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.

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.

Please take a minute to read the instructions below before starting the survey.

2016 Healthy Youth SurveyForm A

INSTRUCTIONS

DSHS 22-1460 (4/16)

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.EXAMPLE: Pepperoni pizza is one of my favorite foods.

In this example, the student marked yes because he or she thinks the statement is mostly true.

This kind of mark will work:Correct Mark

A B D

These kinds of marks will NOT work:Incorrect Marks

a. NO! – means definitely not true for youb. no – means mostly not true for youc. yes – means mostly true for youd. YES! – means definitely true for you

A

B

D

Grades 8, 10 and 12

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6. Who did you live with most of the time in the last 30 days? a. Parent(s) and/or step–parent(s) b. Relatives – like a grandparent, an aunt, an older

brother – but NOT your parentsc. Foster care parent(s)d. An adult friend(s) of your familye. Friends of yours with no adults presentf. On your owng. Other

7. Where did you live most of the time in the last 30 days?a. In my own house or apartment that my family

rents or ownsb. In someone else’s house or apartment with

another familyc. In a group homed. In a sheltere. In a car, park, or campgroundf. On the streetg. Moved from place to placeh. Other

8. Are your current living arrangements the result of losing your home because your family cannot afford housing?a. Nob. Yesc. 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. Almost every monthb. Some months but not every monthc. Only 1 – 2 monthsd. Did not have to skip or cut the size of meals

These statements and questions are about the neighborhood and community where you live.

10. How wrong would most adults in your neighborhood or community think it was for kids your age?

A. To use marijuana?a. Very wrongb. Wrongc. A little bit wrongd. Not wrong at all

1. How old are you?a. 12 or youngerb. 13c. 14d. 15e. 16f. 17g. 18h. 19 or older

2. What grade are you in?a. 7thb. 8thc. 9thd. 10the. 11thf. 12thg. Ungraded or other

3. Are you:a. Femaleb. Male

4. How do you describe yourself? (Select one or more responses.)a. American Indian or Alaskan Nativeb. Asian or Asian Americanc. Black or African-Americand. Hispanic or Latino/Latinae. Native Hawaiian or other Pacific Islanderf. White or Caucasiang. Other

5. What language is usually spoken at home?a. Englishb. Spanishc. Russiand. Ukrainiane. Vietnamesef. Chineseg. Koreanh. Japanesei. Other

A

Healthy Youth Survey Form A Questionnaire • Grades 8, 10 and 12

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B. To drink alcohol?a. Very wrongb. Wrongc. A little bit wrongd. Not wrong at all

C. To smoke cigarettes?a. Very wrongb. Wrongc. A little bit wrongd. Not wrong at all

11. 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 or twice a month)?a. Very wrongb. Wrongc. A little bit wrongd. Not wrong at all

B. Have one or two drinks of an alcoholic beverage nearly every day?a. Very wrongb. Wrongc. A little bit wrongd. Not wrong at all

C. Smoke cigarettes?a. Very wrongb. Wrongc. A little bit wrongd. Not wrong at all

D. Use marijuana?a. Very wrongb. Wrongc. A little bit wrongd. Not wrong at all

E. Use prescription drugs not prescribed to you?a. Very wrongb. Wrongc. A little bit wrongd. Not wrong at all

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

13. If a kid used marijuana in your community, would he or she be caught by the police.a. NO!b. noc. yesd. YES!

14. If a kid carried a handgun in your community, would he or she be caught by the police?a. NO!b. noc. yesd. YES!

15. 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 hardc. Sort of easyd. Very easy

16. If you wanted to get some cigarettes, how easy would it be for you to get some?a. Very hard b. Sort of hardc. Sort of easyd. Very easy

17. If you wanted to get some marijuana, how easy would it be for you to get some?a. Very hard b. Sort of hardc. Sort of easyd. Very easy

18. 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 hardc. Sort of easyd. Very easy

19. There are adults in my neighborhood or community I could talk to about something important.a. NO!b. noc. yesd. YES!

A

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20. Which of the following activities for people your age are available in your community?

