Att.21 Sedentary Behavior Questionnaire

Attachment 21
Sedentary Behaviors Questionnaire OMB#: ####-#### EXP.DATE: ##/##/####
NOTIFICATION TO RESPONDENT OF ESTIMATED BURDEN
Public reporting burden for this collection of information is estimated to average 20 minutes for this questionnaire, including the time to review
instructions, search existing data sources, gather and maintain the data needed, and complete and review the collection of information. An agency may
not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a current, valid OMB control number.
Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to:
NIH, Project Clearance Branch, 6705 Rockledge Drive, MSC 7974, Bethesda, MD 20892-7974, ATTN:PRA (####-####).
1
Sedentary Behavior Questionnaire
Date :______________________( mm/dd/yyyy)
We would like to know how you spent your time during the last 7 days.
In particular, we are interested in time you spent sleeping, and doing activities while you were sitting or reclining.
We will ask you about sitting or reclining you may have done at home, at work or school, and elsewhere (in the
community).
For each question, we will ask how many days you did that activity, if at all, and about how much time you spent doing
the activity.
To answer each question, fill in the boxes to indicate your answer. See Examples 1 and 2 below.
Example 1
In this example, the person reported that they sat and watched television on 5 weekdays and 1 weekend day. They
reported sitting and watching television for 1 to 2 hours each day.
How many days in the last 7 About how much time each day?
days?
Weekdays: 0 days (did not do this

activity) 1-30 min 31 min - 1 hr 1 - 2 hrs 3 - 4 hrs 5
12345 hrs or more
Sitting and watching TV or
days
movies on a TV, computer, or
on any other device
Weekend: 0 days (did not do this 1-30 min 31 min - 1 hr 1 - 2 hrs 3 - 4 hrs 5
activity) hrs or more
1 2 days
Example 2
In this example, the person answering the question did not do any reading for pleasure while sitting in the last 7 days.
days?
Sitting and reading for Weekdays: 0 (did not do this
2
1 - 15 min 16-30 min 31 min 1 hr 1 2 hrs
activity)
3 hrs or more
12345
pleasure days
(e.g., books, newspaper,
1 - 15 min 16-30 min 31 min 1 hr 1 2 hrs
magazines) Weekend: 0 (did not do this
3 hrs or more
activity)
1 2 days
3
Sleeping
1) In the last 7 days, about how many hours per day did you spend sleeping? Please answer for weekdays and
weekend days.
3hrs or less 4 hrs 5 hrs 6 hrs 7 hrs 8 hrs 9 hrs 10 hrs 11 hrs
Weekdays:
12 or more hrs
3hrs or less 4 hrs 5 hrs 6 hrs 7 hrs 8 hrs 9 hrs 10 hrs 11 hrs
Weekend:
12 or more hrs
Activities done at home

Tell us about the sitting and/or reclining activities you may have done at home.
If you did any of these activities at a friends house, or a family members home, please report what you did outside of
your home in the next section (in the Community).
Activities done at How many days in the last 7

home days? About how much time each day?
Weekdays: 0 (did not do this

activity) 1-15 min 16-30 min 31-45 min 46 min-1 hr
12345 1 hr or more
2) Sitting and eating meals at days
home
Weekend: 0 (did not do this 1-15 min 16-30 min 31-45 min 46 min-1 hr
activity) 1 hr or more
1 2 days
1-30 min 31 min - 1 hr 1 - 2 hrs 3 - 4 hrs 5

3) Sitting and watching TV or Weekdays: 0 (did not do this hrs or more
movies on a TV, computer, or activity)
on any other device 12345
4
days
Weekend: 0 (did not do this 1-30 min 31 min - 1 hr 1 - 2 hrs 3 - 4 hrs 5

1 2 days


activity) 1-15 min 16 - 30 min 31 min 1 hr 1 2 hrs
12345 3 hrs or more
4) Sitting and talking in-
days
person
with friends and family
Weekend: 0 (did not do this 1-15 min 16 - 30 min 31 min 1 hr 1 2 hrs
activity) 3 hrs or more
1 2 days

activity) 1 - 15 min 16-30 min 31 min 1 hr 1 2 hrs
12345 3 hrs or more
5) Sitting and talking on the
days
phone or texting with friends
and family
Weekend: 0 (did not do this 1 - 15 min 16-30 min 31 min 1 hr 1 2 hrs
1 2 days

activity) 1 - 15 min 16-30 min 31 min 1 hr 1 2 hrs
6) Sitting and reading for
12345 3 hrs or more
pleasure
days
(e.g., books, newspaper,
magazines, religious
Weekend: 0 (did not do this 1 - 15 min 16-30 min 31 min 1 hr 1 2 hrs
materials)
1 2 days
7) Sitting and playing 1-30 min 31 min -1 hr 1 - 2 hrs 3 - 4 hrs 5

electronic, Weekdays: 0 (did not do this hrs or more
5
activity)
12345
days
computer games
Please report other computer
Weekend: 0 (did not do this 1-30 min 31 min -1 hr 1 - 2 hrs 3 - 4 hrs 5
use below.
1 2 days

