CATCH ‘EM 1 – WHAT ACTIVITIES DID YOU DO? (Q1 & Q3 ...catchinfo.org/wp-content/uploads/2014/11/CATCH-EM-Mini-Surveys_… · Yesterday, did you do any exercise that made your heart

Student Code/Name: _______________________ Gender: Male / Female Age: ________ years

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CATCH ‘EM 1 – WHAT ACTIVITIES DID YOU DO? (Q1 & Q3 responses are for YESTERDAY)

INSTRUCTIONS: Please read the questions carefully and check the box that best fits your answer for each question.

1. Yesterday, did you do any exercise that made your heart beat fast and made you breathe hard for at least

30 minutes? Examples are: basketball, running or jogging, fast dancing, swimming laps, tennis, fast bicycling, soccer, jumping ropes, trampoline, hockey, fast skating, or rollerblading.

Yes No 2. During the past 12 months, on how many sports teams did you play?

Examples are: soccer, basketball, baseball, softball, swimming, gymnastics, cheerleading, wrestling, track, football, dance, tennis, and volleyball teams.

Do not include PE classes. 0 teams 1 team 2 teams 3 or more teams

3. Yesterday, did you play outdoors for at least 30 minutes? Do not count outdoor play during school hours.

Yes No

4. Last week, which days did you go to physical education (PE) or gym classes?

No days Tuesday Thursday Monday Wednesday Friday


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5. Do you currently take part in any other organized physical activities or take lessons? Examples are: martial arts, dance, gymnastics, or tennis?

Yes No

6. Yesterday, how many hours did you watch TV or video movies?

I did not watch TV yesterday 2 hours Less than 1 hour 3 hours 1 hour 4 hours or more

7. Yesterday, how much time did you spend on the computer before or after school?

Examples are: surfing the Internet, instant messaging, or homework.

I did not use a computer yesterday 2 hours Less than 1 hour 3 hours 1 hour 4 hours or more


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8. Yesterday, how much time did you spend using handhelds like Game Boy® or portable DVD players when not in school?

I did not play with handhelds yesterday 2 hours Less than 1 hour 3 hours 1 hour 4 hours or more

9. Yesterday, how much time did you spend playing video games when not in school? Examples are: Nintendo®, Sega®, PlayStation®, Xbox®, or arcade games.

Do not include handhelds like Gameboy®.

I did not play video games yesterday 2 hours Less than 1 hour 3 hours 1 hour 4 hours or more

10. I usually walk or ride my bike to school.

Never or Almost Never Sometimes Always or Almost Always

11. I usually walk or ride my bike from school.



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CATCH ‘EM 1 A – WHAT ACTIVITIES DID YOU DO? (Q1, Q2, Q5 responses are for PAST 7 DAYS)

INSTRUCTIONS: Please read the questions carefully and check all the boxes that best fits your answer for each question 1. Below, check the days you exercised or took part in physical activity that made your heart beat fast and

made you breathe hard for at least 30 minutes? Examples are: basketball, soccer, running or jogging, fast dancing, swimming, bicycling, jumping rope,

trampoline, hockey, fast skating, or rollerblading.

I didn’t do any exercise last week that made my heart beat fast for 30 minutes Monday Tuesday

Wednesday Thursday Friday

Saturday Sunday

2. Below, check the days you play outdoors for at least 30 minutes? Do not count outdoor play during school hours.

I didn’t play outdoors last week. Monday Tuesday


Saturday Sunday


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3. During the past 12 months, on how many sports teams did you play? Examples are: soccer, basketball, baseball, softball, swimming, gymnastics, cheerleading, wrestling, track, football, dance, tennis, and volleyball teams.

Do not include PE classes. 0 teams 1 team 2 teams 3 or more teams 4. Below, check the days last week you went to regular physical education (PE) or gym class?

I didn’t go to PE last week Monday Tuesday

Wednesday Thursday Friday 5. Below, check the days that you took lessons, such as martial arts, dance, gymnastics, or tennis?

I didn’t take any lessons in the past seven days Monday Tuesday


Saturday Sunday

6. Yesterday, how many hours did you watch TV or video movies when not in school?

I did not watch TV yesterday 3 hours Less than 1 hour 4 hours 1 hour 5 hours 2 hours 6 hours or more


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7. Yesterday, how much time did you spend on the computer when not in school? Time on the computer includes time spent surfing the Internet and instant messaging.

