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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!

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* 1. What is today's date?

Date

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* 2. Create a personal code number by answering:

1. What is the FIRST letter of your first name? For example, R for Rose.
2. What is LAST letter of your last name? For example, Z for Gonzalez.
3. What DAY of the month were you born on? For example, the 15th. For example, this code=RZ15.

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

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* 4. Are you:

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* 5. What is your age?

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* 6. What is your race or ethnicity?

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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* 25. How much did you like this lesson?

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

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

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

0 of 28 answered
 

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