Teen Health Myths Inquiry Form
Help us understand what teens believe about common health topics and myths. Your responses are anonymous and will help improve health education.
Your Full Name
First Name
Last Name
Your Age
*
Your Gender
*
Male
Female
Non-binary
Prefer not to say
Other
How much do you agree with the following statements? (1 = Strongly Disagree, 5 = Strongly Agree)
*
Rows
1 (Strongly Disagree)
2
3
4
5 (Strongly Agree)
You can catch a cold from being outside in cold weather.
1
2
3
4
5
Vaccines cause autism.
6
7
8
9
10
Energy drinks are safe for teens.
11
12
13
14
15
You need 8 glasses of water every day.
16
17
18
19
20
Cracking your knuckles causes arthritis.
21
22
23
24
25
Which of the following do you believe is TRUE?
*
Eating chocolate causes acne
You can get addicted to video games
Skipping breakfast is always bad for your health
None of the above
Where do you usually get your health information?
*
Parents/Guardians
Teachers/School
Friends/Peers
Internet/Social Media
Doctors/Healthcare professionals
Other
How confident are you in knowing what is true or false about health topics?
*
Not confident at all
1
2
3
4
Very confident
5
1 is Not confident at all, 5 is Very confident
Have you ever believed in a health myth that turned out to be false?
*
Yes
No
Not sure
If yes, please describe the myth and how you learned the truth.
What health myths or questions have you heard from friends or online? List any you want us to address.
*
Would you like to receive reliable information about teen health myths?
*
Yes, please contact me by email
No, thank you
Your Email Address (if you want to receive information)
example@example.com
Submit Inquiry
Should be Empty: