BrainAbouts QuestionnaireYouth Risk Behavior Survey (Edited by BrainAbouts)High School

This survey is about health behavior. It has been developed so you can tell us what you do that may affect your health. The information you give will be used to improve health education for young people like yourself.

DO NOT write your name on this survey. The answers you give will be kept private. No one will know what you write. Answer the questions based on what you really do.

Completing the survey is voluntary. Whether or not you answer the questions will not affect your grade in this class. If you are not comfortable answering a question, just leave it blank.

The questions that ask about your background will be used only to describe the types of students completing this survey. The information will not be used to find out your name. No names will ever be reported.

Make sure to read every question. When you are finished, follow the instructions of the person giving you the survey.

Thank you very much for your help.

1.How old are you?

2.What is your sex?

Male

Female

Choose Not to Answer

4.What school do you attend?

5.Are you Hispanic or Latino?

Yes

Choose not to answer

6.What is your race? (Select one or more responses.)

7.Has your school used the BrainAbouts Program?

Yes

9.I liked this topic mainly because (Check all that apply)

I learned things that I didn't know

It was engaging and entertaining

It helped me to make better choices

Other

10.Through the BrainAbouts program, I have learned . . .

11.The BrainAbouts program has helped me . . .

14.My frontal lobe is . . .

Is the thinking part of my brain that helps with problem solving, decision making, and empathy.

Is the feeling part of my brain that helps me to "feel all my feelings."

Is the part of my brain that is responsible for my fight, flight, or freeze response.

Is the part of my brain that mirrors the responses of others.

15.My limbic system is the part of my brain that is involved in

Problem Solving

Decision Making

Emotions

Spatial Processing

17.During the past 30 days, how many times did you ride in a car other vehicle driven by someone who had been drinking alcohol?

18.During the past 30 days, how many times did you drive a car or other vehicle when you had been drinking alcohol?

19.During the past 30 days, how many times did you text or email while driving a car or other vehicle?

20.The next 3 questions ask about violence-related behaviors and experiences. During the past 12 months, how many times did anyone force you to sexual things that you did not want to do? (Count such things as kissing, touching, or being physically forced to have sexual intercourse.)

21.During the past 12 months, how many times did someone you were dating or going out with force you to do sexual things that you did not want to do? (Count such things as kissing, touching, or being physically forced to have sexual intercourse.)

22.During the past 12 months, how many times did someone you were dating or going out with physically hurt you on purpose? (Count such things as being hit, slammed into something, or injured with an object or weapon.)

23.The next 2 questions ask about bullying. Bullying is when 1 or more students tease, threaten, spread rumors about, hit, shove, or hurt another student over and over again. It is not bullying when 2 students of about the same strength or power argue or fight or tease each other in a friendly way. During the past 12 months, have you even been bullied on school property?

Yes

24.During the past 12 months, have you ever been electronically bullied? (Count being bullied through texting, Instagram, Facebook, [Snapchat] or other social media.)

Yes

25.The next 5 questions ask about sad feelings and attempted suicide. Sometimes people feel so depressed about the future that they may consider attempting suicide, that is, taking some action to end their own life. During the past 12 months, did you ever feel so sad or hopeless almost every day for two weeks or more in a row that you stopped doing some usual activities?

Yes

26.During the past 12 months, did you ever seriously consider attempting suicide?

Yes

27.During the past 12 months did you make a plan about how you would attempt suicide?

Yes

29.If you attempted suicide during the past 12 months, did any attempt result in an injury, poisoning, or overdose that had to be treated by a doctor or nurse?

I did not attempt suicide during the past 12 months

Yes

30.Have you ever smoked a cigarette, even one or two puffs?

Yes

31.How old were you when you first smoked a cigarette, even one or two puffs?

33.During the past 30 days, on the days you smoked, how many cigarettes did you smoke per day?

34.The next 3 questions ask about electronic vapor products, such as JUUL, Vuse, NJOY, Puff Bar, blu, or Bidi Stick. Electronic vapor products include e-cigarettes, vapes, mods, e-cigs, e-hookahs, or vape pens. Have you ever used an electronic vapor product?

