Sun protection knowledge, attitudes and practices, skin pigmentation and personal UVB exposure among Malaysian national-level outdoor athletes

Outdoor athletes in equatorial regions are exposed to high levels of ultraviolet (UV) radiation year-round, increasing the risk of cumulative photodamage. However, evidence on sun protection behaviours and personal UVB exposure among athletes in tropical settings remains limited. This study assessed sun protection knowledge, attitudes and practices (KAP), skin pigmentation and personal UVB exposure among national-level outdoor athletes in Malaysia. A cross-sectional study was conducted among 79 athletes (53.2% female) from five sporting disciplines. Sun protection KAP was assessed using a culturally adapted questionnaire. Skin pigmentation was objectively measured using spectrophotometry, while personal UVB exposure was quantified using polysulphone film badges. Male athletes were predominantly classified within the darker ITA-based skin colour categories and had greater exposed body surface area than female athletes during training and non-training periods. UVB exposure differed significantly across sporting disciplines, with sailing athletes recording the highest daily exposure (3.5 ± 1.2 SED/day). Female athletes had higher attitude scores than male athletes (79.8 ± 8.2% vs. 74.1 ± 8.8%; P = 0.003). Knowledge was positively correlated with attitudes ( ρ = 0.567; P < 0.001) and practices ( ρ = 0.305; P = 0.006). Overall, sun-protective practices remained inconsistent, highlighting the need for sport-specific sun safety strategies.