Go Sun Smart (GSS)

Excessive exposure to ultraviolet radiation (UVR) from sunlight is both the primary and the most easily prevented cause of skin cancer. Total lifetime exposure to UVR is positively associated with several types of skin cancer, including basal cell carcinoma, squamous cell carcinoma, and possibly melanoma. Intermittent and severe exposure (i.e., sunburning) may also be linked to the development of melanoma.

Although exposure to UVR in sunlight is the most preventable cause of skin cancer, about 1.3 million cases of nonmelanoma skin cancer and 53,600 cases of melanoma were diagnosed in the United States in 2002, with 2,200 and 3,400 deaths, respectively. 

High elevation, in combination with abundant sunlight and sunlight reflected from ice and snow, substantially intensifies the effects of UVR. The alpine environment in winter therefore puts ski area employees at particular risk for skin cancer.  Given these risk factors, it is important to inform ski area employees about the potential hazards of excessive UVR exposure. 

Go Sun Smart is a workplace intervention that uses written, electronic, visual, and interpersonal  communication methods to promote sun-safe practices to ski area employees.  A six-unit training program consisting of a comprehensive instructor's guide, slide presentation, and employee brochures is delivered to employees by supervisors during routine departmental meetings. The training is designed to increase employee awareness of their personal risks for skin cancer, to make sun safety a regular agenda item, and to provide step-by-step instructions on how to reduce risk of exposure to UVR. Employees are also given techniques for discussing sun safety with coworkers. 

The intervention includes targeted messages that promote the adoption of sunburn protection measures among employees. For example, the messages remind employees to carry sunscreen at all times and to reapply often, provide facts about UVR exposure, and urge employees to serve as opinion leaders on sun safety.  The information is disseminated through a wide array of media and in a variety of workplace settings, including signage displayed in employee work areas, lift pole signs, electronic signs, and whiteboards posted at the top and bottom of ski lifts.  New materials are released every six weeks to avoid message fatigue. 

All program materials are branded with a logo and feature a slogan recommending three sun-safety behaviors: "Wear sunscreen, sunglasses, and a hat." Newsletter articles and emails reinforcing these messages are sent to employees, and branded magnets, buttons, window decals, water bottles, banners, and bathroom clings are placed in areas accessed by employees. 

Go Sun Smart also provides free gifts to the lift operations department at each ski area, such as banners, logo-branded gallon dispensers of sunscreen, and wide-brimmed hats. It is also suggested that an informal social gathering be held, such as a barbeque dinner, where the program implementers can present information on sun protection to the ski area staff. 

Employees are encouraged to visit the Go Sun Smart program Web site (www.gosunsmart.org), which provides UVR and sun safety strategies, information to increase perceived risk of skin damage, answers to frequently asked questions, and links to other online resources about skin cancer. 

The estimated time required to implement the Go Sun Smart program includes 45 minutes for employee training, one day to post materials, and two days for staff to monitor the ski area. Maintenance of the signs and targeted messages across various informational channels (e.g., newsletters, email messages) takes an additional eight hours over the course of the ski season. 

The primary audience for the Go Sun Smart is ski area employees.

Go Sun Smart is designed to be administered at ski areas ranging in size from small, single operators to large, multi-area corporations.

The Go Sun Smart Program toolkit includes the following materials:

-Go Sun Smart Guidebook
-Go Sun Smart Training PowerPoint Presentations
   -General Employee
   -Ski School
   -Ski Patrol
-Go Sun Smart Campaign Materials
   -Posters
   -Signs
   -Brochures
   -Magnets
   -Static Clings
-Go Sun Smart Newsletters

In addition, logo-branded sunscreen, wide-brimmed hats, and Go Sun Smart banners are provided to the lift operations department at each ski area. 

Participants included 7,289 ski area employees who were recruited over a 3-month period (October to December 2001) at 26 ski areas in 8 U.S. States and one Canadian province, all in western North America. The ski areas ranged in size from small, single operators to large, multi-area corporations.  The study used a randomized, matched-pairs, nested-cohort, pretest-posttest control group design with the worksite as the unit of randomization. Thirteen of the 26 ski areas served as intervention sites, and 13 served as controls. Ski areas were matched primarily by size and location, as well as other attributes such as ownership and organizational structure.  Consent forms were completed by all participating employees during routine employee meetings. Participants returned completed forms to the researchers in sealed envelopes to protect their confidentiality from other employees and supervisors. 

Pretesting was managed by the research team and the project's contact person at each ski area. Contact persons received training on how to administer the consent forms and pretests at a meeting with researchers in September 2001. Research staff visited each ski area to assist and observe the contact person during pretest administration. 

In November and December 2001, researchers visited each participating ski area and met with the contact person to review the schedule and plan implementation activities. Each contact person received a detailed Go Sun Smart program guide with written protocols for program implementation.  Program implementation was monitored by the researchers through unannounced visits to each ski area. During these visits, the researchers spent the first day observing all visible program materials (without the contact person's knowledge) and the second day touring the site, with the contact person pointing out all of the places where program materials were present. Data collection staff also recorded all printed and oral messages they witnessed around or on the chair lifts. 

Go Sun Smart was implemented from January to April 2002. In March, 2,119 of 4,007 randomly selected employees from the baseline sample agreed to participate in the posttest survey.  The posttest sample was similar to the baseline sample in terms of demographics and job characteristics.  The posttest survey was conducted over the phone by trained interviewers using computer-assisted telephone interviewing software.  The surveys contained questions regarding how many sunburns the participant had received over the past winter, sun protection behaviors, and sun protection beliefs. 

Effects on Sunburn Occurrence

• Employees at the ski areas where the intervention was implemented reported a 14% reduction in sunburns while skiing or snowboarding (from 46% at pretest to 32% at posttest). This decline was significantly greater (p<.05) than the 8% decline observed in the control ski areas (49% at pretest to 41% at posttest).