hys-wa-forma08

Upload: celestegracey

Post on 10-Apr-2018

219 views

Category:

Documents


0 download

TRANSCRIPT

  • 8/8/2019 hys-wa-forma08

    1/16

    Instructions

    A

    2008 Healthy Youth SurveyForm AWe are asking you to take part in this survey about issues facing students in communities inWashington. The questions in this survey ask for your opinions about yourself, your friendsyour school, and your neighborhood or community. School, community, county, and stateofficials will use the information from this survey in planning future programs to help yout

    Your answers to these questions are anonymous. This means that no one will know how you

    answered or which answer sheet is yours. Do not write your name anywhere on theanswer sheet.If you do not want to take this survey now, tell your teacher and you will begiven an alternative activity.

    Some of the questions are personal, such as asking about your relationships and whether yoget in fights or use drugs. Some students may find some of the questions uncomfortable orupsetting. You will be given a list of numbers to call if you want to talk to someone about thsurvey or feelings it brings up. The survey is completely voluntary. You don't have to do thisurvey. You may skip any question you do not wish to answer or stop at any time. It will noaffect your grades. Other students have said this survey is interesting and they enjoyed fillinit out. We hope you will too. If you have any questions about the survey you may ask yourteacher before beginning. Please take a minute to read the instructions below before starting

    the survey.

    1. This is not a test, so there are no right or wrong answers.

    2. The questions should be answered by marking one of the answer spaces on the answersheet. If you don't find an answer that fits exactly, use one that comes closest. If anyquestion does not apply to you, or you are not sure of what it means, just leave it blank

    3. Your answers will be read by a computer. Please follow these instructions carefully.

    Use a pencil only.

    Make heavy marks inside the bubbles.

    Erase cleanly any answer you wish to change.

    Make no other markings or comments on theanswer pages.

    4. Some of the questions have the following format:

    Please mark in the bubble which of the four words best describes how you feel aboutthat sentence.

    EXAMPLE: Pepperoni pizza is one of my favorite foods.

    Mark (the Big) YES! if you think the statement is definitely true for you.

    Mark (the little) yes if you think the statement is mostly true for you.

    Mark (the little) no if you think the statement is mostly not true for you.

    Mark (the Big) NO! if you think the statement is definitely not true for you.

    In the example above, the student marked yes because he or she thinks the statement imostly true. (Please mark one answer.)

    This kind of mark will work:Correct Mark

    These kinds of marks will NOT workIncorrect Marks

    A B C D

    A

    B

    C

    D

    a. NO!b. noc. yesd. YES!

  • 8/8/2019 hys-wa-forma08

    2/16-1-

    1. How old are you?

    a. 12 or younger

    b. 13

    c. 14

    d. 15

    2. What grade are you in?

    a. 7thb. 8th

    c. 9th

    d. 10th

    3. Are you:

    a. Female

    b. Male

    4. How do you describe yourself? (Select one ormore responses.)

    a. American Indian or Alaskan Native b. Asian or Asian American

    c. Black or African-American

    d. Hispanic or Latino/Latina

    e. Native Hawaiian or other Pacific Islander

    f. White or Caucasian

    g. Other

    5. What language is usually spoken at home?

    a. English

    b. Spanish

    c. Russian

    d. Ukrainian

    e. Vietnamese

    8. I like my neighborhood/community.

    a. NO!

    b. no

    c. yes

    d. YES!

    9. How wrong would most adults in yourneighborhood or community think it was

    for kids your age:

    A. To use marijuana?

    a. Very wrong

    b. Wrong

    c. A little bit wrong

    d. Not wrong at all

    B. To drink alcohol?

    a. Very wrong

    b. Wrong

    c. A little bit wrongd. Not wrong at all

    C. To smoke cigarettes?

    a. Very wrong

    b. Wrong

    c. A little bit wrong

    d. Not wrong at all

    10. If a kid drank some beer, wine, or hard liquor (forexample, vodka, whiskey, or gin) in your

    community would he or she be caught by thepolice?

    a. NO!

    b. no

    c. yes

    d. YES!

