Please Wait...
Adolescent Obiesity Template -Form Fill
Questions
Q01
Do you have anyone in this household who is aged 10-19 years?
Yes
No
Q02
If yes, will it be possible to directly speak to this person right now but with you also being present?
Yes, you may
No, you may not
You may but once he/she comes home (seek a time and terminate the call for later)
COMMENCE INTERVIEW WITH INDEX CHILD
A01
What is your name?
A02
Record gender of index respondent
Male
Female
A03
What is your age in completed years?
A04
Did you consume any biscuits during the last 7 days?
Yes
No
A05
How many days during the last one week did you consume biscuits?
A06
If yes in Q6, then were they branded biscuits or locally made unbranded biscuits?
Branded
Unbranded
Both
A07
Where did you procure these biscuits? (Multiple responses possible)
Given at home and consumed at home
Given at home but consumed at school
Bought from the school canteen
Bought from local hawker/vendor/thelawala
Bought from a local store and consumed outside of home
Given at a friend’s /relation’s /other’s home
Given at a social gathering/event
A08
Did you consume Maggie or any other brand of instant noodles during the last 7 days?
Yes
No
A09
How many days during the last one week did you consume instant noodles?
A10
Where did you procure these instant noodles meals? (Multiple responses possible)
Given at home and consumed at home
Given at home but consumed at school
Bought from the school canteen
Bought from local hawker/vendor/thelawala
Bought from a local store and consumed outside of home
Given at a friend’s /relation’s /other’s home
Given at a social gathering/event
A11
Did you consume any sliced bread during the last 7 days?
Yes
No
A12
How many days during the last one week did you consume sliced bread?
A13
Where did you procure this sliced bread? (Multiple responses possible)
Given at home and consumed at home
Given at home but consumed at school
Bought from the school canteen
Bought from local hawker/vendor/thelawala
Bought from a local store and consumed outside of home
Given at a friend’s /relation’s /other’s home
Given at a social gathering/event
A14
Did you consume any chips/Kurkure type of snacks during the last 7 days?
Yes
No
A15
How many days during the last one week did you consume chips/Kurkure type of snacks?
A16
Where did you procure this chips/Kurkure type of snacks? (Multiple responses possible)
Given at home and consumed at home
Given at home but consumed at school
Bought from the school canteen
Bought from local hawker/vendor/thelawala
Bought from a local store and consumed outside of home
Given at a friend’s /relation’s /other’s home
Given at a social gathering/event
A17
Did you consume any cold drinks/soft drinks (like Pepsi) during the last 7 days?
Yes
No
A18
How many days during the last one week did you consume any cold drinks/soft drinks (like Pepsi)?
A19
Where did you procure this cold drinks/soft drinks (like Pepsi)? (Multiple responses possible)
Given at home and consumed at home
Given at home but consumed at school
Bought from the school canteen
Bought from local hawker/vendor/thelawala
Bought from a local store and consumed outside of home
Given at a friend’s /relation’s /other’s home
Given at a social gathering/event
A20
Did you consume any sweets (other than chocolates or ice cream) during the last 7 days?
Yes
No
A21
How many days during the last one week did you consume any sweets (other than chocolates or ice cream)?
A22
Where did you procure these sweets (other than chocolates or ice cream)? (Multiple responses possible)
Given at home and consumed at home
Given at home but consumed at school
Bought from the school canteen
Bought from local hawker/vendor/thelawala
Bought from a local store and consumed outside of home
Given at a friend’s /relation’s /other’s home
Given at a social gathering/event
A23
Did you consume any chocolates/ice cream/lozenges during the last 7 days?
Yes
No
A24
How many days during the last one week did you consume any chocolates/ice cream/lozenges?
A25
Where did you procure these chocolates/ice cream/lozenges? (Multiple responses possible)
Given at home and consumed at home
Given at home but consumed at school
Bought from the school canteen
Bought from local hawker/vendor/thelawala
Bought from a local store and consumed outside of home
Given at a friend’s /relation’s /other’s home
Given at a social gathering/event
A26
During the last 7 days, apart from any meals given from school or any tiffin packed from home which you carried to school or work, how many days have you had any major meal outside of your home (by major meal we mean morning breakfast, lunch, or dinner)?
A27
What was the source of these meals? (Multiple responses possible)
School canteen
Local eatery/hotel
Friends/relatives’ house
Local hawker/vendor/thelawala
Social gathering/event
Bhandara
Restaurant/hotel in the nearby town
A28
Which of the following items did you consume yesterday and where?
Biscuits
Instant noodles
Sliced bread
Chips/Kurkure type of snacks
Cold drinks/soft drinks
Sweets (other than chocolates or ice cream)
Chocolates/ice cream /lozenges
A28_1
At home
Biscuits
Instant noodles
Sliced bread
Chips/Kurkure type of snacks
Cold drinks/soft drinks
Sweets (other than chocolates or ice cream)
Chocolates/ice cream /lozenges
A28_2
At school
Biscuits
Instant noodles
Sliced bread
Chips/Kurkure type of snacks
Cold drinks/soft drinks
Sweets (other than chocolates or ice cream)
Chocolates/ice cream /lozenges
A28_3
Outside of home and school
Biscuits
Instant noodles
Sliced bread
Chips/Kurkure type of snacks
Cold drinks/soft drinks
Sweets (other than chocolates or ice cream)
Chocolates/ice cream /lozenges
A29
Among the following assets, which ones are owned by your household?
Own pucca house
Own semi pucca/kuccha house
Metered electricity
Ceiling fan
Cooler
LPG stove
Colour TV
Refrigerator
Functional toilet within premises
Personal handpump
Agricultural land (≥ 1 ha)
Agricultural land (< 1 ha)
Tractor
Harvester/thrasher
Tube well with electric pump set
Milch cattle
Sewing machine
2-wheeler/3-wheeler
4-wheeler
Dear user, please upgrade your plan to access this feature
See Plans
Please Wait