This article was downloaded by: [DUT Library]

On: 05 October 2014, At: 11:31

Publisher: Routledge
Informa Ltd Registered in England and Wales Registered Number: 1072954 Registered office: Mortimer House,
37-41 Mortimer Street, London W1T 3JH, UK

Archives of Environmental & Occupational Health

Publication details, including instructions for authors and subscription information:
http://www.tandfonline.com/loi/vaeh20

Occupational Cancer Risk Perception in Iranian Workers

a b
Mohammad Javad Zare Sakhvidi PhD , Mostafa Mirzaei Aliabadi MSc , Fariba Zare Sakhvidi
a a c
, Gholamhossein Halvani MSc , Mohammad Ali Morowatisharifabad PhD , Hamid Dehghan
a a
Tezerjani & Ali Firoozichahak MSc
a
Department of Occupational Health , Faculty of Health, Shahid Sadoughi University of
Medical Sciences , Yazd , Iran
b
Department of Occupational Health , School of Public Health, Tehran University of Medical
Sciences , Tehran , Iran
c
Department of Health Education , Faculty of Health, Shahid Sadoughi University of Medical
Sciences , Yazd , Iran
Accepted author version posted online: 11 Mar 2013.Published online: 10 Dec 2013.

To cite this article: Mohammad Javad Zare Sakhvidi PhD , Mostafa Mirzaei Aliabadi MSc , Fariba Zare Sakhvidi , Gholamhossein
Halvani MSc , Mohammad Ali Morowatisharifabad PhD , Hamid Dehghan Tezerjani & Ali Firoozichahak MSc (2014) Occupational
Cancer Risk Perception in Iranian Workers, Archives of Environmental & Occupational Health, 69:3, 167-171, DOI:
10.1080/19338244.2013.763759

To link to this article: http://dx.doi.org/10.1080/19338244.2013.763759

PLEASE SCROLL DOWN FOR ARTICLE

Taylor & Francis makes every effort to ensure the accuracy of all the information (the “Content”) contained
in the publications on our platform. However, Taylor & Francis, our agents, and our licensors make no
representations or warranties whatsoever as to the accuracy, completeness, or suitability for any purpose of the
Content. Any opinions and views expressed in this publication are the opinions and views of the authors, and
are not the views of or endorsed by Taylor & Francis. The accuracy of the Content should not be relied upon and
should be independently verified with primary sources of information. Taylor and Francis shall not be liable for
any losses, actions, claims, proceedings, demands, costs, expenses, damages, and other liabilities whatsoever
or howsoever caused arising directly or indirectly in connection with, in relation to or arising out of the use of
the Content.

This article may be used for research, teaching, and private study purposes. Any substantial or systematic
reproduction, redistribution, reselling, loan, sub-licensing, systematic supply, or distribution in any
form to anyone is expressly forbidden. Terms & Conditions of access and use can be found at http://
www.tandfonline.com/page/terms-and-conditions
 Archives of Environmental & Occupational Health, Vol. 69, No. 3, 2014
Copyright 
C 2014 Taylor & Francis Group, LLC

Occupational Cancer Risk Perception

in Iranian Workers
Mohammad Javad Zare Sakhvidi, PhD; Mostafa Mirzaei Aliabadi, MSc; Fariba
Zare Sakhvidi; Gholamhossein Halvani, MSc; Mohammad Ali
Morowatisharifabad, PhD; Hamid Dehghan Tezerjani; Ali Firoozichahak, MSc

ABSTRACT. This cross-sectional study examined the occupational cancer risk perception among 269
Downloaded by [DUT Library] at 11:31 05 October 2014

Iranian industrial workers according to their knowledge, job titles hazard, and demographical prop-
erties. The structured questionnaire was used to measure participants’ knowledge and perception
toward occupational cancers (reliability of the perception questions = .72). There was significant
difference in both knowledge and perception about occupational cancers in different age and educa-
tional groups. It was significant relation between knowledge and perception (p = .001). True answer
to some questions was less than 20%. An optimistic bias was found in participants’ perception. These
findings prove that cancer risk perception in industrial workforces is affected by several factors. Fur-
ther efforts should be placed in the training of workers to enhance their knowledge and subsequently
their perception toward occupational cancers.
KEYWORDS: Iran, knowledge, occupational cancer, risk perception

