Healthy Habits Ages 13-18 Pre-Survey

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* 1. Which Club do you attend?

Culver

Duneland

Portage

South Haven

Vaparaiso

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* 2. I am a:

Boy

Girl

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* 3. How old are you?

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* 4. How many minutes of physical activity should you get each day

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* 5. Gaining too much weight for your body can lead to:

Diabetes

High blood pressure

Heart problems

All of the above

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* 6. True or False:

	True	False
It is better to cook at home, because it is easier to include fruits, whole grains and high calcium foods like milk	It is better to cook at home, because it is easier to include fruits, whole grains and high calcium foods like milk True	It is better to cook at home, because it is easier to include fruits, whole grains and high calcium foods like milk False
Drinking enough fluids every day is important to help your body get the water it needs	Drinking enough fluids every day is important to help your body get the water it needs True	Drinking enough fluids every day is important to help your body get the water it needs False
It is important to eat lots of different color fruits and vegetables	It is important to eat lots of different color fruits and vegetables True	It is important to eat lots of different color fruits and vegetables False
Advertising is designed to encourage you to buy products	Advertising is designed to encourage you to buy products True	Advertising is designed to encourage you to buy products False

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* 7. During the past 24 hours, how many times did you.......? (Please choose one answer for each statement)

	0 times	1 time	2 times	3 times	4 times	5 times
Drink 100% fruit juice such as orange juice, apple juice or grape juice? (Do not count punch, Kool-Aid, sports drinks or other fruit-flavored drinks).	Drink 100% fruit juice such as orange juice, apple juice or grape juice? (Do not count punch, Kool-Aid, sports drinks or other fruit-flavored drinks). 0 times	Drink 100% fruit juice such as orange juice, apple juice or grape juice? (Do not count punch, Kool-Aid, sports drinks or other fruit-flavored drinks). 1 time	Drink 100% fruit juice such as orange juice, apple juice or grape juice? (Do not count punch, Kool-Aid, sports drinks or other fruit-flavored drinks). 2 times	Drink 100% fruit juice such as orange juice, apple juice or grape juice? (Do not count punch, Kool-Aid, sports drinks or other fruit-flavored drinks). 3 times	Drink 100% fruit juice such as orange juice, apple juice or grape juice? (Do not count punch, Kool-Aid, sports drinks or other fruit-flavored drinks). 4 times	Drink 100% fruit juice such as orange juice, apple juice or grape juice? (Do not count punch, Kool-Aid, sports drinks or other fruit-flavored drinks). 5 times
Eat fruit? (Do not count fruit juice)	Eat fruit? (Do not count fruit juice) 0 times	Eat fruit? (Do not count fruit juice) 1 time	Eat fruit? (Do not count fruit juice) 2 times	Eat fruit? (Do not count fruit juice) 3 times	Eat fruit? (Do not count fruit juice) 4 times	Eat fruit? (Do not count fruit juice) 5 times
Eat green salad?	Eat green salad? 0 times	Eat green salad? 1 time	Eat green salad? 2 times	Eat green salad? 3 times	Eat green salad? 4 times	Eat green salad? 5 times
Eat potatoes (Do not count french fries, fried potatoes or potato chips)	Eat potatoes (Do not count french fries, fried potatoes or potato chips) 0 times	Eat potatoes (Do not count french fries, fried potatoes or potato chips) 1 time	Eat potatoes (Do not count french fries, fried potatoes or potato chips) 2 times	Eat potatoes (Do not count french fries, fried potatoes or potato chips) 3 times	Eat potatoes (Do not count french fries, fried potatoes or potato chips) 4 times	Eat potatoes (Do not count french fries, fried potatoes or potato chips) 5 times
Eat carrots?	Eat carrots? 0 times	Eat carrots? 1 time	Eat carrots? 2 times	Eat carrots? 3 times	Eat carrots? 4 times	Eat carrots? 5 times
Eat other vegetables? (Do not count green salad, potatoes or carrots)	Eat other vegetables? (Do not count green salad, potatoes or carrots) 0 times	Eat other vegetables? (Do not count green salad, potatoes or carrots) 1 time	Eat other vegetables? (Do not count green salad, potatoes or carrots) 2 times	Eat other vegetables? (Do not count green salad, potatoes or carrots) 3 times	Eat other vegetables? (Do not count green salad, potatoes or carrots) 4 times	Eat other vegetables? (Do not count green salad, potatoes or carrots) 5 times

