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  1. Surveys
  2. 2007
  3. April
  4. A
  5. Adolescent Obesity Prevention Program Questionnair
0%
 
 
You are invited to participate in a preliminary survey for a future adolescent nutrition and obesity-related study. In this preliminary trial, a small group of individuals aged 12-15 will be asked to complete a short open-ended questionairre that will be used to construct a similar, large-scale nutritional knowledge survey that will be administered in the near future. It will take approximately 10-15 minutes to complete the questionnaire.
Your participation in this study is completely voluntary. There are no foreseeable risks associated with this project. However, if you feel uncomfortable answering any questions, you can withdraw from the survey at any point. It is very important for us to learn your opinions.
Your survey responses will be strictly confidential and data from this research will be reported only in the aggregate. Your information will be coded and will remain confidential. If you have questions at any time about the survey or the procedures, you may contact the principal investigator by email at [email protected]
Thank you very much for your time and support. Please start with the survey now by clicking on the Continue button below.
 
 

* What is your gender?
 
female
 
male
 
 

* What is your age?
 
 

What is your race or ethnicity?
 
White
 
Black
 
Hispanic
 
Asian/Pacific Islander
 
American Indian
 
Other
 
 
 

* Do you participate regularly in physical activity?
 
No
 
Yes (Please specify.)
 
 
 

On a scale from 1-10, how would you rate your overall health? (1 = Worst, 10 = Best)
1 2 3 4 5 6 7 8 9 10
 
 
 
What constitutes a "healthy" food?
   
 
 
 
Please provide a few examples of "healthy" foods.
   
 
 
 
What constitutes an "unhealthy" food?
   
 
 
 
Please provide a few examples of "unhealthy" foods.
   
 
 

How often do you eat these "unhealthy" foods?
 
once a day
 
2-3 times a day
 
4-5 times a day
 
6 or more times a day
 
 

Do you try to refrain from eating these "unhealthy" foods?
 
No
 
Yes (Why?)
 
 
 
You are invited to participate in a preliminary survey for a future adolescent nutrition and obesity-related study. In this preliminary trial, a small group of individuals aged 12-15 will be asked to complete a short open-ended questionairre that will be used to construct a similar, large-scale nutritional knowledge survey that will be administered in the near future. It will take approximately 10-15 minutes to complete the questionnaire.
Your participation in this study is completely voluntary. There are no foreseeable risks associated with this project. However, if you feel uncomfortable answering any questions, you can withdraw from the survey at any point. It is very important for us to learn your opinions.
Your survey responses will be strictly confidential and data from this research will be reported only in the aggregate. Your information will be coded and will remain confidential. If you have questions at any time about the survey or the procedures, you may contact the principal investigator by email at [email protected]
Thank you very much for your time and support. Please start with the survey now by clicking on the Continue button below.
 
 

* What is your gender?
 
female
 
male
 
Please contact [email protected] if you have any questions regarding this survey.
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