2018 Healthy Youth Survey Form A

Transcription

1 2018 Healthy Youth Survey Form 2018 Grades 8, 10 and 12 We are asking you to take part in this survey about issues facing students in communities in Washington. The questions in this survey ask for your opinions about yourself, your friends, your school, and your neighborhood or community. School, community, county, and state officials will use the information from this survey in planning future programs to help youth. 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 the answer sheet. If you do not want to take this survey now, tell your teacher and you will be given an alternative activity. Some of the questions are personal, such as asking about your relationships and whether you get in fights or use drugs. Some students may find some of the questions uncomfortable or upsetting. You will be given a list of numbers to call if you want to talk to someone about the survey or feelings it brings up. The survey is completely voluntary. You don t have to do this survey. You may skip any question you do not wish to answer or stop at any time. It will not affect your grades. Other students have said this survey is interesting and they enjoyed filling it out. We hope you will too. If you have any questions about this survey you may ask your teacher before beginning. Please take a minute to read the instructions below before starting the survey. INSTRUCTIONS 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 answer sheet. If you don t find an answer that fits exactly, use one that comes closest. If any question 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 mark inside the bubbles. Erase cleanly any answer you wish to change. Make no other markings or comments on the answer 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 about that sentence. EXMPLE: Pepperoni pizza is one of my favorite foods. This kind of mark will work: Correct Mark B D These kinds of marks will NOT work: Incorrect Marks In this example, the student marked yes because he or she thinks the statement is mostly true. B D means definitely not true for you means mostly not true for you means mostly true for you means definitely true for you DSHS (Rev. 4/18)

2 2018 Healthy Youth Survey Form Questionnaire Grades 8, 10 and How old are you? a. 12 or younger b. 13 c. 14 d. 15 e. 16 f. 17 g. 18 h. 19 or older 2. What grade are you in? a. 7th b. 8th c. 9th d. 10th e. 11th f. 12th g. Ungraded or other 3. What sex/gender were you at birth, even if you are not that gender today? a. Female b. Male 4. How do you describe yourself? (Select one or more responses.) a. merican Indian or laskan Native b. sian or sian merican c. Black or frican-merican 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 f. Chinese g. Korean h. Japanese i. Other 6. Who did you live with most of the time in the last 30 days? a. Parent(s), step-parent(s), or legal guardian b. Relatives like a grandparent, an aunt, an older brother but NOT your parents c. Foster care parent(s) d. dults who are NOT your parents or relatives e. Friends of yours with no adults present f. On your own g. Other 7. Where did you live most of the time in the last 30 days? a. In a house or apartment that a relative rents or owns b. In a house or apartment with someone who is not a relative c. In a shelter d. In a car or RV, park, or campground e. In a motel/hotel f. On the street g. Moved from place to place h. Other 8. re your current living arrangements the result of losing your home because your family cannot afford housing? a. No b. Yes c. Not sure 9. How often in the past 12 months did you or your family have to cut meal size or skip meals because there wasn t enough money for food? a. lmost every month b. Some months but not every month c. Only 1 2 months d. Did not have to skip or cut the size of meals 10. Have you or your family moved in the past 3 years to another school district, city, or county for seasonal work in: agriculture, dairy, or fishing? a. Yes b. No c. I do not know 11. During your last school year, how many times did you change schools for reasons other than moving up a grade? a. I did not change schools b. Once c. Twice d. Three or more times 1

3 12. During the past 30 days, on how many days have you been absent from school for any reason? Include any day that you missed at least half of the school day. b. 1 or 2 days c. 3 or more days These statements and questions are about the neighborhood and community where you live. 13. How wrong would most adults in your neighborhood or community think it was for kids your age?. To use marijuana? c. little bit wrong To drink alcohol? c. little bit wrong To smoke cigarettes? c. little bit wrong 14. How wrong do your parents feel it would be for you to:. Drink beer, wine, or hard liquor (for example vodka, whiskey or gin) regularly (at least once or twice a month)? c. little bit wrong Have one or two drinks of an alcoholic beverage nearly every day? c. little bit wrong Smoke cigarettes? c. little bit wrong D. Use marijuana? c. little bit wrong E. Use prescription drugs not prescribed to you? c. little bit wrong 15. If a kid drank some beer, wine, or hard liquor (for example vodka, whiskey, or gin) in your community, would he or she be caught by the police? 16. If a kid used marijuana in your community, would he or she be caught by the police. 17. If a kid carried a handgun in your community, would he or she be caught by the police? 18. 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? a. Very hard b. Sort of hard c. Sort of easy d. Very easy 19. If you wanted to get some cigarettes, how easy would it be for you to get some? a. Very hard b. Sort of hard c. Sort of easy d. Very easy 2

