Economic Evaluation of an Intervention Promoting Adoption of Occupational Sun Protection Policies.

OBJECTIVE: Economic evaluation of an intervention promoting adoption of occupational sun protection actions by Colorado public sector employers. METHODS: Randomized controlled trial with 2-year follow-up conducted during 2010 to 2013. Thirty-three intervention and 30 attention-control worksites in final economic sample. Twenty-four-month intervention of personal contacts, training, and materials. Intervention delivery micro-costed. Costs of implemented actions from employer self-report. RESULTS: Twenty-four-month intervention costs: $121,789, 51.8% incurred by project staff (per-worksite mean=$1,732). Worksite costs: $58,631 (mean = $1,777). Per-employee costs: $118 project staff, $56 worksites. Materials cost: $5990 (mean = $181). Intervention worksites implemented 72 nontraining sun protection actions post-Sun Safe Workplaces (SSW) (mean = 2.18). Control worksites implemented 39 actions (mean = 1.30). Total costs to intervention worksites of implementing the 72 post-SSW actions: $90,645 (mean = $2,747). Control worksite costs: $66,467 (mean = $2,216). Per-employee implementation costs are comparable to other worksite health interventions. CONCLUSION: SSW expanded adoption of sun protection actions at a reasonable per-employee cost.

Senior managers' awareness of sun protection policy predicts implementation of worksite sun safety in a randomized trial.

BACKGROUND: Outdoor workers experience chronic exposure to harmful ultraviolet radiation (UV) elevating their risk for skin cancer. METHODS: A controlled randomized trial promoted the adoption of workplace sun safety policy and employee education at 98 public organizations in Colorado. A 2-year follow-up study with 68 organizations assessed the association of senior manager awareness of sun safety policies and implementation of sun safety actions. RESULTS: Senior managers' awareness of existing sun safety policies, but not their personal sun protection behaviors, predicted implementation of sun safety actions including the number of sun protection messages and sun protection items in the workplace and increased communication about sun safety to employees. CONCLUSIONS: Organizational adoption of sun safety policy must include efforts to broadly inform a workplace's senior management to ensure the policies are actually implemented and provide support for sun protection behaviors by outdoor workers to reduce UV exposure and skin cancer risk.

Implementation of Occupational Sun Safety at a 2-Year Follow-Up in a Randomized Trial: Comparison of Sun Safe Workplaces Policy Intervention to Attention Control.

PURPOSE: Implementation of employer sun safety actions was assessed in a 2-year follow-up to an occupational sun protection policy intervention. DESIGN: Two-year follow-up assessment in a randomized pretest-posttest controlled design. SETTING: Local government organizations with workers in public safety, public works, and parks and recreation. PARTICIPANTS: Sixty-three local government organizations (participation = 64%) and 330 frontline supervisors and 1454 workers. INTERVENTION: Sun Safe Workplaces (SSW) intervention promoting occupational sun safety policy and education. MEASURES: Observations of SSW messages and sun safety items and surveys on organizations' communication and actions on sun safety. ANALYSIS: Comparison between SSW and control groups was conducted using regression models and adjusted for clustering where appropriate, with α criterion set at P = .05 (2-tailed). RESULTS: At intervention worksites, more SSW messages ( P < .001) and sun safety items ( P = .025) were observed; more frontline supervisors reported organizations provided free/reduced price sunscreen ( P = .005) and communicated about sun safety ( P < .001); and more workers recalled receiving sun safety messages ( P < .001) and sun safety training ( P <.001) compared to control organizations. Implementation was greater at larger than smaller intervention organizations for wide-brimmed hats ( P = .009), long work pants ( P = .017), and shade structures ( P = .036). Older workers received the most written messages ( P = .015). CONCLUSIONS: Sun Safe Workplaces appeared to produce actions by organizations to support employee sun safety. Large organizations may have processes, communication channels, and slack resources to achieve more implementation.

