International Journal of Women's Dermatology, 2018
Background: As future physicians, medical students will play an important role in the prevention ... more Background: As future physicians, medical students will play an important role in the prevention of skin cancers by becoming directly involved in skin cancer prevention education and counseling patients about the hazards of ultraviolet light. Objective: We assessed the skin cancer-related knowledge, attitudes, beliefs, and prevention practices reported in previous studies of medical students. Methods: The search for relevant articles was performed in four electronic databases: PubMed (Medline), Cumulative Index to Nursing and Allied Health, ERIC, and PsycINFO. Studies were included if they met the following criteria: 1) targeted medical students; 2) assessed sun avoidance, sun protection, skin selfexamination, and/or indoor tanning behaviors; 3) were published in peer-reviewed journals; and 4) complete data were available for extraction. Results: A total of 21 studies are included in this review. Important findings include moderate-to-high levels of skin cancer knowledge and low levels of both sunscreen and ultraviolet light knowledge. The attitudes and knowledge of medical students reflect a low level of concern with regard to the perceived importance of skin cancer compared with other forms of cancer despite a high level of concern for the importance of skin cancer prevention. Furthermore, this review demonstrated that medical students fail to protect themselves routinely from the sun and have a high interest in tanning bed use. Conclusion: This review demonstrates the need to educate medical students about skin cancer and skin cancer preventive behaviors. New strategies and educational campaigns should be developed to communicate better information on skin cancer morbidity, mortality, and prevention to medical students. This will pay dividends by improving the practice of these future physicians in all specialties.
The field of interpretation is increasingly acknowledging the potential for strategic health prom... more The field of interpretation is increasingly acknowledging the potential for strategic health promotion. The purpose of this paper is to introduce Go Sun Smart (GSS) Resorts, a sun safety program directed to guests recreating outdoors at destination resorts and parks in the United States and Canada. This paper aims to present a sun safety intervention that was designed to promote advanced sun safety practices to the field of interpretation. With a foundation in Diffusion of Innovations Theory and Transportation Theory this paper will present the intervention materials and strategies developed by GSS to showcase the potential to promote health behaviors. Intervention materials that were developed include posters, tip cards, a Public Service Announcement (PSA) video, additional electronic and print materials, employee trainings, GSS certification, and an interpretive script for use prior to various outdoor activities.
Exposure to solar ultraviolet radiation during recreation is a risk factor for skin cancer. A tri... more Exposure to solar ultraviolet radiation during recreation is a risk factor for skin cancer. A trial evaluating an intervention to promote advanced sun protection (sunscreen pre-application/reapplication; protective hats and clothing; use of shade) during vacations. Adult visitors to hotels/resorts with outdoor recreation (i.e., vacationers) participated in a group-randomized pretest-posttest controlled quasi-experimental design in 2012-14. Hotels/resorts were pair-matched and randomly assigned to the intervention or untreated control group. Sun protection (e.g., clothing, hats, shade and sunscreen) was measured in cross-sectional samples by observation and a face-to-face intercept survey during two-day visits. Initially, 41 hotel/resorts (11%) participated but 4 dropped out before posttest. Hotel/resorts were diverse (employees=30 to 900; latitude=24° 78' N to 50° 52' N; elevation=2 ft. to 9,726 ft. above sea level), and had a variety of outdoor venues (beaches/pools, court/...
Journal of occupational and environmental medicine / American College of Occupational and Environmental Medicine, 2015
Sustainability of prevention programs is a public health goal. The effectiveness of Go Sun Smart,... more Sustainability of prevention programs is a public health goal. The effectiveness of Go Sun Smart, an occupational skin cancer prevention program, was evaluated 5 to 7 years out from the conclusion of a controlled randomized dissemination trial that compared an enhanced versus basic dissemination strategy at 53 ski areas enrolled in the trial. Employees (n = 2940) at ski areas in the enhanced condition reported fewer sunburns but did not differ from employees in the basic condition on other sun-protection measures. Significant differences for all sun-protection practices were identified at ski areas that displayed nine or more Go Sun Smart materials or a combined total of nine or more Go Sun Smart and other sun safety messages. Exposure to prevention messages is an important determinant of program effectiveness and potentially of program sustainability.
