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The Tentacle


December 3, 2014

CDC Questionnaire for Students Isnít Academic Ė Part 1 - Middle School

John W. Ashbury

Here is the Center for Disease Control Questionnaire for middle school students. This non-academic exercise also  wastes valuable education time in the classroom.

 

There is already too much being crammed into the 180 days required by the state and this CDC exercise is not only a waste of time, but it is also invasive into the private lives of both the student and the student’s family.

 

Here is the link to the previously posted High School Questionnaire. Read both of them carefully and see if you want your child participating. http://www.thetentacle.com/ShowArticle.cfm?mydocid=6529

 

 

MIDDLE SCHOOL SURVEY

 

1. How old are you?

A. 10 years old or younger

B. 11 years old

C. 12 years old

D. 13 years old

E. 14 years old

F. 15 years old

G. 16 years old or older

 

2. What is your sex?

A. Female

B. Male

 

3. In what grade are you?

A. 6th grade

B. 7th grade

C. 8th grade

D. Ungraded or other grade

 

4. Are you Hispanic or Latino?

A. Yes

B. No

 

5. What is your race? (Select one or more responses.)

A. American Indian or Alaska Native

B. Asian

C. Black or African American

D. Native Hawaiian or Other Pacific

Islander

E. White

 

6. Do your parents or guardians own or rent the home or place where you are living now?

A. They own the home or place where I live

B. They rent the home or place where I live

C. They have some other arrangement

D. Not sure

 

7. During the past 12 months, did you ever live away from your parents or guardiansbecause you were kicked out, ran away, or were abandoned?

A. Yes

B. No

 

8. During the past 12 months, where did you usually sleep at night?

A. At home

B. In a friend's or relative's, or stranger's home

C. In a foster home or group facility

D. In a supervised shelter or time limited housing program

E. In a hotel or motel

F. In a car, park, campground, or other public place

G. Somewhere else

 

The next 5 questions ask about safety.

 

9. When you ride a bicycle, how often do you wear a helmet?

A. I do not ride a bicycle

B. Never wear a helmet

C. Rarely wear a helmet

D. Sometimes wear a helmet

E. Most of the time wear a helmet

F. Always wear a helmet

 

10. When you rollerblade or ride a skateboard, how often do you wear a helmet?

A. I do not rollerblade or ride a skateboard

B. Never wear a helmet

C. Rarely wear a helmet

D. Sometimes wear a helmet

E. Most of the time wear a helmet

F. Always wear a helmet

 

11. How often do you wear a seat belt when riding in a car?

A. Never

B. Rarely

C. Sometimes

D. Most of the time

E. Always

 

12. Have you ever ridden in a car driven by someone who had been drinking alcohol?

A. Yes

B. No

C. Not sure

 

13. Have you ever ridden in a car driven by someone who was texting while they were driving the car?

A. Yes

B. No

C. Not sure

 

The next 4 questions ask about violence-related behaviors.

 

14. Have you ever carried a weapon, such as a gun, knife, or club?

A. Yes

B. No

 

15. Have you ever been in a physical fight?

A. Yes

B. No

 

16. Have you ever been in a physical fight in which you were hurt and had to be treated by a doctor or nurse?

A. Yes

B. No

 

17. How often do you feel safe and secure in your neighborhood?

A. Never

B. Rarely

C. Sometimes

D. Most of the time

E. Always

 

The next 2 questions ask about bullying. Bullying is when 1 or more students tease, threaten, spread rumors about, hit, shove, or hurt another student over and over again. It is not bullying when 2 students of about the same strength or power argue or fight or tease each other in a friendly way.

 

18. Have you ever been bullied on school property?

A. Yes

B. No

 

19. Have you ever been electronically bullied? (Count being bullied through e-mail, chat rooms, instant messaging, websites, or texting.)

A. Yes

B. No

 

The next 2 questions ask about attempted suicide. Sometimes people feel so depressed about the future that they may consider attempting suicide or killing themselves.

