Barbara J. Walkosz

Testing the risk compensation hypothesis for safety helmets in alpine skiing and snowboarding

Objective: The prevalence of helmet use by alpine skiers and snowboarders was estimated and self-reports on risk taking were assessed to test for potential risk compensation when using helmets in these sports. Setting: Skiers and snowboarders were observed and interviewed at 34 resorts in the western United States and Canada. Subjects: Respondents were 1779 adult skiers and snowboarders in the 2003 ski season. Outcome measures: Observations of helmet use and questions about perceived speed and degree of challenge when not wearing a helmet (helmet wearers) or in previous ski seasons (non-helmet wearers). Results: Helmet wearers reported that they skied/snowboarded at slower speeds (OR = 0.64, p<0.05) and challenged themselves less (OR = 0.76, p<0.05) than non-helmet wearers. Adoption of safety helmets in 2003 (23%) continued to increase over 2002 (OR = 0.46, p<0.05) and 2001 (OR = 0.84, p<0.05). Conclusions: No evidence of risk compensation among helmet wearers was found. Decisions to wear helmets may be part of a risk reduction orientation. Helmet use continues to trend upwards but adoption may be slowing.

Increasing Sun Protection in Winter Outdoor Recreation: A Theory-Based Health Communication Program

BACKGROUND Unprotected and excessive exposure to ultraviolet radiation (UVR) is the primary risk factor for skin cancer. DESIGN A pair-matched, group-randomized, pre-test/post-test, quasi-experimental design, with ski resorts as the unit of randomization, tested the effectiveness of Go Sun Smart, a multi-channel skin cancer prevention program. Independent samples of guests were taken at baseline (2001) and follow-up (2002); data were analyzed in 2006. SETTING AND PARTICIPANTS A total of 6516 adult guests at 26 ski areas in the western U.S. and Canada were recruited, consented, and interviewed on chairlifts. This study was nested within an occupational intervention for ski area workers. INTERVENTION Ski areas were pair-matched and randomized to receive Go Sun Smart, which consisted of print, electronic, visual, and interpersonal skin cancer prevention messages. MAIN OUTCOME MEASURES Sun-protection behaviors, sunburning, recall of sun-protection messages, and the association of message exposure to sun protection. RESULTS The difference in recall of all sun-protection messages, messages on signs and posters, and the Go Sun Smart logo was significant between the intervention and control resorts. Reported use of sun-protection practices was higher by guests at intervention ski areas using more (a higher dose of) Go Sun Smart materials. Intervention-group guests who recalled a sun-safety message were more likely to practice sun safety than intervention-group guests who did not recall a message and control-group guests. CONCLUSIONS While the mere implementation of Go Sun Smart did not produce sun-safety improvements, Go Sun Smart appeared to be effective for guests who encountered and remembered it. Many factors can work against message exposure. Signage seemed to produce the greatest increase in exposure to sun-safety messages.

Prevalence and diffusion of helmet use at ski areas in Western North America in 2001–02

Objective: The purpose of this study was to examine diffusion of and predictors of helmet use among skiers and snowboarders in the Western United States and Canada. Design: 6400 skiers and snowboarders at 29 ski resorts in the Western United States and Canada were interviewed on chair lifts and observed for helmet use during two consecutive ski seasons (winters 2001 and 2002). Setting: Skiers and snowboarders were observed and interviewed at 29 ski resorts in Alaska, California, Colorado, Idaho, Montana, New Mexico, Nevada, Oregon, Utah, and British Columbia as part of a sun protection project. Subjects: Participants completing the survey consisted of 3525 adult skiers and snowboarders in the 2002 season and 2978 adult skiers and snowboarders in the 2001 season. Main outcome measure: The outcome measure for all analyses was prevalence of helmet use by skiers and snowboarders. Results: Helmet use by skiers and snowboarders is increasing and is most prevalent among snowboarders, experts, and more frequent skiers/snowboarders. No evidence was found for the hypothesis that helmet use is diffusing more rapidly among earlier adopters of helmets than later adopters. Conclusions: Although controversy remains, helmets are rapidly diffusing as a safety device at western North American ski resorts. Expert and more frequent skiers and snowboarders are more likely to wear helmets, which may indicate that helmets are recognized as a safety device.