I did not use a computer yesterday 3 hours Less than 1 hour 4 hours 1 hour 5 hours 2 hours 6 hours or more

8. Yesterday, how much time did you spend using handhelds like Game Boy® or portable DVD players?

I did not play handhelds yesterday 3 hours Less than 1 hour 4 hours 1 hour 5 hours 2 hours 6 hours or more

9. Yesterday, how much time did you spend playing video games like Nintendo®, Sega®, PlayStation®, Xbox®, or arcade games when not in school? Do not include handhelds like Gameboy®.

I did not play video games yesterday 3 hours Less than 1 hour 4 hours 1 hour 5 hours 2 hours 6 hours or more

10. I usually walk or ride my bike to school.

Never or Almost Never Sometimes Always or Almost Always 11. I usually walk or ride my bike from school.



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CATCH ‘EM 2 - WHAT DID YOU EAT YESTERDAY?

“NUMBER OF TIMES” INSTRUCTIONS: Please read the questions carefully and check the box that best fits your answer for each question. 1. Yesterday, did you eat hamburger meat, hot dogs, sausage (chorizo), steak, bacon, or ribs?

No, I didn’t eat any of the foods listed above yesterday. Yes, I ate one of these foods 1 time yesterday. Yes, I ate one of these foods 2 times yesterday. Yes, I ate one of these foods 3 or more times yesterday.

2. Yesterday, did you eat any fried meat with a crust, like fried chicken, chicken nuggets, chicken fried steak, fried pork chops, or fried fish?


3. Yesterday, did you eat cheese by itself or on your food? Count cheese on pizza or in dishes such as tacos, enchiladas, sandwiches, cheeseburgers, or macaroni and cheese.

No, I didn’t eat cheese yesterday. Yes, I ate cheese 2 times yesterday. Yes, I ate cheese 1 time yesterday. Yes, I ate cheese 3 or more times yesterday.


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4. Yesterday, did you drink any kind of milk? Count chocolate or other flavored milk, milk on cereal, or drinks made with milk.

No, I didn’t drink any milk yesterday. Yes, I drank milk 2 times yesterday. Yes, I drank milk 1 time yesterday. Yes, I drank milk 3 or more times yesterday.

5. Yesterday, did you eat yogurt or cottage cheese or drink a yogurt drink? Do not count frozen yogurt.

No, I didn’t eat any of these foods yesterday. Yes, I ate one of these foods 2 times

yesterday. Yes, I ate one of these foods 1 time yesterday. Yes, I ate one of these foods 3 or more times

yesterday.

6. Yesterday, did you eat rice, macaroni, spaghetti or pasta noodles?


7. Yesterday, did you eat any bread, bun, bagel, tortilla or roll?



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8. Yesterday, did you eat any hot or cold cereal?

No, I didn’t eat any cereal yesterday. Yes, I ate cereal 2 times yesterday. Yes, I ate cereal 1 time yesterday. Yes, I ate cereal 3 or more times yesterday.

9. Yesterday, did you eat French fries or chips? Chips are potato chips, tortilla chips, Cheetos®, corn chips, or other snack chips.

No, I didn’t eat any French fries or chips yesterday. Yes, I ate French fries or chips 1 time yesterday. Yes, I ate French fries or chips 2 times yesterday. Yes, I ate French fries or chips 3 or more times yesterday.

10. Yesterday, did you eat any vegetables? Vegetables are all cooked and uncooked vegetables; salads; and boiled, baked and mashed potatoes. Do not count French fries or chips.

No, I didn’t eat any vegetables yesterday. Yes, I ate vegetables 3 times yesterday. Yes, I ate vegetables 1 time yesterday. Yes, I ate vegetables 4 times yesterday Yes, I ate vegetables 2 times yesterday. Yes, I ate vegetables 5 or more times

yesterday.


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11. Yesterday, did you eat beans such as pinto beans, baked beans, kidney beans, refried beans, or pork and beans? Do not count green beans.

No, I didn’t eat any beans yesterday. Yes, I ate beans 2 times yesterday. Yes, I ate beans 1 time yesterday. Yes, I ate beans 3 or more times yesterday.

12. Yesterday, did you eat fruit? Do not count fruit juice.

No, I didn’t eat any fruit yesterday. Yes, I ate fruit 3 times yesterday. Yes, I ate fruit 1 time yesterday. Yes, I ate fruit 4 times yesterday. Yes, I ate fruit 2 times yesterday. Yes, I ate fruit 5 or more times yesterday.

13. Yesterday, did you drink fruit juice? Fruit juice is a drink, which is 100% juice, like orange juice, apple juice, or grape juice. Do not count punch, Kool-Aid®, sports drinks, or other fruit-flavored drinks.