    11. If a kid smoked marijuana in your communitywould he or she be caught by the police?

    a. NO!

    b. no

    c. yes

    d. YES!

    12. If a kid carried a handgun in your communitywould he or she be caught by the police?

    a. NO!

    b. no

    c. yes

    d. YES!

    e. 16

    f. 17

    g. 18

    h. 19 or older

    e. 11thf. 12th

    g. Ungraded or other

    f. Chineseg. Koreanh. Japanese

    i. Other

    These statements and questions are about theneighborhood and community where you live.

    6. I'd like to get out of my neighborhood orcommunity.

    a. NO!

    b. no

    c. yes

    d. YES!

    7. If I had to move, I would miss the neighborhood orcommunity I now live in.

    a. NO!

    b. no

    c. yes

    d. YES!

  • 8/8/2019 hys-wa-forma08

    3/16

    13. If you wanted to get some beer, wine, or hardliquor (for example, vodka, whiskey, or gin), howeasy would it be for you to get some?

    a. Very hard

    b. Sort of hard

    c. Sort of easy

    d. Very easy

    14. If you wanted to get some cigarettes, how easywould it be for you to get some?

    a. Very hard

    b. Sort of hard

    c. Sort of easy

    d. Very easy

    15. If you wanted to get some marijuana, how easywould it be for you to get some?

    a. Very hard

    b. Sort of hard

    c. Sort of easyd. Very easy

    16. If you wanted to get a drug like cocaine, LSD, oramphetamines, how easy would it be for you to getsome?

    a. Very hard

    b. Sort of hard

    c. Sort of easy

    d. Very easy

    17. If you wanted to get a handgun, how easy would itbe for you to get one?

    a. Very hard

    b. Sort of hard

    c. Sort of easy

    d. Very easy

    18. There are adults in my neighborhood orcommunity I could talk to about somethingimportant.

    a. NO!

    b. no

    c. yes

    d. YES!

    19. Which of the following activities for people yourage are available in your community?

    A. Sports teams and recreation

    a. Yes

    b. No

    -2-

    B. Scouts, Camp Fire, 4-H Clubs, or other

    service clubs

    a. Yes

    b. No

    C. Boys and Girls Club, YMCA, or other

    activity clubs

    a. Yes

    b. No

    20. During the average week, on how many days doyou participate in supervised after-school activitieeither at school or away from school? Includeactivities such as sports, art, music, dance, drama, community service, religious, or club activities.

    a. 0 days

    b. 1-2 days

    c. 3 or more days

    21. My neighbors notice when I am doing a good joband let me know.

    a. NO!

    b. no

    c. yes

    d. YES!

    22. There are people in my neighborhood or communwho encourage me to do my best.

    a. NO!

    b. no

    c. yesd. YES!

    23. There are people in my neighborhood or communwho are proud of me when I do something well.

    a. NO!

    b. no

    c. yes

    d. YES!

    This section asks about your experiences

    with school.

    24. How often do you feel the schoolwork you areassigned is meaningful and important?

    a. Almost always

    b. Often

    c. Sometimes

    d. Seldom

    e. Never

  • 8/8/2019 hys-wa-forma08

    4/16

    29. In my school, students have lots of chances to helpdecide things like class activities and rules.

    a. NO!

    b. no

    c. yes

    d. YES!

    30. There are lots of chances for students in my schoolto talk with a teacher one-on-one.

    a. NO!

    b. no

    c. yes

    d. YES!

    31. Teachers ask me to work on special classroomprojects.

    a. NO!

    b. no

    c. yes

    d. YES!

    32. There are lots of chances for students in my schoolto get involved in sports, clubs, and other schoolactivities outside of class.

    a. NO!

    b. no

    c. yes

    d. YES!

    33. I have lots of chances to be part of class discussions

    or activities.a. NO!

    b. no

    c. yes

    d. YES!

