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Canadian National Survey on Sun Exposure & Protective Behaviours: Outdoor Workers

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34 REVUE CANADIENNE DE SANTÉ PUBLIQUE VOLUME 91, NO. 1
The Western Canada Melanoma Study
1
has linked occupation with elevated risk of
developing basal cell and squamous cell
carcinomas. Cancer of the lip also has been
associated with occupational sun
exposure.
2,3
In contrast, there is insufficient
evidence to link occupation with increased
risk of cutaneous malignant melanoma.
4
Evidence regarding the prevalence of sun-
protective behaviours among outdoor
workers has been based on research con-
ducted in Australia and the United States
5-7
that shows that less than half of workers
adequately protect themselves from the
sun. This paper presents a descriptive pro-
file of sun exposure and protection behav-
iours among outdoor workers in Canada.
Reports on sources of information and
barriers to protection also are described.
METHODS
Data reported here were gathered during
the 1996 Canadian National Survey on
Sun Exposure & Protective Behaviours. A
detailed description of survey questions,
sampling and data collection procedures
are described in a previously published
article.
8
A 55-item random-digit-dialled tele-
phone survey asked outdoor workers to
report on average daily sun exposure and
protective behaviour patterns during work.
Using a 5-point Likert scale, ranging from
“always” to “never”, respondents were
asked about: 1) avoiding the sun between
11:00 am and 4:00 pm, 2) seeking shade,
3) wearing sun-protective clothing, 4) cov-
ering their head, 5) using sunscreen on the
face, and 6) using sunscreen on the body.
Outdoor workers also were asked to identi-
fy their major sources of information (e.g.,
media, worksite) and barriers to sun pro-
tection (e.g., inconvenience, lack of con-
cern). The survey did not collect informa-
tion about occupation type and therefore
cannot provide estimates by occupational
categories. The national survey response
rate was 69% (4,023 successfully complet-
ed surveys).
RESULTS
Outdoor workers 25+ years of age con-
stitute 14% (546 of 4,023) of the national
survey sample. They are predominantly
male (80%) and 95% are between the ages
of 25-64 years.
Most outdoor workers (70%) receive 2+
hours of sun exposure during an average
workday. Less than one half always or
often seek shade (44%) or avoid the sun
(38%) while at work. The majority of out-
door workers report wearing a hat (58%)
and sun-protective clothing (60%). Few
outdoor workers use sunscreen on their
face (23%) or body (18%) during work.
Few outdoor workers (21%) identify
their employers as sources of information
about sun safety. Most receive information
about sun protection from television
(85%); many also receive information
from magazines (66%) and family or
friends (63%).
When asked why they may not always
protect themselves from the sun, 61% of
outdoor workers say they forget to take
sun-protective actions. Over one half
(54%) also say sun protection is inconve-
nient, 38% want to get a tan, and 34%
indicate they are unconcerned about sun
exposure.
DISCUSSION
In general, outdoor workers report low
levels of sun protection. Results presented
here are similar to those found in previous
population-based research among outdoor
workers in Australia and the United
States.
5-7
It is not surprising that hats and
protective clothing are the most prevalent
Canadian National Survey on Sun
Exposure & Protective Behaviours:
Outdoor Workers
Jean A. Shoveller, PhD,
1
Chris Y. Lovato, PhD,
2
Larry Peters, PhD,
3
Jason K. Rivers,
MD, FRCP
4
University of British Columbia
1. Assistant Professor, UBC Department of Health
Care & Epidemiology and the Centre for
Community Child Health Research
2. Associate Professor, UBC Department of Health
Care & Epidemiology and the Centre for
Community Child Health Research
3. Freelance consultant and Clinical Associate
Professor, UBC Department of Health Care &
Epidemiology
4. Associate Professor, UBC Division of
Dermatology and the British Columbia Cancer
Agency
Correspondence and reprint requests: Dr. Jean
Shoveller, Centre for Community Health and Health
Evaluation Research, Room L-408, 4480 Oak Street,
Vancouver, BC, V6H 3V4, Tel: 604-875-2447, Fax:
604-875-3569, E-mail: jshovell@interchange.ubc.ca
TABLE I
Outdoor Workers’ Sun-Related
Behaviours, Information Sources
and Barriers to Sun Protection
Topic Areas Response (%)
Assessed in Survey
Sun Exposure
2+ Hours 70
Sun Protection
Seek shade 44
Avoid sun 11am-4pm 38
Wear hat 58
Wear protective clothes 60
Sunscreen on face 23
Sunscreen on body 18
Source of Information
Employers 21
Television 85
Magazines 66
Family or friends 63
Barriers to Sun Protection
Forget 61
Inconvenient 54
Want a tan 38
Unconcerned about
sun exposure 34
OUTDOOR WORKER SUN EXPOSURE & PROTECTION
JANUARY – FEBRUARY 2000 CANADIAN JOURNAL OF PUBLIC HEALTH 35
forms of sun protection, since these are
typical of the traditional work clothes asso-
ciated with outdoor occupations.
