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CHAMP Home Page Questionnaires

2009 CHAMP Topics

  • General Health
  • Weight/Height
  • Breast Feeding
  • Health Care Access and Utilization
  • Immunizations
  • School Performance
  • Asthma
  • Child Health Conditions
  • Children with Special Health Care Needs
  • Oral Health
  • Nutrition
  • Whole Grain Foods
  • Physical Activity
  • Parent Reaction to Child Weight
  • Food Insecurity
  • Family Involvement
  • Sexual Behavior
  • Child Safety
  • Parent Education


General Health (see results for 2008, 2007, 2006, 2005)

  • Would you say that in general (CHILD)’s health is:

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Weight/Height (see results for 2008, 2007, 2006, 2005)

  • Weight-for-Age Categories
  • BMI-for-Age Weight Status Categories
  • How did you arrive at (CHILD)'s height? Would you say…
  • How did you arrive at (CHILD)'s weight? Would you say…
  • During the past year, has your child’s physician or another health professional told you that your child was overweight?

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Breast Feeding (see results for 2008, 2007, 2006, 2005)

  • Was (CHILD) breastfed for any length of time?
  • For how many days, weeks, or months was (CHILD) breastfed?
  • During the time (CHILD) was breastfed, was (he/she) fed breast milk ONLY or was (CHILD) sometimes fed formula?
  • Did his/her doctors or health providers give you any help or encouragement for breastfeeding?

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Health Care Access and Utilization (see results for 2008, 2007, 2006, 2005)

  • Does (CHILD) have any kind of health care coverage?
  • During the past 12 months was there any time when {he/she} was not covered by ANY health insurance?
  • What kind of place does (CHILD) go to most often for sick care:
  • Do you have one person you think of as the (CHILD)'s personal doctor or nurse?
  • During the past 12 months has (CHILD) had a preventive care visit or Well Child check-up?
  • Has (CHILD)’s doctor or other health care providers ever talked with you about how you can help (CHILD) to eat healthy?
  • Has (CHILD)’s doctor or other health care providers ever talked with you about how you can help (CHILD) to be more physically active?

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Immunizations (see results for 2008, 2007)

  • Has (CHILD)'s school provided you with information about the HPV vaccine in any way?
  • Has (CHILD) had any shots of the HPV vaccine?

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School Performance (see results for 2008, 2007, 2006, 2005)

  • During the past 12 months, about how many days did (CHILD) miss school because of illness or injury?
  • During the past 12 months, about how many days did (CHILD) miss school because of an illness?
  • During the past 12 months, about how many days did (CHILD) miss school because of an injury?
  • As a result of your child's injury, how many days was (CHILD) not able to participate in {his/her} usual activities at home or at school?
  • How would you describe CHILD's grades in school over the past 12 months? Would you say they were MOSTLY…

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Asthma (see results for 2008, 2007, 2006, 2005)

  • Has a doctor ever told you that (CHILD) has asthma?
  • Does (CHILD) still have asthma?
  • During the past 12 months, has {he/she} had to visit a hospital emergency room or urgent care clinic because of {his/her} asthma?
  • Is {he/she} using a medicine every day, (such as a Beclovent, Azmacort, Pulmicort, Flovent, Advair, Singulair, or Vanceril inhaler) that was prescribed by a doctor to keep {him/her} from having asthma problems?
  • Does {he/she} use a rescue medication SUCH AS Albuterol, Alupent, Ventolin, Proventil, Xopenex or Maxair inhaler?
  • During the past 12 months, how many days of daycare or school did (CHILD) miss due to asthma?
  • At school, is (CHILD) allowed to self administer emergency medication for asthma?
  • Have you or (CHILD) ever taken a course or class on how to manage (his/her) asthma?
  • Has a doctor or other health professional ever taught you or (CHILD) how to recognize early signs or symptoms of an asthma episode?
  • Has a doctor or other health professional ever taught you or (CHILD) what to do during an asthma episode or attack?
  • Has a doctor or other health professional ever taught you or (CHILD) how to use a peak flow meter to adjust (his/her) medications?
  • Has a doctor or other health professional ever given you an asthma management plan for (CHILD}?

