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Preventing Skin Cancer: Interventions in Outdoor Occupational Settings

Task Force Finding

The Community Preventive Services Task Force recommends interventions in outdoor occupational settings to prevent skin cancer based on strong evidence of effectiveness in increasing outdoor workers’ sun protective behaviors (e.g., use of sunscreen or sun protective clothing or combination of sun protective behaviors) and reducing sunburns.

Read the full Task Force Finding and Rationale Statement for details including implementation issues, possible added benefits, potential harms, and evidence gaps.

Intervention Definition

Interventions in outdoor occupational settings to promote sun protective behaviors among workers include at least one of the following:

  • Educational approaches (e.g., providing informational messages about sun protection to workers through instruction, small media such as posters or brochures, or both)
  • Activities designed to influence knowledge, attitudes, or behavior of workers (e.g., modeling or demonstrating behaviors)
  • Environmental approaches to encourage sun protection (e.g., providing sunscreen or shade)
  • Policies to support sun protection practices (e.g., requiring sun protective clothing)

About the Systematic Review

The Task Force finding is based on evidence from a Community Guide systematic review published in 2004 (Saraiya et al., 7 studies with behavioral outcomes; search period January 1966 – June 2000) combined with more recent evidence (8 studies, search period June 2000 – April 2013). The systematic review was conducted on behalf of the Task Force by a team of specialists in systematic review methods, and in research, practice, and policy related to preventing skin cancer. This finding updates and replaces the 2002 Task Force finding on Education and Policy Approaches in Outdoor Occupational Settings.

Results

Updated Evidence (search period June 2000 - April 2013)

Included studies (8 studies, 11 study arms) evaluated intervention effects on various measures of sun protection behaviors and on physiological consequences of UV radiation exposure among outdoor workers. Results were generally favorable across outcomes.

  • Sunscreen use
    • Median increase of 8.0 percentage points (range: 7.0 to 10.1 percentage points; 3 studies)
    • Other measures of sunscreen use also showed favorable results (1 study)
  • Hat use
    • Median increase of 8.8 percentage points (range: 4.8 to 11.0 percentage points; 4 studies)
    • Other measures of hat use also showed favorable results (1 study)
  • Clothing use
    • Increases of 23.4 and 52.0 percentage points (2 studies)
    • Other measures of clothing use also showed favorable results (1 study)
  • Combined sun-protective behaviors
    • Several measures of combined sun-protection behaviors showed favorable results (4 studies, 7 study arms)
  • Sunburn incidence
    • Median decrease of 5.2 percentage points in the number of sunburn episodes (range: ‑7.0 to ‑3.0 percentage points; 3 studies)
    • Other measures of decrease in sunburns showed favorable results (1 study)
  • Included studies also showed favorable effects of the intervention on the incidence of solar keratosis (1 study) and skin cancer (1 study).

Unfavorable or mixed results were found for the following outcomes.

  • Shade seeking behavior among outdoor workers (1 study)
  • UV radiation exposure measured as a change in skin pigmentation (2 studies)
Previous Review (search period January 1966-June 2000)

Results from 7 studies of behavioral outcomes found favorable results for sunscreen use (2 studies), hat use (1 study), protective clothing use (2 studies), shade use (1 study), sun exposure (1 study), composite sun protective behaviors (1 study), and number of sunburns (1 study).

Study Characteristics

  • Most studies were randomized control trials conducted in the United States.
  • Most studies combined educational and environmental interventions.
  • 50% of the studies were conducted in recreational settings.
  • One study was implemented as part of a mandatory worksite policy.
  • All studies assessed sun protective behaviors; half assessed sunburns, and one study also assessed solar keratosis and number of skin cancers.

Applicability

Based on the settings and populations from included studies, results are applicable to the following:

  • Workers of all ages
  • People who are white (applicability to other groups is unclear)
  • Full-time and seasonal workers
  • Recreational and non-recreational outdoor settings

Economic Evidence

An economic review is pending.

Considerations for Implementation

The following considerations are drawn from studies included in the evidence review, the broader literature, and expert opinion.

  • Employers should consider worker safety when implementing sun protection interventions.
  • Employers can provide sun safety supports such as shade structures, sun protective clothing, and sunscreen.

image of planetFind a Research-tested Intervention Program (RTIP) External Web Site Icon about skin cancer prevention interventions in outdoor occupational settings (What is an RTIP?).

Supporting Materials

Publication Status

Full peer-reviewed articles of this systematic review will be posted on the Community Guide website when published. Subscribe External Web Site Icon to be notified when we post these publications or other materials. See our library for previous Community Guide publications on this and other topics.

Promotional Materials

Community Guide News

More promotional materials for Community Guide reviews about Preventing Skin Cancer.

References

Saraiya M, Glanz K, Briss PA, et al. Interventions to prevent skin cancer by reducing exposure to ultraviolet radiation: a systematic review Adobe PDF File [PDF - 788 kB]. Am J Prev Med 2004;27(5):422-66.




Disclaimer

The findings and conclusions on this page are those of the Community Preventive Services Task Force and do not necessarily represent those of CDC. Task Force evidence-based recommendations are not mandates for compliance or spending. Instead, they provide information and options for decision makers and stakeholders to consider when determining which programs, services, and policies best meet the needs, preferences, available resources, and constraints of their constituents.

Sample Citation

The content of publications of the Guide to Community Preventive Services is in the public domain. Citation as to source, however, is appreciated. Sample citation: Guide to Community Preventive Services. Preventing skin cancer: interventions in outdoor occupational settings. www.thecommunityguide.org/cancer/skin/education-policy/outdooroccupations.html. Last updated: MM/DD/YYYY.

Review completed: August 2013