San Diego High School Survey. fill in the blank or circle the response beside each question or item. SOFTBALL

Transcription

1 Please Q.l. MINUTES a. c. DAYS BASEBALL TRACK TENNIS GYMNASTICS OTHER: ~alking b. d. Yard San Diego High School Survey fill in the blank or circle the response beside each question or item. ID About how many minutes per week do you spend: a.walking to and from school MINUTES PER 'WEEK b.~alking during breaks and at lunch PER T.JEEK c.walking as part of errands away from your home.. MINUTES PER ~EEK c.riding a bicycle PER WEEK How many days during the past two weeks have you done stretching or other exercises for flexibility -DAYS PER WEEK walked to school DAYS PER WEEK Rode a bicycle PER WEEK Q.3 Check each of the following sports teams you have been on during the past year SOCCER SOFTBALL FOOTBALL BASKETBALL SYIMMING TE.."rnIS & FIELD Check each of the following classes or lessons,you took during the past year: BALLET OTHER DANCE SYIMMING MARTIAL ARTS Following is a list of activities that some people tell us they do * First, write the number of times during the last two weeks you have done each activity in the blank beside the activity. * Then, for each activity you have done at all during the last two weeks, write the number of minutes you did thi activity each time on the average: NUMBER OF TIMES Minutes IN LAST TWO WEEKS Each Time a for exercise Jogging or running. c Hiking work or gardening. SCHEDULE A PAGE 1

2 e. Other j. k. 1. n. q. r. s. Skating. u. v. w. Skiteboarding.. y. z. NUMBER OF TIMES IN PAST TiJO T.JEEKS Minutes Each Time f Aerobics or aerobic dancing. dancing. Calisthenics or general exercise. h. Golf i m. Tennis Bowling Biycycling or exercise cycling Yoga. Weight lifting or training Basketball. 0 Baseball or softball p t Football Soccer. Volleyball. Handball, racquetball, or squash. Skiing. Rowing. Surfing or boogieboarding. x Gymnastics Tennis. Q.6. During a typical week, how often do you do physical exercise when not at school for at least 20 minutes without stopping which is hard enough to make your heart rate and breathing increase a large amount? TIMES PER TJEEK SCHEDu"LE A PAGE 2

3 For a. 12 d. e. 31Lack m. n. p. Q.7 Check each blank beside the item which shows where you do the preceding exerciseactivities: HOME SCHOOL OR CHURCH FACILITY FREE Pu~LIC RECREATION CENTER PARK COMMERCIAL FACILITY OR PRIVATE CLUB (e.g.. YMCA, FAMILY FITNESS, etc.) OUT OF DOORS USING NO SPECIAL FACILITY OTHER Compared to others of your age and sex, circle how active you are 1.MUCH LESS ACTIVE 2.S0METJRAT LESS ACTIVE 3.ABOUT AS ACTIVE 4. SOME"...1iAT MORE ACTIVE.MUCH MORE ACTIVE each of the following items, just circle the extent to which each has prevented you from getting exercise: NEVE3. RARELY SOME- TIMES VERY OFTEN OFTEN Self conscious about my looks when I exercise b Lack of interest in exercise 3 4 c Lack of self-discipline Lack of time Lack of energy f. Lack of company. g Lack of enjoyment from exercise. h. Discouragement. i Lack of equipment. j Lack of good weather k Lack of skills of facilities or space Lack of knowledge on how to exercise Lack of good health o. Fear of injury Other: SCHEDULE A PAGE 3

4 j.i Q.ll. STATIONARY OTHER: For b, f. 1 Q.1O Following are some things that some people have told us are reasons why theyparticipate in exercise. Beside each item, circle whether you disagree strongly, disagree, are neutral, agree, or agree strongly. STRONGLY SOMET.JHAT DISAGREE DISAGREE NEUTRAL T.,7HAT AGREE SOME- STRO- NGLY AGREE a.i will feel less depressed and/or bored. 1 b.i will improve my self esteem c.r will meet new people d.l will lose weight or improve my shape 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 i.i will feel more attractive.. will improve my heart and lung fitness.. Check each item you have in your home or yard: BICYCLE CYCLE JOGGING TRA.t'iPOLINE ROWING MACHINE ST,.7IMMING POOL WEIGHT LIFTING EQUIPMENT RUNNING SHOES BASKETBALL HOOP AEROBIC VIDEOTAPES AEROBIC AUDIOTAPES, RECORDS Q.12 each of the following, circle whether the facility is easy for you to use DO NOT!:!Q~~ - a Aerobic dance studio q Basketball court... c Bike lane d. Bowling alley. e Golf course Health spa/gym. SCHEDULE A PAGE 4

