Skin Cancer Knowledge, Beliefs, Self-Efficacy, and Preventative Behaviors among North Mississippi Landscapers

There are slightly over one million workers in the landscape service industry in the US. These workers have potential for high levels of solar ultraviolet radiation exposure, increasing their risk of skin cancer. A cross-sectional sample of 109 landscapers completed a self-administered questionnaire based on Health Belief Model (HBM). The participants correctly answered 67.1% of the knowledge questions, 69.7% believed they were more likely than the average person to get skin cancer, and 87.2% perceived skin cancer as a severe disease. Participants believed that the use of wide-brimmed hats, long sleeved shirts/long pants, and sunscreen was beneficial but reported low usage of these and other sun protective strategies. The primary barriers to using sun protection were “I forget to wear it” and “it is too hot to wear.” Of the HBM variables, perceived benefits outweighing perceived barrier ( , ) and self-efficacy ( , ) were correlated with sun protection behaviors. The reasons for absence of the relationship between perceived skin cancer threat and sun protection behaviors could be lack of skin cancer knowledge and low rate of personal skin cancer history. 1. Introduction In the US, there are millions of workers in the outdoor occupations who have the potential for overexposure to solar ultraviolet radiation (UVR), placing them at higher risk of developing skin cancer [1, 2]. Outdoor workers are generally exposed to UVR during work for two to eight hours which far exceeds recommended guidelines [3, 4]. Additionally, a vast majority of outdoor jobs in the US are held by fair skinned individuals who are increasingly at risk of skin cancer [5]. However, several studies report that some outdoor workers are engaging in sun protection practice but a large population of outdoor workers continues to show inadequate levels of sun protection [6]. This use of inadequate levels of sun protective behaviors amongst outdoor workers could be due to many of the outdoor workers being males, who often engage in lower levels of sun protection behaviors than females [5]. A review article showed that a number of research studies were conducted on outdoor workers to assess quantitative data of sun exposure and sun protection behaviors, with the majority of studies carried out on farmers and recreation workers [6]. Nonetheless, far too little attention was given to members of other occupational groups that work outdoors, such as landscapers. It was estimated in the US that there are slightly over one million workers in the landscape service industry [7]. To best of our knowledge,