The purpose of this survey is to determine what young people are thinking and doing about their health habits.  Your answers will be kept secret.  Please be honest with your answers. Thank you!

Question Title

1. What is today's date?

Date

Question Title

2. Create an anonymous code number by answering:

1. What are the first two letters of your mother's first name? For example, MA for Mary.
2. What is your two-digit birth month number? For example, 06 for a birthday in June.
3. What are the last two digits of your phone number? For example, 27 for a phone number 904-477-3027.
For example: Mary+June+phone ending 27=MA0627.
Are you SURE this is the same code you used before?

Question Title

3. School or location code (Answer only if provided a code):

Question Title

4. Are you:

Question Title

5. What is your age?

Question Title

6. What is your race or ethnicity?

Question Title

7. In the next 30 days, how likely are you to get physical activity most days a week?

Question Title

8. In the next 30 days, how likely are you to get 8 or more hours of sleep most nights a week?

Question Title

9. In the next 30 days, how likely are you to eat fruits and vegetables most days a week?

Question Title

10. In the next 30 days, how likely are you to eat breakfast most days a week?

Question Title

11. In the next year, how likely are you to take a drink of alcohol?

Question Title

12. In the next year, how likely are you to puff on a tobacco cigarette?

Question Title

13. In the next year, how likely are you to use any marijuana?

Question Title

14. In the next year, how likely are you to vape an e-cigarette?

Question Title

15. In the next 30 days, how likely are you to practice a stress control or relaxation technique most days a week?

Question Title

16. In the next year, how likely are you to use any opioids for nonmedical reasons?

Question Title

17. In the next 30 days, how likely are you to set goals to improve your health or fitness?

Question Title

18. In the next year, how likely are you to feel so sad or hopeless that you stop doing some of your usual activities?

Question Title

19. If you were to drink alcohol often or heavily, would it harm your health or healthy habits?

Question Title

20. If you were to smoke tobacco cigarettes often or heavily, would they harm your health or healthy habits?

Question Title

21. If you were to use marijuana often or heavily, would it harm your health or healthy habits?

Question Title

22. If you were to vape e-cigarettes often or heavily, would they harm your health or healthy habits?

Question Title

23. If you were to use opioids often or heavily, would they harm your health or healthy habits?

Question Title

24. How happy are you with your current physical and mental health?

Question Title

25. How much did you like this lesson?

Question Title

26. How much will this lesson help you improve your health?

Question Title

27. What did you like BEST about this lesson? For example, how it affected your healthy habits, substance use, motivation, goal setting, etc.

Question Title

28. What did you like LEAST about this lesson? For example, what would you like to see changed or improved?

0 of 28 answered
 

T