Supplementary Information
Sunlight exposure questionnaire
- Lifestyle and breast cancer prevention in Hong Kong women
Reference No. / ______/ RefnoInterview date
(dd/mm/yy) / ______/______/______/ Intdates
Interview timeBeginning: / ______:______am/pm
Interview timeEnding: / ______:______am/pm
Minutes taken: / ______mins / Times
IntervieweeName / Ints
(For data entry use only)
Check“✔” if it is completedQuestionnaire checking
1st Data entry
2nd Data entry
Updated information from interviewee
Name (English):______(Chinese):______
Identification number:______( ___ )
Date of Birth (dd/mm/yyyy) :______/______/______
Telephone: (Home) a.______
(Mobile) b.______
(Company) c.______
(Page) d.______
Fax:______/ Name
ID
Birthdate
telas
telbs
telcs
telds
faxs
A1. Whether you agree to participate in this survey(about 20 minutes)?
□1= Yes (→ B)
□2= No / SA1f
A2. Rearrange date of survey / ______Year_____Month_____Day
Weekly____(Monday to Sunday)
______:______/ SA2date
SA2week
SA2time
B1. Skin color turns dark under strong sunlight during 45 to 60 min without protection at the beginning of summer / □1 = no
□2 = difficult
□3 =easily
□4 =never experienced / SunB1
B2. Skin gets burnt under strong sunlight during 45 to 60 min without protection at the beginning of summer / □1 =always
□2 = easily
□3 = sometimes
□4 =no
□5 =never experienced / SunB2
【6-12 years】
C1. Where did you live (over 50% time) / □ 1 = Hong Kong□ 2 = China, Province ______City ______County______
□ 3 = Other country,Country______State______
City______/ SunC1a
SunC1b, SunC1c, SunC1d
C2. Average daily outdoor activities in summer / ______Hours / SunC2
C3. Average daily outdoor activities in other seasons / ______Hours / SunC3
C4. Vitamin D supplements intake / □ 1 =None
□2 =Vitamin D solely
□3 =Multivitamin containing Vitamin D
□ 4 =Cod liver oil containing Vitamin D
□ 5 = Other fish oil containingVitamin D / SunC4
C5. Usual sun protection (50%time) / □ 1 = None
□ 2 = Spring
□ 3 = Summer
□ 4 = Autumn
□ 5 = Winter / SunC5
C6. Traveled somewhere in summerduring the period of winter / □ 1 = None
□ 2 = Once every 3-4 years
□ 3 = Once every 2 years
□ 4 = Once every year / SunC6
【13-19 years】
D1. Where did you live (over 50% time) / □ 1 = Hong Kong□ 2 = China, Province ______City ______County______
□ 3 = Other country,Country______State______
City______/ SunD1a
SunD1b, SunD1c, SunD1d
D2. Average daily outdoor activities in summer / ______Hours / SunD2
D3. Average daily outdoor activities in other seasons / ______Hours / SunD3
D4. Vitamin D supplements intake / □ 1 =None
□2 = Vitamin D solely
□3 =Multivitamin containing Vitamin D
□ 4 =Cod liver oil containing Vitamin D
□ 5 = Other fish oil containingVitamin D / SunD4
D5. Usual sun protection(50%time) / □ 1 = None
□ 2 = Spring
□ 3 = Summer
□ 4 = Autumn
□ 5 = Winter / SunD5
D6. Traveled somewhere in summerduring the period of winter / □ 1 = None
□ 2 = Once every 3-4 years
□ 3 = Once every 2 years
□ 4 = Once every year / SunD6
【20-34 years】
E1. Where did you live (over 50% time) / □ 1 = Hong Kong□ 2 = China, Province ______City ______County______
□ 3 = Other country,Country______State______