    34. My teacher(s) notices when I am doing a good joband lets me know about it.

    a. NO!

    b. no

    c. yes

    d. YES!

    35. The school lets my parents know when I have donesomething well.

    a. NO!

    b. no

    c. yes

    d. YES!

    -3-

    25. How interesting are most of your courses to you?

    a. Very interesting and stimulating

    b. Quite interesting

    c. Fairly interesting

    d. Slightly dull

    e. Very dull

    26. How important do you think the things you are

    learning in school are going to be for you laterin life?

    a. Very important

    b. Quite important

    c. Fairly important

    d. Slightly important

    e. Not at all important

    27. Think back over the past year in school. How oftendid you:

    A. Enjoy being in school?a. Never

    b. Seldom

    c. Sometimes

    d. Often

    e. Almost always

    B. Hate being in school?

    a. Never

    b. Seldom

    c. Sometimes

    d. Oftene. Almost always

    C. Try to do your best work in school?

    a. Never

    b. Seldom

    c. Sometimes

    d. Often

    e. Almost always

    28. During the LAST 4 WEEKS, how many whole days

    of school have you missed because you skipped orcut?

    a. None

    b. 1

    c. 2

    d. 3

    e. 4 5

    f. 6 10

    g. 11 or more

  • 8/8/2019 hys-wa-forma08

    5/16-4-

    42. During the past 30 days, on how many days didyou carry a weapon such as a gun, knife, or clubon school property?

    a. 0 days

    b. 1 5 days

    c. 6 or more days

    36. I feel safe at my school.

    a. NO!

    b. no

    c. yes

    d. YES!

    37. My teachers praise me when I work hard

    in school.

    a. NO!

    b. no

    c. yes

    d. YES!

    38. Putting them all together, what were your gradeslike last year?

    a. Mostly As

    b. Mostly Bs

    c. Mostly Cs

    d. Mostly Ds

    e. Mostly Fs

    39. Are your school grades better than the grades ofmost students in your class?

    a. NO!

    b. no

    c. yes

    d. YES

    40. How far did your mother get in school?

    a. Did not finish high school

    b. Graduated from high school or GEDc. Had some college or technical training

    after high school

    d. Graduated from a 4-year college

    e. Earned an advanced graduate degree

    f. Don't know

    g. Does not apply

    41. How far did your father get in school?

    a. Did not finish high school

    b. Graduated from high school or GED

    c. Had some college or technical trainingafter high school

    d. Graduated from a 4-year college

    e. Earned an advanced graduate degree

    f. Don't know

    g. Does not apply

    43. During the past 30 days, have you seen or heardadvertisements on TV, the Internet, the radio, ormagazines about the dangers of kids drinkingalcohol?

    a. Not in the past 30 days

    b. 1 3 times in the past 30 days

    c. 1 3 times per week

    d. Daily or almost daily

    e. More than once a day

    44. NOT including talks on drinking and driving, inthe past year have your parents or guardianstalked to you about why you should not drinkalcohol?

    a. Yes, a number of times

    b. Yes, once

    c. No

    d. I don't remember

    45. How much do you think people risk harmingthemselves if they:

    A. Smoke one or more packs of cigarettes perday?

    a. No risk

    b. Slight risk

    c. Moderate risk

    d. Great risk

    e. Not sure

    B. Try marijuana once or twice?

    a. No risk

    b. Slight riskc. Moderate risk

    d. Great risk

    e. Not sure

    The next questions ask about issues related

    to alcohol and other drugs.

