Form 9 survey

Public reporting burden for this collection of information is estimated to average 10 minutes per response, including the time for reviewing

instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of

information. An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a

currently valid OMB control number. Send comments regarding this burden estimate or any other aspect of this collection of information, including

suggestions for reducing this burden, to: NIH, Project Clearance Branch, 6705 Rockledge Drive, MSC 7974, Bethesda, MD 20892-7974, ATTN:

PRA (####-####). Do not return the completed form to this address.

NEXT Generation Health Study

Date:

__________

Student ID:

School Data Collection Form

(insert label)

Height1: ___ ___ ___ . ___ cm

Height2: ___ ___ ___ . ___ cm

If needed:

Height3: ___ ___ ___ . ___ cm

Two must be within

Height4: ___ ___ ___ . ___ cm

≤

+ 1.0 cm of each other

Height5: ___ ___ ___ . ___ cm

Height6: ___ ___ ___ . ___ cm

Weight1: ___ ___ ___ . ___ kg

Weight2: ___ ___ ___ . ___ kg

If needed:

Weight3: ___ ___ ___ . ___ kg

Two must be within

Weight4: ___ ___ ___ . ___ kg

≤

+ 0.2 kg of each other

Weight5: ___ ___ ___ . ___ kg

Weight6: ___ ___ ___ . ___ kg

Waist1: ___ ___ ___ . ___ cm

Waist2: ___ ___ ___ . ___ cm

If needed:

Waist3: ___ ___ ___ . ___ cm

Two must be within

Waist4: ___ ___ ___ . ___ cm

≤

+ 1 cm of each other

Waist5: ___ ___ ___ . ___ cm

Gift Card given:

…

Yes

…

No

Saliva sample:

…

Completed

…

Not completed

If not, reason _____________________________________

Gift Card given:

…

Yes

…

No

NEXT Plus Home Data Collection

Public reporting burden for this collection of information is estimated to average 15 minutes per response, including the time for reviewing instructions, searching

existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. An agency may not conduct or

sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number. Send comments regarding

this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to: NIH, Project Clearance Branch, 6705

Rockledge Drive, MSC 7974, Bethesda, MD 20892-7974, ATTN: PRA (####-####). Do not return the completed form to this address.

NEXT Plus

Date:

__________

Student ID:

Home Data Collection Form

(insert label)

Start time: ____

Height1: ___ ___ ___ . ___ cm Height2: ___ ___ ___ . ___ cm

If needed:

Height3: ___ ___ ___ . ___ cm

Two must be within

Height4: ___ ___ ___ . ___ cm

≤

+ 1.0 cm of each other

Height5: ___ ___ ___ . ___ cm

Height6: ___ ___ ___ . ___ cm

Weight1: ___ ___ ___ . ___ kg

Weight2: ___ ___ ___ . ___ kg

If needed:

Weight3: ___ ___ ___ . ___ kg

Two must be within

Weight4: ___ ___ ___ . ___ kg

≤

+ 0.2 kg of each other

Weight5: ___ ___ ___ . ___ kg

Weight6: ___ ___ ___ . ___ kg

Waist1: ___ ___ ___ . ___ cm

Waist2: ___ ___ ___ . ___ cm

If needed:

Waist3: ___ ___ ___ . ___ cm

Two must be within

Waist4: ___ ___ ___ . ___ cm

≤

+ 1 cm of each other

Waist5: ___ ___ ___ . ___ cm

BP1: ______/_____ mm Hg

BP2: ______/_____ mm Hg

BP3: ______/_____ mm Hg

If any 2 of the 3 systolic measures OR any 2 of the 3 diastolic measures differ by > 20 mm Hg, then redo the entire BP measurement procedures

and record those values on the data collection form below.

BP4: ______/_____ mm Hg

BP5: ______/_____ mm Hg

BP6: ______/_____ mm Hg

[

if BP is over the 95

th

percentile for age, gende,r and height, please notify parent immediately and advise contacting health care provider]

Accelerometer Training:

…

Completed

…

Not completed

Start time: ____ End time: ____

If not, reason _____________________________________________

ActiWatch Training:

…

Completed

…

Not completed

Start time: ____ End time: ____

If not, reason ______________________________________________

Physical Activity

Diary Training:

…

Completed

…

Not completed

Start time: ____ End time: ____

If not, reason _______________________________________________

Dietary Recall Training:

…

Completed

…

Not completed

Start time: ____ End time: ____

If not, reason _______________________________________________

NEXT Plus Home Data Collection

Public reporting burden for this collection of information is estimated to average 15 minutes per response, including the time for reviewing instructions, searching

existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. An agency may not conduct or

sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number. Send comments regarding

this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to: NIH, Project Clearance Branch, 6705

Rockledge Drive, MSC 7974, Bethesda, MD 20892-7974, ATTN: PRA (####-####). Do not return the completed form to this address.

NEXT Plus

Date:

__________

Student ID:

Home Data Collection Form

(insert label)

Start time: ____

Height1: ___ ___ ___ . ___ cm Height2: ___ ___ ___ . ___ cm

If needed:

Height3: ___ ___ ___ . ___ cm

Two must be within

Height4: ___ ___ ___ . ___ cm

≤

+ 1.0 cm of each other

Height5: ___ ___ ___ . ___ cm

Height6: ___ ___ ___ . ___ cm

Weight1: ___ ___ ___ . ___ kg

Weight2: ___ ___ ___ . ___ kg

If needed:

Weight3: ___ ___ ___ . ___ kg

Two must be within

Weight4: ___ ___ ___ . ___ kg

≤

+ 0.2 kg of each other

Weight5: ___ ___ ___ . ___ kg

Weight6: ___ ___ ___ . ___ kg

Waist1: ___ ___ ___ . ___ cm

Waist2: ___ ___ ___ . ___ cm

If needed:

Waist3: ___ ___ ___ . ___ cm

Two must be within

Waist4: ___ ___ ___ . ___ cm

≤

+ 1 cm of each other

Waist5: ___ ___ ___ . ___ cm

BP1: ______/_____ mm Hg

BP2: ______/_____ mm Hg

BP3: ______/_____ mm Hg

If any 2 of the 3 systolic measures OR any 2 of the 3 diastolic measures differ by > 20 mm Hg, then redo the entire BP measurement procedures

and record those values on the data collection form below.

BP4: ______/_____ mm Hg

BP5: ______/_____ mm Hg

BP6: ______/_____ mm Hg

[

if BP is over the 95

th

percentile for age, gende,r and height, please notify parent immediately and advise contacting health care provider]

Accelerometer Training:

…

Completed

…

Not completed

Start time: ____ End time: ____

If not, reason _____________________________________________

ActiWatch Training:

…

Completed

…

Not completed

Start time: ____ End time: ____

If not, reason ______________________________________________

Physical Activity

Diary Training:

…

Completed

…

Not completed

Start time: ____ End time: ____

If not, reason _______________________________________________

Dietary Recall Training:

…

Completed

…

Not completed

Start time: ____ End time: ____

If not, reason _______________________________________________