4 20. If you wanted to get some marijuana, how easy would it be for you to get some? a. Very hard b. Sort of hard c. Sort of easy d. Very easy 21. If you wanted to get a drug like cocaine, LSD, or amphetamines, how easy would it be for you to get some? a. Very hard b. Sort of hard c. Sort of easy d. Very easy 22. If you wanted to get a handgun, how easy would it be for you to get one? a. Very hard b. Sort of hard c. Sort of easy d. Very easy 23. There are adults in my neighborhood or community I could talk to about something important. 24. Which of the following activities for people your age are available in your community? 3. Sports teams and recreation a. Yes b. No Scouts, Camp Fire, 4 H Clubs, or other service clubs a. Yes b. No Boys and Girls Club, YMC, or other activity clubs a. Yes b. No This section asks about your experiences with school. 25. During the average week, on how many days do you participate in supervised after school activities either at school or away from school? Include activities such as sports, art, music, dance, drama, or community service, religious, or club activities. b. 1 2 days c. 3 or more days 26. How often do you feel the schoolwork you are assigned is meaningful and important? a. lmost always b. Often c. Sometimes d. Seldom e. Never 27. 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 28. How important do you think the things you are learning in school are going to be for you later in life? a. Very important b. Quite important c. Fairly important d. Slightly important e. Not at all important 29. Think back over the past year in school. How often did you:. Enjoy being in school? a. Never b. Seldom c. Sometimes d. Often e. lmost always Hate being in school? a. Never b. Seldom c. Sometimes d. Often e. lmost always Try to do your best work in school? a. Never b. Seldom c. Sometimes d. Often e. lmost always

5 30. During the LST 4 WEEKS, how many whole days of school have you missed because you skipped or cut? b. 1 day c. 2 days d. 3 days e. 4 5 days f days g. 11 or more days 31. In the last 30 days, how often have you been bullied? Bullying is when one or more students threaten, spread rumors about, hit, shove, or otherwise hurt another student over and over again. It is not bullying when two students of about the same strength or power argue or fight or tease each other in a friendly way. a. I have not been bullied b. Once c. 2 3 times d. bout once a week e. Several times a week 32. In my school, students have lots of chances to help decide things like class activities and rules. 33. There are lots of chances for students in my school to talk with a teacher one-on-one. 34. Teachers ask me to work on special classroom projects. 35. There are lots of chances for students in my school to get involved in sports, clubs, and other school activities outside of class. 36. I have lots of chances to be part of class discussions or activities. 37. My teacher(s) notices when I am doing a good job and lets me know about it. 38. The school lets my parents know when I have done something well. 39. I feel safe at my school. 40. My teachers praise me when I work hard in school. 41. Putting them all together, what were your grades like last year? a. Mostly s b. Mostly Bs c. Mostly Cs d. Mostly Ds e. Mostly Fs 42. re your school grades better than the grades of most students in your class? 4

