Youth Risk Behavior Survey Template Page 3
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168.
During the past 12 months, how
12.
During the past 30 days, how many
would you describe your grades in
times did you drive a car or other
school?
vehicle when you had been
Mostly A’s
A.
drinking alcohol?
Mostly B’s
B.
A.
0 times
Mostly C’s
C.
B.
1 time
Mostly D’s
D.
C.
2 or 3 times
Mostly F’s
E.
D.
4 or 5 times
F.
None of these grades
E.
6 or more times
G.
Not sure
The next 11 questions ask about violence-
The next 4 questions ask about safety.
related behaviors.
9.
When you rode a bicycle during the
13.
During the past 30 days, on how
past 12 months, how often did you
many days did you carry a weapon
wear a helmet?
such as a gun, knife, or club?
A.
I did not ride a bicycle during
A.
0 days
the past 12 months
B.
1 day
B.
Never wore a helmet
C.
2 or 3 days
C.
Rarely wore a helmet
D.
4 or 5 days
D.
Sometimes wore a helmet
E.
6 or more days
E.
Most of the time wore a
helmet
14.
During the past 30 days, on how
F.
Always wore a helmet
many days did you carry a gun?
A.
0 days
10.
How often do you wear a seat belt
B.
1 day
when riding in a car driven by
C.
2 or 3 days
someone else?
D.
4 or 5 days
A.
Never
E.
6 or more days
B.
Rarely
C.
Sometimes
15.
During the past 30 days, on how
D.
Most of the time
many days did you carry a weapon
E.
Always
such as a gun, knife, or club on
school property?
11.
During the past 30 days, how many
A.
0 days
times did you ride in a car or other
B.
1 day
vehicle driven by a friend who had
C.
2 or 3 days
been drinking alcohol?
D.
4 or 5 days
A.
0 times
E.
6 or more days
B.
1 time
C.
2 or 3 times
D.
4 or 5 times
E.
6 or more times
-3-
2009 YRBS
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