Youth Risk Behavior Survey
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    1. How old are you?


      2. 12 years old or younger
      13 years old
      14 years old
      15 years old
      16 years old
      17 years old
      18 years old
      19 years old
      20 years old
      21 years old
      22 years old
      23 years old or older
       

    2. What is your sex?


      3. Female
      Male
       

    3. In what grade are you?


      4. 9th grade
      10th grade
      11th grade
      12th grade
      freshman, college
      sophomore, college
      junior, college
      senior, college
      Ungraded or other
       

    4. How do you describe yourself?


      5. White - not Hispanic
      Black - not Hispanic
      Hispanic or Latino
      Asian or Pacific Islander
      American Indian or Alaskan Native
      Other

      The next 17 questions ask about safety and violence.
       

    5. How often do you wear a seat belt when riding in a car driven by someone else?


      6. Never
      Rarely
      Sometimes
      Most of the time
      Always
       

    6. During the past 12 months, how many times did you ride a motorcycle?


      7. 0 times
      1 to 10 times
      11 to 20 times
      21 to 39 times
      40 or more times
       

    7. When you rode a motorcycle during the past 12 months, how often did you wear a helmet?


      8. I did not ride a motorcycle during the past 12 months
      Never wore a helmet
      Rarely wore a helmet
      Sometimes wore a helmet
      Most of the time wore a helmet
      Always wore a helmet
       

    8. During the past 12 months, how many times did you ride a bicycle?


      9. 0 times
      1 to 10 times
      11 to 20 times
      21 to 39 times
      40 or more times
       

    9. When you rode a bicycle during the past 12 months, how often did you wear a helmet?


      10. I did not ride a bicycle during the past 12 months
      Never wore a helmet
      Rarely wore a helmet
      Sometimes wore a helmet
      Most of the time wore a helmet
      Always wore a helmet
       

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


      11. 0 times
      1 time
      2 or 3 times
      4 or 5 times
      6 or more times
       

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


      12. 0 times
      1 time
      2 or 3 times
      4 or 5 times
      6 or more times
       

    12. During the past 30 days, on how many days did you carry a weapon such as a gun, knife, or club?


      13. 0 days
      1 day
      2 or 3 days
      4 or 5 days
      6 or more days
       

    13. During the past 30 days, on how many days did you carry a gun?


      14. 0 days
      1 day
      2 or 3 days
      4 or 5 days
      6 or more days
       

    14. During the past 30 days, on how many days did you carry a weapons such as a gun, knife, or club on school property?


      15. 0 days
      1 day
      2 or 3 days
      4 or 5 days
      6 or more days
       

    15. During the past 30 days, how many days did you not go to school because you felt you would be unsafe at school or on your way to or from school?


      16. 0 days
      1 day
      2 or 3 days
      4 or 5 days
      6 or more days
       

    16. During the past 12 months, how many times has someone threatened or injured you with a weapon such as a gun, knife, or club on school property?


      17. 0 times
      1 time
      2 or 3 times
      4 or 5 times
      6 or 7 times
      8 or 9 times
      10 or 11 times
      12 or more times
       

    17. During the past 12 months, how many times has someone stolen or deliberately damaged your property such as your car, clothing, or books on school property?


      18. 0 times
      1 time
      2 or 3 times
      4 or 5 times
      6 or 7 times
      8 or 9 times
      10 or 11 times
      12 or more times
       

    18. During the past 12 months, how many times were you in a physical fight?


      19. 0 times
      1 time
      2 or 3 times
      4 or 5 times
      6 or 7 times
      8 or 9 times
      10 or 11 times
      12 or more times
       

    19. During the past 12 months, how many times were you in a physical fight in which you were injured and had to be treated by a doctor or nurse?


