Skin cancer (SC) is the most frequent neoplasm in White-skinned populations.1 Overexposure to ultraviolet radiation (UVR) is its primary cause. Good sun exposure (SE) practices should be acquired at a young age and maintained throughout adolescence2,3 to prevent sunburns. Sunburns during the first 20 years of life significantly increase the risk of developing different types of SC in adulthood,4 especially melanoma.5 Recently, the incidence of this type of SC and of basal cell carcinoma has increased among people younger than 40 years, particularly young women.6,7 This increase in this population is estimated to be caused, in part, by deliberate exposure to UVR to meet aesthetic standards related to tanned skin.8 Intentional and unintentional tanning are associated with a higher risk of sunburn.19

The media play a crucial role in shaping aesthetic ideals, including the preference for tanning,10 developed, in part, by Coco Chanel's campaigns,11 which attributed attractiveness to tanned skin.10,12 A century later, this preference persists,13 and tanning remains one of the reasons for UVR exposure.14 Therefore, seeing people with tanned skin in the media can establish tanning as a “social norm,”14 and the use of Instagram and Twitter has been linked to increased artificial tanning practices.12 Messages on social media (SM), including visual elements showing tanned skin,15 can influence the desire to tan.16

This is particularly concerning among young people, as SM penetration is higher among those aged 16–24 years,17 with use of 6.5 social media platforms per person,18 especially the most visual platforms,19 for approximately 3h 4min per day among women and 2h 37min per day among men.17

The use of SM in health communication has experienced significant growth.20 The results of the first studies reviewing interventions in SC prevention15,21–23 agree that SM has the potential to deliver effective messages, although there remain areas for improvement. Several studies acknowledge that the most common content on different SM platforms – Instagram in the United States,24 Facebook,22 and Twitter23 in Spain – focuses mainly on melanoma and sunscreen use as a prevention method. This prominence overshadows other less aggressive but more common types of SC, as well as other photoprotection methods.

Other studies show a lack of efforts aimed at eliminating the preference for tanning in SC prevention messages.15,25 In contrast, Mingoia et al.10 concluded that their pilot SM intervention, conducted in Australia, was effective in reducing favorable attitudes toward tanning. Similarly, SM interventions aimed at reducing sunbed use in the United States through Instagram26 or Facebook groups13 have also been successful.

The objective of this study was to provide useful information for the development of communication campaigns aimed at Spanish university students, given their considerable SM penetration and vulnerability to sunburns and subsequent SC risk. Specifically, the study describes their habits, attitudes, and knowledge about SE and evaluates the information about tanning and SC that they receive on SM.

This study is the first in Europe to investigate the relationship between SM use, tanning preferences, and the incidence of sunburns in young adults as potential risk factors for SC.

Sun protection habits were deficient, characterized by a highly favorable attitude toward and very frequent use of sunscreens, with these findings being more prominent among women. There is evidence of inadequate practice of other photoprotection measures that may be considered more effective, such as seeking shade and wearing appropriate clothing.27

Sunscreens are considered by most respondents to be the best way to protect against sun exposure and prevent SC, but the high rates of sunburn call into question the proper use and application of these products. They may also be used to prolong SE.8

Sunburns in the previous year, especially in coastal regions, are concerning. These results are consistent with those of other recent studies in similar populations from various geographic areas: Las Palmas de Gran Canaria28 and Aragón29 in Spain, Denmark,30 the United States,9 and Ecuador.31

Having skin type I to III, intense sports practice, outdoor leisure activities, and a high degree of agreement with the statement “tanned people are more attractive” influenced having experienced sunburn in the previous year. Approximately half of the sample expressed a high degree of agreement with this item, and an even higher proportion considered that clothes looked better on them with tanned skin, consistent with the results observed among medical students.28 This positive attitude toward tanning was more common among women.

Agreement with the statement about the attractiveness of tanned people was influenced by being female and by having read messages about tanning on SM. A large proportion of women confirmed having done so, especially on Instagram and TikTok. These results are concerning: these platforms are associated with health problems related to body image dissatisfaction, especially in young women.32,33

On the other hand, “avoiding midday hours” and “seeking shade” were associated with a lower preference for tanning and were more common practices among men. This would imply a lower sunburn rate, but this was not the case. Their lack of knowledge about the risks of SE and their low concern about SC should be highlighted. Additionally, outdoor sports, practiced on more days per year by men than women in our sample, have been associated with a higher risk of SC.34

Previous studies state that the use of SM can increase the practice of artificial tanning with sunbeds.12 Other studies suggest that the same relationship exists between these platforms and the preference for tanning.10,14,16 The findings of the present study corroborate the results of previous research.

Furthermore, we identified key aspects for designing future educational interventions on SM aimed at this target population to improve SE-related behaviors and reduce the preference for tanning. Likewise, the differences between genders are valuable for appropriately connecting with different target audiences.

The high rate of sunburns highlights the magnitude of SC risk and the need for efficient strategies targeting university students to improve their SE habits. Our study reveals significant differences between men and women in terms of SE and photoprotection behaviors, attitudes, and knowledge.

We highlight the higher percentage of women who confirmed having read messages on SM about SE risks and tanning in general, showing a worryingly positive attitude toward tanning. In contrast, men experienced greater SE while practicing sports and outdoor activities throughout the year, showed less concern about SC risk, and were less accessible through SM.

Reducing the desire for tanning and SE time, and improving photoprotection measures other than sunscreen, should be the main messages of future campaigns aimed at this population in terms of SC prevention.

The main limitation of the study is the overrepresentation of women. This could affect the generalizability of preventive messages to a more heterogeneous audience on SM. However, the results are significant for a target population of female university students aged 18–24 years. Additionally, there is a constant increase in the percentage of female graduates compared with men, and, depending on the degree, women may be more highly represented.35

The use of a self-completed survey implies that responses may be conditioned by the degree of understanding of the questions. The length of the questionnaire reduced the response rate, especially in the final part. The social media block received the fewest responses.

During the preparation of this work, the author(s) used Gemini to improve the wording. After using this tool/service, the author(s) reviewed and edited the content as needed and take full responsibility for the content of the publication.

This work was funded by the Ministerio de Ciencia, Innovación y Universidades of Spain/Agencia Estatal de Investigación/10.13039/501100011033 [Project PID2020-116487RB-100].

None declared.