A total of 699 participants from 2001 and 987 from 2002 were included in the analyses. Forty-six participants were excluded because they did not report an age of 15 to 60 years. A total of 191 pools participated in the program during 1 or both summers (79 pools participated both summers), with a range of 1 to 21 respondents from each pool and a median of 9 respondents per pool. Most respondents were white and female, and just over half were 15 to 19 years old. Skin cancer risk scores among participants were normally distributed, and the north and south regions of the United States were equally represented.
The most commonly reported SPH were wearing sunglasses (over 80% of respondents) and wearing sunscreen (over 60%). However, less than half the respondents reported usually or always wearing a shirt with sleeves, staying in the shade or under an umbrella, or wearing a hat when outside on a sunny day. Sunburn rates of 0, 1, and 2 or more sunburns for that summer were each reported by about one-third of the lifeguards. The mean score for social norms regarding sun safety was 3.61 in 2001 and 3.51 in 2002 (range, 1 [strongly disagree] to 5 [strongly agree]), and the mean score for pool policies regarding sun safety was 4.55 in 2001 and 4.50 in 2002 (0–7 “yes” responses). Just over 60% of respondents reported teaching the Pool Cool sun safety lessons each year.
There were significant differences in the mean SPH scores reported by the 2 age groups, with participants ages 15 to 19 reporting significantly fewer SPH than those aged 20 to 60 (P < .001). Those who reported teaching Pool Cool sun safety lessons had significantly higher mean SPH scores than those who reported not having taught Pool Cool sun safety lessons (P < .001 for both years). Among those who taught Pool Cool lessons, lifeguards who had taught the lessons more frequently tended to have higher SPH scores. Those who reported that they were “not able to teach Pool Cool lessons” tended to have the lowest SPH scores. There were no significant differences in the mean SPH scores by sex (P=.73 in 2001 and P=.22 in 2002) or geographic location (P=.30 in 2001 and P=.54 in 2002). However, in 2002 only, white individuals had significantly lower SPH scores than nonwhite lifeguards (P < .01), and those in the group at high risk for skin cancer had significantly higher SPH scores than those in the medium-risk group (P=.03).
There was a modest positive association between pool policy scores and SPH scores (r=0.18–0.25; P < .001) and a significant positive association between sun safety norms and SPH scores each year (r=0.36–0.38; P < .001). A significant positive association was also found between each individual norms question (regarding sunscreen use, hat use, and covering up while in the sun) and the corresponding sun safety habits question (aggregated by lifeguards’ behaviors at the pools) (r=0.28–0.43; P < .001). There was a moderate positive correlation between norms scores and policy scores in both years (r=0.23–0.27; P < .001).
gives the results of mixed-models regression analyses, including 5 covariates (age, sex, race/ethnicity, skin cancer risk, and geographic location), 3 independent variables (social norms, pool policies, and having taught Pool Cool sun safety lessons), and SPH score as the dependent variable. In both years, higher social norms were associated with higher SPH scores (P < .001), as were higher pool policies (P < .05). Having taught Pool Cool sun safety lessons was not significantly associated with SPH scores (P ≥ .34 for all analyses).
Mixed Regression Models of the Relationship of Covariates,a Social Norms, Pool Policies, and Having Taught Pool Cool Sun Safety Lessons for Sun Protection Habits in 2001 and 2002
Ordinal regression models including the 5 covariates (age, sex, race/ethnicity, skin cancer risk, and geographic location), 3 independent variables (social norms, pool policies, and having taught Pool Cool sun safety lessons), and sunburn as the dependent variable were created for each year. Although the trends within the models were similar, the models differed with regard to significant results.
In the 2001 model, lower social norms scores (P < .01) and pool policy scores (P < .01) tended to be associated with a greater number of reported sunburns. The association between having taught Pool Cool sun safety lessons and the number of sunburns reported was not significant (P=.74). Odds of reporting 2 or more sunburns were 1.6 times greater for females than males (P < .01) and 2.2 times greater for white individuals than for individuals of other ethnicities (P < .01). Higher skin cancer risk scores were also associated with a higher number of sunburns (P < .001).
In 2002, the association between pool policies and social norms and the number of reported sunburns was not significant, although there was a nonsignificant trend toward fewer sunburns as pool policies (P=.16) and social norms (P=.24) supporting sun safety increased. The odds of reporting 2 or more sunburns were 1.5 times greater for individuals who reported not having taught Pool Cool sun safety lessons (P < .05). As in 2001, the odds of reporting 2 or more sunburns were 2 times higher for white individuals than for individuals of other ethnicities (P < .01), and higher skin cancer risk scores were associated with a greater number of reported sunburns (P < .001).
In 2001 and 2002, there was a negative correlation between SPH scores and number of sunburns (r=−0.12, P=.001 in 2001; r=−0.14, P < .001 in 2002). For both years, ordinal regression models including SPH scores as the independent variable, skin cancer risk level as a covariate, and sunburn as the dependent variable were significant, with higher SPH scores associated with fewer sunburns (P < .001).