  • 8/8/2019 hys-wa-forma08

    6/16-5-

    D. Carried a handgun?

    a. No or very little chance

    b. Little chance

    c. Some chance

    d. Pretty good chance

    e. Very good chance

    47. During the past 12 months, how many times wereyou in a physical fight?

    a. 0 times

    b. 1 time

    c. 2 3 times

    d. 4 5 times

    e. 6 or more times

    C. Smoke marijuana occasionally?

    a. No risk

    b. Slight risk

    c. Moderate risk

    d. Great risk

    e. Not sure

    D. Smoke marijuana regularly (at least once or

    twice a week)?

    a. No risk

    b. Slight risk

    c. Moderate risk

    d. Great risk

    e. Not sure

    E. Take one or two drinks of an alcoholicbeverage (wine, beer, a shot, liquor) nearlyevery day?

    a. No risk

    b. Slight riskc. Moderate risk

    d. Great risk

    e. Not sure

    46. What are the chances you would be seen as cool ifyou:

    A. Smoked cigarettes?

    a. No or very little chance

    b. Little chance

    c. Some chanced. Pretty good chance

    e. Very good chance

    B. Began drinking alcoholic beverages regularly,that is, at least once or twice a month?

    a. No or very little chance

    b. Little chance

    c. Some chance

    d. Pretty good chance

    e. Very good chance

    C. Smoked marijuana?

    a. No or very little chance

    b. Little chance

    c. Some chance

    d. Pretty good chance

    e. Very good chance

    48. I think it is okay to take something without asking

    as long as you get away with it.a. NO!

    b. no

    c. yes

    d. YES!

    49. I think sometimes its okay to cheat at school.

    a. NO!

    b. no

    c. yes

    d. YES!

    50. It is all right to beat up people if they start the fight.

    a. NO!

    b. no

    c. yes

    d. YES!

    51. It is important to be honest with your parents, evenif they become upset or you get punished.

    a. NO!

    b. no

    c. yesd. YES!

    The next questions ask for your opinion.

  • 8/8/2019 hys-wa-forma08

    7/16-6-

    The next questions ask about what youwould do in certain situations.

    52. You're looking at CDs in a music store with afriend. You look up and see her slip a CD under hercoat. She smiles and says, Which one do youwant? Go ahead, take it while nobody's around.There is nobody in sight, no employees, and no

    other customers. What would you do now?a. Ignore her

    b. Grab a CD and leave the store

    c. Tell her to put the CD back

    d. Act like its a joke and ask her to put the

    CD back

    53. It's 8:00 on a weeknight and you are about to goover to a friend's house when your mom asks youwhere you are going. You say, Oh, just going tohang out with some friends. She says, No, you'lljust get into trouble if you go out. Stay hometonight. What would you do now?

    a. Leave the house anyway

    b. Explain what you are going to do with yourfriends, tell her when you will get home, andask if you can go out

    c. Not say anything and start watching TV

    d. Get into an argument with her

    54. You are visiting another part of town and you don'tknow any of the people your age there. You arewalking down the street and some teenager youdon't know is walking toward you. He is aboutyour size. As he is about to pass you, hedeliberately bumps into you and you almost loseyour balance. What would you say or do?

    a. Push the person back

    b. Say nothing and keep on walking

    c. Say, Watch where youre going, and keep

    on walking

    d. Swear at the person and walk away

    55. You are at a party at someone's house and one ofyour friends offers you a drink containing alcohol.

    What would you say or do?a. Drink it

    b. Tell your friend, No thanks. I dont drink, andsuggest that you and your friend go and dosomething else

    c. Just say, No, thanks, and walk away

    d. Make up a good excuse, tell your friend you hadsomething else to do, and leave

    The next section asks questions about youand your friends.

    Remember, no one but you will know howyou answered.

    56. Think of your four best friends (the friends you feelclosest to). In the past year (12 months), how many

    of your best friends have:

    A. Been suspended from school?

    a. None of my friends

    b. 1 of my friends

    c. 2 of my friends

    d. 3 of my friends

    e. 4 of my friends

    B. Carried a handgun?

    a. None of my friends

    b. 1 of my friendsc. 2 of my friends

    d. 3 of my friends

    e. 4 of my friends

    C. Sold illegal drugs?

    a. None of my friends

    b. 1 of my friends

    c. 2 of my friends

    d. 3 of my friends

    e. 4 of my friends

    D. Stolen or tried to steal a motor vehicle such

    as a car or motorcycle?

