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2011 Behavior Survey
1. All answers are anonymous and confidential.
1
. How old are you?
How old are you?
Less than 17 years old
18 or 19 years old
20 to 22 years old
23 years old or older
2
. What is your gender?
What is your gender?
Male
Female
3
. What is your class standing?
What is your class standing?
Freshman
Sophomore
Junior
Senior
Grad Student
Entering Freshman
Other (please specify)
4
. Are you a full-time student?
Are you a full-time student?
Yes
No
5
. How would you describe yourself?
How would you describe yourself?
White - not Hispanic
Black - not Hispanic
Hispanic or Latino
Asian or Pacific Islander
American Indian or Alaskan Native
Other (please specify)
6
. Where will you be living this semester?
Where will you be living this semester?
College dormitory or residence hall
Fraternity or sorority house
Other university/college housing
Off-campus house or apartment
Parent/guardian's home
Other (please specify)
7
. How many hours a week do you plan to work?
How many hours a week do you plan to work?
0 hours
1-9 hours
10-19 hours
20-29 hours
30-39 hours
40 hours
More than 40 hours
8
. How often do you wear a seat belt?
How often do you wear a seat belt?
Never wear a seat belt
Rarely wear a seat belt
Sometimes wear a seat belt
Most of the time wear a seat belt
Always wear a seat belt
9
. When you rode a bicycle during the past 12 months, how often did you wear a helmet?
When you rode a bicycle during the past 12 months, how often did you wear a helmet?
I did not ride a bicycle during the past 12 months
Never wore a helmet
Rarely wore a helmet
Sometimes wore a helmet
Most of the time wore a helmet
Always wore a helmet
10
. When you participated in water sports during the past 12 months, how often did you drink alcohol?
When you participated in water sports during the past 12 months, how often did you drink alcohol?
Never drank alcohol
Rarely drank alcohol
Sometimes drank alcohol
Most of the time drank alcohol
Always drank alcohol
11
. During the past 30 days, how many times did you ride in a car or other vehicle when you had been drinking alcohol?
During the past 30 days, how many times did you ride in a car or other vehicle when you had been drinking alcohol?
0 times
1 time
2 or 3 times
4 or 5 times
6 or more times
12
. During the past 30 days, how many times did you drive a car or other vehicle when you had been drinking alcohol?
During the past 30 days, how many times did you drive a car or other vehicle when you had been drinking alcohol?
0 times
1 time
2 or 3 times
4 or 5 times
6 or more times
13
. During the past 12 months, on how many days did you carry a weapon such as a gun, knife or club? Do not count carrying a weapon as part or your job.
During the past 12 months, on how many days did you carry a weapon such as a gun, knife or club? Do not count carrying a weapon as part or your job.
0 times
1 time
2 or 3 times
4 or 5 times
6 or more times
14
. During the past 12 months, how many times were you in a physical fight?
During the past 12 months, how many times were you in a physical fight?
0 times
1 time
2 or 3 times
4 or 5 times
6 or 7 times
8 or 9 times
10 or 11 times
12 or more times
15
. During the past 12 months, how many times were you in a physical fight in which you were injured and had to be treated by a doctor or nurse?
During the past 12 months, how many times were you in a physical fight in which you were injured and had to be treated by a doctor or nurse?
0 times
1 time
2 or 3 times
4 or 5 times
6 or more times
16
. During the past 12 months, how many times were you in a physical fight in which you were injured and had to be treated by a doctor or nurse and alcohol was involved?
During the past 12 months, how many times were you in a physical fight in which you were injured and had to be treated by a doctor or nurse and alcohol was involved?
0 times
1 time
2 or 3 times
4 or 5 times
6 or more times
17
. How many times in the past 3 months have you felt moderately or severely angry?
How many times in the past 3 months have you felt moderately or severely angry?
0 times
1 time
2 or 3 times
4 or 5 times
6 to 10 times
11 or more times
18
. How many times in the past 12 months have you felt moderately or severely depressed?
How many times in the past 12 months have you felt moderately or severely depressed?
0 times
1 time
2 or 3 times
4 or 5 times
6 to 10 times
11 or more times
19
. During the past 12 months, did you ever seriously consider suicide?
During the past 12 months, did you ever seriously consider suicide?
Yes
No
20
. During the past 12 months, did you make a plan about how you would attempt suicide?
During the past 12 months, did you make a plan about how you would attempt suicide?
Yes
No
21
. During the past 12 months, how many times did you actually attempt suicide?
During the past 12 months, how many times did you actually attempt suicide?
0 times
1 time
2 or 3 times
4 or 5 times
6 or more times
22
. During the past 30 days, on the days you smoked how many cigarettes did you smoke per day?
During the past 30 days, on the days you smoked how many cigarettes did you smoke per day?
