Surveys

English Spanish

Please select county/school district

Select City

Please answer the following questions as best you can. This first set of questions are about you.

The next questions ask about alcohol, tobacco, and other substance use. Remember, all of your responses will be kept private.

8. In the past three months, have you...

MARK ONLY ONE ANSWER PER ROW

#	Yes	No
a. drunk alcohol (more than a few sips, including beer, wine, and liquor)?
b. smoked cigarettes or cigar products (cigars, cigarillos, or little cigars)?
c. used other tobacco products (such as chewing tobacco, snuff, dip, or snus)?
d. used electronic vapor products (such as JUUL, Vuse, MarkTen, and blu)? (electronic vapor products include e-cigarettes, vapes, vape pens, e-cigars, hookahs, hookah pens, and mods)
e. used marijuana (also called pot, weed, or cannabis)?
f. taken prescription pain medicine without a doctor's prescription or differently than how a doctor told you to use it?

9. In the past three months, how often would you say you...

MARK ONLY ONE ANSWER PER ROW

#	All of the Time	Most of the Time	Some of the Time	None of the Time
a. resisted or said no to peer pressure?
b. managed your emotions in healthy ways (for example, ways that are not hurtful to you or others)?
c. thought about the consequences before making a decision?
d. talked with my parent, guardian, or caregiver about sex?

10. For each of the items below, please mark how true each statement is of you.

MARK ONLY ONE ANSWER PER ROW

#	Not true at all	Somewhat true of me	Very true of me
a. I make plans to reach my goals
b. I care about doing well in school
c. I save money to get things I want
d. I would speak up or ask for help if I am being bullied in person or online, via text, while gaming, or through other social media
e. I would speak up or ask for help if others are being bullied in person or online, via text, while gaming, or through other social media

The next few questions are about relationships and dating. Please answer the questions below even if you are not currently dating or going out with someone.

11. For each of the items below, please mark how true each statement is of you.

MARK ONLY ONE ANSWER PER ROW

#	Not true at all	Somewhat true of me	Very true of me
a. I understand what makes a relationship healthy
b. I would be able to resist or say no to someone if they pressured me to participate in acts, such as kissing, touching private parts, or sex
c. I would talk to a trusted person/adult (for example, a family member, teacher, counselor, coach, etc.) if someone makes me uncomfortable, hurts me, or pressures me to do things I don’t want to do

12. For each of the items below, please mark how true each statement is of you.

MARK ONLY ONE ANSWER PER ROW

#	Not true at all	Somewhat true of me	Very true of me
a. I plan to delay having sexual intercourse until I graduate high school or receive my GED
b. I plan to delay having sexual intercourse until I graduate college or complete another education or training program
c. I plan to delay having sexual intercourse until I am married
d. I plan to be married before I have a child
e. I plan to have a steady full-time job before I get married
f. I plan to have a steady full-time job before I have a child

The next questions ask about some personal behaviors, including sex and pregnancy. Remember, all of your responses will be kept private.

13. Have you ever had sexual intercourse?

MARK ONLY ONE ANSWER

Yes
No

14. To the best of your knowledge, have you ever been pregnant or gotten someone else pregnant?

MARK ONLY ONE ANSWER

Yes
No
Not Sure

15. Have you ever been told by a doctor or other medical provider that you had a sexually transmitted infection (STI)?

MARK ONLY ONE ANSWER

Yes
No