Rhode Island Sun Safety in Parks and Recreation Settings

Problem

Skin cancer is the most common type of cancer in the United States[1].¹ Melanoma accounts for the majority of skin cancer deaths.¹ For the period 2013-2017, the incidence rate of melanoma among Rhode Islanders was 23.7 per 100,000, compared to the national rate of 22.3 per 100,000.³ The American Cancer Society projects 340 new cases of melanoma in Rhode Island in 2020.¹

Research shows that excess exposure to ultraviolet radiation from sunlight increases the risk of skin cancer¹, and that high rates of skin cancer occur in individuals working outdoors.² Protecting skin from excessive sun exposure is one means of preventing skin cancer.¹ 

To help reduce incidence and mortality in the state, Rhode Island Department of Health’s (RIDOH) Comprehensive Cancer Control Program (CCC Program) and the Partnership to Reduce Cancer in Rhode Island (Partnership) worked together on a sun safety initiative. The initiative was designed to increase sun safety elements at outdoor recreation areas and to improve policies protecting employees and patrons. Together, these elements and policies made it easier for employees and patrons to engage in sun-safe behaviors.

[1] The two most common types of skin cancer, basal cell and squamous cell (i.e., keratinocyte carcinoma), also referred to as nonmelanoma skin cancer, are not required to be reported to cancer registries (ACS, 2020).

PSE Solution

This PSE change effort involved the development, promotion, and implementation of an evidence-based, multicomponent, community-wide intervention to reduce community members’ risk for skin cancer. The intervention involved educating stakeholders and developing and providing resources for implementing the suggested PSE changes.

Efforts targeted parks and recreation departments, beaches, and other outdoor recreation areas where protective PSE changes could be made, including the provision of sunscreen, installation of shade structures, acquisition of UV-protective uniforms, and implementation of policies limiting the time employees spent in the sun during peak hours. The RIDOH CCC Program and the Partnership worked with a community stakeholder to develop a model for parks and recreation departments, allowing them to generate support from the community to provide sunscreen, shade structures for guests, and UV protective uniforms for employees.

Actions/Results

Actions

The actions the RIDOH CCC Program and the Partnership took included:

• Conducted background research to establish the need for PSE change, including a review of Rhode Island’s incidence and mortality rates of reportable skin cancers and of the evidence-based PSE interventions recommended for preventing skin cancer in outdoor recreation settings (Step 2: Scan).
• Connected with parks and recreation departments around the state (Step 1: Engage).
• Delivered three presentations: one to each of three stakeholder groups – beach managers, golf course superintendents/managers, and parks and recreation departments – to educate them on the types of PSE change interventions that would improve sun safety protections for patrons and employees. To maximize reach, presentations were delivered at annual meetings of Rhode Island’s beach managers, the RI Golf Course Superintendents’ Association, and the RI Recreation & Parks Association, all of which include stakeholders from across Rhode Island.
• Worked with the Partnership to develop resources, including lists of vendors for PSE change intervention planning and implementation.
• Presented and disseminated materials endorsed by professional associations to educate and motivate stakeholders to implement the PSE changes promoted through this initiative.
• Provided technical assistance and follow-up guidance to departments that were provided a PSE change consultation (Step 6: Implement).

Results

The Narragansett Parks and Recreation Department implemented the model to support their provision of sunscreen to employees and patrons. The department conducted a one-year pilot study to evaluate the use of sunscreen dispensers on their popular town beach and shared construction plans for covered lifeguard chairs protecting beach employees from overexposure while on duty.

The RIDOH CCC Program developed a Sun Safety PSE Resource Sheet and made it available to all organizations involved in outdoor recreation that could use the resources to protect their patrons or employees. Outdoor banners and laminated posters advising patrons and employees to seek shade and use sunscreen were also distributed. All resources were made available through statewide associations of stakeholders responsible for managing beaches, golf courses, and state and municipal parks in Rhode Island.

Success Factors and Key Questions Addressed

How did you frame your message for each audience?

This campaign involved in-person engagement with stakeholders positioned to enact PSE changes within their organizations. The RIDOH CCC Program reached out to three stakeholder groups: beach managers, golf course superintendents and managers, and parks and recreation departments. The basic message was the same for each group: improving sun safety for your employees and patrons is simple, and easy-to-implement evidence-based options exist for every setting. The RIDOH CCC Program developed a general set of widely applicable PSE change recommendations, which served as the basis of engagement with each stakeholder group, along with a handful of stakeholder-specific recommendations.

Messaging distributed through emails and at in-person meetings and presentations included recommendations to:

• Provide uniforms that include pants, long-sleeved shirts, and wide-brimmed hats, made of ultraviolet protection factor (UPF) protective materials, for all outdoor workers.
• Provide free, FDA-approved sunscreen to all patrons and outdoor employees.
• Increase overall shade coverage available at outdoor recreation areas.

RIDOH worked with Brown Dermatology, its skin cancer screening partner, to present relevant information on risk and sun safety at some of the trainings.