6 43. How far did your mother get in school? a. Did not finish high school b. Graduated from high school or GED c. 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 The next questions ask about issues related to alcohol and other drugs. 44. NOT including talks on drinking and driving, in the past year have your parents or guardians talked to you about why you should not drink alcohol? a. Yes, a number of times b. Yes, once c. No d. I don t remember 45. In the past year, have your parents or guardians talked to you about why you should not use marijuana? a. Yes, a number of times b. Yes, once c. No d. I don t remember 46. When you used marijuana during the past 30 days, did you ever drink alcohol at the same time? a. I have not used marijuana in the past 30 days b. Yes, most of the time c. Yes, some of the time d. Yes, rarely e. No 47. During the past year in school, how many times did you get information in classes about reasons not to use alcohol or drugs? a. Never b. Once c. 2 3 times d. 4 or more times 48. How much do you think people risk harming themselves if they: 5. Smoke one or more packs of cigarettes per day? a. No risk b. Slight risk c. Moderate risk d. Great risk e. Not sure Try marijuana once or twice? a. No risk b. Slight risk c. Moderate risk d. Great risk e. Not sure Use marijuana regularly (at least once or twice a week)? a. No risk b. Slight risk c. Moderate risk d. Great risk e. Not sure D. Take one or two drinks of an alcoholic beverage (wine, beer, a shot, liquor) nearly every day? a. No risk b. Slight risk c. Moderate risk d. Great risk e. Not sure E. Have 5 or more drinks of an alcoholic beverage once or twice a week? a. No risk b. Slight risk c. Moderate risk d. Great risk e. Not sure F. Use prescription drugs that are not prescribed to them? a. No risk b. Slight risk c. Moderate risk d. Great risk e. Not sure 49. During the past 12 months, how many times were you in a physical fight? a. 0 times b. 1 time c. 2 3 times d. 4 5 times e. 6 or more times

7 The next questions ask about sad feelings and attempted suicide. Sometimes people feel so depressed about the future that they may consider attempting suicide, that is, taking some action to end their own life. 50. During the past 12 months, did you ever feel so sad or hopeless almost every day for two weeks or more in a row that you stopped doing some usual activities? a. Yes b. No 51. During the past 12 months, did you ever seriously consider attempting suicide? a. Yes b. No 52. How often over the last 2 weeks were you bothered by:. Feeling nervous, anxious or on edge? a. Not at all b. Several days c. More than half the days d. Nearly every day Not being able to stop or control worrying? a. Not at all b. Several days c. More than half the days d. Nearly every day 53. If you feel sad or hopeless almost every day for two weeks or more in a row, to whom would you most likely turn for help? (Check all that apply.) a. Sibling or cousin b. Teacher, school counselor, or other adult in my school c. Friend or peer d. Parent/Guardian e. dult friend or adult relative that is not my parent/ guardian f. Religious/faith leader g. I don t have anyone I would talk to. h. I have not felt sad or hopeless for two weeks or more in a row. The next section asks about your experiences with alcohol and other drugs. Remember, no one but you will know how you answered. 54. During the past 30 days, on how many days did you:. Smoke cigarettes? b. 1 2 days c. 3 5 days d. 6 9 days e days f. ll 30 days Drink a glass, can or bottle of alcohol (beer, wine, wine coolers, hard liquor)? b. 1 2 days c. 3 5 days d. 6 9 days e. 10 or more days Use marijuana or hashish (weed, hash, pot)? b. 1 2 days c. 3 5 days d. 6 9 days e days f days g. ll 30 days D. Not counting alcohol, tobacco, or marijuana, use another illegal drug? b. 1 2 days c. 3 5 days d. 6 9 days e. 10 or more days E. Use brezidox? b. 1 2 days c. 3 5 days d. 6 9 days e. 10 or more days F. Use a pain killer TO GET HIGH, like Vicodin, OxyContin (sometimes called Oxy or OC) or Percocet (sometimes called Percs)? b. 1 2 days c. 3 5 days d. 6 9 days e. 10 or more days 6

8 G. Use prescription drugs not prescribed to you? b. 1 2 days c. 3 5 days d. 6 9 days e. 10 or more days 55. During the past 30 days, which of the following have you used for non-medical reasons? Select all that apply. a. I did not take any of these for non-medical reasons b. I used a stimulant, like dderall or Ritalin c. I used a painkiller, like Vicodin, OxyContin, or Percocet d. I used a tranquilizer, like Valium or Xanax e. I used another kind of prescription drug f. I used an over-the-counter drug, like cough syrup or cold medicine 56. Does your school provide a counselor, intervention specialist, or other school staff member for students to discuss problems with alcohol, tobacco, or other drugs? a. No b. Yes c. Not sure This section asks other questions about alcohol, tobacco and other drugs. 57. Think back over the last 2 weeks. How many times have you had five or more drinks in a row? ( drink is a glass of wine, a bottle of beer, a shot glass of liquor, or a mixed drink.) a. 0 times b. 1 time c. 2 times d. 3 5 times e. 6 9 times f. 10 or more times 58. How many times in the past year (12 months) have you 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 59. How old were you the first time you:. Used marijuana? a. Never have b. 10 or younger c. 11 d. 12 e. 13 f. 14 g. 15 h. 16 i. 17 or older Smoked a cigarette, even just a puff? a. Never have b. 10 or younger c. 11 d. 12 e. 13 f. 14 g. 15 h. 16 i. 17 or older Had more than a sip or two of beer, wine, or hard liquor (for example vodka, whiskey, or gin)? a. Never have b. 10 or younger c. 11 d. 12 e. 13 f. 14 g. 15 h. 16 i. 17 or older D. 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. 14 g. 15 h. 16 i. 17 or older 60. Have you ever, even once in your life, used inhalants? Select all that apply. a. No, I ve never used it b. Yes, within the past year c. Yes, over a year ago 7