5 NQ i. k. 1Soccer 12 Tennis 1Circle 4. Q.14 2.DIFFIGULT 1. Q.16. Q.18 Q.1 lli~ DO NOT g. Public park h Public recreation center Racquetball/squash court j Running track..... Skating rink or football field... m. Sporting goods store. Swimming pool.. 0 court p. Amusement center Q.13 how safe it is to walk or jog alone in your neighborhood during the day: 1.VERY UNSAFE SOMEWHAT UNSAFE SOMEYHAT SAFE.VERY SAFE Circle how difficult is it to walk or jog in your neighborhood because of things liketraffic, no sidewalks, dogs, gangs, and so on? I.VERY DIFFICULT 3.S0MET.JHAT DIFFICULT 4.NOT AT ALL DIFFICULT Q.1S, Circle whether you enjoy physical education classes a lot, enjoy them, feel neutral toward them, dislike them, or dislike physical education classes a lot? ENJOY A LOT 2.ENJOY 3.NEUTRAL 4.DISLlKE.DISLIKE A LOT During the last two weeks, about how many days did you attend physical education (PE) classes? NUMBER OF DAYS Q.17. Normally, about how many days a week do you participate in physical education? DAYS During a typical week, about how many physical education classes include activities which last 20 minutes or longer and are hard enough to make your heart rate and breathing increase a large amount? NUMBER OF TIMES About how many times have you been sick in the last year so that you had to miss school? NUMBER OF TIMES SCHEDULE A PAGE

6 Q YES Q.23 Q.24 I 1 Q.20 Do you currently need to limit your exercise because of illness? 1.NO 2. YES Do you currently need to limit your exercise because of injury or handicap? Q.22 Please list your sports and exercise related injuries during the past 24 months. Also list the type of injury, the specific body part that was injured, the kind of activity you were doing when injured, and the number of weeks that your activity was limited due to the injurj. Finally, check if you sought medical attention for the injury and also check if you were hospitalized for the injury: TYPE OF INJ1;,?, Y SPECIFIC BODY PART INJURED ACTIVITY NUMBER OF YEEKS ACTIVITY LIMITED CHECK IF YOU SOUGHT MEDICAL ATTENTION CHECK IF YOU WERE HOSPITALIZED Compared to others of the same age and sex, circle how you rate your athletic coordination? I.MUCH LESS COORDINATED 2. SOMEWHAT LESS COORDINATED 3.ABOUT AS 4. SOMET,.7HAT MORE COORDINATED COORDINATED.MUCH MORE COORDINATED Following are some of the things that people have told us about themselves. For each of the following, circle whether you agree strongly, agree, disagree, or disagreestrongly: AGREE DISAGREE STRONGLY AGREE SO-SO DISAGREE STRONGLY a. I feel satisfied with the shape of my body b feel concerned that I am less physically attractive than others Q.2S. Circle whether anyone ever ~old you that you might be anorexic? 1.YES 2.NO -Q.26. a Following are some of the things that people have told us they sometimes do in order to lose weight. Circle whether you have never, sometimes, or frequently have done each of the following in order to lose weight: SOME- FREQ- NEVER TIMES UENTLY ~~~ Vomit to lose weight 1 2 b Use laxatives to lose weight SCHEDULE A PAGE 6

7 ~se 12 eexercise NUMBER DRINKS FRIENDS-> 1 c diuretics/water pills to lose weight SOME-TIMES FREQ- NEVER UENTLY ~ ~ ~ 3 do Use diet pills to lose weight. S~op eating entirely for one or more days to lose weight f, until too tired to do anything else to lose weight 2 3 Q.27.About how many cigarettes a week do you smoke now? PER T.o1EEK Q.28.~.bout how many beers or other alcoholic drinks do you have during an average week? PER YEEK Q.2.Circle whether you have ever used anabolic steroids to build muscles? 1.YES Z.Na Q.30.Below are some activities that family members and friends might do. For each item, circle how often members of your family do it. Then, circle how often your friends do it. A FEW VERY NEVER RARELY TIMES OFTEN OF-rEN a.exercised with me FAMILY-> b.offered to exercise with me....family=> FRIENDS-> c.reminded me to exercise (e.g., Aren't you going to exercise today?) FAMILY-> FRIENDS=> 1 d.gave me encouragement to exercise FAMILY-> FRIENDS-> e.complained about the time I spend exercising.. FAMILY-> FRIENDS-> f.made fun of or criticized me for exercising..family-> FRIENDS=> SCHEDULE A PAGE 7

