Department of Nutrition & Dietetics Faculty of Medicine & Health Sciences PKK 3304 Behavior and Health

Health Behavior Questionnaire

Please circle your answer to these questions. There are NO right or wrong answers. This is NOT a quiz that will be graded. 1. My health is: A. Poor B. Fair C. Good D. Excellent My diet is: A. Low fat B. Moderate fat C. High fat My cholesterol is: A. High B. Normal C. I don't now I eat breakfast A. Everyday B. 4-6 days a week C. 1-3 days/week D. Rarely I smoke: A. Not at all B. 0-10 cigarettes/day C. 11-20 cigarettes/day D. more than 20 per day I usually sleep _______ hours a night. A. Less than 6 B. 6 C. 7 D. 8 E. More than 8 I have at least one close friend or intimate relationship A. True B. False

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I am satisfied with my academic performance A. Never or rarely B. Sometimes C. Usually D. Always My stress level is: A. Low B. Moderate C. High I exercise for 20 minutes or more: A. Never or rarely B. Once or twice per week C. 3 or 4 times per week D. 5 or more times per week My blood pressure is: A. High B. Normal C. I don't know My alcohol consumption is: A. None B. Less than one drink a day C. One drink a day D. More than one drink a day E. More than 4-5 drinks at a time whenever I drink (binge drinking) I practice safe sex: A. Always B. Sometimes C. Never D. I don't have sex now E. I have never had sex I use my seat belt whenever I am driving or in a car: A. Always B. Sometimes C. Never I avoid exposure to the sun (wear clothes or use sunscreen): A. Always B. Sometimes C. Never I brush my teeth: A. More than once daily B. Once a day C. Less than once a day D. Rarely or never 2

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I floss my teeth A. More than once daily B. Once a day C. Less than once a day D. Rarely or never I share personal items (toothbrush, hairbrush, towels, etc.) with other people. A. True B. False I share eating and drinking utensils (glasses, forks, spoons, napkins, etc.) with other people. A. True B. False I take medication which has been prescribed to me for a chronic health problem every day: A. True B. False One serving of a certain food has 90 calories. This serving contains 10 grams of fat. There are 9 calories in a gram of fat. What percent of the calories in this serving are from fat? A. 100% B. 90% C. 10% D. 9% E. None of the above are correct I am: A. Female B. Male I am: A. Freshman (Bongsu) B. Sophomore (Kecil) C. Junior (Muda) D. Senior (Sulung) I am My weight is I am a A. Chinese B. Indian C. Malay D. Others years old kg and my height is cm

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PKK3304/Sem 2, 2012-2013 / 19 February 2013