Demographics

Name:  

Age: 

Race/ethnicity:

Gender:

Height: feet inches

Weight: pounds

Sexual orientation:

Marital or partner status:

Highest educational degree:

Estimated household income:

How did you hear about this survey?

Contact information

Address:

Phone number (please include area code):

Email address:  

In order to protect your confidentiality, we will separate your name and contact information  from the rest of this survey and store it in a different database.  You will be identified only by a participant number in the main database.

 HEALTH PRACTICE #1  (If you need to see the examples of health practices again, CLICK HERE)

Please list the health practice:

PLEASE ANSWER THE FOLLOWING QUESTIONS IN RELATION TO THE HEALTH PRACTICE YOU LISTED:

1. Please provide a brief description of how you engage in this practice in a typical week (e.g., how many times per week?, how often?)

2. When did you begin to engage in this practice regularly?

3. What motivated you to start?

4.Were there any times in which you stopped doing the practice but started up again?  If so, how were you able to begin it again?

5. What motivates you to do the practice now?

6. On a scale from 1 to 10, where 1= not at all enjoyable and 10 = extremely enjoyable, how enjoyable do you find engaging in this practice?

7. What are the obstacles to you engaging in this practice?

    7a. How do you overcome these obstacles?

8. What supports you in engaging in this practice?

9. On a scale from 1 to 10, where 1= not at all confident and 10 = extremely confident, how confident are you that you will continue to engage in this practice in the future?

 HEALTH PRACTICE #2  (If you need to see the examples of health practices again, CLICK HERE)

Please list the health practice:

PLEASE ANSWER THE FOLLOWING QUESTIONS IN RELATION TO THE HEALTH PRACTICE YOU LISTED:

1. Please provide a brief description of how you engage in this practice in a typical week (e.g., how many times per week?, how often?)

2. When did you begin to engage in this practice regularly?

3. What motivated you to start?

4.Were there any times in which you stopped doing the practice but started up again?  If so, how were you able to begin it again?

5. What motivates you to do the practice now?

6. On a scale from 1 to 10, where 1= not at all enjoyable and 10 = extremely enjoyable, how enjoyable do you find engaging in this practice?

7. What are the obstacles to you engaging in this practice?

    7a. How do you overcome these obstacles?

8. What supports you in engaging in this practice?

9. On a scale from 1 to 10, where 1= not at all confident and 10 = extremely confident, how confident are you that you will continue to engage in this practice in the future?

 HEALTH PRACTICE #3  (If you need to see the examples of health practices again, CLICK HERE)

Please list the health practice:

PLEASE ANSWER THE FOLLOWING QUESTIONS IN RELATION TO THE HEALTH PRACTICE YOU LISTED:

1. Please provide a brief description of how you engage in this practice in a typical week (e.g., how many times per week?, how often?)

2. When did you begin to engage in this practice regularly?

3. What motivated you to start?

4.Were there any times in which you stopped doing the practice but started up again?  If so, how were you able to begin it again?

5. What motivates you to do the practice now?

6. On a scale from 1 to 10, where 1= not at all enjoyable and 10 = extremely enjoyable, how enjoyable do you find engaging in this practice?

7. What are the obstacles to you engaging in this practice?

    7a. How do you overcome these obstacles?

8. What supports you in engaging in this practice?

9. On a scale from 1 to 10, where 1= not at all confident and 10 = extremely confident, how confident are you that you will continue to engage in this practice in the future?

 HEALTH PRACTICE #4  (If you need to see the examples of health practices again, CLICK HERE)

Please list the health practice:

PLEASE ANSWER THE FOLLOWING QUESTIONS IN RELATION TO THE HEALTH PRACTICE YOU LISTED:

1. Please provide a brief description of how you engage in this practice in a typical week (e.g., how many times per week?, how often?)

2. When did you begin to engage in this practice regularly?

3. What motivated you to start?

4.Were there any times in which you stopped doing the practice but started up again?  If so, how were you able to begin it again?

5. What motivates you to do the practice now?

6. On a scale from 1 to 10, where 1= not at all enjoyable and 10 = extremely enjoyable, how enjoyable do you find engaging in this practice?

7. What are the obstacles to you engaging in this practice?

    7a. How do you overcome these obstacles?

8. What supports you in engaging in this practice?

9. On a scale from 1 to 10, where 1= not at all confident and 10 = extremely confident, how confident are you that you will continue to engage in this practice in the future?

 HEALTH PRACTICE #5  (If you need to see the examples of health practices again, CLICK HERE)

Please list the health practice:

PLEASE ANSWER THE FOLLOWING QUESTIONS IN RELATION TO THE HEALTH PRACTICE YOU LISTED:

1. Please provide a brief description of how you engage in this practice in a typical week (e.g., how many times per week?, how often?)

2. When did you begin to engage in this practice regularly?

3. What motivated you to start?

4.Were there any times in which you stopped doing the practice but started up again?  If so, how were you able to begin it again?

5. What motivates you to do the practice now?

6. On a scale from 1 to 10, where 1= not at all enjoyable and 10 = extremely enjoyable, how enjoyable do you find engaging in this practice?

7. What are the obstacles to you engaging in this practice?

    7a. How do you overcome these obstacles?

8. What supports you in engaging in this practice?

9. On a scale from 1 to 10, where 1= not at all confident and 10 = extremely confident, how confident are you that you will continue to engage in this practice in the future?

Any other comments?