Arizona Youth Risk Behavior Survey Template Page 6
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1433.
During the past 12 months, how
38.
During the past 30 days, on the days
many times did you actually attempt
you smoked, how many cigarettes
suicide?
did you smoke per day?
A.
0 times
A.
I did not smoke cigarettes
B.
1 time
during the past 30 days
C.
2 or 3 times
B.
Less than 1 cigarette per day
D.
4 or 5 times
C.
1 cigarette per day
E.
6 or more times
D.
2 to 5 cigarettes per day
E.
6 to 10 cigarettes per day
34.
If you attempted suicide during the
F.
11 to 20 cigarettes per day
past 12 months, did any attempt
G.
More than 20 cigarettes per
result in an injury, poisoning, or
day
overdose that had to be treated by a
doctor or nurse?
39.
During the past 30 days, how did you
I did not attempt suicide
usually get your own cigarettes?
A.
during the past 12 months
(Select only one response.)
B.
Yes
A.
I did not smoke cigarettes
C.
No
during the past 30 days
B.
I bought them in a store such
The next 15 questions ask about tobacco
as a convenience store,
supermarket, discount store,
use.
or gas station
35.
Have you ever tried cigarette
C.
I bought them from a vending
smoking, even one or two puffs?
machine
A.
Yes
D.
I gave someone else money
B.
No
to buy them for me
E.
I borrowed (or bummed)
36.
How old were you when you smoked
them from someone else
a whole cigarette for the first time?
F.
A person 18 years old or
A.
I have never smoked a whole
older gave them to me
cigarette
G.
I took them from a store or
B.
8 years old or younger
family member
C.
9 or 10 years old
H.
I got them some other way
D.
11 or 12 years old
E.
13 or 14 years old
40.
During the past 30 days, on how
F.
15 or 16 years old
many days did you smoke cigarettes
G.
17 years old or older
on school property?
A.
0 days
37.
During the past 30 days, on how
B.
1 or 2 days
many days did you smoke cigarettes?
C.
3 to 5 days
A.
0 days
D.
6 to 9 days
B.
1 or 2 days
E.
10 to 19 days
C.
3 to 5 days
F.
20 to 29 days
D.
6 to 9 days
G.
All 30 days
E.
10 to 19 days
F.
20 to 29 days
41.
During the past 12 months, did you
ever try to quit smoking cigarettes?
G.
All 30 days
A.
I did not smoke during the
past 12 months
B.
Yes
C.
No
-6-
2013 Arizona YRBS
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