Given the nature of many outdoor occu-
pations, it is not always convenient for out-
door workers to regularly reapply sun-
screen, seek shade, or avoid the sun. Thus,
an intervention that emphasizes protective
clothing and hats is more likely to be suc-
cessful. Few outdoor workers identify their
employer as a source of information about
sun safety. Worksite interventions, includ-
ing safety policies and exposure guidelines,
should be developed and incorporated into
existing occupational health and safety pro-
grams.
9
For example, BC Ferries has insti-
tuted a policy to provide outdoor workers
with broad-brimmed hats during the sum-
mer months. Some types of outdoor occu-
pations also may lend themselves to sched-
uling that reduces workers’ exposure during
the hours of peak ultraviolet flux.
This survey did not collect specific infor-
mation about the type of hat worn. Thus,
the results may over-estimate the propor-
tion of individuals who wear a hat that
shades the head, face, and neck areas. A
similar limitation pertains to the data on
protective clothing (e.g., sleeve length on
shirts).
Based on the available evidence, it is rec-
ommended that individuals who must be
exposed to the sun for lengthy periods,
such as outdoor workers, take extra precau-
tionary measures. However, additional
research needs to be conducted regarding
the relationship between occupational sun
exposure and risk of developing skin can-
cer. This descriptive profile provides a
baseline from which changes in behaviour
patterns can be monitored and evaluated.
Additional research is needed to assess the
status of workplace policies and programs
and to establish the efficacy of interven-
tions.
ACKNOWLEDGEMENTS
The primary funding for this research
was provided by the National Cancer
Institute of Canada with funds from the
Canadian Cancer Society (Operating
Grant #007066), the Canadian
Dermatology Association, and
Environment Canada. Other supporters
included Health Canada, the Canadian
Association of Optometrists, and BC Tel.
We would like to acknowledge the assis-
tance of Special Surveys Division, Statistics
Canada, for their contributions to the
methods and collection of data for this sur-
vey as well as Ms. Ann-Louise Ellwood for
her assistance in the preparation of this
brief report.
REFERENCES
1. Gallagher RP, Elwood JM, Threlfall WJ, et al.
Socio-economic status, sunlight exposure, and
risk of malignant melanoma: The Western
Canada Melanoma Study. JNCI 1987;79(4):647-
52.
2. Hall NEL, Rosenman KD. Cancer by industry:
Analysis of a population-based cancer registry
with an emphasis on blue-collar workers. Am J
Industrial Medicine 1991;19:145-59.
3. Gallagher RP, Threlfall WJ, Jeffries E, et al.
Cancer and aplastic anemia in British Columbia
farmers. JNCI 1984;72(6):1311-15.
4. Elwood JM, Jopson J. Melanoma and sun expo-
sure: An overview of published studies. Int J
Cancer 1997;73(2):198-203.
5. Girgis A, Sanson-Fisher RW, Watson A. A work-
place intervention for increasing outdoor work-
ers’ use of solar protection. Am J Public Health
1994;84(1):77-81.
6. Borland RM, Hocking B, Godkin GA, et al. The
impact of a skin cancer control education pack-
age for outdoor workers. Med J Australia
1991;154:686-88.
7. Rosenman KD, Gardiner J, Swanson GM. Use of
skin-cancer prevention strategies among farmers
and their spouses. Am J Prev Med
1995;11(5):342-47.
8. Lovato CY, Shoveller JA, Peters L, Rivers JK.
Canadian National Survey on Sun Exposure &
Protective Behaviours: Methods. Cancer
Prevention & Control 1998;2(3):105-10.
9. The Federal-Provincial-Territorial Radiation
Protection Committee. Report from the
Working Group on Ultraviolet Radiation:
Position Statement and Overview. 1998.
Received: November 26, 1997
Accepted: November 5, 1999
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... Solar ultraviolet radiation (UVR) exposure and sunburn are among the top risk factors in the development of skin cancer in Ireland [2]. While most workers may experience solar UVR exposure on an intermittent or short-term basis during their working day, outdoor workers are more exposed than indoor workers [3][4][5]. Research examining occupational solar UVR exposure in Ireland is limited, with only two previous studies, examining exposure among golf course workers [6] and gardeners [7]. Data on solar UVR exposure among construction and agricultural workers are available for many EU countries [8][9][10][11], but there have been no such studies conducted in Ireland to date. ...
