Youth Survey Ages 12-18 Question Title * 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 Question Title * 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 Question Title * 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 Question Title * 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 Question Title * 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 Question Title * 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 Question Title * 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 Question Title * 8. How do you think your parents would feel about you using heroin? Neither approve nor disapprove Somewhat disapprove Strongly disapprove Question Title * 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 Question Title * 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 Question Title * 11. How do you think your close friends would feel about you using heroin? Neither approve or disapprove Somewhat disapprove Strongly disapprove Question Title * 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 Question Title * 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 Question Title * 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 Question Title * 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 Question Title * 16. What is you sex? Female Male Question Title * 17. What grade are you in? 6th grade 7th grade 8th grade 9th grade 10th grade 11th grade 12th grade Other Question Title * 18. Are you Hispanic or Latino? Yes No Question Title * 19. What is your race? American Indian or Alaska Native Asian Black or African American Native Hawaiian or Other Pacific Islander White Question Title * 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 Question Title * 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 Question Title * 22. How often do you wear a seatbelt when riding in the car? Never Rarely Sometimes Most of the time Always Question Title * 23. Have you ever ridden in the car driven by someone who has been drinking alcohol? Yes No Not sure Question Title * 24. Have you ever carried a weapon, such as a gun, knife, or club? Yes No Question Title * 25. Have you ever been in a physical fight? Yes No Question Title * 26. Have you ever been bullied on school property? Yes No Question Title * 27. Have you ever been electronically bullied or Cyber Bullied? Yes No Question Title * 28. Have you ever seriously thought about killing yourself? Yes No Question Title * 29. Have you ever made a plan about what you would do to kill yourself? Yes No Question Title * 30. Have you ever tried to kill yourself? Yes No Question Title * 31. Have you ever tried cigarette smoking, even one or two puffs? Yes No Question Title * 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 Question Title * 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 Question Title * 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 Question Title * 35. Have you ever used an electronic vapor product? Yes No Question Title * 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 Question Title * 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 Question Title * 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 Question Title * 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 Question Title * 40. Have you ever had a drink of alcohol other than a few sips? Yes No Question Title * 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 Question Title * 42. Have you ever used marijuana? Yes No Question Title * 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 Question Title * 44. Have you ever used any form of cocaine, including powder, crack, or freebase? Yes No Question Title * 45. Have you ever sniffed glue, breathed the contents of spray cans, or inhaled any paints or sprays to get high? Yes No Question Title * 46. Have you ever taken steroid pills or shots without a doctor's prescription? Yes No Question Title * 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 Question Title * 48. Have you ever had sexual intercourse? Yes No Question Title * 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 Question Title * 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 Question Title * 51. The last time you had sexual intercourse, did you or your partner use a condom? I have never had sexual intercourse Yes No Question Title * 52. How would you describe your body weight? Very underweight Slightly underweight About the right weight Slightly overweight Very overweight Question Title * 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 Question Title * 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 Question Title * 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 Question Title * 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 Question Title * 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 Question Title * 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 Question Title * 59. During the past 12 months, on how many sports teams did you play? 0 teams 1 team 2 teams 3 or more teams Question Title * 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 Question Title * 61. Has a doctor or nurse ever told you that you have asthma? Yes No Not sure Question Title * 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 Question Title * 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 Question Title * 64. Please text NPC to 757-500-3729 when you are complete, and a representative will assist you in receiving your gift. Done