A sample of local government organizations are recruited to a group-randomized pretest-posttest controlled trial evaluating the effect of a campaign to promote workplace policy and education on sun protection for outdoor workers. Primary outcome is adoption of formal policies and secondary outcomes are implementation of policy and sun protection practices by outdoor workers.

Workers in the United States spend large amounts of time on the job, making the workplace a key venue for preventive health programs. A workplace risk that has received limited attention is sun protection, despite the fact 8% of the U.S. workforce (over 9 million workers) work outdoors. The investigators have demonstrated that sun safety education can promote sun protection at work. In this revised application, the investigators propose to systematically study a more comprehensive approach to workplace sun safety that goes beyond employee education to promote institutional change. The investigators will implement and evaluate a proactive campaign to change workplace sun protection policies and promote sun safety to managers rather than individual employees. The investigators will assess whether policy adoption alters organizational operations in public employers rather than the private employers examined in our previous research. The specific aims are to: a) create a campaign comprised of personal contacts, printed materials, and Internet tools and resources (i.e., pubic health communication) to promote workplace sun protection policies to managers at public employers, b) evaluate the effectiveness of the campaign at promoting adoption and implementation of workplace sun protection policies, and c) assess whether policy adoption is associated in increases in workers' sun protection practices. An advisory board of public administrators and health experts has been constituted to advise the investigators on campaign and evaluation procedures. Analysis of public employers' existing policies and practices, additional in-depth interviews with public administrators, information design analysis, and usability testing will be conducted to develop an effective campaign. The campaign will be evaluated in a group-randomized, pretest-posttest controlled design. City and county governments in Colorado will serve as the unit of randomization and analysis. Interviews will be conducted with a sample of administrators at these public employers at baseline, interim posttest (n=6 per employer) and final posttest (n=5 per employer). In a subsequent four-year follow-up, surveys with employees and front line supervisors will assess employees' sun protection practices and workplace actions to support employee sun safety; (2) on-site observations of sun protection actions by the employers (e.g., posters, sunscreen, shade structures) will be documented; and (3) costs of implementing the policy campaign and induced employer costs will be tracked. Public employers will be studied because they employ a sizable number of outdoor workers (but results should generalize to for-profit companies). Outcomes will be evaluated at the employer, administrator, and employee levels. At the employer level, adoption of workplace sun protection policies at pretest and each posttest will be assessed with a protocol for coding written workplace policies (primary outcome measure) that demonstrated high reliability in a pilot study. At the administrator level, policy implementation (secondary outcome), theoretical mediators of adoption and implementation, and individual, organizational, political decision making and program variables that might moderate change will be measured in baseline, interim posttest (halfway through the intervention) and final posttest (end of intervention) surveys. At the employee level, analyses will compare the sun protection practices of employees between workplaces that received the intervention and controls and among workplaces that provided education and adopted policy, provided education only, and control workplaces. Analyses will also determine if the extent of sun protection actions by employers influences employees' sun safety practices. At the cost level, the economic evaluation will estimate the return on investment (i.e., comparison of the estimated program benefits to combined cost elements). The proposed study is significant and innovative because it provides critical information applicable to a wide range of industrial sectors with outdoor workers on a workplace risk that has received scant attention. Determining the effectiveness and return on investment of prevention programs is essential for national and local resource investment.

Inclusion Criteria:

• A local government organization with employees who worked outdoors in at least one of the following service areas: public works, public safety, and parks and recreation,
• Having a full time executive,
• Having a population of at least 3000 residents,
• Being employed at a participating local government organization as a manager
• Being employed at a participating local government organization in a job requiring outdoor work at least part of the time.

Exclusion Criteria:

• Organization had participated in the authors' previous occupational sun protection project.