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Background Agricultural and construction workers spend much of their work time outdoors and have higher risks of developing skin cancer when compared to indoor workers. However, there is limited research on ultraviolet radiation (UVR) exposure knowledge, sun safety practices and constraints within these occupational groups in Ireland. Aims This study aimed to examine self-reported time spent outdoors in a sample of Irish agricultural and construction workers; to describe and compare UVR exposure knowledge, safety practices and perceived constraints in both occupational groups, and to assess the association of demographic, personal and occupational factors with sun-related knowledge, practices and perceived constraints. Methods Agricultural workers (n = 154) and construction workers (n = 467) completed a questionnaire, which measured solar UVR exposure knowledge, safety practices, and perceived constraints to sun personal protective equipment and sunscreen use in addition to demographic, personal, and workplace characteristics. Mann–Whitney and Kruskal–Wallis tests were used to examine differences in knowledge, practices and perceived constraints by these characteristics. Results Both groups spend a significant proportion of their working week outdoors (25 hours per week on average). Although participation in sun safety training was high for both groups, UVR exposure knowledge and sunscreen use were low, and annual rates of reported sunburn were high. Knowledge, practices and perceived constraints also differed significantly according to demographic, personal, occupational and workplace characteristics. Conclusions In addition to training by employers and advisory groups, interventions are required to address perceived barriers that impede the uptake and usage of control measures that can lower risk.
... 17 Studies indicate that the aesthetic of tanned skin remains highly valued and a key motivation of intentional tanning behaviours. [18][19][20] Previous studies conducted by our group have provided a detailed analysis of Canadian CM epidemiologic trends and the associated disease burden between 1992 and 2010. 6,11,21 Our group also evaluated the relationship between several geographic and environmental factors and their association with CM incidence for 1992-2010 across Canada, 22 concluding that increases in annual average temperature, summer UV radiation, and greenspace/vegetation were associated with a higher expected incidence of CM cases. ...
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Background Cutaneous melanoma (CM) is a significant contributor to skin cancer-related mortality globally and in Canada. Despite the well-established link between ultraviolet (UV) radiation exposure and skin cancer risk, there remains a gap in population-level interventions and persistent misconceptions about sun exposure and impact of environment on individual behavior. Objective The current study provides an ecological analysis using latest available data (2011-2017) to define geographic/environmental contributors to the CM landscape in Canada. Methods Utilizing Canadian Cancer Registry and Canadian Urban Environmental Health Research Consortium data, we analyzed 39,605 CM cases occurring in Canada from 2011 to 2017. Environmental data, including UV radiation, greenspace (normalized difference vegetation index), temperature, heat events, and precipitation was used to evaluate the effect of environment on CM incidence rates across Forward Sortation Area postal codes. Results Forward Sortation Areas with increased CM incidence were associated with higher annual average temperature, snowfall, heat events, normalized difference vegetation index, and vitamin D-weighted UV exposure. Conversely, factors associated with decreased incidence included an increased annual highest temperature, rain precipitation, and a longer duration of heat events. Limitations This study is subject to ecological bias and findings should be interpreted with caution. Conclusion This study further substantiates associations between specific environmental factors and CM incidence.
... There has been limited research conducted in Canada to assess the levels of awareness and engagement among outdoor workers regarding sun safety. Examples include the 1996 Canadian National Survey, which included 546 self-identified outdoor workers (of 4,023 participants) [33], and the Second National Sun Survey (2006), which surveyed 1,337 outdoor workers [19]. Two more recent studies asked outdoor workers about their sun protection practices while at work and leisure [24,30]. ...
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... 15,16 However, none of these three comprehensive studies included a breakdown of the results according to occupational groups or made an attempt to capture sun-protective behavior. 10,17,18 In view of the current state of research, our original manuscript uses a nationwide sample of outdoor workers to investigate (1) which occupational groups are exposed to UV radiation, (2) which occupational groups show a particularly high prevalence of sunburn in relation to work activities, and (3) to what extent outdoor workers implement the most important recommended sun protection measures. ...
... A 73-item survey instrument was developed using questionnaires from prior research studies (Marlenga, 1995;Rosenman et al., 1995;Shoveller et al., 2000;Von Ah et al., 2004;Salas et al., 2005;Hammond et al., 2008). A panel of three experts in the area of health behavior research assessed the instrument for face and content validity. ...
