Could this intervention be effective at improving sun protective behaviors among other outdoor workers?
Image by the U.S. Navy, public domain via Wikimedia Commons
Implementing a sun safety educational program improved sunscreen use and reduced rates of reported sunburn among heavy equipment operators in Michigan, according to findings from a randomized, controlled trial published online ahead of print in Cancer Epidemiology, Biomarkers & Prevention (June 28, 2018).
“The rates of melanoma have been increasing in recent decades in the United States, and outdoor workers are at an increased risk for developing this deadliest form of skin cancer,” said lead author Sonia Duffy, PhD, in a press release. “We wanted to investigate how behavioural interventions can affect sunscreen use and sunburning among operating engineers as a way to prevent skin cancer.”
Dr. Duffy is a cancer control researcher at The Ohio State University Comprehensive Cancer Center-Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, a professor and the Mildred E. Newton Endowed Chair at the College of Nursing at The Ohio State University in Columbus, and a research scientist at the Department of Veterans Affairs in Ann Arbor, Mich.
A systematic analysis had shown that this population of heavy equipment operators—also known as operating engineers—had inadequate sun-protective behaviours, according to the releaase. Dr. Duffy and her colleagues had also found in a previous analysis (Workplace Health & Safety Feb. 2014; 62(2):70–9) that approximately two-thirds of operating engineers reported rarely or never wearing sunscreen, while 80% of the population reported four to five daily hours of sun exposure during the summer work period.
For the new trial, some 357 operators were recruited during the winter or spring of 2012–2013. Baseline surveys were conducted and the participants were randomized into one of four interventions: education only; education plus text message reminders; education plus mailed sunscreen; and education plus both text message reminders and mailed sunscreen. After the summer intervention period, 82.1% of the participants responded to follow-up surveys.
The educational intervention was a 30-minute PowerPoint presentation that was delivered as part of pre-existing annual safety training sessions. It covered topics that included the current use of sun protection among this population, incidence and prevalence of skin cancer among outdoor workers, risk factors for and types of skin cancer, and sunburn prevention methods.
Examples of the text message reminders include: “Your family and friends love you—put on sunscreen!” and “86% of [operating engineers] burn each summer—but not you, right?”
The mailed sunscreen intervention comprised three deliveries of a large bottle of SPF 30 sun lotion and a small, refillable lotion bottle that could be attached to a key ring.
Overall, the percentage of participants who reported never wearing sunscreen decreased from 38.1% at baseline to 21.8% at followup, with all four interventions resulting in significantly increased use of sunscreen. This increase was marginally significant in the sub-group that received only education and text messages.
The percentage of participants who reported burning four or more times through the summer decreased from 18.6% at baseline to 5.8% at follow-up. As well, the total number of reported sunburns decreased significantly in all sub-groups, with no significant difference in number of reported sunburns between the groups.
“Our most important finding was that a simple educational intervention significantly decreased the number of sunburns in operational engineers,” said Dr. Duffy. “Text messages and mailed sunscreen further improved outcomes, but education had the largest effect. I think there’s a lack of knowledge about the risks of UV exposure in this population, and it was inspiring to see how a small effort resulted in a sizable health behavioural change.”
Two limitations the study authors identify were the reliance on self-reported data, and that approximately half of the participants who were assigned to receive the text message reminders opted out of the service—a choice the authors attributed to a perception of the costs of text messaging fees.