Occupational Solar Exposure at Summer Camp: The Failure to Protect from a Known Hazard





occupational solar exposure, UV exposure, workplace hazards, summer camp, camp counselors


Summer camps are an $18 billion industry while providing over 14,000 individual programs in the United States in 2015. Camp counselors, like other outdoor workers, are at risk of occupational solar exposure. Occupational solar exposure increases an individual’s lifetime accumulation of solar radiation, leading to skin damage and higher rates of skin cancer. This study fills a gap in the research about the sun protection behaviors of camp counselors and their attitude towards protecting themselves and the campers in their care. Overall, counselors did not achieve experts’ recommendations for sun protection. The findings suggest that summer camps are not taking adequate steps to protect their staff from a known workplace hazard. The Occupational Safety and Health Administration appears to currently not be holding summer camps accountable. The findings have implications for hiring, training, and risk management practices for the summer camp industry.

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Abroms, L., Jorgensen, C. M., Southwell, B. G., Geller, A. C., & Emmons, K. M. (2003). Gender differences in youth adults’ beliefs about sunscreen use. Health Education & Behavior, 30(1), 29-43, https://doi.org/10.1177/1090198102239257.

American Academy of Dermatology Association. (2018). Prevent skin cancer. Retrieved from www.aad.org/public/diseases/skin-cancer/prevent/how

American Camp Association. (2016). 2016 ACA camp compensation and benefits report. Retrieved from www.acacamps.org/press-room/aca-facts-trends

American Camp Association. (2015a). ACA camp business operations report. Retrieved from www.acacamps.org/resource-library/research/aca-camp-business-operations-report

American Camp Association. (2015b). Camp enrollment and staff recruitment survey. Retrieved from www.acacamps.org/sites/default/files/resource_library/2015-ACA-Fall-Enrollment-Summary-Results_0.pdf

American Camp Association. (2000). For counselors only: Describing your job skills to future employers. Retrieved from www.acacamps.org/resource-library/camping-magazine/camp-counselors-only-describing-your-job-skills-future-employers

American Cancer Society. (2017). Are some people more likely to get skin damage from the sun? Retrieved from www.cancer.org/healthy/be-safe-in-sun/sun-damage.html

American Cancer Society. (2019). Cancer facts and figures 2019. Retrieved from www.cancer.org/research/cancer-facts-statistics/all-cancer-facts-figures/cancer-facts-figures-2019.html

American Cancer Society. (2019). Ultraviolet (UV) radiation. Retrieved from www.cancer.org/cancer/cancer-causes/radiation-exposure/uv-radiation.html

Apalla, Z., Lallas, A., Sotiriou, E., Lazaridou, E., & Ioannides, D. (2017). Epidemiological trends in skin cancer. Dermatology Practical & Conceptual, 7(2), 1-6, https://dx.doi.org/10.5826%2Fdpc.0702a01

Armstrong, B. K., & Kricker, A. (2001). The epidemiology of UV induced skin cancer. Journal of Photochemistry and Photobiology, 63(1-3), 8-18, https://doi.org/10.1016/S1011-1344(01)00198-1

Azizi, E., Pavlotski, F., Vered, I. & Kudish, Al. (2009). Occupational exposure to solar UVB and seasonal monitoring of serum levels of 25-hydroxy vitamin D3: A case-control study. Photochemistry and Photobiology, 85(5), 1240-1244, https://doi.org/10.1111/j.1751-1097.2009.00569.x

Cetintepe, S. P. (2018). Sun related risks and risk reduction practices in Irish outdoor workers. Occupational Medicine, 68(9), 2018, https://doi.org/10.1093/occmed/kqy142

Champion, V., & Skinner (2008). The health belief model. San Francisco, CA: Jossey-Bass.

Cokkinides, V. E., Johnston-Davis, K., Weinstock, M., O’Connell, M. C., Kalsbeek, W., Thun, M. J., & Wingo, P. A. (2001). Sun exposure and sun-protection behaviors and attitudes among U.S. youth, 11 to 18 years of age. Preventative Medicine, 33(3), 141-151, https://doi.org/10.1006/pmed.2001.0877

Craythorne, E. & Al-Niami, F. (2017). Skin cancer. Medicine, 45(7), 431-434, https://doi.org/10.1016/j.mpmed.2017.04.003

de Gruijl, F. R. (1999). Skin cancer and solar UV radiation. European Journal of Cancer, 35(14), 2003-2009, https://doi.org/10.1016/S0959-8049(99)00283-X

Diepgen, T. L., Fartasch, M., Drexter, H., & Schmitt, J. (2012). Occupational skin cancer induced by ultraviolet radiation and its prevention. British Journal of Dermatology, 167(2), 76-84, https://doi.org/10.1111/j.1365-2133.2012.11090.x

