ORIGINAL RESEARCH article

Front. Public Health

Sec. Radiation and Health

Volume 13 - 2025 | doi: 10.3389/fpubh.2025.1579180

This article is part of the Research TopicNon-Ionizing Radiation: Impacts on Human Health from Exposures in Occupational SettingsView all articles

Evaluation of a Toolbox for the Prevention of Skin Cancer Among Outdoor Workers: An Intervention Study

Provisionally accepted
Florentine de BoerFlorentine de Boer1*Daisy VreenegoorDaisy Vreenegoor1Jos TwiskJos Twisk2Jack van der GragtJack van der Gragt3Thomas RustemeyerThomas Rustemeyer4Sanja KezicSanja Kezic1*Henk Van Der MolenHenk Van Der Molen1
  • 1Department of Public and Occupational Health, Amsterdam Public Health Research Institute, VU Medical Center, Amsterdam, Netherlands, Netherlands
  • 2Department of Epidemiology and Data Science, Amsterdam University Medical Center, Amsterdam, Netherlands
  • 3Volandis, The Dutch knowledge and advice center for the construction industry, Harderwijk, Netherlands
  • 4Department of Dermatology, Amsterdam University Medical Center, Amsterdam, Netherlands

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Due 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.This 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 six weeks . Secondary outcomes included sun-protective behavior, workplace encouragement, knowledge and attitude/motivation, all assessed using questionnaires.A 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.The toolbox intervention led to a reduction of internal UVR exposure, consistent with a selfreported 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

Keywords: Tables: 3 + 1 Supplementary Figures: 3 Files: 2 Supplementary files non-melanoma skin cancer, solar radiation, Ultraviolet exposure, Construction workers, arboricultural workers, occupational disease, Sunscreen use, stratum corneum

Received: 18 Feb 2025; Accepted: 14 May 2025.

Copyright: © 2025 Boer, Vreenegoor, Twisk, Gragt, Rustemeyer, Kezic and Van Der Molen. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

* Correspondence:
Florentine de Boer, Department of Public and Occupational Health, Amsterdam Public Health Research Institute, VU Medical Center, Amsterdam, 1105, Netherlands, Netherlands
Sanja Kezic, Department of Public and Occupational Health, Amsterdam Public Health Research Institute, VU Medical Center, Amsterdam, 1105, Netherlands, Netherlands

Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.

Supplementary Material