Download:
pdf |
pdfOMB Control No.
PRE-TEST
We 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.
1. What month is it?
January
February
July
August
2. How old are you?
March
September
8
3. Are you a boy or a girl?
9
10
Boy
4. What is the color of your hair?
April
October
11
May
November
12
13
June
December
14
Girl
Blond
5. Does your skin burn easily in the sun?
Red
Yes
Brown
No
Black
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
7. When do you have to use the most sun protection?
When the UV (Ultraviolet) Index is:
1
5
10 or higher
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.
10. Keeping your skin safe from the sun is:
I don’t know
Hard to do
True
False
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.
I forget to put on sunscreen.
It stings my eyes.
Sunscreen feels greasy on my skin.
It’s hard to put sunscreen on my whole body.
I don’t have any sunscreen.
None—I always wear sunscreen!
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.
It’s too hot to wear a hat.
13. Do you like to get a tan?
I don’t like to wear a hat.
None—I always wear a hat!
Yes
No
14. Do you think people look healthier with a tan?
Yes
Continued on the back—please turn over.
APPROVED: ICF/Caliber IRB on 4/7/08
I don’t have a hat.
No
OMB Control No.
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 ears
My arms
My stomach
My shoulders
My neck
16. Have you ever reminded a:
Friend to put on sunscreen?
Sibling (brother or sister) to put on sunscreen?
Parent or guardian to put on sunscreen?
Parent or guardian to put sunscreen on you ?
My legs
I don’t put it on
Yes
Yes
Yes
Yes
My back
No
No
No
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
20. Have you had a school lesson before on sun protection?
No
Yes
No
When you were outside in the sun last summer:
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
APPROVED: ICF/Caliber IRB on 4/7/08
| File Type | application/pdf |
| File Modified | 2008-04-11 |
| File Created | 2008-04-11 |