The following measures have been shared on behalf of Dr. Kim Witte, with her consent. These measures are free to use for non-commercial purposes.
Citation: Witte, K. (2010). Examples of items from Dr. Kim Witte. Retrieved from: enter website URL here
What is your health threat (be specific)______________________.
What is your recommended response to avert the health threat (again, be specific, list as many recommended responses as appropriate)?
_________________________________________________________________________________
Please note: In these examples, skin cancer is the health threat and there are several recommended responses (using SPF-15 or greater sunscreen, reapplying sunscreen after swimming and/or two hours, wearing protective clothing, etc.)
Please answer the following questions with the message you just read in mind.
[FEAR]
How much did this message make you feel frightened?1 2 3 4 5 6 7
Not Very
At all muchHow much did this message make you feel tense?
1 2 3 4 5 6 7
Not Very
At all much
How much did this message make you feel nervous?
1 2 3 4 5 6 7
Not Very
At all much
How much did this message make you feel anxious?
1 2 3 4 5 6 7
Not Very
At all much
How much did this message make you feel uncomfortable?
1 2 3 4 5 6 7
Not Very
At all much
How much did this message make you feel nauseous?
1 2 3 4 5 6 7
Not Very
At all much
Please indicate the degree to which you agree or disagree with each of the following statements by circling a number. 7 means “strongly agree,” 4 means “neutral,” and 1 means “strongly disagree.”
[SUSCEPTIBILITY]
I am at risk for skin cancer.
1 2 3 4 5 6 7
Strongly Strongly
Disagree Agree
It is likely that I will develop skin cancer.
1 2 3 4 5 6 7
Strongly Strongly
Disagree Agree
It is possible that I will develop skin cancer.
1 2 3 4 5 6 7
Strongly Strongly
Disagree Agree
[SEVERITY]
I believe that skin cancer is a severe health problem.
1 2 3 4 5 6 7
Strongly Strongly
Disagree Agree
I believe that skin cancer is serious threat to my health.
1 2 3 4 5 6 7
Strongly Strongly
Disagree Agree
I believe that skin cancer is a significant disease.
1 2 3 4 5 6 7
Strongly Strongly
Disagree Agree
[SELF-EFFICACY]
I am able to use sunscreen with at least SPF-15 or higher to prevent skin cancer.
1 2 3 4 5 6 7
Strongly Strongly
Disagree Agree
Using sunscreen with at least SPF-15 or higher to prevent skin cancer is easy for me.
1 2 3 4 5 6 7
Strongly Strongly
Disagree Agree
Using sunscreen with at least SPF-15 or higher to prevent skin cancer is inconvenient for me. [REVERSE SCORE]
1 2 3 4 5 6 7
Strongly Strongly
Disagree Agree
Applying sunscreen to all areas of my body exposed to the sun to prevent skin cancer is difficult for me. [REVERSE SCORE]
1 2 3 4 5 6 7
Strongly Strongly
Disagree Agree
Reapplying sunscreen every two hours to prevent skin cancer is convenient for me.
1 2 3 4 5 6 7
Strongly Strongly
Disagree Agree
Reapplying sunscreen after swimming or perspiring to prevent skin cancer is easy for me.
1 2 3 4 5 6 7
Strongly Strongly
Disagree Agree
Wearing clothing that covers my body to prevent skin cancer is inconvenient for me. [REVERSE SCORE]
1 2 3 4 5 6 7
Strongly Strongly
Disagree Agree
Wearing a hat that provide shade for my face to prevent skin cancer is easy for me.
1 2 3 4 5 6 7
Strongly Strongly
Disagree Agree
I am able to minimize my exposure to the sun at midday to prevent skin cancer.
1 2 3 4 5 6 7
Strongly Strongly
Disagree Agree
[RESPONSE EFFICACY]
My using sunscreen is effective in preventing skin cancer.
1 2 3 4 5 6 7
Strongly Strongly
Disagree Agree
Applying sunscreen with at least a SPF-15 or higher is effective in preventing skin cancer.
1 2 3 4 5 6 7
Strongly Strongly
Disagree Agree
Applying sunscreen to all areas of my body exposed to the sun is effective in preventing skin cancer.
1 2 3 4 5 6 7
Strongly Strongly
Disagree Agree
Reapplying sunscreen every two hours is effective in preventing skin cancer.
1 2 3 4 5 6 7
Strongly Strongly
Disagree Agree
Reapplying sunscreen after swimming or perspiring is effective in preventing skin cancer.
1 2 3 4 5 6 7
Strongly Strongly
Disagree Agree
Wearing clothing that covers the body is effective in preventing skin cancer.
1 2 3 4 5 6 7
Strongly Strongly
Disagree Agree
Wearing a hat that provides shade for my face is effective in preventing skin cancer.
1 2 3 4 5 6 7
Strongly Strongly
Disagree Agree
Minimizing my exposure to the sun at midday is effective in preventing skin cancer. 1 2 3 4 5 6 7
Strongly Strongly
Disagree AgreeBelow are sets of word pairs. For each pair, please place a check next to the word that best describes how you personally feel about each behavior.