8) Sitting and using a 1-15 min 16-30 min 31 min-1 hr 1-2 hrs
activity)
computer in your free time at 3 hrs or more
12345
home (e.g., email, shopping, days
reading blogs, socializing,
etc.) 1-15 min 16-30 min 31 min-1 hr 1-2 hrs
Weekend: 0 (did not do this
Please report computer use 3 hrs or more
activity)
for work or school below.
1 2 days


1-15 min 16-30 min 31 min 1 hr 1 -2 hrs
activity)
3 hrs or more
9) Sitting and working at a 12345
desk in free-time, without a days
computer (e.g., paying bills,
1-15 min 16-30 min 31 min 1 hr 1 -2 hrs
writing a letter, etc.) Weekend: 0 (did not do this
3 hrs or more
activity)
1 2 days
School or educational activities done at home

10a) Using a computer for
school work(e.g., homework, Weekdays: 0 (did not do this 1-30 min 30 min - 1 hr 1-1 hrs 1 -2 hrs
paper writing online classes) activity) 3 hrs or more
12345
days
1-30 min 30 min - 1 hr 1-1 hrs 1 -2 hrs
Weekend: 0 (did not do this 3 hrs or more
activity)
1 2 days
6
activity) 1-30 min 31 min - 1 hr 1-1 hrs 1 -2 hrs
12345 3 hrs or more
10b) Reading, writing,
days
studying with friends, not on
the computer
Weekend: 0 (did not do this 1-30 min 31 min - 1 hr 1-1 hrs 1 -2 hrs
1 2 days
Work activities (for pay) done at home

If your home is your primary workplace, please record your paid work activities in the work section.

12345 3 hrs or more
11a) Work related computer
days
use done at home
1 2 days

12345 3 hrs or more
11b) Sitting and reading,
days
writing, or making phone calls
for work
1 2 days

12) Sitting while getting 1-5 min 6-10 min 11-15 min 16-30 min 30
dressed, putting on make-up, Weekdays: 0 (did not do this mins or more
or styling hair activity)
12345
7
days
1-5 min 6-10 min 11-15 min 16-30 min 30
mins or more
activity)
1 2 days

activity) 1-15 min 16-30 min 31 min 1 hr 1 - 2hrs
12345 3 hrs or more
13) Sitting quietly relaxing
days
(listening to music, doing
nothing)
Weekend: 0 (did not do this 1-15 min 16-30 min 31 min 1 hr 1 - 2hrs
1 2 days

activity) 1-30 min 31 min 1 hr 1-1 hrs 1 - 2 hrs
12345 3 hrs or more
days
14) Napping
Weekend: 0 (did not do this 1-30 min 31 min 1 hr 1-1 hrs 1 - 2 hrs
1 2 days

activity) 1-30 min 31 min 1 hr 1 - 2 hrs 3-4 hrs 5
12345 hrs or more
15) Sitting and playing board
days
games, cards, or other non-
computer games
Weekend: 0 (did not do this 1-30 min 31 min 1 hr 1 - 2 hrs 3-4 hrs 5
1 2 days
16) Sitting or reclining while

praying or meditating Weekdays: 0 (did not do this 1-15 min 16-30 min 31 min 1 hr 1 -2 hrs
12345
days
8
Weekend: 0 (did not do this 1-15 min 16-30 min 31 min 1 hr 1 -2 hrs
1 2 days


activity) 1-30 min 31 min 1 hr 1 - 2 hrs 3-4 hrs 5
17) Sitting doing hobbies 12345 hrs or more
(e.g., arts and crafts, playing days
music, etc.)
Weekend: 0 (did not do this 1-30 min 31 min 1 hr 1 - 2 hrs 3-4 hrs 5
1 2 days

