Solar UV Measured under Built-Shade in Public Parks: Findings from a Randomized Trial in Denver and Melbourne.

Reducing exposure to ultraviolet radiation (UV) is crucial for preventing UV-induced diseases of the skin and eyes. Shade may offer significant protection from UV. More empirical research to quantify the UV protection offered from built shade is needed to guide disease prevention practices and confidence in investment in shade. This study quantified UV levels under built-shade relative to unshaded passive recreation areas (PRAs) over summer months in parks in two cities. In a randomized controlled trial, n = 1144 UV measurements were conducted at the center and periphery of PRAs in a total sample of 144 public parks as part of pretest and posttest measures of use of the PRAs by park visitors for three recruitment waves per city during 2010 to 2014. Following pretest, 36 PRAs received built-shade and 108 did not. Regression analyses modelled pre-post change in UV (Standard Erythemal Dose (SED) per 30 min) at PRAs; and environmental predictors. Mean UV at the center of built-shade PRAs decreased from pretest to posttest (x¯ = 3.39, x¯ = 0.93 SED), a change of x¯ = -3.47 SED relative to control PRAs (p < 0.001) adjusting for the covariates of ambient SED, (cosine) solar elevation and cloud cover. Clouds decreased and solar elevation increased UV levels under shade. No significant differences in UV by shade design occurred. A substantial reduction in exposure to UV can be achieved using built-shade with shade cloth designs, offering considerable protection for shade users. Supplementary sun protection is recommended for extended periods of shade use during clear sky days.

Usability of a Technology-Based Bystander Bullying Intervention for Middle School Students in Rural, Low-Income Communities: Mixed Methods Study.

BACKGROUND: Students who are targets of bullying and who witness bullying are at high risk for negative mental health outcomes. Bystander training is essential to reduce bullying and the negative associated consequences for targets and bystanders. Resources necessary for program delivery, however, pose significant barriers for schools, particularly those in rural, low-income communities. Technology-based programs can reduce health disparities for students in these communities through cost-effective, easy-to-disseminate programming. OBJECTIVE: The aim of this study is to conduct usability testing of a bystander bullying web app prototype, STAC-T (technology-based STAC, which stands for the 4 bystander strategies Stealing the Show, Turning it Over, Accompanying Others, and Coaching Compassion) as an initial step in the development of a full-scale STAC-T intervention. Objectives include assessing usability and acceptability of the STAC-T prototype, understanding school needs and barriers to program implementation, and assessing differences in usability between school personnel and students. METHODS: A sample of 16 participants, including school personnel and students recruited from 3 middle schools in rural, low-income communities, completed usability testing followed by a qualitative interview. Descriptive statistics, 2-tailed independent sample t tests, and consensual qualitative research were used to assess usability and program satisfaction and to extract themes related to acceptability, feasibility, needs, barriers, and feedback for intervention development. RESULTS: Usability testing indicated that the app was easy to use, acceptable, and feasible. Both school personnel (mean rating 89.6, SD 5.1) and students (mean rating 91.8, SD 7.0) rated the app well above the standard cutoff score for above-average usability (ie, 68), and both school personnel (mean rating 5.83, SD 0.41) and students (mean rating 6.10, SD 0.57) gave the app high user-friendliness ratings (0-7 scale, with 7 as high user-friendliness). The overall ratings also suggested that school personnel and students were satisfied with the program. Of the 6 school personnel who said they would recommend the program, 1 (17%), 4 (66%), and 1 (17%) rated the program as 3, 4, and 5 stars, respectively; 80% (8/10) of students said they would recommend the program; and 60% (6/10) and 40% (4/10) rated the program as 4 stars and 5 stars, respectively. Qualitative data revealed that school personnel and students found the STAC-T app to be useful, user-friendly, and relevant, while providing feedback related to the importance of digital learning activities that engage the user. Data from school personnel also indicated positive perceptions regarding program feasibility and probability of program adoption, with the most significant barrier being cost, suggesting the importance of considering the financial resources available to schools in rural, low-income communities when setting the price point for the full-scale STAC-T intervention. CONCLUSIONS: This study provides support for the full-scale development of the STAC-T app and provides key information for revision to enhance used engagement. TRIAL REGISTRATION: ClinicalTrials.gov NCT04681495; https://clinicaltrials.gov/ct2/show/NCT04681495.

