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What gender do you identify with?
 
Male
 
Female
 
 
 
Do you receive flyers for indoor tanning to your room?
 
Yes
 
No
 
 
 
Do you use a tanning bed?
 
Yes
 
No
 
 
 
What other forms of tanning, if any, do you use? (Check all that apply)
 
Spray Tan
 
Tanning Lotion
 
Sun Tanning
 
None
 
 
 
Why do you use a tanning bed? (Check all that apply)
 
Peer Influence
 
"I feel that I look better when I am tan"
 
Other
 
 
 
 
Are you aware of the health risks associated with tanning beds?
 
Yes
 
No
 
 
 
List all the risks you are aware of:
   
 
 
 
What would influence you to stop tanning?
 
Health Risks
 
Costs
 
Peer Influence
 
First Hand Encounters (hearing/seeing personal stories)
 
Other
 
 
 
 
Where did you hear about your tanning facility? (check all that apply)
 
Friends
 
Online
 
Coupons