8 b. c.sister(s). 3 1 A FEY NEVER RARELY TIMES VERY OFTEN OFTEN g.rewarded me for exercising (e.g., Bought or gave me something for exercising)... FAMILY-> 1 FRIENDS-> Q.3l.Circle how sure you are that you can do the following things. For each item, circle whether you know that you can do it, might be able to do it, or know that you cannot do 1. "-. '-. KNOW I MAYBE I KNO'.1 I CANNOT ~ ~ a c Get up early, even on weekends, to exercise Exercise even though you are feeling sad or highly stressed S~ick to your exercise program even when your family or friends demand more time from you. d Stick to your exercise program even when you have a lot of school work to do Q.32 Circle how often each of the following people exercise regularly (3 or more times per 'Neek). NEVER RARELY SOMETIMES FREOUENTLY DON'T KNOT..] a.mother 1 b.father d.brother(s) e.friend(s) f.teacher(s) Q.33 g.coach(es) 1 ' -Now, circle how often the following people have exercised with you NEVER RARELY SOMETIMES FREOUENTLY DON'T KNOW a.mother 2 4 b.father c.sister(s) SCHEDL'rLE A PAGE 8

9 g.coach(es). 13. Circle i.others HOURS YES Q.4l. I.D'S Of NEVER RARELY SOMETIMES FREOUENTLY DON'T KNOW d.brother(s) e.friend(s) f.teacher(s). Q.34. How many days during the past two weeks did one of your parents exercise with you? NUMBER OF TIMES Q.3 Circle how often you see people walking or jogging for exercise in your neighborhood: 1.NEVER 2.RARELY 3.S0METIMES 4.0FrEN.VERY OFTEN Q.36 During the last few years, circle how often have you been forced to exercise or playsports: I.NEVER 2.RARELY SOMETIMES 4.0FrEN.VERY OFTEN Q.37 each of the following who ever forced you to exercise or play sports a.parents b.brother OR SISTER c.teacher d.friends e.coach Q.38 About how many hours of sleep do you get on an average week night? Q.3. About how many hours of sleep do you get on an average weekend night? Q.40. Are you employed for money? NO IF YOU ARE EMPLOYED FOR MONEY, Describe what specific kind of job you have and list who you work for? DESCRIBE KIND OF JOB EXACTLY AND NAME OF EMPLOYER IF YOU ARE ~~LOYED FOR MONEY. How many hours a week do you work on your job on theaverage? HOURS PER W'~EK - As far as grades have been concerned at this school, circle whether you have received mostly A's, B's, C's, D's, or F's: 4.A'S 3.B'S 2.C'S O.F'S the following people, circle all who do you live with? 1. MOTHER AND FATHER 2. PARENT AND STEPPARENT 3.GUARDIAN 4. FOSTER PARENTS.BROTHER OR S I STL~ 6.0THER RELATIVES 7.NO ADULTS 8.0THER LIVING SITUATION SCHEDULE A PAGE

10 INCHES 4.0ther: 1.W'hite Q.4.About how many hours a day do you watch television programs on the average? HOURS Q.46.About how many times during an average week do you talk with friends about sports or exercise? ~"'UMB ERjTJEEK Q.47.Circle whether you are: I.MALE 2.FEMALE Q.48.Yhen were you born? MONTH DAY YEAR Q.l.How would you say your weight compares with others of your age and sex? Circle whether you are: I.MUCH HEAVIER 2.S0ME HEAVIER 3.ABOUT THE SAME 4. SOME LIGHTER.MUCH LIGHTER Q.S2.Circle whether you are of Hispanic, Latino, or Mexican descent? 1.YES 2.NO Q.3.What is your race? 2.Black 3.Asian Q.4.IF YOU ARE OF ASIAN DESCENT, What country is your family from originally? Q..How many people live in your immediate household? NUMBER Q.6.0f the people who live in your household, how many of them are under 18 years of age? NUMBER.: SCHEDULE A PAGE 10