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THE SURVEY FOR PARENTS

Association NCE

PROJECT:
BUILDING UP THE HEALTH AWARENESS AMONG PARENTS

Child

Age: ________ Gender: ________

Who does the child live with? Father Mother Siblings Others: ..........

Is there anyone in the family having the obesity? Yes No

Parents

Age: ________ Gender: ________

Level of education: ...................................................


Yes No

Food Survey

Food Survey

1. How often does your child eat the following food items:

Rarely or never

At least once

a week

At least once

a day

Fruits

Vegetables

Sweet or junk food (e.g. chocolate; croissant; sugary breakfast cereals), food with added sugar (e.g. added sugar to milk), soft drinks

Dairy products (e.g. milk; yoghurt; cheese)

Fish, eggs, meat

Cereals or cereal-based food (e.g. bread; pasta; rice; corn), Pulses (e.g. beans; chickpeas) and Wholemeal food

2. How often does your child:

Rarely or never

1-3 times a week

3-6 times a week

Everyday

Eat a soup

Eat a fast-food

Have a breakfast

Have meals with his/her family

3. While doing shopping, do you usually choose food with a label including the following:

Rarely or never

Sometimes

Often

“Low sugar or sugar free”

“Low fat or fat free”

4. Have you ever had any contact with nutritionist issues (training, professional advice/guidance)? Yes No

Lifestyle Survey

1. How many hours per day does your child spend on the TV or computer?

· 1-2 hours

· 3-4 hours

· more than 4 hours

· I don't know

2. How many times a week does your child spend his/her free time on physical activities?

· 1-2 times

· 3-4 times

· more than 4 times

· I don’t know

3. How many hours does your child usually sleep?

· 1-4 hours

· 5-7 hours

· 8-10 hours

· I don’t know

4. Have you ever met in your family environment with:

· Drugs

· Cigarettes

· Alcohol

· Medicines




This project has been funded with support from the European Commission. This publication reflects the views only of the author, and the Commission cannot be held responsible for any use which may be made of the information contained therein.


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