Sun Safe Workplaces: Effect of an Occupational Skin Cancer Prevention Program on Employee Sun Safety Practices.

OBJECTIVE: Occupational skin cancer prevention is a priority because outdoor workers are exposed to high levels of ultraviolet radiation, the primary risk factor for skin cancer. METHODS: A 2-year follow-up assessment of the impact of Sun Safe Workplaces (SSW), a workplace sun safety program that promoted policy adoption and education, on employee sun safety behavior was conducted. Sixty-three of 98 local government organizations from the original study participated. RESULTS: Outdoor workers (n = 1724) completed surveys on personal sun protection practices. Employees' sun protection improved statistically significantly in the intervention group receiving the SSW program. SSW's effect was mediated by the number of workplace actions to implement elements of the policy, including sun protection messages and equipment and employee reports of sun safety training. CONCLUSION: Policy promotion is a feasible approach to occupational skin cancer prevention.

Results of a Randomized Trial on an Intervention Promoting Adoption of Occupational Sun Protection Policies.

PURPOSE: To evaluate an intervention promoting adoption of occupational sun protection policies by employers in a randomized trial. DESIGN: A randomized pretest-posttest controlled design with 2-year follow-up was conducted in 2010 to 2013. SETTING: Local government organizations in Colorado who had outdoor workers in public works, public safety, and/or parks and recreation. PARTICIPANTS: Ninety-eight local government organizations (n = 51 municipalities, 10 counties, and 37 special districts). INTERVENTION: Organizations were randomly assigned to receive a policy and education intervention comprised of personal contacts and theory-based training and materials or to an attention control group. MEASURES: Occupational policy documents were coded for sun safety content by a trained research assistant blind to condition. ANALYSIS: Policy scores were analyzed with logistic and Poisson regression models using imputation. RESULTS: At posttest, more organizations in the intervention group had a sun protection policy than in the control group (odds ratio [OR] = 4.91, P < .05; intent to treat: OR = 5.95, P < .05) and policies were more extensive (χ2 = 31.29, P < .01; intent to treat: χ2 =73.79, P < .01) and stronger (χ2 = 24.50, P < .01; intent to treat: χ2 = 51.95, P < .01). Policy adoption was higher when the number of contacts and trainings increased ( P < .05). CONCLUSION: The intervention had a large effect on adoption of formal sun protection policies, perhaps because of its fit with legal requirements to maintain safe workplaces. Personal contacts with managers were influential on adoption of occupational policy even in this age of communication technology and social media.

Factors Associated With Occupational Sun-Protection Policies in Local Government Organizations in Colorado.

IMPORTANCE: Skin cancer prevention remains a national priority. Reducing chronic UV radiation exposure for outdoor workers through sun-safety practices is an important step to help reduce the incidence of skin cancer. OBJECTIVE: To determine the presence of occupational sun-safety policies at local government organizations in a single state. DESIGN, SETTING, AND PARTICIPANTS: Of 571 potentially eligible local government organizations of Colorado cities, counties, and special tax districts, we enrolled 98 in a randomized pretest-posttest controlled experiment starting August 15, 2010, that evaluated an intervention to promote the adoption of sun-safety policies. We used a policy-coding protocol to evaluate personal sun-protection practices, environmental and administrative controls, and policy directives for sun safety starting February 10, 2011. We report the baseline assessment of the occupational sun-protection policies of these organizations. MAIN OUTCOMES AND MEASURES: The presence of an occupational sun-safety policy. RESULTS: Overall, 85 local government organizations (87%) had policies that required personal sun-protection practices, including the use of eyewear, hats, and protective clothing. However, of the 98 responding organizations, only 8 hat policies (8%), 10 eyewear policies (10%), and 7 clothing policies (7%) mentioned sun protection as the intent of the policy. Only cosmopoliteness, operationalized as proximity to an urban area, was associated with the presence of a sun-safety policy (odds ratio, 0.99 [95% CI, 0.98-1.00]; P = .02). CONCLUSIONS AND RELEVANCE: Outdoor workers are at increased risk for skin cancer because of long-term exposure to solar UV radiation. Although organizational policies have the potential to increase sun protection in occupational settings, occupational sun-safety policies were uncommon among local governments. Opportunities exist for dermatologists and other physicians to influence occupational sun-safety practices and policies, which are consistent with other safety procedures and could easily be integrated into existing workplace practices.

