Youth Risk Behavior Questionnaire Template Page 9
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1458.
During the past 30 days, how many
62.
During your life, how many times
times did you use any form of
have you used methamphetamines
cocaine, including powder, crack, or
(also called speed, crystal, crank, or
freebase?
ice)?
A.
0 times
A.
0 times
B.
1 or 2 times
B.
1 or 2 times
C.
3 to 9 times
C.
3 to 9 times
D.
10 to 19 times
D.
10 to 19 times
E.
20 to 39 times
E.
20 to 39 times
F.
40 or more times
F.
40 or more times
59.
During your life, how many times
63.
During the past 30 days, how many
have you sniffed glue, breathed the
times did you use
contents of aerosol spray cans, or
methamphetamines (also called
inhaled any paints or sprays to get
speed, crystal, crank, or ice)?
high?
A.
0 times
A.
0 times
B.
1 or 2 times
B.
1 or 2 times
C.
3 to 9 times
C.
3 to 9 times
D.
10 to 19 times
D.
10 to 19 times
E.
20 to 39 times
E.
20 to 39 times
F.
40 or more times
F.
40 or more times
64.
During the past 30 days, how many
60.
During the past 30 days, how many
times did you use ecstasy (also
times did you sniff glue, breathe the
called MDMA)?
contents of aerosol spray cans, or
A.
0 times
inhale any paints or sprays to get
B.
1 or 2 times
high?
C.
3 to 9 times
A.
0 times
D.
10 to 19 times
B.
1 or 2 times
E.
20 to 39 times
C.
3 to 9 times
F.
40 or more times
D.
10 to 19 times
E.
20 to 39 times
65.
During your life, how many times
F.
40 or more times
have you taken steroid pills or shots
without a doctor's prescription?
61.
During your life, how many times
A.
0 times
have you used heroin (also called
B.
1 or 2 times
smack, junk, or China White)?
C.
3 to 9 times
A.
0 times
D.
10 to 19 times
B.
1 or 2 times
E.
20 to 39 times
C.
3 to 9 times
F.
40 or more times
D.
10 to 19 times
E.
20 to 39 times
66.
During the past 12 months, has
F.
40 or more times
anyone offered, sold, or given you an
illegal drug on school property?
A.
Yes
B.
No
9
2015 Arizona HS YRBS
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