title: Rationale, design, samples, and baseline sun protection in a randomized trial on a skin cancer prevention intervention in resort environments.
abstract: BACKGROUND
  Exposure to solar ultraviolet radiation during recreation is a risk factor for skin cancer. A trial evaluated an intervention to promote advanced sun protection (sunscreen pre-application/reapplication; protective hats and clothing; use of shade) during vacations.
  
  
  METHODS
  Adult visitors to hotels/resorts with outdoor recreation (i.e., vacationers) participated in a group-randomized pretest-posttest controlled quasi-experimental design in 2012-14. Hotels/resorts were pair-matched and randomly assigned to the intervention or untreated control group. Sun. protection (e.g., clothing, hats, shade and sunscreen) was measured in cross-sectional samples by observation and a face-to-face intercept survey during two-day visits.
  
  
  RESULTS
  Initially, 41 hotel/resorts (11%) participated but 4 dropped out before posttest. Hotel/resorts were diverse (employees=30 to 900; latitude=24° 78' N to 50° 52' N; elevation=2ft. to 9726ft. above sea level), and had a variety of outdoor venues (beaches/pools, court/lawn games, golf courses, common areas, and chairlifts). At pretest, 4347 vacationers were observed and 3531 surveyed. More females were surveyed (61%) than observed (50%). Vacationers were mostly 35-60years old, highly educated (college education=68%) and non-Hispanic white (93%), with high-risk skin types (22%). Vacationers reported covering 60% of their skin with clothing. Also, 40% of vacationers used shade; 60% applied sunscreen; and 42% had been sunburned.
  
  
  CONCLUSIONS
  The trial faced challenges recruiting resorts but result showed that the large, multi-state sample of vacationers were at high risk for solar UV exposure.
authors.affiliation: Klein Buendel, Inc., 1667 Cole Boulevard, Suite 225, Golden, CO 80401, United States. Electronic address: dbuller@kleinbuendel.com.
authors.forename: David B
authors.initials: DB
authors.lastname: Buller
authors.affiliation: School of Communication, San Diego State University, 5500 Campanile Drive, San Diego, CA 92182, United States. Electronic address: westone47@gmail.com.
authors.forename: Peter A
authors.initials: PA
authors.lastname: Andersen
authors.affiliation: Klein Buendel, Inc., 1667 Cole Boulevard, Suite 225, Golden, CO 80401, United States. Electronic address: bwalkosz@kleinbuendel.com.
authors.forename: Barbara J
authors.initials: BJ
authors.lastname: Walkosz
authors.affiliation: California State University and President of Mikonics, Inc., 40 B Old Road South, Santa Fe, NM 87540, United States. Electronic address: michael.granker@gmail.com.
authors.forename: Michael D
authors.initials: MD
authors.lastname: Scott
authors.affiliation: L. Robert Payne School of Hospitality and Tourism Management, Room PSFA 445, San Diego State University, San Diego, CA 92182, United States. Electronic address: lbeck@mail.sdsu.edu.
authors.forename: Larry
authors.initials: L
authors.lastname: Beck
authors.affiliation: Department of Biostatistics, School of Public Health, RPHB 401B, University of Alabama, 1720 2nd Avenue South, Birmingham, AL 35294, United States. Electronic address: cutterg@uab.edu.
authors.forename: Gary R
authors.initials: GR
authors.lastname: Cutter
mesh_terms: D000328:Adult; D003430:Cross-Sectional Studies; D005260:Female; D015438:Health Behavior; D006293:Health Promotion / Q000379:methods*; D006294:Health Resorts; D006693:Holidays; D006801:Humans; D008297:Male; D008875:Middle Aged; D011481:Protective Clothing; D011998:Recreation; D012878:Skin Neoplasms / Q000517:prevention & control*; D013473:Sunscreening Agents / Q000627:therapeutic use*; D014481:United States; D055815:Young Adult
chemical_list: D013473:Sunscreening Agents
keywords: Clothing; Intervention; Prevention; Recreation; Skin cancer; Sunscreen