C
ancer is the leading cause of death, with annually
7.6 million deaths worldwide. About 19% of cancers
are attributed to environmental and occupational fac-
tors.1 These diseases can impose a heavy health and economic
burden on society, especially in developing and underdevel-
oped countries.2 Most of cancer deaths also occur in low-
and middle-income countries. The International Agency for
Research on Cancer (IARC) has classified about 150 agents,
mixtures, and exposure situations as a known or probable hu-
man carcinogen.3 Occupational cancers are not clinically and
biologically different from nonoccupational cancers. Long
latency period and lack of knowledge about their causes
lead to late diagnosis and high mortality among the patients.
However, all of them have controllable causes and hence pre-
ventable.4 Therefore, there is a need for comprehensive and
structured actions to prevent the casual factors.
The World Health Organization (WHO) recommends that
the primary preventions such as education, risk communica-
tion, and industrial hygiene practices are the vital steps in the
global control of occupational and environmental cancers.
According to the WHO, “ . . . all countries need to develop
communication campaigns tailored to local needs to educate
their populations about environmental causes of cancer and
prevention strategies . . . ”5
Old technologies and lack of awareness of the hazards
in developing countries increase the exposure to carcino-
genic agents.6 Despite achievements in diagnostic tools and
biomarkers discoveries, exposure avoidance is a most useful
approach for preventing occupational cancers.7 Forcing on
control measures such as training and awareness enhance-
ment programs can lead to better perspective for the de-
veloping countries. Measuring risk perception is one of the

Mohammad Javad Zare Sakhvidi, Fariba Zare Sakhvidi, Gholamhossein Halvani, Hamid Dehghan Tezerjani, and Ali Firoozicha-
hak are with the Department of Occupational Health, Faculty of Health, Shahid Sadoughi University of Medical Sciences, Yazd, Iran. Mostafa
Mirzaei Aliabadi is with the Department of Occupational Health, School of Public Health, Tehran University of Medical Sciences, Tehran,
Iran. Mohammad Ali Morowatisharifabad is with the Department of Health Education, Faculty of Health, Shahid Sadoughi University of
Medical Sciences, Yazd, Iran.

2014, Vol. 69, No. 3 167

 essential steps in cancer risk reduction and communication.8,9
Proper knowledge and perception on health risks can posi-
tively shift the behavior to the safe side. Good risk percep-
tion influences the behavior and, finally, the overall safety
and health of the community. It seems by educating and in-
crease the awareness of workforces, we can reduce the cases
of occupational cancers.10
Risk perception depends on various parameters such as so-
ciodemographic factors, culture, nationality, and background
working history.11,12 Determination of influential parameters
is the key challenge in risk perception studies.13 Cordeiro
showed an inverse association between risk perception and
accident in a metallurgic plant.14 Cases with higher risk per-
ception also showed higher screening behavior toward can-
cers, but not for all cancers.15
The purpose of this study was to determine the main in-
fluential factors in cancer risk knowledge and perception of
Iranian workers. Based on our searches, there is no consen-
sus study concerned with the occupational cancer perception
and its influential factors. However, there are many studies
Downloaded by [DUT Library] at 11:31 05 October 2014
dence of carcinogenicity were considered. The ranking was
also performed based on the presence of the occupational
carcinogen agents and mixtures as well as exposure circum-
stances that are classified by IARC till 2004.2 Questionnaire
data were transferred into SPSS software (SPSS, Chicago, IL,
USA) and analyzed for hypothesizes. Mean scores were com-
pared by t test for significant difference. Linear regression
was performed for exploration of the relationship between
knowledge and perception.
RESULTS
Two hundred and sixty-nine industrial workers from 6
different industries in Yazd City (central part of Iran) were
enrolled from 329 questionnaires (response rate = 81.4%).
Table 1 shows the demographic frequencies of participants.
All subjects were male, with ages in the range of 18–50 years
(mean = 30.28, SD = 6.33). Results showed most of partic-
ipants were in range of 21–30 years (55.3%) and only about
6.6% of them were older than 40. Mean working history was

