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A randomized trial of the Hawaii SunSmart program's impact on outdoor recreation staff☆,☆☆,★

https://doi.org/10.1067/mjd.2001.113466Get rights and content

Abstract

Background: Skin cancer is the most common form of cancer in the United States and one of the most preventable. Prevention programs for children at outdoor recreation sites may influence not only the youth, but the staff, or caregivers, as well. By teaching children about sun protection, staff may also change their sun protection behaviors. Objective: We report on the impact of a childhood skin cancer prevention program (SunSmart) on staff at outdoor recreation sites where a child-focused intervention was conducted. Methods: The intervention included staff training, on-site activities delivered by staff, distribution of sunscreen, and the promotion of sun-safe environments. It was hypothesized that by teaching children about sun protection, staff would change their sun protection behaviors. A randomized trial at 14 recreation sites (n = 176 staff) in Hawaii tested the efficacy of education only, and education plus environmental changes, compared with a control condition. Results: Results showed significant positive changes in knowledge, sun protection habits, norms, and sun protection policies. The education plus environment group was not superior to education alone. Conclusion: Changes in staff behavior and attitudes are important for their own health, as positive role models, and for the dissemination of skin cancer control programs. (J Am Acad Dermatol 2001;44:973-8.)

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Design and setting

The SunSmart evaluation was a 3-arm randomized controlled trial, conducted at 14 recreation sites on the island of Oahu (city-managed community park sites and YMCAs) during the summer of 1996. All of the sites provided “Summer Fun programs,” a local variety of what might be thought of as “day camp.” Sites were randomized by means of a blocking strategy to balance site size and location across the study arms. The sites in the education arm received a 60- to 90-minute staff training, a leader's

Description of samples, nonresponse analysis, and baseline equivalence of groups

A total of 176 staff members responded to the baseline survey (T1) (68.2% response rate). Response rates for posttest and follow-up surveys were 71.9% (n = 144) and 61.4% (n = 66), respectively. Seventeen respondents to the posttest survey were not in the main analysis cohort because they had not completed baseline surveys, and the total number of recreation staff at the sites had decreased to 200 at the time of the posttest survey. Most respondents were female (60.9%) and the average age was

Discussion

The randomized evaluation of SunSmart showed that the two intervention conditions (both the education and education plus environment) resulted in improvements in sun protection knowledge and perceived norms. The education only intervention also led to improved sun protection practices among staff members. A substantial increase in sun protection programs and policies in sites that had the SunSmart program was also found. Both intervention groups had outcomes that were significantly better than

Acknowledgements

We gratefully acknowledge the contributions of the following individuals: Roger Tomihama, Anthony Fo, Tesa Ho, Gwen Ramelb, Rommel Silverio, Elena Carbone, Laurie Chang, Mae Isonaga, Rosemary Casey, Valerie Song, Joyce Mitsunaga, and Sharon Hanzawa. The Hawaii Medical Services Association Division of Community Affairs made significant contributions to this project. We are also most grateful to the children, parents, and recreation staff members who participated.

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This work was completed through a cooperative agreement with the Health Promotion and Education Branch, Department of Health, State of Hawaii, and the Division of Cancer Prevention and Control at the Centers for Disease Control and Prevention, within the US Public Health Service.

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Reprint requests: Karen Glanz, PhD, MPH, Prevention and Control Program, Cancer Research Center of Hawaii, 1236 Lauhala St, Honolulu, HI 96813.

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J Am Acad Dermatol 2001;44:973-8

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Copyright © 2001 American Academy of Dermatology, Inc. Published by Mosby, Inc. All rights reserved.