Randomized Trial Testing an Online Responsible Vendor Training in Recreational Marijuana Stores in the United States.

OBJECTIVE: An online training in responsible marijuana vendor (RMV) practices was evaluated for effects on compliance with ID checking regulations. METHOD: A random sample of state-licensed recreational marijuana stores (n = 175) in Colorado and Washington State was selected in 2016-2017 and was enrolled in a randomized pretest-posttest controlled design. After baseline assessment, 75 stores were randomly assigned to a usual and customary training control group, stratified by state and region. The remaining stores (n = 100) were invited to use the RMV training. Stores were posttested at 3 and 9 months postrandomization. The primary outcome was refusal of sale measured with pseudo-underage patrons who attempted to enter stores and purchase cannabis without a state-approved ID. RESULTS: There was no difference by treatment group in refusal of pseudo-underage patron buyers (baseline: 92.5% intervention vs. 94.7% control; 3-month posttest 94.8% vs. 97.5%; 9-month posttest 97.5% vs. 97.1%, p = .286 [one tailed, adjusted for covariates]). The use of training increased refusals at store entry (trained: 65.9% baseline 82.5%, 3 months 79.9%, 9 months; not trained: 82.6%, 83.1%, 84.5%, p = .020 [two tailed, adjusted for covariates]). This difference was especially evident in Washington State (trained: 40.3%, 65.1%, 60.4%; not trained: 57.9%, 68.5%, 72.3%) but not in Colorado (trained: 95.2%, 101.0%, 101.4; not trained: 95.7%, 98.6%, 99.2%, p = .033 [two tailed, adjusted for covariates]). CONCLUSIONS: When used by store personnel, online RMV training increased refusal of buyers who appeared young and did not provide a state-approved ID. However, it did not improve refusal rates overall. Stores that had lower refusals at baseline and used the training may have benefited from it.

Association of occupational sun safety policy and actions in state transportation sector in the United States.

BACKGROUND: Occupational sun protection is recommended by government health authorities. Sun safety policies and predictors of managers' reports of sun safety actions were assessed. METHODS: Written policies from 21 state departments of transportation (DOTs) enrolled in a randomized trial to test methods for scaling-up an occupational sun safety intervention were coded for sun safety content at baseline. Managers (n = 1113) supervising outdoor workers reported on sun safety actions in a baseline survey. RESULTS: Twenty state DOTs (95.2%) have a policy with at least one sun protection component. Sun safety training was increased at workplaces with a written sun safety policy (p < 0.001) and unwritten standard procedures on sun protection (p < 0.001). Reported sun safety actions were highest where there was a written sun safety policy (p < 0.001) and unwritten standard procedures on sun protection (p < 0.001). CONCLUSIONS: Policies are essential for the implementation of employee sun safety. There is room for improvement in existing policies of state DOTs.

Design and baseline data of a randomized trial comparing two methods for scaling-up an occupational sun protection intervention.

BACKGROUND: Successful methods for scaling-up evidence-based programs are needed to prevent skin cancer among adults who work outdoors in the sun. METHODS: A randomized trial is being conducted comparing two methods of scaling-up the Sun Safe Workplaces (SSW) intervention. Departments of transportation (DOTs) from 21 U.S. states are participating and their 138 regional districts were randomized following baseline assessment. In districts assigned to the in-person method (n = 46), project staff meets personally with managers, conducts trainings for employees, and provides printed materials. In districts assigned to the digital method (n = 92), project staff conduct these same activities virtually, using conferencing technology, online training, and electronic materials. Delivery of SSW in both groups was tailored to managers' readiness to adopt occupational sun safety. Posttesting will assess manager's support for and use of SSW and employees' sun safety. An economic evaluation will explore whether the method that uses digital technology results in lower implementation of SSW but is more cost-effective relative to the in-person method. RESULTS: The state DOTs range in size from 997 to 18,415 employees. At baseline, 1113 managers (49.0%) completed the pretest (91.5% male, 91.1% white, 19.77 years on the job, 66.5% worked outdoors; and 24.4% had high-risk skin types). They were generally supportive of occupational sun safety. A minority reported that the employer had a written policy, half reported training, and two-thirds, messaging on sun protection. CONCLUSIONS: Digital methods are available that may make scale-up of SSW cost-effective in a national distribution to nearly half of the state DOTs. TRIAL REGISTRATION: The ClinicalTrials.gov registration number is NCT03278340.

