Form 1 Solar Cell Pretest

OMB No.: 0925-xxxx

Expiration Date: xx/xx/20xx

NOTIFICATION TO RESPONDENT OF ESTIMATED BURDEN

Public reporting burden for this collection of information is estimated to average 20 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to: NIH, Project Clearance Branch, 6705 Rockledge Drive, MSC 7974, Bethesda, MD 20892-7974, ATTN: PRA (0925-xxxx). Do not return the completed form to this address.

Solar Cell Randomized Trial

Pretest Survey

1. Please estimate how many days in the past 3 months,that is from [date 3 months ago] until today, have you been outdoors in the sun between 10 am and 4 pm?

days

2. About how many hours were your outdoors in the sun between 10 am and 4 pm in the past 3 months, that is from [date 3 months ago] until today?

hours

Of the [number days reported in Q1] days you said you were outdoors in the sun between 10 am and 4 pm in the past 3 months, on approximately how many of those days did you:

Don’t know/

Days remember

3. Wear sunscreen with SPF 15 or greater -99

4. Wear a sunscreen lip balm with SPF 15 or greater -99

5. Wear clothing that protected your skin from the sun -99

such as long sleeve shirts and long pants

6. Wear a hat with a wide brim -99

7. Wear sunglasses (including eye glasses with transition -99

lenses that darken in the sun)

8. Keep your time in the sun to a minimum -99

9. Stay in the shade -99

10. Has your skin been sunburned in the past 3 months between [date 3 months ago] and today? That is, has it been red and/or painful from exposure to the sun?

Yes -1

No -2

Don’t know/don’t remember -3

(If “Yes” to Q10, continue with Q11; if “No” or “Don’t know/remember,” skip to Q12)

11. About how many times has your skin been sunburned in the past 3 months between [date 3 months ago] and today?

sunburns (record exactly)

Don’t know/don’t remember -999

Do you agree or disagree with the following statements?

	Strongly Agree	Agree	Neither Agree nor Disagree/ Don’t Know	Disagree	Strongly Disagree
12. Most of my family think getting a sun tan is a good thing.	-5	-4	-3	-2	-1
13. Most of my family think people should protect their skin from the sun.	-5	-4	-3	-2	-1
14. Most of my friends think getting a sun tan is a good thing.	-5	-4	-3	-2	-1
15. Most of my friends think people should protect their skin from the sun.	-5	-4	-3	-2	-1
16. I think I look healthier when I am suntanned.	-5	-4	-3	-2	-1
17. I think I look better when I am suntanned.	-5	-4	-3	-2	-1
18. It is too complicated to protect my skin from the sun so I still get sunburned.	-5	-4	-3	-2	-1
19. Protecting my skin from the sun fits well with my outdoor activities.	-5	-4	-3	-2	-1
20. It is easy to protect my skin from the sun.	-5	-4	-3	-2	-1
21. I am confident that I can avoid getting sunburned while outdoors in the summer sun.	-5	-4	-3	-2	-1

22. How confident are you that you can practice sun safety, that is wear sunscreen, protective clothing, a hat, and sunglasses, the next time you go out in the sun?

Very confident -4

Somewhat confident -3

A little confident -2

Not confident at all -1

23. Over the next 3 months, how often do you think you will spend time in the sun in order to get a sun tan?

A lot -5

Often -4

Sometimes -3

Seldom -2

Never -1

Don’t know/remember -5

24. On the average, out of 100 people like you, how many do you think will:

Don’t know

a. Get sunburned while outdoors this summer -99

b. Intentionally try to get a sun tan this summer -99

c. Protect their skin from the sun this summer -99

25. Do you plan to protect your skin from the sun when you are outdoors this summer? That is, are you planning to apply sunscreen, wear protective clothing, wear a hat with a brim, limit your time out to the sun, and/or stay in the shade?

Yes -1

No -2

Don’t know -3

26. How willing are you to protect your skin from the sun when you are outdoors in the future?

Very willing -1

Somewhat willing -2

Neither willing or unwilling -3

Somewhat unwilling -4

Very unwilling -5

The next 3 questions will tell how sensitive your skin is to the sun.

27. What is your eye color?

Grey -1

Green -2

Blue -3

Hazel -4

Brown -5

28. How deeply does your skin tan if it is repeatedly exposed to bright sunlight over several days in the summer without any protection? Would it:

Get no sun tan at all or only get freckled -1

Get mildly or occasionally tanned -2

Get moderately tanned -3

Get very brown or deeply tanned -4

29. What was your natural hair color before age 20, without artificial hair dye?

(If under 20, ask:) What is your natural hair color?

Red -1

Blonde -2

Light brown -3

Dark brown -4

Black -5

These last questions will be used simply to separate responses into groups.

30. How many years of education have you completed?

11^th grade or less -1

High school graduate -2

Trade, technical, or vocational

Education beyond high school -3

Some college -4

2-year college degree (A.A.) -5

4-year college degree (B.A. or B.S.) -6

Post graduate degree -7

Refused -8

31. Has a doctor ever told you or anyone in your family that you or they had skin cancer, for example, basal cell or squamous cell cancer or melanoma?

Yes, basal cell or squamous cell cancer -1

Yes, melanoma -2

Yes, don’t know what type of skin cancer -3

No -4

Don’t know/remember -5

Refused -6

32. What is your home zip code? ___________________________

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