UV radiation is the main preventable cause of skin cancer, and outdoor workers are a high-risk group.1–3 Skin cancer induced by UV radiation is a recognized occupational disease, but preventive measures for outdoor workers are rare in the construction sector.4
We performed a cross-sectional study to analyze sun exposure behaviors and skin cancer and UV radiation literacy among workers with different levels of education at an outdoor construction site. After reviewing the relevant literature,5 we designed a questionnaire consisting of 23 questions to collect information on demographic, constitutional, and socioeconomic factors, sun exposure behaviors, and knowledge about skin cancer and UV radiation. Level of education was classified as primary (4-6 six years of schooling), secondary (9-10 years), or university (degree). We created contingency tables and analyzed associations using the X2 test of independence. Statistical significance was set at a P level of less than .05.
All the construction workers (n = 95) completed the questionnaire; they had a mean age of 42 years and 88% were men.
Workers with a primary education were more likely to work outdoors (97% vs. 64%, P < .001) and to have experienced sunburn during work (36% vs. 13%, P < .001). They were less likely to be screened for skin cancer (10% vs. 28%, P = .024).
Most workers, regardless of their level of education, did not associate actinic keratosis with a risk of skin cancer. Workers with a university degree were largely aware that a high index of UV did not necessarily mean high temperatures (95% vs. 44%, p < .001), but only half knew what the UV index scale was (Table 1). These rates, however, are higher than those reported elsewhere.6
Sun Exposure Behavior and Literacy Among Construction Site Workers (n = 95) by Level of Education.
| Education | |||||||
|---|---|---|---|---|---|---|---|
| Primary (n = 33, 34%) | Secondary (n = 24, 25%) | University (n = 39, 41%) | |||||
| No. | (%) | No. | (%) | No. | (%) | P | |
| Sex | <. 001** | ||||||
| Male | 32 | (97) | 24 | (100) | 26 | (68) | |
| Skin type | .596** | ||||||
| I | 3 | (13) | 1 | (5) | 1 | (3) | |
| II | 7 | (29) | 4 | (20) | 15 | (39) | |
| III | 8 | (33) | 8 | (40) | 15 | (39) | |
| IV | 6 | (25) | 6 | (30) | 6 | (16) | |
| V | 0 | (0) | 1 | (5) | 1 | (3) | |
| Outdoor work | < .001* | ||||||
| Yes | 32 | (97) | 22 | (92) | 25 | (64) | |
| Outdoor leisure activities | .192* | ||||||
| Yes | 24 | (75) | 22 | (92) | 34 | (87) | |
| History of sunburn during outdoor work | <.001** | ||||||
| Yes, 1-2 episodes | 6 | (18) | 2 | (8) | 5 | (13) | |
| Yes, ≥ 3 episodes | 6 | (18) | 0 | (0) | 0 | (0) | |
| Did not recall | 5 | (15) | 0 | (0) | 0 | (0) | |
| History of sunburn during outdoor leisure activities | .056** | ||||||
| Yes, 1-2 episodes | 8 | (25) | 6 | (25) | 14 | (36) | |
| Yes, ≥ 3 episodes | 4 | (13) | 1 | (4) | 6 | (15) | |
| Did not recall | 4 | (13) | 0 | (0) | 0 | (0) | |
| Skin cancer screening | |||||||
| Yes | 3 | (10) | 1 | (4) | 11 | (28) | .024** |
| Self-skin examination | |||||||
| Yes | 9 | (28) | 8 | (35) | 19 | (49) | .202* |
| Holidays in a tropical country | |||||||
| Yes | 10 | (31) | 3 | (13) | 21 | (54) | .003* |
| The following conditions are associated with skin cancer: | |||||||
| Actinic keratosis | .116* | ||||||
| Yes | 3 | (23) | 5 | (50) | 13 | (59) | |
| Basal cell carcinoma | .004** | ||||||
| Yes | 8 | (62) | 4 | (50) | 26 | (96) | |
| Squamous cell carcinoma | .004** | ||||||
| Yes | 6 | (50) | 4 | (50) | 25 | (93) | |
| Melanoma | .001** | ||||||
| Yes | 9 | (60) | 5 | (50) | 29 | (97) | |
| Do you tend to consult information on the IPMA? (www.ipma.pt) | .874* | ||||||
| Yes | 13 | (50) | 9 | (43) | 19 | (49) | |
| Are you familiar with the UV index scale? | .027** | ||||||
| Yes | 17 | (59) | 12 | (52) | 32 | (82) | |
| If so, what is the scale? | .766* | ||||||
| 1, 15, 20, 30, 40, 50 | 7 | (54) | 7 | (58) | 13 | (46) | |
| 1-11 | 6 | (46) | 5 | (42) | 15 | (54) | |
| A high UV index always means high temperatures | < .001* | ||||||
| False | 11 | (44) | 6 | (29) | 37 | (95) | |
Abbreviation: IPMA, Instituto Português do Mar e da Atmosfera (Portuguese Institute for the Sea and Atmosphere).
Despite its limitations (self-reported data from a single construction site), our study offers some interesting results. Construction workers with a primary or secondary education have low levels of skin cancer and UV literacy, were more likely to be exposed to sun at work, and were less likely to screened for skin cancer. Only 19% of all workers surveyed had a history of sunburn at work; 40%, by contrast, reported having been burnt during leisure time. There were no significant differences between the groups in terms of sun exposure during leisure time, but, in agreement with reports elsewhere,7 sunburn while doing leisure activities was more common among workers with a university education.
Organizational measures such as scheduling outdoor work during times of the day with a low UV index or providing shade are often not possible in the construction industry. In the interest of occupational safety, it should be obligatory to implement standard sun protection measures and screening programs for workers chronically exposed to UV radiation.
Outdoor workers, and particularly those with a primary school education only, have poor sun exposure habits and low skin cancer literacy.8 Construction companies should target this group of workers, as their protection is an investment opportunity with high returns: improved health, less absenteeism, and lower disease-associated costs.
Conflicts of interestThe authors declare that they have no conflicts of interest.
FundingThe authors would like to thank the Portuguese Skin Cancer Association, its president Dr. António Picoto, and Orquídea Ribeiro for performing the statistical analysis.
Please cite this article as: Duarte AF, Mota I, Campo M, Correia O. Cáncer de piel y alfabetización sobre UV: Estudio en trabajadores al aire libre. Actas Dermosifiliogr. 2020;111:531–533.