activity) 1-15 min 16-30 min 31 min 1 hr 1 -2 hrs
12345 3 hrs or more
18) Sitting while caring for days
children or elders
Weekend: 0 (did not do this 1-15 min 16-30 min 31 min 1 hr 1 -2 hrs
1 2 days
In the community
The next questions ask about the time you spent sitting while out in your community. That is, when you
were somewhere other than home, school, or work. We will ask about work and school time later in the survey.
In the community How many days in the last 7

days? About how much time each day?
9
12345 1 hr or more
19) Sitting and eating meals
days
by yourself away from home,
work, or school
1 2 days

activity) 1-15 min 16-30 min 31-45 min 46 min-1 hrs
12345 1 hrs or more
20) Sitting and eating in a
days
social setting away from
home, work, or school
Weekend: 0 (did not do this 1-15 min 16-30 min 31-45 min 46 min-1 hrs
1 2 days

21) Driving or riding in cars, trucks, or other motorized personal vehicles

1 - 15 min 16-30 min 31 min 1 hr 1 2 hrs
activity)
3 hrs or more
12345
days
21a) To and from work or
1 - 15 min 16-30 min 31 min 1 hr 1 2 hrs
school Weekend: 0 (did not do this
3 hrs or more
activity)
1 2 days
21b) To do errands, go to Weekdays: 0 (did not do this 1 - 15 min 16-30 min 31 min 1 hr 1 2 hrs
appointments, and to go activity) 3 hrs or more
places 12345
10
days
1 - 15 min 16-30 min 31 min 1 hr 1 2 hrs
3 hrs or more
activity)
1 2 days
22) Sitting and riding on public transportation (e.g., bus, train, plane, or school bus, shuttle bus, taxis)

1 - 15 min 16-30 min 31 min 1 hr 1 2 hrs
activity)
3 hrs or more
12345
22a) To and from work or
days
school
1 - 15 min 16-30 min 31 min 1 hr 1 2 hrs
3 hrs or more
activity)
1 2 days
Weekdays: 0 (did not do this 1 - 15 min 16-30 min 31 min 1 hr 1 2 hrs

22b) To do errands, go
12345
to
days
appointments, and to go
1 - 15 min 16-30 min 31 min 1 hr 1 2 hrs
places
activity)
1 2 days

23) Sitting and waiting for
public transportation (e.g., Weekdays: 0 (did not do this 1 - 5 min 6-10 min 11-15 min 16-30 min 30
bus, train, plane, school bus, activity) mins or more
shuttle bus, taxis) 12345
days
1 - 5 min 6-10 min 11-15 min 16-30 min 30
Weekend: 0 (did not do this mins or more
11
activity)
1 2 days
24) Sitting and using a Weekdays: 0 (did not do this 1-15 min 16-30 min 31 min-1 hr 1-2 hrs
computer in your free time activity) 3 hrs or more
outside of home or work (e.g., 12345
email, shopping, reading days
blogs, socializing, etc.) 1-15 min 16-30 min 31 min-1 hr 1-2 hrs
Please report computer use Weekend: 0 (did not do this 3 hrs or more
for school or work below. activity)
1 2 days
School or educational activities done outside of home or

school

1-30 min 30 min - 1 hr 1-1 hrs 1 -2 hrs
activity)
3 hrs or more
25a) Using a computer for 12345
school work (e.g., homework, , days
paper writing, etc)
1-30 min 30 min - 1 hr 1-1 hrs 1 -2 hrs
3 hrs or more
activity)
1 2 days

25b) Reading, writing, 12345 3 hrs or more
studying with friends, not on days
the computer
1 2 days
12
Work activities (for pay) done outside of home or the

worksite

1-30 min 30 min - 1 hr 1-1 hrs 1 -2 hrs
activity)
26a) Work related computer 3 hrs or more
12345
use done out in the
days
community
1-30 min 30 min - 1 hr 1-1 hrs 1 -2 hrs
3 hrs or more
activity)
1 2 days

1-30 min 31 min - 1 hr 1-1 hrs 1 -2 hrs
activity)
3 hrs or more
26b) Sitting and reading, 12345
writing, or making phone calls days
for work
1-30 min 31 min - 1 hr 1-1 hrs 1 -2 hrs
3 hrs or more
activity)
1 2 days
27) Sitting and talking in-

person Weekdays: 0 (did not do this 1-15 min 16 - 30 min 31 min 1 hr 1 2 hrs
with friends and family activity) 3 hrs or more
12345
days
1-15 min 16 - 30 min 31 min 1 hr 1 2 hrs
13
activity)
1 2 days

