Implementation of Occupational Sun Safety at a 2-Year Follow-Up in a Randomized Trial: Comparison of Sun Safe Workplaces Policy Intervention to Attention Control.

PURPOSE: Implementation of employer sun safety actions was assessed in a 2-year follow-up to an occupational sun protection policy intervention. DESIGN: Two-year follow-up assessment in a randomized pretest-posttest controlled design. SETTING: Local government organizations with workers in public safety, public works, and parks and recreation. PARTICIPANTS: Sixty-three local government organizations (participation = 64%) and 330 frontline supervisors and 1454 workers. INTERVENTION: Sun Safe Workplaces (SSW) intervention promoting occupational sun safety policy and education. MEASURES: Observations of SSW messages and sun safety items and surveys on organizations' communication and actions on sun safety. ANALYSIS: Comparison between SSW and control groups was conducted using regression models and adjusted for clustering where appropriate, with α criterion set at P = .05 (2-tailed). RESULTS: At intervention worksites, more SSW messages ( P < .001) and sun safety items ( P = .025) were observed; more frontline supervisors reported organizations provided free/reduced price sunscreen ( P = .005) and communicated about sun safety ( P < .001); and more workers recalled receiving sun safety messages ( P < .001) and sun safety training ( P <.001) compared to control organizations. Implementation was greater at larger than smaller intervention organizations for wide-brimmed hats ( P = .009), long work pants ( P = .017), and shade structures ( P = .036). Older workers received the most written messages ( P = .015). CONCLUSIONS: Sun Safe Workplaces appeared to produce actions by organizations to support employee sun safety. Large organizations may have processes, communication channels, and slack resources to achieve more implementation.

Randomized Trial Evaluating Targeted Photographic Health Communication Messages in Three Stigmatized Populations: Physically-Disabled, Senior, and Overweight/Obese Individuals.

The homophily principle that perceived similarities among people produce positive reactions is a cross-cultural, global phenomenon. The prediction that photographs depicting models similar to the target population improve health communication was tested. Three nationally-representative samples (n = 1,796) of adults who are disabled, seniors, or considered overweight/obese were selected from GfK's Knowledge Panel®. Participants read a message promoting physical activity and improved diets and responded to assessments of behavioral intentions, outcome and self-efficacy expectations, and identification. Photographs from a stock photograph service versus photographs created for the research project to match the three populations, Real Health Photos (RHP), were included in the message. Structural equation modeling confirmed that RHP which matched the population increased behavioral intentions mediated by identification (p < 0.05) in the physically-disabled and overweight/obese samples. Messages with only half of the matched RHP images had these same positive indirect effects (p < 0.05). Matched visual images in health messages improved effectiveness by capitalizing on the homophily and identification processes. Health educators should leverage these hardwired, evolutionary, biological phenomena that extend to health status as well as race and ethnicity. For optimal effects, not all persons shown need to be homophilous to the target audience, reducing logistical difficulties in showing diverse persons of various types.

Results of a Randomized Trial on an Intervention Promoting Adoption of Occupational Sun Protection Policies.

PURPOSE: To evaluate an intervention promoting adoption of occupational sun protection policies by employers in a randomized trial. DESIGN: A randomized pretest-posttest controlled design with 2-year follow-up was conducted in 2010 to 2013. SETTING: Local government organizations in Colorado who had outdoor workers in public works, public safety, and/or parks and recreation. PARTICIPANTS: Ninety-eight local government organizations (n = 51 municipalities, 10 counties, and 37 special districts). INTERVENTION: Organizations were randomly assigned to receive a policy and education intervention comprised of personal contacts and theory-based training and materials or to an attention control group. MEASURES: Occupational policy documents were coded for sun safety content by a trained research assistant blind to condition. ANALYSIS: Policy scores were analyzed with logistic and Poisson regression models using imputation. RESULTS: At posttest, more organizations in the intervention group had a sun protection policy than in the control group (odds ratio [OR] = 4.91, P < .05; intent to treat: OR = 5.95, P < .05) and policies were more extensive (χ2 = 31.29, P < .01; intent to treat: χ2 =73.79, P < .01) and stronger (χ2 = 24.50, P < .01; intent to treat: χ2 = 51.95, P < .01). Policy adoption was higher when the number of contacts and trainings increased ( P < .05). CONCLUSION: The intervention had a large effect on adoption of formal sun protection policies, perhaps because of its fit with legal requirements to maintain safe workplaces. Personal contacts with managers were influential on adoption of occupational policy even in this age of communication technology and social media.

A Randomized Trial of an Advanced Sun Safety Intervention for Vacationers at 41 North American Resorts.

Taking vacations in sunny locations is associated with the development of skin cancer. This study tested a multi-component sun protection intervention based on diffusion of innovations theory and transportation theory designed to increase vacationers' comprehensive sun protection, i.e., use of clothing, hats, and shade, and use, pre-application, and reapplication of sunscreen. The trial enrolled 41 warm weather resorts in North America in a pair-matched group randomized pretest-posttest design and assessed samples of adult vacationers at resort outdoor recreation venues regarding sun protection at pretest (n = 3,531) and posttest (n = 3,226). While results showed no overall effect of the intervention on comprehensive sun protection across venues, the intervention produced statistically significant improvements in sun protection at waterside venues (pools and beaches). The intervention's overall effects may have been impeded by a lack of uniformly robust implementation, low interest in skin cancer prevention by guests, or shortcomings of the theories used to create prevention messages. The intervention may have worked best with guests in the highest-risk recreation venue, i.e., waterside recreation where they exposed the most skin. Alternative approaches that alter resort organizations, such as through changes in policy, environmental features, or occupational efforts might be more effective than targeting vacationers with behavior-change messages.

Prevalence of Sun Protection at Outdoor Recreation and Leisure Venues at Resorts in North America.

BACKGROUND: Exposure to solar ultra violet radiation (UVR) is a primary risk factor for skin cancer. Vacationers often fail to protect themselves from harmful UVR. PURPOSE: The study assessed the sun protection practices of resort guests in various outdoor leisure and recreation venues during warm-weather seasons. METHOD: 41 North American resorts were enrolled in a quasi-experimental randomized controlled trial. Adult guests were observed (n=4091) and surveyed (n=3694) in a cross sectional sample. Data collection was conducted in recreation and leisure venues with outdoors commons/reception areas acting as the comparison condition. RESULTS: The mean percent of vacationers at pools and beaches were more likely (p < 0.001) to wear sunscreen than in commons areas but less likely (p < 0.001) to wear cover-up clothing or use shade. In both samples, the combined sun protection scores were higher in commons areas compared to all venues except for outdoor dining (p < 0.001). DISCUSSION: Sun safety was suboptimal in all venues and was potentially mitigated by venue type. TRANSLATION TO HEALTH EDUCATION PRACTICE: Approaches are needed to encourage vacationers to practice comprehensive sun protection and to work with resorts to construct built environments that facilitate rather than act as barriers to sun safety.

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.

Environmental variables associated with vacationers' sun protection at warm weather resorts in North America.

BACKGROUND: Vacationing at sunny, warm weather locations is a risk factor for excessive solar ultraviolet (UV) radiation exposure and skin cancer. OBJECTIVES: This study examined the association of environmental variables related to UV levels with vacationers' sun protection. METHODS: Vacationers at 41 summer resorts in 17 states and 1 Canadian Province were interviewed (n=3531) and observed (N=4347) during 2012 and 2013. Clothing coverage, sunglasses, and shade use were observed. Use of sunscreen and sunburns were self-reported. Environmental information was recorded by research staff or acquired from ground stations and the weather service. RESULTS: Temperature was positively associated with sun protection behaviors; however clothing coverage was negatively associated with temperature. Cloud cover was negatively associated with sun protection, with the exception of clothing coverage which was positively associated with it. Elevation showed a mixed pattern of associations with vacationer's sun protection. Latitude of a resort was negatively associated with most sun protection behaviors, such that sun protection increased at more southerly resorts. Similarly, the farther south a vacationer traveled to the resort, the less sun protection they employed. The UV index showed a weak, positive relationship with some sun protection behaviors even when controlling for temperature. CONCLUSIONS: Vacationers appeared aware that UV is higher at southern latitudes and may learn UV is intense when living in southern regions. However, many used temperature, an unreliable cue, to judge UV intensity and seemed to adjust clothing for warmth not UV protection. Efforts are needed to help individuals make more accurate sun safety decisions.

