanced Dissemination strategy) of Go Sun Smart (GSS) | No significant differences in sun protection scale or sunburn history between BDS and EDS groups | No pretest or adjustment for baseline levels of sun protection | III-2 |
Cluster-randomised post test only | Employees at 68 U.S and Canadian ski areas | Control (n = 35 ski areas): BDS only of GSS sun safety program. | Employees at organisations where 9+ of the 23 GSS items were used scored significantly higher on the sun protection scale compared to those where <4 GSS items were used (3% difference, p < 0.05) | ||
Disseminated over a single ski season in three waves (2004, 2005, 2006) | 64% male, mean age 35.7 years, 93% white |