Sun Exposure Prevention Practices Within U.S. Naval Aviation
Authors: Lyford Willis H , Crotty Angela , Logemann Nicholas Fred 
Published: March 2021

ABSTRACT

Introduction
Occupational exposure to ultraviolet radiation is a critical concern for those serving in the U.S. Military. Work and mission requirements predispose members to significant sun exposure, while sun-protective behavior often comes second to mission accomplishment. Prior research implicated institutional practices and constraints as preventing the routine use of sun protection modalities, but no large-scale studies have assessed service members’ perceptions regarding sun protection modalities available to them in their work environment or their daily sun protection practices.

Methods
The study employed a cross-sectional survey distributed to active duty (AD) U.S. Navy service members assigned to 1 of 19 aircraft squadrons based in Southern California and deployed on missions across the Pacific theater of operations. The intent was to evaluate rates of sunburn, sun-protective practices, and perceptions regarding sun exposure and prevention practices in their workplace. The study and survey tool received approval from the Naval Medical Center San Diego Institutional Review Board. Statistical analysis of survey answers was performed to assess for trends in response rates overall and response rates within sociodemographic groups. Pearson’s chi-squared tests were utilized to assess for significance where appropriate. P-values &lt;.05 were used to determine statistically significant trends in response rates.

Results
One thousand surveys were distributed, of which 896 surveys were completed. The response rate was 89.6%. Eight hundred and eighty-eight surveys were included in the analysis. The surveyed population was consistent with the demographics of the U.S. Navy as a whole. 55.1% of survey respondents reported sunburn within the past year, higher than the rate reported in a previously surveyed civilian population. Reports of sunburn within the past year were not significantly different in regard to gender (P = .88), age (P = .53), and years of AD (P = .48). Increasing rank did show a significant correlation with reports of sunburn (P = .0) (Table S1). 62.2% of those surveyed reported frequent/routine use of some form of sun protection. This was lower than the rate reported in a previously surveyed civilian population. A large majority of service members surveyed (75.9%) reported using sunscreen with a sun protection factor &gt;15.
29.1% of survey respondents reported working in direct sunlight always/almost always. This was lower than the rates reported in a previously surveyed U.S. Air Force population of aviation maintainers. Low rates of respondents reported frequent reminders to use sun protection (18.9%), and fewer reported the routine or frequent use of sunscreen while at work (12.3%). A higher percentage reported regular use of sunscreen during outdoor leisure activities (36.5%), suggesting a barrier to use in the workplace.

Conclusions
U.S. Military personnel report higher rates of sunburn and lower rates of routine use of sun protection practices compared to a previously surveyed civilian population. The overall rates of sun protection use while in the work setting are low both overall and compared to reports of routine use during outdoor leisure activities. Reported rates of reminders to use sunscreen are low, suggesting that increased education regarding the risk of excessive sun exposure and tools for effective sun protection are still needed.