Healthy?

Male or female?

• male
• female

Whar grade are you in?

• 9th
• 10th
• 11th
• 12th

Mark the meals you eat on a daily basis.

• breakfest
• lunch
• dinner

How often do you eat breakfast?

Please select all that apply.

• At leat once a week
• At least 3 times a week
• At least 5 times a week
• 7 days a week

Do you eat five servings of fruits and vegetables per day?

• yes
• no

How often do you eat fast food?

• two times a week or less
• three times a week
• five times a week
• seven times a week

Why do you eat unhealthy food?

Please select all that apply.

• It’s easy and fast.
• I’m hungry and I don’t care
• It tastes good
• other

How many calories do you eat per day?

• 1500 or less
• 2000
• 2500
• 3500
• More then 3500
• I don't know

Do you prefer junk food or healthy food?

• Junk food
• Healthy food

In order from most to least, which do you consume more of?

• Soda, juice, water
• juice, water, soda
• water, juice, soda
• water, soda, juice

How many hours per week do you exercise? (exercise defined by consistently elevated heart beat)

• 1-3
• 4-6
• 7-9
• 10+

About how long do you exercise per day?

• 1/2 hour - 1 hour
• 1 1/2 hour to 2 hours
• 2 hours to 2 1/2 hours
• more then 2 1/2 hours

Do you play a sport?

• yes
• no

How would you describe your snacking habits?

• I don’t snack
• I snack on healthy food between breakfast and lunch and lunch and dinner
• I snack on unhealthy food between breakfast and lunch and lunch and dinner
• I don’t eat meals I only snack on healthy foods
• I don’t eat meals I only snack on unhealthy foods

Why do you snack?

• I'm bored
• I'm stressed
• I'm hungry
• Other

Do you buy or bring your lunch to school?

• Buy
• Bring
• Don't eat at school
• Both