Sociodemographic and Psychological Correlates of Sun Protection Behaviors among Outdoor Workers: A Review

Table 1

A Summary of the reviewed studies.

Author, date	Study design, methods	Population, sample size (n)	Average sun exposure and occupational years	Sun protection behaviors	Barriers to sun protection	Correlates of sun protection behavior	Limitations
Marlenga [36]	Cross-sectional Self-administered mail surveys	Dairy farmers, 100% male, 𝑛=202	4.15 hours/day; 42.95 years	Long pants (90%), wide-brimmed hat (13%), sunscreen (8%), and long-sleeved shirts (7%)	Too hot to wear long-sleeved shirt (88%), tan looks attractive (>50%), and I forgot to wear sunscreen (45%)	Psychological: perceived barriers	Results were not generalizable to all farmers
Rosenman; et al. [32]	Cross-sectional Self-administered mail survey	Farmers, 𝑛 = 1,342	Not reported	65% of the women and 43% of the men were very likely to practice some type of sun protection	Not reported	Demographic: female gender, increased age, higher personal history of skin cancer, and greater income among females	Results were not generalizable to all rural populations; Superficial data on potential confounders
Parrott; et al.[37]	Cross-sectional pilot Intercept survey, field; observations, and in-depth interviews	Intercept survey: 155 farmers, 100% White; Fields observations: 49 farmers, 41 construction workers, 39 road workers, and 15 other outdoor workers; In-depth interview: 9 farmers	Not reported	65% did not wear long-sleeved shirts, 49%; did not apply sunscreen, and 43% did not wear wide-brimmed hats	Amount of time needed to put on long-sleeved shirt (30%), wide-brimmed hats are uncomfortable (21%), and sunscreen is messy to apply (11%)	Demographic: increased age	Not reported
Stepanski; and Mayer [35]	Cross-sectional; field observation,; and self-administered survey	Construction workers,; Caltransworkers,; and mail carriers; 80.1% males and 61.0% White, 𝑛=240 (survey data); 𝑛=312 (observation data)	5.11–7.94 hours/work day	50.4% reported sufficient use of sun protection (observational data)	Not reported	Not found	Observational data did not represent typical sun protection behavior; Convenience sample; Recall, social desirability, and self-selection bias; Study design
Shoveller; et al. [38]	Cross-sectional; Telephone survey	General outdoor workers, 80% male, 𝑛=546	>2 hours/work day (70%)	Sun protective clothing (60%), hat (58%), sunscreen on face (23%), and sunscreen on body (18%)	I forgot (61%), inconvenient (54%), liked tanned skin (38%), and not worried about UVR exposure (34%)	Not reported	No information was provided about types of hats worn and lengths of sleeves on shirts
Cioffi; et al. [39]	Cross-sectional; Self-administered survey	Construction workers, 97.8% males, 𝑛=142	Not reported	Sunglasses (61%), wide-brimmed hat (54%), sunscreen (34%), long-sleeved shirt (11%), and use of shade (5%)	Perceived tan is attractive (72%) and healthy (44%)	Not reported	Validity and reliability of instrument was not tested; Convenience sample
Woolley; et al. [29]	Cross-sectional; Self-administered mail survey	General outdoor workers, 100% males, 𝑛=300	>50% of mainly outdoor workers spent >6 hours/work day	Wide-brimmed hat (77.2%) and long-sleeved shirts (43.6%)	Not get around to putting it on (24%), inconvenience (22%), and forget to bring it along (21%)	Demographic: sun sensitive skin type and personal history of skin cancer	Recall bias; Self-selection bias; Low response rate
Parrott and; Lemieux [40]	Cross-sectional; Telephone survey	Farmers, 100% males, 𝑛=448	37.5 years	Not reported	Not reported	Psychological: knowledge about skin cancer; Social: families’ expectations and familial information giving	Not reported
Pichon; et al.[6]	Cross-sectional; Self-administered survey	Postal workers, 68% males, 53.63% White, 𝑛= 2,543	4 hours/day; 12 years	Sunscreen (14–30%), wide-brim hat (20–34%), and sunglasses use (44%–63%)	Not reported	Demographic: ethnicity, sensitive skin type, female gender (sunscreen), and male gender (hat)	Self-identified race; Social desirability bias
Salas; et al. [41]	Cross-sectional; Interview and observation; Self-administered survey	Farmworkers, 100% males, 100% Latino, 𝑛=326	14.23 years	Long-sleeved shirt (89.7%), wide-brimmed hat (6%), sunglasses (2.6%), and sunscreen (1.6%)	Not reported	Demographic: longer years of work	Design of the study; Convenience sample; Social desirability bias
Lewis; et al. [33]	Cross-sectional; Field observation; Self-administered survey	Postal workers, 69% males, 51.3% White, 𝑛 = 2,600	3.9 hours/work day; 3.3 hours/nonwork day	Sunscreen during work (25%); Sunscreen during leisure time (12%); Hat during work (24%); Hat during leisure time (4%)	Not reported	Demographic: ethnicity, sun sensitive skin type, hours spent outdoors, female gender with sunscreen use, male gender with hat use,; and family history of skin cancer	Design of the study; Differences in time period for reporting work days (5 days) and nonworking days (2 days) sun safety behavior
Hammond; et al. [42]	Cross-sectional; Self-administered survey; Sun protection chart diary	Horticulture, roading, and building, 82% males, 𝑛=74	Not reported	Not reported	Not reported	Psychological: suntan attitude and perceived risk of skin cancer; Social: workplace support	Validity and reliability was not checked; Small sample size; Convenience sample; Low response rate
Gies; et al. [43]	Cross-sectional; Field observation; Self-administered survey; 4-day diary	Lifeguards, 59.3% females, 𝑛=168	4.29 hours/day	Phoenix: sunglasses (90.4%) and sunscreen (76.4%); Austin: hat (37%) and shade (31.2%); Portland: shirt (31.3%)	Not reported	Not reported	2-day UVR exposure measurements; Difference in availability of natural shade at each pool site
McCool; et al. [34]	Cross-sectional; Self-administered survey	General outdoor workers, 𝑛 = 1,283	Not reported	Not reported	Not reported	Demographic: female gender, increased age, and higher education; Psychological: knowledge, perceived priority of sun protection, and higher concern about sun exposure; Social: workplace support	Use of other sun protection measures (e.g., clothing and hat) were not investigated; Self-selection bias
Madgwick; et al. [44]	Cross-sectional; Self-administered survey	Construction workers, 100% male, 𝑛=360	6.6 hours/day	Sunscreen (60%), wearing long-sleeved loose fitted tops and trousers (51%), sunglasses (44%), and wide-brimmed hat (23%)	Not reported	Demographic: age, personal history of skin cancer, family history of skin cancer, hours spent outdoors, and receipt of sun safety training; Psychological: desire for suntan	Self-selection bias; Response bias