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Prevent Cancer Foundation Survey
Instructions: Please skip a question if it is gender specific and therefore does not relate to you.
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1. Have you ever looked for information about health or medical topics from any source? |
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2. Where have you looked for information about health or medical topics? (Check all that apply) |
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3. What type of information were you looking for in your most recent search? (Check all that apply) |
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4. Have you ever read, seen, or heard about an organization that works to prevent cancer called…? (The list below shows the organizations that came up on the first page of a Google search for “cancer organizations”) (Check all that apply) |
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5a. Thinking about cancer prevention, what information sources do you trust for accurate cancer prevention information? (Check all that apply) |
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5b. If you trust online medical sites, newspapers/magazines, and/or social media sites for cancer prevention information please specify which ones below.
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6. How do you share information about how to reduce cancer risk with others? (Check all that apply) |
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7. What areas surrounding cancer prevention are most important to you? (Rank these areas from 1 being most important to 5 being least important).
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Cancer Perception Questions: |
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8. How likely do you think it is that you will develop cancer in the future? |
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9. How often do you worry about getting cancer? Would you say… |
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10. How likely in your lifetime do you think you are to get the following types of cancer? (5=very likely, 4=likely, 3=neither likely nor unlikely, 2= unlikely, 1=very unlikely, N/A=Not Applicable)
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11. Which of these steps have you taken to reduce your risk of getting cancer? (Check all that apply) |
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12. If you responded that you haven’t done anything to prevent cancer, why? (Check all that apply) |
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13. What is your level of agreement with the following statement: Cancer is an illness that when detected early can sometimes be treated. |
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14. Do you personally know of anyone (friend, family, co-worker, etc) who is a cancer survivor or has died of cancer in the last 6 months? |
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15. Do you personally know of anyone (friend, family, co-worker, etc) who is a cancer survivor or has died of cancer in the last 12 months? |
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16. Do you personally know of anyone (friend, family, co-worker, etc) who is a cancer survivor or has died of cancer in the last 3 years? |
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17. If you have ever had cancer in your immediate family (i.e. parent, sibling, child, grandparent), how likely do you think that increases your risk of getting cancer? |
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Personal Cancer Prevention Habits Questions: |
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18. For the following questions, please answer yes, no or N/A.
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| 19. If you currently smoke cigarettes or use another form of tobacco, how old were you when you started? | | |
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20. If you currently smoke and have not tried to quit smoking, why haven’t you? |
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21. On average, how many times per week do you exercise? |
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22. Some health organizations recommend that people exercise 2.5 hours per week. Do you usually exercise 2.5 hours a week? |
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23. How much would you say your current level of exercise improves your overall health and well-being on a scale of 1 to 5? (scale = 1 does not improve it at all and 5 = improves it a lot) |
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24. Do you feel that your current level of exercise reduces your risk of getting cancer? |
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25. For the following questions, please answer yes or no.
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26. Some health organizations recommend that people should eat 5 servings each of fruits and vegetables per day. Do you usually eat 5 servings each of fruits and vegetables every day? |
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27. How often do you do each of the following (on a scale of 1-5 with 1=always, 5=never, N/A=Not Applicable)?
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28. In the last 12 months, have you used a tanning bed? |
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29. How frequently do you use a tanning bed? |
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30. Would you say you strongly agree, somewhat agree, neither agree nor disagree, somewhat disagree, or strongly disagree with each of the following statements:
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31. What is your level of agreement with the following statement: Getting checked for cancer according to guidelines helps find cancer when it is easier to treat. |
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Cancer Screening Questions: |
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32. Which of the following screenings or tests have your doctor, nurse, or other healthcare provider recommended for you in the past five years? (Check all that apply) |
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33. How likely are you to follow screening advice from your doctor, nurse, or healthcare provider? |
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34. There are many organizations with different opinions on screening for cancer. Has public debate about screening affected your decision to get screened? |
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35. What type of cancer screening has public debate affected your decision on whether or not to get screened? (Check all that apply) |
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38. What is your highest level of education? |
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39. What is your total household income? |
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40. What is your employment status? |
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| 41. What state do you live in? | | |
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Note: For this survey please answer BOTH question 42 about Hispanic origin and question 43 about race. |
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42. Are you of Hispanic/Latino Origin? |
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44. What is your marital status? |
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| 45. How often are you supposed to change the batteries in smoke detectors around your house? | | |
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| 46. How often are you supposed to change the oil in your car? | | |
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| If you would like to be eligible to receive a $20 Amazon gift card for completing this survey please enter your email address. | | |
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