Attachment 3a

OMB Control No. 2060-0439

PRE-TEST

Expiration Date: 02/28/2011

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. 2060-0439

Expiration Date: 02/28/2011

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

This survey asks questions about how to keep your skin safe from the
sun. You do not have to answer any questions that you do not want to.
You can stop being part of the study at any time. To keep your answers
private, your name will not be on the survey. This survey should take
about 10 minutes to fill out.

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