title: Sun Safety at Work Canada: a multiple case-study protocol to develop sun safety and heat protection programs and policies for outdoor workers.
abstract: BACKGROUND
  CAREX Canada has identified solar ultraviolet radiation (UV) as the second most prominent carcinogenic exposure in Canada, and over 75 % of Canadian outdoor workers fall within the highest exposure category. Heat stress also presents an important public health issue, particularly for outdoor workers. The most serious form of heat stress is heat stroke, which can cause irreversible damage to the heart, lungs, kidneys, and liver. Although the need for sun and heat protection has been identified, there is no Canada-wide heat and sun safety program for outdoor workers. Further, no prevention programs have addressed both skin cancer prevention and heat stress in an integrated approach. The aim of this partnered study is to evaluate whether a multi-implementation, multi-evaluation approach can help develop sustainable workplace-specific programs, policies, and procedures to increase the use of UV safety and heat protection.
  
  
  METHODS
  This 2-year study is a theory-driven, multi-site, non-randomized study design with a cross-case analysis of 13 workplaces across four provinces in Canada. The first phase of the study includes the development of workplace-specific programs with the support of the intensive engagement of knowledge brokers. There will be a three-points-in-time evaluation with process and impact components involving the occupational health and safety (OHS) director, management, and workers with the goal of measuring changes in workplace policies, procedures, and practices. It will use mixed methods involving semi-structured key informant interviews, focus groups, surveys, site observations, and UV dosimetry assessment. Using the findings from phase I, in phase 2, a web-based, interactive, intervention planning tool for workplaces will be developed, as will the intensive engagement of intermediaries such as industry decision-makers to link to policymakers about the importance of heat and sun safety for outdoor workers.
  
  
  CONCLUSIONS
  Solar UV and heat are both health and safety hazards. Using an occupational health and safety risk assessment and control framework, Sun Safety at Work Canada will support workplaces to assess their exposure risks, implement control strategies that build on their existing programs, and embed the controls into their existing occupational health and safety system.
authors.affiliation: Occupational Cancer Research Centre, Cancer Care Ontario, 3rd floor, 525 University Avenue, Toronto, ON, M5G 1X3, Canada. Desre.kramer@occupationalcancer.ca.
authors.forename: Desre M
authors.initials: DM
authors.lastname: Kramer
authors.affiliation: School of Occupational and Public and Health, Ryerson University, 350 Victoria Street, Toronto, ON, M5B 2K3, Canada.
authors.forename: Thomas
authors.initials: T
authors.lastname: Tenkate
authors.affiliation: School of Occupational and Public and Health, Ryerson University, 350 Victoria Street, Toronto, ON, M5B 2K3, Canada.
authors.forename: Peter
authors.initials: P
authors.lastname: Strahlendorf
authors.affiliation: Occupational Cancer Research Centre, Cancer Care Ontario, 3rd floor, 525 University Avenue, Toronto, ON, M5G 1X3, Canada.
authors.forename: Rivka
authors.initials: R
authors.lastname: Kushner
authors.affiliation: School of Occupational and Public and Health, Ryerson University, 350 Victoria Street, Toronto, ON, M5B 2K3, Canada.
authors.forename: Audrey
authors.initials: A
authors.lastname: Gardner
authors.affiliation: St Michael's Hospital, 30 Bond St., Toronto, ON, M5B 1W8, Canada.
authors.forename: D Linn
authors.initials: DL
authors.lastname: Holness
mesh_terms: D002170:Canada; D006291:Health Policy; D018883:Heat Stroke / Q000517:prevention & control*; D006801:Humans; D016273:Occupational Exposure / Q000517:prevention & control / Q000592:standards; D016272:Occupational Health / Q000592:standards; D019982:Organizational Case Studies; D016730:Program Development; D011481:Protective Clothing; D013474:Sunstroke / Q000517:prevention & control*; D017132:Workplace / Q000592:standards