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      Skin Cancer Prevention Behaviors Among Agricultural and Construction Workers in the United States, 2015

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          Abstract

          Introduction

          Nearly 5 million people are treated for skin cancer each year in the United States. Agricultural and construction workers (ACWs) may be at increased risk for skin cancer because of high levels of ultraviolet radiation exposure from the sun. This is the first study that uses nationally representative data to assess sun-protection behaviors among ACWs.

          Methods

          We analyzed data from the 2015 National Health Interview Survey Cancer Control Supplement to examine the prevalence of sun-protection behaviors among ACWs. We calculated national, weighted, self-reported prevalence estimates. We used χ 2 tests to assess differences between ACWs by industry and occupation.

          Results

          Most of the 2,298 agricultural and construction workers studied were male (by industry, 72.4% in agriculture and 89.3% in construction; by occupation, 66.1% in agriculture and 95.6% in construction) and non-Hispanic white. About one-third had at least 1 sunburn in the past year. The prevalence of sunscreen use and shade seeking was low and did not significantly differ among groups, ranging from 15.1% to 21.4% for sunscreen use and 24.5% to 29.1% for shade seeking. The prevalence of wearing protective clothing was significantly higher among agricultural workers than among construction workers by industry (70.9% vs 50.7%) and occupation (70.5% vs 53.0%).

          Conclusion

          Our findings could be used to improve occupational health approaches to reducing skin cancer risk among ACWs and to inform education and prevention initiatives addressing skin cancer. Sun-safety initiatives may include modifying work sites to increase shade and adding sun safety to workplace policies and training. Employers can help reduce occupational health inequities and protect workers by creating workplaces that facilitate sun protection.

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          Most cited references18

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          Sunburns and risk of cutaneous melanoma: does age matter? A comprehensive meta-analysis.

          Sunburns are an important risk factor for melanoma and those occurring in childhood are often cited as posing the greatest risk. We conducted a meta-analysis to quantify the magnitude of association for melanoma and sunburns during childhood, adolescence, adulthood and over a lifetime. After reviewing over 1300 article titles and evaluating 270 articles in detail, we pooled odds ratios from 51 independent study populations for "ever" sunburned and risk of cutaneous melanoma. Among these, 26 studies reported results from dose-response analyses. Dose-response analyses were examined using both fixed-effects models and Bayesian random-effects models. An increased risk of melanoma was seen with increasing number of sunburns for all time-periods (childhood, adolescence, adulthood, and lifetime). In an attempt to understand how risk between life-periods compares, we also report these same linear models on a scale of five sunburns per decade for each life-period. The magnitude of risk for five sunburns per decade is highest for adult and lifetime sunburns. Overall, these results show an increased risk of melanoma with increasing number of sunburns during all life-periods, not just childhood. Prevention efforts should focus on reducing sunburns during all life-periods.
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            Prevalence of obesity among U.S. workers and associations with occupational factors.

            Along with public health and clinical professionals, employers are taking note of rising obesity rates among their employees, as obesity is strongly related to chronic health problems and concomitant increased healthcare costs. Contributors to the obesity epidemic are complex and numerous, and may include several work characteristics. To explore associations between occupational factors and obesity among U.S. workers. Data from the 2010 National Health Interview Survey were utilized to calculate weighted prevalence rates and prevalence ratios (PRs) for obesity in relation to workweek length, work schedule, work arrangement, hostile work environment, job insecurity, work-family imbalance, and industry and occupation of employment. Data were collected in 2010 and analyzed in 2012-2013. Overall, 27.7% of U.S. workers met the BMI criterion for obesity. Among all workers, employment for more than 40 hours per week and exposure to a hostile work environment were significantly associated with an increased prevalence of obesity, although the differences were modest. Employment in health care and social assistance and public administration industries, as well as architecture and engineering, community and social service, protective service, and office and administrative support occupations was also associated with increased obesity prevalence. Work-related factors may contribute to the high prevalence of obesity in the U.S. working population. Public health professionals and employers should consider workplace interventions that target organization-level factors, such as scheduling and prevention of workplace hostility, along with individual-level factors such as diet and exercise. © 2014 Published by American Journal of Preventive Medicine on behalf of American Journal of Preventive Medicine.
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              Prevalence of Sun Protection Use and Sunburn and Association of Demographic and Behaviorial Characteristics With Sunburn Among US Adults

