Sun Exposure and Behaviours in Saudi Arabia: A National Study of over Eleven Thousand Participants Utilising the...

Background: Excessive sun exposure is a major modifiable risk factor for skin cancer, with ultraviolet (UV) radiation identified as a key contributor. Saudi Arabia's high UV index and hot climate increase the risk of photo-induced skin damage among residents. Although awareness of sun protection is growing, inconsistent use of preventive measures persists, often due to misconceptions and limited knowledge. This study aimed to assess patterns of current and prior sun exposure across demographic groups in Saudi Arabia using the validated Arabic version of the Sun Exposure and Behaviour Inventory (Ar-SEBI). Methods: An analytical cross-sectional study was conducted between August 2024 and January 2025 across all five Saudi regions using non-probability quota sampling to ensure geographic representation. Sun-exposure practices and protective behaviours were measured using the Ar-SEBI. Data were collected via an online questionnaire and analysed using IBM SPSS Statistics 26. Normality was assessed via Shapiro-Wilk and Levene's tests. Depending on the distribution, data were analysed using the Mann-Whitney U test, the Kruskal-Wallis H test, unpaired t-tests, or ANOVA. A p-value < 0.05 was considered statistically significant. Results: A total of 11,491 adults participated. Significant demographic and regional differences in sun-related behaviours were observed. Overall, 72.7% of participants were unaware of the SPF level of their sunscreen. Males and individuals under 30 years of age had significantly higher sun exposure scores than females and older adults, respectively (p < 0.001). Residents of the Southern region had the highest exposure and behaviour scores (p < 0.001), despite also reporting higher engagement in some protective measures. Additionally, sun exposure scores increased progressively with darker Fitzpatrick skin types (IV-VI) (p < 0.001), suggesting a common belief that darker skin confers adequate protection. Conclusions: This study reveals notable disparities in sun-protection practices across Saudi Arabia. Younger adults, males, and individuals with darker skin types reported greater sun exposure and indicators of lower protective awareness. These findings support the need for targeted, culturally tailored public health campaigns and policy measures to enhance sun safety and reduce long-term dermatological risks.