Physical Health
1. How often do you engage in physical activity or exercise?
o Daily
o A few times a week
o Rarely
o Never
2. Do you have any chronic health conditions (e.g., asthma, diabetes)?
o Yes (please specify)
o No
3. How would you rate your overall physical health?
o Excellent
o Good
o Fair
o Poor
4. Do you experience any sleep-related issues (e.g., insomnia, excessive sleepiness)?
o Yes
o No
5. How often do you consume fruits and vegetables?
o Daily
o A few times a week
o Rarely
o Never
Mental Health
6. Have you experienced feelings of sadness or hopelessness in the past year?
o Yes
o No
7. How often do you feel stressed or anxious?
o Daily
o A few times a week
o Rarely
o Never
8. Do you have access to mental health resources (e.g., counseling, therapy)?
o Yes
o No
9. How comfortable are you discussing your mental health with others?
o Very comfortable
o Somewhat comfortable
o Not comfortable
10. Have you ever engaged in self-harm or had thoughts of self-harm?
o Yes
o No
Social Health
11. Do you feel supported by your family and friends?
o Yes
o No
o Sometimes
12. How often do you participate in social activities or clubs?
o Frequently
o Occasionally
o Rarely
o Never
13. Have you experienced bullying or peer pressure?
o Yes
o No
14. Do you feel safe in your school environment?
o Yes
o No
15. How would you rate your overall social well-being?
o Excellent
o Good
o Fair
o Poor
General Health and Well-being
16. Do you have regular medical check-ups?
o Yes
o No
17. How often do you consume fast food or sugary drinks?
o Daily
o A few times a week
o Rarely
o Never
18. Do you use any substances (e.g., tobacco, alcohol, drugs)?
o Yes
o No
19. How informed do you feel about maintaining a healthy lifestyle?
o Very informed
o Somewhat informed
o Not informed
Open-ended Questions
20. What is the biggest health-related challenge you face as an adolescent?