Rationale, design, samples, and baseline sun protection in a randomized trial on a skin cancer prevention intervention in resort environments.

INTRODUCTION: Exposure to solar ultraviolet radiation during recreation is a risk factor for skin cancer. A trial evaluated an intervention to promote advanced sun protection (sunscreen pre-application/reapplication; protective hats and clothing; use of shade) during vacations. MATERIALS AND METHODS: Adult visitors to hotels/resorts with outdoor recreation (i.e., vacationers) participated in a group-randomized pretest-posttest controlled quasi-experimental design in 2012-14. Hotels/resorts were pair-matched and randomly assigned to the intervention or untreated control group. Sun. protection (e.g., clothing, hats, shade and sunscreen) was measured in cross-sectional samples by observation and a face-to-face intercept survey during two-day visits. RESULTS: Initially, 41 hotel/resorts (11%) participated but 4 dropped out before posttest. Hotel/resorts were diverse (employees=30 to 900; latitude=24° 78' N to 50° 52' N; elevation=2ft. to 9726ft. above sea level), and had a variety of outdoor venues (beaches/pools, court/lawn games, golf courses, common areas, and chairlifts). At pretest, 4347 vacationers were observed and 3531 surveyed. More females were surveyed (61%) than observed (50%). Vacationers were mostly 35-60years old, highly educated (college education=68%) and non-Hispanic white (93%), with high-risk skin types (22%). Vacationers reported covering 60% of their skin with clothing. Also, 40% of vacationers used shade; 60% applied sunscreen; and 42% had been sunburned. CONCLUSIONS: The trial faced challenges recruiting resorts but result showed that the large, multi-state sample of vacationers were at high risk for solar UV exposure.

Sustained use of an occupational sun safety program in a recreation industry: follow-up to a randomized trial on dissemination strategies.

The sustainability of evidence-based programs is needed to obtain long-term benefits. To assess sustainability of Go Sun Smart (GSS), an occupational skin cancer prevention program disseminated to the North American ski industry. Fifty-three of the 68 ski areas from the original dissemination trial participated in 2012 and 2013, 5 to 7 years after program distribution by enhanced or basic dissemination strategies. Sustained use was measured by: (1) on-site observation of sun protection communication and (2) an online survey with senior managers. In the sustainability assessment, sun safety communication had declined, and dissemination strategy did not affect continued use. Managers held weaker attitudes about skin cancer importance and program fit, but more managers provided free/reduced-cost sunscreen than in the dissemination trial. Manager turnover was a key factor in program discontinuance. Sustainability remains a challenge. Additional research is needed to determine the best strategies for sustainability.

The Sustainability of an Occupational Skin Cancer Prevention Program.

OBJECTIVE: Sustainability of prevention programs is a public health goal. METHODS: The effectiveness of Go Sun Smart, an occupational skin cancer prevention program, was evaluated 5 to 7 years out from the conclusion of a controlled randomized dissemination trial that compared an enhanced versus basic dissemination strategy at 53 ski areas enrolled in the trial. RESULTS: Employees (n = 2940) at ski areas in the enhanced condition reported fewer sunburns but did not differ from employees in the basic condition on other sun-protection measures. Significant differences for all sun-protection practices were identified at ski areas that displayed nine or more Go Sun Smart materials or a combined total of nine or more Go Sun Smart and other sun safety messages. CONCLUSIONS: Exposure to prevention messages is an important determinant of program effectiveness and potentially of program sustainability.

