Australia has one of the highest skin cancer rates in the world. ‘SunSmart’ is a multi-component, internationally recognised community-wide skin cancer prevention program implemented in Melbourne, Australia, since summer 1988–1989. Following recent reductions in melanoma rates among younger Australian cohorts, the extent of behaviour change and the potential contribution of prevention programs to this decline in melanoma rates are of interest. Sun protection is a multifaceted behaviour. Measures previously applied to monitor change over time in preventive behaviour for this population focused on individual behaviours. The omission of multiple behaviours that reduce exposure to ultraviolet radiation (UV) may have led to underestimates of behaviour change, meriting further analysis of long-term trends to contribute to this debate. A population-based survey was conducted in Melbourne in the summer before SunSmart commenced (1987–1988) and across summers in 3 subsequent decades (1988–2017). During summer months, residents (14–69 years) were recruited to cross-sectional weekly telephone interviews assessing their tanning attitudes, sun protection behaviour, and sunburn incidence on the weekend prior to interview. Quotas were used to ensure the sample was proportional to the population by age and sex, while younger respondents were oversampled in some years. The majority of the respondents reported their skin was susceptible to sunburn. Changes in sun protection behaviour were analysed for N = 13,285 respondents in multivariable models, cumulating surveys within decades (1987–1988: N = 1,655; 1990s: N = 5,258; 2000s: N = 3,385; 2010s: N = 2,987) and adjusting for relevant ambient weather conditions and UV levels on weekend dates. We analysed specific and composite behaviours including a novel analysis of the use of maximal sun protection, which considered those people who stayed indoors during peak UV hours together with those people well-protected when outdoors. From a low base, use of sun protection increased rapidly in the decade after SunSmart commenced. The odds of use of at least 1 sun protection behaviours on summer weekends was 3 times higher in the 1990s than pre-SunSmart (adjusted odds ratio [AOR] 3.04, 95% CI 2.52–3.68, p < 0.001). There was a smaller increase in use of maximal sun protection including shade (AOR = 1.68, 95% CI 1.44–1.97, p < 0.001). These improvements were sustained into the 2000s and continued to increase in the 2010s. Inferences about program effects are limited by the self-reported data, the absence of a control population, the cross-sectional study design, and the fact that the survey was not conducted in all years. Other potential confounders may include increasing educational attainment among respondents over time and exposure to other campaigns such as tobacco and obesity prevention. With an estimated 20-year lag between sun exposure and melanoma incidence, our findings are consistent with SunSmart having contributed to the reduction in melanoma among younger cohorts.

In recent years, some health agencies offered sponsorship to sporting associations to promote healthy environments by encouraging clubs to develop health-related policies. However, the extent to which these sponsorship contracts reach their stated aims is of concern. This study aimed to quantify levels of policy development and practice in sports clubs for each of five key health areas, namely smoke-free facilities, sun protection, healthy catering, responsible serving of alcohol and sports injury prevention. Representatives from 932 Victorian sports clubs were contacted by telephone with 640 clubs (69%) participating in the survey. Results suggested that the establishment of written policies on the key health areas by sports clubs varied widely by affiliated sport and health area: 70% of all clubs with bar facilities had written policies on responsible serving of alcohol, ranging from 58% of tennis clubs to 100% of diving and surfing clubs. In contrast, approximately one-third of sports clubs had a smoke-free policy, with 36% of tennis, 28% of country football and 28% of men's cricket clubs having policy. Moreover, 34% of clubs overall had established sun protection policy, whereas clubs competing outside during summer months, [diving (86%) and life-saving (81%)] were most likely to have a written sun protection policy. Injury prevention policies were established in 30% of sports clubs, and were most common among football (56%), diving (43%) and life-saving (41%). This study suggests that policy development for health promotion can be achieved in sports clubs when it is well supported by health agencies and consideration is given to the appropriateness of the specific behaviours to be encouraged for a given sport. Communication between associations and clubs needs to be monitored by health agencies to ensure support and resources for policy development to reach the club level.