[ATTITUDES]
In general, sunbathing is:
Good____:____:____:____:____Bad [REVERSE SCORE]
Undesirable____:____:____:____:____Desirable
Favorable___:____:____:____:____Unfavorable [REVERSE SCORE]
In general, suntanning is:
Good____:____:____:____:____Bad [REVERSE SCORE]
Undesirable____:____:____:____:____Desirable
Favorable___:____:____:____:____Unfavorable[REVERSE SCORE]
Going to tanning parlors is:
Good____:____:____:____:____Bad [REVERSE SCORE]
Undesirable____:____:____:____:____Desirable
Favorable___:____:____:____:____Unfavorable [REVERSE SCORE]
Minimizing my exposure to the sun at midday during summer is:
Good____:____:____:____:____Bad [REVERSE SCORE]
Undesirable____:____:____:____:____Desirable
Favorable___:____:____:____:____Unfavorable [REVERSE SCORE]
Applying sunscreen of SPF-15 or higher when out in the sun is:
Good____:____:____:____:____Bad [REVERSE SCORE]
Undesirable____:____:____:____:____Desirable
Favorable___:____:____:____:____Unfavorable[REVERSE SCORE]
Applying sunscreen to all areas of the body exposed to the sun is:
Good____:____:____:____:____Bad [REVERSE SCORE]
Undesirable____:____:____:____:____Desirable
Favorable___:____:____:____:____Unfavorable [REVERSE SCORE]
Reapplying sunscreen every two hours is:
Good____:____:____:____:____Bad [REVERSE SCORE]
Undesirable____:____:____:____:____Desirable
Favorable___:____:____:____:____Unfavorable [REVERSE SCORE]
Reapplying sunscreen after swimming or perspiring is:
Good____:____:____:____:____Bad [REVERSE SCORE]
Undesirable____:____:____:____:____Desirable
Favorable___:____:____:____:____Unfavorable [REVERSE SCORE]
Wearing clothing to cover my body when out in the sun is:
Good____:____:____:____:____Bad [REVERSE SCORE]
Undesirable____:____:____:____:____Desirable
Favorable___:____:____:____:____Unfavorable [REVERSE SCORE]
Wearing a hat to provide shade for my face is:
Good____:____:____:____:____Bad [REVERSE SCORE]
Undesirable____:____:____:____:____Desirable
Favorable___:____:____:____:____Unfavorable [REVERSE SCORE]
[DEFENSIVE AVOIDANCE]
Please think about the message you read in answering the following questions.
When I sunbathe, I tend to avoid thoughts of skin cancer.
1 2 3 4 5 6 7
Strongly Strongly
Disagree Agree
When I get a sunburn, I tend to avoid thinking about skin cancer.
1 2 3 4 5 6 7
Strongly Strongly
Disagree Agree
When I suntan, I try to not think about skin cancer.
1 2 3 4 5 6 7
Strongly Strongly
Disagree Agree
When I was reading the message and looking at the pictures, my instinct was to:
1 2 3 4 5 6 7
Want to Not want to
Protect myself To protect
From skin cancer Myself from
Skin cancer
When I was reading the message and looking at the pictures, my instinct was to:
1 2 3 4 5 6 7
Want to Not want to
Think about Think about
Skin cancer Skin cancer
[PERCEIVED MANIPULATION]
This message was manipulative.
1 2 3 4 5 6 7
Strongly Strongly
Disagree Agree
This message was misleading.
1 2 3 4 5 6 7
Strongly Strongly
Disagree Agree
This message tried to manipulate me.
1 2 3 4 5 6 7
Strongly Strongly
Disagree Agree
This message was exploitative.
1 2 3 4 5 6 7
Strongly Strongly
Disagree Agree
[MESSAGE DEROGATION]
This message was EXAGGERATED:
1 2 3 4 5 6 7
Strongly Strongly
Disagree Agree
This message was DISTORTED:
1 2 3 4 5 6 7
Strongly Strongly
Disagree Agree
This message was OVERBLOWN:
1 2 3 4 5 6 7
Strongly Strongly
Disagree Agree
This message was OVERSTATED: 1 2 3 4 5 6 7
Strongly Strongly
Disagree Agree
Please tell us what you plan to do in the future.
[INTENTIONS]
I intend to use sunscreen consistently within the next 6 months.
1 2 3 4 5 6 7
Strongly Strongly
Disagree AgreeWhy or why not?
______________________________________________________________________________I intend to use sunscreen consistently within the next 30 days.
1 2 3 4 5 6 7
Strongly Strongly
Disagree Agree
Why or why not?
______________________________________________________________________________For the next month, each time when I’m exposed to the sun, I intend to use sunscreen.
1 2 3 4 5 6 7
Strongly Strongly
Disagree Agree
I intend to use sunscreen consistently when exposed to the sun.
1 2 3 4 5 6 7
Strongly Strongly
Disagree Agree
The next time I’m exposed to the sun, I intend to use sunscreen.
1 2 3 4 5 6 7
Strongly Strongly
Disagree Agree
I intend to apply sunscreen at least a SPF-15 or higher to prevent skin cancer.
