Survey 

Please complete each of the questions:

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* 1. Please provide your Age: _________________________

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* 2. Gender:



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* 3. Race/Ethnicity:

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* 4. Education Level

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* 5. Marital Status

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* 6. Income Level

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* 7. Section I: Health Maintenance

(1)How often in the past year have you visited any physician for a skin examination?


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* 8. (2) How often in the past year have you had a full body skin check by a healthcare provider?

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* 9. (3)How often in the past year have you self-examined your skin for abnormal markings (changing color, getting bigger, new mole) for growths?

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* 10. Section II: Skin Protection

(4)How often do you wear a hat with a wide brim all the way around?

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* 11. (5)How often do you wear long sleeved shirts?

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* 12. (6)How often do you wear sunscreen of at least SPF 30?

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* 13. (7)How often do you wear sunglasses?

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* 14. (8)How often do you wear pants that reach your ankles?

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* 15. Section III: Sun Avoidance Behavior

(9)How often do you limit your outdoor activity

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* 16. (10) When outside, how often do you seek shade?

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* 17. (11) How often do you worry about developing another case of skin cancer?

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* 18. (12)How often do you wear a hat, scarf, cap, or use an umbrella?

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* 19. (13) Since being diagnosed with melanoma, how often do you take part in outdoor activities compared to before the diagnosis?

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* 20. (14) Since being diagnosed with melanoma, how often do you worry about melanoma compared to before the diagnosis?

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