DIRECTIONS: In this survey, we are trying to learn how you and your classmates feel about physical activity and about nutrition. You will have about 20 minutes to complete the survey. This is NOT a test for your class and you will not be graded! In fact, there are no right or wrong answers; we are merely interested in your personal opinions. Only the Seattle University College of Nursing researchers will see the results of this questionnaire. Please answer the questions to the best of your ability. Thank you for your cooperation!
Please enter your ID number¿Cuántos años tienes hoy?
How many years old are you?¿Cuántos años tienes hoy?
What grade are you in?
What is your gender?
Have you ever smoked any cigarette? (choose one):
Do you currently smoke any cigarettes? (choose one):
Do any members of your family that you live with currently smoke cigarettes? (choose one):
Do any members of your family have high blood pressure? (choose one):
Do any members of your family have heart disease? (choose one):
Do any members of your family have diabetes? (choose one):
Please indicate your self-identified Race/Ethnicity:
Do you consider yourself to be:
With whom do you live (check all that apply)?
In the past 30 days my weight has increased by:
In the past 30 days my weight has decreased by:
In this part of the survey we are interested in your thoughts about physical activity. Being physically active means participating in moderate to vigorous physical exercise (for example, jogging, running, working out at the gym) every day for at least 60 minutes; spending less than 2 hours a day in front of the television or computer; walking to and from school several times a week; walking up and down stairs instead of taking the elevator; and so on. We will refer to this pattern of behavior as being physically active.For each of the following questions, check the one answer that best expresses your opinion with respect to your being physically active every day.
For me to be physically active every day is
Most people who are important to me would approve of my being physically active every day.
I am confident that I can be physically active every day.
Looking ahead, I think I will try to be physically active every day.
Most people I am close to are themselves physically active every day.
It is entirely up to me whether I am physically active every day.
I am planning to be physically active every day.
Most people whose opinions I value think that I should be physically active every day.
If I wanted to, I could easily be physically active every day.
Looking ahead, I am determined to be physically active every day.
Most people I look up to are physically active every day.
I have complete control over being physically active every day.
I intend to be physically active every day.
Looking back over the past six months, how often have you been physically active?
In the second part of our survey we are interested in your thoughts about eating a healthy diet. By this we mean eating at least 4 1/2 cups of fruit and vegetables daily; choosing foods with little salt and not adding salt to food; eating fish at least twice a week; eating 3 or more servings of whole grain and high fiber foods each day; not drinking more than 4 sugar-sweetened drinks a week; eating breakfast every day; and so on. We will refer to this pattern of eating behavior as "eating a healthy diet." For each of the following questions, check the one answer that best expresses your opinion with respect to your eating a healthy diet every day.
For me to eat a healthy diet every day is
Most people who are important to me would approve of my eating a healthy diet every day.
I am confident that I can eat a healthy diet every day.
Looking ahead, I think I will try to eat a healthy diet every day.
Most people I am close to are themselves eating a healthy diet every day.
It is entirely up to me whether I eat a healthy diet every day.
I am planning to eat a healthy diet every day.
Most people whose opinions I value think that I should eat a healthy diet every day.
If I wanted to, I could easily eat a healthy diet every day.
Looking ahead, I am determined to eat a healthy diet every day.
Most people I look up to are eating a healthy diet every day.
I have complete control over eating a healthy every day.
I intend to eat a healthy diet every day.
Looking back over the past six months, how often have you eaten a healthy diet?
In the final part of our survey, we are trying to see how much information young people like you have about the heart and the blood circulation system (also known as the cardiovascular system), and how the workings of this system relates to physical health.For each of the following items, check the answer that best expresses your understanding with respect to cardiovascular system, hearth disease and health. If you don't know the correct answer, check "Not sure."
When the heart contracts, blood circulates throughout the body because of a difference in pressure between the heart and the circulatory system.
The terms "heart attack" and "cardiac arrest" mean the same thing.
Smoking cigarettes is a modifiable risk factor for cardiovascular disease.
High blood pressure (hypertension) can be controlled with a healthy diet and regular exercise.
I understand what the nutrition content labels on food mean.
Stress can increase the risk of heart disease.
Smoking can increase my risk for heart disease.
My culture/ethnicity, race, gender, family income level, and age may affect my risk for heart disease.
Heart disease begins when people get old.
My weight is healthy for my age/gender.
If I wanted to, I could become a health scientist (for example, doctor, nurse, pharmacist, nutritionist, or researcher).
I understand how to ask a research question and conduct an experiment.
A blood pressure of 140/90 is normal for a person my age.
Blood from the left side of the heart travels to the lungs to get oxygen.
Valves prevent blood from moving forward through the heart too quickly.
Press the "Finish" button below to send your results.
Oprima el botón "Terminar" para mandar su información.
FinishTerminar
