This multi-component, community-wide intervention targeted members of communities in Vermont and New Hampshire from 2000 to 2003. To be eligible, communities had to have a middle school where grades six through eight were offered in one building, at least one primary care practice, and a freshwater beach or town swimming pool used primarily by local residents.
From the eligible communities, 10 middle schools were recruited in pairs matched for size and proportion of students eligible for federal free-lunch programs. Once the researchers had the buy-in of the schools, the schools were randomly assigned to an intervention or control condition through computer-generated numbers.
The participants included recreation directors, athletic coaches, teachers, primary care practice staff, and other community-based organizations, who were engaged in all 10 communities after the school had been enrolled. Control communities were offered the intervention once the study was completed. Children entering grades six to eight (ages 11 to 14) at the community beaches and swimming pools or school sponsored water activities were approached and screened for eligibility. If they were eligible, they were asked for their consent to be interviewed anonymously.
Cross-sectional samples of early adolescents were observed and interviewed in year 1, and in 3 subsequent years. Because of a dramatic decline in the number of older adolescents (those entering grades eight and nine, particularly nine) attending the beach and pool venues, data from year 3 were not included in the analyses. Trained observers visited the community beaches and swimming pools between 11:00 a.m. and 3:00 p.m. from June through August, when weather reports did not predict rain or heavily overcast skies.
Adolescents were asked about sunscreen application for each of four body areas (face/neck, arms, legs, and trunk) and the sun-protection factor (SPF) of any sunscreen they had used. They were also asked to show the sunscreen bottle to corroborate their self-report. The trained observers also noted the proportion of the individual participant's body surface that was protected from the sun by clothing, sunscreen, or shade. An inter-rater reliability of .90 was obtained for this measure. Observers noted the UV index and temperature during every hour of the observation period. They also interviewed participants regarding their propensity to burn, and whether key adults (school personnel, primary care staff, or coaches) had talked to them about sun safety.