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  • Hkcs 2013 Form A

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    78 vizualizări8 pagini

    Hkcs 2013 Form A

    Încărcat de

    api-222304611

    Drepturi de autor:

    © All Rights Reserved
    Descărcați ca PDF sau citiți online pe Scribd
    Indicator pentru conținut neadecvat
    din 8
    Healthy Kids Colorado Survey HKCS A ‘This eurvey is about health behavior. It has been developed so you can tell us what you do that may affect your health. ‘The information you give will be used to improve health education for young people like yourself. DO NOT write your name on this survey. ‘The answers you give will be kept priv “Answer the questions based on what you really do, No one will know what you write Completing the survey is voluntary, Whether or not you answer the questions will not affect your grade in this class. If you are not comfortable answering a question, just leave it blank, "The questions that ask about your background will be used only ta deseribe the types of students completing this survey. The information will not be used to find out your name, No names will ever be reported, Make sure to read every question. Fill in the ovals completely. When you are finished, follow the instructions of the person giving you the survey. ‘Thank you very much for your help. ‘Throughout the survey you will sea some questions with possible responses, big NO! no, yes, or big YES! NOI means definitely not true for you, ‘no means mostly not true for you, moans most ue for You, 4nd YES! moans defintely true for you Example: Chocolate is the best ice cream flavor. ONO! Ono = @ yes OvESt Inthe example above, the student marked "yes" because he or she thinks the statement is mostly true. Directions meas et Use a #2 penc only Tenses [ Comp eny Make dark marks, Flin a response lke this, © QA @B Oc OD sepoeScen I you change your answer, erase your old answer completely. 1. How ol are you? How al ar you without 7. How much do you woigh S $B years old or younger icons: Wie your Brociote: Wie your S {years ou Rotate snodoa ‘wowgitin tho shod S Hevea Blanc bores Fi inthe Bian boves, inthe S years ou matching oval blow matching oval below S Bo years od cach mabe cach mabe S ta Joa odor odor eit Weight 2. Whatis your sox? i went © Female [| [| S Mate 3. Inwhat rade ae you? a PF gael ain grade le] fo [lala Feta le] fa lala S Hin grade ll fo oka] S tah grate Io [ele] © Ungeed or other grade | ele 4 Ave you Hispanic or Latino? 2 ee Yes Io [ole] She B ‘5. What is your race? (Select one or more responses.) © American Indian or Alaska Native Sasian © Black or African American © Native Hawaiian or Other Pacifc Islander White ‘8, What isthe language you use most often at home? Gocco dSSSESSSSS8S500000000 SERIAL 8. Which ofthe following best describes you? © Heterosexual (straight) © Gay orlesbian © Bisexual Not sure ‘The next 4 questions ask about safety. 10. During the past 30 days, how many times did you ride ina car or other vehicle driven by someone who had been drinking alcohol? © 0times Sttime. S2or8 times 4 or5times © 6 oF more times 414, During the past 30 days, how many times did you drive a car or other vehicle when you had beon drinking alcohol? © I did not drive a car or other vehicle during the past 30 days times Ot time. S2or3 times 4 orb times 6 oF more times 12. During the past 30 days, how many times did you ride ina car or other vehicle driven by someone who had been using marijuana? © 0times Sttime. S20r8 times 4 or5times © 6 oF more times 418. During the past 30 days, how many times did you drive a car or other vehicle when you had been using ‘marijuana? (© I did not drive @ car or other vehicle during the past 30 days Ootimes Ot time. S2or3 times 4 orb times © 6 oF more times 17. During the past 12 months, how many times has ‘someone threatened or injured you with a weapon such as a gun, knife, or club on school property? otimes Ot time. S2or8 times 4 or5 times 6 or7 times Bor 9times O100r ti times © 12 or mare times 18. During the past 12 months, how many times were you ina physical fight? otimes Ot time. S20r3times 4 orb times S6or7 times Bor gtimes S40 or 11 times © 12 or more times 19. During the past 12 months, how many times did ‘someone you were dating or going aut with physically hhurt you on purpose? (Count such things as being hit, slammed info something, or injured wih an object or weapon.) © Idid not date or go out with anyone