A. Sports teams and recreationa. Yesb. No

B. Scouts, Camp Fire, 4–H Clubs, or other service clubsa. Yesb. No

C. Boys and Girls Club, YMCA, or other activity clubsa. Yesb. No

This section asks about your experiences with school.

21. 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.a. 0 daysb. 1 – 2 daysc. 3 or more days

22. How often do you feel the schoolwork you are assigned is meaningful and important?a. Almost always b. Oftenc. Sometimesd. Seldome. Never

23. How interesting are most of your courses to you?a. Very interesting and stimulatingb. Quite interestingc. Fairly interestingd. Slightly dulle. Very dull

24. How important do you think the things you are learning in school are going to be for you later in life?a. Very importantb. Quite importantc. Fairly importantd. Slightly importante. Not at all important

25. Think back over the past year in school. How often did you:

A. Enjoy being in school?a. Neverb. Seldomc. Sometimesd. Oftene. Almost always

B. Hate being in school?a. Neverb. Seldomc. Sometimesd. Oftene. Almost always

C. Try to do your best work in school?a. Neverb. Seldomc. Sometimesd. Oftene. Almost always

26. During the LAST 4 WEEKS, how many whole days of school have you missed because you skipped or “cut”?a. 0 daysb. 1 dayc. 2 daysd. 3 dayse. 4 – 5 daysf. 6 – 10 daysg. 11 or more days

27. A student is being bullied when another student, or group of students, say or do nasty or unpleasant things to him or her. It is also bullying when a student is teased repeatedly in a way he or she doesn’t like. It is NOT bullying when two students of about the same strength argue or fight.

In the last 30 days, how often have you been bullied?a. I have not been bulliedb. Oncec. 2 – 3 timesd. About once a weeke. Several times a week

28. In my school, students have lots of chances to help decide things like class activities and rules.a. NO!b. noc. yesd. YES!

A

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29. There are lots of chances for students in my school to talk with a teacher one-on-one.a. NO!b. noc. yesd. YES!

30. Teachers ask me to work on special classroom projects.a. NO!b. noc. yesd. YES!

31. There are lots of chances for students in my school to get involved in sports, clubs, and other school activities outside of class.a. NO!b. noc. yesd. YES!

32. I have lots of chances to be part of class discussions or activities.a. NO!b. noc. yesd. YES!

33. My teacher(s) notices when I am doing a good job and lets me know about it.a. NO!b. noc. yesd. YES!

34. The school lets my parents know when I have done something well.a. NO!b. noc. yesd. YES!

35. I feel safe at my school.a. NO!b. noc. yesd. YES!

36. My teachers praise me when I work hard in school.a. NO!b. noc. yesd. YES!

37. Putting them all together, what were your grades like last year?a. Mostly Asb. Mostly Bsc. Mostly Csd. Mostly Dse. Mostly Fs

38. Are your school grades better than the grades of most students in your class?a. NO!b. noc. yesd. YES!

39. How far did your mother get in school?a. Did not finish high schoolb. 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.

40. 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 timesb. Yes, oncec. Nod. I don’t remember.

41. In the past year, have your parents or guardians talked to you about why you should not use marijuana?a. Yes, a number of timesb. Yes, oncec. Nod. I don’t remember.