concerned with cancer risk perception in general populations also 7.50 years (SD = 5.73). Because of young working pop-
(mostly breast and colorectal cancers).15 ulation in this study, job tenure in most of participant was
less than 5 years (50.8%). Only 12.9% of participants had
METHODS university education and there was no illiterate case.
A cross-sectional study was conducted during mid-2012 in
industrial workers in Yazd City, Iran. Subjects were limited
to Iranian male workers. Participants were clearly informed
Table 1.—-Demographic Frequencies of Participants
about the study and then asked to fill the questionnaires.
(N = 269)
A 16-item structured questionnaire was used to explore oc-
cupational cancer knowledge and perception. Occupational Characteristic %
cancer knowledge was assessed by 7 questions. Six of the
Age (years)
knowledge questions were agree/disagree, I don’t know, first
≤20 2.3%
person (for example: I am at risk because of workplace ex- 21–30 55.3%
posures), third person (he/she), positive, and negative. In 31–40 35.8%
the seventh question, participants were asked to rank primer 41–50 6.6%
cancer causes among options (heredity, job and environ- Tenure (years)
≤1 10.3%
ment, lifestyle, body physiology, and chance). These ques-
2–5 40.5%
tions were selected from simple facts by considering prior 6–10 26.4%
studies,8,15 occupational medicine textbooks, and collabora- 11 and more 22.7%
tion of occupational medicine experts. The global knowledge Education
score was computed by summing each question scores. For Guidance school and lower 38.7%
Diploma 48.4%
the seventh question, the answer was considered true if the
University degree 12.9%
participants stated environmental factors as a leading cause. Marital
Occupational cancer risk perception was also measured by Single 27.1%
9 other questions. Respondents were asked to explain their Married 72.9%
answer based on a 5-item Likert scale (strongly disagree, dis- Smoking
Yes 12.6%
agree, neither agree nor disagree, agree, strongly agree). The
No 78.4%
questionnaire also included 12 demographic questions such Not specified 8.9%
as age, job tenure, job title, marital status, disease history, Disease
and smoking. Yes 6.9%
Job titles were ranked according to their occupational can- No 93.1%
Cancer in family
cer risk. Recently, the UK Health and Safety Executive (HSE)
Yes 6.3%
prioritized 10 agents/occupations according to their cancer No 89.9%
risk.16 In this prioritizing scheme, the factors such as num- Not specified 3.7%
ber of death, number of employee involved, and strong evi-

168 Archives of Environmental & Occupational Health

 Table 2.—-Frequency Data on Knowledge and Risk Perception in Different Industries (N = 269)

Knowledge Perception

Factor Category Mean SD p value Mean SD p value

Age ≤20 years 3.50 0.71 .046 26.50 3.54 .001

21–30 years 4.41 1.30 33.26 4.51
31–40 years 4.31 1.51 33.78 4.12
41–50 years 3.56 1.36 30.63 3.35
Working history <1 years 4.55 1.06 .035 34.35 3.84 .052
2–5 years 4.48 1.31 32.92 4.72
6–10 years 4.30 1.55 34.03 4.08
11 years and more 3.76 1.57 32.04 4.26
Education Primary and guidance school 3.93 1.50 .004 31.90 4.43 .013
Diploma 4.28 1.44 33.47 4.73
University degree 5.09 1.00 34.78 3.10
Smoking Yes 4.14 1.76 .538 31.35 3.44 .019
No 4.32 1.38 33.37 4.56
Marital Single 4.20 1.38 .425 32.39 4.79 .106
Married 4.37 1.42 33.44 4.26
Disease Yes 3.83 1.34 .151 32.94 5.33 .851
No 4.33 1.42 33.15 4.41
Downloaded by [DUT Library] at 11:31 05 October 2014

Cancer Yes 4.29 1.81 .957 32.89 4.50 .774

No 4.27 1.37 33.15 4.49

Note. SD = standard deviation. p values based on Student t test; level of significance: p < .05.