A successful occupational sun-protection program was translated to 67 ski areas where the effecti... more A successful occupational sun-protection program was translated to 67 ski areas where the effectiveness of two dissemination strategies was assessed. An industry professional association distributed materials to the resorts. Half of the resorts received the basic dissemination strategy (BDS) in which the materials were simply distributed to the resorts. In a randomized trial, the BDS was compared with an enhanced dissemination strategy (EDS) that added interpersonal contact with managers. Employees (n=2,228) at worksites that received the EDS had elevated program exposure (74.0% at EDS vs. 57.5% at BDS recalled a message). Exposure increased at two levels of program use: from less than four (55% exposed) to four to eight (68%) and to nine or more (82%) program items in use. More employees exposed to messages engaged in sun-safety behaviors than those unexposed. At worksites using nine or more items (versus 4-8 or <4), employees engaged in additional sun-safety behaviors. Program ...
Sustainability of an occupational sun safety program, Go Sun Smart (GSS), was explored in a rando... more Sustainability of an occupational sun safety program, Go Sun Smart (GSS), was explored in a randomized trial, testing dissemination strategies at 68 U.S. and Canadian ski areas in 2004-2007. All ski areas received GSS from the National Ski Areas Association through a Basic Dissemination Strategy (BDS) using conference presentations and free materials. Half of the ski areas were randomly assigned to a theory-based Enhanced Dissemination Strategy (EDS) with personal contact supporting GSS use. GSS use was assessed at immediate and long-term follow-up posttests by on-site observation. Use of GSS declined from immediate ( M = 6.24) to long-term follow-up ( M = 4.72), F(1, 62) = 6.95, p = .01, but EDS ski areas ( M = 6.53) continued to use GSS more than BDS ski areas ( M = 4.49), F(1, 62) = 5.75, p = .02, regardless of timing of posttest, strategy × observation F(1, 60) = 0.05, p = .83. Despite declines over time, a group of ski areas had sustained high program use and active disseminati...
To predict the prevalence of UV radiation (hereinafter, UV) at North American ski resorts using t... more To predict the prevalence of UV radiation (hereinafter, UV) at North American ski resorts using temporal, seasonal, altitudinal, and meteorological factors and associate UV with a set of adult sun protection behaviors. Design: Ultraviolet radiation observations and crosssectional survey of adults on sun protection were collected. Setting: Data were collected at 32 high-altitude ski areas located in western North America from 2001 through 2003. Participants: The sample consisted of 3937 adult skiers or snowboarders. Main Outcome Measures: Measurements of direct, reflected, and diffuse UV were performed at 487 measurement points using handheld meters and combined with self-reported and observed sun protection assessed for adults interviewed on chairlifts. Results: The strongest predictors of UV were temporal proximity to noon, deviation from winter solstice, and clear skies. By contrast, altitude and latitude had more modest associations with UV and temperature had a small positive relationship with UV. Guest sun safety was inconsistently associated with UV: UV was positively related to adults wearing more sunscreen, reapplying it after 2 hours, and wearing protective eyewear, but fewer adults exhibited many of the other sun protection behaviors, such as wearing hats and protective clothing or using lip balm, on days when UV was elevated. Guests took more sun safety precautions on clear-sky days but took steps to maintain body warmth on inclement days. Conclusions: In future sun safety promotions, adults should be encouraged to wear sunscreen on cloudy days because UV is still high and conditions can change rapidly. They need reminders to rely more on season and time of day when judging UV and the need for sun safety.
Journal of Public Health Management and Practice, 2014
Context-Outdoor workers are especially susceptible to skin cancer, the most common, but also one ... more Context-Outdoor workers are especially susceptible to skin cancer, the most common, but also one of the most preventable, forms of cancer. Colorado, the location of the study, has the second highest rate of skin cancer deaths in the nation. Objective-Local government managers in Colorado-in municipalities, counties and special districts-were surveyed in order to ascertain the extent to which they engage in formal (written) and informal practices to protect their outdoor workers against excessive exposure to sun. Design-The survey consisted of 51 question assessing awareness of formal or informal practices for sun protection of outdoor workers. An index of practices-the study's dependent variable-was created that was comprised or practices such as providing employees free or reduced-cost sunscreen, wide-brimmed hats, sunglasses, long-sleeved work shirts, long work pants, and temporary or permanent outdoor shade shelters. Proscriptive policies, such as restricting the use of broad brimmed hats, were subtracted from the index. Surveys were completed by 825 administrators representing 98 jurisdictions. Responses from administrators in the same jurisdiction were averaged. Results-Over 40 percent of responding jurisdictions indicated that they engaged in informal sun safety practices. Tests conducted to determine what variables might account for the adoption NIH Public Access
American Journal of Preventive Medicine, Jun 1, 2008
Background-Unprotected and excessive exposure to ultraviolet radiation (UVR) is the primary risk ... more Background-Unprotected and excessive exposure to ultraviolet radiation (UVR) is the primary risk factor for skin cancer. Design-A pair-matched, group-randomized, pre-test/post-test, quasi-experimental design, with ski resorts as the unit of randomization, tested the effectiveness of Go Sun Smart, a multi-channel skin cancer prevention program. Independent samples of guests were taken at baseline (2001) and follow-up (2002); data were analyzed in 2006.