42. During the past year in school, how many times did you get information in classes about reasons not to use alcohol or drugs?a. Neverb. Oncec. 2 – 3 timesd. 4 or more times

A

5

43. How much do you think people risk harming themselves if they:

A. Smoke one or more packs of cigarettes per day?a. No riskb. Slight riskc. Moderate riskd. Great riske. Not sure

B. Try marijuana once or twice?a. No riskb. Slight riskc. Moderate riskd. Great riske. Not sure

C. Use marijuana regularly (at least once or twice a week)?a. No riskb. Slight riskc. Moderate riskd. Great riske. Not sure

D. Take one or two drinks of an alcoholic beverage (wine, beer, a shot, liquor) nearly every day?a. No riskb. Slight riskc. Moderate riskd. Great riske. Not sure

E. Have 5 or more drinks of an alcoholic beverage once or twice a week?a. No riskb. Slight riskc. Moderate riskd. Great riske. Not sure

F. Use prescription drugs that are not prescribed to them?a. No riskb. Slight riskc. Moderate riskd. Great riske. Not sure

44. During the past 12 months, how many times were you in a physical fight?a. 0 timesb. 1 timec. 2 – 3 timesd. 4 – 5 timese. 6 or more times

The next questions ask for your opinion. Remember, no one but you will know how you answered.

45. I think it is okay to take something without asking as long as you get away with it.a. NO!b. noc. yesd. YES!

46. I think sometimes it’s okay to cheat at school.a. NO!b. noc. yesd. YES!

47. It is all right to beat up people if they start the fight.a. NO!b. noc. yesd. YES!

48. It is important to be honest with your parents, even if they become upset or you get punished.a. NO!b. noc. yesd. YES!

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.

49. 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. Yesb. No

50. During the past 12 months, did you ever seriously consider attempting suicide?a. Yesb. No

51. How often over the last 2 weeks were you bothered by:

A. Feeling nervous, anxious or on edge?a. Not at allb. Several daysc. More than half the daysd. Nearly every day

A

6

B. Not being able to stop or control worrying?a. Not at allb. Several daysc. More than half the daysd. Nearly every day

52. 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 cousinb. Teacher, school counselor, or other adult in my

schoolc. Friend or peerd. Parent/Guardiane. Adult friend or adult relative that is not my

parent/guardianf. Religious/faith leaderg. 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.

53. During the past 30 days, on how many days did you:

A. Smoke cigarettes?a. 0 daysb. 1 – 2 daysc. 3 – 5 daysd. 6 – 9 dayse. 10 – 29 daysf. All 30 days

B. Drink a glass, can or bottle of alcohol (beer, wine, wine coolers, hard liquor)?a. 0 daysb. 1 – 2 daysc. 3 – 5 daysd. 6 – 9 dayse. 10 or more days

C. Use marijuana or hashish (weed, hash, pot)?a. 0 daysb. 1 – 2 daysc. 3 – 5 daysd. 6 – 9 dayse. 10 – 19 daysf. 20 – 29 daysg. All 30 days

D. Not counting alcohol, tobacco, or marijuana, use another illegal drug?a. 0 daysb. 1 – 2 daysc. 3 – 5 daysd. 6 – 9 dayse. 10 or more days

E. Use loziderb?a. 0 daysb. 1 – 2 daysc. 3 – 5 daysd. 6 – 9 dayse. 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)?a. 0 daysb. 1 – 2 daysc. 3 – 5 daysd. 6 – 9 dayse. 10 or more days

G. Use prescription drugs not prescribed to you?a. 0 daysb. 1 – 2 daysc. 3 – 5 daysd. 6 – 9 dayse. 10 or more days

54. 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. Nob. Yesc. Not sure

This section asks other questions about alcohol, tobacco and other drugs.

55. Think back over the last 2 weeks. How many times have you had five or more drinks in a row? (A drink is a glass of wine, a bottle of beer, a shot glass of liquor, or a mixed drink.)a. 0 timesb. 1 timec. 2 timesd. 3 – 5 timese. 6 – 9 timesf. 10 or more times

A

7

56. How many times in the past year (12 months) have you been drunk or high at school?a. Neverb. 1 – 2 timesc. 3 – 5 timesd. 6 – 9 timese. 10 or more times

