Comprehensive Sun Protection in Recreation: An Advanced Go Sun Smart Program

高级Go Sun Smart（GSS）计划将开发和测试一种全面、创新的阳光安全方法的有效性。高级GSS是一种范式转变，它利用基于运输理论（TT）的叙事说服性信息和针对综合防晒行为的新策略来增强现有的防晒安全方法。尽管取得了进展，皮肤癌的流行在美国正在上升，需要一种新的方法。在过去的10年里，我们的团队在北美350多个滑雪场实施并评估了成功的Go Sun Smart（GSS）计划，主要针对员工，并发表了11篇论文。在这个修改后的应用程序中，两位TT和叙事消息专家，包括TT的发明者，加入了我们的团队。尽管GSS和其他活动，大多数成年人不定期使用防晒霜，不在阳光照射前半小时涂抹，两小时后不重新涂抹，不戴宽边帽或防护服，不使用遮阳伞，也不准确估计紫外线辐射（UV）水平。先进的GSS增强了过去的运动与TT为基础的信息，以改变成年人的假期叙述，包括阳光安全。度假计划包含无拘无束，有趣，无忧无虑的叙述，我们将补充太阳安全信息，通过电子邮件，网站，图形故事和其他材料将太阳安全嵌入度假者的叙述中。先进的GSS将针对下一代太阳安全行为，促进在紫外线暴露和重新应用前半小时使用足够的防晒霜，使用遮阳伞，宽边帽和防护服，以及评估危险紫外线水平的简单方法。先进的GSS将我们的冬季高海拔GSS扩展到紫外线最高的春/夏环境。采用前测-后测、分组随机对照设计，我们将在40家配对的美国酒店和度假村中测试高级GSS的有效性，这些酒店和度假村是从基于客房入住率和地区的分层中随机选择的。符合条件的酒店和度假村将是我们的合作伙伴协会，美国酒店和住宿协会和国际酒店销售和营销协会的成员。参与的酒店/度假村将在三个实验年内分为三波。项目工作人员将在20家干预酒店/度假村与主要联系人经理合作发送、链接、分发和张贴干预材料，就像最初的GSS试验一样。经过数据收集程序培训的研究助理（RA）将在春季和夏季接近夏至（一年中紫外线最高的时间）的测试前和测试后，在每个酒店/度假村对95名游客进行拦截调查（在此次重新提交的试点测试中，响应率为88%）。这些调查中的主要结果指标是当前防晒的报告（即，使用SPF 15+防晒霜，预涂和再涂），并观察帽子、衣服和遮光物的使用。RA还将每天观察酒店/度假村游客的防晒行为，作为次要结局指标。由于所有种族和收入群体的大多数美国人在度假时都在户外娱乐，因此该结果应该适用于美国人口。 公共卫生相关性：该应用程序通过测试基于先进运输理论的消息来解决皮肤癌的流行，以创建户外娱乐的阳光安全度假叙述。许多美国人经常接受极端剂量的无保护的阳光照射，并且经常在度假时故意寻求日光浴，这大大增加了他们患皮肤癌的风险。一项先进的防晒计划将在美国40家酒店和度假村进行随机试验，通过调查和观察评估游客的全面防晒（早期应用和重新应用防晒霜，使用宽边帽，防护服和遮阳，以及注意高紫外线的可靠环境指标）。

DESCRIPTION (provided by applicant): The Advanced Go Sun Smart (GSS) Program will develop and test the efficacy of a comprehensive, innovative sun safety approach. Advanced GSS is a paradigm shift that augments existing sun safety approaches with a new strategy using narrative persuasive messages based on Transportation Theory (TT) and targeting comprehensive sun protection behaviors. Despite progress, the skin cancer epidemic is rising in the U.S. A new approach is needed. Over the past 10 years, our team has implemented and evaluated the successful Go Sun Smart (GSS) program at over 350 ski areas in North America targeted primarily at employees, resulting in 11 publications. In this revised application, two experts in TT and narrative messages, including TT's inventor, join our team. Despite GSS and other campaigns, most adults irregularly use sunscreen, do not apply it half- hour before sun exposure, fail to reapply it after two hours, do not wear wide-brimmed hats or protective clothing, do not use shade, and do not accurately estimate ultraviolet radiation (UV) levels. The Advanced GSS augments past campaigns with TT-based messages to alter adults' vacation narratives to include sun safety. Vacation schemas contain disinhibited, fun, carefree narratives that we will supplement with sun safety messages delivered in emails, web sites, graphic stories, and other materials intended to embed sun safety in vacationers' narratives. Advanced GSS will target next-generation sun safety behaviors promoting sufficient sunscreen application half-hour prior to UV exposure and reapplication, use of shade, wide-brimmed hats and protective clothing, and simple ways to assess dangerous UV levels. Advanced GSS extends our winter high- altitude GSS to spring/ summer environments when UV is highest. Using a pretest-posttest, group-randomized controlled design, we will test the efficacy of Advanced GSS at 40 pair-matched US hotels and resorts randomly selected from strata based on room rack rate and region. Eligible hotels and resorts will be members of our partner associations, The American Hotel and Lodging Association and Hospitality Sales and Marketing Association International. Participating hotels/resorts will be divided into three waves over three experimental years. Project staff will send, link, distribute, and post intervention materials at 20 intervention hotels/resorts working with a key contact manager, as in the original GSS trials. Research assistants (RAs), trained in data collection procedures, will conduct intercept surveys (which had an 88% response rate in a pilot test for this resubmission) with 95 visitors in each hotel/resort at pretest and posttest in the spring and summer in proximity to the summer solstice, the time of year with the highest UV. Primary outcome measures in these surveys are reports of current sun protection (i.e., use of SPF 15+ sunscreen, pre-application and reapplication) and observation of hat, clothing, and shade use. RAs also will make daily observations of sun protection behavior by visitors at the hotels/resorts as secondary outcome measures. Since most Americans of all ethnic and income groups recreate outdoors on vacation, the results should be generalizable to the US population. PUBLIC HEALTH RELEVANCE: This application addresses the epidemic of skin cancer by testing advanced Transportation Theory-based messages to create sun safety vacation narratives for outdoor recreation. Many Americans routinely receive extreme doses of unprotected sun exposure and often intentionally seek a sun tan while on vacation, substantially elevating their risk for developing skin cancer. An advanced sun protection program will be evaluated in a randomized trial at 40 US hotels and resorts where visitors' comprehensive sun protection (early application and re-application of sunscreen, use of wide-brimmed hats, protective clothing, and shade, and attention to reliable environmental indicators of high UV) will be assessed through surveys and observations.