Healthy Habits Ages 9-12 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. A peanut butter and jelly sandwich is a member of which two food groups

Grains and Protein Foods

Vegetable and Dairy

None of the above

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* 6. True or False:

	True	False
It is OK to snack if you are not really hungry	It is OK to snack if you are not really hungry True	It is OK to snack if you are not really hungry False
A way to improve your eating habits is to think about why you eat the kinds of foods you do eat	A way to improve your eating habits is to think about why you eat the kinds of foods you do eat True	A way to improve your eating habits is to think about why you eat the kinds of foods you do eat False
Skipping meals, eating the same food over and over again, and getting too full all the time is not good for you.	Skipping meals, eating the same food over and over again, and getting too full all the time is not good for you. True	Skipping meals, eating the same food over and over again, and getting too full all the time is not good for you. False
It is important to drink enough fluids so your body stays well hydrated, especially in hot weather or if you are playing had or exercising	It is important to drink enough fluids so your body stays well hydrated, especially in hot weather or if you are playing had or exercising True	It is important to drink enough fluids so your body stays well hydrated, especially in hot weather or if you are playing had or exercising False
Washing your hands often, especially before eating or handling food, is important to help fight disease (or keep from getting sick).	Washing your hands often, especially before eating or handling food, is important to help fight disease (or keep from getting sick). True	Washing your hands often, especially before eating or handling food, is important to help fight disease (or keep from getting sick). 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. How many days each week do you exercise, dance or play sports for at least 60 minutes per day that increased your heart rate and made you breathe hard some of the time?

0 days

1 day

2 days

3 days

4 days

5 days

6 days

7 days

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* 9. A good breakfast should includes goods from two or more food groups. Which of the following does that include?

Toast with butter and strawberry jelly

Low fat yogurt and a bran muffin

Scrambled eggs and ham

All of the above

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* 10. ________________ is a mineral that helps protect your teeth from getting cavities

Flouride

Vitamin T

Iron

Vitamin D