I did not smoke cigarettes during the past 30 days
Less than 1 cigarette per day
1 cigarette per day
2 to 5 cigarettes per day
6 to 10 cigarettes per day
11 to 20 cigarettes per day
More than 20 cigarettes per day
23
. How old were you when you first started smoking cigarettes regularly?
How old were you when you first started smoking cigarettes regularly?
I have never smoked cigarettes regularly
12 years or younger
13 or 14 years old
15 or 16 years old
17 or 18 years old
19 or 20 years old
21 to 24 years old
25 years old or older
24
. How many times have you tried to quit smoking?
How many times have you tried to quit smoking?
0 times
1 or 2 times
3 to 9 times
10 to 19 times
20 to 39 times
40 to 99 times
100 or more times
25
. During the past 30 days, on how many days did you use chewing tobacco or snuff?
During the past 30 days, on how many days did you use chewing tobacco or snuff?
0 days
1 or 2 days
3 to 5 days
6 to 9 days
10 to 19 days
20 to 29 days
All 30 days
26
. How old were you when you had your first drink of alcohol other than a few sips?
How old were you when you had your first drink of alcohol other than a few sips?
12 years or younger
13 or 14 years old
15 or 16 years old
17 or 18 years old
19 or 20 years old
21 to 24 years old
25 years old or older
I have not tried alcohol
27
. During the past 30 days, on how many days did you have at least one drink of alcohol?
During the past 30 days, on how many days did you have at least one drink of alcohol?
0 days
1 or 2 days
3 to 5 days
6 to 9 days
10 to 19 days
20 to 29 days
All 30 days
28
. During the past 30 days, on how many days did you have 5 or more drinks of alcohol in a row, that is, within a couple of hours?
During the past 30 days, on how many days did you have 5 or more drinks of alcohol in a row, that is, within a couple of hours?
0 days
1 day
2 days
3 to 5 days
6 to 9 days
10 to 19 days
20 or more days
29
. During the past 30 days, how many drinks containing alcohol did you have on the days in which you drank?
During the past 30 days, how many drinks containing alcohol did you have on the days in which you drank?
I didn't drink in the last 30 days
1-2 drinks
3-4 drinks
5-6 drinks
7-10 drinks
11 or more drinks
30
. During the last 30 days, what is the highest number of drinks that you drank on any one occasion?
During the last 30 days, what is the highest number of drinks that you drank on any one occasion?
I didn't drink in the last 30 days
1-2 drinks
3-4 drinks
5-6 drinks
7-10 drinks
11 or more drinks
31
. Did you drink until you felt drunk or intoxicated at least once in the last month?
Did you drink until you felt drunk or intoxicated at least once in the last month?
Yes, and I do not intend to stop getting drunk
Yes, but I intend to stop getting drunk in the next six months
Yes, but I intend to stop getting drunk in the next 30 days
No, I have not been drunk in the last month, but I have been drunk in the last six months
No, I have not been drunk in the last six months
32
. How old were you when you tried marijuana for the first time?
How old were you when you tried marijuana for the first time?
I've never tried marijuana
12 years or younger
13 or 14 years old
15 or 16 years old
17 or 18 years old
19 or 20 years old
21 to 24 years old
25 years old or older
33
. During the past 30 days, how many times did you use marijuana?
During the past 30 days, how many times did you use marijuana?
0 times
1 or 2 times
3 to 9 times
10 to 19 times
20 to 39 times
40 or more times
34
. During your life, how many times have you used any form of cocaine including powder, crack, or freebase?
During your life, how many times have you used any form of cocaine including powder, crack, or freebase?
0 times
1 or 2 times
3 to 9 times
10 to 19 times
20 to 39 times
40 to 99 times
100 or more times
35
. During your life, how many times have you sniffed glue, or breathed the contents of aerosol spray cans, or inhaled any paints or sprays to get high?
During your life, how many times have you sniffed glue, or breathed the contents of aerosol spray cans, or inhaled any paints or sprays to get high?
0 times
1 or 2 times
3 to 9 times
10 to 19 times
20 to 39 times
40 to 99 times
100 or more times
36
. During your life, how many times have you taken steroids for body building purposes?
During your life, how many times have you taken steroids for body building purposes?
0 times
1 or 2 times
3 to 9 times
10 to 19 times
20 to 39 times
40 to 99 times
100 or more times
37
. During your life, how many times have you used prescription medication such as pain killers, anti-anxiety medication, sleeping pills, appetite suppressants, etc. without a doctor's prescription?
During your life, how many times have you used prescription medication such as pain killers, anti-anxiety medication, sleeping pills, appetite suppressants, etc. without a doctor's prescription?
