catch kids club student survey 2013-2014 oklahoma state department of health revised 05/06/13
TRANSCRIPT
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CATCH Kids Club Student Survey
2013-2014
Oklahoma State Department of Health Revised 05/06/13
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CATCH Kids Club Student Survey
What is your name? _______________
Today’s Date (mm/dd/yy): ________ What grade are you in? ___________ How old are you? ________________ Are you a Boy or a Girl? ___________
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1. On most days, how many fruits do you eat?
a. I do not eat fruits.b. 1-2 fruits per dayc. 3-4 fruits per dayd. 5 or more fruits per day
CATCH Kids Club Student Survey 2013-2014
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2. On most days, how many vegetables do you eat?
a. I do not eat vegetables.b. 1-2 vegetables per dayc. 3-4 vegetables per dayd. 5 or more vegetables per
day
CATCH Kids Club Student Survey 2013-2014
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3. On most days, how many sweets do you eat?
(cake, cookies, candy, ice cream)
a. I do not eat fruits.b. 1-2 fruits per dayc. 3-4 fruits per dayd. 5 or more fruits per day
CATCH Kids Club Student Survey 2013-2014
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4. How many cups of water do you drink every day?
a. I do not drink water.b. 1-3 cups per dayc. 4-5 cups per dayd. 6 or more cups per day
CATCH Kids Club Student Survey 2013-2014
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5. Do you eat breakfast every day?
a. Yesb. No
CATCH Kids Club Student Survey 2013-2014
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6. I have fun with CATCH games.
a. Yesb. Noc. I do not know
CATCH Kids Club Student Survey 2013-2014
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7. I’ve told my family things we do in CATCH Kids Club.
a. Yesb. No
CATCH Kids Club Student Survey 2013-2014
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8. Which type of milk do you drink?
a. I do not drink milk.b. Skim, fat free or 1%.c. Reduced fat (2% milk)d. Whole milke. Other (soy, rice, almond, etc)f. I do not know
CATCH Kids Club Student Survey 2013-2014
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9. Which side dish would you order from a fast food restaurant?
CATCH Kids Club Student Survey 2013-2014
a. Apple slices b. French fries c. Tater Tots
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10. Do you play a GO Activity for 30 minutes every day of the week?
a. Yesb. Noc. I do not know
CATCH Kids Club Student Survey 2013-2014
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11. Your heart is a
a. Valve.b. Muscle.c. Artery.d. I do not know
CATCH Kids Club Student Survey 2013-2014
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12. You know you are playing hard because
a. You get cold.b. You move slowly.c. Your heart beats faster.d. I do not know
CATCH Kids Club Student Survey 2013-2014
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13. Should you warm up and cool down when you exercise?
a. Yes, every timeb. Noc. Yes, sometimesd. I do not know
CATCH Kids Club Student Survey 2013-2014
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14. What does your body need to grow?
a. Moviesb. Foodc. TV d. Music
CATCH Kids Club Student Survey 2013-2014
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15. I know what healthy foods are.
a. Yesb. Noc. I do not know
CATCH Kids Club Student Survey 2013-2014
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16. Which food item has the most fiber?
a. Milkb. Candyc. Beans d. Chicken
CATCH Kids Club Student Survey 2013-2014
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17. Which food has the most salt?
a. Fruitb. Broccolic. Low fat milkd. French Fries
CATCH Kids Club Student Survey 2013-2014
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18. At a fast food restaurant you will mostly find
a. Low calorie food itemsb. Unhealthy fatsc. Many good nutrientsd. High fiber foods
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19. Which breakfast food has the most fiber?
CATCH Kids Club Student Survey 2013-2014
a. Eggs b. Whole-grain cereal c. Bacon
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20. How many cups of water should you drink every day?
a. I should not drink any water.
b. 1-3 cups c. 4-5 cups d. 6-8 cups
CATCH Kids Club Student Survey 2013-2014
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21. An unhealthy food choice is called a
a. GO Foodb. NO Food c. WHOA Food d. I do not know
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22. When I ask my family to buy healthy foods
a. They always buy themb. They sometimes buy themc. They never buy them d. I do not ask
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23. When I am at home
a. I feel safe playing Go Activities outside
b. I do not feel safe playing Go Activities outside
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24. When I am at home
a. I like to play Go Activitiesb. I do not like to play
Go Activities
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25. When I am at home
a. I have a place to play Go Activities
b. I do not have a place to play Go Activities
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26. When I am at home
a. I have someone to play Go Activities with
b. I do not have anyone to play Go Activities with
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27. When I am at home
a. I am encouraged to play Go Activities
b. I am not encouraged to play Go Activities
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NUTRITION FACTS Serving size = 4.5 oz (128 g) Servings Per Container = 1
Amount per Serving Calories = 470
% Daily Value
Total Fat 20 g 31% Sat. fat 11 g 55%
Trans fat 1.5 g
Cholesterol 20 mg 7%
Sodium 440 mg 18% Total Carb. 70 g 23%
Dietary fiber 1 g 4%
Sugars 44g
Protein 4g
Use the following nutrition label to answer questions 28-30.
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28. How many milligrams (mg) of sodium does this food have?
a. 20 mgb. 44 mg c. 440 mg d. I do not know
CATCH Kids Club Student Survey 2013-2014
NUTRITION FACTS Serving size = 4.5 oz (128 g) Servings Per Container = 1
Amount per Serving Calories = 470
% Daily Value
Total Fat 20 g 31% Sat. fat 11 g 55%
Trans fat 1.5 g
Cholesterol 20 mg 7%
Sodium 440 mg 18% Total Carb. 70 g 23%
Dietary fiber 1 g 4%
Sugars 44g
Protein 4g
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29. Is this food a good source of fiber?
a. Yesb. No c. I do not know
CATCH Kids Club Student Survey 2013-2014
NUTRITION FACTS Serving size = 4.5 oz (128 g) Servings Per Container = 1
Amount per Serving Calories = 470
% Daily Value
Total Fat 20 g 31% Sat. fat 11 g 55%
Trans fat 1.5 g
Cholesterol 20 mg 7%
Sodium 440 mg 18% Total Carb. 70 g 23%
Dietary fiber 1 g 4%
Sugars 44g
Protein 4g
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30. Is this food a healthy food choice?
a. Yesb. No c. I do not know
CATCH Kids Club Student Survey 2013-2014
NUTRITION FACTS Serving size = 4.5 oz (128 g) Servings Per Container = 1
Amount per Serving Calories = 470
% Daily Value
Total Fat 20 g 31% Sat. fat 11 g 55%
Trans fat 1.5 g
Cholesterol 20 mg 7%
Sodium 440 mg 18% Total Carb. 70 g 23%
Dietary fiber 1 g 4%
Sugars 44g
Protein 4g
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CATCH Kids Club Student Survey
2013-2014
Oklahoma State Department of Health Revised 05/06/13
• Be sure put your first and last name on the answer sheet.• Send the answer sheets to:
Oklahoma State Department of HealthCATCH Program, Community Development Service
1000 NE 10th Street, Room 508Oklahoma City, OK 73117