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A follow up to the previous study that promoted the adoption of occupational sun protection policies by the local government organization comprised of personal visits with senior managers to promote policy adoption, promotional materials for sun safety, and in-person training of outdoor workers by research staff over two years. The follow up program consists of an analysis of sun safe practices by employees and an economic evaluation of the SSW intervention completed 2 years after the initial intervention.

A follow up to the previous study that promoted occupational sun protection practices by employees in local government organizations through two mailings containing educational materials and presentations at state professional meetings by project staff. The follow up program consists of an analysis of sun safe practices by employees and an economic evaluation of SSW completed 2 years after the initial program contact.

A follow-up analysis of sun safe practices by employees and an economic evaluation of the SSW intervention was conducted with the work-sites who received occupational sun protection policy promotion materials in the prior trial. The analysis of sun safety practices of employees was done by preparing the protocols and measures for surveying employees and front-line supervisors by online and paper methods. The economic evaluation was a retrospective collection of cost information from the prior project ledgers and an in depth interview with the key contact manager at each work-site. No additional treatment was provided and the groups were evaluated based on their prior condition assignment.

Sun Safe Workplaces Program

A follow-up analysis of sun safe practices by employees and an economic evaluation of the SSW intervention was conducted with the work-sites who received occupational sun protection practice promotion materials in the prior trial. The analysis of sun safety practices of employees was done by preparing the protocols and measures for surveying employees and front-line supervisors by online and paper methods. The economic evaluation was a retrospective collection of cost information from the prior project ledgers and an in depth interview with the key contact manager at each work-site. No additional treatment was provided and the groups were evaluated based on their prior condition assignment.

Attention Control

David Buller, PhD

Sun Safe Workplaces (SSW), a comprehensive occupational sun safety program, promoted education and policy to 98 cities, counties, and special districts in Colorado. In a two-year follow-up study, Klein Buendel, Inc. (KB) proposes to examine the effectiveness of SSW on employee sun protection practices by employers and return on investment in an economic evaluation of the cost of the SSW intervention. The results of this follow-up study will provide critical information on effective approaches to increasing sun protection across a wide range of employment sectors with outdoor workers.

Workers in the United States spend large amounts of time on the job, making the workplace a key venue for preventive health programs. A workplace risk that has received limited attention is solar ultraviolet radiation (UVR). Unprotected exposure to solar UVR of outdoor workers can produce both an immediate acute harm (i.e., severe sunburn) and long-term skin damage that can elevate the risk of developing skin cancers. Preventing skin cancer is a priority due to its high prevalence; tendency to recur; association with other cancers; and lost productivity ($66.9 billion in losses were attributed to melanoma-related mortality from 1990-2008). Sun Safe Workplaces (SSW) is a comprehensive occupational sun safety education and policy intervention that was tested by Klein Buendel, Inc.'s (KB) research team in a randomized control trial with 98 cities, counties, and special districts in Colorado. Posttesting was completed in November 2013. The SSW intervention focused on three sectors in the organizations: public works, public safety, and parks and recreation. Half of the employers received the SSW intervention, with the remaining employers in the control condition receiving basic sun safety information. Preliminary analyses indicate that 80% of employers in the SSW intervention condition provided sun safety education to employees and 36% adopted formal sun protection policies. No control organizations reported policy adoption. KB will conduct a two-year follow-up study on the benefits of the SSW intervention (i.e., increasing employees' sun protection) and return on investment (ROI; benefits relative to intervention costs). Employee behavior was not assessed in the current SSW trial because it was uncertain whether the SSW intervention would result in uptake of education and policy and thus have the potential to influence their sun protection practices. The proposed two-year follow-up of the 98 organizations in the SSW trial will include: (1) surveys with employees (n=10,787) and front line supervisors (n=767) to assess employees' sun protection practices and workplace actions to support employee sun safety; (2) on-site observations of sun protection actions by the employers (e.g., posters, sunscreen, shade structures); and (3) tracking of the costs of implementing the SSW intervention and induced employer costs. The proposed analyses will compare the sun protection practices of employees a) between workplaces that received the SSW intervention and controls and b) among workplaces that provided education and adopted policy, provided education only, and control workplaces. Analyses will determine if the extent of sun protection actions by employers influences employees' sun safety practices. The economic evaluation will estimate the ROI (i.e., comparison of the estimated program benefits to combined cost elements). The proposed study is significant and innovative because it provides critical information applicable to a wide range of industrial sectors with outdoor workers on a workplace risk that has received scant attention. Determining the effectiveness and ROI of prevention programs is essential for national and local resource investment.

