SECTION A. QUESTIONS ABOUT SLEEPING

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1 V. 1 SA 2 IA AGE 14 BRIEF QUESTIONNAIRE FOR VIVA TEENS Thank you for continuing to help us learn how teenagers grow up. This year s survey is very similar to the ones you have seen before, but is a little bit shorter! Just like last year, please read each question, mark your answers, and return the survey to us. Remember, you don t have to answer any question that you don t want to. SECTION A. QUESTIONS ABOUT SLEEPING A.1. On average, how many hours per day do you sleep in a usual 24-hour period? (Answer separately for school days and for weekend days). a. hours per day on a school day b. hours per day on a weekend day A.2. On average, how often do you a. Need someone to wake you up in the morning? b. Fall back to sleep after being woken up in the morning? c. Have trouble getting out of bed in the morning? d. Think that you need more sleep? e. Fall asleep or get drowsy during class periods? f. Get sleepy or drowsy while doing your homework? -1-

2 SECTION B. QUESTIONS ABOUT YOUR EATING & DRINKING HABITS B.1. In the past month, how often did you drink a can, bottle, or glass of Less than once per week Once per week 2-4 times per week Nearly daily or daily Twice or more per day a. Soda, such as Coke, Pepsi or Sprite? b. Diet soda, such as Diet Coke, Diet Pepsi or Sprite Zero? c. Sports drink, such as Gatorade or PowerAde? d. Low-calorie sports drink, such as Propel or G2? e. Energy drink, such as Red Bull or Jolt? f. 100% fruit juice, such as orange juice, apple juice, or grape juice? g. Fruit drinks, lemonade, Snapple, Sunny Delight, sweetened tea or coffee drinks? h. White milk? i. Chocolate or other flavored milk? j. Plain water? (Tap and bottled) B.2. On average, how often do you eat something from a fast food restaurant (like Burger King, McDonald s, Dunkin Donuts, Taco Bell, or a pizza place)? Less than 1 day per week 1 or 2 days per week 5 or 6 days per week Every day 3 or 4 days per week B.3. In the past 12 months, have you ever eaten so much food in a short period of time that you would be embarrassed if others saw you? Yes (Go to B.3.a) No (Go to B.4.) a) During the times when you ate this way, did you feel out of control, like you couldn t stop eating even if you wanted to stop? Yes No -2-

3 B.4. Imagine you are eating a meal or snack at home or at a restaurant. Imagine that you have eaten enough so you are no longer hungry. How often would you keep eating? B.5. Imagine you ate a meal or snack a little while ago and are not hungry anymore. How often would you start eating again? SECTION C. QUESTIONS ABOUT HOW YOU FEEL C.1. In the past 12 months, how often do you: a. Feel hopeful about the future b. Notice you didn t have as much energy as you usually do c. Feel down in the dumps or depressed d. Feel worthless e. Have trouble concentrating f. Have trouble enjoying activities you usually enjoy If you are having these problems, please talk to a parent, teacher or other trusted adult. SECTION D. QUESTIONS ABOUT YOUR BODY Remember, there are no right or wrong answers. We just want to know what you think. D.1. Are you currently: Not trying to do anything about your weight Trying to gain weight Trying to stay the same weight Trying to lose weight -3-

4 D.2. Girls go through normal changes as they get older. Please LOOK at the drawings and READ the sentences below each of them. Then choose the drawing closest to your stage of hair development. THIS IS KINDA EMBARRASSING! Stage 1 Stage 2 Stage 3 Stage 4 Stage 5 There is no There is a little, The hair is darker, The hair is now as The hair is now like pubic hair. long, lightly coarser, and dark, curly, and that of a grown colored hair. more curled. coarse as that of a woman. The hair may be It has spread out grown woman. The hair often straight or a little curly. and thinly covers a larger area. The hair has not spread out to the forms a triangle ( ) as it spreads legs. out to the legs. SECTION E. QUESTIONS ABOUT YOUR ACTIVITIES E.1. Have you ever tried or experimented with cigarette smoking, even a few puffs? Yes (Go to E.1.a) No (Go to E.2.) a) On average, in the past year, how often did you smoke a cigarette? Never in the past year 1-2 days per week Less than once a month Less than once a week 3-5 days per week Almost every day or every day E.2. Have you ever tried drinking alcohol (beer, wine or liquor), even a few sips? Yes (Answer E.2.a) No (Go to E.3) a) On average, in the past year, how often did you drink beer, wine or liquor? Never in the past year 1-2 days per week Less than once a month Less than once a week 3-5 days per week Almost every day or every day E.3. In school, how many days per week do you have gym or PE (phys ed)? Less than 1 day per week 3 or 4 days per week 1 or 2 days per week Every day -4-

5 E.4. On average, how many hours per day do you spend watching TV shows, not including DVDs or E.5. videos? Include TV shows you watch on a TV, computer, or handheld device like an ipod, ipad, or iphone. (Check one box for school days and one for weekend days.) On average, in the past month, how many hours per day did you spend watching DVDs, videos or movies? Include those watched on a TV, computer, or handheld device. (Check one box for school days and one for weekend days.) E.6. On average, in the past month, how many hours per day do you spend playing video or computer games? Include those played on a TV, computer, or handheld device. (Check one box for school days and one for weekend days.) c) Are any of these video games physically active (for example, Wii Fit, Dance Dance Revolution or Xbox Kinect)? Yes No I do not play video or computer games -5-

6 E.7. On average, in the past month, how many hours per day do you spend on Internet-related activities, such as social networking, , iphone or ipad Apps, or YouTube (not including homework or games)? (Check one box for school days and one for weekend days.) E.8. Is there a television set in the room where you sleep? Yes No E.9. On average, in the past month, how many hours per week do you spend walking (for example, to/from school, a friend's house or the store)? hours per week E.10. On average, in the past month, how many hours per week do you spend engaged in a) Light or moderate recreational activities or sports such as biking, skateboarding, dancing, gymnastics, baseball, playing outdoors, or other similar activities? (Do not include walking.) hours per week b) Vigorous recreational activities or sports such as swimming, running, basketball, soccer, hockey, football, rollerblading, tennis, karate, or other similar activities? hours per week Thank You!!!