摘要：Objectives. We examined whether US Postal Service letter carriers who received a sun safety intervention would wear wide-brim hats and sunscreen significantly more often than those who did not receive the intervention. Methods. We used a 2-group randomized design with 2662 evaluation cohort participants from 70 US postal stations. Evaluations were conducted at baseline, 3 months, 1 year, and 2 years. Questionnaire items assessed occupational use of sun-screen and wide-brim hats. The 2-year sun safety intervention included the provision of wide-brim hats, accessible sunscreen, reminders, and 6 educational sessions. Results. At the 3-month follow-up evaluations, the odds ratio (OR) for regular sun-screen use was 2.8 times higher among the intervention group than among the control group (95% confidence interval [CI]=2.2, 3.5); at the 2-year follow-up evaluations, the rate was still significantly higher (OR=2.0; 95% CI=1.6, 2.6). Intervention group participants also had significantly higher rates of hat use, with the differences remaining consistent across all follow-ups (OR=2.9; 95% CI=2.3, 3.6). Conclusions. The intervention should be disseminated to postal stations nationwide and possibly to other occupational groups that work outdoors. In 2006, approximately 62 190 people in the United States were diagnosed with melanoma, and more than 1 million were diagnosed with nonmelanoma skin cancers. 1 Exposure to solar ultraviolet radiation (UVR) is a key risk factor for these diseases. 2 – 5 Outdoor workers may receive 6 to 8 times the dose of UVR that indoor workers receive, 6 and they have a higher risk for squamous cell cancer 7 , 8 and possibly other forms of skin cancer. 9 , 10 In a descriptive study, US Postal Service (USPS) letter carriers reported working outdoors an average of 5 hours per day, but only 14% reported that they always wore sun-screen, and only 33% reported that they always wore a hat. 11 Using these data and the results from multiple formative evaluation strategies, we developed an intervention for increasing specific sun safety behaviors among this population. The intervention targeted the regular occupational use of wide-brim hats and sunscreen with a SPF of 15 or higher for 2 reasons: (1) previous data have shown the efficacy of these strategies in reducing UVR exposure and its consequences, 12 – 26 and (2) these target behaviors likely would be feasible for letter carriers to perform. We predicted that letter carriers at the postal stations assigned to receive the sun safety intervention would wear wide-brim hats and sunscreen while on the job more often than would letter carriers at the control postal stations.