12345 1 hr or more
28) Sitting quietly, relaxing
days
(e.g. at a park, smoking, doing
nothing, listening to music)
1 2 days

activity) 1-30 min 31 min 1 hr 1-1 hrs 1 - 2 hrs
12345 3 hrs or more
29) Sitting while attending
days
Church, religious services, or
Bible/religious studies
Weekend: 0 (did not do this 1-30 min 31 min 1 hr 1-1 hrs 1 - 2 hrs
1 2 days


12345 3 hrs or more
30) Sitting or reclining while
days
praying or meditating outside
of the church service
Weekend: 0 (did not do this 1-15 min 16 - 30 min 31 min 1 hr 1 2 hrs
1 2 days
31) Sitting and socializing at 1-15 min 16 - 30 min 31 min 1 hr 1 2 hrs

church, or other places of Weekdays: 0 (did not do this 3 hrs or more
worship activity)
12345
days 1-15 min 16 - 30 min 31 min 1 hr 1 2 hrs
3 hrs or more
14
activity)
1 2 days

1-15 min 16 - 30 min 31 min 1 hr 1 2 hrs
activity)
3 hrs or more
12345
32) Sitting and talking on the
days
phone, or texting, with friends
and family 1-15 min 16 - 30 min 31 min 1 hr 1 2 hrs
3 hrs or more
activity)
1 2 days

33) Sitting and reading for 12345 3 hrs or more
pleasure (e.g., books, days
magazines, newspaper,
religious materials) Weekend: 0 (did not do this 1-15 min 16 - 30 min 31 min 1 hr 1 2 hrs
1 2 days

activity) 1-30 min 31 min -1 hr 1 - 2 hrs 3 - 4 hrs 5
34) Sitting in amovie theater, 12345 hrs or more
at a play, a music days
performance, or a sporting
event Weekend: 0 (did not do this 1-30 min 31 min -1 hr 1 - 2 hrs 3 - 4 hrs 5
1 2 days
How many days in the last 7

In the community days? About how much time each day?
35) Sitting and watching 1-30 min 31 min -1 hr 1 - 2 hrs 3 - 4 hrs 5
television at a friends house Weekdays: 0 (did not do this hrs or more
or restaurant activity)
12345
15
days
1-30 min 31 min -1 hr 1 - 2 hrs 3 - 4 hrs 5
hrs or more
activity)
1 2 days

1-15 min 16-30 min 31 min - 45 min 46 - 1 hr
activity)
1 hr or more
12345
36) Sitting at a medical
days
appointment (e.g., doctor,
dentist, primary care provider) 1-15 min 16-30 min 31 min - 45 min 46 - 1 hr
1 hr or more
activity)
1 2 days

1-15 min 16-30 min 31 min - 45 min 46 - 1 hr
activity)
1 hr or more
12345
37) Sitting at the hair salon,
days
getting nails done, or during
other personal services 1-15 min 16-30 min 31 min - 45 min 46 - 1 hr
1 hr or more
activity)
1 2 days

12345 hrs or more
38) Sitting and playing
days
electronic, computer games
out in the community
1 2 days
39) Sitting and playing board

games, cards, or other games Weekdays: 0 (did not do this 1-30 min 31 min -1 hr 1 - 2 hrs 3 - 4 hrs 5
out in the community activity) hrs or more
12345
days
16
1 2 days
How many days in the last 7

In the community days? About how much time each day?

40) Sitting doing hobbies 12345 hrs or more
(e.g., arts and crafts, playing days
music, etc.)
1 2 days
Now, we will ask you about sitting or reclining that you may have done at work.
In the last 7 days, did you work for pay either at home or outside the home? Yes No
If Yes, please answer the following questions about how you spent time at work for pay during the last 7 days.
If No, please skip to the next section (School).
At work How many days in the last 7 About how much time each day?
days?
0 days (did not do this activity)

41) Sitting at a desk or
1 hr or less 1 - 3 hrs 4 - 6 hrs 7 - 8 hrs 9
computer workstation 1234567
hrs or more
days

42) Sitting in meetings,
presentations, or continuing
1234567 hrs or more
education classes
days
0 days (did not do this activity) 1 hr or less 1 - 3 hrs 4 - 6 hrs 7 - 8 hrs 9
43) Sitting while doing other hrs or more
light work - not a computer 1234567
17
(e.g., filing, lab work,
days
assembly)

44) Driving or riding for work
1234567 hrs or more
days
At work days?

