Skin Cancer: Interventions in Outdoor Occupational Settings
Findings and Recommendations
The Community Preventive Services Task Force (CPSTF) 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.
The full CPSTF Finding and Rationale Statement and supporting documents for Preventing Skin Cancer: Interventions in Outdoor Occupational Settings are available in The Community Guide Collection on CDC Stacks.
Intervention
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 CPSTF 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 CPSTF 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.
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
Summary of 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 showed favorable results (4 studies, 7 study arms)
- Sunburn incidence
- Median decrease of 5.2 percentage points (range: 7.0 to 3.0 percentage points; 3 studies)
- Other measures of decrease in sunburn showed favorable results (1 study)
- Included studies also showed favorable effects on incidence of solar keratosis (1 study) and skin cancer (1 study)
Unfavorable or mixed results were found for shade seeking behavior among outdoor workers (1 study) and 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).
Summary of Economic Evidence
An economic review of this intervention was not conducted.
Applicability
Results are applicable to:
- 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
Evidence Gaps
Large, multi-arm studies, in diverse occupational settings are needed to assess comparative effectiveness by specific intervention components in specific context and settings.
- Limited evidence is available on the following:
- Interventions with worksite policy components
- Interventions targeting non-White outdoor workers
- Interventions that target outdoor workers in non-recreational occupational settings
- Interventions to evaluate health outcomes (e.g., new cases of skin cancers)
- Studies with longer follow-up times would provide useful information about the sustainability of intervention effects and also account for seasonal variations
Implementation Considerations and Resources
- 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
Crosswalks
Find programs from the Evidence-Based Cancer Control Programs (EBCCP) website that align with this systematic review. (What is EBCCP?)
Healthy People 2030 includes the following objectives related to this CPSTF recommendation.