Research articleIncreasing Sun Protection in Winter Outdoor Recreation: A Theory-Based Health Communication Program

BACKGROUND Unprotected and excessive exposure to ultraviolet radiation (UVR) is the primary risk factor for skin cancer. DESIGN A pair-matched, group-randomized, pre-test/post-test, quasi-experimental design, with ski resorts as the unit of randomization, tested the effectiveness of Go Sun Smart, a multi-channel skin cancer prevention program. Independent samples of guests were taken at baseline (2001) and follow-up (2002); data were analyzed in 2006. SETTING AND PARTICIPANTS A total of 6516 adult guests at 26 ski areas in the western U.S. and Canada were recruited, consented, and interviewed on chairlifts. This study was nested within an occupational intervention for ski area workers. INTERVENTION Ski areas were pair-matched and randomized to receive Go Sun Smart, which consisted of print, electronic, visual, and interpersonal skin cancer prevention messages. MAIN OUTCOME MEASURES Sun-protection behaviors, sunburning, recall of sun-protection messages, and the association of message exposure to sun protection. RESULTS The difference in recall of all sun-protection messages, messages on signs and posters, and the Go Sun Smart logo was significant between the intervention and control resorts. Reported use of sun-protection practices was higher by guests at intervention ski areas using more (a higher dose of) Go Sun Smart materials. Intervention-group guests who recalled a sun-safety message were more likely to practice sun safety than intervention-group guests who did not recall a message and control-group guests. CONCLUSIONS While the mere implementation of Go Sun Smart did not produce sun-safety improvements, Go Sun Smart appeared to be effective for guests who encountered and remembered it. Many factors can work against message exposure. Signage seemed to produce the greatest increase in exposure to sun-safety messages.

Compliance with sunscreen advice in a survey of adults engaged in outdoor winter recreation at high-elevation ski areas.

BACKGROUND Adults are advised to wear sunscreen with a sun protection factor (SPF) of 15 or higher, apply it up to 30 minutes before sun exposure, and reapply it after 2 hours to reduce exposure to ultraviolet radiation in sunlight for the prevention of skin cancer. OBJECTIVE This study investigated the extent to which adults comply with sunscreen advice. METHODS A survey was conducted with 4837 adult skiers and snowboarders at 28 high-altitude ski areas in western North America in January through April 2001 through 2002. Respondents self-reported use of sunscreen, its SPF, time of first application, and reapplication. RESULTS Only 4.4% (95% confidence interval [CI] = ±0.6) of adults were in full compliance with all sunscreen advice. Half (49.8% [95% CI = ±1.4]) complied with SPF 15 or higher advice. Of those wearing sunscreen, 73.2% (95% CI = ±1.8) applied the sunscreen 30 minutes before beginning skiing/snowboarding, but only 20.4% (95% CI = ±2.0) complied with advice to reapply it after 2 hours. Total compliance was lowest during inclement weather, on low-ultraviolet days, by men, and among respondents who believed skin cancer was unimportant and with low sun-sensitive skin. It was positively associated with wearing lip balm and hats with a brim. LIMITATIONS The sample was predominantly male and of high socioeconomic status; the results apply most to winter recreation when ultraviolet radiation levels are low, and sunscreen use was assessed by self-report. CONCLUSION Although the recommendation to use SPF 15 or higher sunscreen has reached many adults, the reapplication advice is heeded by few adults and needs to be highlighted in future sun safety promotions.

The prevalence and predictors of helmet use by skiers and snowboarders at ski areas in western North America in 2001.

BACKGROUND Helmets may protect the heads of skiers and snowboarders. The prevalence of helmet use by these groups was estimated. METHODS Helmet use was observed in face-to-face surveys (N = 2,978) on sun protection at 28 ski areas in Alaska, California, Colorado, Idaho, Montana, New Mexico, Nevada, Oregon, Utah, and British Columbia (0.7% refusal rate) from January to April 2001. RESULTS Helmets were worn by 12.1% (95% confidence interval [CI], 11.0-13.3) of the sample. Use was highest among guests who skied or snowboarded more frequently (fourth quartile vs. first quartile, odds ratio [OR] = 11.998 [95% CI, 6.774-21.251]; third vs. first, OR = 5.556 [95% CI, 3.119-9.896]; second vs. first, OR = 2.186 [95% CI, 1.162-4.112]), were experts (OR = 3.326 [95% CI, 1.297-8.528]), used snowboards (OR = 2.301 [95% CI, 1.731-3.058]), and were more educated (college graduate, OR = 2.167 [95% CI, 1.271-3.695]; some college, OR = 1.969 [95% CI, 1.130-3.431]). CONCLUSION Helmet use was generally low but may be high enough by experts, snowboarders, and in the central Rocky Mountains to produce a norm stimulating further adoption.

