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1. Default Section
1
. What is your age?
What is your age?
a. 13
b. 14
c. 15
d. 16
e. 17
f. 18
g. Other
2
. What is your gender?
What is your gender?
a. Male
b. Female
c. Female-to-male
d. Male-to-female
e. Other
3
. How satisfied are you with the shape of your body?
How satisfied are you with the shape of your body?
a. Very satisfied
b. Somewhat satisfied
c. Neither satisfied nor dissatisfied
d. Somewhat dissatisfied
e. Very dissatisfied
4
. Which of the following IS a fact?
Which of the following IS a fact?
a. Eating disorders are uncommon.
b. Eating disorders are a choice.
c. Eating disorders only occur in females.
d. Men who suffer from eating disorders tend to be gay.
e. A person can suffer from more than one eating disorder.
5
. Which of the following is NOT a fact?
Which of the following is NOT a fact?
a. An eating disorder is a mental illness.
b. An eating disorder can be fatal.
c. An eating disorder is dieting gone bad.
d. People in all socioeconomic levels have been diagnosed with eating disorders.
e. Children as young as seven years old have been diagnosed with eating disorders.
6
. Who do you know who has or had an eating disorder? (Check all that apply.)
Who do you know who has or had an eating disorder? (Check all that apply.)
a. No one
b. A parent, guardian, or other family member
c. A friend
d. A coach, teacher, or other professional
e. Other
7
. Have you ever received information about eating disorders outside of Monday's assembly?
Have you ever received information about eating disorders outside of Monday's assembly?
a. Yes
b. No
c. Unsure
8
. Who gave you information about eating disorders? (Check all that apply, not including Monday's assembly.)
Who gave you information about eating disorders? (Check all that apply, not including Monday's assembly.)
a. A parent, guardian, or other family member
b. A friend
c. A coach or teacher
d. A therapist/counselor
e. A doctor
f. The television
g. The internet
h. The newspaper
i. A fiction book
j. A non-fiction book
k. Other
l. None of the above
9
. Which of the following statements is most often true for people with eating disorders?
Which of the following statements is most often true for people with eating disorders?
a. They have a family member with an eating disorder.
b. They do not have self-discipline.
c. They have concerns about their body image.
d. They are primarily seeking attention.
10
. Which is the LEAST likely to be a symptom of an eating disorder?
Which is the LEAST likely to be a symptom of an eating disorder?
a. Watching calorie intake very closely
b. Unrealistic beliefs about the size/weight of one's body
c. Interest in athletics or physical fitness
d. Throwing up or taking laxatives to get rid of food that has been eaten
11
. If you were worried that you might have an eating disorder, with whom would you feel most comfortable talking about it?
If you were worried that you might have an eating disorder, with whom would you feel most comfortable talking about it?
a. A parent, guardian, or other family member
b. A friend
c. A coach or teacher
d. A therapist/counselor
e. A doctor
f. Other
g. No one
12
. Who would probably best be able to help a teenager with an eating disorder?
Who would probably best be able to help a teenager with an eating disorder?
a. The teenager with the eating disorder
b. A parent, guardian, or family member
c. A friend
d. A coach or teacher
e. A therapist/counselor
f. A doctor
g. Other
h. No one
13
. Which of the following may be a warning sign that a person has an eating disorder? (Check all that apply.)
Which of the following may be a warning sign that a person has an eating disorder? (Check all that apply.)
a. Going to the bathroom immediately following meals or snacks.
b. Not having anything but diet soda for lunch for two week in a row.
c. Wearing layers of clothes or baggy clothes
d. Neglecting school work or friendships in order to exercise.
e. All of the above.
f. None of the above.
14
. Do you think that it is helpful to have programs in your school that address eating disorders?
Do you think that it is helpful to have programs in your school that address eating disorders?
a. Yes
b. No
c. Unsure
15
. Questions 15, 16, and 17 address only the dramatic presentation of Monday's assembly and not the question-and-answer period.
How did Monday's dramatic presentation affect your knowledge of eating disorders?
Questions 15, 16, and 17 address only the dramatic presentation of Monday's assembly and not the question-and-answer period. How did Monday's dramatic presentation affect your knowledge of eating disorders?
It increased my knowledge very much.
It increased my knowledge moderately.
It did not increase my knowledge.
16
. How did Monday's dramatic presentation affect your attitude about eating disorders?
How did Monday's dramatic presentation affect your attitude about eating disorders?
It bettered my attitude very much.
It bettered my attitutde moderately.
It neither bettered nor worsened my attitude.
It worsened my attitude moderately.
It worsened my attitude very much.
17
. How did Monday's dramatic presentation affect your ability to respond to eating disorders?
How did Monday's dramatic presentation affect your ability to respond to eating disorders?
It increased my ability to respond to eating disorders very much.
It increased my ability to respond to eating disorders moderately.
It neither increased nor decreased my ability to respond to eating disorders.
It decreased my ability to respond to eating disorders moderately.
It decreased my ability to respond to eating disorders very much.
18
. Questions 18, 19, and 20 address only the question-and-answer session of Monday's assembly and not the dramatic presentation.
How did Monday's question-and-answer session affect your knowledge of eating disorders?
Questions 18, 19, and 20 address only the question-and-answer session of Monday's assembly and not the dramatic presentation. How did Monday's question-and-answer session affect your knowledge of eating disorders?
It increased my knowledge very much.
It increased my knowledge moderately.
It did not increase my knowledge.
19
. How did Monday's question-and-answer session affect your attitude about eating disorders?
How did Monday's question-and-answer session affect your attitude about eating disorders?
It bettered my attitude very much.
It bettered my attitutde moderately.
It neither bettered nor worsened my attitude.
It worsened my attitude moderately.
It worsened my attitude very much.
20
. How did Monday's question-and-answer session affect your ability to respond to eating disorders?
How did Monday's question-and-answer session affect your ability to respond to eating disorders?
It increased my ability to respond to eating disorders very much.
It increased my ability to respond to eating disorders moderately.
It neither increased nor decreased my ability to respond to eating disorders.
It decreased my ability to respond to eating disorders moderately.
It decreased my ability to respond to eating disorders very much.
21
. Overall, how useful did you find Monday's assembly?
Overall, how useful did you find Monday's assembly?
Very useful
Moderately useful
Neither useful nor useless
Moderately useless
Very useless
22
. Optional: please write any additional comments you have about Monday's dramatic presentation, the subsequent question-and-answer session, this survey, or eating disorders in general.
Optional: please write any additional comments you have about Monday's dramatic presentation, the subsequent question-and-answer session, this survey, or eating disorders in general.
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