* 1. How many days of the week do you usually eat or drink something for breakfast?
By breakfast we mean having food or beverages from at least two food groups
(fruit, vegetables, meat and beans, grains, milk).

* 2. How many cups of milk or yogurt did you have yesterday? Include all kinds of milk including flavored milk; drinks made with milk or yogurt like milkshakes or smoothies; or
milk on cereal. A cup is 8 ounces, which is the size of a small glass or a small carton of milk.

* 3. Yesterday, about how many ounces of whole grain food did you eat? An ounce is a slice of whole grain bread, a small whole grain roll, 5 whole grain crackers, 3 cups of popped popcorn, or a half cup of cooked oatmeal or brown rice.

* 4. Yesterday, about how many cups of fruit did you eat? A cup is the size of a small glass or about the size of a baseball.

* 5. Yesterday, about how many cups of vegetables did you eat? A cup is the size of a small glass or about the size of a baseball. Do not include French fries in your answer.

* 6. How much soda pop did you drink yesterday? Soda pop comes in many different sizes, from a 12-ounce can to a 20-ounce plastic bottle to a 48-ounce container. If you had any soda pop yesterday, how many ounces would you estimate you drank?

* 7. Yesterday, how much soda pop did you drink at school? If you had any soda pop at school yesterday, how many ounces would you estimate you drank?

* 8. During the past 7 days, how many days were you physically active for a total of at least 60 minutes per day? ADD UP ALL THE TIME YOU SPENT IN ANY KIND OF PHYSICAL ACTIVITY
EACH DAY.

* 9. During the past 7 days, how many days did you walk or ride a bicycle to or from school?

* 10. How would you describe your usual physical activity level?

* 11. How would you describe your weight?

* 12. During this school year, how many days did you go to physical education (PE) class each week?

* 13. In a usual week, how many days do you partcipate in intense physical activity? Intense physical activity is activity that makes you breathe hard and causes your heart rate to increase a lot, such as basketball, soccer, running, swimming laps, fast bicycling or dancing fast, or
similar activities.

* 14. In a usual week, how many days do you participate in moderate physical activity? Moderate physical activity does not make you sweat and breathe hard. Examples are walking for exercise, chores, slow bicycling, bowling or golf.

* 15. How much time do you spend during a typical or usual day sitting and watching television, playing computer games, talking with friends, or doing other sitting activities?

* 16. How many of your close friends are physically active on a regular basis?

* 17. How many days of the week do you usually lift weights, use weight machines or resistance bands?

* 18. In the last year, on how many school-sponsored sports teams/clubs/activities did you participate?

* 19. Which of the following is the primary reason you neglect to exercise?

* 20. In the last year, on how many non-school sponsored sports teams/clubs/activities did you participate?

* 21. Following is a list of eating and physical activity behaviors. Please indicate whether you are:
Improving my physical activity skills; for example, through physical education classes or classes taken outside of school.
a. Eating healthier food in general/making better food choices

* 22. b. Eating more fruits

* 23. c. Eating more vegetables

* 24. d. Eating breakfast more regularly

* 25. e. Eating less fried food

* 26. f. Drinking less soda pop

* 27. g. Drinking more flavored or plain milk

* 28. h. Eating healthier snacks

* 29. i. Eating smaller servings of food

* 30. j. Eating more whole grain food

* 31. k. Getting more physical activity / exercising or working out more

* 32. l. Improving my physical activity skills; for example, through physical education classes or classes taken outside of school

* 33. m. Watching less TV, spending less time playing video games or spending less time on the computer other than for homework

* 34. Is physical activity a high priority for you?

* 35. Healthy food and beverages that could be offered for school lunch, a la carte or in vending machines at school are listed below. For each option, indicate whether or not you would buy it (assume that the cost would be reasonable). Would Buy or Would NOT buy:

* 36. How would cost affect your decision to buy healthy food?

* 37. Is healthy eating a high priority for you?

* 38. Which of the following physical activities, sports, or intramural (IM) programs would you
participate in if they were offered at your school?

* 39. Think about your school last year and COMPARE IT to this year when selecting the best answer to the following set of questions.

* 40. There are more opportunities to obtain healthy foods and beverages

* 41. There are more opportunities to be physically active

* 42. School meals offer more healthy food and beverage choices

* 43. My school provides students with enough information about healthy eating and nutrition

* 44. My school provides students with enough information about the benefits of physical activity.

* 45. Teachers and administrators are good role models for physical activity and healthy eating

* 46. PE classes I have taken at school helped me become more physically active in general

* 47. Concessions at school events (such as sporting events, concerts, plays, dances) offer healthy food choices

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