MCUSD PEP YRBS HS (Baseline)
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1
. NAME
NAME
*
2
. AGE
AGE
*
3
. GRADE
GRADE
9th
10th
11th
12th
*
4
. During the past 7 days, how many times did you eat fruit? (Do not count fruit juice)
During the past 7 days, how many times did you eat fruit? (Do not count fruit juice)
I did not eat fruit the past 7 days
1 to 3 times during the past 7 days
4 to 6 times during the past 7 days
1 time per day
2 times per day
3 times per day
4 or more times per day
*
5
. During the past 7 days, how many times did you eat green salad?
During the past 7 days, how many times did you eat green salad?
I did not eat green salad during the past 7 days
1 to 3 times during the past 7 days
4 to 6 times during the past 7 days
1 time per day
2 times per day
3 times per day
4 or more times per day
*
6
. During the past 7 days, how many times did you eat potatoes? (Do not count french fries, fried potatoes, or potato chips.)
During the past 7 days, how many times did you eat potatoes? (Do not count french fries, fried potatoes, or potato chips.)
I did not eat potatoes during the past 7 days
1 to 3 times during the past 7 days
4 to 6 times during the past 7 days
1 time per day
2 times per day
3 times per day
4 or more times per day
7
. During the past 7 days, how many times did you eat carrots?
During the past 7 days, how many times did you eat carrots?
I did not eat carrots during the past 7 days
1 to 3 times during the past 7 days
4 to 6 times during the past 7 days
1 time per day
2 times per day
3 times per day
4 or more times per day
*
8
. During the past 7 days, how many times did you eat other vegetables? (Do not count green salad, potatoes, or carrots.)
During the past 7 days, how many times did you eat other vegetables? (Do not count green salad, potatoes, or carrots.)
I did not eat other vegetables during the past 7 days
1 to 3 times during the past 7 days
4 to 6 times during the past 7 days
1 time per day
2 times per day
3 times per day
4 or more times per day
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