title: Effect of an intervention on observed sun protection by vacationers in a randomized controlled trial at North American resorts.
abstract: During vacations, many individuals receive high-risk sun exposure that is associated with skin cancer. Vacationers in outdoor recreation venues (pretest n=4347; posttest n=3986) at warm-weather destination resorts in North America (n=41) were enrolled in a pair-matched, group-randomized pretest-posttest controlled quasi-experimental design in 2012-14. Print, audiovisual, and online messages based on Transportation Theory and Diffusion of Innovation Theory and promoting advanced sun protection (e.g., use of clothing, hats, shade and pre-application/reapplication of sunscreen and reliable cues to high UV) were delivered through resort channels. Vacationers' sun protection practices observed by trained research staff (i.e., body coverage and shade use analyzed individually and in combined scores) did not differ by experimental condition (p>0.05) or intervention implementation (p>0.05). However, recreation venue moderated intervention impact. The intervention improved sun protection at waterside recreation venues (z-score composite: intervention pre=-22.74, post=-15.77; control pre=-27.24, post=-23.24) but not non-waterside venues (z-score composite: intervention pre=20.43, post=20.53; control pre=22.94, post=18.03, p<0.01). An additional analysis showed that resorts with greater program implementation showed more improvements in sun protection by vacationers at waterside (z=score composite: high implementation pre=-25.45, post=-14.05; low implementation pre=-24.70, post=-21.40) compared to non-waterside (z-score composite: high implementation pre=14.51, post=19.98; low implementation pre=24.03, post=18.98, p<0.01) recreation venues. The intervention appeared effective with the vacationers in recreation venues with the highest-risk for sun exposure, waterside venues. However, it was not effective throughout all the resort venues, possibly because of the sun-seeking desires of vacationers, information overload at the resorts, and constraints on clothing styles and sun protection by recreation activity.
authors.affiliation: Klein Buendel, Inc., 1667 Cole Boulevard, Suite 225, Golden, CO 80401, USA. 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 Campanille, San Diego, CA 92182-4560, USA.
authors.forename: Peter A
authors.initials: PA
authors.lastname: Andersen
authors.affiliation: Klein Buendel, Inc., 1667 Cole Boulevard, Suite 225, Golden, CO 80401, USA.
authors.forename: Barbara J
authors.initials: BJ
authors.lastname: Walkosz
authors.affiliation: Department of Communication Arts and Sciences, 400 W 1st Street, California State University, Chico, CA 95929, USA.
authors.forename: Michael D
authors.initials: MD
authors.lastname: Scott
authors.affiliation: L. Robert Payne School of Hospitality and Tourism Management, San Diego State University, San Diego, CA 92182, USA.
authors.forename: Larry
authors.initials: L
authors.lastname: Beck
authors.affiliation: School of Public Health, University of Alabama, Birmingham, 1667 University Blvd, Ryals 410b, Birmingham, AL 35294, USA.
authors.forename: Gary R
authors.initials: GR
authors.lastname: Cutter
mesh_terms: D000328:Adult; D005260:Female; D006293:Health Promotion / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009656:North America; D011481:Protective Clothing / Q000706:statistics & numerical data; D011998:Recreation; D012878:Skin Neoplasms / Q000517:prevention & control*; D013471:Sunburn / Q000517:prevention & control; D013473:Sunscreening Agents / Q000627:therapeutic use*; D014466:Ultraviolet Rays / Q000009:adverse effects
chemical_list: D013473:Sunscreening Agents