title: A randomized trial of the Hawaii SunSmart program's impact on outdoor recreation staff.
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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Cancer Research Center of Hawaii, University of Hawaii at Manoa, USA.
authors.forename: K
authors.initials: K
authors.lastname: Glanz
authors.forename: J E
authors.initials: JE
authors.lastname: Maddock
authors.forename: R A
authors.initials: RA
authors.lastname: Lew
authors.forename: L
authors.initials: L
authors.lastname: Murakami-Akatsuka
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002652:Child Behavior; D002669:Child Welfare; D004493:Education; D005260:Female; D006254:Hawaii; D015438:Health Behavior; D007722:Health Knowledge, Attitudes, Practice; D006293:Health Promotion; D006801:Humans; D008297:Male; D011998:Recreation; D012878:Skin Neoplasms / Q000517:prevention & control*; D013471:Sunburn / Q000517:prevention & control*; D014466:Ultraviolet Rays / Q000009:adverse effects*