Senior managers' awareness of sun protection policy predicts implementation of worksite sun safety in a randomized trial.

BACKGROUND: Outdoor workers experience chronic exposure to harmful ultraviolet radiation (UV) elevating their risk for skin cancer. METHODS: A controlled randomized trial promoted the adoption of workplace sun safety policy and employee education at 98 public organizations in Colorado. A 2-year follow-up study with 68 organizations assessed the association of senior manager awareness of sun safety policies and implementation of sun safety actions. RESULTS: Senior managers' awareness of existing sun safety policies, but not their personal sun protection behaviors, predicted implementation of sun safety actions including the number of sun protection messages and sun protection items in the workplace and increased communication about sun safety to employees. CONCLUSIONS: Organizational adoption of sun safety policy must include efforts to broadly inform a workplace's senior management to ensure the policies are actually implemented and provide support for sun protection behaviors by outdoor workers to reduce UV exposure and skin cancer risk.

Implementation of Occupational Sun Safety at a 2-Year Follow-Up in a Randomized Trial: Comparison of Sun Safe Workplaces Policy Intervention to Attention Control.

PURPOSE: Implementation of employer sun safety actions was assessed in a 2-year follow-up to an occupational sun protection policy intervention. DESIGN: Two-year follow-up assessment in a randomized pretest-posttest controlled design. SETTING: Local government organizations with workers in public safety, public works, and parks and recreation. PARTICIPANTS: Sixty-three local government organizations (participation = 64%) and 330 frontline supervisors and 1454 workers. INTERVENTION: Sun Safe Workplaces (SSW) intervention promoting occupational sun safety policy and education. MEASURES: Observations of SSW messages and sun safety items and surveys on organizations' communication and actions on sun safety. ANALYSIS: Comparison between SSW and control groups was conducted using regression models and adjusted for clustering where appropriate, with α criterion set at P = .05 (2-tailed). RESULTS: At intervention worksites, more SSW messages ( P < .001) and sun safety items ( P = .025) were observed; more frontline supervisors reported organizations provided free/reduced price sunscreen ( P = .005) and communicated about sun safety ( P < .001); and more workers recalled receiving sun safety messages ( P < .001) and sun safety training ( P <.001) compared to control organizations. Implementation was greater at larger than smaller intervention organizations for wide-brimmed hats ( P = .009), long work pants ( P = .017), and shade structures ( P = .036). Older workers received the most written messages ( P = .015). CONCLUSIONS: Sun Safe Workplaces appeared to produce actions by organizations to support employee sun safety. Large organizations may have processes, communication channels, and slack resources to achieve more implementation.

Implementation and Effectiveness of an Online Responsible Vendor Training Program for Recreational Marijuana Stores in Colorado, Oregon, and Washington State.

CONTEXT: Six US states have implemented retail sales of recreational marijuana. Training in responsible sales practices has been effective in the alcohol market. An online responsible marijuana vendor (RMV) training was produced and implemented with stores in a randomized trial. PROGRAM: An online RMV training was developed through meetings with state regulators and local law enforcement personnel, curriculum standards published by the Colorado Marijuana Enforcement Division in May 2015, interviews with recreational marijuana store personnel (n = 15), and usability testing of a prototype training with store personnel (n = 19) in Colorado and Washington State. The training contained 5 modules: state laws and regulations, ID checking, health effects of marijuana, customer service practices including recognizing intoxicated patrons, and rules of the trade. IMPLEMENTATION: A randomized controlled trial testing the training enrolled a random sample of state-licensed retail recreational marijuana stores (n = 225) in Colorado, Oregon, and Washington State. In total, 125 stores were randomly assigned to receive the RMV training. A total of 420 store employees completed the online training between June 2017 and February 2018 (43.5% female, 88.4% younger than 40 years, and 74.1% non-Hispanic white). EVALUATION: Responses to posttraining surveys showed that most trainees found the training user-friendly (78.4%), were satisfied (68.8%), and would recommend it to another employee (91.1%). The training improved trainees' ability to check IDs (pretraining mean = 3.91 [SD = 1.36], posttraining mean = 4.58 [SD = 0.66], t387,388 = 8.68, P < .001) and their confidence to use the state's inventory tracking system (pretraining mean = 2.52 [SD = 0.65], posttraining mean = 2.85 [SD = 0.39], t387, 388 = 10.89, P < .001) and spot intoxicated customers (pretraining mean = 2.79 [SD = 0.41], posttraining mean = 2.94 [SD = 0.25], t387,388 = 6.87, P < .001). DISCUSSION: Online RMV training was acceptable to retail recreational marijuana personnel and potentially improved responsible sales practices. Responsible vendor training has been successful under certain conditions in the alcohol market and should be considered for the recreational marijuana market.