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* 8. Please answer the following questions about your physical fitness activities:

	0 days	1 day	2 days	3 days	4 days	5 days	6 days	7 days
During the past 7 days, how many days were you physically active for a total of at least 60 minutes per day? (Physical activity that increased your heart rate and made you breathe hard some of the time)	During the past 7 days, how many days were you physically active for a total of at least 60 minutes per day? (Physical activity that increased your heart rate and made you breathe hard some of the time) 0 days	During the past 7 days, how many days were you physically active for a total of at least 60 minutes per day? (Physical activity that increased your heart rate and made you breathe hard some of the time) 1 day	During the past 7 days, how many days were you physically active for a total of at least 60 minutes per day? (Physical activity that increased your heart rate and made you breathe hard some of the time) 2 days	During the past 7 days, how many days were you physically active for a total of at least 60 minutes per day? (Physical activity that increased your heart rate and made you breathe hard some of the time) 3 days	During the past 7 days, how many days were you physically active for a total of at least 60 minutes per day? (Physical activity that increased your heart rate and made you breathe hard some of the time) 4 days	During the past 7 days, how many days were you physically active for a total of at least 60 minutes per day? (Physical activity that increased your heart rate and made you breathe hard some of the time) 5 days	During the past 7 days, how many days were you physically active for a total of at least 60 minutes per day? (Physical activity that increased your heart rate and made you breathe hard some of the time) 6 days	During the past 7 days, how many days were you physically active for a total of at least 60 minutes per day? (Physical activity that increased your heart rate and made you breathe hard some of the time) 7 days
Last week at the Boys & Girls Club, how many days did you participate in physical activities like tag, daily challenges, walking, running, dance, karate, team sports, etc.?	Last week at the Boys & Girls Club, how many days did you participate in physical activities like tag, daily challenges, walking, running, dance, karate, team sports, etc.? 0 days	Last week at the Boys & Girls Club, how many days did you participate in physical activities like tag, daily challenges, walking, running, dance, karate, team sports, etc.? 1 day	Last week at the Boys & Girls Club, how many days did you participate in physical activities like tag, daily challenges, walking, running, dance, karate, team sports, etc.? 2 days	Last week at the Boys & Girls Club, how many days did you participate in physical activities like tag, daily challenges, walking, running, dance, karate, team sports, etc.? 3 days	Last week at the Boys & Girls Club, how many days did you participate in physical activities like tag, daily challenges, walking, running, dance, karate, team sports, etc.? 4 days	Last week at the Boys & Girls Club, how many days did you participate in physical activities like tag, daily challenges, walking, running, dance, karate, team sports, etc.? 5 days	Last week at the Boys & Girls Club, how many days did you participate in physical activities like tag, daily challenges, walking, running, dance, karate, team sports, etc.? 6 days	Last week at the Boys & Girls Club, how many days did you participate in physical activities like tag, daily challenges, walking, running, dance, karate, team sports, etc.? 7 days
In the average week when you are in school, how many days do you go to physical (PE) classes?	In the average week when you are in school, how many days do you go to physical (PE) classes? 0 days	In the average week when you are in school, how many days do you go to physical (PE) classes? 1 day	In the average week when you are in school, how many days do you go to physical (PE) classes? 2 days	In the average week when you are in school, how many days do you go to physical (PE) classes? 3 days	In the average week when you are in school, how many days do you go to physical (PE) classes? 4 days	In the average week when you are in school, how many days do you go to physical (PE) classes? 5 days	In the average week when you are in school, how many days do you go to physical (PE) classes? 6 days	In the average week when you are in school, how many days do you go to physical (PE) classes? 7 days

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* 9. To reduce fat and calories or improve the nutritional value, the next time you eat away from home, you could___________:

Choose green salads or fruit to go with your meals

Opt for low fat milk or no calorie/low calorie drinks

Buy smaller sizes of sandwiches and fries

All of the above

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* 10. ___________ are important nutrients for strong bones

Fruits

Calcium, vitamin D and phosphorous

Vegetables