No, I didn’t drink any fruit juice yesterday. Yes, I drank fruit juice 2 times yesterday. Yes, I drank fruit juice 1 time yesterday. Yes, I drank fruit juice 3 or more times

yesterday. 14. Yesterday, did you drink any punch, Kool-Aid®, sports drinks, or other fruit-flavored drinks? Do not count fruit juice.

No, I didn’t drink any of these drinks yesterday. Yes, I drank one of these drinks 1 time yesterday. Yes, I drank one of these drinks 2 times yesterday. Yes, I drank one of these drinks 3 or more times yesterday.


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15. Yesterday, did you drink any regular sodas or soft drinks?

No, I didn’t drink any sodas or soft drinks yesterday. Yes, I drank sodas or soft drinks 1 time yesterday. Yes, I drank sodas or soft drinks 2 times yesterday. Yes, I drank sodas or soft drinks 3 or more times yesterday.

16. Yesterday, did you eat a frozen dessert? A frozen dessert is a cold, sweet food like ice cream, frozen yogurt, an ice cream bar, or a Popsicle.

No, I didn’t eat any frozen dessert yesterday. Yes, I ate a frozen dessert 2 times yesterday. Yes, I ate a frozen dessert 1 time yesterday. Yes, I ate a frozen dessert 3 or more times

yesterday. 17. Yesterday, did you eat sweet rolls, doughnuts, cookies, brownies, pies, or cake?


18. Yesterday, did you eat any chocolate candy? Do not count brownies or chocolate cookies.

No, I didn’t eat any chocolate candy yesterday. Yes, I ate chocolate candy 1 time yesterday. Yes, I ate chocolate candy 2 times yesterday. Yes, I ate chocolate candy 3 or more times yesterday.


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19. Yesterday, did you eat any candy other than chocolate candy?

Yes, I ate other candy 3 or more times yesterday. Yes, I ate other candy 1 time yesterday. No, I didn’t eat any other candy yesterday. Yes, I ate other candy 2 times yesterday.

20. Yesterday, did you eat breakfast?

Yes No

21. Yesterday, how many meals did you eat? Meals include breakfast, lunch, and dinner or supper.

I didn’t have any meals yesterday. I had 2 meals yesterday. I had 1 meal yesterday. I had 3 or more meals yesterday.

22. Yesterday, did you have a snack? A snack is food or drink that you eat or drink before, after, or between meals.

No, I didn’t have any snacks yesterday. Yes, I had a snack 2 times yesterday. Yes, I had a snack 1 time yesterday. Yes, I had a snack 3 or more times yesterday.


CATCH ‘EM 3 - WHICH FOOD IS BETTER FOR YOUR HEALTH?

INSTRUCTIONS: Circle one of the two foods that you think is better for your health.

1.

corn tortilla flour tortilla

2.

doughnut whole-grain, low sugar cereal and low-fat milk

3.

beans macaroni and cheese

4.

1% low-fat or skim whole milk

(fat-free) milk

5.

bologna peanut butter

6.

Green salad French fries

7.

100% orange juice orange-flavored drink

8.

veggie pizza pepperoni pizza

9.

gummy fruit candy fresh fruit 10.

water soft drink (soda)

11.

white bread whole-grain bread

12.

Buttered popcorn unbuttered popcorn

Student Code/Name: _____________________ Gender: Male/Female Age: _______ years

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CATCH ‘EM 4 - HOW SURE ARE YOU ABOUT WHAT YOU DO?

INSTRUCTIONS: Please read the questions carefully and check the box that best fits your answer for each question. Not sure A little sure Very sure 1. How sure are you that you can choose to run, jump,

dance or play during recess?

2. How sure are you that you can be active every day?

3. How sure are you that you can keep moving for most of

the time in PE class?

4. How sure are you that you can improve your fitness by

running, playing sports or biking 3-5 times a week?

5. How sure are you that you can keep up a steady pace

without stopping for 30 minutes when you are physically active?


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CATCH ‘EM 5 - HOW SURE ARE YOU ABOUT WHAT YOU EAT?

INSTRUCTIONS: Please read the questions carefully and circle the choice (Not sure, A little sure, Very sure) that best fits your answer for each question.

1. How sure are you that you can eat whole-grain, low sugar

cereal instead of high sugar cereal?

Not sure

A little sure

Very sure

2. How sure are you that you can ask your parents for fresh fruit for a snack?

Not sure

A little sure

Very sure

3. How sure are you that you can eat a baked potato instead of french fries?

Not sure

A little sure

Very sure

4. How sure are you that you can eat popcorn without butter instead of popcorn with butter?

Not sure

A little sure

Very sure

5. How sure are you that you can eat a grilled chicken sandwich instead of a hamburger?

Not sure

A little sure

Very sure


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6. How sure are you that you can eat fruit instead of candy?

