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Eating Behaviours Survey 

<%if request.form("Submit") <> "Submit" then %>

Regular Food Habits 

Q1.  Do you ... (please tick a response for each item)

Never Rarely Sometimes Frequently Always
Skip breakfast
Skip morning snack
Skip lunch
Skip afternoon snack
Skip dinner
Skip supper

Body satisfaction, mood and social influences

Q2.  Please answer each of the following questions ...

Yes No Sometimes
I eat more when I am bored or sad
When I am happy, I eat more
I feel hungry very often
I think I am too thin
I think I am too fat
People tell me I should lose weight
People tell me I should gain weight
I like my body the way it is

Other Food Habits

Q3.  How often do you ... (Please tick a response for each item)

Never Rarely Sometimes Frequently Always
Read food labels
Worry about food or drinks
Diet to lose weight
Diet to gain weight
Take vitamin pills

Demographics 

Q4. Gender

Male
Female

Q5. Age group

4-7 years
8-11 years
12-15 years
16-18 years
19-24 years
25-44 years
45-64 years
65 years and over

Q6. Weight    kg or lbs

Q7. Height cm or ft in

Q8. Country of residence 

Q9. Postcode (Australia only)

Have you completed this survey before? Yes No

References 

O'Dea, J., Food habits, body image and self esteem of adolescent girls from disadvantaged and non-disadvantaged backgrounds, Aust J Nutr Diet., 1994; 51: 74-78

O'Dea, J., Abraham., S., Heard, R., Food habits, body image and weight control practices of young male and female adolescents, Aust J Nutr Diet., 1996; 53:32-38

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<% 'add to database dim uscore(19) dim frmfields dim dbfields dim vbfields(30) '--define the field names in the form and the database (order is important) frmfields = Array("Q1PART1","Q1PART2","Q1PART3","Q1PART4","Q1PART5","Q1PART6","Q2PART1","Q2PART2","Q2PART3","Q2PART4","Q2PART5","Q2PART6","Q2PART7","Q2PART8","Q3PART1","Q3PART2","Q3PART3","Q3PART4","Q3PART5","Q4","Q5","Q8","Completed","") 'must end with a blank dbfields = Array("Q1PART1","Q1PART2","Q1PART3","Q1PART4","Q1PART5","Q1PART6","Q2PART1","Q2PART2","Q2PART3","Q2PART4","Q2PART5","Q2PART6","Q2PART7","Q2PART8","Q3PART1","Q3PART2","Q3PART3","Q3PART4","Q3PART5","Gender","Age","Country","CompletedBefore","Postcode","Weight","Height","EntryDate","") '--the name of the database connection and the table to be added to ADODBNAME = "eating-behaviours" TABLENAME = "Table1" 'if you want the date of entry (in american format) include the line below currentdate=Formatdatetime( now() ,2) '--read the form fields (names in frmfields) into vb array dim error error=0 numfields=0 Do while frmfields(numfields)<>"" vbfields(numfields)=request.form(frmfields(numfields)) if vbfields(numfields)="" then error=1 if numfields < 19 then uscore(numfields+1)=vbfields(numfields) numfields = numfields + 1 loop 'IF NOT FILLED IN if request.form("Q8")="Australia" and request.form("Q9")="" then error=1 if request.form("Q6kg")="" and request.form("Q6lbs")="" then error=1 if request.form("Q7cm")="" and request.form("Q7ft")="" then error=1 if error=0 then '--create additional fields in vb array (eg the entry date etc) Postcode=request.form("Q9") if Postcode="" then Postcode=" " vbfields(numfields)=Postcode numfields=numfields+1 kg=request.form("Q6kg") if kg="" then lbs=request.form("Q6lbs") vbfields(numfields)=lbs*.4536 numfields = numfields + 1 'always increment the counter when adding a field/s end if if kg<>"" then vbfields(numfields)=kg numfields = numfields + 1 'always increment the counter when adding a field/s end if cm=request.form("Q7cm") if cm="" then ft=request.form("Q7ft") inch=request.form("Q7in") if inch="" then inch=0 ft=ft*0.3048 inch=inch*2.540 vbfields(numfields)=(ft*100)+inch numfields = numfields + 1 end if if cm<>"" then vbfields(numfields)=cm numfields = numfields + 1 end if vbfields(numfields)=currentdate numfields = numfields + 1 'always increment the counter when adding a field/s 'create the insert statement InsertStmt = "INSERT INTO " InsertStmt = InsertStmt & TABLENAME InsertStmt = InsertStmt & "(" ' add all the database field names to the insert into statement count=0 Do While dbfields(count) <> "" if count<>0 then InsertStmt = InsertStmt & "," InsertStmt = InsertStmt & dbfields(count) count=count+1 loop InsertStmt = InsertStmt & ")" 'create the Values statement 'NOTE: IF THE VALUES ARE NOT OF TYPE TEXT THEN THIS WILL NEED TO BE RE-WRITTEN ValueStmt = " VALUES ( '" ' add all the values to the insert into statement count=0 Do while count0 then ValueStmt = ValueStmt & ",'" ValueStmt = ValueStmt & vbfields(count) ValueStmt = ValueStmt & "'" count=count+1 loop ValueStmt = ValueStmt & ")" 'combine to make the whole statement SQLStmt = InsertStmt & ValueStmt 'response.write SQLStmt 'start the connection, execute the sql statment and finally close the connection Set Conn = Server.CreateObject("ADODB.Connection") strConnect = "DRIVER={Microsoft Access Driver (*.mdb)};DBQ=" & Server.MapPath("/databases/eating-behaviours.mdb") conn.open(strConnect) Set RS = Conn.Execute(SQLStmt) Conn.Close response.write "Your questionnaire has been submitted" end if if error=1 then response.write "You did not complete the form. Please go back and resubmit." if error<>1 then%>

