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