Insufficient Primary Photoprotective Behaviours Assessment Among Outdoor Workers Calls for an Update in the Evaluation of Sun Safety Strategies in Industry, Maintenance, and Construction Professions: A Literature Review

To the editor,

Outdoor workers (OW), who are occupationally exposed to ultraviolet (UV) radiation, are faced with a significant skin cancer burden worldwide. ¹ OW are indeed more at risk for actinic keratosis, basal cell carcinoma, and squamous cell carcinoma. ² Additionally, they face an increased risk of high-grade disease and associated mortality.^3,4 OW have also shown a lower health literacy, thus highlighting the importance of assessing and promoting adequate sun-protective behaviours in this subpopulation. ² This review aims to evaluate and describe tendencies in assessed sun-protection habits in recent studies in OW involved in industry, construction, and maintenance (ICM) sectors and identify potential gaps in essential photoprotective behaviours reporting.

A literature review using predefined Medical Subject Headings (MeSH) terms related to ICM sectors OW occupational UV exposition and photoprotection (articles released from January 1, 2018 to December 31, 2022) was performed on the PubMed electronic database by 2 reviewers. Sectors of ICM employment included construction, postal and delivery services, agriculture, forestry, law enforcement, security and military, landscaping and outdoor maintenance services, and navy and airforce. Reviews and analyses of previously published data and papers not available in English were excluded. Studies presenting data on professions outside of our research scope, such as outdoor leisure professions (lifeguard, state and aquatic parks personnel, ski resorts, outdoor sporting employees) without sub-analyses for our selected professions were excluded (Supplementary Material 1 and Figure S1). An analysis of funding sources (private, public, none, or otherwise unspecified) was performed.

A total of 26 original studies (descriptive and interventional) were compared for reported primary prevention photoprotective methods amongst OW practicing in ICM sectors. Sunscreen use was reported among 100% of study measurements (n = 26), whereas sun-protective headwear and clothing were both reported in 80.8% (n = 21) of studies. However, only 23.1% (n = 6) reported the reapplication of sunscreen during the day; further, only 61.5% (n = 16) and 65.4% (n = 17) respectively assessed sun-protective eyewear and shade-seeking habits in ICM sectors’ OW. Of note, the frequency of sunscreen use during work was reported using a variety of options, but clear definitions of possible answers such as “rarely” or “often” were not always provided to participants, thus possibly affecting results reliability. In summary, 15 studies were funded by public organizations (university and government grants, nonprofit organizations), 2 by pharmaceutical companies, while 5 received no external funding and 4 did not disclose financial information. Median scores per funding category were (in number of assessed photoprotective behaviours, out of 6, r = range): 5 (r = 1–5) for public organizations; 4 (r = 3–6) for self-funded studies; 5 (r = 2–5) for surveys with unspecified financial disclosures. While both surveys privately funded assessed 5 out of the 6 preselected photoprotective behaviours.

While the use of sunscreen is a recognized sun-protection method in the recent literature, other crucial primary prevention methods, especially sunscreen reapplication, are understudied in ICM sectors’ OW, in both descriptive and interventional studies (Supplementary Figure S2). The range of assessed photoprotective behaviours varies across studies and funding sources. This lack of standardization in studies focusing on OW calls for an improvement and a better assessment of other sun-protective behaviours, which could possibly impact the development and implementation of future sun-protective policies and interventions.