Prevent Cancer Foundation Survey

Instructions: Please skip a question if it is gender specific and therefore does not relate to you.

Communication Questions:

1. Have you ever looked for information about health or medical topics from any source?

Yes

No

2. Where have you looked for information about health or medical topics? (Check all that apply)

3. What type of information were you looking for in your most recent search? (Check all that apply)

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)

Susan G. Komen For the Cure

Other (please specify):

American Lung Associaton

Prevent Cancer Foundation

Lance Armstrong Livestrong Foundation

American Institute for Cancer Research

Cancer Care

American Cancer Society

5a. Thinking about cancer prevention, what information sources do you trust for accurate cancer prevention information? (Check all that apply)

Doctor/nurse/other healthcare professional

Family/friends

Internet search engines

Online medical sites

Newspapers/magazines

E-newsletter/email

Social media sites

Other (please specify):

5b. If you trust online medical sites, newspapers/magazines, and/or social media sites for cancer prevention information please specify which ones below.

		N/A
Specific online medical sites (please specify):

Newspapers/magazines (please specify):

Social media sites (please specify):

6. How do you share information about how to reduce cancer risk with others? (Check all that apply)

Face-to-face conversation

Conversations by phone

Social media sites

Texting

Email

Other (please specify):

I do not share information about how to reduce cancer risk with others

7. What areas surrounding cancer prevention are most important to you? (Rank these areas from 1 being most important to 5 being least important).

Cancer Perception Questions:

8. How likely do you think it is that you will develop cancer in the future?

9. How often do you worry about getting cancer? Would you say…

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)

11. Which of these steps have you taken to reduce your risk of getting cancer? (Check all that apply)

12. If you responded that you haven’t done anything to prevent cancer, why? (Check all that apply)

No control over getting cancer

Nobody knows of a cure/cause for cancer

Cancer runs in my family

Environmental causes

Chemicals in food/water

I already currently have cancer or have had cancer in the past

Not applicable

Other (please specify):

13. What is your level of agreement with the following statement: Cancer is an illness that when detected early can sometimes be treated.

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?

Survivor of cancer

Died of cancer

Both

I don’t know anyone who is a cancer survivor or has died of cancer.

Don’t know

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?

Survivor of cancer

Died of cancer

Both

I don’t know anyone who is a cancer survivor or has died of cancer.

Don’t know

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?

Survivor of cancer

Died of cancer

Both

I don’t know anyone who is a cancer survivor or has died of cancer.

Don’t know

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?

Very likely

Likely

Neither likely nor unlikely

Unlikely

Very unlikely

I have no history of cancer in my immediate family

Personal Cancer Prevention Habits Questions:

18. For the following questions, please answer yes, no or N/A.

19. If you currently smoke cigarettes or use another form of tobacco, how old were you when you started?

20. If you currently smoke and have not tried to quit smoking, why haven’t you?

Do not feel that I can do it

Have no desire to quit

I have never smoked

Other:

21. On average, how many times per week do you exercise?

22. Some health organizations recommend that people exercise 2.5 hours per week. Do you usually exercise 2.5 hours a week?

Yes

No

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)

24. Do you feel that your current level of exercise reduces your risk of getting cancer?

Yes

No

25. For the following questions, please answer yes or no.

	Yes	No
Are you overweight?

Do you believe you eat enough fruits and/or vegetables daily for good health?

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?

Yes

No

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)?

28. In the last 12 months, have you used a tanning bed?

Yes

No

29. How frequently do you use a tanning bed?

30. Would you say you strongly agree, somewhat agree, neither agree nor disagree, somewhat disagree, or strongly disagree with each of the following statements:

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.

Cancer Screening Questions:

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)

Colonoscopy

Mammogram

PAP test

Prostate Exam

Skin Exam

Testicular Exam

Oral Exam

I have never had a doctor, nurse or other healthcare provider recommend any cancer screenings/tests for me.

Other screening/test

33. How likely are you to follow screening advice from your doctor, nurse, or healthcare provider?

34. There are many organizations with different opinions on screening for cancer. Has public debate about screening affected your decision to get screened?

Yes

No

35. What type of cancer screening has public debate affected your decision on whether or not to get screened? (Check all that apply)

Demographics:

36. What is your age?

37. What is your gender?

Female

Male

38. What is your highest level of education?

High School Graduate or Less

Tech/Vocational/Some College

College Graduate

Post Graduate

39. What is your total household income?

40. What is your employment status?

41. What state do you live in?

Note: For this survey please answer BOTH question 42 about Hispanic origin and question 43 about race.

42. Are you of Hispanic/Latino Origin?

Yes

No

43. What is your race?

American Indian or Alaska Native

Asian

Black or African American

Native Hawaiian or Other Pacific Islander

White

Some other race :

44. What is your marital status?

Miscellaneous:

45. How often are you supposed to change the batteries in smoke detectors around your house?

46. How often are you supposed to change the oil in your car?

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