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Garrett County Adolescent Survey
Developed by the Garrett County Adolescent Health Work Group
1.
What grade are you currently enrolled in?
9th Grade
10th Grade
11th Grade
12th Grade
College
2.
What is your gender?
Female
Male
Non-Binary
Prefer Not to Answer
3.
Regarding the rate of births to teens ages 15-19 years (per 1,000 population of teenaged females), which number do you think comes closest to Garrett County’s rate for the year 2017?
6 births per 1,000 teenaged females
12 births per 1,000 teenaged females
18 births per 1,000 teenaged females
24 births per 1,000 teenaged females
4.
Maryland’s 2017 goal was that >57% of adolescents receive an annual physical exam (annual check-up) by a primary provider (physician or nurse practitioner). The state of Maryland averaged 54.6%. Approximately what percent of adolescents in Garrett County do you think received annual physical exams in 2017?
27%
32%
38%
56%
5.
What percent of Garrett County high school students do you think seriously considered suicide during the year leading up to the 2016 Youth Risk Behavior Survey (YRBS)?
3%
7%
14%
21%
6.
What percentage of Garrett County high school students do you think have ever engaged in sex before graduating?
40%
50%
60%
70%
7.
True or false: Tobacco use among adolescents is highest in Garrett County, compared to all of the counties in Maryland.
True
False
8.
Do you think electronic nicotine delivery systems (also known as vaping devices) are addictive?
Yes
No
9.
Do you think electronic nicotine delivery systems are safe (referring to the effect on health rather than the possible explosiveness of the device.)?
Yes
No
10.
What percentage of Garrett County high school students do you think reported binge drinking on at least 1 day during the 30 days before the 2016 YRBS survey?
15%
23%
40%
55%
11.
During the last 12 months, I saw a health care provider (doctor, nurse practitioner, physician assistant) for the following reasons: (Check all that apply.)
Adolescent wellness check-up.
New illness (ex: flu, cough, fever)
Established illness (ex: asthma follow-up)
Vaccination services
Sports physical
Other (please specify)
12.
What kept you from attending routine adolescent wellness/preventive medicine check-ups in the past 12 months, if any? Choose as many as apply to you.
Not enough time
I am generally well, and not in need of routine wellness checks
I am uncertain about bringing up sensitive issues like sexuality, substance use, and mental illness
I don’t have a medical clinic that caters to my needs
I do not have medical insurance
My parents are unwilling (or probably unwilling) to allow me to have full range of services
Adolescent issues are best addressed within the home by my parents
Other (please specify)
13.
What would you like to talk to your health care provider about if you could see them?
Choose as many as apply:
Weight gain/obesity
Weight loss or eating disorders
Bullying
Anxiety
Depression
Stress
Home life
Dating violence
Abuse of any type (physical, sexual,verbal,emotional)
Drinking alcohol
Addiction to any substance
Suicidal thoughts
Sexual health (birth control, STI prevention)
Sexuality/orientation
Gender identification
Future goals
Financial stressors
How much sleep I need
What’s the best amount of exercise to get
How to avoid pitfalls of peer pressure
Healthiest diet for me
Maximum amount of non-academic screen time I should have
Advice before I go away to college
Other (please specify)
14.
What would help you be healthier?
*
15.
What is your zip code?
(Required.)
