Amherst Health and Activity Study (AHA) STUDENT SURVEY

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School: Amherst Health and Activity Study (AHA) STUDENT SURVEY :, Name: Date: Grade: This part of the survey is about your activities over the past 7.

in tte past week, what did you do for recreation?.what sports, exercise, or physical activity teams, classes, lessons, or practices did you participate in last week?

There are no right or wrong answers. No one does all these activities. Please be as accurate and honest as possible.

1 School: Amherst Health and Activity Study (AHA) STUDENT SURVEY :, Name: Date: Grade: This part of the survey is about your activities over the past 7. Think about your physical activities over the past week. including activities done at school, after school. at home. and on weekends. It may help you remember if you think about the following things:.in tte past week, what did you do for recreation?.what sports, exercise, or physical activity teams, classes, lessons, or practices did you participate in last week?.did you go anywhere unusual last week, for a weekend outing or after-school event?.what activities did you do with your friends? For sports, please report both practices and game play. There are no right or wrong answers. No one does all these activities. Please be as accurate and honest as possible. For each activity, please answer three questions A Did you do this activity in the past 7? (ORCLE YES, NO, DON'T KNOW) B. If yes, how many did you do the activity in the past 7? C. On average, how many did you do this activity on when you did it? Think about your activities during the last 7. AOlVlTY Was this activity done in the last seven? Don't No Yes Know How many in the last 7? On average how many ead day activity was done?. Aerobics/aerobic dancing. Ball play: -square, dodgeball, kickball, catch. Baseball/softball. Basketball. Bicyding or exercise cycling 6. Calisthenics: push-ups, sit-ups, jumping jacks7. Cheerleading, marching band, drill team8. dimbing stairs for exerdse, stairmaster9. Computer/video games/internet a. Dance dasses (ballet, jazz, modem, tap) a. Dancing (social, recreationaq a. Football

AcnVlTY Was this activity done in the last seven? Don't No Yes recall How many in the last 7? On average how many each day activity was done?. Field hockey.

Housedeaning that involves mopping, scrubbing, sweeping, vacuuming. Ice hockey. Indoor or outdoor playground: swing, slide, monkey bars, Kidsports. Jumping rope.

Reading (not for school) 9. Rowing or rowing machine _. Running, jogging, treadmi _. Sitting and listening to music _.

2 AcnVlTY Was this activity done in the last seven? Don't No Yes recall How many in the last 7? On average how many each day activity was done?. Field hockey. Frisbee games. Gardening, yardwork, mowing 6. Golfing 7. Gymnastics, tumbling, trampoline 8. Hiking 9. Homework, studying. Housedeaning that involves mopping, scrubbing, sweeping, vacuuming. Ice hockey. Indoor or outdoor playground: swing, slide, monkey bars, Kidsports. Jumping rope. Laser tag. Martial arts: karate, judo 6. Outdoor play: war, dimb trees, hide & seek 7. Racquet sports: tennis, squash, paddle ball, badminton, etr. 8. Reading (not for school) 9. Rowing or rowing machine _. Running, jogging, treadmi _. Sitting and listening to music _. Sitting and talking with friends (not on phone) _. Skate boarding _. Skating: ice, roller, in-line _. Skiing: cross-country or NordicTrack 6. Skiing: downhill or water 7. Soccer 8. Swimming laps 9. Talking on the phone. Television or video watching. Volleyball

AcnVITY Was this activity done in the last seven? Don't No Yes recall How many in the last 7?

Walking for transportation _. Water play: in pool or lake _. Weight lifting 6. Wrestling - _ 7. Other, ;" - 8.

Indicate which of the following sports teams you have been on during the past year at school and outside of school:

3 AcnVITY Was this activity done in the last seven? Don't No Yes recall How many in the last 7? On average how many each day activity was done?. Walking for exercise (induding treadmill) _. Walking for transportation _. Water play: in pool or lake _. Weight lifting 6. Wrestling - _ 7. Other, ;" - 8. Other t - 9. Other. t _ Q. Indicate which of the following sports teams you have been on during the past year at school and outside of school: (CIRCLE NO "" OR YES "I" FOR EACH ITEM) At School Outside of School No Yes No Yes A. Baseball or softball B. Basketball C Field hockey D. Frisbee E. Football F. Golf G. Ice hockey H. Lacrosse L Soccer Swimming K. Tennis L Track and field M.' Volleyball N. Other (specify):.

Q Indicate which of the following classes or lessons you took during the past year outside of school only: (CIRCLE NO "" OR YES "" FOR EACH ITEM) A. Dance (ballet jazz, modern) B.

