Electronic Theses and Dissertations

Date of Award


Document Type


Degree Name

M.S. in Health Promotion


Health, Exercise Science, and Recreation Management

First Advisor

Allison Ford-Wade

Second Advisor

Martha Bass

Third Advisor

Jeffrey S. Hallam

Relational Format



Skin cancer is a significant public health problem in the US. Each year over 3.5 million cases of skin cancer are diagnosed in more than two million individuals, resulting in nearly 12,000 deaths (American Cancer Society, 2012). Many studies have been conducted on outdoor workers to assess quantitative data of exposure and protection behaviors, with the majority of studies carried out on farmers, construction workers, and postal workers (Saraiya et al., 2004). Nonetheless, far too little attention has been given to members of other occupational groups who mainly work outdoors, such as landscapers. It was estimated in the US that there are slightly over one million workers in the landscape service industry. Moreover, no US based study was identified that targeted landscapers, one of the most comoutdoor workers, who are at high risk of UV damage which increases the individuals' risk of skin cancer development (Centers for Disease Control and Prevention, 2012). This cross-sectional study determined landscapers' skin cancer knowledge, health beliefs, self-efficacy, and protective behaviors. Additional purpose was to assess relationship between selected Health Belief Model (HBM) variables (i.e., perceived threat, perceived benefits minus perceived barrier, and self-efficacy) and protection behavior. Of 140 landscapers from 23 companies contacted, 117 participated (83.6% response rate). Questionnaires were mailed to 22 companies and one company requested on-site administration. Data were collected via a modified version of the "Skin Cancer Survey," which included demographics, knowledge, preventive behaviors, and HBM variables (Marlenga, 1995). Descriptive statistics and Pearson correlations were performed to analyze the survey data. Alpha level of 0.05 was set a priori. The sample (n = 109) had a mean age of 37.06 years (± 12.18), with 94.5% males, and 77.1% White. Participants spent an average of 5.36 hours/day in the during peak hours. 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 that skin cancer is a severe disease. Participants believed the use of wide-brimmed hats, long sleeved shirts/long pants, and sunscreen were beneficial. However, participants reported low use of these and other protective strategies. The primary barriers for not using protection were "I forget to wear it" and "it is too hot to wear." Of the HBM variables, perceived benefits minus perceived barrier (r = 0.285, p = .003) and self-efficacy (r = .538, p = .001) were correlated with protection. The HBM proposes that perceived threat is strongly correlated with an individual's likelihood to engage in protective behaviors. This HBM proposition is not supported in the present study. However, the results indicate that perceived benefits outweigh the perceived barriers to protection. Furthermore, self-efficacy to engage in protection is associated with protection behaviors. The reasons behind absence of the relationship between perceived skin cancer threat and protection behaviors could be lack of skin cancer knowledge, low rate of personal skin cancer history, and several barriers to protection.



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