0 times
1 or 2 times
3 to 9 times
10 to 19 times
20 to 39 times
40 to 99 times
100 or more times
38
. During your life, how many times have you used any other type of recreational drug, such as LSD, PCP, ecstasy, mushrooms, speed, ice, or heroin?
During your life, how many times have you used any other type of recreational drug, such as LSD, PCP, ecstasy, mushrooms, speed, ice, or heroin?
0 times
1 or 2 times
3 to 9 times
10 to 19 times
20 to 39 times
40 to 99 times
100 or more times
39
. During the past 30 days, how many times have you used any recreational drug in combination with drinking alcohol?
During the past 30 days, how many times have you used any recreational drug in combination with drinking alcohol?
0 times
1 or 2 times
3 to 9 times
10 to 19 times
20 to 39 times
40 to 99 times
100 or more times
40
. During your life, how many times have you used a needle to inject any recreational drugs into your body?
During your life, how many times have you used a needle to inject any recreational drugs into your body?
0 times
1 time
2 or more times
41
. How old were you when you had sexual intercourse for the first time?
How old were you when you had sexual intercourse for the first time?
I have not had sexual intercourse
12 years or younger
13 or 14 years old
15 or 16 years old
17 or 18 years old
19 or 20 years old
21 to 24 years old
25 years old or older
42
. During the past 3 months, how many partners did you have sexual intercourse with?
During the past 3 months, how many partners did you have sexual intercourse with?
I have never had sexual intercourse
none
1 partner
2 partners
3 partners
4 partners
5 partners
6 or more partners
43
. During the past 3 months, how many times did you have sexual intercourse?
During the past 3 months, how many times did you have sexual intercourse?
0 times
1 time
2 or 3 times
4 to 9 times
10 to 19 times
20 or more times
44
. During the past 3 months, how often did you or your partner use a condom, oral contraceptives, or other birth control method?
During the past 3 months, how often did you or your partner use a condom, oral contraceptives, or other birth control method?
I have not had sexual intercourse during the past 3 months
Never used a condom, contraceptive, or other birth control
Rarely used a condom, contraceptive, or other birth control
Sometimes used a condom, contraceptive, or other birth control
Most of the time used a condom, contraceptive, or other birth control
Always used a condom, contraceptive, or other birth control
45
. The last time you had sexual intercourse, did you or your partner use a condom?
The last time you had sexual intercourse, did you or your partner use a condom?
not having sexual intercourse
Yes
No
46
. In the last 3 months did you drink alcohol or use drugs before you had sexual intercourse?
In the last 3 months did you drink alcohol or use drugs before you had sexual intercourse?
not having sexual intercourse
Yes
No
47
. The last time you had sexual intercourse, what method did you or your partner use to prevent pregnancy?
The last time you had sexual intercourse, what method did you or your partner use to prevent pregnancy?
not having sexual intercourse
No method was used to prevent pregnancy
Birth control pills
Condoms
Withdrawal
Some other method
48
. How many times have you been pregnant or got someone pregnant?
How many times have you been pregnant or got someone pregnant?
0 times
1 time
2 or more times
not sure
49
. During your life, have you ever been forced to have sexual intercourse against your will?
During your life, have you ever been forced to have sexual intercourse against your will?
Yes
No
50
. Have you ever had your blood tested for HIV/AIDS?
Have you ever had your blood tested for HIV/AIDS?
Yes
No
51
. Do you feel you have had sufficient education regarding sexually transmitted diseases?
Do you feel you have had sufficient education regarding sexually transmitted diseases?
Yes
No
52
. Are you practicing safer sex as the result of sexually transmitted disease education?
Are you practicing safer sex as the result of sexually transmitted disease education?
not having sexual relations
always
often
sometimes
seldom
never
53
. Have you ever had a sexually transmitted disease?
Have you ever had a sexually transmitted disease?
Yes
No
54
. My level of self-esteem is?
My level of self-esteem is?
below what I'd like it to be
about what I'd like it to be
above what I'd like it to be
55
. How do you describe your body?
How do you describe your body?
Very underweight
Slightly underweight
About the right weight
Slightly overweight
Very overweight
56
. Which of the following are you trying to do about your body?
Which of the following are you trying to do about your body?
Lose weight
Gain weight
Stay the same weight
I am not trying to do anything about my weight
57
. Have you ever dieted or exercised to lose weight or to keep from gaining weight?
Have you ever dieted or exercised to lose weight or to keep from gaining weight?
Yes
No
58
. Have you ever vomited or taken laxatives to lose weight or keep from gaining weight?
Have you ever vomited or taken laxatives to lose weight or keep from gaining weight?
Yes
No
59
. Have you ever taken diet pills to lose weight or keep from gaining weight?
Have you ever taken diet pills to lose weight or keep from gaining weight?
Yes
No
60
. Do you feel you have an eating problem or disorder of some kind?