during the past 12 months otmes Ot time S20r3times 4orb times 6 or more times 20. Have you ever been physically forced to have sexual Intercourse when you did not want to? Yes ONo ‘The next 7 questions ask about violence-related behaviors. ‘The next 2 questions ask about bullying. Bullying is when 1 or more students tease, threaten, spread rumors about, hit, shove, or hurt another student over and over again. It is not bullying when 2 students of about the same strength or power argue of fight or tease each other in a iendly way. 14, During the past 30 days, on how many days did you ‘carry @ weapon such as a gun, knife, or club? 20 days Ot day S 20rd days 4 ord days © 6 or more days 415. During the past 30 days, on how many days did you carry a weapon such as a gun, knife, or club on ‘school property? Oo days Ot day S 2ord days 4 ord days 6 or more days, 16. During the past 30 days, on how many days did you not go to school because you fell you would be Unsafe at school or on your way to or from school? 2 0 days S haa 20rd days 4 ors days © 6 or more days, 21. During the past 12 months, have you ever been bullied on school property? O Yes ONG 22. During the past 12 months, have you ever been electronically bullied? (Count being buled through Small chat roms, instant messaging, Websites, texting) Yes ONG ‘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 ond their own iif. 223. During the past 12 months, did you ever feel so sad or hopeless almost every day for two weaks or more in a row that you stopped doing some usual actives? Yes ONe 24, 26. 26. art During the past 12 months, did you ever sé consider attempting suicide? yes ONe jously During the past 12 months, dd you make a plan about hhow you would attempt suicide Yes ONe During the past 12 months, how many times did you actually attempt suicide? 0 times Ot time. S20r3times 4orb times 6 or more times you attempted suicide during the pas! 12 months, dSay ate etn an ry, solange Sverdge that had tobe Woated bys doctor or © 1d not attempt su O Yes " Ske during the past 12 months ye next & questions ask about tobacco use. 28. 28. 30. If 3t How old were you when you smoked a whole cigarette forthe fist time? © Ihave never smoked a whole cigarette 8 years old or younger © 9 or 10 years ola © 11 0 12 years old © 13 or 14 years old © 15 or 18 years ol¢ 47 years old or older During the past 30 days, on how many days did you smoke cigarettes? 10.29 days OAL 30 days Youwantedo got some cgaretes, how easy would ibe for you to get some? © Very hare Sort of nard Sort of easy © Very easy During the past 30 days, how did you usually get your ‘own cigareltes? (Select only one response.) © Idid not smoke cigarettes during the past 30 days © I bought them in a store such as a convenience: ‘slofe, supermarket, discount store, or gas station © I bought them from a vending machine © Igave someone else money to buy them for me © 1 borrowed (or bummed) them from someone else © Apperson 18 years old or older gave them to me © 100k them from a store or family member © Igotthem some other way 532. During the past 30 days, on how many days did you use chewing tobacco, snuff, or dip, such as Redman, Levi Garratt, Beechnut, Skoal, Skoai Bandits, of Copenhagen? days Store days S 3toSdays Bio saays © 4010 19 days S 201029 days, AL 30 days 33. How much do you think people risk harming themselves (physically or in other ways) if they smoke lone or more packs of cigarettes per day? No risk © Slight risk O Moderate risk © Great risk 34. How wrong do your parents or guardians feel it would be for you to smoke cigarettes? © Very wrong © Weng) © ais bit wrong ‘Nat wrong at all 35. How wrong would most adults in your neighborhood, or the area around where you lve, think tis for kids your age to smoke cigarettes? © Very wrong S Wrong Ait bit wrong Nat wrong at al The next 18 questions ask about drinking alcohol. This includes drinking beer, wine, wine coolers, Bier aatunn in teuka cr erionor rer mess ales doray ‘drinking alcohol does rot include drinking a few sips of ‘wine for religious purposes. 