    a. None of my friends

    b. 1 of my friends

    c. 2 of my friends

    d. 3 of my friends

    e. 4 of my friends

    E. Been arrested?

    a. None of my friends

    b. 1 of my friendsc. 2 of my friends

    d. 3 of my friends

    e. 4 of my friends

  • 8/8/2019 hys-wa-forma08

    8/16-7-

    F. Dropped out of school?

    a. None of my friends

    b. 1 of my friends

    c. 2 of my friends

    d. 3 of my friends

    e. 4 of my friends

    57. During the past 30 days, on how many daysdid you:

    A. Smoke cigarettes?

    a. None

    b. 1 2 days

    c. 3 5 days

    d. 6 9 days

    e. 10 29 days

    f. All 30 days

    B. Use chewing tobacco, snuff, or dip?a. None

    b. 1 2 days

    c. 3 5 days

    d. 6 9 days

    e. 10 29 days

    f. All 30 days

    C. Drink a glass, can, or bottle of alcohol (beer,wine, wine coolers, hard liquor)?

    a. None

    b. 1 2 days

    c. 3 5 days

    d. 6 9 days

    e. 10 or more days

    D. Use marijuana or hashish (grass, hash, pot)?

    a. None

    b. 1 2 days

    c. 3 5 days

    d. 6 9 days

    e. 10 or more days

    E. Not counting alcohol, tobacco, or marijuana,

    use another illegal drug?

    a. None

    b. 1 2 days

    c. 3 5 days

    d. 6 9 days

    e. 10 or more days

    F. Use methamphetamines (meth, crystal meth, ice,crank)? Do not include other types ofamphetamines.

    a. None

    b. 1 2 days

    c. 3 5 days

    d. 6 9 days

    e. 10 or more days

    G. Use derbisol (wagon wheels, hope)?

    a. None

    b. 1 2 days

    c. 3 5 days

    d. 6 9 days

    e. 10 or more days

    H.Use Ritalin without a doctor's orders?

    a. None

    b. 1 2 days

    c. 3 5 days

    d. 6 9 days

    e. 10 or more days

    I. Use inhalants (things you sniff to get high)?

    a. None

    b. 1 2 days

    c. 3 5 days

    d. 6 9 days

    e. 10 or more days

    J. Use a pain killer TO GET HIGH, like Vicodin,

    OxyContin (sometimes called Oxy or OC) or

    Percocet (sometimes called Percs)?

    a. None

    b. 1 2 days

    c. 3 5 days

    d. 6 9 days

    e. 10 or more days

  • 8/8/2019 hys-wa-forma08

    9/16-8-

    This section asks other questions aboutalcohol and tobacco:

    63. During the past 30 days, how did you get alcohol(beer, wine, or hard liquor)? Choose all that apply.

    a. I did not get alcohol in the past 30 days

    b. I bought it from a store

    c. I got it from friends

    d. I gave money to someone to get it for me

    e. I took it from home withoutmy parents'

    permission

    f. I got it at home with my parents' permissiong. I got it at a party

    h. I got it from the Internet

    i. I stole it from a store

    j. I got it some other way

    64. If one of your best friends offered you a cigarette,would you smoke it?

    a. Definitely no

    b. Probably no

    c. Probably yes

    d. Definitely yes

    65. Do you think that you will smoke a cigaretteanytime in the next year?

    a. Definitely no

    b. Probably no

    c. Probably yes

    d. Definitely yes

    66. How old were you the first time you:

    A. Smoked marijuana?a. Never have

    b. 10 or younger

    c. 11

    d. 12

    e. 13

    B. Smoked a cigarette, even just a puff?

    a. Never have

    b. 10 or younger

    c. 11

    d. 12e. 13

    C. Smoked a whole cigarette?

    a. Never have

    b. 10 or younger

    c. 11

    d. 12

    e. 13

    61. Think back over the last 2 weeks. How many timeshave you had five or more drinks in a row? (Adrink is a glass of wine, a bottle of beer, a shot glassof liquor, or a mixed drink.)

