Demographics
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1. What is your sex?
3. How old are you?
4 & 5. Summary: Race/Ethnicity (Mutually Exclusive)
4 & 5. Summary: Hispanic/Latino by Race Group (Mutually Exclusive)
6. What is the language you use most often at home?
7. Do you think of yourself as...
Family Affluence Scale (FAS)
164. Do you receive free or reduced price lunches at school?
Health Care Issues
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11. Would you say that in general your physical health is...
12. Would you say that in general your emotional and mental health is...
13. When did you last go to a doctor or nurse practitioner for a check-up or physical exam when you were not sick or injured?
14. During the past 12 months, did you have any physical health care needs that were not met? (Count any situation where you thought you should see a doctor, nurse, or other health professional.)
15. During the past 12 months, did you have any emotional or mental health care needs that were not met? (Count any situation where you thought you should see a counselor, social worker, or other mental health professional.)
16. In the past 12 months, have you visited an emergency room or urgent care clinic for a physical or mental health care need? (Select one or more responses).
Resiliency and Engagement
17. I can do most things if I try.
18. There is at least one teacher or other adult in my school that really cares about me.
19. I volunteer to help others in my community.
20. I can work out my problems.
21. During the past 12 months, how would you describe your grades in school?
22. During the past 12 months, how many days of school did you miss for any reason?
23. During the past 12 months, how many days of school did you miss because of physical health reasons?
24. During the past 12 months, how many days of school did you miss because of emotional or mental health reasons?
25. During the past 12 months, how many days of school did you have unexcused absences (meaning you skipped or cut school)?
Summary: Meets the positive youth development benchmark.
Health and Learning Conditions
26. Are you deaf or do you have serious difficulty hearing?
27. Are you blind or do you have serious difficulty seeing, even when wearing glasses?
28. Because of a physical, mental, or emotional condition, do you have serious difficulty concentrating, remembering or making decisions?
29. Do you have serious difficulty walking or climbing stairs?
30. Do you have difficulty dressing or bathing?
31. Because of a physical, mental, or emotional condition, do you have difficulty doing errands alone such as visiting a physician’s office or shopping?
26-31. Summary: Has any disability.
Oral Health
32. When did you last go to a dentist or dental hygienist for a check-up, exam, teeth cleaning, or other dental work?
33. Have you ever had a cavity?
34. Did you brush your teeth in the past 24 hours?
35. In the past year, were you ever injured in your mouth area while playing sports? The mouth area could be your teeth, gums, lips, cheeks, tongue, or jaw. (Please mark all answers that apply)
36. During the past 12 months, did you miss one or more hours of school due to any of the following reasons? (Please mark all answers that apply)
Asthma
Current asthma prevalence
Nutrition
41. In the past 12 months, did you ever eat less than you felt you should because there wasn’t enough money to buy food?
42-47. Summary: Five-a-day measure: In the past 7 days, average servings per day where student reported consuming fruits or vegetables.
48. During the past 7 days, on how many days did you eat breakfast?
49. During the past 7 days, how many times did all, or most, of your family eat a meal together?
57. During the past 7 days, how many times did you drink a can, bottle, or glass of soda or pop, such as Coke, Pepsi, or Sprite? (Do not include diet soda or diet pop.)
58. During the past 7 days, how many times did you drink: Fruit-flavored beverages such as Kool-Aid, Sunny Delight, or Snapple? (Do not include 100% fruit juice).
59. During the past 7 days, how many times did you drink: Energy drinks such as Red Bull, Rockstar, or Monster? (Do not include diet or sugar-free energy drinks)
60. During the past 7 days, how many times did you drink: Sports drinks such as Gatorade or Powerade?
61. During the past 7 days, how many times did you drink: Flavored milk such as Chocolate or Strawberry milk? (Do not include plain milk).
62. During the past 7 days, how many times did you drink: Plain milk? (Include milk that you added to cereal).
63. During the past 7 days, how many times did you drink: Sweetened coffee or tea beverages such as Starbucks Frappuccino or an Arizona Iced Tea?
64. During the past 7 days, how many times did you drink: Plain water? (Include tap and bottled water).
70. During the past 7 days, how many times did you visit a convenience store such as Plaid Pantry, 7-Eleven, Circle K, a mini-mart, or a gas station store?
Sleep
50. On an average school night, how many hours of sleep do you get?
Physical Activity
51. During the past 7 days, on how many days were you physically active for a total of at least 60 minutes per day?
52. On how many of the past 7 days did you do exercises to strengthen or tone your muscles, such as push-ups, sit-ups, or weight lifting?
53. In an average week when you are in school, on how many days do you go to physical education (PE) classes?
54. During an average physical education (PE) class, how many minutes do you spend actually exercising or playing sports?
54.x. Among only those who took PE: During an average physical education (PE) class, how many minutes do you spend actually exercising or playing sports?
55. On an average school day, how many hours do you watch TV?
56. On an average school day, how many hours do you play video or computer games or use a computer for something that is not school work? (Include activities such as Xbox, Play Station, Nintendo DS, iPod touch, Facebook, and the Internet.)
