News Release: Research, School of Public Health

Oct. 27,  2008

Sun Safety Program Cuts Lifeguards' Sun Exposure, Skin Cancer Risk

A targeted, peer-driven program aimed at getting lifeguards to wear more sunscreen and practice sun safety significantly reduced sunburns among study participants, says Emory University project coordinator Dawn Hall, MPH.

Hall will present findings from her team's pilot study today at the annual meeting of the American Public Health Association in San Diego.

The study evaluated the effectiveness of a targeted, peer-driven intervention called Pool Cool Plus on skin cancer prevention among lifeguards at outdoor swimming pools. Skin cancer is the most commonly diagnosed form of cancer in the U.S. The project is part of a large program of skin cancer research led by Karen Glanz, PhD, MPH, Candler Professor of Behavioral Science and Health Education, Rollins School of Public Health, and director of the Emory Prevention Research Center.

"There is definitely a need to improve sun safety among lifeguards," says Hall.  "They experience large amounts of sun exposure on the job and are typically adolescents and young adults, an age group that tends to have poor sun protection habits. The Pool Cool program provides an ideal avenue for reaching this high-risk group."

Researchers launched the Pool Cool program at 14 outdoor pool sites in Atlanta, Henderson, Nev., and Wichita, Kan. Pools in Wichita received the standard Pool Cool program, and pools in Atlanta and Henderson participated in the Pool Cool Plus program.

The standard Pool Cool program, first developed in 1998 by Glanz and her team from Hawaii and Boston, is a multi-component, educational and environmental skin cancer prevention program designed for outdoor pools. Through the program, lifeguards and aquatic staff teach children between the ages of five and 10 about sun safety as part of their swimming lessons. The lifeguards are trained on basic sun safety and the use of the Pool Cool program materials at the start of the summer. In the standard Pool Cool program, each pool received a tool kit containing educational materials, incentive items such as lanyards, hats, and wristbands, and a one-gallon pump bottle of sunscreen. The program has been conducted and evaluated in more than 400 locations in the U.S. and around the globe.

The Pool Cool Plus intervention incorporated new strategies into the standard program specifically targeting sun-safety behaviors of lifeguards. Additional program components included motivational appeals, policy and environmental supports, and a peer-driven approach to improving the sun-safety behaviors of the lifeguards. Lifeguards watched images and video clips of skin cancer growth and damage and video testimonials from skin cancer survivors. During the training, lifeguards also had the opportunity to use a skin analyzer machine to view existing sun damage on their faces.

The lifeguards at each pool were encouraged to form a sun-safety planning team that would develop and implement changes at their pool to improve sun safety among the staff. As part of the policy and environmental changes, pools were given a free shade structure, and planning teams could request additional sun-safety supports for their pools.

Participants were also invited to visit the Pool Cool web pages on the networking sites Facebook and Myspace. On these Web sites, the lifeguards could interact with Pool Cool Plus participants at other pools as well as individuals who had survived or were currently battling melanoma.

At the end of the study period, researchers found that on average lifeguards that participated in the Pool Cool Plus program experienced fewer sunburns during the summer and spent fewer hours in the sun on weekdays and weekends compared to lifeguards who participated in the standard Pool Cool program.

"Given the success of the pilot study, future research should examine the effectiveness and feasibility of wider dissemination of the Pool Cool Plus program," says Glanz.


In addition to Hall, study authors included principal investigator Karen Glanz, PhD, MPH, Eric Nehl, MS, Frances McCarty, PhD, Tom Elliott, MPH, of the Rollins School of Public Health, Emory University.

Funding support was provided by the National Cancer Institute (NCI Grant CA 92505), Emory Cancer Prevention & Control Research Network (CDC Grant U48 DP000043), and a Georgia Cancer Coalition Distinguished Scholar Award to Karen Glanz


The Robert W. Woodruff Health Sciences Center of Emory University is an academic health science and service center focused on missions of teaching, research, health care and public service. Its components include schools of medicine, nursing, and public health; Yerkes National Primate Research Center; the Emory Winship Cancer Institute; and Emory Healthcare, the largest, most comprehensive health system in Georgia. The Woodruff Health Sciences Center has a $2.3 billion budget, 17,000 employees, 2,300 full-time and 1,900 affiliated faculty, 4,300 students and trainees, and a $4.9 billion economic impact on metro Atlanta.

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