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I am involved in a program to promote self esteem amoung teenaged girls. I wanted to find out what pressures girls are facing and what is affecting the way they feel about themselves, so I created this survey. Thank you so much for your time!
 
 

Great concern Somewhat concerned Neutral Not a concern at all
Popularity
Body Image
Getting Good grades
 
 

From whom do you feel the greatest pressure from?
 
Parents
 
Friends
 
Media
 
 

Do you feel good about yourself.....
 
Always
 
Most of the time
 
A good part of the time
 
Some of the time
 
A little of the time
 
Rarely
 
Never
 
 

Do you wish that you were smarter....
 
Always
 
Most of the time
 
A good part of the time
 
Some of the time
 
A little of the time
 
Rarely
 
Never
 
 

Do you wish you were prettier....
 
Always
 
Most of the time
 
A good part of the time
 
Some of the time
 
A little of the time
 
Rarely
 
Never
 
 

Do you wish you were someone else....
 
Always
 
Most of the time
 
A good part of the time
 
Some of the time
 
A little of the time
 
Rarely
 
Never
 
 

Do wish you were thinner....
 
Always
 
Most of the time
 
A good part of the time
 
Some of the time
 
A little of the time
 
Rarely
 
Never
 
 

Do you feel that if you could be more like other people then you would feel better about yourself.....
 
Always
 
Most of the time
 
A good part of the time
 
Some of the time
 
A little of the time
 
Rarely
 
Never
 
 

Do you tend to compare your body image to.....
women/girls in the media women/girls you associate with both
 
 

My body weight strongly affects my self esteem....
 
Strongly Agree
 
Somewhat Agree
 
Disagree
 
 

My physical attractivness affects my self esteem...
strongly agree somewhat agree disagree
 
 
 
What builds up your self esteem?
   
 
 

Have you ever suffered from an eating disorder?
Yes No
 
 

Have you ever cut or burned yourself to relieve inner hurt, anger, and/or emotions?
Yes No
 
 

Have you ever had suicidal thoughts?
Yes No
 
 

Have you ever tried to commit suicide?
Yes No
 
 

Strongly agree Somewhat agree Disagree
Do you feel that images of women in the media have an overall negative affect on teenaged girls?
 
 

Do you feel you can talk to your parents about your problems?
Yes No
 
 
 
Who is the woman/girl you most admire?
   
Why?
   
 
Please contact [email protected] if you have any questions regarding this survey.
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