Journal of the American Academy of Dermatology, 2012
Background-Adults are advised to wear sunscreen with a sun protection factor of 15+, apply it up ... more Background-Adults are advised to wear sunscreen with a sun protection factor of 15+, apply it up to 30 minutes prior to sun exposure, and reapply it after two hours to reduce exposure to ultraviolet (UV) radiation in sunlight for the prevention of skin cancer. Objective-This study investigated the extent to which adults comply with sunscreen advice. Methods-A survey was conducted with 4,837 adult skiers and snowboarders at 28 high-altitude ski areas in Western North America in January-April 2001-02. Respondents self reported use of sunscreen, its SPF, time of first application, and reapplication.
The sustainability of evidence-based programs is needed to obtain long-term benefits. To assess s... more The sustainability of evidence-based programs is needed to obtain long-term benefits. To assess sustainability of Go Sun Smart (GSS), an occupational skin cancer prevention program disseminated to the North American ski industry. Fifty-three of the 68 ski areas from the original dissemination trial participated in 2012 and 2013, 5 to 7 years after program distribution by enhanced or basic dissemination strategies. Sustained use was measured by: (1) on-site observation of sun protection communication and (2) an online survey with senior managers. In the sustainability assessment, sun safety communication had declined, and dissemination strategy did not affect continued use. Managers held weaker attitudes about skin cancer importance and program fit, but more managers provided free/reduced-cost sunscreen than in the dissemination trial. Manager turnover was a key factor in program discontinuance. Sustainability remains a challenge. Additional research is needed to determine the best strategies for sustainability.
This is the story of Go Sun Smart, a worksite wellness program endorsed by the North American Ski... more This is the story of Go Sun Smart, a worksite wellness program endorsed by the North American Ski Area Association and funded by the National Cancer Institute. Between 2000 and 2002 we designed and implemented a large-scale worksite intervention at over 300 ski resorts in North America with the objective of reducing ski area employees and guests risk for skin cancer by adopting sun safe practices. The following narrative describes the intervention in toto from its design and implementation through assessment. Our theory driven, experimentally tested intervention was successful in reducing employees' risks for skin cancer during and after the ski season. We also succeeded in making ski area guests more aware of the need to take sun safe precautions with both themselves and their children.
Unprotected and excessive exposure to ultraviolet radiation is the primary risk factor for skin c... more Unprotected and excessive exposure to ultraviolet radiation is the primary risk factor for skin cancer. Promoting sun safety practices to children and adolescents who recreate outdoors has the potential to reduce skin cancer occurrence later in life. Go Sun Smart (GSS), a sun safety program for employees and guests of ski areas was distributed to determine if an enhanced disseminations strategy was more effective than a basic dissemination strategy at reaching parents at ski and snowboard schools. On-site observations of GSS use and surveys of 909 parents/caregivers with children enrolled in ski and snowboard schools were conducted and analyzed using techniques for clustered designs. No differences were identified by dissemination strategy. Greater implementation of GSS was associated with greater parental recall of materials but not greater sun protection practices. Greater recall of messages, regardless of level of implementation, resulted in greater sun protection practices for children. GSS effectiveness trial's favorable findings may have been successfully translated to ski and snowboard school across the North American ski industry. Ski areas that used more of the program materials appeared to reach parents with sun safety advice and thus convinced them to take more precautions for their children. Sun safety need not be at odds with children's outdoor recreation activities.
