A Randomized Trial of Skin Cancer Prevention in Aquatics Settings: The Pool Cool Program Karen Glanz University of Hawaii at Manoa Alan C. Geller Boston University Dorothy Shigaki, Jay E. Maddock, and May Rose Isnec University of Hawaii at Manoa Skin cancer is increasing, and prevention programs are essential. This study evaluated the impact of a skin cancer prevention program on sun-protection habits and swimming pool environments. The intervention included staff training; sun-safety lessons; interactive activities; providing sunscreen, shade, and signage; and promoting sun-safe environments. A randomized trial at 28 swimming pools in Hawaii and Massachusetts tested the efficacy of this program (Pool Cool) compared with an attention-matched injury-prevention control program. Results showed significant positive changes in children’s use of sunscreen and shade, overall sun-protection habits, and number of sunburns and improvements in parents’ hat use, sun-protection habits, and reported sun-protection policies and environments. Obser- vations corroborated the positive findings. Pool Cool had significant positive effects at swimming pools in diverse audiences. Key words: skin cancer prevention, sun protection, child health, melanoma, aquatics Skin cancer is the most common form of cancer in the United States, and it accounts for an estimated 1.3 million new cases of cancer each year (American Cancer Society, 2000). The incidence rate of melanoma, the most deadly form of skin cancer, has more than doubled since the early 1970s (American Cancer Society, 2000; National Cancer Institute, 1999) and continues to rise (Je- mal, Devesa, Fears, & Hartge, 2000). Skin cancer is most common in fair-skinned individuals, and persons who live in tropical, sunny climates when they are young are at increased risk (Gilchrest, Eller, Geller, & Yaar, 1999; Harras, 1996). It is believed that lifelong protection from the sun’s rays would prevent most skin cancers (Gilchrest et al., 1999). Because sun exposure during childhood accounts for an estimated 80% of the total lifetime exposure (Preston & Stern, 1992), and children in elementary school receive more solar exposure than preschool and secondary school students (Diffey, Gibson, Haylock, & McKinlay, 1996; Hall, McDavid, Jorgensen, & Kraft, 2001), these children can benefit substantially from preventive actions. Although skin cancer is the most common cancer, it is also one of the most preventable cancers. Behavioral recommendations for primary prevention of skin cancer include the following: Limit time spent in the sun, avoid the sun during peak hours (10 a.m. to 4 p.m.), use sunscreen with a sun-protection factor of 15 or higher when outside, wear protective clothing (hats, shirts, pants) and sunglasses, seek shade when outdoors, avoid sunburn, and make sun safety a family habit (American Cancer Society, 2000; Hill & Ferrini, 1998). Although awareness about skin cancer is growing, the practice of preventive behaviors remains relatively low in the United States (Centers for Disease Control and Prevention, 1998; Koh, Bak, & Geller, 1997; Robinson, Rigel, & Amonette, 1998). Preventive interventions have demonstrated modest success, with the majority of programs being delivered in school settings (Buller & Borland, 1999). A recent comprehensive review of more than 80 studies concluded that the ideal intervention strategies for reducing expo- sure to ultraviolet radiation (UVR) are coordinated, sustained, community-wide approaches that combine education, mass media, and environmental and structural changes. The results of that review further showed how interventions within specific organi- zational settings provide useful ways to reach important audiences, like children, and are suitable venues for structural supports, such as environmental and policy change that complement educational efforts (Glanz, Saraiya, & Briss, in press). Outdoor recreation settings are especially promising for skin cancer prevention activities (Glanz, Chang, Song, Silverio, & Muneoka, 1998; Glanz, Lew, Song, & Murakami-Akatsuka, 2000; Rosenberg, Mayer & Eckhardt, 1997). In particular, aquatics set- tings such as swimming pools are uniquely suited to sun-safety programs for several reasons: Children and adults are minimally clothed, swimming lessons offer a structure for teaching sun-safety skills, families and communities often gather at swimming pools in Karen Glanz, Dorothy Shigaki, Jay E. Maddock, and May Rose Isnec, Cancer Research Center of Hawaii, University of Hawaii at Manoa; Alan C. Geller, Schools of Medicine and Public Health, Boston University. The work reported here was supported by Division of Cancer Prevention and Control, U.S. Centers for Disease Control and Prevention Grant U56-CCU 914658. Correspondence concerning this article should be addressed to Karen Glanz, Cancer Research Center of Hawaii, University of Hawaii at Manoa, 1960 East–West Road, Biomed C-105, Honolulu, Hawaii 96822. E-mail: kglanz@hawaii.edu Health Psychology Copyright 2002 by the American Psychological Association, Inc. 2002, Vol. 21, No. 6, 579 –587 0278-6133/02/$5.00 DOI: 10.1037//0278-6133.21.6.579 579