City______/ SunE1a
SunE1b, SunE1c, SunE1d
E2. Average daily outdoor activities in summer / ______Hours / SunE2
E3. Average daily outdoor activities in other seasons / ______Hours / SunE3
E4. Vitamin D supplements intake / □ 1 =None
□2 = Vitamin D solely
□3 =Multivitamin containing Vitamin D
□ 4 =Cod liver oil containing Vitamin D
□ 5 = Other fish oil containingVitamin D / SunE4
E5. Usual sun protection(50%time) / □ 1 = None
□ 2 = Spring
□ 3 = Summer
□ 4 = Autumn
□ 5 = Winter / SunE5
E6. Traveled somewhere in summerduring the period of winter / □ 1 = None
□ 2 = Once every 3-4 years
□ 3 = Once every 2 years
□ 4 = Once every year / SunE6
【35 years to present】
F1. Where did you live (over 50% time) / □ 1 = Hong Kong□ 2 = China, Province ______City ______County______
□ 3 = Other country,Country______State______
City______/ SunF1a
SunF1b, SunF1c, SunF1d
F2. Average daily outdoor activities in summer / ______Hours / SunF2
F3. Average daily outdoor activities in other seasons / ______Hours / SunF3
F4.Your outdoor activities mainly include: / □1 = Walking □(1) = No □(2) = Yes
□2 = Cycling □(1) = No □(2) = Yes□ 3 = Swimming □(1) = No □(2) = Yes□ 4 = Other sports or exercise □(1) = No □(2) = Yes
□5 = Playing □(1) = No □(2) = Yes□6 = Seaside activity in the sun □(1) = No □(2) = Yes / SunF4a
SunF4b
SunF4c
SunF4d
SunF4e
SunF4f
F5. Traveled somewhere in summerduring the period of winter / □ 1 = None
□ 2 = Once every 3-4 years
□ 3 = Once every 2 years
□ 4 = Once every year / SunF5
F6. Usual sun protection(50%time) / □ 1 = None(F8)
□ 2 = Spring
□ 3 = Summer
□ 4 = Autumn
□ 5 = Winter / SunF6
F7. Usual sun protection methods in summer / (1) Sunscreen □ 1= None[(2)] □ 2= Yes ((i)和(ii))
(i) SPF of the sunscreen?SPF______(999=Unknown)
(ii)Your sunscreencontains UVB ?
□ 1 =No
□2 = Yes
□ 8 = Unknown
(2) Umbrella □ 1= None □ 2= Yes
(3) Brimmed hat □ 1= None □ 2= Yes
(4) Clothes with long sleeves
□ 1= None □ 2= Yes
(5) Long pants □ 1= None □ 2= Yes
(6) Sun glasses □ 1= None □ 2= Yes
(7) Shade □ 1= None □ 2= Yes / SunF7a
SunF7a1, SunF7a2
SunF7b
SunF7c
SunF7d
SunF7e
SunF7f
SunF7g
F8. Vitamin D supplements intake / □ 1 =None
□2 = Vitamin D solely
□3 =Multivitamin containing Vitamin D
□ 4 =Cod liver oil containing Vitamin D
□ 5 = Other fish oil containingVitamin D / SunF8
G1. Have you ever worked outdoor in the sun at least once per month, 30 minutes every time? / □ 1= None □ 2= Yes / SunG1
G2. How long have you ever worked outdoor in the sun? / Total years / Months ever year / Days every week / Hours every day
Summer
Autumn
Winter
Spring
/ SunG2a, SunG2b,SunG2c, SunG2d
SunG2e, SunG2f, SunG2g, SunG2h
SunG2i,SunG2j
SunG2k, SunG2l
SunG2m, SunG2n,SunG2o, SunG2p
H1. Have you ever used sunlamp?
a. Age at first using sunlamp
b. Age at last using sunlamp
c. Times using sunlamp / □ 1 =None (→ H2)
□2 = Yes
______Years
______Years
______Times / SunH1
SunH1a
SunH1b
SunH1c
H2. Have you ever used sunbed?
a. Age at first using sunbed
b. Age at last using sunbed
c. Times using sunbed / □ 1 =None (→ I )
□2 = Yes
______Years
______Years
______Times / SunH2
SunH2a
SunH2b
SunH2c
The end
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