Evaluation of a toolbox for the prevention of skin cancer among outdoor workers: an intervention study

IntroductionDue to ultraviolet radiation (UVR) exposure at work, outdoor workers face a higher risk of keratinocyte carcinoma (KC) than indoor workers. This study evaluates the short-term effectiveness of a sun-safety risk communication toolbox aimed to increase sun-safety behavior among male outdoo...

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Main Authors: Florentine L. de Boer, Daisy Vreenegoor, Jos W. R. Twisk, Jack J. van der Gragt, Thomas Rustemeyer, Sanja Kezic, Henk F. van der Molen
Format: Article
Language:English
Published: Frontiers Media S.A. 2025-06-01
Series:Frontiers in Public Health
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Online Access:https://www.frontiersin.org/articles/10.3389/fpubh.2025.1579180/full
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author Florentine L. de Boer
Daisy Vreenegoor
Jos W. R. Twisk
Jack J. van der Gragt
Thomas Rustemeyer
Sanja Kezic
Henk F. van der Molen
author_facet Florentine L. de Boer
Daisy Vreenegoor
Jos W. R. Twisk
Jack J. van der Gragt
Thomas Rustemeyer
Sanja Kezic
Henk F. van der Molen
author_sort Florentine L. de Boer
collection DOAJ
description IntroductionDue to ultraviolet radiation (UVR) exposure at work, outdoor workers face a higher risk of keratinocyte carcinoma (KC) than indoor workers. This study evaluates the short-term effectiveness of a sun-safety risk communication toolbox aimed to increase sun-safety behavior among male outdoor workers.MethodsThis parallel-controlled, non-randomized study included outdoor construction and arboricultural workers, recruited from five companies. Twenty-eight workers were assigned to the intervention group, where they received a preventive toolbox, while 26 workers were assigned to the control group. The toolbox included information on UVR health risks and preventive measures, as well as sunscreen provision. The primary outcome was internal UVR exposure, measured by the relative cis-urocanic acid (cUCA) levels in the stratum corneum (SC). SC samples were taken from two skin sites (cheek and neck) at baseline and 6 weeks. Secondary outcomes included sun-protective behavior, workplace encouragement, knowledge and attitude/motivation, all assessed using questionnaires.ResultsA difference in cUCA was found between groups with lower cUCA at the cheek (−0.065 (95% CI: −0.101 to −0.029)) and neck location (−0.032 (95% CI: −0.068–0.004)) for the intervention group. Reported sunscreen use significantly improved in the intervention compared with control group (difference between group (11.01 (95% CI: 2.04–20.10)). For other secondary outcomes no statistical differences between groups were found.ConclusionThe toolbox intervention led to a reduction of internal UVR exposure, consistent with a self-reported increase in sunscreen use, compared to no intervention. Future research should focus on the longer-term preventive effects of this type of toolbox following further development and evaluation.
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spelling doaj-art-069004944d1149b09218f41b239663ec2025-08-20T03:11:05ZengFrontiers Media S.A.Frontiers in Public Health2296-25652025-06-011310.3389/fpubh.2025.15791801579180Evaluation of a toolbox for the prevention of skin cancer among outdoor workers: an intervention studyFlorentine L. de Boer0Daisy Vreenegoor1Jos W. R. Twisk2Jack J. van der Gragt3Thomas Rustemeyer4Sanja Kezic5Henk F. van der Molen6Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, NetherlandsDepartment of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, NetherlandsDepartment of Epidemiology and Data Science, Amsterdam University Medical Centers, Amsterdam, NetherlandsVolandis, Harderwijk, NetherlandsDepartment of Dermatology and Allergology, Amsterdam University Medical Centers, Amsterdam, NetherlandsDepartment of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, NetherlandsDepartment of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, NetherlandsIntroductionDue to ultraviolet radiation (UVR) exposure at work, outdoor workers face a higher risk of keratinocyte carcinoma (KC) than indoor workers. This study evaluates the short-term effectiveness of a sun-safety risk communication toolbox aimed to increase sun-safety behavior among male outdoor workers.MethodsThis parallel-controlled, non-randomized study included outdoor construction and arboricultural workers, recruited from five companies. Twenty-eight workers were assigned to the intervention group, where they received a preventive toolbox, while 26 workers were assigned to the control group. The toolbox included information on UVR health risks and preventive measures, as well as sunscreen provision. The primary outcome was internal UVR exposure, measured by the relative cis-urocanic acid (cUCA) levels in the stratum corneum (SC). SC samples were taken from two skin sites (cheek and neck) at baseline and 6 weeks. Secondary outcomes included sun-protective behavior, workplace encouragement, knowledge and attitude/motivation, all assessed using questionnaires.ResultsA difference in cUCA was found between groups with lower cUCA at the cheek (−0.065 (95% CI: −0.101 to −0.029)) and neck location (−0.032 (95% CI: −0.068–0.004)) for the intervention group. Reported sunscreen use significantly improved in the intervention compared with control group (difference between group (11.01 (95% CI: 2.04–20.10)). For other secondary outcomes no statistical differences between groups were found.ConclusionThe toolbox intervention led to a reduction of internal UVR exposure, consistent with a self-reported increase in sunscreen use, compared to no intervention. Future research should focus on the longer-term preventive effects of this type of toolbox following further development and evaluation.https://www.frontiersin.org/articles/10.3389/fpubh.2025.1579180/fullnon-melanoma skin cancersolar radiationultraviolet exposureconstruction workersarboricultural workersoccupational disease
spellingShingle Florentine L. de Boer
Daisy Vreenegoor
Jos W. R. Twisk
Jack J. van der Gragt
Thomas Rustemeyer
Sanja Kezic
Henk F. van der Molen
Evaluation of a toolbox for the prevention of skin cancer among outdoor workers: an intervention study
Frontiers in Public Health
non-melanoma skin cancer
solar radiation
ultraviolet exposure
construction workers
arboricultural workers
occupational disease
title Evaluation of a toolbox for the prevention of skin cancer among outdoor workers: an intervention study
title_full Evaluation of a toolbox for the prevention of skin cancer among outdoor workers: an intervention study
title_fullStr Evaluation of a toolbox for the prevention of skin cancer among outdoor workers: an intervention study
title_full_unstemmed Evaluation of a toolbox for the prevention of skin cancer among outdoor workers: an intervention study
title_short Evaluation of a toolbox for the prevention of skin cancer among outdoor workers: an intervention study
title_sort evaluation of a toolbox for the prevention of skin cancer among outdoor workers an intervention study
topic non-melanoma skin cancer
solar radiation
ultraviolet exposure
construction workers
arboricultural workers
occupational disease
url https://www.frontiersin.org/articles/10.3389/fpubh.2025.1579180/full
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