Occupational cancer knowledge and perception of par-
ticipants were in the range of 0–7 and 22–43, respectively.
Reliability of the perception questions was determined by
Chronbach alpha (α = .72). Mean score of knowledge and
perception was also 4.29 (SD = 1.42) and 33.10 (SD =
4.46). Results showed significant difference in both knowl-
edge and perception about occupational cancers in different
age and educational groups (Table 2). Nonsmokers only had
significantly higher perception, but there was no significant
difference between smokers’ and nonsmokers’ occupational
cancer knowledge. However, there was significant difference
in knowledge score in different working tenure groups, but
there was no difference in occupational cancer perception in
different working tenure. Married subjects had higher knowl-
edge and perception scores in comparison with singles, but
it was not statistically significant. Further analysis showed
that mean age of married group was significantly higher than
the singles. Therefore, the observed difference in knowl-
edge and perception scores among may be due to their age
effect.
With an increase in job tenure, the participants showed
significantly lower knowledge score. It was not observed for
perception. Results showed that cases with higher job tenure
had also higher age and therefore lower education. Therefore,
the age mediated the knowledge through lower education.
Participants were categorized into 4 different cancer risk
categories (Table 3) according to criteria described in Meth-
ods. Table 4 shows the categorization results. About 37.6%
of workers were categorized into moderate- to high-risk jobs
in their present job titles. However, 31.5% of participants
were also categorized into the moderate- to high-risk jobs
according to their previous job titles.
We investigated the knowledge and perception of partici-
pants according to their job title categories (Table 4). Results
showed that there was significant difference between knowl-
edge among different job categories (p < .05), but no sig-
nificant difference was found for perception (p > .05). With
merging previous and present job title history, results showed
that by considering this effect, knowledge is significant in the
.01 level (p = .01). But like previous analysis, there was no
significant difference in perceptions (p = .561).
Table 5 gives a detailed frequency analysis of respondents’
answers to knowledge questions. Some participants marked
the “don’t know” option in their answer sheets. Results
showed that about 39.5 % of respondents marked “don’t
know” as their answer to the question pertaining to the
Table 3.—-Job Categorization According to
Occupational Cancers Risk in Selected Job Titles
Category Example
Negligible risk Student, seller, chef, architect, administrative
worker
Low risk Utility operator, electrical engineer
Moderate risk HSE person, crane operator, scaffold maker,
maintenance worker
High risk Welder, farmer, painter, nylon factory worker,
mechanic, miner

2014, Vol. 69, No. 3 169

 and cancer risk perception. There was significant relation
Table 4.—-Occupational Cancers Knowledge and between knowledge and perception (p = .001, r2 = .323).
Perception in Different Job Titles

Knowledge Perception

Category % Mean SD Mean SD

COMMENT
Present job We found no similar study pertaining to the occupational
Negligible risk 6.8% 5.25 1.22 34.46 4.33
Low risk 55.6% 4.17 1.50 33.07 4.16
cancer risk knowledge and perception in workers. Therefore,
Moderate risk 15.9% 4.64 1.50 32.91 4.84 most of studies discussed in this section are for the general
High risk 21.7% 4.10 1.12 34.05 4.49 population. The findings provide support that workers’ risk
Previous job perception is correlated with their knowledge toward occupa-
Negligible risk 34.6% 4.34 1.38 34.48 4.19 tional cancers. However, the knowledge and perception have
Low risk 34.0% 4.43 1.46 32.63 3.92
Moderate risk 10.1% 4.30 2.11 31.19 4.39
no linear relation with age. Cases in range of 20–40 years
High risk 21.4% 4.22 1.09 32.68 5.00 showed higher knowledge and had also higher perception
score in comparison with the younger and the elder cases.
It might be because of the higher education level in this age
group. Hassali et al17 also reported that deficit of students’
dormant period of occupational cancers. Only 19% of knowledge about breast cancer might be the reason of stu-
participants knew the true answer of this question. Another dents’ delay perception. Occupational hazard risk perception
Downloaded by [DUT Library] at 11:31 05 October 2014