Adoption of sun safe workplace practices by local governments.

CONTEXT: Outdoor workers are especially susceptible to skin cancer--the most common, but also one of the most preventable, forms of cancer. Colorado, the location of the study, has the second highest rate of skin cancer deaths in the nation. OBJECTIVE: Local government managers in Colorado-in municipalities, counties, and special districts-were surveyed to ascertain the extent to which they engage in formal (written) and informal practices to protect their outdoor workers against excessive exposure to sun. DESIGN: The survey consisted of 51 questions assessing awareness of formal or informal practices for sun protection of outdoor workers. An index of practices--the study's dependent variable--was created that was composed or practices such as providing employees free or reduced-cost sunscreen, wide-brimmed hats, sunglasses, long-sleeved work shirts, long work pants, and temporary or permanent outdoor shade shelters. Proscriptive policies, such as restricting the use of broad brimmed hats, were subtracted from the index. Surveys were completed by 825 administrators representing 98 jurisdictions. Responses from administrators in the same jurisdiction were averaged. RESULTS: More than 40% of responding jurisdictions indicated that they engaged in informal sun safety practices. Tests conducted to determine what variables might account for the adoption of these sun protection practices found that the degree to which a community could be regarded as cosmopolite and as having an individualistic political culture were significant predictors. Type of government was also significant. Although, higher community income was a significant predictor, neither local government budget nor size was significant. CONCLUSIONS: The adoption of sun safe practices bears low costs with potentially high returns. Findings from this study suggest that awareness campaigns might most effectively target cosmopolite communities, but that the greatest impact might be achieved by targeting localite communities. Government size and budget do not appear to be constraints in the adoption of sun safe practices.

Leadership training to improve nurse retention.

AIM: This paper discusses findings from an evaluation of a training programme designed to promote collaborative, team-based approaches to improve nurse retention within health care organizations. BACKGROUND: A year-long leadership training programme was designed and implemented to develop effective teams that could address retention challenges in a diverse set of organizations in Colorado ranging from public, private to non-profit. EVALUATION: An evaluation, based on a combination of participant observation, group interviews, and the use of standardized tests measuring individual emotional intelligence and team dynamics was conducted to assess the effectiveness of the training programme. KEY ISSUES: What role do the emotional intelligence of individual members and organizational culture play in team effectiveness? CONCLUSIONS: Out of five teams participating in the training programme, two performed exceptionally well, one experienced moderate success and two encountered significant problems. Team dynamics were significantly affected by the emotional intelligence of key members holding supervisory positions and by the existing culture and structure of the participating organizations. IMPLICATIONS FOR NURSING MANAGEMENT: Team approaches to retention hold promise but require careful development and are most likely to work where organizations have a collaborative problem-solving environment.

Learning how to measure the well-being of OVC in a maturing HIV/AIDS crisis.

The HIV/AIDS epidemic in Africa is frequently referred to as a crisis while the principal U.S. program to address it is labeled emergency relief. These terms trigger specific policy responses and corresponding evaluation activities. In this article, three stages in the response to HIV/AIDS are distinguished: awareness, emergency, and structural integration. In the awareness phase, emphasis is on defining and then estimating the affected population. In the emergency phase, evaluation activity is focused on demonstrating accountability for the assistance provided; and finally, in the structural integration phase, concern shifts to demonstrating the impact of assistance on improving the recipients' well-being. The shifting focus of evaluation is discussed in terms of how to measure the impact of aid on the well-being of orphaned and vulnerable children. A case study based on work in rural Tanzania is presented and then discussed in term of its broader implications for evaluating future aid.