57. How old were you the first time you:

A. Used marijuana?a. Never haveb. 10 or youngerc. 11d. 12e. 13f. 14g. 15h. 16i. 17 or older

B. Smoked a cigarette, even just a puff?a. Never haveb. 10 or youngerc. 11d. 12e. 13f. 14g. 15h. 16i. 17 or older

C. Had more than a sip or two of beer, wine, or hard liquor (for example vodka, whiskey, or gin)?a. Never haveb. 10 or youngerc. 11d. 12e. 13f. 14g. 15h. 16i. 17 or older

D. Began drinking alcoholic beverages regularly, that is, at least once or twice a month?a. Never haveb. 10 or youngerc. 11d. 12e. 13f. 14g. 15h. 16i. 17 or older

58. Have you ever, even once in your life:

A. Used inhalants?a. Nob. Yes

B. Used heroin?a. Nob. Yes

C. Used methamphetamines (meth, crystal meth, ice, crank)? Do not include other types of amphetamines.a. Nob. Yes

D. Used cocaine?a. Nob. Yes

E. Used steroids (muscle builders) without a doctor’s prescription? a. Nob. Yes

The next questions ask about other behaviors.

59. A 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. Nob. Yes

60. Are there gangs at your school?a. Nob. Yesc. Don’t know

61. During the past 30 days, on how many days did you carry a weapon such as a gun, knife, or club on school property?a. 0 daysb. 1 – 5 daysc. 6 or more days

The next questions ask for your opinions.

62. 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?a. Very wrongb. Wrongc. A little bit wrongd. Not wrong at all

A

8

63. How wrong do YOU think it is for someone your age to:

A. Drink beer, wine, or hard liquor (for example vodka, whiskey, or gin) regularly?a. Very wrongb. Wrongc. A little bit wrongd. Not wrong at all

B. Smoke cigarettes?a. Very wrongb. Wrongc. A little bit wrongd. Not wrong at all

C. Use marijuana?a. Very wrongb. Wrongc. A little bit wrongd. Not wrong at all

D. Use LSD, cocaine, amphetamines, or another illegal drug?a. Very wrongb. Wrongc. A little bit wrongd. Not wrong at all

64. How do you feel about someone your age having one or two drinks of an alcoholic beverage nearly every day?a. Neither approve nor disapproveb. Somewhat disapprovec. Strongly disapproved. Don’t know or can’t say

65. 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 timesb. 1 timec. 2 – 3 timesd. 4 – 5 timese. 6 or more times

66. During the past 30 days, how many times did you drive a car or other vehicle when you had been drinking alcohol?a. 0 timesb. 1 timec. 2 – 3 timesd. 4 – 5 timese. 6 or more times

67. 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 timesb. 1 timec. 2 – 3 timesd. 4 – 5 timese. 6 or more times

68. During the past 30 days, how many times did you drive a car or other vehicle within three hours after using marijuana?a. 0 timesb. 1 timec. 2 – 3 timesd. 4 – 5 timese. 6 or more times

69. During the past 30 days, how many days did you text or email while driving a car or other vehicle?a. I did not drive a car or other vehicle during the

past 30 days.b. 0 daysc. 1 or 2 daysd. 3 to 5 dayse. 6 to 9 daysf. 10 to 19 daysg. 20 to 29 daysh. All 30 days

70. In the past 12 months, how often have you gambled (bet) for money or possessions.a. Never in the past yearb. Once or twice in the past yearc. A few times in the past yeard. Once or twice a monthe. At least once a week

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.

71. My parents ask if I’ve gotten my homework done.a. NO!b. noc. yesd. YES!

A

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72. When I am not at home, one of my parents knows where I am and who I am with.a. NO!b. noc. yesd. YES!

73. If I had a personal problem, I could ask my mom or dad for help.a. NO!b. noc. yesd. YES!

74. The rules in my family are clear.a. NO!b. noc. yesd. YES!

75. My family has clear rules about alcohol and drug use.a. NO!b. noc. yesd. YES!

76. My parents give me lots of chances to do fun things with them.a. NO!b. noc. yesd. YES!

77. My parents ask me what I think before most family decisions affecting me are made.a. NO!b. noc. yesd. YES!

78. 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. noc. yesd. YES!

