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Purpose: A systematic review was undertaken to characterize the training approaches that are currently being implemented in postgraduate medical education to teach residents advocacy skills., Method: An initial search was conducted in MEDLINE, PubMed, Embase, ERIC, and PsycINFO in November 2016 (updated in December 2017) for articles discussing postgraduate medical education interventions covering advocacy. Articles published between 1995 and 2017 were included. Two authors independently reviewed titles and abstracts (and, if needed, the full text) for inclusion; disagreements were resolved by consensus. Data were extracted from studies to characterize the content and pedagogy of the interventions by mapping them to the CanMEDS health advocate core competencies and key concepts., Results: A total of 3,027 unique abstracts were retrieved; 2,864 were excluded upon title and abstract review, and another 85 were excluded upon full-text review. Seventy-eight total articles were included. More studies involved residents from pediatrics, psychiatry, primary care or preventative medicine, or internal medicine than from emergency medicine, surgery, obstetrics and gynecology, or neurology. Published interventions varied widely by pedagogical approach and assessment method., Conclusions: Using the CanMEDS framework, this review maps the breadth and nature of postgraduate medical education interventions in health advocacy, with applicability to community organizations, program directors, educators, and administrators working to develop advocacy training interventions. Areas of focus included adapting practice to respond to the needs of or advocacy in partnership with patients, communities, or populations served; determinants of health; health promotion; mobilizing resources as needed; and social accountability.

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., (Copyright © 2016. Published by Elsevier Inc.)

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.

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.