65. In an average school week, on how many days do you use each of these forms of transportation to get to or from school? Walk
66. In an average school week, on how many days do you use each of these forms of transportation to get to or from school? Ride a bike
67. In an average school week, on how many days do you use each of these forms of transportation to get to or from school? Ride a skateboard, scooter, or other non-motorized vehicle
68. In an average school week, on how many days do you use each of these forms of transportation to get to or from school? Ride a school bus or use public transportation
69. In an average school week, on how many days do you use each of these forms of transportation to get to or from school? Ride in a car or other motorized vehicle
Body Weight
Body Weight status as Measured by Body Mass Index (BMI): Weight to Height Ratios.
Mental Health
71. During the past 12 months, did you ever feel so sad or hopeless every day for two weeks or more in a row that you stopped doing some usual activities?
72. During the past 12 months, did you ever seriously consider attempting suicide?
73. During the past 12 months, how times did you actually attempt suicide?
74. 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?
74.x. Among those who 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?
Personal Safety
75. During the past 30 days, on 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?
76. During the past 12 months, how many times has someone threatened you with a weapon such as a gun, knife, or club on school property?
77. During the past 12 months, how many times were you in a physical fight on school property?
78. During the past 12 months, has anyone offered, sold or given you an illegal drug on school property?
Bullying
79. During the past 30 days, have you been bullied by someone using any kind of technology, such as through social media, cell phones, or video games?
80. During the past 30 days, have you ever been bullied at school (including any school events, or on the way to or from school) in relation to any of the following issues? This includes in-person and cyberbullying. (Select one or more responses.)
Gambling
84. Gambling involves betting anything of value (money, a watch, soda, etc.) on a game or event. Please check ALL the different types of gambling that you have bet on, if any, during the last 30 days.
85. During the last 12 months, have you ever felt bad about the amount you bet, or about what happens when you bet money?
86. During the last 12 months, have you ever felt that you would like to stop betting money but didn't think you could?
87. Lied to anyone about betting or gambling?
88. Bet or gambled more than you wanted to?
Sexual Behavior
89. Have you ever had sexual intercourse?
90. How old were you when you had sexual intercourse for the first time?
90.x. Among those who have ever had sex: How old were you when you had sexual intercourse for the first time?
91. During your life, with how many people have you had sexual intercourse?
91.x. Among those who have ever had sex: During your life, with how many people have you had sexual intercourse?
92. During the past 3 months, with how many people did you have sexual intercourse?
92.x. Among those who have ever had sex: Indicator for current sexual activity, defined as sexual intercourse during the past three months.
93. Did you drink alcohol or use drugs before you had sexual intercourse the last time?
93.x. Among those who have ever had sex: Did you drink alcohol or use drugs before you had sexual intercourse the last time?
94. The last time you had sexual intercourse, did you or your partner use a condom?
94.x. Among those who have ever had sex:The last time you had sexual intercourse, did you or your partner use a condom?
95. The last time you had sexual intercourse, what one method(s) did you or your partner use to prevent pregnancy? (Select all that apply)
95x. Among those who have ever had sex: The last time you had sexual intercourse, what one method(s) did you or your partner use to prevent pregnancy? (Select all that apply)
Violence Related Behaviors
97. Have you ever been physically forced to have sexual intercourse when you did not want to?
98. Have you ever given in to sexual activity when you didn't want to because of pressure?
99. During your life, has any adult ever had sexual contact with you?
100. During the past 12 months, did your boyfriend or girlfriend ever hit, slap, or physically hurt you on purpose?
101. During your life, has any adult ever intentionally hit or physically hurt you?
Tobacco
Any cigarette use in past 30 days (includes menthol)
Any tobacco use in past 30 days (includes e-cigarettes)
102. During the past 30 days, on how many days did you smoke cigarettes?
103. During the past 30 days, on how many days did you smoke menthol cigarettes?
104. During the past 30 days, on how many days did you use chewing tobacco, snuff, or dip, such as Redman, Levi Garrett, Beechnut, Skoal, Skoal Bandits, Copenhagen, Camel Snus, or Marlboro Snus?
105. During the past 30 days, on how many days did you use dissolvable tobacco products, such as Camel Orbs, sticks, or strips?
106. During the past 30 days, on how many days did you smoke a little cigar, such as Swisher Sweets?
107. During the past 30 days, on how many days did you smoke a large cigar?
108. During the past 30 days, on how many days did you smoke tobacco in a Hookah, also known as a waterpipe?
109. During the past 30 days, on how many days did you smoke tobacco in a pipe?
110. During the past 30 days, on how many days did you use an e-cigarette or other vaping product?
111. About how many cigarettes have you smoked in your entire life?
112. Have you ever used any type of tobacco or vaping product with mint, fruit, coffee, candy, or other sweet flavor?
113. During the past 30 days, have you used any tobacco or vaping product with mint, fruit, coffee, candy, or other sweet flavors?
114. How old were you when you smoked a whole cigarette for the first time?
115. How old were you when you first used any form of tobacco other than cigarettes? Include e-cigarettes or other vaping products.