9 61. Have you ever, even once in your life, used heroin? Select all that apply. a. No, I ve never used it b. Yes, within the past year c. Yes, over a year ago 62. Have you ever, even once in your life, used methamphetamines (meth, crystal meth, ice, crank)? Do not include other types of amphetamines. Select all that apply. a. No, I ve never used it b. Yes, within the past year c. Yes, over a year ago 63. Have you ever, even once in your life, used cocaine? Select all that apply. a. No, I ve never used it b. Yes, within the past year c. Yes, over a year ago 64. Have you ever, even once in your life, used steroids (muscle builders) without a doctor s prescription? Select all that apply. a. No, I ve never used it b. Yes, within the past year c. Yes, over a year ago The next questions ask about other behaviors. 65. gang is a group of people with a leader who act together often for violent or illegal activities. During the past 12 months, have you been a member of a gang? a. No b. Yes 66. re there gangs at your school? a. No b. Yes c. Don t know 67. During the past 30 days, on how many days did you carry a weapon such as a gun, knife, or club on school property? b. 1 5 days c. 6 or more days The next questions ask for your opinions. 68. Think about the students in your school. If you had to guess, how wrong do most students in your grade think it is to drink alcohol regularly? c. little bit wrong 69. How wrong do YOU think it is for someone your age to:. Drink beer, wine, or hard liquor (for example vodka, whiskey, or gin) regularly? c. little bit wrong Smoke cigarettes? c. little bit wrong Use marijuana? c. little bit wrong D. Use LSD, cocaine, amphetamines, or another illegal drug? c. little bit wrong 70. How do you feel about someone your age having one or two drinks of an alcoholic beverage nearly every day? a. Neither approve nor disapprove b. Somewhat disapprove c. Strongly disapprove d. Don t know or can t say 71. 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? a. 0 times b. 1 time c. 2 3 times d. 4 5 times e. 6 or more times 8

10 72. During the past 30 days, how many times did you drive a car or other vehicle when you had been drinking alcohol? a. 0 times b. 1 time c. 2 3 times d. 4 5 times e. 6 or more times 73. During the past 30 days, how many times did you ride in a car or other vehicle driven by someone who had been using marijuana? a. 0 times b. 1 time c. 2 3 times d. 4 5 times e. 6 or more times 74. During the past 30 days, how many times did you drive a car or other vehicle within three hours after using marijuana? a. 0 times b. 1 time c. 2 3 times d. 4 5 times e. 6 or more times 75. During the past 30 days, how many days did you text or while driving a car or other vehicle? a. I did not drive a car or other vehicle during the past 30 days. b. 0 days c. 1 or 2 days d. 3 to 5 days e. 6 to 9 days f. 10 to 19 days g. 20 to 29 days h. ll 30 days The next set of questions asks about your family. When answering these questions, please think about the people you consider to be your family parents, step-parents, grandparents, aunts, uncles, etc. 76. My parents ask if I ve gotten my homework done When I am not at home, one of my parents knows where I am and who I am with. 78. If I had a personal problem, I could ask my mom or dad for help. 79. The rules in my family are clear. 80. My family has clear rules about alcohol and drug use. 81. My parents give me lots of chances to do fun things with them. 82. My parents ask me what I think before most family decisions affecting me are made. 83. 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? 84. Would your parents know if you did not come home on time?