Participants were not aware of the condition in which their organization was enrolled.

Sun Safe Workplaces: Assessment of Benefits and Costs of a Policy Intervention

Quantitative research in the form of a posttest survey was conducted to examine the sun safety practices by employees among workplaces that received education but did not adopt written policies, those workplaces that received education and adopted written policies and those that were in the control group.safety practices by employees among workplaces that received education but did not adopt written policies.

An observational visit checklist was used to review sun protection items within the environment to assess employer actions to improve worker sun safety in the SSW parent study project. This checklist accounted for program materials (posters, tip cards, brochures, policy tool box items) and other sun safety protective items such as sunscreen and portable and permanent shade provided by the workplace for employees.

Analysis of the association of employer actions (education only vs. education plus policy) on sun safety with employee's sun protection practices.

Cost information from the SSW parent study project ledgers was extracted for the economic evaluation of the benefits and costs of the intervention.

An In-depth manger interview was conducted with managers to determine what sun safety items and practices the worksite was doing before and after the program and the costs associated with those practices.

To compare the actions of intervention employers implementing education, intervention employers implementing education and adopting policy on employee sun safety.

National Cancer Institute (NCI)

Kaiser Foundation Research Institute

University of Colorado, Denver

Klein Buendel, Inc.

Program promoting the adoption of occupational sun protection policies by the local government organization comprised of personal visits with senior managers and in-person training of outdoor workers by research staff over two years.

Program promoting occupational sun protection practices by employees in local government organizations through two mailings containing educational materials and presentations at state professional meetings by project staff.

The intervention began by sending a Program Announcement Packet and requesting the first face-to-face meeting. At the first meeting, intervention staff covered: 1) Introduction to SSW; 2) Sun Safety Practices in the Workplace; 3) Sun Safety Policy for Outdoor Workers; 4) Sun Safety Policy Adoption; 5) Sun Safety Policy Reinforcement and Maintenance. They presented the SSW Website and a Sun Safety Tool Box. Following the first meeting, the manager scheduled Sun Safety Training by intervention staff with various employee groups. Workplace Sun Safety Materials were sent in four sets (twice a year over two years) for distribution to employees. Research staff made monthly Follow-up Contacts with managers.

Research staff sent printed materials on occupational sun safety to local government organizations twice. These included posters with personal protection messages and skin cancer rates, risk assessment brochures, worksite guides, total skin self-examination CD-Rom, the American Academy of Dermatology SPOT bookmark, and a sun safety tip card from the Occupational Safety and Health Administration (OSHA). Staff made presentations on general sun safety topics (not policy) at state professional conferences.

David B Buller, PhD

A sample of local government organizations are recruited to a group-randomized pretest-posttest controlled trial evaluating the effect of a campaign to promote workplace policy and education on sun protection for outdoor workers. Primary outcome is adoption of formal policies and secondary outcomes are implementation of policy and sun protection practices by outdoor workers.

