Screen Reader Mode Icon
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. Today's date is: 

Date

Question Title

* 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.

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 a healthy breakfast most days a week?

Question Title

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

Question Title

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

Question Title

* 13. In the next five years, how likely are you to try any marijuana?

Question Title

* 14. In the next five years, how likely are you to try 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 five years, how likely are you to try 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 five years, 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, would it harm your health or healthy habits?

Question Title

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

Question Title

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

Question Title

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

Question Title

* 23. If you were to use opioids often, 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. During the past 30 days, on how many days did you exercise or participate in a physical activity for at least 30 minutes that made you sweat and breathe hard, such as basketball, soccer, running, swimming laps, fast bike-riding, fast dancing, or similar aerobic activities?

Question Title

* 26. During the past 30 days, on how many days did you exercise or participate in a physical activity for at least 30 minutes that did not make you sweat or breathe hard, such as fast walking, slow bicycling, or skating?

Question Title

* 27. During the past 30 days, on how many days did you eat a healthy breakfast?

Question Title

* 28. During the past 7 days, how many times did you eat fruit and vegetables (total both)?

Question Title

* 29. During the past 30 days, how many hours did you usually sleep each night?

Question Title

* 30. During the past 30 days, on how many days did you use a stress control technique like slow-deep breathing, yoga, meditation, prayer, taking a relaxing bath or shower, placing yourself in a quiet space or walking in nature?

Question Title

* 31. During the past 30 days, on how many weeks did you set goals to improve your health or fitness? 

Question Title

* 32. During the past 30 days, on how many days did you have at
least one drink of alcohol?

Question Title

* 33. During the past 30 days, how many days did you vape e-cigarettes?

Question Title

* 34. During the past 30 days, how many days did you smoke regular cigarettes?

Question Title

* 35. During the past 30 days, how many days did you use mari-
juana?

Question Title

* 36. During the past 30 days, how many days did you use opioids for non-medical reasons?

Question Title

* 37. During the past 30 days, how many days did you feel so sad or hopeless that you stopped doing some usual activities?

0 of 37 answered
 

T