Youth Risk Behavior Survey Template Page 10
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1662.
During the past 30 days, how many
The next 14 questions ask about other
drugs.
times have you sniffed glue, breathed
the contents of aerosol spray cans, or
59.
During your life, how many times
inhaled any paints or sprays to get
high?
have you used any form of cocaine,
including powder, crack, or freebase?
A.
0 times
A.
0 times
B.
1 or 2 times
B.
1 or 2 times
C.
3 to 9 times
D.
10 to 19 times
C.
3 to 9 times
E.
20 to 39 times
D.
10 to 19 times
E.
20 to 39 times
F.
40 or more times
F.
40 or more times
63.
During your life, how many times
60.
During the past 30 days, how many
have you used heroin (also called
times did you use any form of
smack, junk, or China White)?
cocaine, including powder, crack, or
A.
0 times
B.
1 or 2 times
freebase?
C.
3 to 9 times
A.
0 times
B.
1 or 2 times
D.
10 to 19 times
C.
3 to 9 times
E.
20 to 39 times
D.
10 to 19 times
F.
40 or more times
E.
20 to 39 times
64.
During your life, how many times
F.
40 or more times
have you used methamphetamines
61.
During your life, how many times
(also called speed, crystal, crank, or
have you sniffed glue, breathed the
ice)?
contents of aerosol spray cans, or
A.
0 times
inhaled 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 the past 30 days, how many
F.
40 or more times
times have you used
methamphetamines (also called
speed, crystal, crank, or ice)?
A.
0 times
B.
1 or 2 times
C.
3 to 9 times
D.
10 to 19 times
E.
20 to 39 times
F.
40 or more times
-10-
2009 YRBS
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