Workers in the United States spend large amounts of time on the job, making the workplace a key venue for preventive health programs. A workplace risk that has received limited attention is sun protection, despite the fact 8% of the U.S. workforce (over 9 million workers) work outdoors. The investigators have demonstrated that sun safety education can promote sun protection at work. In this revised application, the investigators propose to systematically study a more comprehensive approach to workplace sun safety that goes beyond employee education to promote institutional change. The investigators will implement and evaluate a proactive campaign to change workplace sun protection policies and promote sun safety to managers rather than individual employees. The investigators will assess whether policy adoption alters organizational operations in public employers rather than the private employers examined in our previous research. The specific aims are to: a) create a campaign comprised of personal contacts, printed materials, and Internet tools and resources (i.e., pubic health communication) to promote workplace sun protection policies to managers at public employers, b) evaluate the effectiveness of the campaign at promoting adoption and implementation of workplace sun protection policies, and c) assess whether policy adoption is associated in increases in workers' sun protection practices. An advisory board of public administrators and health experts has been constituted to advise the investigators on campaign and evaluation procedures. Analysis of public employers' existing policies and practices, additional in-depth interviews with public administrators, information design analysis, and usability testing will be conducted to develop an effective campaign. The campaign will be evaluated in a group-randomized, pretest-posttest controlled design. City and county governments in Colorado will serve as the unit of randomization and analysis. Interviews will be conducted with a sample of administrators at these public employers at baseline, interim posttest (n=6 per employer) and final posttest (n=5 per employer). In a subsequent four-year follow-up, surveys with employees and front line supervisors will assess employees' sun protection practices and workplace actions to support employee sun safety; (2) on-site observations of sun protection actions by the employers (e.g., posters, sunscreen, shade structures) will be documented; and (3) costs of implementing the policy campaign and induced employer costs will be tracked. Public employers will be studied because they employ a sizable number of outdoor workers (but results should generalize to for-profit companies). Outcomes will be evaluated at the employer, administrator, and employee levels. At the employer level, adoption of workplace sun protection policies at pretest and each posttest will be assessed with a protocol for coding written workplace policies (primary outcome measure) that demonstrated high reliability in a pilot study. At the administrator level, policy implementation (secondary outcome), theoretical mediators of adoption and implementation, and individual, organizational, political decision making and program variables that might moderate change will be measured in baseline, interim posttest (halfway through the intervention) and final posttest (end of intervention) surveys. At the employee level, analyses will compare the sun protection practices of employees between workplaces that received the intervention and controls and among workplaces that provided education and adopted policy, provided education only, and control workplaces. Analyses will also determine if the extent of sun protection actions by employers influences employees' sun safety practices. At the cost level, the economic evaluation will estimate the return on investment (i.e., comparison of the estimated program benefits to combined cost elements). The proposed study is significant and innovative because it provides critical information applicable to a wide range of industrial sectors with outdoor workers on a workplace risk that has received scant attention. Determining the effectiveness and return on investment of prevention programs is essential for national and local resource investment.

Sun Safe Workplaces: A Campaign on Sun Protection Policies for Outdoor Workers

Project staff coded written workplace policy documents on the presence of 15 "content categories" in three domains: 1) environmental controls; 2) administrative procedures; and 3) personal protection practices. Presence of policy was defined as having one or more policy components present in the written workplace policy documents (value=1) versus no content components present (value=0).

Managers reported whether local government organization provided any of the following to employees (0=No, 1=Yes): sunscreen, wide-brimmed hats, sunglasses, long-sleeved work or uniform shirts, long work or uniform pants, temporary or permanent shade, adjusted works schedules to reduce time outdoor at midday, communication about sun protection with employees. Total number of actions performed at the local government organization was summed.

Managers reported whether the local government organization had formal written policy, administrative procedure, or training standard on sun protection for its employees (0=No or Don't Know, 1=Yes).

Employees who work outdoors reported their frequency of taking the following actions to protect their skin from the sun (1=Never, 2=Rarely, 3=Sometimes, 4=Often, 5=Always): apply sunscreen with sun protection factor (SPF) of 15 or more, wear clothing specifically to protect skin from the sun such as long-sleeved shirts and pants, wear a hat with a brim, wear a hat with a wide-brim, wear sunglasses, limit exposure to the sun during the midday hours, and stay mostly in the shade. The frequency rating are averaged to form a composite sun protection score.

Project staff coded written workplace policy documents on the presence of 15 "content categories" in three domains: 1) environmental controls; 2) administrative procedures; and 3) personal protection practices. Extent of policy was defined as the number of policy content components present in the written workplace policy documents (values=0 to 15).

Project staff coded written workplace policy documents on the presence of 15 "content categories" in three domains: 1) environmental controls; 2) administrative procedures; and 3) personal protection practices. Extent of policy was defined as the sum of the strength scores (0=no advice; 1=recommended; 2=required) for each policy content component present in the written workplace policy documents (values=0 to 30).

Study title	NCT ID	Conditions	Interventions	Eligibility	Organization
Sun Safe Workplaces: Assessment of Benefits and Costs of a Policy Intervention	NCT03281161	Skin Cancer	Sun Safe Workpl... Attention Contr...	18 Years -	Klein Buendel, Inc.
Sun Safe Workplaces: Assessment of Benefits and Costs of a Policy Intervention	NCT03281161	Skin Cancer	Sun Safe Workpl... Attention Contr...	18 Years -	Klein Buendel, Inc.
Sun Safe Workplaces: A Campaign on Sun Protection Policies for Outdoor Workers	NCT02824289	Skin Cancer	Sun Safe Workpl... Attention Contr...	18 Years -	Klein Buendel, Inc.
Sun Safe Workplaces: A Campaign on Sun Protection Policies for Outdoor Workers	NCT02824289	Skin Cancer	Sun Safe Workpl... Attention Contr...	18 Years -	Klein Buendel, Inc.

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