The following questions are related to your health and wellbeing. Please choose responses that best describes you.

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* 1. In which school do you attend?

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* 2. How old are you?

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* 3. What is your gender?

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* 4. Which of these groups would you say best represents your race?

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* 5. Did you have enough energy to get things done yesterday?

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* 6. Would you say that your health is?

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* 7. Do you have health problems that keep you from doing any of the things that other people your age normally can do?

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* 8. Is your limitation because of ANY medical or health condition?

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* 9. Do you have any of the following health conditions? Check all that apply to you.

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* 10. Has a doctor ever told you that you have asthma?

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* 11. Do you still have asthma?

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* 12. Has a doctor or health professional ever told you that you have diabetes or high blood sugar?

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* 13. How would you rate the condition of your teeth? Would you say their condition are:

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* 14. On a typical day, how much time do you spend playing or being physically active?

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* 15. How do you describe your weight?

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* 16. Which of the following are you trying to do about your weight?

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* 17. During the past 7 days, on how many days did you eat breakfast?

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* 18. On an average school night, how many hours of sleep do you get?

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* 19. What time do you go to bed at night?

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* 20. During the past 12 months, how would you describe your grades in school?

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