title: Randomized Trial of Two Dissemination Strategies for a Skin Cancer Prevention Program in Aquatic Settings.
abstract: OBJECTIVE
  We compared 2 strategies for disseminating an evidence-based skin cancer prevention program.
  
  
  METHODS
  We evaluated the effects of 2 strategies (basic vs enhanced) for dissemination of the Pool Cool skin cancer prevention program in outdoor swimming pools on (1) program implementation, maintenance, and sustainability and (2) improvements in organizational and environmental supports for sun protection. The trial used a cluster-randomized design with pools as the unit of intervention and outcome. The enhanced group received extra incentives, reinforcement, feedback, and skill-building guidance. Surveys were collected in successive years (2003-2006) from managers of 435 pools in 33 metropolitan areas across the United States participating in the Pool Cool Diffusion Trial.
  
  
  RESULTS
  Both treatment groups improved their implementation of the program, but pools in the enhanced condition had significantly greater overall maintenance of the program over 3 summers of participation. Furthermore, pools in the enhanced condition established and maintained significantly greater sun-safety policies and supportive environments over time.
  
  
  CONCLUSIONS
  This study found that more intensive, theory-driven dissemination strategies can significantly enhance program implementation and maintenance of health-promoting environmental and policy changes. Future research is warranted through longitudinal follow-up to examine sustainability.
authors.affiliation: Karen Glanz is with Perelman School of Medicine and School of Nursing, University of Pennsylvania, Philadelphia. Cam Escoffery, Tom Elliott, and Eric J. Nehl are with Rollins School of Public Health, Emory University, Atlanta, GA.
authors.forename: Karen
authors.initials: K
authors.lastname: Glanz
authors.forename: Cam
authors.initials: C
authors.lastname: Escoffery
authors.forename: Tom
authors.initials: T
authors.lastname: Elliott
authors.forename: Eric J
authors.initials: EJ
authors.lastname: Nehl
mesh_terms: D000328:Adult; D005260:Female; D006266:Health Education / Q000379:methods; D006291:Health Policy; D006293:Health Promotion / Q000379:methods*; D006801:Humans; D008297:Male; D015397:Program Evaluation; D012878:Skin Neoplasms / Q000517:prevention & control*; D013551:Swimming Pools / Q000706:statistics & numerical data; D014481:United States / Q000453:epidemiology; D055815:Young Adult