USA Today's Coverage of the Top Women Golfers, 1998–2001

Womens sports not only receive less media coverage than male sports but also when women athletes are covered, gender-role stereotypes are often reinforced. This study examines USA Todays coverage of the top 3 professional women golfers, Se Ri Pak (South Korea), Annika Sorenstam (Sweden), and Karrie Webb (Australia), during the 1998–2001 LPGA seasons. The intent of this study is to gain an understanding of how the media covers a top female Asian athlete compared with athletes from Europe and Australia. A multi-method approach, using both content and textual analyses, was used to assess the amount and type of coverage accorded to the athletes. A content analysis of 649 articles indicates that Pak received less coverage proportionate to her wins than Sorenstam or Webb. Further, textual analyses revealed that three themes emerged regarding both positive and negative characteristics of the golfers: caliber, personality/appearance, and achievement. More negative characteristics were used to describe Pak than either Webb or Sorenstam.

Randomized Trial on Sun Safety Education at Ski and Snowboard Schools in Western North America

Abstract:  The purpose of this study was to evaluate the effectiveness of Go Sun Smart, a sun safety education program, directed to parents and children enrolled in ski and snowboard schools at high altitude resorts in western North America. Twenty‐six ski resorts were paired and then randomly assigned to the intervention or control condition. Three hundred fifty‐seven parents were interviewed about their childrens sun safety behavior and exposure to the Go Sun Smart program. More parents at the intervention resorts reported that their child was wearing sunscreen than at the control resorts (OR 2.37, 95% CI 0.93, 5.99) but this result was significant only at resorts in the Northwest region (OR 2.72, 95% CI 1.24, 5.95). Parents at intervention resorts had significantly increased odds of having seen a Go Sun Smart poster than those at the control resorts (OR = 8.53, 95% CI 2.17, 33.54). No significant differences were identified between the intervention and control groups for verbal messages from ski resort employees about sun protection. Outdoor wintertime recreation venues are a potentially effective site from which to implement sun safety education programs for children and parents.

Testing a Theory-Based Health Communication Program: A Replication of Go Sun Smart in Outdoor Winter Recreation

The epidemic of preventable skin cancer in the United States creates an urgent need for health communication campaigns to improve sun protection. Go Sun Smart (GSS), a theory-driven multichannel health communication campaign showed positive effects on sun safety behaviors of employees and guests in a randomized trial at high-altitude ski areas. In this article we report findings from the North American GSS campaign for guests at ski areas that comprosed the original control-group resorts, replicating the results of the original guest intervention. Results showed that after GSS was deployed, guests at the original control group ski areas increased sun protection and reported greater recall of sun safety messages. Conversely, GSS had no effect on sunburning attitudes or self-efficacy beliefs. Like the original GSS guest intervention, the present study found that greater exposure to GSS messages was associated with greater use of sunscreen, sunscreen lip balm, and face covering, but not gloves or overall sun protection. There was no evidence that GSS decreased sunburning or attitudes and self-efficacy beliefs regarding sun safety.

Sustainability of the Dissemination of an Occupational Sun Protection Program in a Randomized Trial

Sustainability of an occupational sun safety program, Go Sun Smart (GSS), was explored in a randomized trial, testing dissemination strategies at 68 U.S. and Canadian ski areas in 2004-2007. All ski areas received GSS from the National Ski Areas Association through a Basic Dissemination Strategy (BDS) using conference presentations and free materials. Half of the ski areas were randomly assigned to a theory-based Enhanced Dissemination Strategy (EDS) with personal contact supporting GSS use. GSS use was assessed at immediate and long-term follow-up posttests by on-site observation. Use of GSS declined from immediate (M = 6.24) to long-term follow-up (M = 4.72), F(1, 62) = 6.95, p = .01, but EDS ski areas (M = 6.53) continued to use GSS more than BDS ski areas (M = 4.49), F(1, 62) = 5.75, p = .02, regardless of timing of posttest, strategy × observation F(1, 60) = 0.05, p = .83. Despite declines over time, a group of ski areas had sustained high program use and active dissemination methods had sustained positive effects on implementation.