Youth Risk Behavior Questionnaire Template Page 10
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1467.
During the past 12 months, how
71.
How old were you when you had
many times did you attend school
sexual intercourse for the first time?
under the influence of alcohol or
A.
I have never had sexual
other illegal drugs, such as marijuana
intercourse
or cocaine?
B.
11 years old or younger
A.
0 times
C.
12 years old
B.
1 or 2 times
D.
13 years old
C.
3 to 9 times
E.
14 years old
D.
10 to 19 times
F.
15 years old
E.
20 to 39 times
G.
16 years old
F.
40 or more times
H.
17 years old or older
The first time you had sexual
68.
During the past 30 days, how many
72.
times did you take an over-the-
intercourse, how old was your
counter drug to get high?
partner?
A.
0 times
A.
I have never had sexual
B.
1 or 2 times
intercourse
C.
3 to 9 times
B.
5 or more years younger
D.
10 to 19 times
C.
3 to 4 years younger
E.
20 to 39 times
D.
About the same age
F.
40 or more times
E.
3 to 4 years older
F.
5 or more years older
69.
During the past 30 days, how many
G.
Not sure
times did you take a prescription
drug (such as OxyContin, Percocet,
73.
During your life, with how many
Vicodin, codeine, Adderall, Ritalin,
people have you had sexual
or Xanax) without a doctor's
intercourse?
prescription?
A.
I have never had sexual
A.
0 times
intercourse
B.
1 or 2 times
B.
1 person
C.
3 to 9 times
C.
2 people
D.
10 to 19 times
D.
3 people
E.
20 to 39 times
E.
4 people
F.
40 or more times
F.
5 people
G.
6 or more people
The next 11 questions ask about sexual
behavior.
74.
During the past 3 months, with how
many people did you have sexual
70.
Have you ever had sexual
intercourse?
intercourse?
A.
I have never had sexual
A.
Yes
intercourse
B.
No
B.
I have had sexual intercourse,
but not during the past 3
months
C.
1 person
D.
2 people
E.
3 people
F.
4 people
G.
5 people
H.
6 or more people
10
2015 Arizona HS YRBS
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Parent category: Life