Effect of an intervention on observed sun protection by vacationers in a randomized controlled trial at North American resorts

During vacations, many individuals receive high-risk sun exposure that is associated with skin cancer. Vacationers in outdoor recreation venues (pretest n = 4347; posttest n = 3986) at warm-weather destination resorts in North America (n = 41) were enrolled in a pair-matched, group-randomized pretest-posttest controlled quasi-experimental design in 2012-14. Print, audiovisual, and online messages based on Transportation Theory and Diffusion of Innovation Theory and promoting advanced sun protection (e.g., use of clothing, hats, shade and pre-application/reapplication of sunscreen and reliable cues to high UV) were delivered through resort channels. Vacationers' sun protection practices observed by trained research staff (i.e., body coverage and shade use analyzed individually and in combined scores) did not differ by experimental condition (p > 0.05) or intervention implementation (p > 0.05). However, recreation venue moderated intervention impact. The intervention improved sun protection at waterside recreation venues (z-score composite: intervention pre = − 22.74, post = − 15.77; control pre = − 27.24, post = − 23.24) but not non-waterside venues (z-score composite: intervention pre = 20.43, post = 20.53; control pre = 22.94, post = 18.03, p < 0.01). An additional analysis showed that resorts with greater program implementation showed more improvements in sun protection by vacationers at waterside (z = score composite: high implementation pre = − 25.45, post = − 14.05; low implementation pre = − 24.70, post = − 21.40) compared to non-waterside (z-score composite: high implementation pre = 14.51, post = 19.98; low implementation pre = 24.03, post = 18.98, p < 0.01) recreation venues. The intervention appeared effective with the vacationers in recreation venues with the highest-risk for sun exposure, waterside venues. However, it was not effective throughout all the resort venues, possibly because of the sun-seeking desires of vacationers, information overload at the resorts, and constraints on clothing styles and sun protection by recreation activity.