Student questionnaire

The Sun Wise School Program (Change)

1904.04 attachment2

The Sun Wise School Program (Change)

OMB: 2060-0439

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1.

What month is it?

January

February

March

April

May

June

July

August

September

October

November

December

2.

How old are you?

8

9

10

11

12

13

14

3.

Are you a boy or a girl?

Boy

Girl

4.

What is the color of your hair?

Blond

Red

Brown

Black

5.

Does your skin burn easily in the sun?

Yes

No

I don’t know

6.

What are some of the ways you can keep your skin safe from the sun?

*

Please fill in as many circles as you need to answer this question.

Eating cereal

Using sunscreen

Wearing a shirt and hat outside

W

e have a few questions we want you to answer about yourself and the sun. Thank you for

answering these questions. Please use a pencil to fill in the circle for each answer you choose.

If you want to change your answer choice, be sure to erase your first choice completely.

7.

When do you have to use the most sun protection?

When the UV (Ultraviolet) Index is:

1

5

10 or higher

I don’t know

8.

You can get a sunburn on a cloudy day.

True

False

9.

You only need to wear sunscreen when you are at the beach or pool.

True

False

10.

Keeping your skin safe from the sun is:

Hard to do

Not too hard, not too easy

Easy to do

11.

Some of the reasons why I do NOT always wear sunscreen when I’m outside are because:

*

Please fill in as many circles as you need to answer this question.

It takes too long to put on sunscreen.

It’s hard to put sunscreen on my whole body.

I forget to put on sunscreen.

I don’t have any sunscreen.

It stings my eyes.

None—I always wear sunscreen!

Sunscreen feels greasy on my skin.

12.

Some of the reasons why I do NOT always wear a hat when I’m outside are because:

*

Please fill in as many circles as you need to answer this question.

I forget to bring a hat.

I don’t like to wear a hat.

I don’t have a hat.

It’s too hot to wear a hat.

None—I always wear a hat!

13.

Do you like to get a tan?

Yes

No

14.

Do you think people look healthier with a tan?

Yes

No

PRE-TEST

APPROVED: ICF/Caliber IRB on 4/7/08

Continued on the baCk—please turn over.

15.

When you wear a bathing suit outside, what are all of the places that you put on sunscreen?

*

Please fill in as many circles as you need to answer this question.

My face

My arms

My shoulders

My legs

My back

My ears

My stomach

My neck

I don’t put it on

16.

Have you ever reminded a:

Friend to put on sunscreen?

Yes

No

Sibling (brother or sister) to put on sunscreen?

Yes

No

Parent or guardian to put on sunscreen?

Yes

No

Parent or guardian to put sunscreen on you ?

Yes

No

17.

When you are outside in the sun this coming summer, will you try to play in the shade instead of in the sun?

Yes

Most likely

Probably not

No

18.

Will you put sunscreen on when you go outside during the day this coming summer?

Yes

Most likely

Probably not

No

19.

Does your school announce the UV Index?

Yes

No

20.

Have you had a school lesson before on sun protection?

Yes

No

21.

Did you wear a hat?

Never

Rarely

Sometimes

Often

Always

22.

Did you wear a long-sleeved shirt?

Never

Rarely

Sometimes

Often

Always

23.

Did you wear sunglasses?

Never

Rarely

Sometimes

Often

Always

24.

Did you wear sunscreen?

Never

Rarely

Sometimes

Often

Always

25.

If you wore sunscreen, what number sunscreen or

SPF (sun protection factor) did you use?

Less than 15

15-29

30 or higher

I don’t know

26.

How many times did you get sunburned?

None

One or two

Three or more

27.

IF you got a sunburn, how many of the sunburns were painful?

None

One or two

Three or more

I did not get sunburned

28.

How many days a week did you spend outside during the day between 10 am and 4 pm?

0-1 day per week

2-3 days per week

4-5 days per week

6-7 days per week

29.

How many hours a day did you spend outside during the day between 10 am and 4 pm?

Less than 1 hour per day

1-2 hours per day

3-4 hours per day

5-6 hours per day

When you were outside in the sun last summer:

APPROVED: ICF/Caliber IRB on 4/7/08

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