Factors Associated With Occupational Sun-Protection Policies in Local Government Organizations in Colorado.

IMPORTANCE: Skin cancer prevention remains a national priority. Reducing chronic UV radiation exposure for outdoor workers through sun-safety practices is an important step to help reduce the incidence of skin cancer. OBJECTIVE: To determine the presence of occupational sun-safety policies at local government organizations in a single state. DESIGN, SETTING, AND PARTICIPANTS: Of 571 potentially eligible local government organizations of Colorado cities, counties, and special tax districts, we enrolled 98 in a randomized pretest-posttest controlled experiment starting August 15, 2010, that evaluated an intervention to promote the adoption of sun-safety policies. We used a policy-coding protocol to evaluate personal sun-protection practices, environmental and administrative controls, and policy directives for sun safety starting February 10, 2011. We report the baseline assessment of the occupational sun-protection policies of these organizations. MAIN OUTCOMES AND MEASURES: The presence of an occupational sun-safety policy. RESULTS: Overall, 85 local government organizations (87%) had policies that required personal sun-protection practices, including the use of eyewear, hats, and protective clothing. However, of the 98 responding organizations, only 8 hat policies (8%), 10 eyewear policies (10%), and 7 clothing policies (7%) mentioned sun protection as the intent of the policy. Only cosmopoliteness, operationalized as proximity to an urban area, was associated with the presence of a sun-safety policy (odds ratio, 0.99 [95% CI, 0.98-1.00]; P = .02). CONCLUSIONS AND RELEVANCE: Outdoor workers are at increased risk for skin cancer because of long-term exposure to solar UV radiation. Although organizational policies have the potential to increase sun protection in occupational settings, occupational sun-safety policies were uncommon among local governments. Opportunities exist for dermatologists and other physicians to influence occupational sun-safety practices and policies, which are consistent with other safety procedures and could easily be integrated into existing workplace practices.

Translation of a Ski School Sun Safety Program to North American Ski and Snowboard Schools.

Health promotion programs that develop and implement strategies to promote sun safety practices to children have the potential to reduce skin cancer occurrence later in life. Go Sun Smart (GSS), a sun safety program for employees and guests of ski areas, was distributed to determine if an enhanced dissemination strategy was more effective than a basic dissemination strategy at reaching parents at ski and snowboard schools. On-site observations of GSS use and surveys of 909 parents/caregivers with children enrolled in ski and snowboard schools at 63 ski areas were conducted and analyzed using techniques for clustered designs. No differences were identified by dissemination strategy. Greater implementation of GSS (>5 messages posted) was associated with greater parental recall, 36.6% versus 16.7%, of materials, but not greater sun protection practices. Greater recall of messages, regardless of level of implementation, resulted in greater sun protection practices including applying sunscreen (p < .05), providing sunglasses and goggles (p < .01), and more use of all sun protection practices (p < .01). Ski areas with more program materials appeared to reach parents with sun safety advice and thus convinced them to take more precautions for their children. Sun safety need not be at odds with children's outdoor recreation activities.

Dissemination of go sun smart in outdoor recreation: effect of program exposure on sun protection of guests at high-altitude ski areas.

Go Sun Smart is a theory-based health communication program designed to influence sun-protection behaviors of employees and guests at high-altitude ski areas to reduce skin cancer risk. The effects of Go Sun Smart, in a Phase IV dissemination randomized posttest-only trial, on sun-protection behaviors of ski area guests are reported. Program use was assessed by on-site observation and guest message exposure, and sun protection was measured in intercept surveys at ski areas. Dissemination strategy-enhanced versus basic-was not significantly related to sun safety practices. Additional analyses examined the relation between message exposure and guests' sun safety practices. Ski areas displaying at least 6 Go Sun Smart materials in guest-only areas and 9 Go Sun Smart materials throughout the area increased guests' message exposure. Higher message exposure within the high-use ski areas was associated with improved sun protection by guests but not within the low-use ski areas. The authors underscore the importance of program implementation and message exposure on the success of evidence-based health communication efforts applied industrywide.