    a. None

    b. Once

    c. Twice

    d. 3 5 times

    e. 6 9 times

    f. 10 or more times

    62. How many times in the past year (12 months) haveyou been drunk or high at school?

    a. Never

    b. 1 2 times

    c. 3 5 times

    d. 6 9 times

    e. 10 or more times

    f. 14

    g. 15

    h. 16

    i. 17 or older

    f. 14

    g. 15

    h. 16

    i. 17 or older

    f. 14

    g. 15

    h. 16

    i. 17 or older

    58. If you have EVER used pain killers to get high,where did you usually get them?

    a. I did not use pain killers to get high

    b. I used my own prescription (from a

    doctor or dentist)

    c. A family member gave them to me

    d. I took them from my home or someone

    else's home without permission

    e. I got them from a friendf. I got them from an acquaintance

    g. I got them from a drug dealer

    h. I got them from the internet

    i. I got them some other way

    59. During the last year, have you felt that youneeded help (such as counseling or treatment)for your alcohol, tobacco, or other drug use?

    a. I have not used alcohol, tobacco, or other

    drugs

    b. I have used alcohol, tobacco, and/or otherdrugs, but I haven't needed help

    c. Yes, I felt I have needed help

    d. Not sure

    60. Does your school provide a counselor,intervention specialist, or other school staffmember for students to discuss problems withalcohol, tobacco, or other drugs?

    a. No

    b. Yes

    c. I'm not sure

  • 8/8/2019 hys-wa-forma08

    10/16

    The next questions ask about other behaviors.

    -9-

    D. Had more than a sip or two of beer, wine, or hardliquor (for example, vodka, whiskey, or gin)?

    a. Never have

    b. 10 or younger

    c. 11

    d. 12

    e. 13

    E. Began drinking alcoholic beverages regularly,that is, at least once or twice a month?

    a. Never have

    b. 10 or younger

    c. 11

    d. 12

    e. 13

    F. Used inhalants?

    a. Never have

    b. 10 or younger

    c. 11d. 12

    e. 13

    G. Used heroin?

    a. Never have

    b. 10 or younger

    c. 11

    d. 12

    e. 13

    H.Used methamphetamines (meth, crystal meth, ice,crank)? Do not include other types ofamphetamines.

    a. Never have

    b. 10 or younger

    c. 11

    d. 12

    e. 13

    I. Used cocaine?

    a. Never have

    b. 10 or youngerc. 11

    d. 12

    e. 13

    f. 14

    g. 15

    h. 16

    i. 17 or older

    A. Got suspended from school?

    a. Never have

    b. 10 or younger

    c. 11

    d. 12

    e. 13

    B. Got arrested?

    a. Never have

    b. 10 or younger

    c. 11

    d. 12

    e. 13

    C. Carried a handgun?

    a. Never haveb. 10 or younger

    c. 11

    d. 12

    e. 13

    D. Attacked someone with the idea of seriouslyhurting them?

    a. Never have

    b. 10 or younger

    c. 11

    d. 12e. 13

    68. During the past 12 months, have you been amember of a gang?

    a. No

    b. Yes

    69. A student is being bullied when another student(or group of students) says or does nasty orunpleasant things to him or her. It is also bullyingwhen a student is teased repeatedly in a way he orshe doesn't like. It is NOT bullying when twostudents of about the same strength argue or fight.

