Dietary Practice and Physical Activity Questionnaire

The purpose of this study is to determine if there are differences in food

consumption and physical activity among different region university
students.
Please answer the following questions to the best of your ability. Your
answers will be kept confidential and only aggregated data will be used
for the completion of a master degree dissertation.
Height: ______m. Weight: ______kg. BMI: ______ Gender: _____
College Name: ____________________________
Name:____________________________________
Age:___
Email id: _______________________ date: __/__/ 20__
State:______________
Section I: This section of the survey will be asking you questions in
regards to how you spend your time throughout the day in daily
activities.
1. How much time do you spend watching T.V. a day ?
< 1 hour
1 3 hours
> 3 hours
2. Do you have computer?
Yes
No
If yes, how many hour/day do you spend on them?
< 1 hour
1 3 hours
> 3 hours
3. Do you play video games or computer games/ internet?
Yes
No
If yes, how many hour/day do you spend on them?
1

< 1 hour

1 3 hours

> 3 hours

4. How do you come to College often?

Walking
By bike
By your car
With driver
5. Do you drive a car/bike?
Yes
No
If yes, how many hour/day do you spend on driving?
< 1 hour
1 3 hours
> 3 hours
6. Do you do any physical activity?
Yes
No
If yes, what type of physical activity do you do?
:-

If yes, how many hour/day do you spend often?

< 1 hour
1 3 hours
> 3 hours
7. How many hours of sleep do you get on average each day?
< 7 hours
7-8 hours
> 8 hours
Section II: This section of the survey will be asking you questions in
regards to meal time, type of foods you select, place where you have
meal, frequency of consuming certain food, food allergies, and diseases
related to food intake.
1. Do you eat breakfast before going to College?
Yes
No
2

2. Do you eat at College?

Yes
No
3. Do you eat at fast food restaurants?
Yes
No
If yes, how many times/week do you eat often?
1 3 times
4 6 times
above
4. Do you consume soft drinks (pop, soda, cola)?
Yes
No
If yes, how many can/day do you drink often?
1 3 times/week
4 6 times/week
above
5. Do you consume energy drinks (Red bull, Horse power, Cloud 9,
Electrol, Glucon-D etc)?
Yes
No
If yes, how many can/bottle/litter per day do you drink often?
1 3 times/week
4 6 times/week
7 or more times/week
above
6. How often do you eat fruit?
1 3 times/week
7 or more times/week

4 6 times/week
above

7. How often do you eat vegetables?

1 3 times/week
4 6 times/week
7 or more times/week
above
8. How often do you consume milk or dairy products?
1 3 times/week
4 6 times/week
7 or more times/week
above
3

9. How often do you consume protein foods ( non-veg. meats like

mutton, beef, chicken, fish, pork or veg. like beans, lentils, nuts)?
1 3 times/week
4 6 times/week
7 or more times/week
above
10. How often do you consume breads and cereals (rice, wheat,
corn, oats) and its products?
1 3 times/week
4 6 times/week
7 or more times/week
above
11. Do you eat snacks (ice cream, chocolate, biscuit, chips, cake )?
Yes
No
If yes, how many times/day do you often eat?
1 3 times/day
> 3 times/day

If yes, what kind of snacks do you eat?

:-

12. Do you have any food allergies or food intolerances?

Yes
No
If yes, what type of allergies or food intolerances do you have?
13. Do you have any genetic gland disorders such as enlarged thyroid or
an inactive thyroid?
Yes
No
14. Do you have Diabetes Mellitus or have you been told that you need
to watch your sugars?
4

Yes

No

15. Do you have any medical problems?

Yes
No
If yes, please explain:
:-

24-Hours Food Recall Form

For Day: Date:

/ /20

List all foods and drinks you ate/drank.

For Meal Time:please write: Breakfast, Lunch, Evening Snacks,
and Dinner.
List all the names of the ingredients in mixed dishes (ex: potato, beans, meat,
green vegetable)
Use the following abbreviations:
tbsp = tablespoon; tsp = teaspoon; c = cup; oz =ounce; lb = pound; sl = slice;
p= piece
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