Attach 8

OMB #: 0925-NEW
Expiration Date: xx/xxxx
This survey should take approximately 25 minutes to complete
In this survey, we are interested in your opinions about genetics and health risks. There are no right answers –
please just answer each question based on your own opinion. Thank you for taking the time to help us!
A. The following items ask your opinions about some characteristics that might describe a person. Please indicate how
much you agree or disagree with each statement by circling your answer.
“Moral character is something very basic about a person that can’t be changed very much.”
Q1.

1--------------------2------------------3----------------------4-------------------------5---------------6--------------------7
Strongly disagree

Disagree

Somewhat disagree Neither agree nor disagree Somewhat agree

Agree

Strongly Agree

“Intelligence is something very basic about a person that can’t be changed very much.”
Q2.

1--------------------2------------------3----------------------4-------------------------5---------------6--------------------7
Strongly disagree

Disagree

Somewhat disagree Neither agree nor disagree Somewhat agree

Agree

Strongly Agree

"Smoking behavior is something very basic about a person that can't be changed very much."
Q3.

1--------------------2------------------3----------------------4-------------------------5---------------6--------------------7
Strongly disagree

Disagree

Somewhat disagree Neither agree nor disagree Somewhat agree

Agree

Strongly Agree

"Body weight is something very basic about a person that can't be changed very much."
Q4.

1--------------------2------------------3----------------------4-------------------------5---------------6--------------------7
Strongly disagree

Disagree

Somewhat disagree Neither agree nor disagree Somewhat agree

Agree

Strongly Agree

B. In these questions, we are interested in your thoughts about various factors that influence the risk of having health
problems. The first set of questions asks about YOUR everyday behaviors, and the questions on the next page ask about
OTHER PEOPLE’S everyday behaviors.
How much do you think YOUR OWN health habits such as diet and exercise determine whether or not YOU will
develop each of the following conditions?
Not at all A little Some

A lot

Completely

a) Diabetes/High blood sugar
b) Obesity
Q5a-g.

c) Heart disease
d) High blood pressure
e) Lung cancer
f) Colorectal cancer
g) Skin cancer
How much do you think YOUR OWN GENETIC MAKEUP, that is, characteristics passed from one generation to the
next in YOUR family, determine whether or not YOU will develop each of the following conditions?
Not at all A little Some
a) Diabetes/High blood sugar

Q6a-g.

b) Obesity
c) Heart disease
d) High blood pressure
e) Lung cancer
f) Colorectal cancer
g) Skin cancer

A lot

Completely

Now think about OTHER PEOPLE of your same age, sex, and race. How much do you think OTHER PEOPLE’S
health habits such as diet and exercise determine whether or not THEY will develop each of the following conditions?

Not at all A little Some

A lot

Completely

a) Diabetes/High blood sugar
Q7a-g.

b) Obesity
c) Heart disease
d) High blood pressure
e) Lung cancer
f) Colorectal cancer
g) Skin cancer

Thinking again about OTHER PEOPLE of your same age, sex, and race, how much do you think their GENES, that is
characteristics passed from one generation to the next in their families, determine whether or not THEY will develop
each of the following conditions?

Not at all A little Some
a) Diabetes/High blood sugar
Q8a-g.

b) Obesity
c) Heart disease
d) High blood pressure
e) Lung cancer
f) Colorectal cancer
g) Skin cancer

A lot

Completely

C. The following questions ask your opinions about health risks. Again, there are no right answers- we are interested in your
opinion.
There are so many recommendations out there about how to stay healthy, it’s hard to know which ones to follow.
Q9.

1--------------------2------------------3----------------------4-------------------------5---------------6--------------------7
Strongly disagree

Disagree

Somewhat disagree Neither agree nor disagree Somewhat agree

Agree

Strongly Agree

How likely are you to have genes that increase your chances of getting CANCER?
Q10.

1--------------------2------------------3----------------------4-------------------------5---------------6--------------------7
Not at all likely

Very unlikely

Unlikely

Neither likely nor unlikely

Likely

Very likely

Extremely likely

I worry that I may have genes that increase my chances of getting CANCER.
Q11.

1--------------------2------------------3----------------------4-------------------------5---------------6--------------------7
Strongly disagree

Disagree

Somewhat disagree Neither agree nor disagree Somewhat agree

Agree

Strongly Agree

I have a gut feeling that I may have genes that increase my chances of getting CANCER.
Q12.

1--------------------2------------------3----------------------4-------------------------5---------------6--------------------7
Strongly disagree

Disagree

Somewhat disagree Neither agree nor disagree Somewhat agree

Agree

Strongly Agree

How likely are you to have genes that increase your chances of getting HEART DISEASE?
Q13.

