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. Which of the following people would you consider to be smokers? (Check all that apply)
Which of the following people would you consider to be smokers? (Check all that apply)  A person who smokes only when socializing
A person who smokes only when drinking alcohol
A person who smokes only after eating
A person who smokes every day
A person who smokes at least once a week but not every dayA person who smokes at least once a month but not every week
A person who smokes at least once a year but not every month
2. Does anyone in your household currently smoke cigarettes, or not?
Does anyone in your household currently smoke cigarettes, or not?  Yes, someone does
No, no one does
Not sure
3. Do you currently smoke cigarettes, or not?
Do you currently smoke cigarettes, or not? Yes, I do
No, I do not
4. At what age did you start smoking cigarettes?

At what age did you start smoking cigarettes?
5. About how many cigarettes do you smoke in a typical day?

About how many cigarettes do you smoke in a typical day?
6. About how much do you spend, in U.S. dollars, on cigarettes in a typical month?

. What is your height in feet and inches? (Remove shoes beforemeasuring.)
What is your height in feet and inches? (Remove shoes before measuring.)  Feet

Inches

2. What is your current weight in pounds?




How important is exercise to you?
How important is exercise to you?  Extremely important
Very important
Moderately important
Slightly important
Not at all important

In a typical week, how many times do you exercise?

In a typical week, howmany times do you exercise?
5. What do you most often do for exercise?
What do you most often do for exercise?  Lift weights
Walk
Run
Hike
Swim
Dance
Aerobics
Pilates
Play a team sport
Other (please specify)

. In a typical day, how many of your meals or snacks include carbohydrates?

In a typical day, how many of your meals or snacks include carbohydrates?
8. In a typical day, howmany of your meals or snacks include protein?

In a typical day, how many of your meals or snacks include protein?
9. In a typical day, how many of your meals or snacks include vegetables?

In a typical day, how many of your meals or snacks include vegetables?
10. In a typical day, how many of your meals or snacks include fruit?

In a typical day, how many of your meals or snacks includefruit?

ENCUESTA HÁBITOS SALUDABLES
• Lla encuesta es anónima (no poner el nombre)
• Marcar todas las opciones que realices (no una por pregunta)
EDAD: 6-8 9-10 11-12 13-15 > 15
SEXO: Chico Chica
I. ALIMENTACIÓN BÁSICA.
1) ¿Qué comidas haces al día?
Desayuno Almuerzo Comida Merienda Cena
2) ¿Qué desayunas por las mañanas?
Nada Cereales Huevos y tortilla
Fruta o zumo de fruta TostadasYogurt
Bollería industrial Leche Café con leche
3) ¿Qué almuerzas?
Nada Cereales Fruta natural
Zumo industrial Bocadillo Frutos secos
Bollería industrial Lácteo Chucherias
4) ¿Qué comes al mediodía?
Legumbres Carne Huevos y tortilla
Pastas Pescado Bocadillo
Patatas Sopas Leche
5) ¿Qué meriendas?
Nada Cereales Fruta natural
Zumo industrial Bocadillo Frutos secos
Bolleríaindustrial Lácteo Chucherias
4) ¿Qué cenas?
Legumbres Carne Huevos y tortilla
Pastas Pescado Bocadillo
Patatas Sopas Leche
5) ¿Comes golosinas?
Todos los días De vez en cuando Nunca II. ALIMENTACIÓN SALUDABLE
6) Marca las verduras que te gustan
Tomate Zanahoria Lechuga
Patatas Espinacas Pepino
Pimientos Judías Champiñones
7) Frecuencia de consumo de verduras
Todos los días Nunca
1a 3 días a la semana 1 día a la semana
8) Marca las frutas que te gustan
Naranjas Plátanos Fresas
Manzana Pera Melocotón
Cerezas Mandarina Sandía
9) Frecuencia de consumo de frutas
Todos los días Nunca
1 a 3 días a la semana 1 día a la semana
10) Marcas las carnes y pescados que te gustan
Pollo Conejo Cordero
Ternera Cerdo Mero
Sardina Lenguado Merluza
11) Frecuencia de...