The incidence rates of both melanoma and nonmelanoma skin cancers have been increasing in the U.S. Exposure to ultraviolet radiation (UVR) in both childhood and adulthood is a key risk factor, and workers of outdoor occupations are a high-risk adult population. Pilot data collected by our research group suggest that postal carriers 1) have relatively low levels of sunscreen and protective hat use and 2) respond favorably to the intervention strategies described below. The primary goal of the proposed project is to develop and evaluate an environmentally-based intervention for promoting sun safety behaviors among United States Postal Service (U.S.P.S.) outdoor carriers. The investigators will use a randomized, 2-group design, with 70 individual post office branches assigned to either the intervention or control conditions (a minimum of 1,400 subjects). The intervention package, based on an ecological model of behavior, will consist of increasing carriers' access to sun protective hats and to sunscreen; implementing a variety of prompts for sun safe behaviors into the carriers' environments; and delivering brief educational presentations regarding skin cancer prevention. Outcome measures will include self-reported frequency of key sun protective behaviors over the past week, unobtrusive observations of carriers' protective clothing as they deliver mail, and changes in skin color that are indicative of tanning measured with a calorimeter. All measures will be administered immediately prior to the 2-year intervention (baseline) and at 12, 24, and 36 months post-baseline. The sun safety questionnaire and observations additionally will be administered 3-months post-baseline. Key project objectives include: 1) develop the intervention components using formative evaluation; 2) implement the intervention package described above in the 35 intervention sites; 3) compare the 2 groups on the outcomes measures; and 4) identify factors that may influence the outcome by collecting a variety of process-related data. If successful, this intervention package has a high potential for institutionalization within and dissemination throughout U.S.P.S. sites nationwide.
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