1--------------------2------------------3----------------------4-------------------------5---------------6--------------------7
Not at all likely

Very unlikely

Unlikely

Neither likely nor unlikely

Likely

Very likely

Extremely likely

I worry that I may have genes that increase my chances of getting HEART DISEASE.
Q14.

1--------------------2------------------3----------------------4-------------------------5---------------6--------------------7
Strongly disagree

Disagree

Somewhat disagree Neither agree nor disagree Somewhat agree

Agree

Strongly Agree

I have a gut feeling that I may have genes that increase my chances of getting HEART DISEASE.
Q15.

1--------------------2------------------3----------------------4-------------------------5---------------6--------------------7
Strongly disagree

Disagree

Somewhat disagree Neither agree nor disagree Somewhat agree

Agree

Strongly Agree

D. We are interested in learning more about you in the following questions.
When I feel threatened or anxious I find myself thinking about my strengths.
Q16.

1--------------------2------------------3----------------------4-------------------------5---------------6--------------------7
Strongly disagree

Disagree

Somewhat disagree Neither agree nor disagree Somewhat agree

Agree

Strongly Agree

When I feel threatened or anxious I find myself thinking about my values.
Q17.

1--------------------2------------------3----------------------4-------------------------5---------------6--------------------7
Strongly disagree

Q18.

Disagree

Somewhat disagree Neither agree nor disagree Somewhat agree

Agree

Strongly Agree

People can talk about the chance of something happening using either words, like "it rarely happens" or numbers, like
"there's a 5% chance." When people tell you the chance of something happening do you prefer they use words or
numbers?
Prefer words

Prefer numbers

No preference

In general, I depend on numbers and statistics to help me make decisions about my health.
Q19.

1--------------------2------------------3----------------------4-------------------------5---------------6--------------------7
Strongly disagree

Disagree

Somewhat disagree Neither agree nor disagree Somewhat agree

Agree

Strongly Agree

E. Some more information about you!
Q20.

About how tall are you without shoes?

Q21.

About how much do you weight in pounds, without shoes?

feet

inches
lbs.

Right now do you feel you are (circle one):

Q22.

Q23a.

1
Very underweight

2
Slightly underweight

If YES, how often do you now smoke cigarettes?
Not at all if not at all go to question 24

10-19

20-29

30-39

40+

If Some Days: On the average, when you smoked during the past 30 days, about how many cigarettes did you smoke
a day?
1-9

Q23e.

Some days go to 23d

If Every Day: On the average, how many cigarettes do you now smoke a day?
1-9

Q23d.

5
Very overweight

Nogo to question 24

Every day go to 23c
Q23c.

4
Slightly overweight

Have you smoked at least 100 cigarettes in your entire life?
Yes go to 23b

Q23b.

3
About the right weight

10-19

20-29

30-39

40+

How soon after you awake in the morning do you usually smoke your first cigarette?

minutes

At any time in the past year, have you stopped smoking for one day or longer because you were trying to quit?
Q23f.
Yes
Q23g.

No

Are you seriously considering quitting smoking in the next six months?

Yes

No

hours

F. Finally, we are interested in your thoughts about genetic tests.
Q24.

Genetic tests that analyze your DNA, diet, and lifestyle for potential health risks are currently being marketed by
companies directly to consumers. Had you heard or read about these genetic tests prior to visiting the exhibit at the
National Museum of Natural History?
Yes
No
In the next year, how likely are you to purchase one of these genetic tests that analyze your DNA, diet, and lifestyle for
potential risks that are currently being marketed by companies directly to consumers?

Q25.

Check if you have already purchased one of these tests.

1--------------------2------------------3----------------------4------------------------5---------------6------------------7
Not at all likely

Very unlikely

Unlikely

Neither likely nor unlikely

Likely

Very likely

Extremely likely

Q26.

Have you ever actively collected health information from your relatives for purposes of documenting your family’s health
history?
Yes
No

Q27.

Have you ever had a genetic test order by your doctor (e.g., BRCA, Huntington’s disease)?

Yes

No

In the next year, how likely are you to actively collect health information from your relatives for the purposes of
documenting your family’s health history?
Q28.

Check if you have already collected this information.

1--------------------2------------------3----------------------4------------------------5---------------6------------------7
Not at all likely

Very unlikely

Unlikely

Neither likely nor unlikely

Likely

Very likely

Extremely likely

In the next year, how likely are you to share any family history information you have collected with a health
professional?
Q29.

Check if you have already shared this information with a health professional.

1--------------------2------------------3----------------------4------------------------5---------------6------------------7
Not at all likely

Very unlikely

Unlikely

Neither likely nor unlikely

Likely

Very likely

Extremely likely