Youth Risk Behavior Questionnaire Template Page 3
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14The next 3 questions ask about safety.
12.
During the past 30 days, on how
many days did you carry a gun?
8.
How often do you wear a seat belt
A.
0 days
when riding in a car driven by
B.
1 day
someone else?
C.
2 or 3 days
A.
Never
D.
4 or 5 days
B.
Rarely
E.
6 or more days
C.
Sometimes
D.
Most of the time
13.
During the past 30 days, on how
E.
Always
many days did you carry a weapon
such as a gun, knife, or club on
9.
During the past 30 days, how many
school property?
times did you ride in a car or other
A.
0 days
vehicle driven by a friend who had
B.
1 day
been drinking alcohol?
C.
2 or 3 days
A.
0 times
D.
4 or 5 days
B.
1 time
E.
6 or more days
C.
2 or 3 times
D.
4 or 5 times
14.
During the past 30 days, on how
E.
6 or more times
many days did you carry a gun on
school property?
10.
During the past 30 days, how many
A.
0 days
times did you drive a car or other
B.
1 day
vehicle when you had been
C.
2 or 3 days
drinking alcohol?
D.
4 or 5 days
A.
I did not drive a car or other
E.
6 or more days
vehicle during the past 30
days
15.
During the past 30 days, on how
B.
0 times
many days did you not go to school
C.
1 time
because you felt you would be
D.
2 or 3 times
unsafe at school or on your way to or
E.
4 or 5 times
from school?
F.
6 or more times
A.
0 days
B.
1 day
The next 11 questions ask about violence-
C.
2 or 3 days
related behaviors.
D.
4 or 5 days
E.
6 or more days
11.
During the past 30 days, on how
many days did you carry a weapon
16.
How often do you feel safe and
such as a gun, knife, or club?
secure at school?
A.
0 days
A.
Never
B.
1 day
B.
Rarely
C.
2 or 3 days
C.
Sometimes
D.
4 or 5 days
D.
Most of the time
E.
6 or more days
E.
Always
3
2015 Arizona HS YRBS
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