Date of Award

8-2026

Document Type

Dissertation

Degree Name

Doctor of Philosophy (PhD)

Department

Parks, Recreation and Tourism Management

Committee Chair/Advisor

Matthew Browning

Committee Member

Barry Garst

Committee Member

Theresa Melton

Committee Member

Bishawjit Mallick

Abstract

Extreme heat is one of the most pressing climate-related public health threats, yet its health implications for children in summer camp settings in the U.S. remain critically underexplored. Despite serving approximately 26 million children annually across more than 15,000 programs in the U.S., summer camps operate largely without formal, evidence-based guidance for managing extreme heat. This dissertation addressed two overarching aims: (1) to examine how camp professionals perceive extreme heat risks and observed health impacts among campers, and (2) to identify the barriers and facilitators influencing implementation of heat adaptation strategies in summer camp settings.

This study employed a multi-method design, considering quantitative and qualitative components as distinct but complementary strands. The quantitative component consisted of a cross-sectional survey administered to 59 camp healthcare providers and directors recruited through the Alliance for Camp Health (ACH) member survey. Survey measures included observed heat-related health outcomes, risk perceptions assessed using the cognitive constructs of Health Belief Model (HBM), self-reported implementation behavior of heat adaptation strategies, and perceived importance of adaptation strategies. The qualitative component involved in-depth interviews with 12 camp professionals, guided by modified Consolidated Framework for Implementation Research (CFIR), to explore the inner-, outer-, and individual-level facilitators and barriers shaping heat adaptation implementation.

Quantitative findings revealed that physical health symptoms, particularly headaches, fatigue, and dehydration, were commonly observed among campers during periods of high temperature. Mental and behavioral symptoms, including irritability and anxiety, were also frequently reported. Camp directors demonstrated high overall knowledge of heat-related health risks, though meaningful gaps emerged around physiological heat acclimatization and the root cause of extreme heat. Risk perceptions were generally high across both groups, with healthcare providers rating perceived susceptibility and severity especially strongly. Implementation of heat adaptation strategies, such as hydration encouragement and shade access, was widespread; however, systematic approaches, including annual heat training, public health collaboration, and formal heat response protocols, were inconsistently adopted. Group comparisons identified significantly higher perceived importance for air-conditioned spaces, camper-focused educational sessions, and heat safety signage among healthcare providers compared to camp directors.

Qualitative findings revealed that strong organizational safety culture, clear communication structures within the camp, access to natural cooling resources, and the personal motivations of camp professionals served as key facilitators of heat adaptation. Structural barriers, particularly the absence of air-conditioned facilities, limited financial resources, and inconsistent staff training, constrained implementation capacity. At the outer setting level, the absence of camp-specific heat guidance and limited formal connections to public health agencies emerged as persistent challenges. At the individual level, variability in heat-related knowledge and experience shaped preparedness, with camps in historically warmer regions demonstrating strong adaptive capacity than those in cooler climates now experiencing increasing heat.

The findings suggest that heat adaptation in U.S. summer camps is shaped by a complex interplay of organizational, environmental, and individual factors. Theoretically, this study extends applications of the cognitive constructs of HBM to proxy health belief contexts and demonstrates the utility of modified CFIR in non-clinical, outdoor youth settings. Practically, the findings point to opportunities for American Camp Association (ACA) and ACH to strengthen accreditation standards, develop targeted training resources, and build regional support networks to advance camper health protection as temperature intensify.

Author ORCID Identifier

0000-0003-4642-1815

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Available for download on Tuesday, August 31, 2027

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