O. List of Previously Fielded Questions in the NYPANS Questionnaire
1. How old are you?
12 years old or younger
13 years old
14 years old
15 years old
16 years old
17 years old
18 years old or older
2. What is your sex?
Female
Male
3. In what grade are you?
9th grade
10th grade
11th grade
12th grade
Ungraded or other grade
4. Are you Hispanic or Latino?
Yes
No
5. What is your race? (Select one or more responses.)
American Indian or Alaska Native
Asian
Black or African American
Native Hawaiian or Other Pacific Islander
White
6. How tall are you without your shoes on?
Directions: Write your height in the shaded blank boxes. Fill in the matching oval below each number.
Example: Answer:
Height |
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Height |
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Feet |
Inches |
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Inches |
5 |
7 |
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7. How much do you weigh without your shoes on?
Directions: Write your weight in the shaded blank boxes. Fill in the matching oval below each number.
Example
Weight in Pounds |
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Weight in Pounds |
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5 |
2 |
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During the past 7 days, on how many days were you physically active for a total of at least 60 minutes per day? (Add up all the time you spent in any kind of physical activity that increased your heart rate and made you breathe hard some of the time.)
1 day
2 days
3 days
4 days
5 days
6 days
7 days
On how many of the past 7 days did you exercise or participate in physical activity for at least 20 minutes that made you sweat and breathe hard, such as basketball, soccer, running, swimming laps, fast bicycling, fast dancing, or similar aerobic activities?
0 days
1 day
2 days
3 days
4 days
5 days
6 days
7 days
On how many of the past 7 days did you do exercises to strengthen or tone your muscles, such as push-ups, sit-ups, or weight lifting?
0 days
1 day
2 days
3 days
4 days
5 days
6 days
7 days
On an average school day, how many hours do you play video or computer games or use a computer for something that is not school work? (Include activities such as Nintendo, Game Boy, PlayStation, Xbox, computer games, and the Internet.)
I do not play video or computer games or use a computer for something that is not school work
Less than 1 hour per day
1 hour per day
2 hours per day
3 hours per day
4 hours per day
5 or more hours per day
On an average school day, how many hours do you watch TV?
I do not watch TV on an average school day
Less than 1 hour per day
1 hour per day
2 hours per day
3 hours per day
4 hours per day
5 or more hours per day
In an average week when you are in school, on how many days do you go to physical education (PE) classes?
0 days
1 day
2 days
3 days
4 days
5 days
During the past 12 months, on how many sports teams did you play? (Include teams run by your school or community groups.)
0 teams
1 team
2 teams
3 or more teams
During the past 7 days, how many times did you eat fruit? (Do not count fruit juice.)
I did not eat fruit during the past 7 days
1 to 3 times during the past 7 days
4 to 6 times during the past 7 days
1 time per day
2 times per day
3 times per day
4 or more times per day
During the past 7 days, how many times did you eat green salad?
I did not eat green salad during the past 7 days
1 to 3 times during the past 7 days
4 to 6 times during the past 7 days
1 time per day
2 times per day
3 times per day
4 or more times per day
During the past 7 days, how many times did you eat potatoes? (Do not count French fries, fried potatoes, or potato chips.)
I did not eat potatoes during the past 7 days
1 to 3 times during the past 7 days
4 to 6 times during the past 7 days
1 time per day
2 times per day
3 times per day
4 or more times per day
During the past 7 days, how many times did you eat carrots?
I did not eat carrots during the past 7 days
1 to 3 times during the past 7 days
4 to 6 times during the past 7 days
1 time per day
2 times per day
3 times per day
4 or more times per day
During the past 7 days, how many times did you eat other vegetables? (Do not count green salad, potatoes, or carrots.)
I did not eat other vegetables during the past 7 days
1 to 3 times during the past 7 days
4 to 6 times during the past 7 days
1 time per day
2 times per day
3 times per day
4 or more times per day
During the past 7 days, how many times did you drink 100% fruit juices such as orange juice, apple juice, or grape juice? (Do not count punch, Kool-Aid, sports drinks, or other fruit-flavored drinks.)
I did not drink 100% fruit juice during the past 7 days
1 to 3 times during the past 7 days
4 to 6 times during the past 7 days
1 time per day
2 times per day
3 times per day
4 or more times per day
During the past 7 days, how many times did you drink a can, bottle, or glass of soda or pop, such as Coke, Pepsi, or Sprite? (Do not count diet soda or diet pop.)
I did not drink soda or pop during the past 7 days
1 to 3 times during the past 7 days
4 to 6 times during the past 7 days
1 time per day
2 times per day
3 times per day
4 or more times per day
22. During the past 7 days, how many glasses of milk did you drink? (Count the milk you drank in a glass or cup, from a carton, or with cereal. Count the half pint of milk served at school as equal to one glass.)
I did not drink milk during the past 7 days
1 to 3 glasses during the past 7 days
4 to 6 glasses during the past 7 days
1 glass per day
2 glasses per day
3 glasses per day
4 or more glasses per day
23. How do you describe your weight?
Very underweight
Slightly underweight
About the right weight
Slightly overweight
Very overweight
24. Which of the following are you trying to do about your weight?
Lose weight
Gain weight
Stay the same weight
I am not trying to do anything about my weight
25. During the past 30 days, did you exercise to lose weight or to keep from gaining weight?
Yes
No
26. During the past 30 days, did you eat less food, fewer calories, or foods low in fat to lose weight to keep from gaining weight?
Yes
No
27. During the past 30 days, did you go without eating for 24 hours or more (also called fasting) to lose weight or to keep from gaining weight?
Yes
No
28. During the past 30 days, did you take any diet pills, powders, or liquids without a doctor’s advice to lose weight or to keep from gaining weight? (Do not include meal replacement products such as Slim Fast.)
Yes
No
29. During the past 30 days, did you vomit or take laxatives to lose weight or to keep from gaining weight?
Yes
No
| File Type | application/msword |
| Author | nad1 |
| Last Modified By | nad1 |
| File Modified | 2009-04-23 |
| File Created | 2009-04-23 |