Not sure

A little sure

Very sure

7. How sure are you that you can eat grilled fish instead of fried fish?

Not sure

A little sure

Very sure

8. How sure are you that you can eat whole-grain bread instead of white bread?

Not sure

A little sure

Very sure

9. How sure are you that you can drink water instead of fruit punch?

Not sure

A little sure

Very sure

10. How sure are you that you can ask your parents for whole-grain bread?

Not sure

A little sure

Very sure


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11. How sure are you that you can drink low-fat milk instead of a soft drink (soda)?

Not sure

A little sure

Very sure

12. How sure are you that you can eat 1 scoop of ice cream instead of 3 scoops of ice cream?

Not sure

A little sure

Very sure

13. How sure are you that you can eat breakfast every day?

Not sure

A little sure

Very sure

14. How sure are you that you can ask your parents for vegetables at dinner?

Not sure

A little sure

Very sure

15.

How sure are you that you can order a salad at a restaurant?

Not sure

A little sure

Very sure


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CATCH ‘EM 6 – WHAT DO OTHER PEOPLE WANT YOU TO DO?

INSTRUCTIONS: Please read the questions carefully and check the box that best fits your answer for each question. Note: Being active means doing exercises like running, jogging, walking fast, bike riding, swimming, dancing, skating, or any other activity that makes you breathe faster and your heart beat faster. Never or

almost never

Sometimes Always or almost always

1. One or both of my parents do exercises with me like

running, jogging, walking fast, bike riding, swimming, dancing, or skating.

2. I think most of my friends want me to be active when we

play.

3. My friends and I have fun when we're active when we play

together.

4. One or both of my parents tell me to stay inside when I

want to be physically active outside.

5. One or both of my parents will not let me be active when I

want to.

6. One or both of my parents like to watch me when I am

being active.

7. When I am active, one or both of my parents smile and

cheer for me.

8. When I am active at recess, most of my classroom

teachers tell me to stop.

9. When I am active in PE class, my PE teacher tells me I am

doing a good job.

10. Most of my friends tease me a lot when I am active.


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CATCH ‘EM 7 - WHAT DO OTHER PEOPLE WANT YOU TO EAT?

INSTRUCTIONS: Please read the questions carefully and check the box that best fits your answer for each question.

Never or

almost never Sometimes Always or

almost always 1. My parents tell me to eat lots of fruits and

vegetables.

2. My parents tell me to drink water instead of a soft

drink (soda).

3. My parents tell me to eat whole-grain bread instead of

white bread.

4. My parents tell me to eat breakfast every morning.

5. My parents tell me to drink low-fat milk.

6. My teachers tell me to eat lots of fruits and

vegetables.

7. My teachers tell me to drink water instead of a soft

drink (soda).

8. My teachers tell me to eat whole-grain bread instead

of white bread.

9. My teachers tell me to eat breakfast every morning.

10. My teachers tell me to drink low-fat milk.

11. I think my friends want me to eat lots of fruits and

vegetables.

12. I think my friends want me to drink water instead of a

soft drink (soda).

13. I think my friends want me to eat whole-grain bread

instead of white bread.

14. I think my friends want me to eat breakfast every

morning.

15. I think my friends want me to drink low-fat milk.


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CATCH ‘EM 8 - WHAT DO YOU KNOW ABOUT CATCH?

INSTRUCTIONS: Please read the questions carefully and check the box that best fits your answer for each question. 1. Did you do CATCH lessons in your classroom this year? Examples are: “Hearty Heart” or “Go For Health” or “Breaking Through Barriers”

Yes No I have never heard of CATCH 2. What is the CATCH Program? Throwing and catching program Bike safety program Program that teaches kids to eat healthy and play everyday I don’t know what the CATCH Program is 3. Which of the following is a GO food?

French toast Green beans without butter Pepperoni I have never heard of GO food

4. Which of the following is a WHOA food? Brown rice Chocolate doughnuts 2% milk I have never heard of WHOA food 5. Which one of the following is a CATCH character?

Cap’n Crunch Freshness Fanatic Hearty Heart VeggieMan I don’t know

Documents

CATCH ‘EM 1 – WHAT ACTIVITIES DID YOU DO? (Q1 & Q3 ...catchinfo.org/wp-content/uploads/2014/11/CATCH-EM-Mini-Surveys_… · Yesterday, did you do any exercise that made your heart