Title : Sun protection behaviours at the beach: Real-time insights to inform skin cancer prevention in Spain
Abstract:
Skin cancer rates continue rising globally, with age-standardised melanoma rates in Spain rising from 8.85 per 100,000 in 2014 to 18.50 per 100,000 in 2023. Sun protection represents a critical preventive strategy, yet adherence to recommended measures remains suboptimal, particularly among beachgoers who face heightened UV exposure due to prolonged sun exposure and reflection from sand and water. This study examines sun protection behaviours among Spanish beachgoers (N=454) during summer 2024, using in-the-moment surveys: an innovative geolocation-triggered survey methodology that captured behaviours in real-time. Participants were surveyed one hour after arriving at one of Spain’s 2,480 mainland beaches, minimising recall bias while gathering event-specific data on sun protection behaviours (usage of sunscreen, sunglasses, umbrella, hat and protective clothing). The survey data was also complemented with meteorological data from external sources (UV biologically effective dose and temperature). Our findings reveal that while 78% of beachgoers used sunscreen and 83% demonstrated accurate knowledge about UV risks, significant gaps persist in comprehensive protection. Only 7% wore protective clothing, and 72% dislike how sunscreen feels which may undermine reapplication. Using Structural Equation Modelling, we identified key determinants of sunscreen usage: attitudes toward sun protection emerged as the strongest predictor, followed by water contact and sunscreen texture attitudes. Environmental factors showed significant effects: cloudiness reduced sunscreen use both directly and indirectly by reducing UV levels, while UV radiation itself modestly increased protection. Positive tanning attitudes negatively affected usage, yet unexpectedly, positive sun exposure attitudes increased sunscreen use. Temperature influenced protection only indirectly by increasing water contact, which then triggered application. Notably, knowledge showed no direct effect on behaviour, and female gender was the only significant demographic predictor. More generally, the model revealed a complex web of indirect paths through which sociodemographic factors shape sun protection behaviour: education, socioeconomic status, and female gender strongly predicted knowledge levels, while gender and skin tone influenced attitudes. These findings have direct implications for preventive health interventions. Effective skin cancer prevention requires moving beyond knowledge-based approaches to attitude-change interventions. Public health campaigns should emphasize that overcast conditions do not eliminate UV risk and leverage water contact as a behavioural trigger for reapplication. While also addressing sunscreen texture concerns could improve adherence. By combining in-the-moment surveys with environmental objective data, this research provides evidence-based insights for designing targeted prevention strategies that can reduce skin cancer incidence among high-risk populations. This approach demonstrates how innovative health data collection can inform proactive, cost-effective public health interventions that build community resilience against preventable diseases.
