Am J Ind Med. 2019;62:893-900. wileyonlinelibrary.com/journal/ajim © 2019 Wiley Periodicals, Inc. | 893 Received: 8 April 2019 | Revised: 16 July 2019 DOI: 10.1002/ajim.23033 BRIEF REPORT Senior managers’ awareness of sun protection policy predicts implementation of worksite sun safety in a randomized trial Barbara J. Walkosz PhD 1 | David B. Buller PhD 1 | Mary Klein Buller MA 1 | Allan Wallis PhD 2 | Xia Liu MS 1 1 Klein Buendel, Inc, Golden, Colorado 2 School of Public Affairs, University of Colorado Denver, Denver, Colorado Correspondence Dr Barbara Walkosz, Klein Buendel, Inc, 1667 Cole Boulevard, Suite 225, Golden, CO 80401. Email: bwalkosz@kleinbuendel.com Funding information National Cancer Institute, Grant/Award Number: RO1CA134705 Abstract 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. KEYWORDS cancer, occupational, policy, prevention, skin 1 | INTRODUCTION Skin cancer is among the most common cancers worldwide. The World Health Organization estimates that up to three million cases of keratinocyte skin cancers (ie, nonmelanoma skin cancer including basal and squamous cell carcinoma) and approximately 132 000 cases of melanoma are diagnosed annually (one in every five American will develop skin cancer). 1 Outdoor workers are exposed over many years to high levels of solar ultraviolet radiation (UV) 2 and are at risk for skin cancer, 3 especially keratinocyte skin cancers. An elevated risk of melanoma with outdoor occupations has also been observed 3,4 and melanoma mortality produced US$66.9 billion in productivity losses from 1990 to 2008 in the United States. 5 Keratinocyte skin cancer prevention is a priority due to its high prevalence, 6 recurrence, and treatment and lost‐productivity costs. 7 Improving occupational sun protection is a priority in the United States. The US Surgeon General and the Community Guide have recommended interventions in occupational settings to reduce solar UV exposure of outdoor workers for skin cancer prevention. 7,8 Sun safety aligns with workplace initiatives to prevent injury, improve well‐being, address concerns over heat stress and climate change, and develop systematic assessments, responses, and evalua- tions of workplace hazards. 9,10 Sun protection should be promoted at work because many outdoor workers fail to practice sun safety. 2,11,12 Studies have shown that workplace education can improve workers’ sun protection. 10,13-19 Based on social‐ecological models, 20 a comprehensive approach that motivates employers to adopt policies for routine sun safety training, to enact environmental controls and administrative proce- dures, and to place sun safety on organizational and individual agendas may reduce outdoor workers’ exposure to UV and skin