Adoption of sun safe workplace practices by local governments.

CONTEXT: Outdoor workers are especially susceptible to skin cancer--the most common, but also one of the most preventable, forms of cancer. Colorado, the location of the study, has the second highest rate of skin cancer deaths in the nation. OBJECTIVE: Local government managers in Colorado-in municipalities, counties, and special districts-were surveyed to ascertain the extent to which they engage in formal (written) and informal practices to protect their outdoor workers against excessive exposure to sun. DESIGN: The survey consisted of 51 questions assessing awareness of formal or informal practices for sun protection of outdoor workers. An index of practices--the study's dependent variable--was created that was composed or practices such as providing employees free or reduced-cost sunscreen, wide-brimmed hats, sunglasses, long-sleeved work shirts, long work pants, and temporary or permanent outdoor shade shelters. Proscriptive policies, such as restricting the use of broad brimmed hats, were subtracted from the index. Surveys were completed by 825 administrators representing 98 jurisdictions. Responses from administrators in the same jurisdiction were averaged. RESULTS: More than 40% of responding jurisdictions indicated that they engaged in informal sun safety practices. Tests conducted to determine what variables might account for the adoption of these sun protection practices found that the degree to which a community could be regarded as cosmopolite and as having an individualistic political culture were significant predictors. Type of government was also significant. Although, higher community income was a significant predictor, neither local government budget nor size was significant. CONCLUSIONS: The adoption of sun safe practices bears low costs with potentially high returns. Findings from this study suggest that awareness campaigns might most effectively target cosmopolite communities, but that the greatest impact might be achieved by targeting localite communities. Government size and budget do not appear to be constraints in the adoption of sun safe practices.

Expanding occupational sun safety to an outdoor recreation industry: a translational study of the Go Sun Smart program.

A successful occupational sun-protection program was translated to 67 ski areas where the effectiveness of two dissemination strategies was assessed. An industry professional association distributed materials to the resorts. Half of the resorts received the basic dissemination strategy (BDS) in which the materials were simply distributed to the resorts. In a randomized trial, the BDS was compared with an enhanced dissemination strategy (EDS) that added interpersonal contact with managers. Employees (n=2,228) at worksites that received the EDS had elevated program exposure (74.0% at EDS vs. 57.5% at BDS recalled a message). Exposure increased at two levels of program use: from less than four (55% exposed) to four to eight (68%) and to nine or more (82%) program items in use. More employees exposed to messages engaged in sun-safety behaviors than those unexposed. At worksites using nine or more items (versus 4-8 or <4), employees engaged in additional sun-safety behaviors. Program effects were strongly mediated by increased self-efficacy. Partnerships with industry associations facilitate dissemination of evidence-based programs. Dissemination methods are needed to maximize implementation and exposure to reduce health risk behaviors.

Enhancing industry-based dissemination of an occupational sun protection program with theory-based strategies employing personal contact.

PURPOSE: Industry-based strategies for dissemination of an evidence-based occupational sun protection program, Go Sun Smart (GSS), were tested. DESIGN: Two dissemination strategies were compared in a randomized trial in 2004-2007. SETTING: The North American ski industry. SUBJECTS: Ski areas in the United States and Canada (n  =  69) and their senior managers (n  =  469). INTERVENTION: Employers received GSS through a basic dissemination strategy (BDS) from the industry's professional association that included conference presentations and free starter kits. Half of the areas also received the enhanced dissemination strategy (EDS), in which project staff met face-to-face with managers and made ongoing contacts to support program use. MEASURES: Observation of program materials in use and managers' reports on communication about sun protection. ANALYSIS: The effects of two alternative dissemination strategies were compared on program use using PROC MIXED in SAS, adjusted for covariates using one-tailed p values. RESULTS: Ski areas receiving the EDS used more GSS materials (x¯  =  7.36) than those receiving the BDS (x¯  =  5.17; F  =  7.82, p < .01). Managers from more areas receiving the EDS reported communicating about sun protection in employee newsletters/flyers (x¯  =  .97, p  =  .04), in guest e-mail messages (x¯  =  .75, p  =  .02), and on ski area Web sites (x¯  =  .38, p  =  .02) than those receiving the BDS (x¯  =  .84, .50, .15, respectively). CONCLUSION: Industry professional associations play an important role in disseminating prevention programs; however, active personal communication may be essential to ensure increased implementation fidelity.