<%'----DATABASE USAGE SCRIPT----- 'variables DatabaseName="Eating Behaviours" DateAccessed = Formatdatetime( now() ,2) TimeAccessed = Formatdatetime( now() ,4) 'create SQL statement SQL="INSERT INTO Table1 (DatabaseName, DateAccessed, TimeAccessed) " SQL=SQL & "VALUES ( '" & DatabaseName & "', " SQL=SQL & "'" & DateAccessed & "', " SQL=SQL & "'" & TimeAccessed & "')" 'write to database Set Conn = Server.CreateObject("ADODB.Connection") strConnect = "DRIVER={Microsoft Access Driver (*.mdb)};DBQ=" & Server.MapPath("/databases/db-usage.mdb") conn.open(strConnect) Conn.Execute(SQL) Conn.Close %> The following graphs display your score against the average response

<% dim col(19) dim total dim score Set Conn = Server.CreateObject("ADODB.Connection") strConnect = "DRIVER={Microsoft Access Driver (*.mdb)};DBQ=" & Server.MapPath("/databases/eating-behaviours.mdb") conn.open(strConnect) sqlstmt="SELECT Table1.* FROM Table1" Set RS = Conn.Execute(sqlstmt) score=0 total=0 dim count count=0 Do While count<20 col(count)=0 count=count+1 Loop Do While Not RS.EOF Comp=RS ("CompletedBefore") if comp="No" then total=total+1 'QUESTION 1 score=RS("Q1PART1") col(1)=col(1)+score score=RS("Q1PART2") col(2)=col(2)+score score=RS("Q1PART3") col(3)=col(3)+score score=RS("Q1PART4") col(4)=col(4)+score score=RS("Q1PART5") col(5)=col(5)+score score=RS("Q1PART6") col(6)=col(6)+score 'QUESTION 2 score=RS("Q2PART1") col(7)=col(7)+score score=RS("Q2PART2") col(8)=col(8)+score score=RS("Q2PART3") col(9)=col(9)+score score=RS("Q2PART4") col(10)=col(10)+score score=RS("Q2PART5") col(11)=col(11)+score score=RS("Q2PART6") col(12)=col(12)+score score=RS("Q2PART7") col(13)=col(13)+score score=RS("Q2PART8") col(14)=col(14)+score 'QUESTION 3 score=RS("Q3PART1") col(15)=col(15)+score score=RS("Q3PART2") col(16)=col(16)+score score=RS("Q3PART3") col(17)=col(17)+score score=RS("Q3PART4") col(18)=col(18)+score score=RS("Q3PART5") col(19)=col(19)+score end if RS.MoveNext Loop Conn.Close 'total=100/total col(1)=col(1)/total col(2)=col(2)/total col(3)=col(3)/total col(4)=col(4)/total col(5)=col(5)/total col(6)=col(6)/total col(7)=col(7)/total col(8)=col(8)/total col(9)=col(9)/total col(10)=col(10)/total col(11)=col(11)/total col(12)=col(12)/total col(13)=col(13)/total col(14)=col(14)/total col(15)=col(15)/total col(16)=col(16)/total col(17)=col(17)/total col(18)=col(18)/total col(19)=col(19)/total %>

Q1.  Do you ... 

 

Skip Breakfast
Skip Morning Snack
Skip Lunch
Skip Afternoon Snack
Skip Dinner
Skip Supper

Q2.  Answer each of the following questions ..

 

I eat more when I am bored or sad
When I am happy, I eat more
I feel hungry very often
I think I am too thin
I think I am too fat
People tell me I should lose weight
People tell me I should gain weight
I like my body the way it is

Q3.  How often do you ...

 

Read food labels
Worry about food or drinks
Diet to lose weight
Diet to gain weight
Take vitamin pills
 

<%end if end if%>

Last updated: April 17, 2001.

 

 


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