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Department of Nutrition & Dietetics Faculty of Medicine & Health Sciences PKK 3304 – Behavior and Health

Health Behavior Questionnaire
Please circle your answer to these questions. There are NO right or wrong answers. This is NOT a quiz that will be graded. 1. My health is: A. Poor B. Fair C. Good D. Excellent My diet is: A. Low fat B. Moderate fat C. High fat My cholesterol is: A. High B. Normal C. I don't now I eat breakfast A. Everyday B. 4-6 days a week C. 1-3 days/week D. Rarely I smoke: A. Not at all B. 0-10 cigarettes/day C. 11-20 cigarettes/day D. more than 20 per day I usually sleep _______ hours a night. A. Less than 6 B. 6 C. 7 D. 8 E. More than 8 I have at least one close friend or intimate relationship A. True B. False

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PKK3304/Sem 2, 2012-2013 / 19 February 2013

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One drink a day D. Sometimes C. Always B. 5 or more times per week My blood pressure is: A. More than 4-5 drinks at a time whenever I drink (binge drinking) I practice safe sex: A.8. Rarely or never 2 9. PKK3304/Sem 2. High I exercise for 20 minutes or more: A. 11. Always My stress level is: A. High B. 16. Never or rarely B. Sometimes C. Usually D. 2012-2013 / 19 February 2013 . Moderate C. Always B. More than once daily B. Low B. 12. 14. Sometimes C. Once or twice per week C. I have never had sex I use my seat belt whenever I am driving or in a car: A. 10. Less than one drink a day C. Never I brush my teeth: A. 13. 3 or 4 times per week D. Never I avoid exposure to the sun (wear clothes or use sunscreen): A. Always B. Never or rarely B. Normal C. Never D. I don't know My alcohol consumption is: A. Less than once a day D. Sometimes C. I don't have sex now E. None B. Once a day C. More than one drink a day E. 15. I am satisfied with my academic performance A.

Indian C. hairbrush. PKK3304/Sem 2. I floss my teeth A. 90% C.) with other people.) with other people. 24. None of the above are correct I am: A. 9% E. More than once daily B. True B. A. Junior (Muda) D. False I take medication which has been prescribed to me for a chronic health problem every day: A. 19. Rarely or never I share personal items (toothbrush. 10% D. etc.17. Less than once a day D. 2012-2013 / 19 February 2013 3 . 100% B. True B. forks. Others years old kg and my height is cm 18. towels. False I share eating and drinking utensils (glasses. What percent of the calories in this serving are from fat? A. Once a day C. etc. napkins. Female B. True B. 21. Malay D. This serving contains 10 grams of fat. spoons. 26. Sophomore (Kecil) C. Freshman (Bongsu) B. 20. Male I am: A. Senior (Sulung) I am My weight is I am a A. False One serving of a certain food has 90 calories. A. 25. 22. 23. There are 9 calories in a gram of fat. Chinese B.