Accuracy of Principal and Teacher Knowledge of School District Policies on Sun Protection in California Elementary Schools.

INTRODUCTION: Policy is a key aspect of school-based efforts to prevent skin cancer. We explored the extent and accuracy of knowledge among principals and teachers in California public school districts about the elements specified in their district's written sun safety policy. METHODS: The sample consisted of California public school districts that subscribed to the California School Boards Association, had an elementary school, adopted Board Policy 5141.7 for sun safety, and posted it online. The content of each policy was coded. Principals (n = 118) and teachers (n = 113) in elementary schools were recruited from September 2013 through December 2015 and completed a survey on sun protection policies and practices from January 2014 through April 2016. RESULTS: Only 38 of 117 principals (32.5%) were aware that their school district had a sun protection policy. A smaller percentage of teachers (13 of 109; 11.9%) than principals were aware of the policy (F108 = 12.76, P < .001). We found greater awareness of the policy among principals and teachers who had more years of experience working in public education (odds ratio [OR] = 1.05, F106 = 4.71, P = .03) and worked in schools with more non-Hispanic white students (OR = 7.65, F109 = 8.61, P = .004) and fewer Hispanic students (OR = 0.28, F109 = 4.27, P = .04). CONCLUSION: Policy adoption is an important step in implementing sun safety practices in schools, but districts may need more effective means of informing school principals and teachers of sun safety policies. Implementation will lag without clear understanding of the policy's content by school personnel.

Results of a Randomized Trial on an Intervention Promoting Adoption of Occupational Sun Protection Policies.

PURPOSE: To evaluate an intervention promoting adoption of occupational sun protection policies by employers in a randomized trial. DESIGN: A randomized pretest-posttest controlled design with 2-year follow-up was conducted in 2010 to 2013. SETTING: Local government organizations in Colorado who had outdoor workers in public works, public safety, and/or parks and recreation. PARTICIPANTS: Ninety-eight local government organizations (n = 51 municipalities, 10 counties, and 37 special districts). INTERVENTION: Organizations were randomly assigned to receive a policy and education intervention comprised of personal contacts and theory-based training and materials or to an attention control group. MEASURES: Occupational policy documents were coded for sun safety content by a trained research assistant blind to condition. ANALYSIS: Policy scores were analyzed with logistic and Poisson regression models using imputation. RESULTS: At posttest, more organizations in the intervention group had a sun protection policy than in the control group (odds ratio [OR] = 4.91, P < .05; intent to treat: OR = 5.95, P < .05) and policies were more extensive (χ2 = 31.29, P < .01; intent to treat: χ2 =73.79, P < .01) and stronger (χ2 = 24.50, P < .01; intent to treat: χ2 = 51.95, P < .01). Policy adoption was higher when the number of contacts and trainings increased ( P < .05). CONCLUSION: The intervention had a large effect on adoption of formal sun protection policies, perhaps because of its fit with legal requirements to maintain safe workplaces. Personal contacts with managers were influential on adoption of occupational policy even in this age of communication technology and social media.

Shade Sails and Passive Recreation in Public Parks of Melbourne and Denver: A Randomized Intervention.

OBJECTIVES: To test whether shade sails will increase the use of passive recreation areas (PRAs). METHODS: We conducted a stratified randomized pretest-posttest controlled design study in Melbourne, Australia, and Denver, Colorado, in 2010 to 2014. We randomized a sample of 144 public parks with 2 PRAs in full sun in a 1:3 ratio to treatment or control. Shade sails were built at 1 PRA per treatment park. The outcome was any use of the study PRA (n = 576 pretest and n = 576 posttest observations; 100% follow-up). RESULTS: Compared with control PRAs (adjusted probability of use: pretest = 0.14, posttest = 0.17), use of treatment PRAs (pretest = 0.10, posttest = 0.32) was higher at posttest (odds ratio [OR] = 3.91; 95% confidence interval [CI] = 1.71, 8.94). Shade increased use of PRAs in Denver (control: pretest = 0.18, posttest = 0.19; treatment: pretest = 0.16, posttest = 0.47) more than Melbourne (control: pretest = 0.11, posttest = 0.14; shaded: pretest = 0.06, posttest = 0.19; OR = 2.98; 95% CI = 1.09, 8.14). CONCLUSIONS: Public investment in shade is warranted for skin cancer prevention and may be especially useful in the United States. TRIAL REGISTRATION: Clinicaltrials.gov identifier NCT02971709.