interesting finding was that about 37% of participants were can be different even in different departments of same com-
unaware of the right answer of the leading causes of cancers. pany.13 However, our finding suggests that there is no signif-
Most of participants (36.4%) regarded environmental factors icant relationship between perceived cancer risk perception
as a leading cause of cancers. It is interesting because and job title categories developed by the authors. However,
it is in agreement with its actual pattern. Among those there was significant difference in cancer risk knowledge in
considered job as a leading cause (n = 18), the mean different job categories. This finding should be interpreted
knowledge and perception scores were 4.06 (SD = 1.11) carefully. Most of the cases in the low-risk category are of-
and 33.28 (SD = 4.52), respectively. These scores are not fice workers and also educated. Therefore, their education is
significantly different from the mean score observed in the a confounding factor and maybe it is the true cause of their
study population. We cannot interpret why these participants better knowledge.
ranked occupational factors as a leading cause of cancer. Our results are different from other researches to some
According to Fontaine and Smith,12 optimistic bias in risk extent. Lee18 showed that smokers had optimistic bias in
perception was measured by 2 questions about “perceived cancer risk perception. But our findings showed that there is
cancer risk” for their own and for other people. Results no difference. Cross-national differences in risk perception
showed that participants estimate their own cancer risk may be source of this discrepancy. It implies that in health
significantly lower than their coworkers (p < .05). Simple promotion programs there is no general model and it should
linear regression was performed for cancer knowledge be considered as a nation-specific case.12 However, we didn’t
enroll the non-Iranian workers in our study, but Fontaine and
Smith12 found that British subjects’ perceived cancer risk
less than American subjects.
Table 5.—-Proportions With Correct, Incorrect, and It seems that education has a significant role in cancer risk
Don’t Know Responses in the Knowledge Section knowledge and perception of workers. One study performed
on students found that groups with high level of education
Item Correct Incorrect Don’t know had not good knowledge about cancer.17 Morris and Smart
Cancer chance is same for 63.2 16.7 20.2 also concluded that there is no significant difference between
every one lay people and physicians in air pollution risk perception.19
Some cancers need 30 years to 41.4 19.2 39.5 In contrast with Honda and Neugut,20 we found that family
show themselves history of cancer has no significant effect on perceived occu-
Lifestyle, occupational, and 56.2 17.3 26.5
pational cancer risk. It may be because of different nature of
environmental factors have
more responsibility than occupational cancers from other cancers. McCool et al21 in a
heredity in cancer study about workers’ perception of the risks of sun exposure
Exposure to some agents in 82.5 4.6 12.9 observed that gender has significant main effect in all per-
workplaces can induce ception measures. The study populations in this study were
cancer
composed of only male subjects. Due to this limitation, we
Job can produce cancer 80.1 7.7 12.3
Cancers are unpreventable 71.8 12.6 15.6 were not able to examine the role of gender in cancer risk
perception.