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For evaluation of occupational mortality in agriculture, age-standardized proportional mortality ratios (PMR) were calculated for 28,032 male farmers with the use of British Columbia (B.C.) death registrations collected from 1950 to 1978. Farmers had significantly elevated risks of death from cancer of the lip (PMR = 191, P = .05), stomach (PMR = 119, P less than .0001), and prostate gland (PMR = 113, P less than .001). In addition, leukemia was higher than expected (PMR = 122, P less than .01), as was aplastic anemia (PMR = 174, P less than .01). The elevated risks were fairly consistent over the 29-year period for stomach, prostate gland, and lip cancer, as well as for leukemia. The PMR for aplastic anemia was highest for the years 1950-59 and declined over the next 19 years. Farmers also showed significant mortality deficits for several important cancer sites, including esophagus (PMR = 59, P less than .0001), colon (PMR = 84, P less than .001), larynx (PMR = 62, P less than .01), and lung (PMR = 66, P less than .0001) for the period 1950-78. More detailed studies in B.C. will be necessary to confirm and extend these cancer-agriculture associations.
Article
Epidemiologic studies show that farmers are at increased risk of skin cancer, presumed to be secondary to the increased time they spend outdoors with exposure to the sun. We surveyed a random sample of farmers and their spouses 40 years of age or older from four rural counties in Michigan on their knowledge, attitudes, and behavior regarding protection of their skin from the sun and screening medical exams for skin cancer. Questionnaires were completed by 1,342 farmers and their spouses. This was a response rate of 63.5%. Eighty to ninety percent knew the changes in the skin that could indicate cancer and required medical follow-up. Only 40% of the men and 65% of the women were likely to protect their skin when they went outdoors. Increasing age and personal history of skin cancer increased the likelihood of both men and women protecting their skin when they went outside. Additionally, higher-income women were likely to use sun protection. Despite the fact that 90% of the respondents had had a physical examination in the last three years, less than one third reported ever having had their skin examined for cancer. Increasing age, income, and education increased the likelihood of having had such an exam. The majority of those who had had a skin exam had the exam for a particular skin problem, and not as part of a routine physical examination. Farmers and their spouses need to increase their use of sun protection when going outside. Additionally, health care providers need to routinely include examination of the skin for skin cancer and alert their patients that it is being performed.
Article
To assess the association between the incidence of cutaneous melanoma; intermittent, occupational and total sun exposure; and history of sunburn at different ages, we conducted a systematic review using results of all published case-control studies which have assessed incident melanoma, sun exposure and sunburn. Twenty-nine studies contributed data on sun exposure and 21 on sunburn. Overall, there was a significant positive association (odds ratio [OR] = 1.71) for intermittent exposure, a significantly reduced risk for heavy occupational exposure (OR = 0.86) and a small, marginally significant excess risk for total exposure (OR = 1.18). There was a significantly increased risk with sunburn at all ages or in adult life (OR = 1.91) and similarly elevated relative risks for sunburn in adolescence (OR = 1.73) and in childhood (OR = 1.95). There was significant heterogeneity with all of these estimates except that of all ages or adult sunburn. These results show the specificity of the positive association between melanoma risk and intermittent sun exposure, in contrast to a reduced risk with high levels of occupational exposure. The association with sunburn also is likely to reflect intermittent exposure; the results do not suggest any strong relationship to age at sunburn. These associations are similar to those reported for basal cell skin cancer but different from those reported for squamous cell cancer. The mechanisms by which intermittent exposure increases risk, while other patterns of exposure do not, remain to be elucidated.
Article
This article describes the methods used for the 1996 Canadian National Survey on Sun Exposure & Protective Behaviours. A 55-item random-digit-dialling telephone household survey of people 15 years of age or more was completed in 1996. Items assessed were daily sun exposure and protective behaviours, as well as other sun-related behaviours and attitudes. Data were collected regarding sun-related behaviours during leisure, work time and winter holidays, as well as for children 12 years of age or less (as reported by parents). To test for an effect on the survey response rate, a letter of introduction was sent to 40% of the households. The survey response rate was 69% (4023 successfully completed surveys out of 5847 households included in the sample). The response rate achieved in the subset that received the introductory letter was 75%. This survey is the first to establish national population estimates for sun exposure and protective behaviours in Canada.
  • Cy Lovato
  • Ja Shoveller
  • L Peters
  • Jk Rivers
Lovato CY, Shoveller JA, Peters L, Rivers JK. Canadian National Survey on Sun Exposure & Protective Behaviours: Methods. Cancer Prevention & Control 1998;2(3):105-10.