Form 5 Adolescent Physical Activity Survey

The Family Life, Activity, Sun, Health, and Eating Study (NCI)

Attach1_Teen Physical Activity Survey REV 2104

Adolescent Physical Activity Survey Instrument (Attachment I)

OMB: 0925-0686

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Those who answer ‘no’ to “Are you currently in school?” receive the following question series and then are routed to Section 2.







Those who answered ‘yes’ to “Are you currently in school?” (the last question on page 3 of this document) receive this question:

Any answer above goes to the question below.

The questions for students in elementary school versus middle school and high school follow. Everyone resumes the same question series at Section 2.













Elementary School Student Series:











Middle and High School student series:















2


File Typeapplication/vnd.openxmlformats-officedocument.wordprocessingml.document
AuthorKaty Caperna
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File Created2021-01-27

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