Yes

36.During the past 30 days, how did you usually get your electronic vapor products? (Select only one response.)

I did not use any electronic vapor products during the past 30 days

I got or bought them from a friend, family member, or someone else

I bought them myself in a vape shop or tobacco shop

I bought them myself in a convenience store, supermarket, discount store, or gas station

I bought them myself at a mall or shopping center kiosk or stand

I bought them myself on the Internet, such as from a product website, vape store website, or other website like eBay, Amazon, Facebook Marketplace, or Craigslist

I took them from a store or another person

I got them in some other way

37.This question asks about other tobacco products. During the past 30 days, on how many days did you smoke cigars, cigarillos, or little cigars, such as Swisher Sweets, Middleton's (including Black & Mild), or Backwoods?

38.The next question asks about drinking alcohol. This includes drinking beer, wine, flavored alcoholic beverages, and liquor such as rum, gin, vodka, or whiskey. For these questions, drinking alcohol does not include drinking a few sips of wine for religious purposes. How old were you when you had your first drink of alcohol other than a few sips?

40.During the past 30 days, on how many days did you have 4 or more drinks of alchol in a row, that is, within a couple of hours (if you are female) or 5 or more drinks of alcohol in a row, that is, within a couple of hours (if you are male)?

41.During the past 30 days, what is the largest number of alcoholic drinks you had in a row, that is, within a couple of hours?

42.During the past 30 days, how did you usually get the alcohol you drank?

I did not drink alcohol during the past 30 days

I bought it in a store such as a liquor store, convenience store, supermarket, discount store, or gas station

I bought it a restaurant, bar, or club

I bought it at a public event such as a concert or sporting event

I gave someone else money to buy it for me

Someone gave it to me

I took it from a store or family member

I got it some other way

43.The next questions ask about marijuana use. Marijuana also is called pot or weed. For these questions, do not count CBD-only or hemp products, which come from the same plant as marijuana, but do not cause a high when used alone. During your life, how many times have you used marijuana?

46.The next question asks about the use of prescription pain medicine without a doctor's prescription or differently than how a doctor told you to use it. For this question, count drugs such as codeine, Vicodine, Oxycontin, Hydrocodone, and Percocet. During your life, how many times have you taken prescription pain medicine without a doctor's prescription or differently than how a doctor told you to use it?

47.During your life, how many times have you used any form of cocaine, including powder, crack, or freebase; sniffed glue, breathed the contents of aerosol spray cans, or inhaled any paints or sprays to get high; used heroin, methamphetamine, ecstasy, or used a need to inject any illegal drug into your body?

48.The next 5 questions ask about sexual behavior. Have you ever had sexual intercourse?

Yes

50.Did you drink alcohol or use drugs before you had sexual intercourse the last time?

Yes

51.The last time you had sexual intercourse, did you or your partner use a condom?

I have never had sexual intercourse

Yes

52.The last time you had sexual intercourse with an opposite-sex partner, what one method did you or your partner use to prevent pregnancy? (Select only one response.)

I have never had sexual intercourse with an opposite-sex partner

No method was used to prevent pregnancy

Birth control pills (Do not count emergency contraception such as Plan B or the "morning after" pill.)

Condoms

An IUD (such as Mirena or ParaGard) or implant (such as Implanon or Nexplanon)

A shot (such as Dep-Provera), patch (such as Ortho Evra) or birth control ring (such as NuvaRing)

Withdrawal or some other method

Not sure

53.The next two questions ask about body weight. How do you describe your weight?

54.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

55.This question is about social media, such as Instagram, Tik Tok, Snapchat and [X]. How often do you use social media?

56.The next 3 questions ask about other health-related topics. During the past 30 days, how often was your mental health not good? (Poor mental health includes stress, anxiety, and depression.)

Rarely

Sometimes

Most of the time

Always

59.A suggestion that I have for making the BrainAbouts program more helpful to me is