      20. 0 times
      1 time
      2 or 3 times
      4 or 5 times
      6 or more times
       

    20. During the past 12 months, how many times were you in a physical fight on school property?


      21. 0 times
      1 time
      2 or 3 times
      4 or 5 times
      6 or 7 times
      8 or 9 times
      10 or 11 times
      12 or more times
       

    21. The last time you were in a physical fight, with whom did you fight?


      22. I have never been in a physical fight
      A total stranger
      A friend or someone I know
      A boyfriend, girlfriend, or date
      A parent, brother,sister, or other family member
      Someone not listed above
      More than one of the persons listed above

      Sometimes people feel so depressed and hopeless about the future that they may consider attempting suicide, that is, taking some action to end their own life.  The next four questions ask about attempted suicide.

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


      23. Yes
      No
       

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


      24. Yes
      No
       

    24. During the past 12 months, how many times did you actually attempt suicide?


      25. 0 times
      1 time
      2 or 3 times
      4 or 5 times
      6 or more times
       

    25. 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?


      26. I did not attempt suicide during the past 12 months
      Yes
      No

      The next ten questions ask about tobacco use.
       

    26. Have you ever tried cigarette smoking, even one or two puffs?


      27. Yes
      No
       

    27. How old were you when you smoked a whole cigarette for the first time?


      28. I have never smoked a whole cigarette
      8 years old or younger
      9 or 10 years old
      11 or 12 years old
      13 or 14 years old
      15 or 16 years old
      17 years old or older
       

    28. During the past 30 days, on how many days did you smoke cigarettes?


      29. I have never smoked a whole cigarette
      8 years old or younger
      9 or 10 years old
      11 or 12 years old
      13 or 14 years old
      15 or 16 years old
      17 years old or older
       

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


      30. I did not smoke cigarettes during the past 30 days
      Less than one cigarette per day
      1 cigarette per day
      2 to 5 cigarettes per day
      6 to 10 cigarettes per days
      11 to 20 cigarettes per day
      More than 20 cigarettes per day
       

    30. During the past 30 days, how did you usually get your own cigarettes?


      31. I did not smoke cigarettes during the past 30 days
      I bought them in a store such as a convenience store, supermarket, or gas station
      I bought them from a vending machine
      I gave someone else money to buy them for me
      I borrowed them from someone else
      I stole them
      I got them some other way
       

    31. When you bought cigarettes in a store during the past 30 days, were you ever asked to show proof of age?


      32. I did not smoke cigarettes during the past 30 days
      I did not buy cigarettes in a store during the past 30 days
      Yes, I was asked to show proof of age
      No, I was not asked to show proof of age
       

    32. During the past 30 days, on how many days did you smoke cigarettes on school property?


      33. 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
       

    33. Have you ever tried to quit smoking cigarettes?


      34. Yes
      No
       

    34. During the past 30 days, on how many days did you use chewing tobacco or snuff, such as Redman, Levi Garrett, Beechnut, Skoal, Skoal Bandits, or Copenhagen?


      35. 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
       

    35. During the past 30 days, on how many days did you use chewing tobacco or snuff on school property?


      36. 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

      The next five questions ask about drinking alcohol.  This includes drinking beer, wine, wine coolers, 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.
       

    36. How old were you when you had your first drink of alcohol other than a few sips?


      37. I have never had a drink of alcohol other than a few sips
      8 years old or younger
      9 or 10 years old
      11 or 12 years old
      13 or 14 years old
      15 or 16 years old
      17 years old or older
       

    37. During your life, on how many days have you had at least one drink of alcohol?


      38. 0 days
      1 or 2 days
      3 to 9 days
      10 to 19 days
      20 to 39 days
      40 to 99 days
      100 or more days
       

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


      39. 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
       

    39. During the pas 30 days, on how many days did you have 5 or more drinks of alcohol in a row, that is, within a couple hours?


      40. 0 days
      1 day
      2 days
      3 to 5 days
      6 to 9 days
      10 to 19 days
      20 or more days
       

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


      41. 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

      The next four questions ask about marijuana use.  Marijuana also is called grass or pot.