45) Sitting and eating meals
1-15 min 16-30 min 31-45 min 46 min-1 hr 1
during your work day
1234567 hr or more
days

46) Sitting or reclining during
1-15 min 16-30 min 31-45 min 46 min-1 hr 1
free time at work (e.g.,
1234567 hr or more
socializing, watching
days
television, relaxing, etc)
Now we are going to ask you about the activities you may have done at school.
In the last 7 days, did you go to school or were you home schooled? Yes No
If Yes, please answer the following questions about how you spent time at school during the last 7 days.
At school How many days in the last 7 About how much time each day?
days?
47) Sitting at your desk
during class time not using a
1234567 hrs or more
computer
days
48) Sitting at a desk using a 1 hr or less 1 - 2 hrs 3 - 4 hrs 5 - 6 hrs 7
computer during class time 1234567 hrs or more
days
18
49) Sitting at a computer
1-30 min 31-45 min 46 min-1 hr 1 -2 hrs 3 hrs
outside of class time at school
1234567 or more
(computer lab, school library)
days

50) Sitting and eating meals 1-15 min 16-30 min 31-45 min 46 min-1 hr 1
during the school day 1234567 hr or more
days
At school days?
51) Sitting or reclining during 0 days (did not do this activity)

free time at school (e.g., 1-30 min 31-45 min 46 min-1 hr 1 -2 hrs 3 hrs
hanging out with friends, 1234567 or more
playing games, watching days
television, relaxing, etc)
52) Sitting and doing school 0 days (did not do this activity)
work before or after school 1-30 min 31-45 min 46 min-1 hr 1 -2 hrs 3 hrs
(e.g., home work, class 1234567 or more
projects) on campus days

53) Sitting and doing
1-30 min 31-45 min 46 min-1 hr 1 -2 hrs 3 hrs
extracurricular activities
1234567 or more
before or after school (e.g.,
days
clubs, other meetings)
19

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Attachment 21

Sedentary Behaviors Questionnaire OMB#: ####-#### EXP.DATE: ##/##/####

NOTIFICATION TO RESPONDENT OF ESTIMATED BURDEN

Date :______________________( mm/dd/yyyy)

Weekdays: 0 days (did not do this

Activities done at home

Activities done at How many days in the last 7

Weekdays: 0 (did not do this

1-30 min 31 min - 1 hr 1 - 2 hrs 3 - 4 hrs 5

Weekend: 0 (did not do this 1-30 min 31 min - 1 hr 1 - 2 hrs 3 - 4 hrs 5

Activities done at How many days in the last 7

Weekdays: 0 (did not do this

Weekdays: 0 (did not do this

Weekdays: 0 (did not do this

7) Sitting and playing 1-30 min 31 min -1 hr 1 - 2 hrs 3 - 4 hrs 5

Weekdays: 0 (did not do this

Activities done at How many days in the last 7

Weekdays: 0 (did not do this

School or educational activities done at home

Work activities (for pay) done at home

Weekdays: 0 (did not do this

Weekdays: 0 (did not do this

Activities done at How many days in the last 7

Weekdays: 0 (did not do this

Weekdays: 0 (did not do this

Weekdays: 0 (did not do this

16) Sitting or reclining while

Activities done at How many days in the last 7

Weekdays: 0 (did not do this

Weekdays: 0 (did not do this

In the community How many days in the last 7

Weekdays: 0 (did not do this

In the community How many days in the last 7

21) Driving or riding in cars, trucks, or other motorized personal vehicles

Weekdays: 0 (did not do this

Weekdays: 0 (did not do this

Weekdays: 0 (did not do this 1 - 15 min 16-30 min 31 min 1 hr 1 2 hrs

In the community How many days in the last 7

School or educational activities done outside of home or

Weekdays: 0 (did not do this

Weekdays: 0 (did not do this

Work activities (for pay) done outside of home or the

Weekdays: 0 (did not do this

Weekdays: 0 (did not do this

27) Sitting and talking in-

Weekdays: 0 (did not do this

Weekdays: 0 (did not do this

In the community How many days in the last 7

Weekdays: 0 (did not do this

31) Sitting and socializing at 1-15 min 16 - 30 min 31 min 1 hr 1 2 hrs

Weekdays: 0 (did not do this

Weekdays: 0 (did not do this

Weekdays: 0 (did not do this

How many days in the last 7

Weekdays: 0 (did not do this

Weekdays: 0 (did not do this

Weekdays: 0 (did not do this

39) Sitting and playing board

How many days in the last 7

Weekdays: 0 (did not do this

0 days (did not do this activity)

0 days (did not do this activity)

0 days (did not do this activity)