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 

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.

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

OMB Control No. 2060-0439 Expiration Date: 02/28/2011 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

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.

OMB Control No. 2060-0439 Expiration Date: 02/28/2011