LIVE IT-ZION-30 Days Question Title * 1. Are you a boy or girl? Boy Girl Question Title * 2. How do you describe yourself? White Black or African American Hispanic or Latino Asian Pacific Islander American Indian Alaskan Native Other Question Title * 3. Yesterday, did you eat French fries or chips? Chips are potato chips, tortilla chips, Cheetos, corn chips, or other snack chips. No, I didn’t eat any French fries or chips yesterday. Yes, I ate French fries or chips 1 time yesterday. Yes, I ate French fries or chips 2 times yesterday. Yes, I ate French fries or chips 3 or more times yesterday. Question Title * 4. Yesterday, did you eat any vegetables? Vegetables are salads; boiled, baked or mashed potatoes; and all cooked or uncooked vegetables. Do not count French fries or chips. No, I didn’t eat any vegetables yesterday. Yes, I ate vegetables 1 time yesterday. Yes, I ate vegetables 2 times yesterday. Yes, I ate vegetables 3 or more times yesterday. Question Title * 5. Yesterday, did you eat beans such as pinto beans, baked beans, kidney beans, refried beans, or pork and beans? Do not count green beans. No, I didn’t eat any beans yesterday. Yes, I ate beans 1 time yesterday. Yes, I ate beans 2 times yesterday. Yes, I ate beans 3 or more times yesterday. Question Title * 6. Yesterday, did you eat fruit? Do not count fruit juice. No, I didn’t eat any fruit yesterday. Yes, I ate fruit 1 time yesterday. Yes, I ate fruit 2 times yesterday. Yes, I ate fruit 3 or more times yesterday. Question Title * 7. Yesterday, did you drink fruit juice? Fruit juice is a drink, which is 100% juice, like orange juice, apple juice, or grape juice. Do not count punch, Kool-Aid, sports drinks, and other fruit-flavored drinks. No, I didn’t drink any fruit juice yesterday. Yes, I drank fruit juice 1 time yesterday. Yes, I drank fruit juice 2 times yesterday. Yes, I drank fruit juice 3 or more times yesterday. Question Title * 8. Yesterday, did you eat sweet rolls, doughnuts, cookies, brownies, pies, or cake? No, I didn’t eat any of the foods listed above yesterday. Yes, I ate one of these foods 1 time yesterday. Yes, I ate one of these foods 2 times yesterday. Yes, I ate one of these foods 3 or more times yesterday. Question Title * 9. Yesterday, did you exercise or participate in sports activities that made your heart beat fast and made you breathe hard for at least 20 minutes. (For example: basketball, jogging, skating, fast dancing, swimming laps, tennis, fast bicycling, or aerobics)? Yes No Question Title * 10. How many hours per day do you usually spend watching TV shows or videos? I don’t watch TV or videos Less than 1 hour a day 1-3 hours a day More than 3 hours a day Question Title * 11. How many TV shows or videos do you usually watch each day? I don’t watch TV or videos 1 2 3 or more Question Title * 12. How many hours per day do you usually play video games like Nintendo, Sega, games at the arcade, or use the computer to surf the Internet? I don’t play video games or use the computer 1 2 3 or more Question Title * 13. Do you ever read the nutrition labels on food packages? Almost always or always Sometimes Almost never or never Question Title * 14. What is the minimum number of cups of vegetables you should eat each day if you are on a 2,000 calorie meal plan? 0.5 1 2.5 4 Question Title * 15. The foods that I eat and drink now are healthy. Yes, all of time. Yes, sometimes. No Question Title * 16. Do you ever eat high fiber cereal? Almost always or always Sometimes Almost never or never I don’t know Question Title * 17. Do you ever eat whole wheat bread? Almost always or always Sometimes Almost never or never I don’t know Question Title * 18. Do you ever drink fruit juice? Almost always or always Sometimes Almost never or never Question Title * 19. Do you ever eat fruit for lunch? Almost always or always Sometimes Almost never or never Question Title * 20. Do you ever eat vegetables for dinner? Almost always or always Sometimes Almost never or never Question Title * 21. If you were at the movies, which one would you pick as a snack? popcorn with butter popcorn without butter Question Title * 22. Which would you pick to drink? Whole milk 2% milk 1% milk Skim milk Question Title * 23. Which food would you eat for a snack? Candy Bar Fresh Fruit Question Title * 24. Which would you do if you were going to eat a piece of chicken? leave on the skin take off the skin and not eat the skin Question Title * 25. Which would you do if you were going to eat a piece of chicken? leave on the skin take off the skin and not eat the skin Question Title * 26. Which food would you ask for? frozen yogurt ice cream Question Title * 27. Which would you choose to cook if you were going to help make dinner at home? French fries Baked potato Question Title * 28. Which would you do if you were going to eat cooked vegetables? Eat without butter Add butter Question Title * 29. Which would you order if you were going to eat at a fast food restaurant? a regular hamburger a grilled chicken sandwich Question Title * 30. How many ounces of water to you drink each day? (8 ounces equals 1 cup) less than 24 ounces 24-40 ounces 40-64 ounces More than 64 ounces Question Title * 31. Please SELECT One of the two foods that you think is better for your health. Whole Wheat Bread White Bread Question Title * 32. Please SELECT One of the two foods that you think is better for your health. Broiled Beef Broiled Fish Question Title * 33. Please SELECT One of the two foods that you think is better for your health. Whole Grain Cereal Eggs and Bacon Question Title * 34. Please SELECT One of the two foods that you think is better for your health. Beef Beans Question Title * 35. Please SELECT One of the two foods that you think is better for your health. Chicken Regular Hamburger Question Title * 36. Please SELECT One of the two foods that you think is better for your health. Regular Milk Low Fat or Skim Milk Question Title * 37. Please SELECT One of the two foods that you think is better for your health. Frozen Yogurt Ice Cream Question Title * 38. Please SELECT One of the two foods that you think is better for your health. Green Salad French Fries Question Title * 39. Please SELECT One of the two foods that you think is better for your health. French Fries Baked Potato Question Title * 40. Please SELECT One of the two foods that you think is better for your health. 100% Fruit Juice Fruit Punch Question Title * 41. How many days per week are you physically active for 30-60 minutes, in which your heart beat fast and you breathed hard? (Physical activity includes going for a walk or run, riding your bike, playing Wii, participating in sports, playing at recess, etc) 0 days per week 1-2 days per week 3-4 days per week 5-7 days per week Question Title * 42. How likely are you to exercise and keep moving for most of the time after school? Not Likely Likely Very Likely Question Title * 43. How likely are you to run or bike 3-5 times a week? Not Likely Likely Very Likely Question Title * 44. How likely are you to keep up a steady pace without stopping for 15-20 minutes when you are physically active? Not Likely Likely Very Likely Question Title * 45. How many minutes a day should you be physically active? 15 Minutes 30 Minutes 60 Minutes 90 Minutes Next