Do you feel you have an eating problem or disorder of some kind?
not at all
in the past but not presently
presently but not in the past
both presently and in the past
61
. Yesterday, how many times did you eat a piece of fruit or drink fruit juice?
Yesterday, how many times did you eat a piece of fruit or drink fruit juice?
0 times
1 time
2 times
3 or more times
62
. Yesterday, how many times did you eat green salad or vegetables?
Yesterday, how many times did you eat green salad or vegetables?
0 times
1 time
2 times
3 or more times
63
. Yesterday, how many times did you drink milk, eat cheese, yogurt, or other dairy products?
Yesterday, how many times did you drink milk, eat cheese, yogurt, or other dairy products?
0 times
1 time
2 times
3 or more times
64
. Do you eat a vegetarian diet?
Do you eat a vegetarian diet?
never
seldom
sometimes
often
always
65
. On how many of the past 7 days did you do exercises to strengthen or tone your muscles, such as push-ups, sit-ups, or weight lifting?
On how many of the past 7 days did you do exercises to strengthen or tone your muscles, such as push-ups, sit-ups, or weight lifting?
0 days
1 day
2 days
3 days
4 days
5 days
6 days
7 days
66
. On how many of the past 7 days did you do exercise or participate in sport activities for at least 20 minutes?
On how many of the past 7 days did you do exercise or participate in sport activities for at least 20 minutes?
0 days
1 day
2 days
3 days
4 days
5 days
6 days
7 days
67
. During the past year, in how many sports teams (intramural or extramural) did you participate?
During the past year, in how many sports teams (intramural or extramural) did you participate?
0 teams
1 teams
2 teams
3 or more teams
68
. When making behavioral choices, who and/or what has the greatest influence on your decision-making?
When making behavioral choices, who and/or what has the greatest influence on your decision-making?
friends/peers
relatives
parents
TV/media
siblings
Other (please specify)
69
. On which of the following health topics would you like Health Services to provide information.
On which of the following health topics would you like Health Services to provide information.
Alcohol
Alternative Therapy
Anger Management
Anxiety
Birth Control
Body Art
Body Image
Depression
Dealing with stress
Eating Issues and Disorders
Family Issues
Grief/Loss
Healthy Relationships
HIV/AIDS
Injury and Safety
Nutrition
Pregnancy
Physical Activity and Fitness
Substance Use/Abuse
Self-Esteem
Sexual Decision Making
Sexually Transmitted Infections
Sleep
Suicide
Supplements
Tobacco Use
Unhealthy Relationships
Other (please specify)
70
. I am satisfied with my life in the past.
I am satisfied with my life in the past.
Strongly Disagree
Disagree
Agree
Strongly Agree
71
. I am satisfied with my current life.
I am satisfied with my current life.
Strongly Disagree
Disagree
Agree
Strongly Agree
72
. I will be satisfied with my life in the future.
I will be satisfied with my life in the future.
Strongly Disagree
Disagree
Agree
Strongly Agree
73
. Life does not have much meaning.
Life does not have much meaning.
Strongly Disagree
Disagree
Agree
Strongly Agree
74
. I do not enjoy much about life.
I do not enjoy much about life.
Strongly Disagree
Disagree
Agree
Strongly Agree
75
. I feel unsettled about the future.
I feel unsettled about the future.
Strongly Disagree
Disagree
Agree
Strongly Agree
76
. I am unable to cope with difficult situations.
I am unable to cope with difficult situations.
Strongly Disagree
Disagree
Agree
Strongly Agree
77
. I successfully solve problems that come up.
I successfully solve problems that come up.
Strongly Disagree
Disagree
Agree
Strongly Agree
78
. I feel able to cope with stress.
I feel able to cope with stress.
Strongly Disagree
Disagree
Agree
Strongly Agree
79
. I feel pressured by others.
I feel pressured by others.
Strongly Disagree
Disagree
Agree
Strongly Agree
80
. I feel overwhelmed.
I feel overwhelmed.
Strongly Disagree
Disagree
Agree
Strongly Agree
81
. I feel I have more stress than usual.
I feel I have more stress than usual.
Strongly Disagree
Disagree
Agree
Strongly Agree
82
. My social support system from my FRIENDS is ...
My social support system from my FRIENDS is ...
non-existent
poor
fair
good
very good
excellent
83
. My social support system from my FAMILY is ...
My social support system from my FAMILY is ...
non-existent
poor
fair
good
very good
excellent
84
. My current feelings about my own self worth are...
My current feelings about my own self worth are...
non-existent
poor
fair
good
very good
excellent
85
. The following members of my family abused alcohol or drugs before I was 18 years old.
The following members of my family abused alcohol or drugs before I was 18 years old.
Mother
Father
Brothers and/or Sisters, including step/half
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