| 1 |
Age: |
Gender: |
a) Male |
b) Female |
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| 2 |
What grade are you in: .............. |
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Your weight: .............. kg |
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| 3 |
Your length: .............. cm |
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| 4 |
Your father’s education: .............. |
a) Not literate |
b) Literate |
c) Primary school |
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d) High school |
e) University |
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| 5 |
What is your father’s occupation: .............. |
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| 6 |
What is your mother’s education: .............. |
a) Not literate |
b) Literate |
c) Primary school |
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d) High school |
e) University |
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| 7 |
What is your mother’s occupation: .............. |
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| 8 |
What is the average monthly income of the family: .............. TL |
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| 9 |
How many brothers and sisters you have in total: .............. |
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Your descendant of the family: .............. |
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| 10 |
Do you have any illnesses: |
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a) No |
b) Yes (please write) ............. |
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| PHYSICAL ACTIVITY MODULE |
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| 1 |
How many times have you been involved in sporting events in the past 12 months? |
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a) Never |
b) Once |
c) Twice |
d) Three times and more |
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| 2 |
During the past 7 days, how many days did you do muscle strengthening exercises such as push-ups, shuttles, weight lifting? |
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a) Never |
b) One day |
c) Two days |
d) Three days |
e) Four days |
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f) Five days |
g) Six days |
h) Seven days |
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| 3 |
During the past 7 days, how many days did you do stretching exercises such as touching your toes, knee bending, leg extension? |
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a) Never |
b) One day |
c) Two days |
d) Three days |
e) Four days |
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f) Five days |
g) Six days |
h) Seven days |
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| 4 |
How many hours do you sleep on average at school time? |
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a) Four hours or less |
b) Five hours |
c) Six hours |
d) Seven hours |
e) Eight hours |
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f) Nine hours |
g) Ten hours or more |
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| 5 |
Did you learn in your lectures this year how to build a “fitness” plan? |
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a) Yes |
b) No |
c) I do not know |
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| 6 |
Has the ways to protect yourself from injuries during physical activity been taught in your lectures this year? |
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a) Yes |
b) No |
c) I do not know |
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| 7 |
Has the benefits of physical activity been taught in your lectures this year? |
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a) Yes |
b) No |
c) I do not know |
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| 8 |
Have you been informed about physical activity facilities in your area this year? |
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a) Yes |
b) No |
c) I do not know |
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| NUTRITION MODULE |
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| 1 |
How often did you have breakfast in the last 30 days? |
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a) Never |
b) Rarely |
c) Occasional |
d) Most of the time |
e) Always |
| 2 |
How do you define your weight? |
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a) Very weak |
b) Slightly weak |
c) Right weight |
d) Slightly overweight |
e) Fairly overweight |
| 3 |
Which of the following are you trying to do apply for your fitness? |
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a) I do nothing for my kilo |
b) I try to lose weight |
c) I try to get weight |
d) I try to keep my weight |
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| 4 |
Have you ever weighed and measured in the last 12 months? |
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a) Yes |
b) No |
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| 5 |
What’s the main reason you’re not having breakfast? |
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a) I always do |
b) I do not have time |
c) I can not eat early in the morning |
d) There is not always the food at home |
e) Other |
| 6 |
Have you exercised in the last 30 days to lose weight or to protect your weight? |
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a) Yes |
b) No |
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| 7 |
Do you take diet pills, powder or drink without doctor’s advice to lose or protect your weight in the last 30 days? |
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a) Yes |
b) No |
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| 8 |
Did you choose to eat low calorie, fat-free foods or less to lose weight or protect the weight in the last 30 days? |
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a) Yes |
b) No |
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| 9 |
Have you been hungry for 24 hours or more to lose weight or protect your weight in the last 30 days? |
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a) Yes |
b) No |
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| 10 |
Have you taken any medicines or laxatives to lose weight or protect your weight in the last 30 days? |
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a) Yes |
b) No |
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| 11 |
Have you exercised to gain weight in the last 30 days? |
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a) Yes |
b) No |
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| 12 |
Do you prefer to eat high calorie, fatty foods or more to gain weight in the last 30 days? |
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a) Yes |
b) No |
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| 13 |
Do you take pills, powder or drinks without doctor’s advice to gain weight in the last 30 days? |
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a) Yes |
b) No |
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| 14 |
In the last 30 days, how often did you bring your lunch to school? |
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a) Never |
b) Rarely |
c) Sometimes |
d) Most of the time |
e) Always |
| 15 |
How many times has breakfast been served at school during the last 30 days? |
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a) Never |
b) Rarely |
c) Sometimes |
d) Most of the time |
e) Always |
| 16 |
How often have lunch been served in school in the last 30 days? |
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a) Never |
b) Rarely |
c) Sometimes |
d) Most of the time |
e) Always |
| 17 |
How many times a day did you usually consume milk or dairy products in the last 30 days? |
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a) Never during the last 30 days |
b) Less than one time per day |
c) One per day |
d) Two per day |
e) Three per day |
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f) Four per day |
g) Five times or more per day |
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| 18 |
How many times have you eaten salty food daily for the last 30 days? |
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a) I did not eat salty foods |
b) Less than one time per day |
c) One per day |
d) Two per day |
e) Three per day |
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f) Four per day |
g) Five times or more per day |
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| 19 |
How many times a day have you consumed fatty foods in the last 30 days? |
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a) I did not eat greasy food |
b) Less than one time per day |
c) One per day |
d) Two per day |
e) Three per day |
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f) Four per day |
g) Five times or more per day |
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| 20 |
How many times a day did you drink fruit juice in the last 30 days? |
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a) Never during the last 30 days |
b) Less than one time per day |
c) One per day |
d) Two per day |
e) Three per day |
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f) Four per day |
g) Five times or more per day |
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