              This cross-sectional study using National Health Interview Survey data examined the prevalence of sun protection use and sunburn and the association between sunburn and demographic characteristics and health behaviors in the US population. Questions Among US adults, what is the prevalence of sun protection and sunburn, and what factors are associated with sunburn? Findings In this cross-sectional study of 31 162 US adults, the prevalence of sunburn was highest among younger adults, non-Hispanic white individuals, and those with sun-sensitive skin but was also high among groups considered to have low skin cancer risk (eg, black and Hispanic individuals). Sun avoidance behaviors were associated with a lower likelihood and sunscreen use, sunless tanning, aerobic activity, binge drinking, and overweight/obesity with a greater likelihood of sunburn. Meaning Although sunburn is more common among certain groups (eg, younger, sun-sensitive, and physically active adults), targeted prevention efforts are needed across all demographic groups. Importance Monitoring sun protection and sunburn over time at the population level can provide valuable information about progress toward skin cancer prevention goals and inform future intervention efforts. Objective To examine the prevalence of sun protection use (shade, sunscreen, and clothing) and sunburn and the association between sunburn and individual characteristics and health behaviors in the US population. Design, Setting, and Participants In this cross-sectional study using a nationally representative sample of 31 162 US adults from the 2015 National Health Interview Survey–Cancer Control Supplement, household interviews of civilian, noninstitutionalized US adults were conducted throughout 2015 in person and completed on the telephone when necessary. Data analysis was performed from August 16, 2016, to September 6, 2017. Main Outcomes and Measures The prevalence of sunburn and use of sun protection and their association with demographic characteristics, sun sensitivity, and health-related behaviors and conditions using multivariable logistic regression modeling. Results A total of 31 162 respondents (mean [SD] age, 47.0 [0.36] years; 13 932 male [44.7%] and 17 230 female [55.3%]) were included in the analyses, with 34.2% experiencing sunburn in 2015. Sunburn prevalence was higher among younger age groups (51.2% in adults 18-29 years old; 95% CI, 48.8%-53.7%), non-Hispanic white individuals (42.5%; 95% CI, 41.2%-43.9%), and those with sun-sensitive skin (50.2%). However, sunburn was also prevalent among black (13.2%; 95% CI, 11.6%-15.1%) and Hispanic (29.7%; 95% CI, 27.6%-31.9%) individuals, demographic groups that are often considered to be at low risk of skin cancer. The most frequent sun protection behaviors were staying in the shade (37.1%; 95% CI, 36.3%-38.0%) and using sunscreen (31.5%; 95% CI, 30.7%-32.3%) followed by wearing long clothing to the ankles (28.4%; 95% CI, 27.6-29.1). Sun avoidance behaviors (seeking shade and not going in the sun) were significantly (39.5% vs 35.1%; P < .001) associated with a lower prevalence of sunburn. Those who used self-applied sunless tanning products (45.0% of users vs 36.1% of nonusers; P < .001), those who engaged in aerobic activity (37.9% of aerobic exercisers vs 32.8% of non–aerobic exercisers; P < .001), binge drinkers (45.1% of binge drinkers vs 35.0% of non–binge drinkers; P < .001), and overweight or obese individuals (37.9% of overweight or obese individuals vs 34.4% of non–overweight or obese individuals; P < .001) were more likely to experience sunburn compared with the respective comparison groups. Conclusions and Relevance Sun sensitivity was significantly associated with a higher sunburn prevalence, independent of race/ethnicity, suggesting a need to consider sun sensitivity when identifying target demographic groups for sun safety interventions. Efforts to improve vigilance and consistency with use of sun protection are needed. In addition, those who engage in physical activity, use sunless tanners, or use sunscreen for tanning purposes may require additional intervention strategies to address the unique barriers they face in staying adequately protected.
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                Author and article information

                Journal
                Prev Chronic Dis
                Prev Chronic Dis
                PCD
                Preventing Chronic Disease
                Centers for Disease Control and Prevention
                1545-1151
                2019
                07 February 2019
                : 16
                : E15
                Affiliations
                [1 ]Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Division of Cancer Prevention and Control, Atlanta, Georgia
                [2 ]Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, Spokane Mining Research Division, Spokane, Washington
                Author notes
                Corresponding Author: Kathleen R. Ragan, MSPH, Division of Cancer Prevention and Control; Centers for Disease Control and Prevention, 4770 Buford Hwy, MS F76, Atlanta, GA 30341. Telephone: 404-718-6626. Email: Kathleen.Ragan@ 123456cdc.hhs.gov .
                Article
                18_0446
                10.5888/pcd16.180446
                6395080
                30730830
                c8bc1bbb-d488-489c-883a-686847a75cc7
                History
                Categories
                Original Research
                Peer Reviewed

                Health & Social care
                Health & Social care

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