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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 Intervention Results: Summary Effect Measures Limitations
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