title: Impact of skin cancer prevention on outdoor aquatics staff: the Pool Cool program in Hawaii and Massachusetts.
abstract: BACKGROUND
  Aquatic staff, including lifeguards, are exposed to intense sunlight for many hours each day and are likely to be at a relatively high risk for developing skin cancer. However, no interventions have been specifically directed to staff at outdoor swimming pool sites.
  
  
  METHODS
  We conducted a randomized controlled trial among aquatic staff at 28 outdoor pool sites in Hawaii and Massachusetts. Intervention pools received sun protection education and control pools received education on child injury prevention. Staff in both arms received orientation sessions and led instruction during swim lessons. Analysis of covariance was used to compare and test for changes in outcome variables (sun protection habits and sunburning rates of aquatic staff) and pool protection policies. Surveys were completed at the beginning and end of the summer.
  
  
  RESULTS
  Surveys were completed by 220 aquatics staff at baseline; 194 surveys were completed at posttest. Compared with staff at control pools, sun protection policies (P < 0.04) and sunburning rates (P < 0.05) improved at sun protection pools from baseline to posttest. However, the difference in the mean score of all sun protection habits between the two study groups was nonsignificant.
  
  
  CONCLUSIONS
  The Pool Cool sun protection intervention had significant effects on lifeguards' sunburn rates and pool sun safety policies but did not improve reported sun protection behaviors. More intensive strategies may be needed to influence aquatics workers who have already begun to adopt skin cancer prevention practices.
authors.affiliation: Department of Dermatology, School of Medicine, Boston University, Massachusetts 02118, USA. ageller@bu.edu
authors.forename: A C
authors.initials: AC
authors.lastname: Geller
authors.forename: K
authors.initials: K
authors.lastname: Glanz
authors.forename: D
authors.initials: D
authors.lastname: Shigaki
authors.forename: M R
authors.initials: MR
authors.lastname: Isnec
authors.forename: T
authors.initials: T
authors.lastname: Sun
authors.forename: J
authors.initials: J
authors.lastname: Maddock
mesh_terms: D000328:Adult; D000704:Analysis of Variance; D002648:Child; D005260:Female; D006254:Hawaii; D006266:Health Education; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D008404:Massachusetts; D016273:Occupational Exposure / Q000517:prevention & control*; D012878:Skin Neoplasms / Q000517:prevention & control*; D013471:Sunburn / Q000517:prevention & control*; D013550:Swimming