Journal of Occupational and Environmental Medicine, Nov 1, 2018
Objective: Occupational skin cancer prevention is a priority because outdoor workers are exposed ... more Objective: Occupational skin cancer prevention is a priority because outdoor workers are exposed to high levels of ultraviolet radiation, the primary risk factor for skin cancer. Methods: A two-year follow-up assessment of the impact of Sun Safe Workplaces (SSW), a workplace sun safety program that promoted policy adoption and education, on employee sun safety behavior was conducted. 63 of 98 local government organizations from the original study participated. Results: Outdoor workers (n=1724) completed surveys on personal sun protection practices. Employees' sun protection improved statistically significantly in the intervention group receiving the SSW program. SSW's effect was mediated by the number of workplace actions to implement elements of the policy including sun protection messages and equipment and employee reports of sun safety training. Conclusion: Policy promotion is a feasible approach to occupational skin cancer prevention.
The epidemic of preventable skin cancer in the United States creates an urgent need for health co... more The epidemic of preventable skin cancer in the United States creates an urgent need for health communication campaigns to improve sun protection. Go Sun Smart (GSS), a theory-driven multichannel health communication campaign showed positive effects on sun safety behaviors of employees and guests in a randomized trial at high-altitude ski areas. In this article we report findings from the North American GSS campaign for guests at ski areas that comprosed the original control-group resorts, replicating the results of the original guest intervention. Results showed that after GSS was deployed, guests at the original control group ski areas increased sun protection and reported greater recall of sun safety messages. Conversely, GSS had no effect on sunburning attitudes or self-efficacy beliefs. Like the original GSS guest intervention, the present study found that greater exposure to GSS messages was associated with greater use of sunscreen, sunscreen lip balm, and face covering, but not gloves or overall sun protection. There was no evidence that GSS decreased sunburning or attitudes and self-efficacy beliefs regarding sun safety. Skin cancer prevention programs are an important national health priority. In the United States, skin cancer is both the most commonly occurring and the most preventable cancer (American Cancer Society, 2007). Several large health communication trials on sun safety have been effective with outdoor workers (
Purpose-Industry-based strategies for dissemination of an evidence-based occupational sun protect... more Purpose-Industry-based strategies for dissemination of an evidence-based occupational sun protection program, Go Sun Smart (GSS), were tested. Design-Two dissemination strategies were compared in a randomized trial in 2004-2007. Setting-The North American ski industry. Subjects-Ski areas in the United States and Canada (n=69) and their senior managers (n=469).
International Journal of Women's Dermatology, 2018
Background: As future physicians, medical students will play an important role in the prevention ... more Background: As future physicians, medical students will play an important role in the prevention of skin cancers by becoming directly involved in skin cancer prevention education and counseling patients about the hazards of ultraviolet light. Objective: We assessed the skin cancer-related knowledge, attitudes, beliefs, and prevention practices reported in previous studies of medical students. Methods: The search for relevant articles was performed in four electronic databases: PubMed (Medline), Cumulative Index to Nursing and Allied Health, ERIC, and PsycINFO. Studies were included if they met the following criteria: 1) targeted medical students; 2) assessed sun avoidance, sun protection, skin selfexamination, and/or indoor tanning behaviors; 3) were published in peer-reviewed journals; and 4) complete data were available for extraction. Results: A total of 21 studies are included in this review. Important findings include moderate-to-high levels of skin cancer knowledge and low levels of both sunscreen and ultraviolet light knowledge. The attitudes and knowledge of medical students reflect a low level of concern with regard to the perceived importance of skin cancer compared with other forms of cancer despite a high level of concern for the importance of skin cancer prevention. Furthermore, this review demonstrated that medical students fail to protect themselves routinely from the sun and have a high interest in tanning bed use. Conclusion: This review demonstrates the need to educate medical students about skin cancer and skin cancer preventive behaviors. New strategies and educational campaigns should be developed to communicate better information on skin cancer morbidity, mortality, and prevention to medical students. This will pay dividends by improving the practice of these future physicians in all specialties.
The field of interpretation is increasingly acknowledging the potential for strategic health prom... more The field of interpretation is increasingly acknowledging the potential for strategic health promotion. The purpose of this paper is to introduce Go Sun Smart (GSS) Resorts, a sun safety program directed to guests recreating outdoors at destination resorts and parks in the United States and Canada. This paper aims to present a sun safety intervention that was designed to promote advanced sun safety practices to the field of interpretation. With a foundation in Diffusion of Innovations Theory and Transportation Theory this paper will present the intervention materials and strategies developed by GSS to showcase the potential to promote health behaviors. Intervention materials that were developed include posters, tip cards, a Public Service Announcement (PSA) video, additional electronic and print materials, employee trainings, GSS certification, and an interpretive script for use prior to various outdoor activities.
