Sun protection practices of beachgoers using a reliable observational measure

Background: Skin cancer is the most prevalent form of cancer in the United States and is rising rapidly; however, most skin cancers are preventable. Compared to self-report, direct observational methodologies could be a more valid and reliable tool for assessing sun protective behaviors within a specific environment. Purpose: The aim of the study is to assess the sun protection practices of beachgoers using a reliable observational measure. Methods: A systematic observation system for assessing sun protective behaviors among beachgoers was developed. Data were collected by 2 raters over 3 days using momentary ecological sampling methods. Individuals in a representative zone were assessed for head wear, upper body wear, sunglasses use, shade use, and gender. Results: Over the 3 days, Observers A and B made 1,678 and 1,725 observations, respectively. Interrater reliability ranged from 0.77 to 0.99. Hats, sunglasses, shirts, and shade were all used by less than 30% of the population. Sun protection behaviors varied by time of day and cloud cover. Conclusions: A reliable, observational measure designed to assess population behavior at the setting level showed low use of sun protection practices among beachgoers. Test-retest reliability, the inclusion of low body protection, coding for age, and skin tone are recommended for future versions of this system.