Youth Risk Behavior Survey Template - 2003 Page 4
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21The next 4 questions ask about personal safety.
8.
When you rode a bicycle during the past 12 months, how often did you wear a helmet?
A.
I did not ride a bicycle during the past 12 months
B.
Never wore a helmet
C.
Rarely wore a helmet
D.
Sometimes wore a helmet
E.
Most of the time wore a helmet
F.
Always wore a helmet
9.
How often do you wear a seat belt when riding in a car driven by someone else?
A.
Never
B.
Rarely
C.
Sometimes
D.
Most of the time
E.
Always
10.
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 times
B.
1 time
C.
2 or 3 times
D.
4 or 5 times
E.
6 or more times
11.
During the past 30 days, how many times did you drive a car or other vehicle when you
had been drinking alcohol?
A.
0 times
B.
1 time
C.
2 or 3 times
D.
4 or 5 times
E.
6 or more times
The next 11 questions ask about violence-related behaviors.
12.
During the past 30 days, on how many days did you carry a weapon such as a gun, knife,
or club?
A.
0 days
B.
1 day
C.
2 or 3 days
D.
4 or 5 days
E.
6 or more days
4
2003 YRBS
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