Lifeguards' sun protection habits and sunburns: association with sun-safe environments and skin cancer prevention program participation.

OBJECTIVE To examine associations among outdoor pool environments, social norms, pool policies, and participation in a sun safety program with lifeguards' sun protection habits and sunburn. DESIGN Cross-sectional survey. SETTING Outdoor swimming pools across the United States. PARTICIPANTS Lifeguards and aquatic instructors at pools participating in the Pool Cool skin cancer prevention program in 2001 (N = 699) and 2002 (N = 987). MAIN OUTCOME MEASURES Sun protection habits and number of sunburns. RESULTS Social norms supporting sun safety were associated with more sun protection habits (95% confidence intervals [CIs], 0.18-0.28 in 2001 and 0.17-0.26 in 2002), as were pool policies supporting sun safety (95% CI, 0.02-0.07 in 2001 and 0.002-0.04 in 2002). There was a trend toward fewer sunburns as social norms, pool policies, and participation in the Pool Cool program increased, but results differed across the 2 years. In 2001, lower social norms scores and pool policy scores were associated with more reported sunburns. In 2002, teaching Pool Cool sun safety lessons was associated with fewer sunburns. CONCLUSION The pool environment is related to sun safety behaviors of outdoor pool staff, with social norms showing the strongest association.