Sun-protection awareness, habits, and recommendations of USA Swimming coaches

Swimming is the 5^th most popular sport in the United States, and many of its athletes train outside. This study aimed to examine the sun-protection habits and recommendations of USA Swimming coaches and perceived sunscreen use among their athletes. We performed a cross-sectional survey of USA Swimming coaches. We evaluated associations between coach sun-protection habits, coach discussing sunscreen use with athletes, and the outcome of perceived sunscreen use among athletes using multivariate ordinal logistic regression. A total of 2729 coaches responded to the survey and were included. Most were women (59.8%), were White (93.1%), were aged 35-64 years (58.0%), and reported having coached outside (89.7%), and 12.0% reported a history of skin cancer. The majority (76.8%) of coaches discuss sunscreen use with their athletes. In multivariable analysis, increased perceived sunscreen use among athletes was associated with increased coach sun-protection habits with a dose-response relationship and was associated with binary discussion of sunscreen use with athletes (OR = 2.37, 95% confidence interval = 1.93-2.89) and, in a separate model, with frequency of discussing sunscreen with athletes with a dose-response relationship (statistically significant OR = 1.62 for yearly to OR = 5.17 for daily). These findings suggest a potential role for swimming coaches in improving sun protection of athletes.