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Youth Survey Ages 12-18
1.
During the
past 30 days
, on how many days did you have at least one drink of alcohol?
0
1 or 2
3 to 5
6 to 9
10 to 19
20 to 29
All 30 days
2.
During the
past 30 days
, how many times did you take a prescription drug
without
a doctors prescription?
0 times
1 or 2 times
3 to 9 times
10 to 19 times
20 to 39 times
40 or more times
3.
During the
past 30 days
how many time did you use heroin?
0 times
1 or 2 times
3 to 9 times
10 to 19 times
20 to 39 times
40 or more times
4.
During the
past 12 months
, how many times did you take a prescription drug
without
a doctors prescription?
0 times
1 or 2 times
3 to 9 times
10 to 19 times
20 to 39 times
40 or more times
5.
During the
past 12 months
, how many times did you use heroin?
0 times
1 or 2 times
3 to 9 times
10 to 19 times
20 to 39 times
40 or more times
6.
How do you think your parents would feel about you having one or two drinks of an alcoholic beverage nearly every day?
Neither approve or disapprove
Somewhat disapprove
Strongly disapprove
7.
How do you think your parents would feel about you using prescription drugs not prescribed to you or that you took only for the experience or feeling that they caused?
Neither approve or disapprove
Somewhat disapprove
Strongly disapprove
8.
How do you think your parents would feel about you using heroin?
Neither approve nor disapprove
Somewhat disapprove
Strongly disapprove
9.
How do you think your close friends would feel about you having one or two drinks of an alcoholic beverage nearly everyday?
Neither approve nor disapprove
Somewhat disapprove
Strongly disapprove
10.
How do you think your close friends would feel about you using prescription drugs not prescribed to you or that you took only for the experience or feeling they cause?
Neither approve or disapprove
Somewhat disapprove
Strongly disapprove
11.
How do you think your close friends would feel about you using heroin?
Neither approve or disapprove
Somewhat disapprove
Strongly disapprove
12.
How much do people risk harming themselves physically and in other ways when they have five or more drinks of an alcoholic beverage once or twice a week?
No risk
Slight risk
Moderate risk
Great risk
13.
How much do people risk harming themselves physically and in other ways if they use prescription drugs that are not prescribed to them or that they took only for the experience or feeling that they caused?
No risk
Slight risk
Moderate risk
Great risk
14.
How much do people risk harming themselves physically or in other ways when they use heroin?
No risk
Slight risk
Moderate risk
Great risk
15.
How old are you?
12 years old
13 years old
14 years old
15 years old
16 years old
17 years old
18 years or older
16.
What is you sex?
Female
Male
17.
What grade are you in?
6th grade
7th grade
8th grade
9th grade
10th grade
11th grade
12th grade
Other
18.
Are you Hispanic or Latino?
Yes
No
19.
What is your race?
American Indian or Alaska Native
Asian
Black or African American
Native Hawaiian or Other Pacific Islander
White
20.
When you ride a bicycle, how often do you wear a helmet?
I do not ride a bicycle
Never wear a helmet
Rarely wear a helmet
Sometimes wear a helmet
Most of the time wear a helmet
Always wear a helmet
21.
When you rollerblade or skateboard, how often do you wear a helmet?
I do not rollerblade or ride a skateboard
Never wear a helmet
Rarely wear a helmet
Sometimes wear a helmet
Most of the time wear a helmet
Always wear a helmet
22.
How often do you wear a seatbelt when riding in the car?
Never
Rarely
Sometimes
Most of the time
Always
23.
Have you ever ridden in the car driven by someone who has been drinking alcohol?
Yes
No
Not sure
24.
Have you ever carried a weapon, such as a gun, knife, or club?
Yes
No
25.
Have you ever been in a physical fight?
Yes
No
26.
Have you ever been bullied on school property?
Yes
No
27.
Have you ever been electronically bullied or Cyber Bullied?
Yes
No
28.
Have you ever seriously thought about killing yourself?
Yes
No
29.
Have you ever made a plan about what you would do to kill yourself?
Yes
No
30.
Have you ever tried to kill yourself?
Yes
No
31.
Have you ever tried cigarette smoking, even one or two puffs?
Yes
No
32.
How old were you when you first tried cigarette smoking, even one or two puffs?
I have never tried cigarette smoking, not even one or two puffs
8 years old or younger
9 years old
10 years old
11 years old
12 years old
13 years old or older
33.