    41. How old were you when you tried marijuana for the first time?


      42. I have never had a drink of alcohol other than a few sips
      8 years old or younger
      9 or 10 years old
      11 or 12 years old
      13 or 14 years old
      15 or 16 years old
      17 years old or older
       

    42. During your life, how many times have you used Marijuana.


      43. 0 times
      1 or 2 times
      3 to 9 times
      10 to 19 times
      20 to 39 times
      40 to 99 times
      100 or more times
       

    43. During the past 30 days, how many times did you use marijuana?


      44. 0 times
      1 or 2 times
      3 to 9 times
      10 to 19 times
      20 to 39 times
      40 or more times
       

    44. During the past 30 days, how many time did you use marijuana on school property?


      45. 0 times
      1 or 2 times
      3 to 9 times
      10 to 19 times
      20 to 39 times
      40 or more times

      The next nine questions ask about cocaine and other drug use.
       

    45. How old were you when you tried any form of cocaine, including power, crack, or freebase, for the first time?


      46. I have never had a drink of alcohol other than a few sips
      8 years old or younger
      9 or 10 years old
      11 or 12 years old
      13 or 14 years old
      15 or 16 years old
      17 years old or older
       

    46. During you life, how many time have you used any form of cocaine, including power, crack, for freebase?


      47. 0 times
      1 or 2 times
      3 to 9 times
      10 to 19 times
      20 to 39 times
      40 or more times
       

    47. During the past 30 days  how many time have you used any form of cocaine, including power, crack, for freebase?


      48. 0 times
      1 or 2 times
      3 to 9 times
      10 to 19 times
      20 to 39 times
      40 or more times
       

    48.   During you life, how many time have you used the crack or freebase forms of cocaine?


      49. 0 times
      1 or 2 times
      3 to 9 times
      10 to 19 times
      20 to 39 times
      40 or more times
       

    49. During your life, how many times have you sniffed glue, or breathed the contents of aerosol spray cans, or inhaled any paints or sprays to get high?


      50. 0 times
      1 or 2 times
      3 to 9 times
      10 to 19 times
      20 to 39 times
      40 or more times
       

    50. During you life, how many times have you taken steroid pills or shots without a doctor's prescription?


      51. 0 times
      1 or 2 times
      3 to 9 times
      10 to 19 times
      20 to 39 times
      40 or more times
       

    51. During your life, how many times have you used any other type of illegal drug, such as LSD, PCP, ecstasy, mushrooms, speed, ice, or heroin?


      52. 0 times
      1 or 2 times
      3 to 9 times
      10 to 19 times
      20 to 39 times
      40 or more times
       

    52. During your life, how many times have you used a needle to inject any illegal drug into your body?


      53. 0 times
      1 time
      2 or more times
       

    53. During the past 12 months, has anyone offered, sold, or given you an illegal drug on school property?


      54. Yes
      No

      The next two questions ask about AIDS education and information.

    54. Have you ever been taught about AIDS or HIV infection in school?


      55. Yes
      No
      Not sure
       

    55. Have you ever talked about AIDS or HIV infection with your parents or other adults in you family?


      56. Yes
      No
      Not sure

      The next eight questions ask about sexual behavior.
       

    56. Have you ever had sexual intercourse?


      57. Yes
      No
       

    57. How old were you when you had sexual intercourse for the first time?


      58. I have never had sexual intercourse
      11 years old or younger
      11 years old
      12 years old
      13 years old
      14 years old
      15 years old or older
      16 years old
      17 years old or older
       

    58. During you life, with how many people have you had sexual inter course


      59. I have never had sexual intercourse
      1 person
      2 people
      3 people
      4 people
      5 people
      6 or more people
       

    59. During the past 3 months, with how many people did you have sexual intercourse.


      60. I have never had sexual intercourse
      I have had sexual intercourse, but not during the past 3 months
      1 person
      2 people
      3 people
      4 people
      5 people
      6 or more people
       

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


      61. I have never had sexual intercourse
      Yes
      No
       

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


      62. I have never had sexual intercourse
      Yes
      No
       

    62. the last time you had sexual intercourse, what one method did you or your partner use to prevent pregnancy?