D’Orazio, J., Jarrett, S., Amaro-Oritz, A., & Scott, T. (2013). UV radiation and the skin. International Journal of Molecular Sciences, 14(2013), 12222-12248, https://doi.org/10.3390/ijms140612222

Fairfax, R. E. (1998). PPE for overexposure to the sun’s radiation. Retrieved from www.osha.gov/laws-regs/standardinterpretations/1998-08-28

Fairfax, R. E. (2003). Workplace exposure limits for ultra-violet radiation. Retrieved from www.osha.gov/laws-regs/standardinterpretations/2003-02-26

Fartasch, M., Diepgen, T. L., Schmitt, J., & Drexler, H. (2012). The relationship between occupational sun exposure and non-melanoma skin cancer: Clinical basics, epidemiology, occupational disease evaluation, and prevention. Deutsches Arzteblatt International, 109(43), 715-720, https://dx.doi.org/10.3238%2Farztebl.2012.0715

Gies, P., Glanz, K., O’Riordan, D., Elliot, T., & Nehl, E. (2009). Measured occupational solar UVR exposures of lifeguards in pool settings. American Journal of Industrial Medicine, 52(8), 645-653, https://doi.org/10.1002/ajim.20722

Girgis, A., Sanson-Fisher, R. W., & Watson, A. (1994). A workplace intervention for increasing outdoor workers’ use of solar protection. American Journal of Public Health, 84(1), 77-81.

Gobba, F., Modenese, A., & S.M. John. (2019). Skin cancer in outdoor workers exposed to solar radiation: A largely underreported occupational disease in Italy. Journal of the European Academy of Dermatology and Venereology, 33(11), 2068-2074, https://doi.org/10.1111/jdv.15768

Guy Jr., G. P., Berkowitz, Z., & Watson, M. (2017). Estimated cost of sunburn-associated visits to US hospital emergency departments. JAMA Dermatology, 153(1), 90-92, https://doi.org/10.1001/jamadermatol.2016.4231

Guy Jr. G. P., Machlin, S. R., Ekwueme, D. U., Yabroff, K. R. (2015a). Prevalence and costs of skin cancer treatment in the US, 2002–2006 and 2007–2011. American Journal of Preventative Medicine, 48(2), 183–187, https://doi.org/10.1016/j.amepre.2014.08.036

Guy Jr., G. P., Thomas, C. C., Thompson, T., Watson, M., Massetti, G. M., & Richardson, L. C. (2015b). Vital signs: Melanoma incidence and mortality trends and projections—United States, 1982–2030. MMWR Morbidity and Mortality Weekly Report, 64(21), 591-596.

Holman, C. D., Gibson, I. M., Stephenson, M., & Armstrong, B. K. (1983). Ultraviolet irradiation of human body sites in relation to occupation and outdoor activity: Field studies using personal UVR dosimeters. Clinical and Experimental Dermatology, 8, 269-277, https://doi.org/10.1111/j.1365-2230.1983.tb01779.x

John. S. M., Trakatelli, M., Gehring, R., Finlay, K., Fionda, C., Wittlich, M., Augustin, M., Hilpert, G., Barroso Dias, J. M., Ulrich, C., & Pellacani, G. (2016). Consensus report: Recognizing non-melanoma skin cancer, including actinic keratosis, as an occupational disease-a call to action. Journal of the European Academy of Dermatology and Venerology, 30(3), 38-45, https://doi.org/10.1111/jdv.13608

Kim, I., & He, Y. (2014). Ultraviolet radiation-induced non-melanoma skin cancer: Regulation of DNA damage repair and inflammation. Genes & Diseases, 1(2), 188-198, https://doi.org/10.1016/j.gendis.2014.08.005

McCarthy, E. M., Ethridge, K. P., & Wagner, R. F. (1999). Beach holiday sunburn: The sunscreen paradox and gender differences. Cutis, 64(1), 37-42.

