Youth Risk Behavior Questionnaire Template Page 4
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1417.
During the past 12 months, how
The next 5 questions ask about bullying.
many times has someone threatened
Bullying is when 1 or more students tease,
or injured you with a weapon such as
threaten, spread rumors about, hit, shove,
a gun, knife, or club on school
or hurt another student over and over
property?
again. It is not bullying when 2 students
A.
0 times
of about the same strength or power
B.
1 time
argue or fight or tease each other in a
C.
2 or 3 times
friendly way.
D.
4 or 5 times
E.
6 or 7 times
22.
During the past 12 months, how
F.
8 or 9 times
frequently have you been harassed or
G.
10 or 11 times
bullied on school property?
H.
12 or more times
A.
Never
B.
Once or twice
18.
During the past 12 months, how
C.
Monthly
many times were you in a physical
D.
Weekly
fight?
E.
Daily
A.
0 times
B.
1 time
23.
During the past 12 months, how
C.
2 or 3 times
frequently have you harassed or
D.
4 or 5 times
bullied someone else on school
property?
E.
6 or 7 times
F.
8 or 9 times
A.
Never
G.
10 or 11 times
B.
Once or twice
H.
12 or more times
C.
Monthly
D.
Weekly
19.
During the past 12 months, how
E.
Daily
many times were you in a physical
fight on school property?
24.
During the past 12 months, how
A.
0 times
frequently have you been
B.
1 time
electronically bullied, such as
C.
2 or 3 times
through e-mail, chat rooms, instant
D.
4 or 5 times
messaging, web sites, or text
E.
6 or 7 times
messaging?
F.
8 or 9 times
A.
Never
G.
10 or 11 times
B.
Once or twice
H.
12 or more times
C.
Monthly
D.
Weekly
20.
During the past 12 months, did your
E.
Daily
boyfriend or girlfriend ever hit, slap,
or physically hurt you on purpose?
25.
During the past 12 months, how
A.
Yes
frequently have you electronically
B.
No
bullied someone else, such as
through e-mail, chat rooms, instant
21.
Have you ever been physically
messaging, web sites, or text
forced to have sexual intercourse
messaging?
when you did not want to?
A.
Never
A.
Yes
B.
Once or twice
B.
No
C.
Monthly
D.
Weekly
E.
Daily
4
2015 Arizona HS YRBS
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