4 Q Indicate which of the following classes or lessons you took during the past year outside of school only: (CIRCLE NO "" OR YES "" FOR EACH ITEM) A. Dance (ballet jazz, modern) B. Aerobics C Figure skating D. Gymnastics E. Martial arts F. Skiing G. SwimmingH. Tennis I. Baseball or softball J. Basketball K. Field Hockey L Football M Golf N. Ice HockeyO. LacrosseP. SoccerQ. Track and Field R. Other (spedfy):. S. Other (spedfy):. No Yes. For the following questions, please circle one number for eadl statement using these definitions of -exercise" and.regular exercise". Exercise indudes activities such as power walkin& joggin& swimmin& aerobic dandn& bikin& rowin& weight liftin& volleyball, basketball, tennis, etc. R~ular exercise means times or more per week for or longer each time. (cma.e NO." OR YES "" FOR EACH ITEM) I QJrrently exercise I intend to exercise in the next. 6 months I QJrrently exercise regularly I have exercised regularly for the past 6 months I have exercised regularly in the past for at least months N.a ~

5 How much do you agree with the following statements? (CIRCLE ONE NUMBER FOR EACH ITEM) Strongly Somewhat Somewhat Strongly disa~e disa~ee Neutral ~ee a~ Q. At home there are enough supplies and pieces of sports equipment (like balls, bicy'des, skates) to use for physical activity. Q. There are playgrounds, parks, or gyms dose to my home or that I can get to easily. Q6. It is safe to walk or jog alone in my neighborhood during tile day.q7. It is difficult to walk or jog in my neighborhood because of tilings like traffic, no sidewalks, dogs, gangs, and so on. Durin~ a ~ical week. how often has a member of your household: (CIRCLE ONE NUMBER FOR EACH iype OF PERSON) Qa Encouraged you to do physical activities or play sports? C Other children Q9 Done a physical activity or played sports with you? C Other children QQ Provided transportation to a place where you can do physical activities or play sports? C Other children Q. Watched you participate in physica I activities or sports? C Other children Q Told you that physical activity is good for his or her health? C Other children Almost Don't None Once Sometimes dail't DailY know a a a

6 Q. Ql. 9. How important is it to adults in your household that you are good at sports and physical activities? (CIRCLE ONE NUMBER FOR EACH YPE OF PERSON) Very Somewhat Somewhat Very unim~rtant unimoortant Neutral imdortant im~ortant Q. How much do the adults in your family enjoy physical activity or exercise? (CIRCLE ONE NUMBER FOR EACH lype OF PERSON) Not A little Somewhat Very enio~able enjoyable Neutral enjoyable enjoyable How many of your five closest friends are physically active on a regular basis? (CIRCLE ONE NUMBER ONLY) Number of closest friends Durin~ a wical week. how often: (CIRCLE ONE NUMBER) Almost Don't None Once Sometimes daily DailY know Ql6. Do you encourage your friends to do physical activities or organize games or SpOrS? 7. Do your friends encourage you to do sports or physical activities? Ql8. Do your friends do physical activities or play sports with you? Do your friends or dassmates tease you about not being good at physical activities or sports? QQ How often do the following prevent you from getting exercise? (CIRClE ONE NUMBER FOR EACH ITEM) Never Rare~ Sometimes Often VerY Often A. Self conscious about my looks when I do activities B. Lack of interest in physical activity C Lack of self-discipline (will power) D. Lack of time E Lack of energy F. I do not have anyone to do physical activities with me G. I do not enjoy ph'y'$ical activity H. Lack of equipment L The weather is too bad 6

7 This Q. ~ever Rarely Sometimes Often VerY Often J. Lack of skills K. I am too tired to exercise L. Lack of knowledge on how to do physical activities M. Lack of a convenient place to do physical activity N. I am too overweight O. Physical activity is boring P. My friends don't like to exercise Q. My friends tease me during exercise or sports R. I'm chosen last for teams S. I don't like to sweatt... Physical activity messes up my appearance (hair, clothes, or makeup) U. My job V. I don't want to get too strong or muscular W. Homework section is about some possible benefits of regular physical activity. Beside each item, please indicate your level of agreement or disagreement: (ORCLE ONE NUMBER FOR EACH ITEM) If I participate in regular physical activity or sports, then: Strongly Somewhat Somewhat Strongly di~agrepc disa~pce Neutral a~e a~ee A. I will feel less depressed or bored B. I will improve my self-esteem c. I will ~et new people D. I will lose weight E. I will build up my muscle strength F. I will feel less tension and stress G. I will improve my health or reduce my risk of disease H. I will do better on my job L I will be more attractive to the opposite sex I will improve my heart and lung fitness K. I will feel better about my body L I will increase my energy level M My body will look better 7

Q. How sure are you that you can do the following things on your own time outside of school.

Exercise even though you are feeling sad or highly stressed. C Stick to regular exercise even when your family or friends demand more time from you.d. Stick to regular exercise even when you have a lot of school work to do.

