SCHEDULE TO ELICIT THE INFORMATION ON THE SOCIO - ECONOMIC LIFE STYLE AND HEALTH STATUS OF ADOLESCENT GIRLS

I. 1. 2. 3. 4. 5. 6. 7.

GENERAL INFORMATION Name of the subject Address Age Educational Qualification Religion Community Family Type : : : a) 13-15 : : a) Hindu : : a) NUCLEAR b) JOINT b) Christian c) Muslim b) 16- 18 c) 19-20

8. FAMILY COMPOSITION
SL No: Member Sex Relation to subject Age Educational Status Occupation Income

II.
9.

LIFE STYLE
How do you spend your free time? a) With internet b) with TV

10.

When you first started using computer? a) 16 yrs b) 18 yrs c) 20 yrs d) less than 16 years

11.

How did you learn to use the internet? a) At home b) At College c) Friends home d) Others

12.

How do you access internet? a) Indoor b) Outdoor

13.

How do you use internet? a) Individual b) with peer

14.

What is the purpose of using computer? a) Studying b) Entertainment c) Others

15.

Where do you keep your computer? a) Common room b) Own room c) others

16.

How often do you use the internet? a) Every day b) 2-3 day/week c) 6-7 days/week

17.

How much time do you spent on the computer? a) 1 hr b) 2 hrs c) 3 hrs d) more than 3 hrs.

18.

When will you use the internet? a) Day time b) Night time c) both

19.

How much time you spent on your academics daily? a) 1 hr b) 2 hrs c) 3hrs d) more than 3 hrs

20.

How long do you sleep daily? a) 6 hrs b) 8 hrs c) more than 8 hrs d) Not sleeping

21.

Do you exercise regularly? a) Yes b) No

22.

How long you take exercise? a) hr b) 1 hr c) more than 1 hr d) No exercise

23.

When will you take exercise regularly? a) Early morning b) Evening c) Whenever free

24.

Do you consider yourself as a healthy individual?

a) Yes

b) No

III. DIETARY HABITS

25. Do you have a balanced diet? a) Yes 26. b) No c) dont know

Do you have knowledge about nutrition? a) Yes b) No c) No more

27.

Do you skip any meal? a) Yes b) No c) Sometime

28.

Reason for skipping? a) Lack of time b) Dislike c) Stress d) Lack of appetite

29.

Do you have habit of munching in between meals? a) Yes b) No c) Some time

30.

Do you have habit of munching while using internet? a) Yes b) No c) Some time

31.

Do you eat vegetable and fruits regularly? a) Yes b) No c) Sometime

32.

How many meals do you intake on daily basis? a) 2 meals/day b) 3 meals/day c) 4 meals/day

33.

Are you a vegetarian? a) Yes b) No

34.

Do you wash fruits before eating? a) Yes b) No c) Sometime

35.

Do you consume food from outside? a) Yes b) No c) Sometime

36.

What kind of food do you take from outside? a) Snacks b) Baked items c) Fast foods d) Others

37.

How much water do you consume?

a) 4 glass 38.

b) 6 glass

c) 8 glass

d) More than 8 glass

Which of the beverages do you drink regularly? a) Milk b) Tea/Coffee c) Pop d) Juice

39.

Do you take desert after the meals? a) Always b) Often c) Some time d) Never

IV. HEALTH STATUS

40. Do you have headache while using computer? a) Yes 41. b) No c) Some time d) Usually

Do you have regular menstrual cycle? a) Yes b) No

42.

Do you have any menstrual discomforts? a) Yes b) No

43.

If yes a) Headache b) Fatigue c) Abdominal pain d) Vomiting e) Back pain

44.

Do you take any special food during menstruation? a) Yes b) No

45.

Do you perform any household activities? a) Yes b) No

46.

Do you take any Iron supplements? a) Yes b) No

SCHEDULE TO ELICIT THE NUTRITIONAL STATUS

V. ANTHROPOMETRIC MEASUREMENT
a) Height (cm) b) Weight (Kg) c) BMI d) Waist-hip ratio e) Mid upper Circumference f) Skin fold thickness: : : : : :

VI. BIOCHEMICAL ASSESSMENT

a) Blood haemoglobin level b) Blood Cholesterol level : :

VII. CLINICAL ASSESSMENT

Eyes a) Normal Skin a) Rough b) Wrinkled c) Scaly b) Coloured d) dry d) keratinised

Nail a) Pale b) Pink c) Spoon Shaped d) Dark Coloration

X.

CHECKING AWARENESS MODULE Agree Disagree Dont

Statement

know
Deficiency of iron cause anemia High salt in the diet not cause hypertension Dried fruits are good source of iron Green leafy vegetables are rich in vitamin A High carbohydrate diet is necessary for a diabetic patient It is not necessary it include fruits I our diet Fibre rich food reduces cholesterol Pregnant women should take protein rich foods Milk is a good source of calcium Ajinomoto is not good health for health Lack of physical exercises lead to metabolic disorders

VIII. Dietary Survey: 24 hour recall method

TIME

MEAL

MENU

IX. Food Frequency Table

Codes : weekly1(1), weekly2(2), weekly3(3), weekly4(4), weekly5(5), weekly6(6), weekly7(7), occasionally(8), monthly(9),never(0)

Food items
1.CEREALS a. Rice b. Wheat c. Rava d. Maida e. Vermicelli f. Ragi 2.PULSES a. Bengal gram b. Green gram c. Red gram d. Black gram e. Peas f. Cow pea 3.LEAFY VEGETABLES a. Cabbage b. Cauliflower c. Amaranth d. Drumstick leaves 4. ROOTS AND TUBERSS a. Beet root b. Carrot c. Potato

codes

Food items
d. Colocasia e. Tapioca f. Yam 5.OTHER VEGETABLES a. Ash gourd b. Bitter gourd c. Brinjal d. Cucumber e. Drum stick f. Beans g. Ladies finger h. Green mango i. Pumpkin j. Snake gourd k. Plantain stem l. Cluster beans 6. FATS AND OILS a. Butter b. Ghee c. Dalda d. Coconut oil

codes

7.MILK AND MILK PRODUCTS a. Cows milk b. Buffalo milk c. Curd d. Butter milk 8.ANIMAL FOODS a. Fish b. Meat c. Egg d. Poultry

9.FRUITS a. Apple b. Banana c. Grapes d. Guava e. Mango f. Papaya 10.SUGAR a. Jaggery b. Molasses

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