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Table 2 Studies evaluating interventions to improve sun protection by outdoor workers

From: Reducing ultraviolet radiation exposure among outdoor workers: State of the evidence and recommendations

Author, Date, Design, Duration, Study Quality

Population and Sample Size


Results: Summary Effect Measures


Azizi et al., 2000

Non-randomized trial 20-month follow-up

Fair quality

N = 144

(67.6% retention rate)

Outdoor workers for Israel Water Company 100% male

Comprehensive/partial/minimal sun protection program(3 groups)

Comprehensive = local safety officer training, education sessions, protective gear

Partial = health education, protective gear, brochures

Minimal = health education, brochures, sunscreen

Increase in sunscreen use in all groups, mostly in Comp. & Partial (+150%)

Reduced exposure, highest in Comp. group (-25% skin exposed, -31.5% mean daily occupational exposure)

Recall bias for self-report; UVR dose not validated by other measure; low follow-up rate (68%) and differential (41% in minimal intervention group)

Dobbinson et al., 1999

Non-randomized trial

Immediate follow-up and comparison to 9 previous years

Fair quality

N = 263

Lifeguards in Australia 67% male, 52% < 20 years old

SunSmart campaign program for lifeguards; promotion of long-sleeved shirts, wide-brim hats, sunscreen, shade; raising awareness and providing training for youth

Absolute change in:

-regular hat use +34%

-regular long-sleeved shirt use + 21%

-regular sunscreen +12%

-use of shelter +15%

Sampling methods differed by groups; self-reported outcome measures; confounders not assessed

Geller et al, 2001

Randomized controlled trial (RCT) 3-month follow-up

Fair quality

N = 194

(88.2% retention rate)

Lifeguards in Hawaii and Massachusetts 68.7% female, 62.5% white

Mean age: 20.9 years

Intervention: sun protection education including training module, materials for sun safety education for children, provision of sunscreen at pool, posters/signs, shade structures, incentives

Control group: injury prevention program

Sun protection behaviors measured on 4-point scale: increases in wearing shirts, using shade, and composite sun protection (not sig.). Significant improvement in sun protection policies, significant reduction in sunburns

Self-reported outcome measures; no assessment of participants lost to follow-up

Girgis et al., 1994


1-month follow-up

Fair quality

N = 142

(77.4% retention rate)

Outdoor workers – Australia 98% male

Mean age: 40.5 years

Intervention: skin screening by a dermatologist, education session

Control group: no-treatment delayed control group

Absolute change + 16% in % with highest level protection (significant)

Significant improvement in knowledge, but no significant attitude change

Sampling frame and site selection not described, loss to follow-up

Glanz et al., 2001


2- and 5-month follow-up

Fair quality

N = 176

(71.9% retention at T2, 61.4% at T3; final n = 66)

Outdoor recreation staff in Hawaii

60.9% female, multiethnic Mean age: 20.9 years

3-arm trial

Intervention Group #1: training/education about sun safety and for conducting children's sun safety program

Intervention Group #2:

Same as Group #1 plus environmental/policy supports, sunscreen provided, signs, shade, and policy consultations

Control Group: Delayed program after first (2 mo.) post-test survey

Sun protection habits score: +1 to 4% change over controls

Knowledge increase: + 15% over controls

Perceived norms increase: + 18% over controls

Sun protection policies: +7% increase > controls

Improvements in both Treatment groups, not significant #1 vs. #2

Self-report assessments

No assessment of non-responders

Sampling method not described

Glanz et al., 1998

Pre-/post-test study 1- to 2-month follow-up

Fair quality

N = 154

Outdoor recreation staff in Hawaii 66.7% female, multiethnic

Mean age: 20 years

Staff training, group activities, children's sun safety program, promotion of sun safe environments and policies

Within-group changes: Sun protection habits score: +1.7%

Stage of change: + 9.1%

Staff knowledge: + 7.5%

Staff sun protection norms: + 5.1%

Self-report assessments

Sampling method not described

Hanrahan, 1995

RCT 3-month follow-up

Fair quality

N = 219

(70% retention rate)

Industry workers in Australia

100% male

Mean age: 54 years

All groups: knowledge questionnaire + self-exam body chart (delivered at varied times)

Intervention group:

2 educational brochures, including questions and answers; self-exam body chart at baseline

2 Control groups: one received self-exam body chart at end of intervention period; other received at same time as intervention group

Increased knowledge about melanoma:+12.6% greater than for controls

No information about sampling or response rate

Sampling method not described

No report of race/ethnicity and SES of study groups

Lombard et al., 1991

Pre-post test study 1-month avg. follow-up

Fair quality

N – not reported; done at 2 swimming pools with 600 members

Lifeguards in Virginia

No description of sample

Peer leader modeling by lifeguards, informational posters and fliers, posted feedback & goals, free sunscreen and commitment raffle; intervention lasted average of 25 days/pool

% lifeguards covering up with target behaviors (hat, shirt, sunglasses, shade, zinc oxide): + 160%, + 675%

No description of sample

No statistical testing

Convenience sample, 2 pools