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.

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.

Supporting tobacco control: stimulating local newspaper coverage with a technical assistance website for local coalitions.

A large and growing literature confirms that well-designed web-based programs can be effective in preventing or treating several chronic diseases. This study examined how the Internet can deliver information and train community activists and specifically tested the effects of web-based technical assistance on local tobacco control coalitions' efforts to use media advocacy to advance their agendas. The authors compared a highly interactive, Enhanced website (intervention) to a noninteractive, Basic text-based website (comparison) in Colorado communities. A total of 24 tobacco control coalitions led by local county health departments and nursing services were enrolled in the project and randomly assigned to use either the intervention or comparison website. A total of 73 local daily and weekly newspapers were identified in the service areas of 23 of the 24 coalitions. A posttest assessment of newspaper coverage was conducted to locate all newspaper articles with tobacco control information published between January 1 and April 9, 2004, the last 3 months of the intervention. Although there was no evidence of a treatment effect on the frequency of newspaper articles on tobacco-related issues, there was, however, evidence that newspapers in counties where the coalition had access to the Enhanced website printed more stories focused on local/regional issues and more anti-tobacco local/regional stories than in the counties where coalitions had access to the Basic website. Coalitions can improve their influence on local media for community tobacco control when high-quality online technical assistance, training, and resources are available to them.

Continued benefits of a technical assistance web site to local tobacco control coalitions during a state budget shortfall.

CONTEXT: A state budget shortfall defunded 10 local tobacco coalitions during a randomized trial but defunded coalitions continued to have access to 2 technical assistance Web sites. OBJECTIVE: To test the ability of Web-based technology to provide technical assistance to local tobacco control coalitions. DESIGN: Randomized 2-group trial with local tobacco control coalitions as the unit of randomization. SETTING: Local communities (ie, counties) within the State of Colorado. PARTICIPANTS: Leaders and members in 34 local tobacco control coalitions funded by the state health department in Colorado. INTERVENTION: Two technical assistance Web sites: A Basic Web site with text-based information and a multimedia Enhanced Web site containing learning modules, resources, and communication features. MAIN OUTCOME MEASURE(S): Use of the Web sites in minutes, pages, and session and evaluations of coalition functioning on coalition development, conflict resolution, leadership satisfaction, decision-making satisfaction, shared mission, personal involvement, and organization involvement in survey of leaders and members. RESULTS: Coalitions that were defunded but had access to the multimedia Enhanced Web site during the Fully Funded period and after defunding continued to use it (treatment group × funding status × period, F(3,714) = 3.18, P = .0234). Coalitions with access to the Basic Web site had low Web site use throughout and use by defunded coalitions was nearly zero when funding ceased. Members in defunded Basic Web site coalitions reported that their coalitions functioned worse than defunded Enhanced Web site coalitions (coalition development: group × status, F(1,360) = 4.81, P = .029; conflict resolution: group × status, F(1,306) = 5.69, P = .018; leadership satisfaction: group × status, F(1,342) = 5.69, P = .023). CONCLUSIONS: The Enhanced Web site may have had a protective effect on defunded coalitions. Defunded coalitions may have increased their capacity by using the Enhanced Web site when fully funded or by continuing to use the available online resources after defunding. Web-based technical assistance with online training and resources may be a good investment when future funding is not ensured.