11 85. If you carried a handgun without your parent s permission, would you be caught by them? 86. If you skipped school, would you be caught by your parents? The next section asks about your experience with alcohol and other drugs. Remember, no one but you will know how you answered. 87. During the past 30 days, which of the following did you use on school property? Select all that apply. a. I didn t use any of these on school property b. Tobacco (cigarettes, cigars, or chew/dip) c. Electronic cigarette, also called e-cigs, or vape pens d. Marijuana e. lcohol (at least one drink) 88. 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 stole it from a store. d. I got it from friends. e. I got it at a party. f. I got it from an older brother or sister. g. I gave money to someone to get it for me. h. I took it from home without my parents permission. i. I got it at home with my parents permission. j. I got it some other way. 89. During the past 30 days, what type of alcohol did you usually drink? a. I did not drink alcohol during the past 30 days. b. I do not have a usual type. c. Beer d. Flavored malt beverages, such as Smirnoff Ice, Bacardi Silver, or Hard Lemonade e. Wine coolers, such as Bartles & Jaymes or Seagrams f. Wine g. Liquor, such as vodka, rum, scotch, bourbon or whiskey h. Some other type 90. During the past 30 days, how did you get marijuana? Choose all that apply. a. I did not get marijuana in the past 30 days. b. I bought it from a store. c. I stole it from a store. d. I got it from friends. e. I got it at a party. f. I got it from an older brother or sister. g. I gave money to someone to get it for me. h. I took it from home without my parents permission. i. I got it at home with my parents permission. j. I got it some other way. 91. During the past 30 days, if you used marijuana, how did you usually use it? a. I did not use marijuana during the past 30 days. b. Smoked it (in a joint, bong, pipe, blunt) c. te it (in brownies, cakes, cookies, candy) d. Drank it (tea, cola, alcohol) e. Vaporized it f. Dabbed it g. Used it some other way 92. If you use marijuana or hashish (weed, hash, pot) how long do you usually stay high? a. I don t use marijuana. b. I usually don t get high. c. 1 to 2 hours d. 3 to 4 hours e. 5 to 6 hours f. 7 to 8 hours g. 9 or more hours 93. Does anyone who lives with you now use marijuana? a. No b. Yes The next questions are about your friends. 94. Think of your four best friends (the friends you feel closest to). In the past year (12 months), how many of your best friends have:. Smoked cigarettes? 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 10

12 Tried beer, wine, or hard liquor (for example vodka, whiskey, or gin) when their parents didn t know about it? 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 Used marijuana? 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. Used LSD, cocaine, amphetamines, or other 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 95. How wrong do your friends feel it would be for you to:. Have one or two drinks of an alcoholic beverage nearly every day? c. little bit wrong d. Not at all wrong Use tobacco? c. little bit wrong d. Not at all wrong Use marijuana? c. little bit wrong d. Not at all wrong D. Use prescription drugs not prescribed to you? c. little bit wrong d. Not at all wrong 96. You re looking at shirts in a store with a friend. You look up and see her slip a shirt under her coat. She smiles and says, Which one do you want? Go ahead, take it while nobody s around. There are no security cameras, no employees, and no other customers. What would you do now? a. Ignore her b. Grab a shirt and leave the store c. Tell her to put the shirt back d. ct like it s a joke and ask her to put the shirt back 97. You are visiting another part of town and you don t know any of the people your age there. You are walking down the street and some teenager you don t know is walking toward you. He is about your size. s he is about to pass you, he deliberately bumps into you and you almost lose your balance. What would you say or do? a. Push the person back b. Say nothing and keep on walking c. Say, Watch where you re going, and keep on walking d. Swear at the person and walk away 98. You are at a party at someone s house and one of your friends offers you a drink containing alcohol. What would you say or do? a. Drink it b. Tell your friend, No thanks. I don t drink, and suggest that you and your friend go and do something else c. Just say, No, thanks, and walk away d. Make up a good excuse, tell your friend you had something else to do, and leave 99. 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. 11

13 100. Which of the following best describes you? a. Heterosexual (straight) b. Gay or lesbian c. Bisexual d. Questioning/not sure e. Something else fits better f. I do not know what this question is asking 101. How do you currently identify yourself? Select all that apply. a. Male b. Female c. Transgender d. Questioning/not sure of my gender identity e. Something else fits better f. I do not know what this question is asking 12

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