Team Nutrition Educational Materials for Summer Meals - Individuals/Households (IC 2 of 2)

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Attachment K: Child Survey

• Hello, my name is ________ and I’m a researcher. That means I like to ask a lot of questions.

• This site was selected to try some new activities this summer and we want to know what you think. We also want to know what children your age like to eat and drink and activities you like to do in the summer.

• It will take about 5 minutes for the interview.

• No friends, parents or people here will see your answers. Later, when we tell people what we learned, we will not use your name and no one will know who we are talking about.

• If you do not want to answer a question, you can skip it. You may stop being part of this project at any time by letting us know or you can tell any adult working here.

• Being part of this interview is completely up to you. Whatever you choose is OK, and you can still do all of the activities here.

• Do you have any questions?

• Would you like to participate?

[Note: The child should answer “Yes” or “No.” Only a definite “Yes” may be taken as assent to participate.]

Great, let’s get started. [Note to interviewer: read all questions to child and use finger to show the answers as you read].

1. If you were going to tell your friend three ways they could be healthy during the summer, what would they be?

[Note to interviewer: Only indicate whether children reply using the specific codes below that represent messages from the summer meals activities

• Make 1/2 your plate fruits and vegetables

• Vary your fruit and vegetables

• Choose foods from all five good groups

• Get moving for 60 minutes a day

• Drink water

• Limit sugar-sweetened beverages

• Eat Smart and Play Hard

• Limit screen time

2. How many minutes of physical activity should you get each day?

• At least 15 minutes

• At least 30 minutes

• At least 45 minutes

• At least 60 minutes

• At least 2 hours

3. Which of the following are sugar-sweetened drinks?

• Water

• Sparkling water

• Regular (not diet) soft drinks, soda, or pop.

• Fruit punch

• Lemonade

• 100% juice

• Sports drinks

4. What are the names of the five food groups?

____________________________________

____________________________________

____________________________________

____________________________________

____________________________________

Please listen to the following statements. After each one, answer either “Not Sure”, “I Think So”, or “Very Sure” to indicate how much you agree.

I can snack on fruits I like (such as grapes or bananas) instead of on foods like cake or cookies.	Not Sure	I Think So	Very Sure
I can snack on vegetables I like (such as carrots or celery sticks) instead of on foods like potato or corn chips.	Not Sure	I Think So	Very Sure

7. Check the days during the last week that you exercised or took part in physical activity that made your heart beat fast and made you breathe hard for at least 60 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 60 minutes

• Monday

• Tuesday

• Wednesday

• Thursday

• Friday

• Saturday

• Sunday

8. Yesterday, did you drink any punch, sports drinks or other fruit-flavored drinks? Do not count 100% fruit juice or diet drinks.

• 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.

9. Yesterday, did you drink any regular (not diet) sodas, soft drinks, or pop?

• No, I didn’t drink any regular (not diet) sodas or soft drinks yesterday.

• Yes, I drank regular (not diet) sodas or soft drinks 1 time yesterday.

• Yes, I drank regular (not diet) sodas or soft drinks 2 times yesterday.

• Yes, I drank regular (not diet) sodas or soft drinks 3 or more times yesterday.

10. Yesterday, did you drink any water or plain sparkling water, such as water from a glass, a bottle, or a water fountain?

• No, I didn’t drink any water yesterday.

• Yes, I drank water 1 time yesterday.

• Yes, I drank water 2 times yesterday.

• Yes, I drank water 3 times yesterday.

• Yes, I drank water 4 times yesterday.

• Yes, I drank water 5 or more times yesterday.

11. Yesterday, did you eat French fries or chips? Chips are potato chips, tortilla chips, corn ships, 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.

12. Yesterday, did you eat any sweet rolls, doughnuts, cookies, brownies, pies, or cake?

• No, I didn’t eat any of these foods 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.

Please respond either “No” or “Yes” for each of the sentences below. “No” means that you do not agree with the sentence. “Yes” means that you agree with the sentence. Remember that physical activity can be any play, game, sport, or exercise that gets you moving and breathing harder.

I think I can be physically active in the summer.	No	Yes
I think I can be physically active even if it is very hot or cold outside	No	Yes
I think I have the skills I need to be physically active	No	Yes
I think I can ask my best friend to be physically active with me.	No	Yes

17. About how many hours a day do you usually watch television (including movies) in your free time? [Note: Show the list of responses for each question]

• Not at all

• About half an hour a day

• About 1 hour a day

• About 2 hours a day

• About 3 hours a day

• About 4 hours a day

• About 5 hours a day

• About 6 hours a day

• About 7 or more hours a day

18. About how many hours a day do you usually use a computer (for playing games, emailing, chatting or surfing on the internet) in your free time?

• Not at all

• About half an hour a day

• About 1 hour a day

• About 2 hours a day

• About 3 hours a day

• About 4 hours a day

• About 5 hours a day

• About 6 hours a day

• About 7 or more hours a day

19. [Post-Test Only] What did you like most about coming to this summer meals site?

20. [Post-Test Only] How often did you attend this summer meals site this summer?

• A few times this summer

• About one day a week

• About two days a week

• About three days a week

• About four or more days a week