    In the last 30 days, how often have you beenbullied?

    a. I have not been bullied

    b. Once

    c. 2 3 times

    d. About once a week

    e. Several times a week

    f. 14

    g. 15

    h. 16

    i. 17 or older

    67. How old were you when you first:f. 14

    g. 15

    h. 16

    i. 17 or older

    f. 14g. 15

    h. 16

    i. 17 or older

    f. 14

    g. 15

    h. 16

    i. 17 or older

    f. 14

    g. 15h. 16

    i. 17 or older

    f. 14

    g. 15

    h. 16

    i. 17 or older

    f. 14

    g. 15

    h. 16

    i. 17 or older

    f. 14

    g. 15

    h. 16i. 17 or older

    f. 14

    g. 15

    h. 16

    i. 17 or older

  • 8/8/2019 hys-wa-forma08

    11/16

    70. How wrong do you think it is for someone yourage to:

    A. Take a handgun to school?

    a. Very wrong

    b. Wrong

    c. A little bit wrongd. Not wrong at all

    B. Steal anything worth more than $5?

    a. Very wrong

    b. Wrong

    c. A little bit wrong

    d. Not wrong at all

    C. Pick a fight with someone?

    a. Very wrong

    b. Wrongc. A little bit wrong

    d. Not wrong at all

    D. Attack someone with the idea of seriouslyhurting them?

    a. Very wrong

    b. Wrong

    c. A little bit wrong

    d. Not wrong at all

    E. Stay away from school all day when theirparents think they are at school?

    a. Very wrong

    b. Wrong

    c. A little bit wrong

    d. Not wrong at all

    71. How wrong do you think it is for someone yourage to:

    A. Drink beer, wine, or hard liquor (for example,vodka, whiskey, or gin) regularly?

    a. Very wrong

    b. Wrong

    c. A little bit wrong

    d. Not wrong at all

    B. Smoke cigarettes?

    a. Very wrong

    b. Wrong

    c. A little bit wrong

    d. Not wrong at all

    -10-

    C. Smoke marijuana?

    a. Very wrong

    b. Wrong

    c. A little bit wrong

    d. Not wrong at all

    D. Use LSD, cocaine, amphetamines, or anotherillegal drug?

    a. Very wrongb. Wrong

    c. A little bit wrong

    d. Not wrong at all

    72. In the past 12 months, how often have yougambled (bet) for money or possessions?

    a. Never in the past year

    b. Once or twice in the past year

    c. A few times in the past year

    d. Once or twice a month

    e. At least once a week

    73. Has YOUR gambling ever caused you problems athome, school or with your friends?

    a. I have not gambled

    b. Yes

    c. No

    74. Think about your four best friends (the friends youfeel closest to). In the past year (12 months), howmany of your best friends have. . .

    A. Participated in clubs, organizations or activitiesat school?

    a. None of my friends

    b. 1 of my friends

    c. 2 of my friends

    d. 3 of my friends

    e. 4 of my friends

    B. Made a commitment to stay drug-free?

    a. None of my friends

    b. 1 of my friends

    c. 2 of my friends

    d. 3 of my friends

    e. 4 of my friends

    C. Liked school?

    a. None of my friends

    b. 1 of my friends

    c. 2 of my friends

    d. 3 of my friends

    e. 4 of my friends

    The next questions ask for your opinions.

  • 8/8/2019 hys-wa-forma08

    12/16

    D. Regularly attended religious services?

    a. None of my friends

    b. 1 of my friends

    c. 2 of my friends

    d. 3 of my friends

    e. 4 of my friends

    E. Tried to do well in school?

    a. None of my friends

    b. 1 of my friends

    c. 2 of my friends

    d. 3 of my friends

    e. 4 of my friends

    75. Think of your four best friends (the friends you feelclosest to). In the past year (12 months), how manyof your best friends have. . .

    A. Smoked cigarettes?

    a. Noneb. 1 of my friends

    c. 2 of my friends

    d. 3 of my friends

    e. 4 of my friends

    B. Tried beer, wine, or hard liquor (for example,vodka, whiskey, or gin) when their parentsdidnt know about it?

    a. None

    b. 1 of my friends

    c. 2 of my friendsd. 3 of my friends

    e. 4 of my friends

    C. Used marijuana?

    a. None

    b. 1 of my friends

    c. 2 of my friends

    d. 3 of my friends

    e. 4 of my friends

    D. Used LSD, cocaine, amphetamines, or otherillegal drugs?

    a. None

    b. 1 of my friends

    c. 2 of my friends

    d. 3 of my friends

    e. 4 of my friends

    -11-

    76. During the past 12 months, did you ever feel so sador hopeless almost every day for two weeks ormore in a row that you stopped doing some usualactivities?

    a. Yes

    b. No

    77. During the past 12 months, did you ever seriously

    consider attempting suicide?a. Yes

    b. No

    Sometimes we don't know what we will do asadults, but we may have an idea. Please try toguess how true these statements may be foryou as an adult.

