Survey Sample

1. How much exercise do you get?
A. 10 minutes or more
B. 20 -30 minutes
C. 30-60 minutes
D. More than 1 hour
E. less than 10 minutes

2. How often do you exercise?
A. Less than weekly
B. Once a week
C. Twice a week
D. Three times a week
E. Daily

3. What kind of fast foods do you like?
A. Burgers
B. Hot dogs
C. Fried Chicken
D. French Fries
E. Other Fried food
F. Sandwiches

4. Which fast food restaurants do you go to?
A. KFC
B. McDonalds
C. Burger King
D. Other

5. Are you a boy or a girl?
Boy
Girl

6. What kind of healthy food do you like?
A. Salad.
B. Rice.
C. Fish.
D. Fruits.
E. Other. (Please name)____________________

7. How often do you eat fast food?
A. Once a week.
B. Twice a week.
C. Three times a week.
D. Everyday.
E. Once a month
F. Rarely.

8. Are you physically fit?
A. Yes. B. No.

9. What size of meals / drinks do you order?
A. Small.
B. Medium.
C. Large.
D. Super-size (only if you have it in the restaurants in your country)

10. What beverages (drinks) do you order in restaurants?
A. Water.
B. Juice.
C. Soda.
D. Alcohol

11. What age range are you in?
A. Under 11
B. 11-13
C. 13-16
D. 16-19
E. Older.

12. When you're not eating fast food do you eat healthy food all the time?

A. Daily

B. Twice a week

C. Once a month

D. Five times a month

13. When you have fast food do you have a salad with your meal?

A. No

B. Sometimes

C. Yes every time

14. Do you enjoy vegetables?

Yes or No

15. Which of the following do you eat at, the most often?
A. Fast Food Restaurants

16. Do you know what a Food Pyramid?

Yes or No

17. If so, do you follow it?

Yes or No

18. Are your parents concerned about your health?

Yes or No

19. Do you like fast food?
A. Yes
B. sometimes
C. only for the convenience
D. no, but I eat it
E. no

20. Who in you family eats fast food? (Mark all that apply)
A. everyone
B. the kids (under 10)
C. the teenagers (11 to 19)
D. the young adults (20- 29)
E. middle ages (30's or 40's)
F. older adults (over 50)