Form A - Healthy Youth Survey - 2012 Page 2
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161. How old are you?
Where did you live most of the time in the last
7.
a. 12 or younger
30 days?
b. 13
a. In a house, apartment, or mobile home
c. 14
b. In a motel or hotel
d. 15
c. In a group home
e. 16
d. In a shelter
f. 17
e. In a car, park, or campground
g. 18
f. On the street
h. 19 or older
g. Moved from place to place
h. Other
2. What grade are you in?
a. 7th
These statements and questions are about the
b. 8th
c. 9th
neighborhood and community where you live.
d. 10th
e. 11th
8. How wrong would most adults in your
f. 12th
neighborhood or community think it was for kids
g. Ungraded or other
your age:
3. Are you:
A. To use marijuana?
a. Female
a. Very wrong
b. Male
b. Wrong
c. A little bit wrong
4. How do you describe yourself? (Select one or
d. Not wrong at all
more responses.)
a. American Indian or Alaskan Native
B. To drink alcohol?
b. Asian or Asian American
a. Very wrong
c. Black or African-American
b. Wrong
c. A little bit wrong
d. Hispanic or Latino/Latina
e. Native Hawaiian or other Pacific Islander
d. Not wrong at all
f. White or Caucasian
C. To smoke cigarettes?
g. Other
a. Very wrong
b. Wrong
5. What language is usually spoken at home?
c. A little bit wrong
a. English
d. Not wrong at all
b. Spanish
c. Russian
9. How wrong do your parents feel it would be for
d. Ukrainian
you to:
e. Vietnamese
A. Drink beer, wine, or hard liquor (for example:
f. Chinese
vodka, whiskey, or gin) regularly (at least once
g. Korean
or twice a month)?
h. Japanese
a. Very wrong
i. Other
b. Wrong
6. Who did you live with most of time in the last
c. A little bit wrong
d. Not wrong at all
30 days?
a. Parent(s) and/or step-parents
B. Smoke cigarettes?
b. Relatives – like a grandparent, an aunt, an
a. Very wrong
older brother – but NOT your parent(s)
b. Wrong
c. Foster care parent(s)
c. A little bit wrong
d. The family of one of your friends
d. Not wrong at all
e. Friends of yours with no adults present
f. On your own
C. Smoke marijuana?
g. Other
a. Very wrong
b. Wrong
c. A little bit wrong
d. Not wrong at all
A
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