Life Balance for Teens

Do you eat breakfast?

• Never

• Sometimes

• Most days

• Yes, everyday.

in a TYPICAL day, how much time do you spend on LEISURE video/internet/gaming activities? (Do not count school work.)

• 1 hour or less

• more than 1 and less than 2 hours

• 2 or more and less than 3 hours

• 3 or more hours

In a TYPICAL day, how many servings of fruits or vegetables do you eat.

• 0 - none

• 1-2

• 3-4

• 5 or more

How much time do you spend on school days completing homework (completing worksheets, reading assignments, completing projects or activities)?

• I rarely do homework

• less than 30 minutes

• 30 minutes to one hour

• between 1-2 hours

• more than 2 hours

What do you do when something (or someone) is bothering you?

• I get really upset sometimes.

• I just keep it to myself.

• I talk to a friend.

• I talk to an adult.

How many days each week do you engage in sustained physical exercise of 30 minutes or more?

• 0 - none

• 1-2

• 3-4

• 5-7

On nights before school days, how much sleep do you usual get?

• less than 5 hours

• 5-6 hours

• 6-7 hours

• 8 hours or more

How would you describe your STUDY habits? Study habits include reviewing notes or reading assignments, quizzing yourself or with study partners, & other methods used to remember information for tests or quizzes.

• I never really study.

• I study only if I have a test the next day.

• I study most school days.

• I study at least one hour most school days.

How many times each month do you participate in sports games or recreational exercise that lasts an hour or more?

• 0 - never

• at least once each month

• 2-3 times per month

• 4 or more times per month.

When I am angry, I ....

• keep it to myself

• I sometimes yell at people.

• I throw things.

• I talk to someone about it.

• I do things to calm down like deep breathing, exercising, or thinking about something pleasant.