The Pool Cool program began in 1998 with a pilot study in Hawaii and Massachusetts and then, a randomized controlled efficacy trial in 1999. Results from the efficacy trial showed a positive effect on the sun protection behaviors of parents and their children, a decrease in sunburn among lifeguards, and an increase in policy and environmental supports for sun safety (Glanz, Geller, Shigaki, Maddock, & Isnec, 2002; Geller, Glanz, Shigaki, Isnec, Sun, & Maddock, 2001).
From 2000 to 2002, the program was disseminated to over 280 pools across the United States as part of a Pilot Dissemination Trial, demonstrating the feasibility and acceptability of implementing the Pool Cool program in diverse aquatic settings. Upon the success of the Dissemination Trial, the Main Pool Cool Diffusion Trial was launched in 2003 (Glanz, Steffen, Elliott, & O’Riordan, 2005). Field work for the Diffusion trial was conducted from 2003 to 2006 at over 400 pools (click here for a map of pools). The main aims were to evaluate the effects of two strategies for diffusion of the Pool Cool program on: program implementation, maintenance, and sustainability; organizational and environmental supports for sun protection; and sun protection habits and sunburns among children. The study used a three-level nested experimental design, with the three levels being Field Coordinators, swimming pools, and children ages 5 to 10 years in swimming lessons. Field Coordinators were aquatic professionals, and served as linking agents between the Pool Cool research staff and individual pools. Each Field Coordinator worked with a cluster of pools within a region, and randomization to treatment group occurred at the Field Coordinator level.
During the Diffusion Trial, an independent Process Evaluation involving telephone interviews and site visits was conducted to supplement outcome data. Pool contacts were interviewed about program participation, implementation, and challenges to implementation. During site visits, evaluators also made visual observations of program implementation, the pool environment, and staff sun safety practices (Escoffery, Glanz, & Elliott, 2008; Glanz, Isnec, Geller, & Spangler, 2002).
Most recently, a pilot study was conducted in 2007 to evaluate new strategies for improving sun safety among lifeguards: motivational appeals, a peer-driven approach and policy and environmental changes. The targeted, peer-driven intervention, named Pool Cool Plus, was found to reduce sunburns among lifeguards and increase the pool policies and environmental supports for sun-safety among the pool staff (Hall, Elliott, Nehl, & Glanz, 2008).
In 2006, the final year of field work for the main Diffusion Trial, a supplement study was conducted to compare self-report measures of sun exposure and sun protection to more objective measures. The study used state-of-the-science multidisciplinary measurement techniques, including polysulphone dosimeters and sunscreen swabbing and provided information on the reliability and validity of self-report measures of sun exposure and sun protection (Glanz, et al., 2009; O'Riordan, et al., in press).