2013 - 14 Behavior Survey

1. All answers are anonymous and confidential.

 
1. How old are you?
2. What is your gender?
3. What is your class standing?
4. Are you a full-time student?
5. How would you describe yourself?
6. Where will you be living this semester?
7. How many hours a week do you plan to work?
8. How often do you wear a seat belt?
9. When you rode a bicycle during the past 12 months, how often did you wear a helmet?
10. When you participated in water sports during the past 12 months, how often did you drink 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?
12. During the past 30 days, how many times did you drive a car or other vehicle when you had been drinking alcohol?
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.
14. During the past 12 months, how many times were you in a physical fight?
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?
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?
17. How many times in the past 3 months have you felt moderately or severely angry?
18. How many times in the past 12 months have you felt moderately or severely depressed?
19. During the past 12 months, did you ever seriously consider suicide?
20. During the past 12 months, did you make a plan about how you would attempt suicide?
21. During the past 12 months, how many times did you actually attempt suicide?
22. During the past 30 days, on the days you smoked how many cigarettes did you smoke per day?
23. How old were you when you first started smoking cigarettes regularly?
24. How many times have you tried to quit smoking?
25. During the past 30 days, on how many days did you use chewing tobacco or snuff?
26. How old were you when you had your first drink of alcohol other than a few sips?
27. During the past 30 days, on how many days did you have at least one drink of alcohol?
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?
29. During the past 30 days, how many drinks containing alcohol did you have on the days in which you drank?
30. During the last 30 days, what is the highest number of drinks that you drank on any one occasion?
31. Did you drink until you felt drunk or intoxicated at least once in the last month?
32. How old were you when you tried marijuana for the first time?
33. During the past 30 days, how many times did you use marijuana?
34. During your life, how many times have you used any form of cocaine including powder, crack, or freebase?
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?
36. During your life, how many times have you taken steroids for body building purposes?
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?
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?
39. During the past 30 days, how many times have you used any recreational drug in combination with drinking alcohol?
40. During your life, how many times have you used a needle to inject any recreational drugs into your body?
41. How old were you when you had sexual intercourse for the first time?
42. During the past 3 months, how many partners did you have sexual intercourse with?
43. During the past 3 months, how many times did you have sexual intercourse?
44. During the past 3 months, how often did you or your partner use a condom, oral contraceptives, or other birth control method?
45. The last time you had sexual intercourse, did you or your partner use a condom?
46. In the last 3 months did you drink alcohol or use drugs before you had sexual intercourse?
47. The last time you had sexual intercourse, what method did you or your partner use to prevent pregnancy?
48. How many times have you been pregnant or got someone pregnant?
49. During your life, have you ever been forced to have sexual intercourse against your will?
50. Have you ever had your blood tested for HIV/AIDS?
51. Do you feel you have had sufficient education regarding sexually transmitted diseases?
52. Are you practicing safer sex as the result of sexually transmitted disease education?
53. Have you ever had a sexually transmitted disease?
54. My level of self-esteem is?
55. How do you describe your body?
56. Which of the following are you trying to do about your body?
57. Have you ever dieted or exercised to lose weight or to keep from gaining weight?
58. Have you ever vomited or taken laxatives to lose weight or keep from gaining weight?
59. Have you ever taken diet pills to lose weight or keep from gaining weight?
60. Do you feel you have an eating problem or disorder of some kind?
61. Yesterday, how many times did you eat a piece of fruit or drink fruit juice?
62. Yesterday, how many times did you eat green salad or vegetables?
63. Yesterday, how many times did you drink milk, eat cheese, yogurt, or other dairy products?
64. Do you eat a vegetarian diet?
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?
66. On how many of the past 7 days did you do exercise or participate in sport activities for at least 20 minutes?
67. During the past year, in how many sports teams (intramural or extramural) did you participate?
68. When making behavioral choices, who and/or what has the greatest influence on your decision-making?
69. On which of the following health topics would you like Health Services to provide information.
70. On an average night, how many hours of sleep do you get?
71. I am satisfied with my life in the past.
72. I am satisfied with my current life.
73. I will be satisfied with my life in the future.
74. Life does not have much meaning.
75. I do not enjoy much about life.
76. I feel unsettled about the future.
77. I am unable to cope with difficult situations.
78. I successfully solve problems that come up.
79. I feel able to cope with stress.
80. I feel pressured by others.
81. I feel overwhelmed.
82. I feel I have more stress than usual.
83. My social support system from my FRIENDS is ...
84. My social support system from my FAMILY is ...
85. My current feelings about my own self worth are...
86. The following members of my family abused alcohol or drugs before I was 18 years old.
 1 / 1 
Powered by SurveyMonkey
Check out our sample surveys and create your own now!