 

20. During the past 12 months, did you ever feel so sad or hopeless almost every day for two weeks or more in a row that you stopped doing some usual activities?

A. Yes

B. No

 

21. Have you ever seriously thought about killing yourself?

A. Yes

B. No

 

The next 3 questions ask about any tobacco use. This could include use of cigarettes, smokeless tobacco, cigars, or any other product that includes tobacco.

 

22. During the past 12 months, did you try or use tobacco products for the first time?

A. Yes

B. No

 

23. During the past 12 months, did you completely quit using all tobacco products?

A. I did not use any tobacco products during the past 12 months

B. Yes, I completely quit using all tobacco products during the past 12 months

C. No, I did not completely quit using all tobacco products during the past 12 months

 

24. During the past 30 days, which flavored tobacco products (such as fruit-, candy-, or alcohol-flavored tobacco products) did you use? (Do not count menthol cigarettes.)

A. I did not use any flavored tobacco products during the past 30 days

B. Only flavored cigars, cigarillos, or little cigars

C. Only flavored smokeless tobacco products

D. Both flavored cigar products and flavored smokeless tobacco products

 

The next 7 questions ask only about cigarette use.

 

25. How old were you when you smoked a whole cigarette for the first time?

A. I have never smoked a whole cigarette

B. 8 years old or younger

C. 9 years old

D. 10 years old

E. 11 years old

F. 12 years old

G. 13 years old or older

 

26. During your life, about how many cigarettes have you smoked?

A. 0 cigarettes

B. 1 or more puffs but never a whole cigarette

C. 1 cigarette

D. 2 to 5 cigarettes

E. 6 to 15 cigarettes (about ½ pack total)

F. 16 to 25 cigarettes (about 1 pack total)

G. 26 to 99 cigarettes (more than 1 pack but less than 5 packs)

H. 100 or more cigarettes (5 or more packs)

 

27. During the past 30 days, on how many days did you smoke cigarettes?

A. 0 days

B. 1 or 2 days

C. 3 to 5 days

D. 6 to 9 days

E. 10 to 19 days

F. 20 to 29 days

G. All 30 days

 

28. During the past 30 days, how did you usually get your own cigarettes? (Select only one response.)

A. I did not smoke cigarettes during the past 30 days

B. I bought them in a store such as a convenience store, supermarket, discount store, or gas station

C. I got them on the Internet

D. I gave someone else money to buy them for me

E. I borrowed (or bummed) them from someone else

F. A person 18 years old or older gave them to me

G. I took them from a store or family member

H. I got them some other way

 

29. When you bought or tried to buy cigarettes in a store during the past 30 days, were you ever asked to show proof of age?

A. I did not try to buy cigarettes in a store during the past 30 days

B. Yes, I was asked to show proof of age

C. No, I was not asked to show proof of age

 

30. During the past 30 days, did anyone refuse to sell you cigarettes because of your age?

A. I did not try to buy cigarettes during the past 30 days

B. Yes

C. No

 

31. Menthol cigarettes are cigarettes that taste like mint. During the past 30 days, did you usually smoke menthol cigarettes?

A. I did not smoke cigarettes duringthe past 30 days

B. Yes

C. No

D. Not sure

 

The next question asks only about smokelesstobacco use.

 

32. During the past 30 days, on how many days did you use chewing tobacco, snuff, or dip, such as Redman, Levi Garrett, Beechnut, Skoal, Skoal Bandits, or Copenhagen?

A. 0 days

B. 1 or 2 days

C. 3 to 5 days

D. 6 to 9 days

E. 10 to 19 days

F. 20 to 29 days

G. All 30 days

 

The next question asks only about cigar use.

 

33. During the past 30 days, on how many days did you smoke cigars, cigarillos, or little cigars?

A. 0 days

B. 1 or 2 days

C. 3 to 5 days

D. 6 to 9 days

E. 10 to 19 days

F. 20 to 29 days

G. All 30 days

 


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