Youth Risk Behavior Survey Template Page 8
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1645.
During the past 30 days, on how
49.
Which of these best describes the
many days did you smoke cigars,
rules about smoking cigarettes inside
the home where you live?
cigarillos, or little cigars?
A.
Never allowed inside my
A.
0 days
home
B.
1 or 2 days
C.
3 to 5 days
B.
Allowed only at some times
or in some places inside my
D.
6 to 9 days
home
E.
10 to 19 days
C.
Always allowed inside my
F.
20 to 29 days
home
G.
All 30 days
46.
Have you ever used a waterpipe
The next 5 questions ask about drinking
(also called a hookah, shisha, or
narghile) to smoke tobacco, even one
alcohol. This includes drinking beer,
wine, wine coolers, and liquor such as
or two puffs?
rum, gin, vodka, or whiskey. For these
A.
Yes
questions, drinking alcohol does not
B.
No
include drinking a few sips of wine for
47.
During the past 30 days, on how
religious purposes.
many days did you use a waterpipe
50.
How old were you when you had
(also called a hookah, shisha, or
your first drink of alcohol other than
narghile) to smoke tobacco?
a few sips?
A.
0 days
A.
I have never had a drink of
B.
1 or 2 days
alcohol other than a few sips
C.
3 to 5 days
B.
8 years old or younger
D.
6 to 9 days
C.
9 or 10 years old
E.
10 to 19 days
D.
11 or 12 years old
F.
20 to 29 days
E.
13 or 14 years old
G.
All 30 days
F.
15 or 16 years old
G.
17 years old or older
48.
During the past 7 days, on how many
days were you in the same room with
51.
During the past 30 days, on how
someone who was smoking
many days did you have at least one
cigarettes?
drink of alcohol?
A.
0 days
A.
0 days
B.
1 day
B.
1 or 2 days
C.
2 days
C.
3 to 5 days
D.
3 days
D.
6 to 9 days
E.
4 days
E.
10 to 19 days
F.
5 days
F.
20 to 29 days
G.
6 days
G.
All 30 days
H.
All 7 days
-8-
2009 YRBS
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