1 2 3 4 5 6 7
Strongly Strongly
Disagree Agree
I intend to apply sunscreen to all areas of my body exposed to the sun to prevent skin cancer.
1 2 3 4 5 6 7
Strongly Strongly
Disagree Agree
I intend to reapply sunscreen every two hours to prevent skin cancer.
1 2 3 4 5 6 7
Strongly Strongly
Disagree Agree
I intend to reapply sunscreen after swimming or perspiring to prevent skin cancer.
1 2 3 4 5 6 7
Strongly Strongly
Disagree Agree
I intend to wear clothing that covers my body to prevent skin cancer.
1 2 3 4 5 6 7
Strongly Strongly
Disagree Agree
I intend to wear hats that provide shades for my face to prevent skin cancer.
1 2 3 4 5 6 7
Strongly Strongly
Disagree Agree
I intend to avoid exposure to UV radiation from sunlamps or tanning parlors to prevent skin cancer.
1 2 3 4 5 6 7
Strongly Strongly
Disagree Agree
I intend to minimize my exposure to the sun at middays to prevent skin cancer.
1 2 3 4 5 6 7
Strongly Strongly
Disagree Agree
I intend to buy a sunscreen to prevent skin cancer during the next two weeks.
1 2 3 4 5 6 7
Strongly Strongly
Disagree Agree
I intend to talk to my friends about using sunscreen to prevent skin cancer within the next two weeks.
1 2 3 4 5 6 7
Strongly Strongly
Disagree Agree
[CONFOUND CHECKS]
This message was an accurate description of skin cancer.
1 2 3 4 5 6 7
Strongly Strongly
Disagree Agree
This message was an objective description of skin cancer.
1 2 3 4 5 6 7
Strongly Strongly
Disagree Agree
This message was clearly written.
1 2 3 4 5 6 7
Strongly Strongly
Disagree Agree
I clearly understood this message.
1 2 3 4 5 6 7
Strongly Strongly
Disagree Agree
I learned a lot about skin cancer from this message.
1 2 3 4 5 6 7
Strongly Strongly
Disagree Agree
The quality of arguments in this message were good.
1 2 3 4 5 6 7
Strongly Strongly
Disagree Agree
CURRENT BEHAVIOR ITEMS:
I currently use sunscreen when out in the sun more than 2 hours per day.
1 2 3 4 5 6 7
Strongly Strongly
Disagree Agree
I currently wear a hat to protect against overexposure to the sun.
1 2 3 4 5 6 7
Strongly Strongly
Disagree Agree
I currently sunbathe to get a tan each spring/summer.
1 2 3 4 5 6 7
Strongly Strongly
Disagree Agree
I currently go to a tanning parlor each year to get a tan.
1 2 3 4 5 6 7
Strongly Strongly
Disagree Agree
[LIFESTYLE/DEMOGRAPHICS] [[BE SURE TO INCLUDE AS MANY POTENTIAL CONFOUND VARIABLES THAT MAY MASK YOUR RESULTS AS POSSIBLE.]]
Here are some questions about your lifestyle. Please place a check next to a phrase that best describes your lifestyle.
How often do you go to a tanning parlor?
_____Never
_____Less than 1 week per year
_____Less than 2 weeks per year
_____Less than 3 weeks per year
_____Less than 1 month per year
_____Less than 6 weeks per year
_____More than 6 weeks per year
Please place a check next to phrases that best describe your skin type._____ Always burns; never tans
_____ Burns easily; tans minimally
_____ Burns moderately; tans gradually to light brown
_____ Burns minimally; always tans well to moderately
_____ Rarely burns; tans a lot to dark
_____ Never burns; deeply pigmented; insensitiveDo you know of anyone who has skin cancer? (Please check all that apply.)I do: _____Myself
_____Family
_____Friend
_____Acquaintance
_____NeighborDo you work out in the sun?_____Not at all_____Rarely_____Some of the time
_____1/2 of the time
_____Most of the timeHow often do you currently use sunscreen?_____Always when exposed to the sun
_____Often when exposed to the sun
_____Sometimes when exposed to the sun
_____Rarely when exposed to the sun
_____Never when exposed to the sunPlease rate how tan you are now. (Please check only one.)_____Not at all
_____A little tan
_____Medium tan
_____A lot of tan
_____Very tan
_____N/A (Black skin)
_____I don’t try to tanWhat SPF factor do you most often use? (Please circle on a number.)
2 4 8 15 25 30
How many hours per week do you spend in the sun doing leisure activities? _____ hours per week
I have gotten sunburned _____ time(s) during the last 2 years.
I have peeled _____ time(s) during the last 2 years.
How many hours do you spend out in the sun during the summer per week? _____ hours per week
Thank you. Now, we’d like to ask a few questions about you to help us classify our data.
How old were you on your last birthday? ______
What is your gender? ____Male ____Female
What best describes your race or ethnic group?
____Caucasian
____African American
____Hispanic
____Asian or Pacific Islander
Other (please specify)_____________________________
*Please do NOT talk with any of your classmates about these pictures until the end of the term.