170 Archives of Environmental & Occupational Health

 Conclusion
This study was a part of another comprehensive project on
occupational cancer risk perception in Iranian workers. We
aimed to detect the influential factors on cancer risk knowl-
edge and perception in the industrial workers. We found a
significant relation between occupational cancer risk knowl-
edge and perception. Our findings prove that cancer risk per-
ception in industrial workforces is affected by several factors.
Regarding to this fact that most of questions in the knowledge
section of this study were about simple facts about occupa-
tional cancers, it reveals that there is need to train workers
about occupational cancers. It is necessary to improve the
general and even work-specific training for participants. An-
other important finding in our results is the differences be-
tween our findings and other studies about cancer risk percep-
tion in the general population. It seems that there is different
model for perception of occupational cancers in workforces.
We suggest that future studies focus on the applicability of
common risk perception casual models for occupational can-
Downloaded by [DUT Library] at 11:31 05 October 2014
cer risk perception in workers.
**********
For comments and further information, address correspondence to Mo-
hammad Javad Zare Sakhvidi, Department of Occupational Health, Fac-
ulty of Health, Shahid Sadoughi University of Medical Sciences, Yazd,
8916189165 Iran
E-mail: mjzs63@gmail.com
**********
References
1. World Health Organisation (WHO). Environmental and occupa-
tional cancers. 2011. Available at: http://www.who.int/mediacentre/
factsheets/fs350/en/index.html. Accessed April 10, 2012.
2. Boffetta,P. Epidemiology of environmental and occupational cancer.
Oncogene. 2004;23:6392–6403.
3. International Agency for Research on Cancer (IARC). IARC Mono-
graphs on the Evaluation of Carcinogenic Risks to Humans. Lyon:
IARC; 2002.
4. Rushton L, Hutchings S, Brown T. The burden of cancer at work:
estimation as the first step to prevention. Occup Environ Med.
2008;65:789–800.
2014, Vol. 69, No. 3
5. Landrigan PJ, Espina C, Neira M. Global prevention of environ-
mental and occupational cancer. Environ Health Perspect. 2011;119:
a280.
6. McCormack VA, Schüz J. Africa’s growing cancer burden: environ-
mental and occupational contributions. Cancer Epidemiol. 2011;36:
1–7.
7. Weiderpass E, Boffetta P, Vainio H. Occupational causes of cancer. In:
Alison M, ed. The Cancer Handbook. Chichester, UK: John Wiley &
Sons; 2007:443–452.
8. Dantzker HC, Chandrasekaran D, Snedeker SM. Exploring cancer risk
perceptions of turf and lawn pesticide professionals in New York State.
Environ Behav. 2010;42:740–764.
9. Klein WMP, Stefanek ME. Cancer risk elicitation and communication:
lessons from the psychology of risk perception. CA Cancer J Clin.
2007;57:147–167.
10. Veys C. ABC of work related disorders: occupational cancers. BMJ.
1996;313:615.
11. Anuar I, Zahedi F, Kadir A, Mokhtar AB. Occupational safety and health
risk perception among medical laboratory workers in klang valley. J
Community Health. 2009;15:77–82.
12. Fontaine KR, Smith S. Optimistic bias in cancer risk perception: a
cross-national study. Psychol Rep. 1995;77:143–146.
13. Leiter MP, Zanaletti W, Argentero P. Occupational risk perception,
safety training, and injury prevention: testing a model in the Italian
printing industry. J Occup Health Psychol. 2009;14:1–10.
14. Cordeiro R. Suggestion of an inverse relationship between perception
of occupational risks and work-related injuries. Cad Saúde Pública.
2002;18:45–54.
15. Vernon SW. Risk perception and risk communication for cancer screen-
ing behaviors: a review. J Natl Cancer Inst Monogr. 1999;25:101–
119.
16. Health and Safety Executive (HSE). Occupational cancer—
priorities for future intervention. Available at: www.hse.gov.uk/
aboutus/meetings/hseboard/2012/160512/pmayb1236.pdf. Accessed
Sep-tember 10, 2012.
17. Hassali MA, Shafie AA, Awaisu A. Evaluation of breast cancer aware-
ness among female university students in Malaysia. Pharmacy Pract.
2010;8:29–34.
18. Lee C. Perceptions of immunity to disease in adult smokers. J Behav
Med. 1989;12:267–277.
19. Morris EA, Smart MJ. Expert versus lay perception of the risks of motor
vehicle-generated air pollution. Transport Res D Transport Environ.
2012;17:78–85.
20. Honda K, Neugut AI. Associations between perceived cancer risk and
established risk factors in a national community sample. Cancer Detect
Prevent. 2004;28:1–7.
21. McCool JP, Reeder AI, Robinson EM, Petrie KJ, Gorman DF. Out-
door workers’ perceptions of the risks of excess sun-exposure. J Occup
Health. 2009;51:404–411.
171