Addressing the awareness-behavior gap in skin cancer prevention: A large-scale multi-institutional cross-sectional study among young adults.

PURPOSE: This study aimed to assess skin cancer knowledge, attitudes, and sun-protective behaviors among university students in Lebanon, and to examine the effects of gender, university type, and geographic region on protective practices. METHOD: A cross-sectional survey of 1330 university students in Lebanon assessed skin cancer knowledge, attitudes, and sun-protective behaviors using a structured questionnaire. Participants recruited via convenience and snowball sampling from randomly selected public and private institutions across various regions were analyzed using Pearson correlations and multivariate regression to identify behavioral predictors. RESULTS: Despite 86.4% awareness of skin cancer, misconceptions were widespread: 35.9% believed that darker-skinned individuals are protected against sunburn, and only 38.2% identified melanoma as a type of skin cancer. Just 33.8% consistently used sun protection, and only 12.6% reapplied sunscreen every 2-3 h. Knowledge, attitude, and behavior scores were positively moderately correlated (r = 0.193-0.274; p < 0.001). Female sex independently predicted higher scores across all domains, with the strongest effect on protective behaviors (β = 1.45; p < 0.001). Although students at private universities exhibited significantly greater knowledge than their public counterparts (β = 0.36; p < 0.001), their sun-protective behaviors were notably poorer (β = -0.31; p < 0.001), revealing a persistent and clinically relevant knowledge-behavior gap. Less urbanized regions showed lower knowledge and practice scores (p < 0.05). Only 46.8% of students sought medical advice for a changing mole, and 79.3% reported ≥1 lifetime sunburn. CONCLUSIONS: Among young adults, awareness alone does not translate into protective behavior. Behaviorally informed interventions are needed to bridge this gap and reduce the future skin cancer burden.