    78. When I am an adult I will smoke cigarettes.

    a. NO!

    b. noc. yes

    d. YES!

    79. When I am an adult I will drink beer, wine, or liquor.

    a. NO!

    b. no

    c. yes

    d. YES!

    80. When I am an adult I will smoke marijuana.

    a. NO!b. no

    c. yes

    d. YES!

    81. How honest were you in filling out this survey?

    a. I was very honest

    b. I was honest pretty much of the time

    c. I was honest some of the time

    d. I was honest once in a while

    e. I was not honest at all

  • 8/8/2019 hys-wa-forma08

    13/16-12-

    88. My parents ask me what I think before most

    family decisions affecting me are made.

    a. NO!

    b. no

    c. yes

    d.YES!

    89. My parents notice when I am doing a good job

    and let me know about it.

    a. Never or almost never

    b. Sometimes

    c. Often

    d.All the time

    90. How often do your parents tell you they're proud

    of you for something you've done?

    a. Never or almost never

    b. Sometimes

    c. Often

    d.All the time

    91. Do you enjoy spending time with your mother?

    a. NO!

    b. no

    c. yes

    d. YES!

    92. Do you enjoy spending time with your father?

    a. NO!

    b. no

    c. yesd. YES!

    93. How wrong do your parents feel it would be for

    you to:

    A. Drink beer, wine, or hard liquor (for example:vodka, whiskey, or gin) regularly (at least once ortwice a month)?

    a. Very wrong

    b. Wrong

    c. A little bit wrong

    d. Not wrong at all

    B. Smoke cigarettes?

    a. Very wrong

    b. Wrong

    c. A little bit wrong

    d. Not wrong at all

    The next set of questions asks about yourfamily. When answering these questions,please think about the people you consider tobe your family parents, stepparents,grandparents, aunts, uncles, etc.

    82. My parents ask if I've gotten my homework done.

    a. NO!b. no

    c. yes

    d. YES!

    83. When I am not at home, one of my parents knows

    where I am and who I am with.

    a. NO!

    b. no

    c. yes

    d. YES!

    84. If I had a personal problem, I could ask my mom

    or dad for help.

    a. NO!

    b. no

    c. yes

    d. YES!

    85. The rules in my family are clear.

    a. NO!

    b. no

    c. yes

    d. YES!

    86. My family has clear rules about alcohol and

    drug use.

    a. NO!

    b. no

    c. yes

    d. YES!

    87. My parents give me lots of chances to do fun

    things with them.

    a. NO!b. no

    c. yes

    d. YES!

  • 8/8/2019 hys-wa-forma08

    14/16-13-

    C. Smoke marijuana?

    a. Very wrong

    b. Wrong

    c. A little bit wrong

    d. Not wrong at all

    94. If you drank some beer, wine, or liquor (for example

    vodka, whiskey, or gin) without your parent's

    permission, would you be caught by them?

    a. NO!

    b. no

    c. yes

    d. YES!

    95. Would your parents know if you did not come home

    on time?

    a. NO!

    b. no

    c. yes

    d. YES!

    96. If you carried a handgun without your parent's

    permission, would you be caught by them?

    a. NO!

    b. no

    c. yes

    d. YES!

    97. If you skipped school, would you be caught by

    your parents?

    a. NO!b. no

    c. yesd. YES!

  • 8/8/2019 hys-wa-forma08

    15/16

  • 8/8/2019 hys-wa-forma08

    16/16