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Child Health Conditions (see results for 2008, 2007, 2006, 2005)

  • Has a doctor or health professional ever told you that (CHILD) had diabetes or high blood sugar?
  • Has a doctor or health professional ever told you that (CHILD) has borderline diabetes or pre-diabetes?
  • Has a doctor or health professional ever told you that (CHILD) has high blood pressure?
  • Has a doctor or health professional ever told you that (CHILD) has a permanent hearing loss or hearing impairment?

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Children with Special Health Care Needs (CSHCN) (see results for 2008, 2007, 2006, 2005)

  • Children with Special Health Care Needs
  • Does (CHILD) currently need or use more medical care, mental health or educational services than is usual for most children of the same age?
  • Is (CHILD)'s need for medical care, mental health or educational services because of ANY medical, behavioral, or other health condition?
  • Is this a condition that has lasted or is expected to last for at least 12 months?
  • Has (CHILD)’s doctor or health care provider ever given you or your child a written plan to help them manage their condition as they become an adult?

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Parent Reaction to Child Weight (see results for 2006, 2005)

  • How would you describe your child's weight?
  • How would you describe your child's weight? Ages 10 to 17 years

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Oral Health (see results for 2008, 2007, 2006, 2005)

  • How would you rate the condition of (CHILD)'s teeth?
  • Does he/she have a dentist or dental clinic where he/she goes regularly?
  • About how long has it been since (CHILD) last saw a dentist?

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Nutrition (see results for 2008, 2007, 2006, 2005)

  • How often does (CHILD) eat fast food?
  • On a typical day, how many times does (CHILD) drink sweetened beverages such as soda pop, sweet tea, fruit punch, Kool-aid, sports drinks or fruit drinks?
  • On a typical day, how many servings of 100% fruit juice does (CHILD) drink?
  • On a typical day, how many servings of fruit does (CHILD) eat?
  • On a typical day, how many servings of vegetables does (CHILD) eat, not including french fries?
  • On a typical day, how many servings of fruit and/or vegetables does (CHILD) eat?
  • On a typical day, how many servings of fruit, 100% fruit juice and/or vegetables does (CHILD) eat?

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Whole Grain Foods

  • In the past week, has (CHILD) eaten any whole grain foods?
  • In the past week, how many times did (CHILD) eat: Whole grain cereals like Cheerios, Wheaties, Life, Bran Flakes or Grape Nuts?
  • In the past week, how many times did (CHILD) eat: Whole wheat breads or whole grain breads like 100% whole wheat or 12 grain bread?
  • In the past week, how many times did (CHILD) eat: Brown rice?
  • In the past week, how many times did (CHILD) eat: Soft corn or whole wheat tortillas?

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Physical Activity (see results for 2008, 2007, 2006, 2005)

  • On a typical day, how much total time does (CHILD) spend in physically active play?
  • How often do you or your child use any of the playing fields or facilities at a school in your community during after-school hours or on weekends?
  • How many days per week does your child walk or ride a bicycle to school?
  • On a typical day how much total time does (CHILD) spend watching television?

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Food Insecurity (see results for 2008, 2007, 2006, 2005)

  • Is {he/she} currently enrolled in the WIC program?
  • Is your household currently enrolled in the Food Stamp Program?
  • In the last 12 months, how often did you rely on only a few kinds of low-cost food to feed (CHILD) because you were running out of money to buy food?

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Family Involvement (see results for 2008, 2007, 2006, 2005)

  • How many times in a typical week do members of your household eat a main meal together that was prepared at home?

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Sexual Behavior (see results for 2008, 2007, 2006, 2005)

  • Have you or other members of your family ever talked with your child about what you expect them to do or not do when it comes to sex?
  • Do you believe (CHILD) is sexually active?

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Child Safety (see results for 2007, 2006, 2005)

  • When you are driving and (CHILD) rides in the vehicle with you, how often does (he/she) ride in a child safety seat?
  • When you are driving and (CHILD) rides in the vehicle with you how often does (he/she) wear a seatbelt?
  • During the past 12 months, has (CHILD) ridden a bike, scooter, skateboard, roller skates, or rollerblades?
  • How often does (he/she) wear a helmet when riding a bike, scooter, skateboard, roller skates, or rollerblades?
  • When you are in a vehicle with children, how often do you use your cell phone while driving?
  • Do you currently have any prescription medications in your household?
  • Do you keep all of these prescription medications in a locked place?

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Parent Education (see results for 2008)

  • Have you heard that there is now a Local Wellness Policy for all the schools in your county?

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Page Last Updated September 27, 2012

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