Almost always choose activities like TV, reading, listening to music, or computers. Usually choose activities like TV, reading, listening to music, or computers.

8 Q. How sure are you that you can do the following things on your own time outside of school. (CIRCLE ONE NUMBER FOR EACH ITEM) I'm sure I probably I probably I'm sure I cnn't can't Neutral cnn I cnn A Get up early, even on weekends, to exercise. B. Exercise even though you are feeling sad or highly stressed. C Stick to regular exercise even when your family or friends demand more time from you.d. Stick to regular exercise even when you have a lot of school work to do. E Set aside time for regular exercise.. What do you usually do when you have a choice about how you spend recreational time? (CIRCLE ONE NUMBER ONLY). Almost always choose activities like TV, reading, listening to music, or computers. Usually choose activities like TV, reading, listening to music, or computers. Just as likely to choose active as inactive recreation. Usually choose activities like bicycling, dancing, outdoor games, or active sports. Almost always choose activities like bicycling, dancing, outdoor games, or active sports Q. How do you rate your athletic coordination. compared to others of the same age and sex,? (CIRCLE ONE NUMBER ONLY). Mum less coordinated. Somewhat less coordinated. About the same. Somewhat more coordinated. Much more coordinated Q. How do you rate your physical activity, compared to others of the same age and sex,? (ORClE ONE NUMBER ONLY). Much less than others. Sorrewhat less than others. About the same. Somewhat more than others. Much more than others Q6. How much do you enjoy physical activity? (ORCLE ONE NUMBER ONLY). Actjvity is very un-enjoyable. Activity is somewhat un-enjoyable. Neutral. Actjvity is somewhat enjoyable. Ac:tivity is very enjoyable 8

7. How much do you enjoy physical education classes at school? (ORCLE ONE NUMBER ONLY). PE is very un-enjoyable. PE is somewhat un-enjoyable. Neutral. PE is somewhat enjoyable. PE is very enjoyable 6.

how many do you spend actually exercising or playing sports? per dass QG. I intend to go to college. (ORCLE ONE NUMBER ONLY). Strongly disagree. Somewhat disagree. Not sure. Somewhat agree.

9 7. How much do you enjoy physical education classes at school? (ORCLE ONE NUMBER ONLY). PE is very un-enjoyable. PE is somewhat un-enjoyable. Neutral. PE is somewhat enjoyable. PE is very enjoyable 6. Not enrolled in PE 8. In an averi!ge WPPk, when you are in school, on how many do you go to physical education classes? - per week Q9. During an average ~h~ical education (P~ class. how many do you spend actually exercising or playing sports? per dass QG. I intend to go to college. (ORCLE ONE NUMBER ONLY). Strongly disagree. Somewhat disagree. Not sure. Somewhat agree. Strongly agree Q. Yesterda~. did you eat the following: (CIRClE ONE NUMBER FOR EACH ITEM) None Once More than once A. Fresh fruit B. Drank fruit juice C Green salad D. Cooked vegetables E Hamburger, hot do& or sausage F. French fries or potato chips G Cookies, doughnuts, pie, or cake Q. Durin~ the past dt!~. did you diet to lose weight or to keep from gaining weight? O. No Q. Durin~ the Qr!st da~- did you exercise to lose weight or to keep from gaining weight? O. No Q. On how many of the past 7 did you do stretr.hing exercises such as toe toudling, knee bending, or leg stretching? - in the past 7 9

10 . 7. DEMOGRAPHICS. On how many of the past 7 did you do exercises to strengthen or tone your muscles, such as push-ups, sit-ups, or weight lifting? in the past 7 6. What is your gender? O. Male Female What is your height? -feet -inches 8. What is your weight? -pounds 9. How many hours per week do you usually work for pay? hours per week Thank you for completing this survey.

Physical activity can occur at a range of intensities, such as the following: (2) LIGHT

Physical activity can occur at a range of intensities, such as the following: (2) LIGHT Active Participation On the following pages, you will find a series of statements about the general levels and types of physical activity you participate in. Read each statement/question and then decide