Milon, A., Bulliard, J.-L., Vuilleumier, L., Danuser, B., & Vernez, D. (2013). Estimating the contribution of occupational solar ultraviolet exposure to skin cancer. British Journal of Dermatology, 170(1), 157-164, https://doi.org/10.1111/bjd.12604

Modenese, A., & Gobba, F. (2017). Occupational exposure to solar radiation at different latitudes and pterygium: A systematic review of the last 10 years of scientific literature. International Journal of Environmental Research and Public Health, 15(37) 1-20, https://doi.org/10.3390/ijerph15010037

Modenese, A., Korpinen, L., & Gobba, F. (2018). Solar radiation exposure and outdoor work: An underestimated occupational risk. International Journal of Environmental Research and Public Health, 15(10), 2063-2086, https://doi.org/10.3390/ijerph15102063

Mofidi, A., Tompa, E., Spencer, J., Kalcevich, C., Peters, C. E., Kim, J., Song, C., Mortazavi, S. B., & Demers, P. A. (2018). The economic burden of occupational non-melanoma skin cancer due to solar radiation. Journal of Occupational and Environmental Hygiene, 15(6) 481-491, https://doi.org/10.1080/15459624.2018.1447118

Neale, R., Williams, G., & Green, A. (2002). Application patterns among participants randomized to daily sunscreen use in a skin cancer prevention trial. Arch Dermatol, 138(2002), 1319-1325, https://doi.org/10.1001/archderm.138.10.1319

Occupational Safety and Health Administration. (n.d.a). About OSHA. Retrieved from www.osha.gov/aboutosha

Occupational Safety and Health Administration (2013). Memorandum of understanding between the U.S. nuclear regulatory commission and the occupational safety and health administration. Retrieved from www.osha.gov/enforcement/directives/cpl-02-00-086

Occupational Safety and Health Administration. (n.d.b). Recommended practices for safety and health programs. Retrieved from www.osha.gov/shpguidelines/

Occupational Safety and Health Administration. (n.d.c). Young workers. Retrieved from www.osha.gov/Publications/young_workers.html

Parkin, D. M., Mesher, D., & Sasieni, P. (2011). Cancers attributed to solar (ultraviolet) radiation exposure in the UK in 2010. British Journal of Cancer, 105, 66-69, http://dx.doi.org/10.1038/bjc.2011.486

Saraiya, M., Glanz, K., Briss, P., Nichols, P., White, C., & Debjani, D. (2003). Preventing skin cancer. Findings of the task force on community preventative services on reducing exposure to ultraviolet light. Retrieved from https://www.cdc.gov/mmWR/preview/mmwrhtml/rr5215a1.htm

Schmitt, J., Haufe, E., Trautmann, F., Schulze, H., Elsner, P., Drexler, H., Bauer, A., Letzel, S., Swen, J., Fartach, M., Bruning, T., Seidler, A., Dugas-Breit, S., Gina, M., Weistenhofer, W., Bachmann, K., Bruhn, I., MareenLang, B., Bonness,… Diepgen, T. L. (2018). Occupational UV-exposure is a major risk factor for basal cell carcinoma: Results of the population-based case-control study FB-181. Journal of Occupational and Environmental Medicine, 60(1), 36-43, https://doi.org/10.1097/JOM.0000000000001217

Stern, R. S. (2010). Prevalence of a history of skin cancer in 2007: Results of an incidence-based model. Archives of Dermatology, 146(3), 279-282, https://doi.org/10.1001/archdermatol.2010.4

Reinau, D., Weiss, M., Meier, C. R., Diepgen, T. L. & Surber, C. (2013). Outdoor workers’ sun-related knowledge, attitudes and protective behaviors: A systematic review of cross-sectional and interventional studies. British Journal of Dermatology, 168(5), 928-940, https://doi.org/10.1111/bjd.12160

Rogers H. W., Weinstock M. A., Feldman S. R., & Coldiron, B. M. (2015). Incidence estimate of nonmelanoma akin cancer (keratinocyte carcinomas) in the US population, 2012. JAMA Dermatology, 151(10), 1081-1086, https://doi.org/10.1001/jamadermatol.2015.1187

Rosenstock, I. M., Strecher, V. J., & Becker, M. H. (1988). Social learning theory and the health belief model. Health Education Quarterly, 15(2), 175-183, https://doi.org/10.1177%2F109019818801500203

Taylor, H., Williams, P., & Gray, D. (2004). Homelessness and dog ownership: An investigation into animal empathy, attachment, crime, drug use, health and public opinion. Anthrozoös, 17(4), 353-368, https://doi.org/10.2752/089279304785643230

Toussaint, L. & Webb, J. R. (2005). Gender differences in the relationship between empathy and forgiveness. Journal of Social Psychology, 145(6), 673-685, https://doi.org/10.3200/SOCP.145.6.673-686

Warthan, M. M., Sewell, D. S., Marlow, R. A., Warthan, M. L., & Wagner, R. J. (2003). The economic impact of acute sunburn. JAMA Dermatology, 139(8), 1003-1006, https://doi.org/10.1001/archderm.139.8.1003

Wright, M. W., Wright, S. T., & Wagner, R. F. (2001). Mechanisms of sunscreen failure. Journal of the American Academy of Dermatology, 44(5), 781-784, https://doi.org/10.1067/mjd.2001.113685






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