Rationale, design, and baseline data of a cross-national randomized trial on the effect of built shade in public parks for sun protection.

Environments can be structured to reduce solar ultraviolet radiation (UV) exposure to prevent skin cancer. A prospective randomized trial is being conducted to test whether introducing shade sails in passive recreation areas (PRAs) in public parks will increase use and decrease UV exposure in the shaded compared to unshaded PRAs. Shade effects will be compared between Melbourne, Australia and Denver, USA. The trial enrolled 145 public parks with PRAs suitable for shade construction and randomized parks to intervention or control in a 1:3 ratio. Use of PRAs and UV levels were recorded at each park by trained observers during 30-minute periods on four weekend days in each of two summers (pretest and posttest). Shade sails were constructed between the summers. Given low numbers of users at pretest, the outcome measure was modified to use of the PRA (use vs. no use) and unit of analysis to the individual observation. Observations (n=580) occurred on average 29days from the summer solstice and 55min from solar noon in warm weather (mean=26.2°C) with some cloud cover but only slight or no wind. Typically, PRAs had benches and picnic tables and were located near playgrounds. PRAs were in use during 13.3% of observations (mean=0.41 users). UV over 30-minutes at the PRA boundary (mean=3.2 standard erythemal dose [SED]) and center (mean=3.3 SED) was high. Shade for skin cancer prevention has been understudied. This study will address this gap by determining whether purpose-built shade structures promote greater use of shaded areas within public parks.

Compliance With Personal ID Regulations by Recreational Marijuana Stores in Two U.S. States.

OBJECTIVE: The purpose of this study was to measure compliance with age and personal ID regulations by state-licensed recreational marijuana stores in two states. METHOD: Recreational marijuana stores (N = 175) in Colorado and Washington State were each visited twice by pseudo-buyer assessment teams in September 2016 to April 2017. The observer entered the store first, performed an environmental scan, and observed the buyer's purchase behavior. In both Washington State visits and in the first visit in Colorado, a young-adult buyer attempted to enter the store and purchase marijuana without showing a state-approved ID (i.e., valid driver's license). In the second Colorado visit, a buyer age 18-20 showed an underage driver's license and attempted to enter the store and purchase marijuana. RESULTS: All stores (100%) requested an ID. Stores refused buyers in 73.6% of visits at the entrance, 88.3% cumulative before the counter, and 92.6% by the time of a purchase attempt. Refusal was lower in Washington State (at entry, 53.1%; before the counter, 80.5%; and at purchase attempt, 86.6%) than in Colorado (at entry, 95.3%, p < .01; before the counter, 96.5%, p < .01; and at purchase attempt, 98.8%, p < .01), but it did not differ by buyer protocol (p > .05). CONCLUSIONS: Compliance with laws restricting marijuana sales to individuals 21 or older with a valid ID was high. Compliance in Washington State might be improved by having store personnel check IDs at the store entry. Although recreational stores may not be selling marijuana directly to youth, no information was collected on straw purchases.

Factors Associated With Occupational Sun-Protection Policies in Local Government Organizations in Colorado.