During the past 30 days, on how many days did you smoke cigarettes?
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
34.
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
35.
Have you ever used an electronic vapor product?
Yes
No
36.
During the past 30 days, on how many days did you use an electronic vapor product?
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
37.
During the past 30 days, how do you usually get your own electronic vapor products?
I did not use any electronic vapor products during the last 30 days
I bought them in a store
I got them on the internet
I gave someone else money to buy them for me
I borrowed them from someone else
A person 18 years or older gave them to me
I took them from a store or another person
I got them some other way
38.
During the past 30 days, on how many days did you use chewing tobacco, snuff, dip, suns, or dissolvable tobacco products? (Not electronic vapor products)
0 days
1 or 2 days
3 to 5 days
6 to 9 day
10 to 19 days
20 to 29 days
All 30 days
39.
During the past 30 days, on how many days did you smoke cigars, cigarillos, or little cigars?
0 days
1 or 2 days
3 to 5days
6 to 9 days
10 to 19 days
20 to 29 days
All 30 days
40.
Have you ever had a drink of alcohol other than a few sips?
Yes
No
41.
How old were you when you had your first drink of alcohol other than a few sips?
I have never had a drink of alcohol other than a few sips
8 years old or younger
9 years old
10 years old
11 years old
12 years old
13 years old or older
42.
Have you ever used marijuana?
Yes
No
43.
How old were you when you tried marijuana for the first time?
I have never tried marijuana
8 years old or younger
9 years old
10 years old
11 years old
12 years old
13 years old or older
44.
Have you ever used any form of cocaine, including powder, crack, or freebase?
Yes
No
45.
Have you ever sniffed glue, breathed the contents of spray cans, or inhaled any paints or sprays to get high?
Yes
No
46.
Have you ever taken steroid pills or shots without a doctor's prescription?
Yes
No
47.
Have you ever taken
prescription pain medicine without a doctor's prescription
or differently than how the doctor told you to use it?
Yes
No
48.
Have you ever had sexual intercourse?
Yes
No
49.
How old were you when you had sexual intercourse for the first time?
I have never had sexual intercourse
8 years old or younger
9 years old
10 years old
11 years old
12 years old
13 years old or older
50.
With how many people have have you ever had sexual intercourse?
I have never had sexual intercourse
1 person
2 people
3 people
4 people
5 people
6 or more people
51.
The
last time
you had sexual intercourse, did you or your partner use a condom?
I have never had sexual intercourse
Yes
No
52.
How would
you
describe your body weight?
Very underweight
Slightly underweight
About the right weight
Slightly overweight
Very overweight
53.
Which of the following are you trying to do about your weight?
Lose weight
Gain weight
Stay the same weight
I am not trying to do anything about my weight
54.
During the past 7 days, on how many days did you eat breakfast?
0 days
1 day
2 days
3 days
4 days
5 days
6 days
7 days
55.
During the past 7 days, on how many days were you physically activefor a total of
at least 60 minutes
per day?
0 days
1 day
2 days
3 days
4 days
5 days
6 days
7 days
56.
On an average school day, how many hours do you watch TV?
I do not watch TV on an average school day
Less than 1 hour per day
1 hour per day
2 hours per day
3 hours per day
4 hours per day
5 or more hours per day
57.
On an average school day, how many hours do you play video or computer games or use a computer for something that is not school work?
I do not play video or computer games or use a computer for something that is not school work
Less than 1 hour per day
1 hour per day
2 hours per day
3 hours per day
4 hours per day
5 or more hours per day
58.
On an average week when you are in school, on how many days do you go to physical education (PE) classes?
0 days
1 day
2 days
3 days
4 days
5 days
59.
During the past 12 months, on how many sports teams did you play?
0 teams
1 team
2 teams
3 or more teams
60.
During the past 12 months, how many times did you have a
concussion from playing a sport or being physically active?
0 times
1 time
2 times
3 times
4 or more times
61.
Has a doctor or nurse ever told you that you have asthma?
Yes
No
Not sure
62.
On an average school night, how many hours of sleep do you get?
4 or less hours of sleep
5 hours
6 hours
7 hours
8 hours
9 hours
10 or more hours
63.
During the past 12 months, how would you describe your grades in school?
Mostly A's
Mostly B's
Mostly C's
Mostly D's
Mostly F's
None of these grades
64.
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