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
| File Type | application/pdf |
| File Modified | 2008-04-08 |
| File Created | 2008-04-08 |