Exposure to solar ultraviolet radiation during recreation is a risk factor for skin cancer. A tri... more Exposure to solar ultraviolet radiation during recreation is a risk factor for skin cancer. A trial evaluating an intervention to promote advanced sun protection (sunscreen pre-application/reapplication; protective hats and clothing; use of shade) during vacations. Adult visitors to hotels/resorts with outdoor recreation (i.e., vacationers) participated in a group-randomized pretest-posttest controlled quasi-experimental design in 2012-14. Hotels/resorts were pair-matched and randomly assigned to the intervention or untreated control group. Sun protection (e.g., clothing, hats, shade and sunscreen) was measured in cross-sectional samples by observation and a face-to-face intercept survey during two-day visits. Initially, 41 hotel/resorts (11%) participated but 4 dropped out before posttest. Hotel/resorts were diverse (employees=30 to 900; latitude=24° 78' N to 50° 52' N; elevation=2 ft. to 9,726 ft. above sea level), and had a variety of outdoor venues (beaches/pools, court/...
Journal of occupational and environmental medicine / American College of Occupational and Environmental Medicine, 2015
Sustainability of prevention programs is a public health goal. The effectiveness of Go Sun Smart,... more Sustainability of prevention programs is a public health goal. The effectiveness of Go Sun Smart, an occupational skin cancer prevention program, was evaluated 5 to 7 years out from the conclusion of a controlled randomized dissemination trial that compared an enhanced versus basic dissemination strategy at 53 ski areas enrolled in the trial. Employees (n = 2940) at ski areas in the enhanced condition reported fewer sunburns but did not differ from employees in the basic condition on other sun-protection measures. Significant differences for all sun-protection practices were identified at ski areas that displayed nine or more Go Sun Smart materials or a combined total of nine or more Go Sun Smart and other sun safety messages. Exposure to prevention messages is an important determinant of program effectiveness and potentially of program sustainability.
A successful occupational sun-protection program was translated to 67 ski areas where the effecti... more A successful occupational sun-protection program was translated to 67 ski areas where the effectiveness of two dissemination strategies was assessed. An industry professional association distributed materials to the resorts. Half of the resorts received the basic dissemination strategy (BDS) in which the materials were simply distributed to the resorts. In a randomized trial, the BDS was compared with an enhanced dissemination strategy (EDS) that added interpersonal contact with managers. Employees (n=2,228) at worksites that received the EDS had elevated program exposure (74.0% at EDS vs. 57.5% at BDS recalled a message). Exposure increased at two levels of program use: from less than four (55% exposed) to four to eight (68%) and to nine or more (82%) program items in use. More employees exposed to messages engaged in sun-safety behaviors than those unexposed. At worksites using nine or more items (versus 4-8 or <4), employees engaged in additional sun-safety behaviors. Program ...
Sustainability of an occupational sun safety program, Go Sun Smart (GSS), was explored in a rando... more Sustainability of an occupational sun safety program, Go Sun Smart (GSS), was explored in a randomized trial, testing dissemination strategies at 68 U.S. and Canadian ski areas in 2004-2007. All ski areas received GSS from the National Ski Areas Association through a Basic Dissemination Strategy (BDS) using conference presentations and free materials. Half of the ski areas were randomly assigned to a theory-based Enhanced Dissemination Strategy (EDS) with personal contact supporting GSS use. GSS use was assessed at immediate and long-term follow-up posttests by on-site observation. Use of GSS declined from immediate ( M = 6.24) to long-term follow-up ( M = 4.72), F(1, 62) = 6.95, p = .01, but EDS ski areas ( M = 6.53) continued to use GSS more than BDS ski areas ( M = 4.49), F(1, 62) = 5.75, p = .02, regardless of timing of posttest, strategy × observation F(1, 60) = 0.05, p = .83. Despite declines over time, a group of ski areas had sustained high program use and active disseminati...
