PPW Elementary School Survey Pretest
1.
Are you a...
Boy
Girl
2.
What grade are you in?
3rd grade
4th grade
5th grade
Other
3.
Next month, will you play sports or get physical activity on most days?
Yes
Maybe yes
Maybe no
No
4.
Next month, will you get at least 8 hours of sleep on most nights?
Yes
Maybe yes
Maybe no
No
5.
Next month, will you eat fruits and vegetables each day?
Yes
Maybe yes
Maybe no
No
6.
Next month, will you eat a healthy breakfast each day?
Yes
Maybe yes
Maybe no
No
7.
When you are an adult, will you drink or try any alcohol?
Yes
Maybe yes
Maybe no
No
8.
When you are an adult, will you smoke or puff on a cigarette?
Yes
Maybe yes
Maybe no
No
9.
When you are an adult, will you try any drugs like marijuana?
Yes
Maybe yes
Maybe no
No
10.
Next month, will you talk with your parents about your health or health habits?
Yes
Maybe yes
Maybe no
No
11.
Next month, will you set goals to improve your health habits?
Yes
Maybe yes
Maybe no
No
12.
When you are an adult, will you try or puff on an e-cigarette?
Yes
Maybe yes
Maybe no
No
13.
(Optional) Enter a code number given to you or one you'd like to use (Hint: one you can easily remember):
Current Progress,
0 of 13 answered
