Rising skin cancer incidence rates have led to sun awareness campaigns in Malta since the early 1990s. The aim of this study is to assess the impact of these campaigns by analysing trends in sun exposure-related knowledge and behaviour amongst the Maltese people. A total of 559 Maltese pedestrians aged 16-50 years were interviewed in 1999. The same questionnaire was used to interview 304 pedestrians in 2004. More people admitted spending leisure time outdoors during peak sunshine hours in 2004 than in 1999 (85.9% vs 62.4%, p<0.001). There was a drop in people regularly wearing a hat during outdoor leisure activities from 32.4% to 18.4% (p<0.001), and from 37.5% to 9.3% (p<0.001) during outdoor work activities. Rates of regular sunscreen use remained constant at about 50% using it for outdoor leisure activities, but dropped from 25.0% to 9.3% for outdoor work (p=0.02). In 2004, 96.1% of participants having children aged less than 12 years stated that they regularly used sunscreen on their children (87.0% in 1999, p=0.01), while 66.2% said that their children regularly wore a hat (78.4% in 1999, p=0.05). More people were regarding a suntan as unhealthy in 2004 than in 1999 (62.8% versus 37.0%, p<0.001). The mass media remained the most important source of health information.peer-reviewe
