Sun Safety Among U.S. Postal Service Letter Carriers ("Project SUNWISE")
|Purpose||Designed to promote sun safety practices to postal service letter carrier employees. (2007)|
|Program Focus||Awareness building and Behavior Modification|
|Age||Adults (40-65 years), Young Adults (19-39 years)|
|Race/Ethnicity||American Indian, Asian, Black, not of Hispanic or Latino origin, Hispanic or Latino, Pacific Islander, White, not of Hispanic or Latino origin|
|Setting||Suburban, Urban/Inner City, Workplace|
|Funded by||NCI (Grant number(s): R01CA85980)|
Sun Safety Among US Postal Service Letter Carriers ("Project SUNWISE") is a skin cancer prevention intervention promoting the regular occupational use of wide-brimmed hats and sunscreen by USPS letter carriers.
Health educators visit participating postal stations and distribute free 12-ounce refillable bottles of sunscreen, hats, and coupons for discounts on replacement hats to the letter carriers. The health educators install large pump bottles of sunscreen in locker rooms at the intervention stations, which they refill regularly. They also distribute materials to promote use of solar protective strategies.
In addition, the health educators deliver an introductory presentation at the beginning of the intervention followed by five 5- to 10-minute on-site educational presentations over a 2-year period. The introductory presentation includes information on the amount of UVR letter carriers are exposed to and UVR as a skin cancer risk factor. A case study is given of a former carrier who had a precancerous growth removed. Protection strategies and specific information about the hats and sunscreen are given. Subsequent presentations offer the following themes: (1) importance of sun safety, even in winter; (2) sun safety for the eyes; (3) sharing sun safety tips with loved ones; (4) relevance of sun safety to letter carriers of all races/ethnicities; and (5) recap and encouragement to continue practicing sun safety behaviors. The presentations are given using large flip charts with colorful illustrations tailored to letter carriers.
The Implementation Guide is a resource for implementing this program. It provides important information about the staffing and functions necessary for administering this program in the user's setting. Additionally, the steps needed to carry out the research-tested program, relevant program materials, and information for evaluating the program are included. The Implementation Guide can be viewed and downloaded in the Products page.
Community Preventive Services Task Force Finding
The program toolkit includes the following materials:
- Postal scripts for sun safety presentations (6 sessions)
- Wide-brimmed hats (to be provided by the implementer)
- Sunscreen (to be provided by the implementer)
Although not required, research staff also distributed water bottles, mouse pads, key chains, and magnetic clips imprinted with sun safety messages. Additionally, an "ask the skin doctor" poster was placed in the break room and was updated monthly with sun safety questions asked by members of the target audience and answers provided by a dermatologist.
Costs associated with the program's implementation are not provided.
About the Study
Sun Safety Among US Postal Service Letter Carriers ("Project SUNWISE") was evaluated using a randomized controlled trial of a sun safety intervention, with randomization at the USPS station level. Seventy postal stations participated, representing three geographic regions in Southern California: San Diego County, Riverside County (nondesert) and San Bernardino County, and Riverside County (desert). The local postmaster and the USPS district manager ensured the participation of these stations.
Approval for all study-related procedures and materials was obtained from USPS officials (regional) and from the National Association of Letter Carriers (local, regional, and national). To meet the required number of stations, all but two stations in San Diego County were included, and the remaining stations were those located closest to San Diego County. Employees at the remaining two San Diego stations provided input on all intervention strategies during their development. Stations were stratified by region and were randomly assigned to either intervention or control group (delayed intervention). Within each station, the researchers attempted to recruit all letter carriers to participate voluntarily in the evaluation cohort. Small incentives (valued at less than $10 each) were used to promote participation in each evaluation.
Data were collected at baseline and 3 months, 1 year, and 2 years later. At the baseline evaluation, letter carriers were unaware of their station's study group, and data collectors were blinded to group assignment. Until the completion of the 2-year evaluation, control stations received evaluation procedures only. After that, they received all components of the intervention during a 1-year period.
The final sample included 1,183 intervention participants and 1,318 control participants. They had a mean age of 43 years (SD=8.6) and had worked for the USPS for an average of 12.4 years (SD=7.9). The majority were men (69.9%), were married (69.3%), and had completed at least some college (71.7%). The sample was 51.3% non-Latino White, 19.3% Latino, 12.4% Asian, 8.3% African American, 4.3% Pacific Islander, 0.6% American Indian, and 3.7% other race/ethnicity.
The primary outcomes were self-reported occupational use of (1) sunscreen with an SPF of 15 or higher and (2) wide-brimmed hats (>2.5 inches wide). These behaviors were measured at the stations via a paper-and-pencil questionnaire, which asked how often respondents had used each item while carrying mail during their past 5 workdays.
Effects on Use of Wide-Brimmed Hats While Delivering Mail
- The percentage of postal carriers reporting the use of wide-brimmed hats during their past 5 workdays increased significantly (p<.05) from baseline to 3-month follow-up for the intervention group (from 27.3% to 42.7%), but not for the control group (from 21.0% to 21.4%). This effect persisted at the 1-year follow-up (41.4% for intervention vs. 24.0% for control, p<.05) and 2-year follow-up (40.0% for intervention vs. 22.3% for control, p<.05).
Effects on Use of Sunscreen While Delivering Mail
- The percentage of postal carriers reporting the use of sunscreen during their past 5 workdays increased significantly (p<.05) from baseline to 3-month follow-up for the intervention group (from 26.9% to 39.4%), but not for the control group (from 23.5% to 23.1%). This effect persisted at the 1-year follow-up (41.6% for intervention vs. 28.1% for control, p<.05) and 2-year follow-up (39.2% for intervention vs. 26.3% for control, p<.05).
Mayer,J.A.; Slymen,D.J.; Clapp,E.J.; Pichon,L.C.; Eckhardt,L.; Eichenfield,L.F.; Elder,J.P.; Sallis,J.F.; Weinstock,M.A.; Achter,A.; Balderrama,C.; Galindo,G.R.; Oh,S.S.; (2007). Promoting sun safety among US Postal Service letter carriers: impact of a 2-year intervention. American Journal of Public Health, 97 (3), 559-565.
Mayer, J. A., Slymen, D., Clapp, E. J., Pichon, L. C., Elder, J. P., Sallis, J. F., Eichenfield, L. F., & Weinstock, M. A. (2009). Long-term maintenance of a successful occupational sun safety intervention. Archives of Dermatology, 145 (1), 88-89.
Pichon, L. C., Mayer, L. A., Slymen, D. J., Elder, J. P, Lewis, E. C., & Galindo, G. R. (2005). Ethnoracial differences among outdoor workers in key sun-safety behaviors. American Journal of Preventive Medicine, 28 (5), 374-378.
Oh, S. S., Mayer, J. A., Lewis, E. C., Slymen, D. J., Sallis, J. F., Elder, J. P., Eckhardt, L., Achter, A., Weinstock, M., Eichenfield, L., Pichon, L. C., & Galindo, G. R. (2004). Validating outdoor workers' self-report of sun protection. Preventive Medicine, 39 , 798-803.