79. Would your parents know if you did not come home on time?a. NO!b. noc. yesd. YES!

80. If you carried a handgun without your parent’s permission, would you be caught by them?a. NO!b. noc. yesd. YES!

81. If you skipped school, would you be caught by your parents?a. NO!b. noc. yesd. YES!

The next section asks about your experience with alcohol and other drugs. Remember, no one but you will know how you answered.

82. During the past 30 days, on how many days did you have at least one drink of alcohol on school property?a. 0 daysb. 1 – 2 daysc. 3 – 9 daysd. 10 – 29 dayse. All 30 days

83. During the past 30 days, on how many days did you use marijuana on school property?a. 0 daysb. 1 – 2 daysc. 3 – 9 daysd. 10 – 29 dayse. All 30 days

84. 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.

A

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85. 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. Beerd. Flavored malt beverages, such as Smirnoff Ice,

Bacardi Silver, or Hard Lemonadee. Wine coolers, such as Bartles & Jaymes or

Seagramsf. Wine g. Liquor, such as vodka, rum, scotch, bourbon or

whiskeyh. Some other type

86. 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.

87. 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. Ate it (in brownies, cakes, cookies, candy)d. Drank it (tea, cola, alcohol)e. Vaporized itf. Used it some other way

88. 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 hoursd. 3 to 4 hourse. 5 to 6 hoursf. 7 to 8 hoursg. 9 or more hours

89. Does anyone who lives with you now use marijuana?a. Nob. Yes

90. In the past year, which of the following happened because you drank alcohol or used drugs? Choose all that apply.a. I did not use alcohol or drugs in the past year.b. I did not have any problems from drinking

alcohol or using drugs in the past year.c. I missed classes or school.d. I failed classes or dropped out of school.e. I got sick (vomited) or had a hangover.f. I felt depressed, anxious, scared, or had other

emotional problems.g. I got hurt or injured.h. I hurt or injured someone else.i. I got in trouble with my parents or family.j. I did things I didn’t want to do or regretted

afterward.

The next questions are about your friends.

91. 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:

A. Participated in clubs, organizations or activities at school?a. None of my friendsb. 1 of my friendsc. 2 of my friendsd. 3 of my friendse. 4 of my friends

B. Made a commitment to stay drug–free?a. None of my friendsb. 1 of my friendsc. 2 of my friendsd. 3 of my friendse. 4 of my friends

C. Liked school?a. None of my friendsb. 1 of my friendsc. 2 of my friendsd. 3 of my friendse. 4 of my friends

D. Regularly attended religious services?a. None of my friendsb. 1 of my friendsc. 2 of my friendsd. 3 of my friendse. 4 of my friends

A

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E. Tried to do well in school?a. None of my friendsb. 1 of my friendsc. 2 of my friendsd. 3 of my friendse. 4 of my friends

92. 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:

A. Smoked cigarettes?a. None of my friendsb. 1 of my friendsc. 2 of my friendsd. 3 of my friendse. 4 of my friends

B. Tried beer, wine, or hard liquor (for example vodka, whiskey, or gin) when their parents didn’t know about it?a. None of my friendsb. 1 of my friendsc. 2 of my friendsd. 3 of my friendse. 4 of my friends

C. Used marijuana?a. None of my friendsb. 1 of my friendsc. 2 of my friendsd. 3 of my friendse. 4 of my friends

D. Used LSD, cocaine, amphetamines, or other illegal drugs?a. None of my friendsb. 1 of my friendsc. 2 of my friendsd. 3 of my friendse. 4 of my friends

93. How wrong do your friends feel it would be for you to:

A. Have one or two drinks of an alcoholic beverage nearly every day?a. Very wrongb. Wrongc. A little bit wrongd. Not at all wrong