To predict the prevalence of UV radiation (hereinafter, UV) at North American ski resorts using t... more To predict the prevalence of UV radiation (hereinafter, UV) at North American ski resorts using temporal, seasonal, altitudinal, and meteorological factors and associate UV with a set of adult sun protection behaviors. Design: Ultraviolet radiation observations and crosssectional survey of adults on sun protection were collected. Setting: Data were collected at 32 high-altitude ski areas located in western North America from 2001 through 2003. Participants: The sample consisted of 3937 adult skiers or snowboarders. Main Outcome Measures: Measurements of direct, reflected, and diffuse UV were performed at 487 measurement points using handheld meters and combined with self-reported and observed sun protection assessed for adults interviewed on chairlifts. Results: The strongest predictors of UV were temporal proximity to noon, deviation from winter solstice, and clear skies. By contrast, altitude and latitude had more modest associations with UV and temperature had a small positive relationship with UV. Guest sun safety was inconsistently associated with UV: UV was positively related to adults wearing more sunscreen, reapplying it after 2 hours, and wearing protective eyewear, but fewer adults exhibited many of the other sun protection behaviors, such as wearing hats and protective clothing or using lip balm, on days when UV was elevated. Guests took more sun safety precautions on clear-sky days but took steps to maintain body warmth on inclement days. Conclusions: In future sun safety promotions, adults should be encouraged to wear sunscreen on cloudy days because UV is still high and conditions can change rapidly. They need reminders to rely more on season and time of day when judging UV and the need for sun safety.
Journal of Public Health Management and Practice, 2014
Context-Outdoor workers are especially susceptible to skin cancer, the most common, but also one ... more Context-Outdoor workers are especially susceptible to skin cancer, the most common, but also one of the most preventable, forms of cancer. Colorado, the location of the study, has the second highest rate of skin cancer deaths in the nation. Objective-Local government managers in Colorado-in municipalities, counties and special districts-were surveyed in order to ascertain the extent to which they engage in formal (written) and informal practices to protect their outdoor workers against excessive exposure to sun. Design-The survey consisted of 51 question assessing awareness of formal or informal practices for sun protection of outdoor workers. An index of practices-the study's dependent variable-was created that was comprised or practices such as providing employees free or reduced-cost sunscreen, wide-brimmed hats, sunglasses, long-sleeved work shirts, long work pants, and temporary or permanent outdoor shade shelters. Proscriptive policies, such as restricting the use of broad brimmed hats, were subtracted from the index. Surveys were completed by 825 administrators representing 98 jurisdictions. Responses from administrators in the same jurisdiction were averaged. Results-Over 40 percent of responding jurisdictions indicated that they engaged in informal sun safety practices. Tests conducted to determine what variables might account for the adoption NIH Public Access
American Journal of Preventive Medicine, Jun 1, 2008
Background-Unprotected and excessive exposure to ultraviolet radiation (UVR) is the primary risk ... more Background-Unprotected and excessive exposure to ultraviolet radiation (UVR) is the primary risk factor for skin cancer. Design-A pair-matched, group-randomized, pre-test/post-test, quasi-experimental design, with ski resorts as the unit of randomization, tested the effectiveness of Go Sun Smart, a multi-channel skin cancer prevention program. Independent samples of guests were taken at baseline (2001) and follow-up (2002); data were analyzed in 2006.
Journal of the American Academy of Dermatology, 2012
Background-Adults are advised to wear sunscreen with a sun protection factor of 15+, apply it up ... more Background-Adults are advised to wear sunscreen with a sun protection factor of 15+, apply it up to 30 minutes prior to sun exposure, and reapply it after two hours to reduce exposure to ultraviolet (UV) radiation in sunlight for the prevention of skin cancer. Objective-This study investigated the extent to which adults comply with sunscreen advice. Methods-A survey was conducted with 4,837 adult skiers and snowboarders at 28 high-altitude ski areas in Western North America in January-April 2001-02. Respondents self reported use of sunscreen, its SPF, time of first application, and reapplication.
The sustainability of evidence-based programs is needed to obtain long-term benefits. To assess s... more The sustainability of evidence-based programs is needed to obtain long-term benefits. To assess sustainability of Go Sun Smart (GSS), an occupational skin cancer prevention program disseminated to the North American ski industry. Fifty-three of the 68 ski areas from the original dissemination trial participated in 2012 and 2013, 5 to 7 years after program distribution by enhanced or basic dissemination strategies. Sustained use was measured by: (1) on-site observation of sun protection communication and (2) an online survey with senior managers. In the sustainability assessment, sun safety communication had declined, and dissemination strategy did not affect continued use. Managers held weaker attitudes about skin cancer importance and program fit, but more managers provided free/reduced-cost sunscreen than in the dissemination trial. Manager turnover was a key factor in program discontinuance. Sustainability remains a challenge. Additional research is needed to determine the best strategies for sustainability.