IMPORTANCE: Skin cancer prevention remains a national priority. Reducing chronic UV radiation exposure for outdoor workers through sun-safety practices is an important step to help reduce the incidence of skin cancer. OBJECTIVE: To determine the presence of occupational sun-safety policies at local government organizations in a single state. DESIGN, SETTING, AND PARTICIPANTS: Of 571 potentially eligible local government organizations of Colorado cities, counties, and special tax districts, we enrolled 98 in a randomized pretest-posttest controlled experiment starting August 15, 2010, that evaluated an intervention to promote the adoption of sun-safety policies. We used a policy-coding protocol to evaluate personal sun-protection practices, environmental and administrative controls, and policy directives for sun safety starting February 10, 2011. We report the baseline assessment of the occupational sun-protection policies of these organizations. MAIN OUTCOMES AND MEASURES: The presence of an occupational sun-safety policy. RESULTS: Overall, 85 local government organizations (87%) had policies that required personal sun-protection practices, including the use of eyewear, hats, and protective clothing. However, of the 98 responding organizations, only 8 hat policies (8%), 10 eyewear policies (10%), and 7 clothing policies (7%) mentioned sun protection as the intent of the policy. Only cosmopoliteness, operationalized as proximity to an urban area, was associated with the presence of a sun-safety policy (odds ratio, 0.99 [95% CI, 0.98-1.00]; P = .02). CONCLUSIONS AND RELEVANCE: Outdoor workers are at increased risk for skin cancer because of long-term exposure to solar UV radiation. Although organizational policies have the potential to increase sun protection in occupational settings, occupational sun-safety policies were uncommon among local governments. Opportunities exist for dermatologists and other physicians to influence occupational sun-safety practices and policies, which are consistent with other safety procedures and could easily be integrated into existing workplace practices.

Smartphone mobile application delivering personalized, real-time sun protection advice: a randomized clinical trial.

IMPORTANCE: Mobile smartphones are rapidly emerging as an effective means of communicating with many Americans. Using mobile applications (apps), they can access remote databases, track time and location, and integrate user input to provide tailored health information. OBJECTIVE: A smartphone mobile app providing personalized, real-time sun protection advice was evaluated in a randomized clinical trial. DESIGN, SETTING, AND PARTICIPANTS: The trial was conducted in 2012 and had a randomized pretest-posttest controlled design with a 10-week follow-up. Data were collected from a nationwide population-based survey panel. A sample of 604 non-Hispanic and Hispanic adults from the Knowledge Panel 18 years or older who owned an Android smartphone were enrolled. INTERVENTIONS: The mobile app provided advice on sun protection (ie, protection practices and risk of sunburn) and alerts (to apply or reapply sunscreen and get out of the sun), hourly UV Index, and vitamin D production based on the forecast UV Index, the phone's time and location, and user input. MAIN OUTCOMES AND MEASURES: Percentage of days using sun protection and time spent outdoors (days and minutes) in the midday sun and number of sunburns in the past 3 months were collected. RESULTS: Individuals in the treatment group reported more shade use (mean days staying in the shade, 41.0% vs 33.7%; P = .03) but less sunscreen use (mean days, 28.6% vs 34.5%; P = .048) than controls. There was no significant difference in number of sunburns in the past 3 months (mean, 0.60 in the treatment group vs 0.62 for controls; P = .87). Those who used the mobile app reported spending less time in the sun (mean days keeping time in the sun to a minimum, 60.4% for app users vs 49.3% for nonusers; P = .04) and using all protection behaviors combined more (mean days, 39.4% vs 33.8%; P = .04). CONCLUSIONS AND RELEVANCE: The mobile app improved some sun protection. Use of the mobile app was lower than expected but associated with increased sun protection. Providing personalized advice when and where people are in the sun may help reduce sun exposure.

Evaluation of immediate and 12-week effects of a smartphone sun-safety mobile application: a randomized clinical trial.

IMPORTANCE: Mobile applications on smartphones can communicate a large amount of personalized, real-time health information, including advice on skin cancer prevention, but their effectiveness may be affected by whether recipients can be convinced to use them. OBJECTIVE: To evaluate a smartphone mobile application (Solar Cell) delivering real-time advice about sun protection for a second time in a randomized clinical trial. DESIGN, SETTING, AND PARTICIPANTS: A previous trial conducted in 2012 used a randomized pretest-posttest design. For the present trial, we collected data from a volunteer sample of 202 adults 18 years or older who owned a smartphone. Participants were recruited nationwide through online promotions. Screening procedures and a 3-week run-in period were added to increase the use of the mobile application. We conducted follow-ups at 3 and 8 weeks after randomization to examine the immediate and the longer-term effects of the intervention. INTERVENTIONS: Use of the mobile application. The application gave feedback on sun protection (ie, sun-safety practices and the risk for sunburn) and alerted users to apply or to reapply sunscreen and to get out of the sun. The application also displayed the hourly UV Index and vitamin D production based on the forecast UV Index, time, and location. MAIN OUTCOMES AND MEASURES: Percentage of days with the use of sun protection, time spent outdoors in the midday sun (days and hours), and the number of sunburns in the last 3 months. RESULTS: Participants in the intervention group used wide-brimmed hats more at 7 weeks than control participants (23.8% vs 17.4%; F = 4.07; P = .045). Women who used the mobile application reported using all sun protection combined more than men (46.4% vs 43.3%; F = 1.49; P = .04), whereas men and older individuals reported less use of sunscreen (32.7% vs 35.5%; F = 5.36; P = .02) and hats (15.6% vs 17.9%; F = 4.72; P = .03). CONCLUSIONS AND RELEVANCE: The mobile application initially appeared to confer weak improvement of sun protection. Use of the mobile application was greater than in a previous trial and was associated with greater sun protection, especially among women. Strategies to increase the use of the mobile application are needed if the application is to be deployed effectively to the general adult population.

