Skin cancer is one of the most common cancers in the United States, and it is also one of the most preventable. Preventive behaviors include reducing peak sun exposure, wearing sunscreen, seeking shade, wearing protective clothing, and avoiding sunburn. Few skin cancer prevention programs in outdoor settings have been evaluated in controlled trials, and as with many preventive interventions, little is known about how to successfully disseminate those that are found efficacious. The efficacy of the Pool Cool program in aquatic settings (swimming pools) was demonstrated in a previous trial, and a Dissemination Pilot Study with 186 swimming pools was completed.
The aims of this study are to evaluate the effects of two strategies for diffusion of the Pool Cool skin cancer prevention program on: program implementation, maintenance, and sustainability; organizational and environmental supports for sun protection; and sun protection habits and sunbums among children. Ancillary aims are to examine predictors of diffusion, examine the mediating role of lifeguards and aquatic instructors; characterize correlates of participation in a diffusion trial and rates of spontaneous diffusion; and investigate longitudinal patterns of sun protection behaviors over multiple years. The study will use a three-level nested experimental design; the three levels are Field Coordinators, swimming pools, and children ages 5 to 10 years in swimming lessons. 32 Field Coordinators will be randomized into Basic and Enhanced (reinforcement + feedback) diffusion conditions. Intervention materials for the children, and strategies for the Field Coordinators, are based principally on Social Cognitive Theory and Diffusion of Innovations. Each Field Coordinator will work with 10 pools for three years (n=320 pools final sample). A sample of 20 parents per pool will be surveyed about their children at baseline and at the end of each summer (n= 6,400 final sample); a cohort sub-sample will be followed over multiple years. The main outcomes of interest will be pool level diffusion endpoints, organizational/environmental change at pools, and child sun protection habits and sunburns. Process evaluation will supplement outcome data. The results of this research will increase our knowledge of the diffusion of evidence-based cancer prevention programs in community settings, and of their long term maintenance and sustainability. The findings will make a significant contribution to our understanding of skin cancer prevention behaviors of individuals and aquatics organizations.

National Institute of Health (NIH)
National Cancer Institute (NCI)
Research Project (R01)
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Special Emphasis Panel (ZRG1-SNEM-1 (01))
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Yaroch, Amy L
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Emory University
Schools of Public Health
United States
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Glanz, Karen; Escoffery, Cam; Elliott, Tom et al. (2015) Randomized Trial of Two Dissemination Strategies for a Skin Cancer Prevention Program in Aquatic Settings. Am J Public Health 105:1415-23
Kim, Bang Hyun; Glanz, Karen; Nehl, Eric J (2012) Vitamin D beliefs and associations with sunburns, sun exposure, and sun protection. Int J Environ Res Public Health 9:2386-95
Hiemstra, Marieke; Glanz, Karen; Nehl, Eric (2012) Changes in sunburn and tanning attitudes among lifeguards over a summer season. J Am Acad Dermatol 66:430-7
Hall, Dawn; Kline, Melissa; Glanz, Karen (2011) Analysis of participatory photojournalism in a widely disseminated skin cancer prevention program. Health Promot Pract 12:666-72
Glanz, Karen; Gies, Peter; O'Riordan, David L et al. (2010) Validity of self-reported solar UVR exposure compared with objectively measured UVR exposure. Cancer Epidemiol Biomarkers Prev 19:3005-12
Hall, Dawn M; Escoffery, Cam; Nehl, Eric et al. (2010) Spontaneous diffusion of an effective skin cancer prevention program through Web-based access to program materials. Prev Chronic Dis 7:A125
Gies, Peter; Glanz, Karen; O'Riordan, David et al. (2009) Measured occupational solar UVR exposures of lifeguards in pool settings. Am J Ind Med 52:645-53
O'Riordan, David L; Nehl, Eric; Gies, Peter et al. (2009) Validity of covering-up sun-protection habits: Association of observations and self-report. J Am Acad Dermatol 60:739-44
Hall, Dawn; Dubruiel, Nicole; Elliott, Tom et al. (2009) Linking agents' activities and communication patterns in a study of the dissemination of an effective skin cancer prevention program. J Public Health Manag Pract 15:409-15
Glanz, Karen; McCarty, Frances; Nehl, Eric J et al. (2009) Validity of self-reported sunscreen use by parents, children, and lifeguards. Am J Prev Med 36:63-9

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