36, During your Ife, on how many days have you had at Teast ane drink of alcohol?” days Store days S3toadays © 1010 19 days, © 2010.39 days. S 40 1039 days, © 100 or more days 37. How old were you when you had your first drink of aleahol other than a few sips? (© Ihave never had a drink of alcohol other than a few ‘sips. © B years old or younger S 9 or 10 years old © 11 or 12 years old © 13 or 14 years old © 45 or 16 years old 17 years old of older 38. How old were you when you first began drinking alcohol regularly, that is, atleast once or twice & mont? © Ihave never drunk alcohol regularly © B years old or younger © 9 or 10 years ola © 11 0 12 years old © 13 or 14 years old © 15 or 18 years ol¢ 17 years old or older 39. During the past 30 days, on how many days did you have atleast one drink of alcohol? 0 days Ot ore days Sates days SB to 9 days © 1010 19 days, © 2010.28 days © All 30 days 40. During the past 20 days, on how many days did you have 9 or more drinks of alcohol in a row, thats, within a couple of hours? (Oto 19 days 10 oF more days 41. During the past 30 days, on how many days did you have atleast one drink of alcohol on school property? 42, During the past 30 days, on how many days do you think a typical student at your school drank alcohot? (0 to 19 days 0 10 29 days OAL 30 days 43. During the past 30 days, on how many days do you think atypical student at your school hac 5 or more drinks of aleohol? © 0 days Store days S3toSdays Sto aaays © 4010 19 days S 201029 days, OAL 30 days 44. you wanted to get some beer, wine, or hard liquor, how easy would be for you to gat some?” © Very hard © Sort of nard © Sort of easy © Very easy 45, During the past 30 days, how did you usually get the alcohol you drank? (Select only one response.) ‘© I did not drink alcohol during the past 30 days © Taught it in a store such as a liquor store, ‘convenience store, supermarket, discount store, ‘or gas station © I bought it ata restaurant, bar, oF club © I bought it at a public event such as a concert or sporting event © I gave someone else money to buy it for me © Someone gave it to me © Mook it from a store or family member © Igot it some other way (SERIAL 46. 47. 48, 49, 50, 51 52, 53, NX During the past 12 months, where did you usually drink alcohol? (Select only one response.) © 1 did not drink alcohol during the past 12 months O atmy home © Atanother person's home © When riding in or driving a ear or other vehicle O Ata restaurant, bar, of clio © Ata place such as a park, beach, or parking lot © Ata public event such as'a concert of sporting event © On school property How much do you think people risk harming themselves (physically or in other ways), i they have ‘one or two drinks of alcohol nearly every day? ONo risk © Slight risk O Moderate risk © Great risk How much do you think people risk harming themselves (physically of in other ways), they have § ‘or more drinks of alcohol once or twice each weekend?’ No risk © Slight risk © Moderate risk © Great risk How wrong do you think itis for someone your age to dnnk alcohol regularly (at least once or twice a month)? Very wrong S Wrong) © Alitte bit wrong © Not wrong at all How wrong do your parents or guardians feel it would bbe for you to drink alcohal regularly (at least once or twice a month)? © Very wrong Wrong © ailile bit wrong ‘Not wrong at all How wrong would most adults in your neighborhood, or the area around where you lve, think tis for kids your age to drink alcohol regularly (atleast once or twice a month)? © Very wrong © Wrong Ait bit wrong Nat wrong at al Hak rank alcaheln your neighborhood othe ‘area around where you live, would he or she be caught by the police? nor Sno O yes Ove! Think of your four best friends (the friends you fee! closest to). Inthe past year (12 months), how many of your best friends have tried beer, wine, or hard iquor ‘When their parents didn't know about i” © None of my friends S tet my Mends S 2 of my fiends © 3 of my fiends © 4 of my fiends iv ‘The next 14 questions ask about marijuana use. Marijuana also Is called grass oF pot. 55, 56, 57, 58, 58. 60. 6 During your life, how many times have you used ‘marijuana? Ootimes Stor 2 times S310 9 times ©1010 19 times © 2010 39 times © 49 10.89 times © 100 or more times. How old were you when you tried marijuana for the first time? Ihave never tied marijuana 8 years old or younger © Gor tO years old © 11 or 12 years ole © 19 0F 14 years old © 15 or 16 years old (17 years old or older During the past 30 days, how many times did you use ‘marijuana? Ootimes Stor 2 times S310 9 times ©1010 19 times © 2010 39times © 40 or more times During the past 30 days, how did you most often use ‘marijuana? (Select only one response.) © Idid not use marijuana during the past 30 days SI smoked it Late it (in an edible, candy, tincture or other food) © lused a vaporizer © Teonsumed tin some other way I you wanted to get some marjuana, how easy would Ite for you to get some? © Very hare Sort of nard Sort of easy © Very easy During the past 30 days, how did you usually get the ‘marijuana that you used? (Select only one response.) © {did not use marijuana during the past 30 days © Igot lata public event such as a party, bar, club, restaurant, concert, or sporting event (© I gotit trom someone with a Medical Marijuana License (Card) © Someone gave it to me © Mook it from a family member © I got it at school © Igotit some other way During the past 30 days, how many times did you use ‘marijuana en school property? Oo times Stor 2 times S310 9 times ©1010 19 times © 201039 times © 40 or more times How much do you think people risk harming themselves (physically or in other ways), they use ‘marijuana once or twice? ONo risk © Slight risk © Moderate risk © Great risk 62, 63. 66. 66. 67. How much do you think people risk harming themselves (physically or in other ways) if they use ‘marijuana regularly? No risk Slight risk O Moderate risk © Great risk How wrong do you think itis for someone your age to use marijuana? © Very wrong © Weng) © ais bit wrong ‘Nat wrong at all How wrong do your parents or guardians feel it would be for you to use marijuana? © Very wrong © Wrong) © aliie bit wrong ‘Not wrong at al How wrong would mest adults in your neighborhood, or the area around where you live, think itis for kids your age to use marijuana? © Very wrong © Weng) © aie bit wrong ‘Nat wrong at al l¥a kid used marjuana in your neighborhood, or the area around where you ive, would he or she be caught by the police? nor Sno © yes Yes! Do you know anyone wih a Medical Marjuana Licanse or Card (or example 2 Ind or family member? Nes SNS SNSt sure The next 10 questions ask about other drugs 68. 69. 70, During your ife, how many times have you used an format Gocaine, including power, crack, or reebase? Ootmes Starz times 53109 times Stoo 19tmes S200 39 times S40 or more times During your fe, how many times have you sniffed glue, breathed the contents of aerosol spray cans, or inhaled any paints or sprays fo get high? otimes Ot or2 times © 3t09 times 1010 19 times S 2010 391imes © 40 or mare times During your fe, how many times have you used heroin {also éated smack, junk, or China Whitey? © otimes Stor? times ©3108 times S100 18 times 2010 38 times © 40 oF more times SERIAL 71. During your ife, how many times have you used methamphetamine (ao caledepeed, cyst crank, Ootimes Stor 2 times S 3'0 9 times ©1010 19 times © 2010 39times © 40 or more times 72. During your fe, how many times have you used ‘ecstasy (also called MDMA)? otimes 102 times 3toatimes © Jot 19 times © 201039 times © 40 or more times 73, During your Ife, how many times have you taken a prescription drug (such as OxyContin, Percocet icadin, codeine, Adderall, Ritalin, or Xanax) without @ doctor's prescription? times 102 times 30 atimes © Jot 19 times © 201039 times © 40 or more times 74, During your if, how many times have you taken steroid pills or shots without a doctor's prescription? Ootimes Stor? times S310 9 times ©1010 19 times © 201039 times © 40 or more times 75. Ifyou wanted to get a drug like cocaine, LSD, amphetamines, of any other illegal drug, how easy ‘would itbe for you to get some? © Very hard © Sort of nara © Sort of easy © Very easy 76. During the past 12 months, has anyone offered, sold, or given you an iiegal drug on school property? Yes Ono 77. During the past 12 months, have you talked with at least one of your parents about the dangers of tobacco, alcohol, or drug use? 79. During the past 30 days, where did you most often see or hear advertisements or messages about preventing Use of tobacco, alcohol, or other drugs? (Select only fone response.) © Idid not see of hear any advertisements or messages about preventing use of alcohol, tobacco, or other drugs © Ona sign or bilboard © ina TVor radio ad © Ata sporting event or sports stadium OA school Ina magazine or newspaper © Onthe internet © Inanother place £80. During the past 12 months, how often did you hear, read, or watch an advertisement promoting or encouraging tobacco, alcohol, of other drug use? Alt © Sometimes © Hardly ever O Never Not sure £81. During the past 30 days, where did you most often see ‘or hear advertisements or messages promoting or encouraging the use of tobacco, alcohol, or other

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