Healthy Youth Survey, 2015
Name: 


A red asterisk (*) indicates required questions.

  1. What grade are you in currently?  *


  1. In the last 30 days, did NOT smoke cigarettes? *
    Yes
    No


  1. Have you ever smoked cigarettes?*
    Yes
    No


  1. In the last 30 days, did NOT drink alcohol?*
    Yes
    No


  1. Have you ever drunk alcohol?*
    Yes
    No


  1. In the last 30 days, did NOT smoke marijuana?*
    Yes
    No


  1. Have you ever smoked marijuana?*
    Yes
    No


  1. In the last 30 days, did NOT use chew, snuff or dip?*
    Yes
    No


  1. Have you ever used chew, snuff or dip?*
    Yes
    No


  1. In the last 30 days, did NOT use a pain killer to get high?*
    Yes
    No


  1. Have you ever used a pain killer to get high?*
    Yes
    No


  1. In the last 30 days, did NOT use prescription drugs to get high?*
    Yes
    No


  1. Have you ever used prescription drugs to get high?*
    Yes
    No


  1. In the last 30 days, did NOT use recreational drugs (LSD, PCP, cocaine, heroin, etc.) to get high?*
    Yes
    No


  1. Have you ever used recreational drugs (LSD, PCP, cocaine, heroin, etc.) to get high?*
    Yes
    No


  1. Have you been drunk or high at school in the past year?*
    Yes
    No


  1. Have you ridden in a vehicle driven by someone drinking alcohol?
    *
    Yes
    No


  1. Have you drank alcohol and driven a vehicle?*
    Yes
    No


  1. Do you feel safe at school?*
    Yes
    No


  1. Do you believe that second hand smoking is harmful to non-smokers?*
    Yes
    No


  1. Have you ever purchased tobacco products?*
    Yes
    No


  1. Do you eat less than 2 cups of fruits and vegetables a day?*
    Yes
    No


  1. Do you get less than 8 hours of sleep a day?*
    Yes
    No


  1. Do you eat breakfast in the morning?*
    Yes
    No


  1. Do you watch TV for 3 or more hours on a school day?*
    Yes
    No


  1. Have you been depressed for 2 weeks or more in the past year?*
    Yes
    No


  1. Do you get less than 2.5 hours of exercise a week?*
    Yes
    No


  1. Do you drink 2 or more sodas a day?*
    Yes
    No


  1. Do you have severe asthma?*
    Yes
    No


  1. Do you feel overweight or obese?*
    Yes
    No


  1. Do you feel like you are a victim of bullying?*
    Yes
    No


  1. How likely are you to partake in the following activities? Please rate each on a scale of 1-7, where 1 is not likely at all and 7 is extremely likely.

            1 2 3 4 5 6 7      
      Trying/using drugs other than alcohol or marijuana not likely at all extremely likely  
      Missing class or work not likely at all extremely likely  
      Leaving a social event with someone I just met not likely at all extremely likely  
      Driving after drinking alcohol not likely at all extremely likely  
      Sex without protection not likely at all extremely likely  
      Leaving tasks or assignments for the last minute not likely at all extremely likely  
      Making a scene in public not likely at all extremely likely  
      Snow or water skiing not likely at all extremely likely  
      Entering a sweepstakes or betting pool not likely at all extremely likely  
      Punching or hitting someone with fist not likely at all extremely likely  





Mrs. Hill