User-centered development of a smart phone mobile application delivering personalized real-time advice on sun protection.

Smart phones are changing health communication for Americans. User-centered production of a mobile application for sun protection is reported. Focus groups (n = 16 adults) provided input on the mobile application concept. Four rounds of usability testing were conducted with 22 adults to develop the interface. An iterative programming procedure moved from a specification document to the final mobile application, named Solar Cell. Adults desired a variety of sun protection advice, identified few barriers to use and were willing to input personal data. The Solar Cell prototype was improved from round 1 (seven of 12 tasks completed) to round 2 (11 of 12 task completed) of usability testing and was interoperable across handsets and networks. The fully produced version was revised during testing. Adults rated Solar Cell as highly user friendly (mean = 5.06). The user-centered process produced a mobile application that should help many adults manage sun safety.

Evaluation of the Sunny Days, Healthy Ways sun safety curriculum for children in kindergarten through fifth grade.

Childhood sun protection is important to reduce the risk of developing skin cancer later in life. An evaluation of an expanded version of the Sunny Days, Healthy Ways sun safety instructional program was conducted with 744 students in 77 kindergarten to fifth grade classes in 10 elementary schools. Students in six schools received instruction twice over two school years. Students in four schools received it only once in a single school year or were enrolled in a no-treatment control group. A single presentation of the sun safety materials improved sun safety knowledge in students in grades 2-5 (p < 0.05). Repeated presentation over 2 years improved all outcomes, including increasing self-reported sun protection (p < 0.05) and decreasing skin darkening indicative of exposure to ultraviolet radiation (p < 0.05). The program did not improve children's knowledge or skin darkening in kindergarten and grade 1. These results highlight the need to provide sun protection education over several school years, not just one time, to produce changes in sun safety behavior.

A survey of sun protection policy and education in secondary schools.

BACKGROUND: The Centers for Disease Control and Prevention (CDC) issued recommendations for school programs to reduce skin cancer. OBJECTIVE: Personnel at US secondary schools were surveyed to describe sun protection policy and education before the CDC recommendations. METHODS: School principals or other personnel at 484 secondary schools in 27 cities responded to a telephone survey in January and February 2002 (response rate = 31%). RESULTS: A sun protection policy was reported at 10% of the schools, but sun protection education occurred at nearly all schools (96%). Policies were more prevalent in regions with high ultraviolet radiation (P < .0001), but education was not. Many personnel were willing to adopt a policy (41%) and interested in obtaining a sun safety curriculum (96%). LIMITATIONS: Self-report measures, nonresponse, and new schools not in the sampling frame. CONCLUSION: Sun protection was a low policy priority for US schools. Sun safety education was prevalent, but written materials were used infrequently. A substantial proportion of school personnel were receptive to the CDC's advice.

Web-based strategies to disseminate a sun safety curriculum to public elementary schools and state-licensed child-care facilities.

The Sunny Days, Healthy Ways curriculum, which has been effective in previous trials, was disseminated to public elementary schools (n=2,030) and state-licensed child-care facilities (n=3,755) in 4 states. Two Web sites were created, varying in the amount and type of information. Mailings referred principals and directors to the sites. Overall 117 unique users made 172 visits to the sites. More repeat visits were made to the enhanced than to the basic site (p=.04). In a survey, 20.0% of principals and directors recalled receiving the mailings and 80.9% of these read them. Web-based strategies were weak, but the low response rate may be typical for such marketing. They will require supplementation by more personal approaches.