B. Use tobacco?a. Very wrongb. Wrongc. A little bit wrongd. Not at all wrong

C. Use marijuana?a. Very wrongb. Wrongc. A little bit wrongd. Not at all wrong

D. Use prescription drugs not prescribed to you?a. Very wrongb. Wrongc. A little bit wrongd. Not at all wrong

94. You’re looking at CDs in a music store with a friend. You look up and see her slip a CD under her coat. She smiles and says, “Which one do you want? 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 herb. Grab a CD and leave the storec. Tell her to put the CD backd. Act like it’s a joke and ask her to put the CD back

95. 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. As 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 backb. Say nothing and keep on walkingc. Say, “Watch where you’re going,” and keep on

walkingd. Swear at the person and walk away

96. 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 itb. 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 awayd. Make up a good excuse, tell your friend you had

something else to do, and leave

97. 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.

A

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98. Which of the following best describes you?a. Heterosexual (straight)b. Gay or lesbianc. Bisexuald. Not sure

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A B C D E

A B C D

A B C D

A B C D

A B

A B C D E F G

A B C D E F G H I

A B C

A B C D

A B C D

A B C D

A B C

A B C D

A B C D

A B C D

A B C D

A B C D E

A B C D E

A B C D E F

Tear

her

e

A B C D E F G

A B C D E F G

A B C D E F G H

A B C D

A B C D

A B C D

A B C D

A B C D

A B C D

A B C D

A B C D

A B C D

A B C D

A B C D

A B C D

A B

A B

A B C D E

A B C D E

A B C D E

A B C D E

A B C D E

A B C D E

A B C D E F G

A B C D

A B C D E

A B C D E F G

A B C D

A B C D E

A B C D E

A B C D E

A B C D

A B C D

A B

A B

A B C D E

A B C D

A B

A B C D

A B C D E

A B C D

A B C D E F G H

A B C D

A B C D

*HYSFormA2!* *Page2*

2016 Healthy Youth Survey Grades 8, 10 and 12 • Form APA

GE

6

PAG

E 9

PAG

E 1

1

PAG

E 7

C.

D.

E.

F.

G.

54.

55.

56.

57. A.

B.

C.

D.

58. A.

B.

C.

D.

E.

59.

60.

61.

62.

63. A.

B.

C.

D.

64.

65.

66.

67.

68.

69.

70.

71.

72.

73.

74.

75.

76.

77.

78.

79.

80.

81.

82.

83.

84.

85.

86.

87.

88.

89.

90.

91. A.

B.

C.

D.

E.

92. A.

B.

C.

D.

93. A.

B.

C.

D.

94

95.

96.

97.

98.

A B C D E

A B C D E

A B C D E

A B

A B

A B

A B C D

PAG

E 1

0

A B C D E

A B C

A B C D E F G H I

PAG

E 1

0

A B C D E

A B C D

A B C D

A B C D

Tear

her

eTe

ar h

ere

Tear

her

e

A B C D E F G

A B C D E

A B C D E

A B C D E F G H I

A B C D E F G H I

A B

A B

A B C

A B C D

A B C D

A B C D E

A B C D E

A B C D E

A B C D

A B C D

A B C D

A B C D

A B C D

A B C D

A B C D

A B C D

A B C D E

A B C D E F G H

A B C D

A B C D E

PAG

E 8 A B C D E F

A B C D E F G H I J

A B C D E

A B C D E

A B C D E

A B C D

A B C D

PAG

E 1

2

A B C D E

A B C D E F G H I

A B C D E

PAG

E 8

A B C D

A B C D

A B C D

A B C D E F G H I J

A B

A B C D E F G

A B C D

A B C D E

A B C D E F

A B

A B C

A B C D

A B C D E F G H

A B C D

A B C D E

A B C D E

A B C D E F G H I J

A B C D E

A B C D

A B C D

A B C D E