Resources offered to all stakeholders included free educational signage available in English and Spanish, as either laminated 8.5” by 11” outdoor signs or 4’ by 8’ outdoor banners. All campaign media show a bottle of SPF 30 sunscreen with the message “Play it safe – seek shade and use sunscreen!” Further, the RIDOH CCC Program PSE Specialist worked with the Partnership’s coordinator to develop a resource list of vendors that provide products necessary to implement the recommended PSE changes. The provision of this coalition-produced resource made it easier for stakeholders to identify vendors that offer essential products or services, further reducing barriers to enacting recommended changes.

Other recommendations were adjusted for each stakeholder group, depending on their needs and the nature of UV exposure their employees and patrons experience at their outdoor recreation areas.

• For the past five years, beach managers have been invited by the RIDOH’s Beach Monitoring Program to learn about sun safety and skin cancer prevention at statewide beach season kickoff meetings held at the beginning of each summer season. Recommendations specific to beach managers include the construction of covered chairs for lifeguards, who would otherwise spend the majority of each workday in direct sunlight. The importance of providing free, FDA-recommended sunscreen to lifeguards was also emphasized, as these public safety personnel often spend entire shifts in bathing suits during peak sun hours and are exposed to additional UV rays reflecting off water and sand.
• Golf course superintendents received a list of PSE change strategies specifically applicable to golf courses. These suggestions include the construction of shade structures over teeing grounds, patios and other outdoor areas of congregation around the property; adding shades to golf carts; offering discounted tee-times for golfers playing before or after peak sun hours; and stocking only clothing made from UPF protective fabrics in the course’s pro shop.
• Similarly, parks and recreation department managers received a customized list of strategies specific to their settings. Recommendations on this list included: plan for trees and shade structures in future park development projects, avoid scheduling events during peak sun hours, encourage recreational sporting leagues to supply shade structures to cover athletes and coaches, and make tents and other modular shade structures available to patrons renting park space for events. The RIDOH CCC Program and the Partnership also provided information about national grant programs to support the construction of shade structures.

Another component of this campaign created targeted messages for the general public, as well as outdoor workers, using Facebook, Instagram, and local radio stations.

What cultural and/or community norms were incorporated to strengthen the message and make it more acceptable to your intended audience(s)?

A community norm common among the RIDOH CCC Program and the Partnership’s intended audiences is the improvement and preservation of personal health. Many individuals who regularly engage in outdoor recreation activities do so as a means by which they can improve and protect their health. All signage distributed in English and Spanish functioned as a call to action for patrons to protect their health by applying sunscreen or seeking shade while engaging in outdoor recreation activities.

Stakeholders also shared norms that were incorporated into educational materials and in-person meetings to ensure the safety of patrons who use their outdoor recreation areas and the employees who work to maintain them. By framing this responsibility as a primary concern for decision-makers and other key stakeholders, we were able to garner interest and engagement in PSE change work to improve sun safety.

Which media platform(s) were best suited to promoting your message and why?

Media platforms engaged through this PSE change initiative included Facebook, Instagram and radio; social media posts reached more than 75,000 individuals and radio spots totaled over 150,000 impressions.

We retained a local marketing company to create four different skin cancer prevention posts on Facebook and Instagram, where they ran for one month. Two of these PSAs were focused on outdoor workers, and two were created for the general public; they reached a total of 44,753 unique individuals through Instagram and 31,819 through Facebook. We also purchased radio spots to engage English- and Spanish-speaking listeners. The 78 spots, each one minute long, included educational messaging around sun safety read by the Director of RIDOH. Radio spots were spread out over two weeks on three radio stations with demographics favoring outdoor workers, and made approximately 152,500 listener impressions.

Additionally, the RIDOH CCC Program appreciated the collaborative efforts of the Rhode Island Golf Course Superintendents’ Association, which provided a full page in two consecutive issues of its bi-monthly newsletter for inclusion of the full PSE Resource Sheet created specifically for golf course managers and superintendents. Local media also covered the sun safety initiative in a story reported by WJAR.

Related Resources

For more information on Rhode Island’s efforts, visit the webpages of Rhode Island’s Comprehensive Cancer Control Program and the Partnership to Reduce Cancer in Rhode Island.

Program materials include:

Implementing Sun Safety Practices to Protect Your Employees and Patrons (Golf Courses)

Implementing Sun Safety Practices to Protect Your Employees and Patrons (Parks and Rec)

Practicing Sun Safety – What You’ll Need to Protect Employees and Guests (Resources)

Sun Safety Practices To Protect Yourself, Family, and Friends

Play It Safe. Seek Shade and Sunscreen (1/2 page)

Play It Safe. Seek Shade and Sunscreen (full page)

To learn more about sun safety, see the American Cancer Society’s Be Safe in the Sun webpage.

References

¹American Cancer Society. (2020). Cancer Facts & Figures 2020. Retrieved from https://www.cancer.org/content/dam/cancer-org/research/cancer-facts-and-statistics/annual-cancer-facts-and-figures/2020/cancer-facts-and-figures-2020.pdf

²Glanz, K., Buller, D. B., & Saraiya, M. (2007). Reducing ultraviolet radiation exposure among outdoor workers: State of the evidence and recommendations. Environmental Health 6(22). https://doi.org/10.1186/1476-069X-6-22

³United States Cancer Statistics. (2020). Leading Cancer Cases and Deaths, All Races/Ethnicities, Male and Female, 2013-2017. Retrieved from https://gis.cdc.gov/Cancer/USCS/DataViz.html