116. The very first time you used any tobacco or vaping product (including e-cigarettes), which type of product did you use?
117. During the past 12 months, did you ever try to quit smoking cigarettes?
118. If one of your best friends were to offer you a cigarette, would you smoke it?
119. During the past 30 days, from which of the following sources did you get tobacco or vaping products? (Select one or more responses.) (Under age 18)
119.x.Among those who used tobacco in the last 30 days: During the past 30 days, from which of the following sources did you get tobacco or vaping products? (Select one or more responses.) (Under age 18)
120. Does someone living in your house (other than you) smoke tobacco?
121. During the past 30 days, have you seen an advertisement promoting tobacco or a vaping products: On a storefront or in a store?
122. During the past 30 days, have you seen an advertisement promoting tobacco or a vaping products: Online? On our cellphone, tablet, or computer (through email, websites, or social media)?
123. During the past 30 days, have you seen an advertisement promoting tobacco or a vaping products: In a magazine or newspaper?
124. During the past 30 days, have you seen an advertisement promoting tobacco or a vaping products: That came in the mail to your home?
125. If you have a favorite, what is the brand of your favorite cigarette advertisement? (Select only one answer.)
126. Do you agree or disagree with the following statement: Cigarette companies deliberately advertise and promote cigarettes to encourage youth under 18 to smoke.
127. Do you think tobacco companies have been honest or dishonest with the public about the dangers of tobacco use?
128. During the past 30 days, did you receive tobacco or vaping coupons or other discounts in the mail, over the Internet, or from any other source?
129. In the past 30 days, did you buy any tobacco or vaping product using coupons, buy 1 get 1 free, or any other price reduction?
141. If you wanted to get some tobacco (cigarettes, chew, cigars), how easy would it be for you to get some?
142. If you wanted to get e-cigarettes or other vaping products, how easy would it be for you to get some?
Alcohol
130. How old were you when you had your first drink of alcohol other than a few sips?
131. During the past 30 days, on how many days did you have at least one drink of alcohol?
132. During the past 30 days, on how many days did you have 5 or more drinks of alcohol in a row, that is, within a couple of hours?
133. During the past 30 days, what type of alcohol did you usually drink? (Select only one response.)
134. During the past 30 days, how many times did you drive a car or other vehicle when you had been drinking alcohol?
140. If you wanted to get some beer, wine or hard liquor (for example, vodka, whiskey or gin), how easy would it be for you to get some?
Marijuana and Prescription Drug Use
135. During the past 30 days, on how many days did you use marijuana or hashish (weed, hash, pot)?
135.x Summary: During the past 30 days, on how many days did you use marijuana or hashish (weed, hash, pot)?
136. During the past 30 days, if you used marijuana, how did you usually use it?
136.x. Among those who used marijuana in the last 30 days: During the past 30 days, if you used marijuana, how did you usually use it?
137. During the past 30 days, how did you get marijuana? (Select one or more responses.)
138. During the past 30 days, how many times did you drive a car or other vehicle within three hours after using marijuana?
138.x. Among those who used marijuana in the last 30 days: During the past 30 days, how many times did you drive a car or other vehicle within three hours after using marijuana?
139. During the past 30 days, how many times have you used prescription drugs (such as Oxycontin, Percocet, Vicodin, Codeine, Adderall, Ritalin, or Xanax) without a doctor's orders?
143. If you wanted to get some marijuana, how easy would it be for you to get some?
144. If you wanted to get prescription drugs not prescribed to you, how easy would it be for you to get some?
Perceived Risk
145. How much do you think people risk harming themselves (physically or in other ways) if they smoke one or more packs of cigarettes per day?
146. How much do you think people risk harming themselves (physically or in other ways) if they use smokeless tobacco every day?
147. How much do you think people risk harming themselves (physically or in other ways) if they use e-cigarettes or other vaping products every day?
148. How much do you think people risk harming themselves (physically or in other ways) if they use marijuana regularly (at least once or twice a week)
149. How much do you think people risk harming themselves (physically or in other ways) if they take one or two drinks of an alcoholic beverage (beer, wine, liquor) nearly every day?
150. How much do you think people risk harming themselves (physically or in other ways) if they have five or more drinks of an alcoholic beverage once or twice a week?
151. How much do you think people risk harming themselves (physically or in other ways) if they use prescription drugs that are not prescribed to them?
Family Beliefs
152. How wrong do your parents feel it would be for you to smoke cigarettes?
153. How wrong do your parents feel it would be for you to drink beer, wine, or liquor (e.g., vodka, whiskey, or gin) regularly?
154. How wrong do your parents feel it would be for you to use smoke marijuana?
155. How wrong do your parents feel it would be for you to use prescription drugs not prescribed to you?
Peer Beliefs
156. How wrong do your friends feel it would be for you to smoke cigarettes.
157. How wrong do your friends feel it would be for you to use an e-cigarette or other vaping product?
158. How wrong do your friends feel it would be for you to use marijuana?
159. How wrong do your friends feel it would be for you to use prescription drugs not prescribed to you?