This is the story of Go Sun Smart, a worksite wellness program endorsed by the North American Ski... more This is the story of Go Sun Smart, a worksite wellness program endorsed by the North American Ski Area Association and funded by the National Cancer Institute. Between 2000 and 2002 we designed and implemented a large-scale worksite intervention at over 300 ski resorts in North America with the objective of reducing ski area employees and guests risk for skin cancer by adopting sun safe practices. The following narrative describes the intervention in toto from its design and implementation through assessment. Our theory driven, experimentally tested intervention was successful in reducing employees' risks for skin cancer during and after the ski season. We also succeeded in making ski area guests more aware of the need to take sun safe precautions with both themselves and their children.
Unprotected and excessive exposure to ultraviolet radiation is the primary risk factor for skin c... more Unprotected and excessive exposure to ultraviolet radiation is the primary risk factor for skin cancer. Promoting sun safety practices to children and adolescents who recreate outdoors has the potential to reduce skin cancer occurrence later in life. Go Sun Smart (GSS), a sun safety program for employees and guests of ski areas was distributed to determine if an enhanced disseminations strategy was more effective than a basic dissemination strategy at reaching parents at ski and snowboard schools. On-site observations of GSS use and surveys of 909 parents/caregivers with children enrolled in ski and snowboard schools were conducted and analyzed using techniques for clustered designs. No differences were identified by dissemination strategy. Greater implementation of GSS was associated with greater parental recall of materials but not greater sun protection practices. Greater recall of messages, regardless of level of implementation, resulted in greater sun protection practices for children. GSS effectiveness trial's favorable findings may have been successfully translated to ski and snowboard school across the North American ski industry. Ski areas that used more of the program materials appeared to reach parents with sun safety advice and thus convinced them to take more precautions for their children. Sun safety need not be at odds with children's outdoor recreation activities.
Journal of Occupational and Environmental Medicine, Nov 1, 2018
Objective: Occupational skin cancer prevention is a priority because outdoor workers are exposed ... more Objective: Occupational skin cancer prevention is a priority because outdoor workers are exposed to high levels of ultraviolet radiation, the primary risk factor for skin cancer. Methods: A two-year follow-up assessment of the impact of Sun Safe Workplaces (SSW), a workplace sun safety program that promoted policy adoption and education, on employee sun safety behavior was conducted. 63 of 98 local government organizations from the original study participated. Results: Outdoor workers (n=1724) completed surveys on personal sun protection practices. Employees' sun protection improved statistically significantly in the intervention group receiving the SSW program. SSW's effect was mediated by the number of workplace actions to implement elements of the policy including sun protection messages and equipment and employee reports of sun safety training. Conclusion: Policy promotion is a feasible approach to occupational skin cancer prevention.
The epidemic of preventable skin cancer in the United States creates an urgent need for health co... more The epidemic of preventable skin cancer in the United States creates an urgent need for health communication campaigns to improve sun protection. Go Sun Smart (GSS), a theory-driven multichannel health communication campaign showed positive effects on sun safety behaviors of employees and guests in a randomized trial at high-altitude ski areas. In this article we report findings from the North American GSS campaign for guests at ski areas that comprosed the original control-group resorts, replicating the results of the original guest intervention. Results showed that after GSS was deployed, guests at the original control group ski areas increased sun protection and reported greater recall of sun safety messages. Conversely, GSS had no effect on sunburning attitudes or self-efficacy beliefs. Like the original GSS guest intervention, the present study found that greater exposure to GSS messages was associated with greater use of sunscreen, sunscreen lip balm, and face covering, but not gloves or overall sun protection. There was no evidence that GSS decreased sunburning or attitudes and self-efficacy beliefs regarding sun safety. Skin cancer prevention programs are an important national health priority. In the United States, skin cancer is both the most commonly occurring and the most preventable cancer (American Cancer Society, 2007). Several large health communication trials on sun safety have been effective with outdoor workers (
Purpose-Industry-based strategies for dissemination of an evidence-based occupational sun protect... more Purpose-Industry-based strategies for dissemination of an evidence-based occupational sun protection program, Go Sun Smart (GSS), were tested. Design-Two dissemination strategies were compared in a randomized trial in 2004-2007. Setting-The North American ski industry. Subjects-Ski areas in the United States and Canada (n=69) and their senior managers (n=469).
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Papers by Michael Scott