Form A - Healthy Youth Survey - 2012 Page 6
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16The next questions ask about sad feelings and
45. If you had to guess, how many students in your
grade at school drank alcohol during the past 30
attempted suicide. Sometimes people feel so depressed
days?
about the future that they may consider attempting
a. 0 out of 10 (none)
suicide, that is, taking some action to end their own life.
b. 1 out of 10
c. 2 out of 10
d. 3 out of 10
51. During the past 12 months, did you ever feel so
e. 4 out of 10
sad or hopeless almost every day for two weeks
f. 5 out of 10 (about half)
or more in a row that you stopped doing some
g. 6 out of 10
usual activities?
h. 7 out of 10
a. Yes
i. 8 out of 10
b. No
j. 9 out of 10
k. 10 out of 10 (all)
52. During the past 12 months, did you ever
seriously consider attempting suicide?
46. During the past 12 months, how many times
a. Yes
were you in a physical fight?
b. No
a. 0 times
b. 1 time
c. 2 – 3 times
The next section asks about your experience with alcohol
d. 4 – 5 times
and other drugs. Remember, no one but you will know
e. 6 or more times
how you answered.
The next questions ask for your opinion. Remember, no
53. During the past 30 days, on how many days did
one but you will know how you answered.
you:
A. Smoke cigarettes?
47. I think it is okay to take something without
a. None
asking as long as you get away with it.
b. 1 – 2 days
a. NO!
c. 3 – 5 days
b. no
d. 6 – 9 days
c. yes
e. 10 – 29 days
d. YES!
f. All 30 days
B. Use chewing tobacco, snuff, or dip?
48. I think sometimes it is okay to cheat at school.
a. None
a. NO!
b. 1 – 2 days
b. no
c. 3 – 5 days
c. yes
d. 6 – 9 days
d. YES!
e. 10 – 29 days
f. All 30 days
49. It is all right to beat up people if they start the
fight.
C. Drink a glass, can, or bottle of alcohol (beer,
a. NO!
wine, wine coolers, hard liquor)?
b. no
a. None
c. yes
b. 1 – 2 days
d. YES!
c. 3 – 5 days
d. 6 – 9 days
50. It is important to be honest with your parents,
e. 10 or more days
even if they become upset or you get punished.
a. NO!
D. Use marijuana or hashish (grass, hash, pot)?
b. no
a. None
c. yes
b. 1 – 2 days
d. YES!
c. 3 – 5 days
d. 6 – 9 days
e. 10 or more days
A
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