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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
Health Statistics from
the Americas, 1999
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