      63. I have never had sexual intercourse
      No method was used to prevent pregnancy
      Birth control pills
      Condoms
      Withdrawal
      Some other method
      Not sure
       

    63. How many times have you been pregnant or gotten someone pregnant?


      64. 0 times
      1 time
      2 or more times
      Not sure

      The next six questions ask about body weight.
       

    64. How do you describe your weight?


      65. Very underweight
      Slightly underweight
      About the right weight
      Slightly overweight
      Very overweight
       

    65. Which of the following are you trying to do about your weight?


      66. Lose weight
      Gain weight
      Stay the same weight
      I am not trying to do anything about my weight
       

    66. During the past 30 days, did you diet to lose weight or to keep from gaining weight?


      67. Yes
      No
       

    67. During the past 30 days, did you exercise to lose weight or to keep from gaining weight?


      68. Yes
      No
       

    68. During the past 30 days, did you vomit or take laxatives to lose weight or to keep from gaining weight?


      69. Yes
      No
       

    69. During the past 30 days, did you take diet pills to lose weight or to keep from gaining weight?


      70. Yes
      No

      The next seven questions ask about food you ate yesterday.  Think about all meals and snacks you ate yesterday from the time you got up until you went to bed.   Be sure to include food you ate at home, at school, at restaurants, or anywhere else.
       

    70. Yesterday, how many times did you eat fruit?


      71. 0 times
      1 time
      2 times
      3 or more times
       

    71. Yesterday, how many times did you drink fruit juice?


      72. 0 times
      1 time
      2 times
      3 or more times
       

    72. Yesterday, how many times did you eat green salad?


      73. 0 times
      1 time
      2 times
      3 or more times
       

    73. Yesterday, how many times did you eat cooked vegetables?


      74. 0 times
      1 time
      2 times
      3 or more times
       

    74. Yesterday, how many times did you eat hamburger, hot dogs, or sausage?


      75. 0 times
      1 time
      2 times
      3 or more times
       

    75. Yesterday, how many times did you eat french fries or potato chips?


      76. 0 times
      1 time
      2 times
      3 or more times
       

    76. Yesterday, how many times did you each cookies, doughnuts, pie, or cake?


      77. 0 times
      1 time
      2 times
      3 or more times

      The next eight questions ask about physical activity.
       

    77. On how many of the past 7 days did you exercise or participate in sports activities for at least 20 minutes that made you sweat and breathe hard, such as basketball, jogging, swimming laps, tennis, fast bicycling, or similar aerobic activities?


      78. 0 days
      1 day
      2 days
      3 days
      4 days
      5 days
      6 days
      7 days
       

    78. On how many of the past 7 days did you do stretching exercises, such as toe touching, knee bending, or leg stretching?


      79. 0 days
      1 day
      2 days
      3 days
      4 days
      5 days
      6 days
      7 days
       

    79. On how man of the past 7 days did you do exercises to strengthen or tone you muscles, such as push-ups, sit-ups, or weight lifting?


      80. 0 days
      1 day
      2 days
      3 days
      4 days
      5 days
      6 days
      7 days
       

    80. On how many of the past 7 days did you walk or bicycle for at least 30 minutes at a time? (include walking or bicycling to or from school.)


      81. 0 days
      1 day
      2 days
      3 days
      4 days
      5 days
      6 days
      7 days
       

    81. In an average week when you are in school, on how many days do you go to physical education (PE) classes?


      82. 0 days
      1 day
      2 days
      3 days
      4 days
      5 days
       

    82. During an average physical education (PE) class, how many minutes do you spend actually exercising or playing sports?


      83. I do not take PE
      Less than 10 minutes
      10 to 20 minutes
      21 to 30 minutes
      More than 30 minutes
       

    83. During the past 12 months, on how many sports teams run by your school, did you play? (Do not include PE classes.)


      84. 0 teams
      1 team
      2 teams
      3 or more teams
       

    84. During the past 12 months, on how many sports teams run by organizations outside of your school, did you play?


      85. 0 teams
      1 team
      2 teams
      3 or more teams

     
     

    This is the end of the survey.
    Thank you very much for your help.

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