The Advanced Go Sun Smart (GSS) Program will develop and test the efficacy of a comprehensive, innovative sun safety approach. Advanced GSS is a paradigm shift that augments existing sun safety approaches with a new strategy using narrative persuasive messages based on Transportation Theory (TT) and targeting comprehensive sun protection behaviors. Despite progress, the skin cancer epidemic is rising in the U.S. A new approach is needed. Over the past 10 years, our team has implemented and evaluated the successful Go Sun Smart (GSS) program at over 350 ski areas in North America targeted primarily at employees, resulting in 11 publications. In this revised application, two experts in TT and narrative messages, including TT's inventor, join our team. Despite GSS and other campaigns, most adults irregularly use sunscreen, do not apply it half- hour before sun exposure, fail to reapply it after two hours, do not wear wide-brimmed hats or protective clothing, do not use shade, and do not accurately estimate ultraviolet radiation (UV) levels. The Advanced GSS augments past campaigns with TT-based messages to alter adults'vacation narratives to include sun safety. Vacation schemas contain disinhibited, fun, carefree narratives that we will supplement with sun safety messages delivered in emails, web sites, graphic stories, and other materials intended to embed sun safety in vacationers'narratives. Advanced GSS will target next-generation sun safety behaviors promoting sufficient sunscreen application half-hour prior to UV exposure and reapplication, use of shade, wide-brimmed hats and protective clothing, and simple ways to assess dangerous UV levels. Advanced GSS extends our winter high- altitude GSS to spring/ summer environments when UV is highest. Using a pretest-posttest, group-randomized controlled design, we will test the efficacy of Advanced GSS at 40 pair-matched US hotels and resorts randomly selected from strata based on room rack rate and region. Eligible hotels and resorts will be members of our partner associations, The American Hotel and Lodging Association and Hospitality Sales and Marketing Association International. Participating hotels/resorts will be divided into three waves over three experimental years. Project staff will send, link, distribute, and post intervention materials at 20 intervention hotels/resorts working with a key contact manager, as in the original GSS trials. Research assistants (RAs), trained in data collection procedures, will conduct intercept surveys (which had an 88% response rate in a pilot test for this resubmission) with 95 visitors in each hotel/resort at pretest and posttest in the spring and summer in proximity to the summer solstice, the time of year with the highest UV. Primary outcome measures in these surveys are reports of current sun protection (i.e., use of SPF 15+ sunscreen, pre-application and reapplication) and observation of hat, clothing, and shade use. RAs also will make daily observations of sun protection behavior by visitors at the hotels/resorts as secondary outcome measures. Since most Americans of all ethnic and income groups recreate outdoors on vacation, the results should be generalizable to the US population.
This application addresses the epidemic of skin cancer by testing advanced Transportation Theory-based messages to create sun safety vacation narratives for outdoor recreation. Many Americans routinely receive extreme doses of unprotected sun exposure and often intentionally seek a sun tan while on vacation, substantially elevating their risk for developing skin cancer. An advanced sun protection program will be evaluated in a randomized trial at 40 US hotels and resorts where visitors'comprehensive sun protection (early application and re-application of sunscreen, use of wide-brimmed hats, protective clothing, and shade, and attention to reliable environmental indicators of high UV) will be assessed through surveys and observations.
